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Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT)
Hello, and welcome back to another meet the experts video. Today we are talking with Dr. Steve Parry, who is a consultant physician, but also a researcher in the University who does research into falls. And if you remember back, we met Dr. Parry back in week two. Hi, Steve. Thank you for joining us. I want to talk to you today about falls, fear of falling, and cognitive behavioural therapy. So let’s start off right at the beginning. What is fear of falling? Fear of falling is a term that’s used to describe some of the worries and concerns that people have about falls and their consequences.
Sometimes that fear that is almost to the point of being phobic, so people are terribly frightened to even go out of their houses. They become very isolated. But even when it’s not as extreme as that, fear of falling is an incredibly debilitating condition. It’s something that impacts hugely on people’s quality of life. Most people who know an older person, or several older people particularly, will know people who are a little bit anxious about falling, a little bit concerned about falling. And fear of falling is sort of an umbrella term that’s used to describe all of those psychosocial consequences, if you like, of concerns and worries and anxieties about falls.
From what you’ve said, that sounds like a very important and debilitating condition, but how many people are we talking about that it might affect? An astonishing number, and looking at the worldwide literature, some studies have reported as many as 80% of older adults having reported fear of falling. From our experience running a clinic in North Tyneside, where everybody had a falls efficacy scale, which is one of the measures of fear of falling, a very reliable questionnaire. On the falls efficacy scale, around 50% of our population– the people coming to the falls service– had a fear of falling. And that was a group of older people, from the age of 60 and above.
So it’s not peculiar to the very frail and elderly at all. This is something that can be a really important factor in people’s lives at much younger ages than people would traditionally think of people as having worries and concerns about falls. OK, so it’s important, and it’s usually common. So in that case, it means we probably need to do something about it. Indeed. Unfortunately, as with much to do with falls, we’re into Cinderella territory here. So, this is something that people may acknowledge, both from the patient’s perspective, their carers’ and families’ perspectives, and health professionals’ perspectives, but it’s something that people feel pretty helpless about. And it’s something that– OK, it’s another one of those things.
There’s too many one of those things to do with falls and older people, and it’s something that really needs some impact in terms of how to address it. OK. So what is this thing you’ve been doing, that involves cognitive behavioural therapy. CBT. First off, what is it? What, the CBT? Yeah. So, cognitive behavioural therapy is one of the talking treatments. So one of the ways of trying to improve psychological problems through discussion. And cognitive behavioural therapy rests on trying to unravel people’s thought processes that perhaps have become run into a track of circular, unpleasant, ruminating thoughts. Things that are not perhaps true anymore, if you like.
So items of thought and thought processes, that drag the person into this spiral of misery and increasing fear and anxiety. And cognitive behavioural therapy is a way of trying to unpick some of those abnormal thoughts and correct them. So trying to show people how best you can improve those thoughts, and it’s an incredibly useful, incredibly effective treatment for all sorts of problems. Anxiety, depression, very, very useful, indeed. So it’s a way of trying to help someone change the way they think and behave about something. That’s right.
And some of the best things about cognitive behavioural therapy is that it’s a way of not only helping correct the psychological, but in our particular context here with fear of falling, to try and improve people’s thought process in such a way that they feel more confident– appropriately confident, rather than inappropriately confident– about improving their physical well being, too. And you did some research into how CBT can be used to help people with fear of falling. I believe that’s finished now, that study. That’s right. Are there any preliminary results coming out of that? Yes.
So the study was designed to look at how we could best improve fear of falling in older people through a randomised trial, with one arm randomised to cognitive behavioural therapy, and the other arm randomised to their normal treatment so they got everything that they normally would have. As did the patients who underwent cognitive behaviour therapy, in addition. So the wrinkle for this study wasn’t just that it’s the first to look at an individualised cognitive behavioural therapy approach. The study also is the first to teach cognitive behavioural therapy techniques to health care assistant grade staff, and have them deliver the cognitive behavioural therapy. So the study, we recruited 415 people who were randomised.
And then the results have been really pretty amazing. In the main outcome measure, which was the falls efficacy scale score, the measure of fear of falling, there were both statistical and clinical improvements in those parameters. Both at the beginning, so the patients had eight weeks of cognitive behavioural therapy, an hour at a time, then a six months refresher, and then we completed the study at a year. The benefits began fairly early on. They stayed there through month six. And then persisted, despite no therapy for six months, right the way through to the end of the study. So this seems a pretty powerful way of trying to improve people’s fear of falling. It certainly sounds like impressive results.
How did people get on with doing the therapy? The majority of people really enjoyed it, actually. The majority of people had very, very positive statements around the study and how the cognitive behavioural therapy was delivered. It was an interesting study in other ways, in that we uncovered a lot that hasn’t been written before in the world literature around fear of falling, to do with what underlies the problems of fear of falling. As I’ve said it’s an umbrella term, but the study has allowed us two unpick an awful lot more of what underlies that, around pain, problems with walking, difficulties with strength and balance, as well as psychological constructs like depression, anxiety, and fear, phobic anxiety, that kind of stuff.
And with the health care assistants delivering the cognitive behavioural therapy, appropriately supervised by clinical psychologists, this gives us a prayer that this could be adopted in the health service. The numbers I gave you before, in terms of how many people suffer from fear of falling, there’s not a chance in the world that qualified psychologists would be available in anything like the number needed to actually deliver this kind of treatment, to help the number of people who need it. So the cognitive behavioural therapy delivered by health care assistants at least gives us a chance for the health care system to be able to afford to do this.
Now these results really are very much hot off the press, so people can’t go and ask their doctor for the therapy immediately. But fingers crossed, in the future this might be available to more people. So as you say, this is brand spanking new stuff, in the last month or two we’ve got the results through. So the results aren’t published anywhere yet, and they need to be submitted to our funding body, the National Institute of Health Research HTA Programme. So very much hot off the presses, but I would hope that they’ll be published in a good peer reviewed journal so that we can start getting this stuff out into the public domain, and try and get more people sorted.
Last question for you. Can you give me three of your top tips on how people can prevent falls in their life? OK. Top tips would be exercise, exercise, exercise. And I’m not being at all facetious. From as early as possible in the lifespan, people need to be gearing themselves towards things that keep them mobile and independent, and that as life progresses and our bodies start to fail in subtle ways, to use strength and balance training and strength and balance exercises to keep themselves in that kind of condition. And there’s some pretty simple stuff. I’m sure you’ll be able to find readily exercises that people will use. Absolutely. Thank you very much. You’re welcome. And thanks for joining us.
Recent research has shown great promise for cognitive behavioural therapy (CBT) as a treatment for fear of falling. CBT is a form of therapy where the therapist helps to retrain the way we think about things. Our mind and our body constantly interact, but this interaction can sometimes go uncontrolled, especially when a fear of something leads to disabling physical problems, such as a fear of falling. CBT aims to ‘re-train’ the way in which the mind and body interact. This could improve the vicious cycle of falls and fear of falling.
This therapy is not yet widely available but offers hope for the future. Dr Steve Parry discusses his work in this area during this video.
Do you have any thoughts about CBT? Is it something you would use if you were fearful of falling?
If you would like to find out more about CBT, or more about Steve’s study please see the links below.
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Ageing Well: Why Older People Fall

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