Adrian Leddy

Adrian Leddy

Dr Adrian Leddy is a Clinical Psychologist who has worked in the NHS with older adults for 14 years. He has been a Clinical Tutor on the Doctorate in Clinical Psychology Course at UEA since 2012.

Location Norwich

Activity

  • Some nice examples, and I can see you and a few other people have picked up on wisdom which is really important and something we talk more about in week 3 when applying CBT with older adults.

  • Hi Alex. This statistic about levels of life satisfaction is quite often a surprise for clinicians who are new to working with older adults. It is important though as it reminds us that a "normal experience" of ageing is having high levels of life satisfaction, and that the research indicates this is what most people experience.

  • Absolutely. Quality of life and improvements in health care are key reasons for this increase in life expectancy. Another key factor is that in some parts of the world there was a baby boom following the Second World War where a lot of babies were born. This cohort are now reaching older adulthood.

  • Welcome everyone. I am Adrian and I am a Clinical Psychologist by background. I have worked in older adults services delivering CBT since 2005 and look forward to trying to answer your questions over then next few weeks. I appreciate there is a range of experiences and professional and personal interests in attending the course, and hopefully there is...

  • Welcome everyone. It seems there is a range of backgrounds and aims for this course, and hopefully we can meet these hopes over the next few weeks.

  • @alisonlocke Hi Alison, sorry for the slow reply. I didn't see the notification in my feed. Yes, it is a 29 second clip this one.

  • Yes, and also if you consider there were a lot of people born just after the Second World War (the baby boom population) this cohort is now passing into older adulthood which on top of the improvements in healthcare and standards in living also adds to an increased population.

  • Hi Sally. I have just tried it and works okay for me. You might to try and reload the page and see if that helps?

  • I think that is a really important part of therapy for people, as often people do think I must be the only one who does this, and having it reflected back that it is actually quite common can be a powerful technique in its own right.

  • Hi Lorraine, this is a really good example, and one we see quite a lot in clinical practice. Often the pitfall for the therapist is they get drawn into that belief rather than seeing this and thinking about it as a depressed cognition.

  • I think this is the crux of CBT. So like the image there is no right of wrong answer, it is just how people interpret that image, and when depressed, people often see information in a certain way (it doesn't mean it is wrong), but it is helpful to try and understand other ways that information can be interpreted.

  • @PearlDewar Hi Pearl. There is no right or wrong to this, I was just noticing that as far as problems go, I thought it was quite a nice one to have. Don't worry about giving fuller answers.

  • @EllenCheng There is some research on this (and I am afraid I can't bring the reference to mind), but it shows that when you ask people to specify what age you consider to be old (regardless of how old they are), they often give a number that is approximately 5-10 years older than they are.

  • @LorrainePostlethwaite Hi Lorraine. I agree that these might be more unusual examples, but we include them as I think it challenges stereotypes that often people hold about what happens in older adulthood. When I reflect on the people I have worked with over the years, I have often found that have overcome their own significant challenges in ways that I had...

  • Really pleased that you mentioned wisdom Heidi, as the focus of week 3 is using wisdom enhancement with older people, and I think it is a huge positive of ageing.

  • Thanks Pearl. Some interesting reflections there. I was struck by two of the negatives. One was that actually a negative sits with others and their stereotypes about older age - i.e. ageing seems to be more a problem for others. Secondly the negative about not finding enough time to fit in everything sounds a consequence of a positive i.e. having lots of...

  • Hi Brenda. I think this is a tricky question to give an exact answer to. I think you are right that the older one gets, the more likelihood is that you will start to outlive your peers and that can be a challenge of feeling more isolation in later life. Reflecting on the people I have worked with who have faced this and it has come up in therapy, one of the...

  • That would be my understanding of it. I would also add in that middle age period, there are lots of other stressors attached to that, i.e. you might feel that you have not progressed in your career, or generally your life is not where you had imagined it might have been at that point.

  • Welcome both, and to anyone else that joins us. I am Adrian, I am a Clinical Psychologist by background and I have been working with older people (predominantly in mental health services) since 2003. I first developed an interest in using CBT with older people in 2003 and will frequently use it in my clinical practice.

  • Great to read this Shona, and in therapy, when using the timeline effectively these are the type of the things that people sometimes realise about themselves based on their own experiences.

  • Hi Karen. This is correct, being able to recall the significant event is the important part and the exact date is less important. Sometimes the chronology can be useful to think about as you might be able to see some evidence already of using wisdom between two events in the timeline, and in that sense the chronology is useful.

  • Hi Casey. There is no correct answer for this and I would always advocate a pragmatic approach based on how the client is managing with the tasks set in therapy. So for some, it might be fine to do this as a between session task and require very little input from the therapist, where as others might struggle more, and you might need to use more time and the...

  • @KarenW There is a bit of research into this, which has found that PTG is observed more often in women. I am unsure if these papers are freely available:
    Park, C. L., Cohen, L. H., & Murch, R. L. (1996). Assessment and prediction of stress-related growth. Journal of Personality, 64(1), 71-105.
    Powell, S., Rosner, R., Butollo, W., Tedeschi, R. G., &...

  • That is a good example. In this example we would call that selective abstraction. In CBT this is a type of cognitive error where we discount or ignore all the positive/favourable aspects of something and focus only on the negative/less favourable. So another example of selective abstraction would be, you hold a dinner party, ten guests attend, 9 of them say...

  • That's a really good contemporary (and sadly very painful) example of how the same event can be interpreted very differently.

  • @AlisonCooper Hi Alison. I think all of those examples you give would be challenging and distressing, and we would expect a normal reaction to any of those things to incorporate some sadness, fear, etc. In the diagnostic classification systems for identifying depression or anxiety, they will state that symptoms need to be present for a certain period of time...

  • @AlisonCooper Hi Alison. I think all of those examples you give would be challenging and distressing, and we would expect a normal reaction to any of those things to incorporate some sadness, fear, etc. In the diagnostic classification systems for identifying depression or anxiety, they will state that symptoms need to be present for a certain period of time...

  • Hi Casey, I think I understand your question. For the AAQ you don't get an overall score, rather three scores on separate domains related to ageing. This means you get three separate scores for each of the domains. On one of the domains (psychological loss) the questions do read as backwards, and if you score higher on this domain it more likely indicates a...

  • I think wisdom is a really good example of a positive aspect of ageing. In week 3, we spent a lot of time thinking about how wisdom can be used when applying CBT with older people.

  • Some interesting examples here and people tapping into some similar themes, and some nice examples of positive aspects of ageing.

  • Hi Mandy. There are a few reasons for this. One reason is historically men have been more likely to work in environments which would have increased likelihood of long-term physical health conditions that shortened life expectancy, i.e. mines, factories where there might have been exposure to things like asbestos, health and safety measures would have been...

  • I'm Adrian. I am on of the facilitators for this course. I am a Clinical Psychologist by background and worked in older people's mental health services since 2003. I have an interest in CBT, and particularly how we apply this to working with older adults.

  • I agree. Also (in the UK) there was no national health care system until post World War 2, so people grew up when there would have been less ability to access healthcare and would have been exposed to values and beliefs that reflected this.

  • I think it is a combination of things. Advances in medical care is a big one, but also improvements in quality of life (i.e. less likely to be working in places like mines) will also be a contributory factor.

  • That is how I understand the data as well. I think it is that stage in life where we might have traditionally thought about contentment, but actually there are lots of stressors in life at this point which seem to reflect these lower well being scores in middle ages.

  • I agree with increased life expectancy due to , improvements in medical care and standards of living the 65 no longer feels old. I think historically in 1908 when state pension in the UK was first introduced it was set at 70 (although interestingly life expectancy at this point was the early 40's).

    We do sometimes think about younger old versus older old to...

  • @MaureenDunbar Hi Maureen. I agree if it is done badly, it can appear more of a checklist and is more like to damage rapport. Doing it chronologically is helpful to ensure you capture everything important, but the skill in doing it is developing it into a collaborative experience so when information is given for the therapist to take a curious approach to...

  • I agree, and my experience after doing it for the last 18 years is exactly that. As a therapy the ideas and concepts are quite easy to understand and get your head around, but doing CBT well is much harder.

  • I agree. At the time we are unlikely to ask ourselves whether we are thinking and interpreting this with a lens, but rather see the interpretation as the only explanation. The nice thing about the drawing is it shows information can be interpreted in different ways and there is not necessarily a right or wrong way to interpret it.

  • Hi Graham, yes, this is what we are trying to do here. It can be a nice way of gathering tangible examples of how people have (hopefully) coped with adversity previously and perhaps more resourceful than they might have realised.

  • You are right, they are used across most modalities of CBT. Although traditionally the function of the timeline has been more aligned to ensuring that all the developmental and relevant history is recorded rather than trying to use it to think about wisdom.

  • I am not sure of the demographical breakdown of care home admission, but given women on average lives nearly four years longer than men it does make more sense that they are more likely to live with conditions where the prevalence increases with age, e.g. dementia which in turn will increase likelihood of admission to care home as illness progresses.

  • Good afternoon, and welcome.

    I am Adrian Leddy. I am a Clinical Psychologist by background and if worked at the University of East Anglia since 2012 on the Doctorate in Clinical Psychology Program.

    I first started working with older people using CBT in 2003 and continue to use it in my practice today.

  • @MarianneHeron It sounds like some of what you're describing relates a lot to resilience which would overlap with optimism. I agree that if one is more optimistic (and that can be due to a variety of factors) you are likely to do better. I suppose the wisdom bit would be able to recognise from experience when optimism is unhelpful i.e. the problem is too...

  • Adrian Leddy made a comment

    Really interesting to read the comments on this page. It looks people have really had a full hearted attempt and taken the time to do this, and it looks it has been a useful experience for most people.

  • Working with older adults that is something that often comes up and I would think about it as a "cohort belief" i.e. the values that existed in society when you were growing up.

    So when I first worked with older adults a lot of them had been younger people/young adults during the Second World War where "keep your chin up and just get on with it" was almost...

  • I agree. I am very much an advocate of the idea that a good litmus test for any therapeutic technique is that as a therapist you should only be asking a client to do what you would feel comfortable to do yourself.

  • Absolutely, and that is quite a core feature of depression (i.e. it is past focused, we look at things we did and analyse it through a lens), where as anxiety tends to be future focused (I am worried x/y will happen).

    So having the timeline approach does give a vehicle from being able to integrate these episodes.

  • ... them as much as they will struggle to understand you, so it is hard to really explore their use of wisdom in their past life in a meaningful way.

    In my experience, people develop wisdom in a way that is unique to them and part of part of therapy is to learn about this in a collaborative way. So if someone has a cultural background that is completely...

  • I am not entirely sure if I have understood the question, but I will try and answer as best I can.

    So the concept of wisdom we are referring to is the idea that you learn something from a lived experience (can be positive or negative). So wisdom is the ability to reflect on and learn from something that has happened and to be able to use it in future. So...

  • That's a good question, as if low in mood there may be a bias in how people look at past events and a propensity to view lots of things as failures.

    I guess the way I try to work with that is by not looking just at the specific event in isolation but the consequences of how they managed. So whilst someone might feel they were handling it badly at the time,...

  • @EvaF. Thanks for the recommendation. I have to admit I am not familiar with either of those books. That Harari one sounds similar to Viktor Frankl's "mans search for meaning" which was a very powerful story of Holocaust survival and how meaning can always be found in life.

  • These are really good examples of depressed cognitions that you might see in late life depression. So we know the evidence is that age is not a predictor of response to CBT i.e. a young and older person are equally likely to benefit. So the idea about being too old to change is contradictory to the outcome research and we would view it as a depressed...

  • It depends and you would take it on a case by case basis. I am personally not worried if someone is on medication and that would never be an exclusion for CBT (or any therapy). I would maybe be a bit cautious if they were lots of new changes to medications and perhaps the person was experiencing lots of side effects I might suggest we wait until this has...

  • One of the aims of CBT is to teach the person to become their own therapist, so absolutely we are trying to equip them with their own toolkit.

  • There have been lots more studies since both randomised control trials and meta-analyses. We use this reference as it is a summary of a number of meta-analyses covering lots of presentations.

    Other recent meta-analyses looking at specific presentations and populations include:

    Springer et al., 2018 - CBT for adult anxiety disorders

    Twomey et al.,...

  • @BridgetHansberry Absolutely and having an understanding about how depression might shape those thought processes is a really useful starting point to making sense of someone's experience of depression.

  • I think that is a really nice example of how the same event can be interpreted in numerous different ways, and one of the foundations of CBT is recognising this and understanding that it not necessarily the event, but rather how we interpret and make sense of it that causes distress.

  • I always think this drawing conveys some of the key concepts of CBT that there is different ways of interpreting the same thing. Neither answer is incorrect and neither answer is more correct than the other.

  • @ronaldfasht I guess that would vary on an individual basis. My impression from the people I have worked with is that they did these things because they found them meaningful or in some way rewarding, rather than to fill time. That said, for some people I wonder if they originally start it as a time filler but continue with it because it provides meaning/is...

  • It's pleasing to read that people have found the first week useful. I know in the past sometimes people have felt they wanted to get going with the CBT part quicker and we have had the fed back in the first week summary.

    We do place a lot of emphasis on ageing, and we do this as we feel an in order to be able to do CBT with older adults well it is essential...

  • Whilst these are two quite high profile examples, I have often experienced this myself in my own clinical practice working with older people.

    For example, a lady in her 90's who starting writing poetry again for 30 years of not doing it and then having it read at an arts festival. So whilst not everyone will be running marathons, there are often meaningful...

  • Hi Maurice, there is some really interesting statistics around this where it describes people falling into categories as either survivors (so those who have had and live with physical health conditions), delayers (those who reach the age of 80 before developing any significant physical health concerns) and avoiders (those who reach 90 I think and avoid...

  • @JillPhillips I think your post really nicely sums up the underpinnings of this data. Before I started working with older adults I held lots of unhelpful assumptions about later life being a time of depression and isolation. It was only through working with older people that I could see my assumptions were stereotypes and actually the lived experience of older...

  • I think the first part is a combination of women being likely to live longer than men anyway, but also on average a husband is between 2.5-3 years older than their wife. So combined it explains why more women living alone.

    Not sure re: the second point, but I wonder if it is something to do with change in society, i.e. years ago more men would have worked...

  • Dear all, welcome to the course and great to see so many people here.

    It's nice to see there is a blend of people with professional experience wanting to expand knowledge, but also those with a more personal interest in the area. Welcome to you all.

    I am Adrian Leddy. I am a Clinical Psychologist who has worked with older people since 2003. Despite...

  • Certainly that will be one of the implications for more older people, i.e. more therapists, or more therapists that feel confident and are competent in working with older people.

  • Welcome to all the new learners who have joined more recently and interesting to read about the areas you work in.

  • @SarahS Hi Katie. Sorry if it is a bit unclear. It refers to the later, so the dysfunctional assumption/rule for living develops to protect the person from the core belief.

    So if we use a hypothetical example where a child's early experience is very over protective parenting, i.e. parent won't let the child go anywhere alone, gets really upset if they...

  • Adrian Leddy made a comment

    Having done one myself, I have to admit I found mine more exposing that I initially thought. Reflecting back, I probably thought I knew everything I would put on it, but the more I engaged with it the more it prompted to think about things I had forgotten or not thought about for a long time and made me reconnect with those memories (good and bad). It also...

  • Some really good ideas in all your comments below. It is really nice to see these ideas be linked back to content both earlier in this week of the teaching, but also in the previous weeks. The comments do also have a real collaborative feel to them, i.e. really getting alongside and working with Peter rather than having a really prescriptive approach.

  • I think it is really difficult to do this in day to day life as when something happens and leaves us feeling a certain way often reason and emotion are completely intertwined and often we don't really look back or reflect on it in a curious type way.

    In CBT this would be one of the key roles of the therapist to listen to the event/incident and paying...

  • @VickyGrandon Hi Vicky, I think you are right in that the more life experience someone has then naturally we would expect then to have more thigs to talk about and reflect on. That said within this there will still be incidents/events from life that have had a more profound effect (both positive and negative) and be easier for the person to recall because of...

  • I agree, my experience of doing a timeline is that for some people it certainly they do seem to find this much easier and less pressurised.

  • I would view this as entirely different. So the free association would be the word that comes to mind when hearing a certain word. The response to this would then be thought about and interpreted in a psychodynamic way i.e. what does it mean they have associated x with y. Where as the timeline technique would be a factual account of events and times, when...

  • I think it can be a really powerful took when working with someone with depression. We know when someone has depression it is not unusual for them to minimise or discount the positive achievements or adversity they have previously faced in life and conquered and sometimes it can be really challenging to get them to identify these things. In my own experience...