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Updated: Apr 4, 2026

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing
Published on: January 24, 2020
Enabling lay providers to conduct CBT for older adults: key steps for expanding treatment capacity
Cynthia Kraus-Schuman1, Nancy L Wilson2, Amber B Amspoker2
1Mental Health Care Line (MHCL 116), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA.
Abstract:
The Institute of Medicine advocates the examination of innovative models of care to expand mental health services available for older adults. This article describes training and supervision procedures in a recent clinical trial of cognitive behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD) delivered by bachelor-level lay providers (BLPs) and to Ph.D.-level expert providers (PLPs). Supervision and training differences, ratings by treatment integrity raters (TIRs), treatment characteristics, and patient perceptions between BLPs and PLPs are examined. The training and supervision procedures for BLPs led to comparable integrity ratings, patient perceptions, and treatment characteristics compared with PLPs. These results support this training protocol as a model for future implementation and effectiveness trials of CBT for late-life GAD, with treatment delivered by lay providers supervised by a licensed provider in other practice settings.
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