The Role of Cognitive Behavioural Therapy in Enhancing Mental Health and Reducing Loneliness among Nursing Home Residents
DOI:
https://doi.org/10.31674/mjn.2025.v16i04.010Abstract
Background: The increasing elderly population necessitates comprehensive healthcare, including palliative care. Elderly patients in palliative care often experience loneliness, decreased resilience, and mental health issues that affect their quality of life. Cognitive Behavioural Therapy (CBT) has been recognised as an effective intervention for addressing psychological issues, but its effectiveness in elderly palliative care patients remains limited. Objectives: This study aims to evaluate the impact of CBT intervention on levels of loneliness, resilience, and mental health in elderly patients undergoing palliative care. Methods: This quasi-experimental study involved 126 elderly participants aged 60-90 years undergoing palliative care at long term care Budi Mulia 1. Participants were divided into two groups: an intervention group receiving CBT sessions for four weeks and a control group receiving no intervention. Data were collected using the UCLA (University of California, Los Angeles Loneliness Scale) Loneliness Scale, Resilience Scale, and General Health Questionnaire (GHQ-12). Data analysis was performed using a paired t-test and linear regression. Results: The study results indicated that the intervention group experienced a significant reduction in loneliness scores from 65 ± 10 to 45 ± 8 (p = 0.000), a significant increase in resilience scores from 90 ± 12 to 130 ± 15 (p = 0.000), and a significant improvement in mental health scores from 25 ± 5 to 10 ± 3 (p = 0.000) compared to the control group. Conclusion: CBT intervention is effective in reducing loneliness, increasing resilience, and improving mental health in elderly patients under palliative care. These findings not only support the use of CBT as part of holistic care for the elderly but also highlight its potential to transform healthcare practices by addressing psychological needs alongside physical care, ultimately improving overall quality of life.
Keywords:
Cognitive Behavioural Therapy, Elderly: General Health Questionnaire (GHQ-12), Resilience Scale, UCLA Loneliness ScaleDownloads
References
Andas, A. M., Harahap, D., Purnamasari, A., & Prima, A. (2022). Effectiveness of cognitive behaviour therapy (CBT) to improve the sleep quality of the elderly in hospital. International Journal of Health Sciences, 6(April), 1669–1678. https://doi.org/10.53730/ijhs.v6ns4.6320
Andas, A. M., Sansuwito, T. bin, Said, F. M., Puspitasari, I., Prima, A., & Andas, N. H. (2023). The effect of box breathing on sleep disorders in elderly at Tresna Werdha Social Institution. Malaysian Journal of Medicine and Health Sciences, 19(Supplement 9), 197–204. https://doi.org/10.47836/mjmhs.19.s9.29
Andas, A. M., Sansuwito, T., Said, F. M., Wada, F. H., Purnamasari, A., Prima, A., & Andas, N. H. (2024). The influence of sleep hygiene on the sleep disorders of elderly at integrated long-term care. Malaysian Journal of Nursing, 15(4), 109–117. https://doi.org/10.31674/mjn.2024.v15i04.013
Alavi, N., Omrani, M., Shirazi, A., Layzell, G., Eadie, J., Jagayat, J., Stephenson, C., Kain, D., Soares, C. N., & Yang, M. (2023). Efficacious web-based psychotherapy to address depression and anxiety among patients receiving oncological and palliative care: an open-label randomised controlled trial. European Psychiatry, 66, S482–S483. http://dx.doi.org/10.1192/j.eurpsy.2023.1032
Dafsari, F. S., Bewernick, B., Böhringer, S., Domschke, K., Elsaesser, M., Löbner, M., Luppa, M., Preis, L., Püsken, J., Schmitt, S., Szekely, A.-J., Hellmich, M., Müller, W., Wagner, M., Peters, O., Frölich, L., Riedel-Heller, S., Schramm, E., Hautzinger, M., & Jessen, F. (2023). Cognitive behavioral therapy for late-life depression (cbtlate): results of a multicenter, randomized, observer-blinded, controlled trial. Psychotherapy and Psychosomatics, 92(3), 180–192. https://doi.org/10.1159/000529445
Domènech-Abella, J., Switsers, L., Mundó, J., Dierckx, E., Dury, S., & De Donder, L. (2021). The association between perceived social and physical environment and mental health among older adults: mediating effects of loneliness. Aging & Mental Health, 25(5), 962–968. https://doi.org/10.1080/13607863.2020.1727853
Elovanio, M., Hakulinen, C., Pulkki-Råback, L., Aalto, A.-M., Virtanen, M., Partonen, T., & Suvisaari, J. (2020). General Health Questionnaire (GHQ-12), Beck Depression Inventory (BDI-6), and Mental Health Index (MHI-5): psychometric and predictive properties in a Finnish population-based sample. Psychiatry Research, 289. https://doi.org/10.1016/j.psychres.2020.112973
Huang, S., Wang, Y., Li, G., Hall, B. J., & Nyman, T. J. (2024). Digital mental health interventions for alleviating depression and anxiety during psychotherapy waiting lists: systematic review. JMIR mental health, 11(1). Retrieved from: https://mental.jmir.org/2024/1/e56650/PDF, Accessed on 14th June, 2024.
Inaloo, R. B., Bijani, M., Nikrouz, L., Dehghan, A., Alkamel, A., Taghinezhad, A., & Khiyali, Z. (2025). Spirituality-based palliative care education on quality of life, death anxiety, and resilience of heart failure patients: Randomized controlled clinical trial. International Journal of Africa Nursing Sciences, 22. https://doi.org/10.1016/j.ijans.2025.100818
Kabiri, M., Namdari, K., & Abedi, A. (2023). Psychological resilience level after cognitive-behavior therapy in old people with empty nest syndrome - A single-case experimental design. Clinical Gerontologist, 46(3), 446–456. https://doi.org/10.1080/07317115.2022.2108361
Koder, D., Bhar, S., Armstrong, R., Joffe, R., Silver, M., Linossier, J., Collins, R., Dunkerley, S., & Waloszek, J. (2025). ELders AT Ease (ELATE): a description of adapting cognitive behaviour therapy for treating mental health issues in nursing homes. The Cognitive Behaviour Therapist, 18. https://doi.org/10.1017/S1754470X24000382
Lenouvel, E., Ullrich, P., Siemens, W., Dallmeier, D., Denkinger, M., Kienle, G., ... & Klöppel, S. (2023). Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database of Systematic Reviews, 11. https://doi.org/10.1002/14651858.CD014666.pub2
Lalani, N., Hamash, K., & Wang, Y. (2024). Palliative care needs and preferences of older adults with advanced or serious chronic illnesses and their families in rural communities of Indiana, USA. The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association, 40(2), 368–375. https://doi.org/10.1111/jrh.12787
Lima, G. S., Figueira, A. L. G., Carvalho, E. C. de, Kusumota, L., & Caldeira, S. (2023). Resilience in older people: A concept analysis. Healthcare (Basel, Switzerland), 11(18). https://doi.org/10.3390/healthcare11182491
Mayahara, M., & Paun, O. (2023). Mental health of older adults at the end of life. Journal of Psychosocial Nursing and Mental Health Services, 61(1), 12–15. https://doi.org/10.3928/02793695-20221207-03
McCabe, D. E. (2023). Promoting older adult mental health through integrated care. Geriatric Nursing (New York, N.Y.), 52, 215–218. https://doi.org/10.1016/j.gerinurse.2023.06.009
Morrish, N., Choudhury, S., & Medina-Lara, A. (2023). What works in interventions targeting loneliness: a systematic review of intervention characteristics. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-17097-2
Moye, J. (2023). Psychological interventions to improve wellness in older adults. Clinical Gerontologist, 46(3), 277–279. https://doi.org/10.1080/07317115.2023.2183458
Nicholson, C. J., Combes, S., Mold, F., King, H., & Green, R. (2023). Addressing inequity in palliative care provision for older people living with multimorbidity. Perspectives of community-dwelling older people on their palliative care needs: A scoping review. Palliative Medicine, 37(4), 475-497. https://doi.org/10.1177/02692163221118230
Peeler, A., Doran, A., Winter-Dean, L., Ijaz, M., Brittain, M., Hansford, L., Wyatt, K., Sallnow, L., & Harding, R. (2023). Public health palliative care interventions that enable communities to support people who are dying and their carers: a scoping review of studies that assess person-centered outcomes. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1180571
Ramli, D. B., Shahar, S., Mat, S., Ibrahim, N., Ali, N. M., & Tohit, N. M. (2023). The effectiveness of preventive home visit on resiliency,health status and quality of life of older adults: A systematic review. Age and Ageing, 52(Supplement_1). https://doi.org/10.1093/ageing/afac322.022
Reynolds, C. F. 3rd, Jeste, D. V, Sachdev, P. S., & Blazer, D. G. (2022). Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 21(3), 336–363. https://doi.org/10.1002/wps.20996
Roshanghalb, A., Hansen, B., Rudoler, D., & Best, M. W. (2024). Predicting CBT modality, treatment participation, and reliable improvements for individuals with anxiety and depression in a specialized mental health centre: a retrospective population-based cohort study. BMC Psychiatry, 24(1). https://doi.org/10.1186/s12888-024-05817-w
Sancho, P., Pinazo‐hernandis, S., Donio‐bellegarde, M., & Tomás, J. M. (2020). Validation of the University of California, Los Angeles Loneliness Scale (version 3) in Spanish older population: An application of exploratory structural equation modelling. Australian Psychologist, 55(3), 283–292. https://doi.org/10.1111/ap.12428
Santini, Z. I., Jose, P. E., York Cornwell, E., Koyanagi, A., Nielsen, L., Hinrichsen, C., Meilstrup, C., Madsen, K. R., & Koushede, V. (2020). Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. The Lancet Public Health, 5(1), e62–e70. https://doi.org/10.1016/S2468-2667(19)30230-0
Smith, R., Wuthrich, V., Johnco, C., & Belcher, J. (2021). Effect of group cognitive behavioural therapy on loneliness in a community sample of older adults: a secondary analysis of a randomized controlled trial. Clinical Gerontologist, 44(4), 439–449. https://doi.org/10.1080/07317115.2020.1836105
Stenzel, K. L., Keller, J., Kirchner, L., Rief, W., & Berg, M. (2025). Efficacy of cognitive behavioral therapy in treating repetitive negative thinking, rumination, and worry – a transdiagnostic meta-analysis. Psychological Medicine, 55. https://doi.org/10.1017/S0033291725000017
Tapia-Munoz, T., Ajnakina, O., Fancourt, D., & Steptoe, A. (2023). Personality traits and loneliness among older people in the UK: Cross-sectional and longitudinal analysis from the English Longitudinal Study of Ageing. European Journal of Personality, 38(4), 599–614. https://doi.org/10.1177/08902070231206196
Taylor, M. G., & Carr, D. (2021). Psychological resilience and health among older adults: A comparison of personal resources. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 76(6), 1241–1250. https://doi.org/10.1093/geronb/gbaa116
Wang, H., Hou, Y., Zhang, L., Yang, M., Deng, R., & Yao, J. (2022). Chinese elderly migrants’ loneliness, anxiety and depressive symptoms: The mediation effect of perceived stress and resilience. Frontiers in Public Health, 10. Retrieved from: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.998532. Accessed on 14th January, 2023.
World Health Organisation (WHO) (2023). World Population Ageing 2023. United Nations, 2023. Retrieved from: www.unpopulation.org . Accessed on 18th January, 2023.
Williams-Farrelly, M., Schroeder, M., Li, C., & Fowler, N. (2023). Loneliness and quality of life in older adult primary care patients. Innovation in Aging, 7(Supplement_1). https://doi.org/10.1093/geroni/igad104.1993
Yongpraderm, S., Inpithuk, P., & Wongprom, I. (2025). Resilience-building in palliative care professionals: scoping review. BMJ Supportive &Amp; Palliative Care, https://doi.org/10.1136/spcare-2024-005144
Zhang, S.-Y., Pan, M.-R., Zhang, L.-Q., Li, H.-M., Zhao, M.-J., Dong, M., Si, F.-F., Liu, L., Wang, Y.-F., & Qian, Q.-J. (2025). Efficacy of internet-based cognitive behavioral therapy for medicated adults with attention-deficit/hyperactivity disorder (ADHD): A randomized controlled trial. Psychiatry Research, 344. https://doi.org/10.1016/j.psychres.2025.116352
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Malaysian Journal of Nursing (MJN)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
