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Cognitive-behavioural therapy can reduce fear of falling

Liu TW, Ng GYF, Chung RCK, et al. Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis. Age Ageing. 2018 Feb 20. [Epub ahead of print]

Review question

Does cognitive-behavioural therapy reduce fear of falling and improve balance in people over 60 years of age?


Fear of falling is common in older people and can lead to reduced balance, activity, and quality of life.

Cognitive-behavioural therapy can be used to modify thoughts and behaviours and may help people reduce their fear of falling.

How the review was done

The researchers did a systematic review based on studies available up to October 2017.

They found 6 randomized controlled trials with 1,626 people.

The key features of the studies were:

  • people were mostly women (69%), average age 76 years, lived in the community (at home or with a family member but not in a nursing home or hospital), and may or may not have fallen in the past;
  • therapy was done in groups or individually with face-to-face and/or telephone contact;
  • therapy lasted from 4 to 20 weeks;
  • components of therapy included goal setting, promotion of physical activities, and cognitive restructuring (a process that helps people replace or modify negative thoughts); and
  • cognitive-behavioural therapy was compared with no therapy or exercise therapy.

What the researchers found

Compared with control, cognitive-behavioural therapy:

  • reduced fear of falling by a small amount immediately after therapy ended that lasted for 6 months or longer in some studies; and
  • improved balance by a very small amount within 6 months of therapy ending.


Cognitive-behavioural therapy may reduce fear of falling by a small amount but has very little or no effect on balance.

Cognitive-behavioural therapy (CBT) vs control in older people who are afraid of falling


Time points

Number of trials

Effect of CBT*

Fear of falling

Immediately after therapy


CBT reduced fear of falling by a small amount compared with no CBT.


Less than 6 months after therapy


CBT reduced fear of falling by a small amount compared with no CBT.


6 months or longer after therapy


CBT reduced fear of falling by a small amount compared with no CBT.


Immediately after therapy


CBT did not affect balance compared with no CBT.


Less than 6 months after therapy


CBT improved balance by a very small amount compared with no CBT.


6 months or longer after therapy


Not available.

*Based on standard mean differences (SMD); very small = less than 0.2 SMD, small = 0.2 to 0.49 SMD, medium = 0.5 to 0.79 SMD, large = 0.8 or more SMD.


Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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