“My father is 78 years old and is complaining about mood problems. He is physically healthy and as far as I can see very active, but he still says his mood is low. Could he benefit from therapy, or does that only work in younger people?”
An old assumption that turned out to be wrong
It was assumed for a long time that therapies do not work in older adults, because of rigidity in thinking, entrenched personality traits or cognitive decline. Modern research has, however, shown that this simply is not true.
There is no evidence whatsoever that the effects of therapies are smaller in older people than in younger adults.
There are even quite a few studies in older adults above 75 years of age which show that psychotherapy works for them. That means that those who receive psychotherapy are better off than people who receive usual care or are on waiting lists for psychotherapy. And that is true in all adult age groups, with no significant differences between adult age groups (therapies are less effective in children and adolescents, but that is another matter).
Which therapies have been shown to work?
There are several types of psychotherapy that have been shown to be effective:
- Cognitive behavioural therapy — the best known type, in which patients learn to think more positively about themselves, about their life, and about their future.
- Behavioral activation, in which they learn to do more positive activities that make them feel good.
- Problem-solving therapy, in which they learn to cope with their most important problems in a systematic way.
- Psychodynamic therapy, in which they explore unconscious thoughts, emotions, and early life experiences to gain insight into how their past influences their life and their problems.
- Life review therapy — one type of therapy that was specifically developed for older adults. In this therapy, patients systematically go through their life course and try to validate each of these phases of their life and evaluate them in a more positive way.
Unfortunately, there is very little knowledge about who benefits from which therapy. That means that it cannot be predicted if a patient will get better through one therapy or another.
Even in residential settings
Most studies in older adults with depression are done in people who live independently in the community. But there are also some studies for older adults who do not live independently anymore, but who live in nursing homes or residential homes. These studies show that psychotherapies also work in older adults who live in such homes.
What “working” actually means
That these therapies work does not mean that everyone benefits from them. Outcomes are often measured in terms of response, which means a symptom reduction of 50% between the start and the end of the therapy. It has been estimated that 42% of the people who get therapy respond. This is not a fixed percentage but only the mean. It has been found for example, that the proportion of responders is higher in people with more severe depression.
About 25% of patients are completely recovered, meaning that there is no difference with people without depression anymore. That means that a lot of people who get therapy are not better after one treatment, and these people need another therapy. Maybe they need to combine the therapy with antidepressant drugs, or they need an extension of the current therapy.
Pim Cuijpers is professor emeritus of clinical psychology and scientific director of Metapsy. He has been involved in more than 1,100 scientific studies, mostly on psychological treatments of mental health problems. This is one of a series of evidence summaries in which Prof. Cuijpers tries to answer questions from patients and clinicians, based on what is known in science about treatments. The knowledge is mostly drawn from collective work of the Metapsy collaboration of at least 15 years. Do you have other questions you would like Prof. Cuijpers to discuss? Feel free to contact us.
Literature
- Cuijpers P, Karyotaki E, Pot AM, Park M, Reynolds CF. (2014). Managing depression in older age: psychological interventions. Maturitas, 79, 160–169.
- Cuijpers P, Karyotaki E, Eckshtain D, et al. (2020). Psychotherapy for depression across different age groups: A meta-analysis. JAMA Psychiatry, 77(7), 694–702.
- Cuijpers P, Ciharova M, Miguel C, Harrer M, Ebert DD, Brakemeier EL, Karyotaki E. (2021). Psychological treatment of depression in institutional settings: A meta-analytic review. Journal of Affective Disorders, 286, 340–350.
- Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Papola D, Ebert D, Karyotaki E. (2023). Psychological treatment of depression: A systematic overview of a ‘Meta-Analytic Research Domain’. Journal of Affective Disorders, 335, 141–151.
- Cuijpers P, Harrer M, Miguel C, Ciharova M, Karyotaki E. (2025). Five decades of research on psychological treatments of depression: A historical and meta-analytic overview. American Psychologist, 80, 297–310.