Psychotherapy in Older Adults: Benefits and Consequences  

In a research article by (Blackburn, Wilkins-Ho & Weise, 2017), the effects that psychotherapy can have on patients who suffer from late-life depression, LDL, were investigated. The article explains the intimate awareness of clinical depression among older adults to be a very real problem in society today. It is important to note that before any form of treatment is being given as an option to the patient, they must be thoroughly examined physical as well as a screening tool, in this case, the Geriatric Depression Scale must be utilized to determine any consideration for how to proceed with the individual’s treatment.

(Blackburn, Wilkins-Ho & Weise, 2017). Through this study, it was found that the degree of the effect that this kind of therapy holds on patients varies greatly depending on what other outside sources are being utilized alongside the psychotherapy itself. Some of the groups that they utilized as “control groups” were receiving supportive therapy that included things such as increased attention, increased reassurance, increased education, etc.

Through the comparison being made alongside other forms of therapy such as cognitive-behavioral therapy, interpersonal therapy, problem-solving therapy, and several other forms of therapy, it was ultimately found that psychotherapy is only moderately effective and would primarily be recommended for those who are suffering from milder forms of late-life depression (Blackburn, Wilkins-Ho & Weise, 2017). Psychotherapy, according to this article was also said to be best as a stand-alone treatment, but the patient should also take into consideration taking the form of pharmacotherapy that is so required by their therapists.

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Therefore, it is so concluded that other forms of therapy may be more beneficial for the individual being treated if their depression seems to be more severe, however, when dealing with chronic depression or severe depression, it is important to seek further mental health services that may be more severe in return.

With depression among the offender population becoming an increasing problem, being able to determine whether psychotherapy is an effective treatment or not is critical to be able to determine a solution to such a growing issue. A research study conducted by (Cuijpers et al., 2006) developed a form of using meta-analysis to determine the overall effect that psychotherapy would have on the elderly population. The control trials utilized in this study were randomly for the actual geriatric treatment being used. In the literature that was studied 25 other comparative studies were found to include in the analysis that (Cuijpers et al., 2006) were planning on initiating. These 25 comparative studied were the separated into different subgroups, those that included 17 treatments that were being used as comparisons for psychological treatments against the control group being used, 5 that were comparing psychological treatment being given to antidepressants being used, and 8 that were comparing the several forms of psychotherapy among each other. In this study, it was evident that the most widely used form of psychotherapy happened to be cognitive-behavioral therapy as well as simple behavior therapy as well. When analyzing the results of this study, (Cuijpers et al., 2006) concluded that a mean effect size of .72 was found. What this would mean was that psychotherapy seemed to have a moderate to rather a grand effect as a treatment method for those patients in the older population who happened to be suffering from late-life depression. When looking at each separate subgroup, no significant differences seemed to be apparent. When psychotherapy was compared to antidepressants there was no suggestion of apparent differences between the categories being compared. On the other hand, when comparing psychotherapy and other forms of medications, the effect size found was in favor of conjoining treatment methods (Cuijpers et al., 2006). With all of this being said, it is evident that indisputably psychotherapy being used as a form of treatment for those elderly suffering from depression is strongly effective.

Like the previous studies, (Lee et al., 2012) also see the severity that geriatric depression has become within the older population which can place even further burdens on their already possible difficult lives. It is known that become older adults already seem to take a plethora of medications, and they seem to be keener toward receiving psychotherapy as opposed to pharmacotherapy treatment as a means to reduce their intake of pills or even to simply reduce feelings of dependency on medication to “be okay.” However, minimal psychotherapy options are available for older adults which can make it difficult to pursue this form of treatment in primary care settings, as opposed to pharmacotherapy. Because the primary care setting is where older adults seek their mental health treatments, this may become an issue as many will not seek secondary sources to acquire the necessary treatments. Many benefits of psychotherapy are outlined in this study as it is said to be primarily cost-effective as opposed to a lot of the medications available for the same purpose, psychotherapy is also easier for individuals to acquire when the severity of their depression has not hit a certain high or in other words reach the conditions that must be met to be classified as suffering from “major depression” and receiving pharmacotherapy in that manner (Lee et al., 2012). Because of these benefits being seen in the realm of psychotherapy, several randomized control trials were conducted, in the same manner, that (Blackburn, Wilkins-Ho & Weise, 2017) and (Cuijpers et al., 2006) conducted to define the effectiveness of psychotherapy on those older adults suffering from what the researchers categorize as “subthreshold depression.” As a standard to determine the quality of the study, the United States Preventative Services Task Force (USPSTF) was utilized to give suggestions as to what would work best in terms of late-life depression. From the USPSTF, it was concluded that psychotherapy is not only inexpensive but is also a safe method to reduce depression among the older population (Lee et al., 2006). The only catch here is that they dealt with subthreshold depression and not all forms.

In a study conducted by Hinrichsen, a more detailed form of psychotherapy was examined, interpersonal psychotherapy for depression (IPT). As opposed to the previous literature studied examining more moderate forms of depression with their psychotherapy, IPT is known to best treat those older adults suffering from a major depressive disorder. Because IPT seems to be more aimed to place importance and treat those suffering from interpersonally relevant problems, it would only seem plausible that this kind of therapy would be especially important to be given to those who suffer from depression after the loss of a loved one or even after discovering a terminal ailment of their own or a loved one as well. Because of this, (Hinrichsen, 1999) has found that IPT is incredibly effective when treating older adults with severe depression as many older adults who do suffer from depression are said to do so after the fact that they find out about another illness or that they recognize that their significant others are on the verge of death as well. In clinical practice thus, Hinrichsen was able to conclude that IPT is effective as a treatment for those in the older population suffering from depression, severe depression specifically.

In the study conducted by (Cujipers et al., 2006), several indicators pointed toward the positive efficacy that psychotherapy had on those patients that belonged to the elderly population. However, a problem that arises now is the problem of having a rather acute sample size. Thus, SpiPsychotherapy in Older Adults: Benefits and Consequences by elmanwayElman, Berman, and Usitalo offers a broader viewpoint on the population, as their research focuses on the older adult population as a whole when looking towards the literature that provides input on the effectiveness of psychotherapy among those older adults that are suffering from depression. By comparing psychotherapy to one of the most efficient treatments for depression, second-generation antidepressants (SGAs), (Spielmans et al., 2001) were able to determine the actual usefulness of psychotherapy as a treatment. Not only did the authors compare the efficiency of second-generation antidepressants in the time frame of short-term, but they also concluded follow-ups with the people being tested. Therefore, through this, the authors further utilized a meta-analytic process like (Cujipers et al., 2006) to compare the effects that the SGAs held in comparison to the effects that psychotherapy held in terms of being a better treatment for depression among the older population. It is important to note that the common psychotherapies being represented in the study were both cognitive and/or behavioral therapies. When looking at the post-treatment portions of their study, (Spielmans et al., 2001) were able to conclude that psychotherapy and the use of SGAs did not have a significant difference in the efficacy of treating or even diminishing the feelings of depression among the older population. Thus, through the measures conducted in the follow-up portions of the study, there was minimal, but still, a difference found in favor of psychotherapy being utilized among older depressive patients (Spielmans et al., 2001). Therefore, this is further important information because since a lot of older patients chose to keep their intake of medications to a minimum, studies like these show that psychotherapy has the same effect if not slightly greater at treating depression among older adults than pharmacotherapy.

In an article written by Landreville and Gervais, depression is seen as a disability that can become a problem in later life, therefore, in this case, we are also looking at late-life depression. Through this article, both theoretical and empirical literature was viewed and reviewed to determine the literature currently available on psychotherapy being used as a treatment method for those older adults suffering from depression, but more specifically with those older adults suffering from a current disability. Similar to those modalities being utilized by (Spielmans et al., 2001), (Landerville & Gervais, 1997) use cognitive and behavioral therapies as models/modalities within psychotherapy as they are the most relevant in treating depression among the specific older adult population. When looking at the empirical evidence presented, it is clear that psychotherapy is effective in reducing depressive symptoms, however, it is rather unclear whether or not psychotherapy is effective for treating depression itself. For those elderly patients with a disability, it is clear that more well-developed studies are necessary to be able to decide the long-term effects that psychotherapy would have on those older adults that suffer from depression, but that also have a disability. From the psychotherapy, however, it was able to be concluded that progress in their functioning in their day-to-day activities was evident due to the lessening of their disabilities through the therapy itself (Landerville & Gervais, 1997). The only limitation that is present here is that we were looking at a population with a specific other disability being present and this may not be the case in all other cases.

Finally, we look into psychotherapy being used as a treatment for the older population suffering from depression, however, this time it is within a group format as it seems to be more efficient that way. In an article published in 2011, six different random control groups were presented as these were the variables that showed variances within depression scores. These controlled groups of psychotherapy were compared with another type of control variables or to some method of effective treatment. All in all, the results determined that group psychotherapy was an efficient way to treat those of the older population who happened to be suffering from depression. When looking at the results, the effect size although only moderate, depicted psychotherapy to withhold striking upholding of the effects at follow-up check-ins. Because of this, because of such high maintenance benefits and also how inexpensive group psychotherapy seems to be, psychotherapy would be the best treatment option for those older adults who seem to suffer from depression (Krishna et al., 2011).

Conclusion

All in all, psychotherapy among the various spectrums seems to overall be an efficient wa to treat those of the older population who suffer from depression. From using psychotherapy with pharmacotherapy as a suggestion, to using more cognitive/behavioral therapies, to using more intense forms like interpersonal psychotherapy for depression, to even using psychotherapy in a group format, psychotherapy overall seems to take many roles in helping decrease depression among the elderly population. From benefits ranging from ineffectiveness to most beneficial and straying away from taking medications and consequences being not getting the overall full, proper treatment, it is evident that those who chose to pursue psychotherapy may have to outweigh their pros and cons when choosing which kind of treatment they would like to obtain. It is important to note how different an older patient suffering from depression can be from someone in their teens and early adulthood dealing with depression. As we know, there are many limitations to the above research and because depression among older adults is so new to society, more education must be given and dispersed to understand the full effects of depression on the elderly population.