Psychological interventions

People living with dementia often experience changes to their identity, status, and feelings of control. [1] Psychological illness is more common among those living with dementia than among those without a diagnosis of dementia. Psychological treatments usually aim to reduce symptoms of depression and anxiety. Psychological approaches are also often directed toward the carer, to improve coping and quality of life, and reduce the impact of supporting someone with dementia (also sometimes referred to as ‘carer burden’). [2]

There are multiple psychological approaches that aim to improve outcomes for people living with dementia and/or their carers. Some common approaches are outlined below.

Cognitive behaviour therapy

Cognitive behaviour therapy supports clients and their carers to learn structured problem-solving skills and better integrate accommodations for cognitive impairment into daily life. [3]

Validation therapy

Validation therapy involves validating and generalising the feelings and motivation of the person living with dementia. [4]

Functional analysis

Functional analysis is a therapist-led behavioural approach to managing responsive behaviours of people living with dementia. It focuses attention on the meaning or purpose behind the behaviour, equipping carers to work to resolve the person’s cause of distress. [5]

Mindfulness therapy

Mindfulness involves a non-judgemental approach to one’s own experiences and attention to the present moment. [6]

Individual or group psychotherapy

Psychotherapy aims to assist people to resolve emotional threats, to retain or maintain a greater level of control over their lives and to adjust to their current circumstances. [3]

Person-centred counselling

Person-centred counselling or therapy is an empathetic and accepting approach that focuses on the experience and life story of the person living with dementia, the carer, or both. [3]

This evidence theme on psychological interventions is a summary of one of the key topics identified by a scoping review of dementia research. If you need more information on this topic, try using the PubMed search below.

We found five systematic reviews that assessed the impact of psychological interventions for people living with dementia and/or their carers. These studies aimed to find out if psychological interventions reduced outcomes such as depression and anxiety, or improved outcomes such as quality of life, for both those living with dementia and those providing care. 

Overall, some studies report the benefits of psychological interventions for persons living with dementia. For validation therapy, these include reductions in responsive behaviours and carer distress. [3]

For cognitive behaviour therapy, there was some evidence of benefit for people living with dementia. Benefits included improvements in:

• Depression [3]
• Quality of life. [3]

However, there was only limited improvement in self-esteem and cognitive functioning, and no change in people’s ability to manage their self-care. [3]

For person-centred counselling, there was evidence of improvement in cognition and mood for the person living with dementia, as well as carer attitudes. [3] There is inconclusive evidence that person-centred counselling improves depression. This is because some studies observed benefits while others did not. [3]

For group psychotherapy, there was evidence from one study for improvement in quality of life for the person living with dementia, and carer coping. [3]

There is inconclusive evidence that group psychotherapy reduces depressive symptoms for the person living with dementia. This is because some studies reported benefits while others did not. [3]

The evidence for functional analysis for managing responsive behaviours remains inconclusive but promising according to one review. [5] 

A review that focused on psychological treatments, in general, reported an overall positive impact on depression. [2] There is inconclusive evidence that psychological treatments influence:

• Neuropsychiatric symptoms [2]
• Cognition [2]
• People’s ability to manage their self-care [2]
• Anxiety [2, 3]
• Carer self-rated depressive symptoms. [2]

 This is because some studies reported that psychological treatment influenced these outcomes, and others did not.

Studies that have assessed the relationship between psychological interventions overall and quality of life for the person living with dementia found no benefit. [2] In our search, we did not find any reviews that focused on mindfulness.

Overall, psychological interventions are most effective when:

• They have multiple components [7]
• They incorporate technology [7]
• They combine individual and group sessions [7]
• They are personalised to the individual [7]
• Group interventions are focused on a common issue. [7]

The reviews highlighted concerns about the methods used to assess the impact of psychological interventions. This reduces the degree of certainty we might have about the benefits of these approaches. For example:

• Studies were not always clear about the type, frequency, intensity, and duration of the intervention. [7]
• Studies did not compare the effectiveness of psychological interventions across varying stages of dementia. [2]
• Many studies focus on multi-component interventions, which can make it difficult to determine which psychological approaches may be the most beneficial. [2]
• Potentially important outcomes were not assessed (e.g., how psychological interventions may help people to manage shame and stigma). [3]

• Be familiar with psychological approaches and their benefits and potential limitations for people living with dementia (see resources below).
• Gain more knowledge around signs of depression and/or anxiety among people living with dementia.
• Refer or escalate concerns you may have about the psychological wellbeing of an individual living with dementia or their carer.

• Consider employing or contracting someone with psychological expertise within your organisation.
• Consider conducting group interventions based on a common issue (with the help of a psychologist or mental health professional).
• Support and encourage staff to approach management with any concerns about individuals’ psychological wellbeing.

1. Cations M, Low L-F. Psychological therapy for people with dementia. InPsych [Internet]. Australia: InPsych; 2020 [cited 2023 Jun 29]; 42(6). Available from: https://psychology.org.au/for-members/publications/inpsych/2020/dec-jan-issue-6/psychological-therapy-for-people-with-dementia.
2. Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev. 2014(1):CD009125.
3. Cheston R, Ivanecka A. Individual and group psychotherapy with people diagnosed with dementia: A systematic review of the literature. Int J Geriatr Psychiatry. 2017;32(1):3-31.
4. Erdmann A, Schnepp W. Conditions, components and outcomes of integrative validation therapy in a long-term care facility for people with dementia. A qualitative evaluation study. Dementia. 2016;15(5):1184-204.
5. Moniz Cook ED, Swift K, James I, Malouf R, De Vugt M, Verhey F. Functional analysis-based interventions for challenging behaviour in dementia. Cochrane Database Syst Rev. 2012(2):CD006929.
6. Berk L, Warmenhoven F, Van Os J, Van Boxtel M. Mindfulness training for people with dementia and their caregivers: Rationale, current research, and future directions. Front Psychol. 2018;9:982.
7. Elvish R, Lever S-J, Johnstone J, Cawley R, Keady J. Psychological interventions for carers of people with dementia: A systematic review of quantitative and qualitative evidence. Couns Psychother Res. 2013;13(2):106-25.