Psychological approaches

Psychological approaches (or therapies or treatments) provide people with the opportunity to discuss their thoughts and feelings with a trained professional to assist them with understanding and coping with their daily life or negative events. [1] Psychological approaches can be used for a variety of mental health conditions (including depression and anxiety) and can also be used to improve overall wellbeing. Some approaches are outlined below.

Cognitive behavioural therapy

Cognitive behavioural therapy supports individuals to learn structured problem-solving skills and encourages them to consider their life events in a more realistic and adaptive way. [2]

Problem-solving therapy

Problem-solving therapy focuses on training constructive problem-solving attitudes and skills to improve wellbeing in the presence of stressful life events. [2]

Reminiscence therapy and life review 

Reminiscence and its more psychotherapeutic version, ‘reminiscence therapy’ usually involve the older person discussing their memories with another individual or in a group. [3] Life review and life review therapy are highly structured therapeutic biographical approaches. They aim to cover the person’s full lifespan and may be most appropriate for older people with more serious psychological conditions. [4] Reminiscence and life review approaches are covered briefly below but also have a specific evidence theme dedicated to them. 

Psychotherapy

Psychotherapy is a structured, time-limited approach which focuses on correcting dysfunctional beliefs to help people cope with daily life or negative life events. There are several types of psychotherapy, and some types may work better for certain issues. [5]

Competitive memory training

Competitive memory training does not aim to change negative thoughts, but rather to reduce the amount of time the individual spends engaging in these thoughts. [6]

Who is likely to benefit from psychological approaches?

Not all psychological approaches are helpful for everyone, and each person may need to try a few approaches before finding what works for them. [1]

Psychological approaches have been shown to improve mental health and wellbeing in older adulthood. [7] Although psychological approaches are preferred by older adults compared to drug approaches such as antidepressant medications, older adults are less likely to engage in psychological therapies than younger people. [7] This may be due to the misconception that low mood or depression is a normal part of ageing [8] or due to a lack of mental health services specialising in care for older people. [9]

In Australia, access to psychological services differs depending on where people live. For those living at home, access to psychological services is accessible through a general practitioner with a Medicare-subsidised Mental Health Treatment Plan. [10] Until quite recently, however, access to these same services has been unavailable to those living in government-subsidised aged care facilities. [10]

This evidence theme on psychological approaches is a summary of one of the key topics identified by a scoping review of mental health and wellbeing in aged care research. It does not include therapies for people living with dementia as this theme is covered separately in our psychological interventions in dementia care section.

If you need more information on this topic, try using the PubMed search below.

We found six systematic reviews focusing on psychological approaches for improving the mental health and wellbeing of older adults. Psychological approaches can help to improve multiple components of wellbeing or reduce the symptoms of a variety of mental health conditions. However, all reviews except one [11] focused on depression only.

Overall, multiple psychological approaches appear to be effective in reducing depression. These approaches include:

• Cognitive behavioural therapy (including internet-delivered therapy) [2, 5, 11, 12]
• Problem-solving therapy [2]
• Competitive memory training [2]
• Reminiscence therapy (including group reminiscence) [2]
• Life review therapy.  [5]

Two other reviews report that psychotherapy in general is relatively consistent in reducing depressive symptoms. [13, 14] One review found that reminiscence therapy and cognitive behavioural therapy have the most consistent effect. [14]

Only one review reported on anxiety symptoms among older adults. Overall, there was inconsistent evidence that cognitive behavioural interventions can reduce anxiety symptoms among people living in residential aged care. This is because some studies report benefits to the approach, while others do not. [11]

The reviews highlighted concerns about the methods used in some of the studies. This reduces the degree of certainty we might have about the effectiveness of psychological approaches. For example:

• It was often unclear if participants had a diagnosis of depression or anxiety when the study began. [2, 11, 13]
• Outcomes were measured using a wide variety of tools, making comparison across studies difficult. [2, 11]
• Studies varied widely in the type, frequency, and duration of the psychological intervention, as well as who was facilitating the therapy. This makes it difficult to draw conclusions about what may work best. [2, 11-13]
• Some studies only had a small number of participants. [2, 14]
• There was a lack of diversity among the participants, with most people having relatively high education, and being from a Caucasian background. [12]

• Be familiar with different psychological approaches and their benefits and potential limitations for older people (see resources below).
• Gain more knowledge around signs of poor mental health among older people.
• Refer or escalate concerns you may have about the psychological wellbeing of an individual to a supervisor or service manager.

• Consider employing or contracting someone with psychological expertise within the organisation.
• Rather than focusing solely on those with signs of poor mental health, consider taking steps to increase the wellbeing of all individuals in their care (e.g., by supporting meaningful activities and implementing a person-centred approach). 
• Provide regular staff training about mental health and wellbeing. 
• Encourage collaboration between mental health clinicians and other staff. Consider hosting case conferences for individuals that staff may be concerned about.
• Support and encourage staff to approach management with any concerns about individuals’ psychological wellbeing.

1. BetterHealth Channel. Mental illness treatments [Internet]. 2019 [cited 2023 Jun 29]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mental-illness-treatments#psychological-treatments-for-mental-illness.
2. Apostolo J, Bobrowicz-Campos E, Rodrigues M, Castro I, Cardoso D. The effectiveness of non-pharmacological interventions in older adults with depressive disorders: A systematic review. Int J Nurs Stud. 2016;58:59-70.
3. Shropshire M. Reminiscence intervention for community-dwelling older adults without dementia: A literature review. Br J Community Nurs. 2020;25(1):40-4.
4. Menn L, Corsten S, Lauer N, Wallace SJ. The effectiveness of biographical approaches in long-term care: A systematic review. Gerontologist. 2020;60(4):e309-e28.
5. Chen Y-j, Li X-x, Pan B, Wang B, Jing G-z, Liu Q-q, et al. Non-pharmacological interventions for older adults with depressive symptoms: A network meta-analysis of 35 randomized controlled trials. Aging Ment Health. 2021;25(5):773-86.
6. Ekkers W, Korrelboom K, Huijbrechts I, Smits N, Cuijpers P, van der Gaag M. Competitive Memory Training for treating depression and rumination in depressed older adults: A randomized controlled trial. Behav Res Ther. 2011;49(10):588-96.
7. Liu Y, Gellatly J. Barriers and facilitators of engagement in psychological therapies among older adults with depression: A systematic review and thematic synthesis. Psychiatr Ment Health Nurs. 2021;28(4):509-20.
8. Batten G. Normalising mental illness in older adults is a barrier to care [Internet]. Canberra, ACT: Australian Institute of Family Studies; 2019 [cited 2023 Jun 29]. Available from: https://aifs.gov.au/resources/short-articles/normalising-mental-illness-older-adults-barrier-care.
9. Muir-Cochrane E, O’Kane D, Barkway P, Oster C, Fuller J. Service provision for older people with mental health problems in a rural area of Australia. Aging Ment Health. 2014;18(6):759-66.
10. Cations M, Collier LR, Caughey G, Bartholomaeus J, Lang C, Crotty M, et al. Government-subsidised mental health services are underused in Australian residential aged care facilities. Aust Health Rev. 2022;46(4):432-41.
11. Chan P, Bhar S, Davison TE, Doyle C, Knight BG, Koder D, et al. Characteristics and effectiveness of cognitive behavioral therapy for older adults living in residential care: A systematic review. Aging Ment Health. 2021;25(2):187-205.
12. Xiang X, Wu S, Zuverink A, Tomasino KN, An R, Himle JA. Internet-delivered cognitive behavioral therapies for late-life depressive symptoms: A systematic review and meta-analysis. Aging Ment Health. 2020;24(8):1196-206.
13. Gramaglia C, Gattoni E, Marangon D, Concina D, Grossini E, Rinaldi C, et al. Non-pharmacological approaches to depressed elderly with no or mild cognitive impairment in long-term care facilities. A systematic review of the literature. Front Public Health. 2021 Jul 16;9:685860.
14. Cody RA, Drysdale K. The effects of psychotherapy on reducing depression in residential aged care: A meta-analytic review. Clin Gerontol. 2013;36(1):46-69.