Psychotherapies and Non-pharmacological Interventions

  • Laura KenkelEmail author
  • Caroline Giroux


This chapter provides an overview of therapeutic modalities that may be useful for geriatric patients within inpatient settings including, but not limited to, medical units, skilled nursing facilities, and acute psychiatric units. Despite the time and resource limitations inherent in each of these settings, there are psychotherapeutic approaches that may be adapted to the environmental and staffing resources while also being individualized for the patient. Several approaches discussed here may be also used in groups. Inpatient settings also offer the opportunity for team members to make direct interventions throughout the day, which can facilitate early readjustments based on each patient’s needs, potentially accelerating improvement. Team members of various experience levels can undergo training in specific therapeutic modalities and coordinate appropriate interventions with the primary or consulting psychiatrist. Despite the logistical and environmental challenges to implementation, the targeted use of a thoughtfully chosen psychotherapeutic approach has the potential to not only improve the patient’s mental health but also enable him/her to participate more fully in medical care, with better treatment outcomes and quality of life.


Cognitive behavioral therapy (CBT) Psychotherapy Geriatrics Inpatient Problem-solving therapy (PST) Competitive memory training (CMT) Reminiscence group therapy (RGT) Problem adaptation therapy (PAT) Mindfulness-oriented intervention (MOI) Behavioral activation (BA) Acceptance and commitment therapy (ACT) Social problem-solving therapy (SPST) Reminiscence therapy and life review (RT & LR) Group psychotherapy Art Music Exercise 


  1. 1.
    Winningham RG, Pike NL. A cognitive intervention to enhance institutionalized older adults’ social support networks and decrease loneliness. Aging Ment Health. 2007;11(6):716–21.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    van Zon L, Kirby JR, Anderson N. The efficacy of a volunteer-administered cognitive stimulation program in long-term care homes. Int Psychogeriatr. 2016;28(6):995–1004.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Sera LC, McPherson ML. Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy. Clin Geriatr Med. 2012;28(2):273–86.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Hanson AE, Scogin F. Older Adults’ acceptance of psychological, pharmacological, and combination treatments for geriatric depression. J Gerontol B Psychol Sci Soc Sci. 2008;63(4):P245–P8.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    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.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Jonsson U, Bertilsson G, Allard P, Gyllensvard H, Soderlund A, Tham A, et al. Psychological treatment of depression in people aged 65 years and over: a systematic review of efficacy, safety, and cost-effectiveness. PLoS One. 2016;11(8):e0160859.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Wilson KC, Mottram PG, Vassilas CA. Psychotherapeutic treatments for older depressed people. Cochrane Database Syst Rev. 2008;1:CD004853.Google Scholar
  8. 8.
    Francis JL, Kumar A. Psychological treatment of late-life depression. Psychiatr Clin North Am. 2013;36(4):561–75.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Nikolitch K, Laliberte V, Yu C, Strychowsky N, Segal M, Looper KJ, et al. Tolerability and suitability of brief group mindfulness-oriented interventions in psychiatric inpatients: a pilot study. Int J Psychiatry Clin Pract. 2016;20(3):170–4.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Hummel J, Weisbrod C, Boesch L, Himpler K, Hauer K, Hautzinger M, et al. AIDE-acute illness and depression in elderly patients. Cognitive behavioral group psychotherapy in geriatric patients with comorbid depression: a randomized, controlled trial. J Am Med Dir Assoc. 2017;18(4):341–9.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Payman V. Psychotherapeutic treatments in late life. Curr Opin Psychiatry. 2011;24(6):484–8.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Schore AN. Affect regulation and the repair of the self. New York: W.W. Norton; 2003.Google Scholar
  13. 13.
    Brody AL, Saxena S, Stoessel P, Gillies LA, Fairbanks LA, Alborzian S, et al. Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy. Arch Gen Psychiatry. 2001;58(7):631.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Hecht D. Depression and the hyperactive right-hemisphere. Neurosci Res. 2010;68(2):77–87.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Cuijpers P, Karyotaki E, Pot AM, Park M, Reynolds CF. Managing depression in older age: psychological interventions. Maturitas. 2014;79(2):160–9.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Levin TT, White CA, Kissane DW. A review of cognitive therapy in acute medical settings. Part I: therapy model and assessment. Palliat Support Care. 2013;11(2):141–53.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Snarski M, Scogin F, DiNapoli EA, Presnell A, McAlpine J, Marcinak J. The effects of behavioral activation therapy with inpatient geriatric psychiatry patients. Behav Ther. 2011;42:100–8.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, et al. Cost and outcome of Behavioural activation versus cognitive Behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet. 2016;388(10047):871–80.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013;44(2):180–98.CrossRefGoogle Scholar
  20. 20.
    Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Gaudiano BA, Herbert JD. Acute treatment of inpatients with psychotic symptoms using acceptance and commitment therapy: pilot results. Behav Res Ther. 2006;44(3):415–37.CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Davison TE, Eppingstall B, Runci S, O’Connor DW. A pilot trial of acceptance and commitment therapy for symptoms of depression and anxiety in older adults residing in long-term care facilities. Aging Ment Health. 2017;21(7):766–73.CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Villatte JL, Vilardaga R, Villatte M, Plumb Vilardaga JC, Atkins DC, Hayes SC. Acceptance and commitment therapy modules: differential impact on treatment processes and outcomes. Behav Res Ther. 2016;77:52–61.CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Miller MD. Using interpersonal therapy (IPT) with older adults today and tomorrow- a review of the literature and new developments. Curr Psychiatry Rep. 2008;10:16–22.CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Mackin RS, Arean PA. Evidence-based psychotherapeutic interventions for geriatric depression. Psychiatr Clin North Am. 2005;28(4):805–20, vii-viii.CrossRefPubMedCentralGoogle Scholar
  26. 26.
    van Schaik DJ, van Marwijk HW, Beekman AT, de Haan M, van Dyck R. Interpersonal psychotherapy (IPT) for late-life depression in general practice: uptake and satisfaction by patients, therapists and physicians. BMC Fam Pract. 2007;8:52.CrossRefPubMedCentralGoogle Scholar
  27. 27.
    Areán PA, Cook BL. Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression. Biol Psychiatry. 2002;52(3):293–303.CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Syed Elias SM, Neville C, Scott T. The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: a systematic review. Geriatr Nurs. 2015;36(5):372–80.CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Keisari S, Palgi Y. Life-crossroads on stage: integrating life review and drama therapy for older adults. Aging Ment Health. 2017;21(10):1079–89.CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Chiang KJ, Chu H, Chang HJ, Chung MH, Chen CH, Chiou HY, et al. The effects of reminiscence therapy on psychological Well-being, depression, and loneliness among the institutionalized aged. Int J Geriatr Psychiatry. 2010;25(4):380–8.CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Fodor I. A female Therapist’s perspective on growing older. J Clin Psychol. 2015;71(11):1115–20.CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Bateman A, Fonagy P. Mentalization-based treatment. Psychoanal Inq. 2013;33(6):595–613.CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Pati D, Freier P, O’Boyle M, Amor C, Valipoor S. The impact of simulated nature on patient outcomes: a study of photographic sky compositions. HERD. 2016;9(2):36–51.CrossRefPubMedCentralGoogle Scholar
  34. 34.
    Kwok TC, Bai X, Kao HS, Li JC, Ho FK. Cognitive effects of calligraphy therapy for older people: a randomized controlled trial in Hong Kong. Clin Interv Aging. 2011;6:269–73.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Kao H, Zhu L, Chao AA, Chen HY, Liu IC, Zhang M. Calligraphy and meditation for stress reduction: an experimental comparison. Psychol Res Behav Manag. 2014;7:47–52.CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Chan SCC, Chan CCH, Derbie AY, Hui I, Tan DGH, Pang MYC, et al. Chinese calligraphy writing for augmenting attentional control and working memory of older adults at risk of mild cognitive impairment: a randomized controlled trial. J Alzheimers Dis. 2017;58(3):735–46.CrossRefPubMedCentralGoogle Scholar
  37. 37.
    Schore AN. The right brain implicit self lies at the Core of psychoanalysis. Psychoanalytic Dialogues. 2011;21(1):75–100.CrossRefGoogle Scholar
  38. 38.
    Jacquart SD, Marshak HH, Santos HD, Luu SM, Berk LS, McMahon PT, et al. The effects of simultaneous exercise and psychotherapy on depressive symptoms in inpatient, psychiatric older adults. Adv Mind Body Med. 2014;28(4):8–17.PubMedGoogle Scholar
  39. 39.
    Theleritis C, Siarkos K, Politis AA, Katirtzoglou E, Politis A. A systematic review of non-pharmacological treatments for apathy in dementia. Int J Geriatr Psychiatry. 2018;33(2):e177–e92.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesUC Davis Health SystemSacramentoUSA
  2. 2.Department of Psychiatry and Behavioral SciencesUC Davis Health System, Behavioral Health ClinicSacramentoUSA

Personalised recommendations