Characteristics of Psychotherapeutic Integration for Depression in Older Adults: A Delphi Study

Abstract

Although research on several psychotherapies indicates psychotherapy to be an effective treatment of depression, a large group of elderly patients have yet to respond to treatment. Psychotherapy integration (PI) seems to be more successful with these patients. However, there is a lack of empirical evidence on overall effectiveness and specific components of PI. Consequently, the aim of this study is to provide a detailed description of the use of PI for the treatment of older adults. A Delphi study was conducted among 24 Dutch experts on 52 statements of specific aspects of PI for the treatment of depressed older adults. A consensus on a statement was reached when at least two of three pre-defined criteria were met. This Delphi study yielded consensus on 34 of 52 statements. The experts confirmed that PI consists of age-related and unique characteristics, such as negative life experiences, physical illness, cognitive disorders, personality characteristics, grief, sleep disorders, previous depression, and functional changes. Values and norms, shame and guilt regarding relationship problems, and changing life perspective were emphasized as important therapeutic variables. Systems, cognitive-behavioral, and client-centered approaches were the most used therapeutic techniques. In conclusion, PI is a preferred approach in the multidisciplinary treatment of depression in older adults. Age-related and unique characteristics as well as therapeutic techniques were explicated. Future research is planned to involve cross-validation studies of these 52 Delphi statements in other countries.