When older adults struggle with depression or anxiety, doctors often recommend Cognitive Behavioral Therapy, or CBT. This talk therapy has decades of research showing it works well across different age groups. But there's a problem: when researchers look closely at how older adults respond to standard CBT, the results are inconsistent. Sometimes it works great, and sometimes it doesn't help as much as it does for younger people.
Why would a therapy that's proven effective suddenly become less reliable when someone crosses into their senior years? The answer might seem obvious: aging changes us. Our bodies change, our brains process information differently, and our life circumstances shift dramatically. Yet most CBT programs are designed the same way regardless of who's sitting in the therapy room.
A psychiatrist named Cassidy developed a modified version of CBT specifically tailored for older adults. This enhanced approach considers how aging affects learning and memory. It also incorporates something called positive psychiatry, which focuses not just on reducing symptoms but on building wellbeing, resilience, and positive attitudes about aging itself.
The first study testing this modified program showed promising results. But in science, one study isn't enough. Treatments need to work in different places, with different therapists, and with different groups of patients. That's where replication studies come in.
Researchers recently completed the first replication study of this enhanced CBT program for older adults. They worked with 40 community dwelling outpatients over age 65 who had symptoms of depression or anxiety. The participants met in small groups of six to nine people for weekly sessions lasting two hours each. The program ran for seven to nine weeks, with most groups meeting for eight weeks.
Before and after the therapy, participants filled out questionnaires measuring their depression symptoms, anxiety levels, and perceived quality of life. The results showed significant improvements across all three areas. Depression scores dropped, anxiety decreased, and people reported feeling better about their quality of life. The effect sizes ranged from small to medium, which aligns with what previous research has found for CBT in elderly populations.
These findings matched the original study, which is exactly what researchers hoped to see. When a treatment works consistently across different settings and populations, it suggests the benefits are real and reliable.
But here's where things get interesting. The researchers divided participants into two age groups: those between 65 and 79, and those 80 and older. Both groups improved, but the younger seniors showed notably greater gains. Those in the younger group moved from borderline clinical depression into the normal range of mood. Their anxiety dropped from moderate to mild levels. The older group improved too, but the changes were less dramatic.
This age difference raises important questions. Why would people in their seventies respond better than people in their eighties to the same treatment? One possible explanation involves something called frailty.
Frailty isn't just about physical weakness. It's a medical concept that includes diminished stamina, shorter attention span, sensory problems, slower cognitive processing, and multiple health conditions. Frailty becomes more common and more severe as people age. Some research suggests that standard CBT may not work as well for frailer older adults, and these limitations might apply even to therapy programs specifically designed for seniors.
There's another factor at play too. Very old adults often have different expectations about their wellbeing. They may view anxiety and sadness as normal parts of aging rather than symptoms that deserve treatment. They're also more reluctant to seek help for anxiety, perhaps because they've normalized it or because they believe nothing can be done.
The study also found something else worth noting. Participants who started with higher levels of anxiety showed larger improvements. This suggests that the therapy might be particularly helpful for people whose symptoms are more severe to begin with.
The modified CBT program differs from standard approaches in several ways. It accounts for age related changes in how people learn and remember information. Sessions might move at a different pace or use different teaching methods. The content acknowledges the real challenges of aging while actively countering negative stereotypes and attitudes about growing older.
The positive psychiatry component is particularly notable. Traditional therapy often focuses on what's wrong and how to fix it. Positive psychiatry adds another dimension by actively building positive emotions, meaning, and engagement. For older adults, this might include working on maintaining social connections, finding new purposes after retirement, or developing self compassion.
There are limitations to this research. The study didn't include a control group, so researchers can't be absolutely certain the improvements came from the therapy rather than other factors. Maybe people naturally felt better over time as life stressors changed. Maybe just being part of a supportive group made the difference. Maybe people improved simply because they expected to.
The quality of life measure used in the study might not fully capture what matters most to older adults. Some researchers argue that standard quality of life questionnaires focus too much on physical health and economic factors and not enough on other aspects that become important in later life, like social connections, autonomy, and sense of purpose.
Future research should include measures specifically designed for older populations. Studies should also look at whether the therapy reduces relapse rates and improves wellbeing over the long term, not just immediately after treatment ends. Researchers also want to explore whether factors like symptom severity, degree of frailty, or readiness for treatment affect how well people respond.
The need for effective treatments for older adults with depression and anxiety will only grow. The population is aging, and these conditions are common in later life. CBT offers an appealing alternative or complement to medication, especially for frailer older adults who might be more vulnerable to medication side effects.
Group therapy is particularly valuable because it's cost effective and makes efficient use of limited mental health resources. But for group therapy to work, it needs to be designed appropriately for the people in the room. What works for a 35 year old experiencing their first depressive episode might not be ideal for an 85 year old managing chronic illness, recent losses, and a lifetime of accumulated experiences.
This research contributes to a long standing conversation in geriatric psychiatry about the need to adapt psychological treatments for older adults. The fact that this modified approach has now shown benefits in multiple studies, in different locations, with different therapists, and with diverse groups of older adults strengthens the case for its effectiveness.
The findings also demonstrate something important about aging itself: older adults can and do benefit from therapy. Depression and anxiety aren't inevitable parts of growing older, and psychological interventions can make a meaningful difference in quality of life. The key is ensuring those interventions are thoughtfully designed to meet the specific needs of older people.
As our understanding grows, the field continues to refine these approaches. The difference between how people in their seventies and eighties responded to this therapy suggests there may not be a single "older adult" approach. Perhaps what's needed are multiple levels of adaptation, with different modifications for different stages of later life.
For now, this replication study adds to the evidence that thoughtfully modified CBT can effectively treat depression and anxiety in older adults. It works not just by reducing symptoms, but by fostering resilience, building on strengths, and helping people develop more positive attitudes about aging itself. In a society that often marginalizes and stereotypes older adults, that might be just as important as the symptom reduction.
Skosireva, A., Gobessi, L., Eskes, G., & Cassidy, K. L. (2025). Effectiveness of enhanced group cognitive behaviour therapy for older adults (CBT-OA) with depression and anxiety: A replication study. International Psychogeriatrics, 37(2), 100013.
