Meta-analysis of Life Review Therapy RCTs for Treating Depressive Symptoms in Older Adults

Joyce is a woman of 63 years. Like almost one in five older adults, she struggles with feelings of depression. In her case, important life events seem to be related to these depressive feelings, as she recently retired and also lost her husband just two years ago. In her own words, she feels that life is meaningless: “I believe I have to spend my time well. It is completely new to me that every activity every time does not feel real to me.” Given her feelings of depression and her difficulty to find meaning in a new phase in life, she is a good candidate for life review therapy.

In the 1960s already, Robert Butler argued that a return to the past is not a sign of age-related decline, but rather an adaptive means to come to terms with life’s finitude. Over the years, it has become clear that reminiscence and life review are not only important for this purpose in the latest phase of life. Rather, they contribute to mental health and well-being during the adult lifespan. In the field of gerontology, these insights have stimulated the development of a variety of interventions with different aims and target groups over the past decades. Interventions that aim to reduce depressive feelings in depressed older adults can be called life review therapy.

Joyce follows a protocol “The Stories We Live By” that in her case was delivered online through a trained master student in psychology under supervision of a licensed health care psychologist. First, she conducts some writing assignments relating to different phases of her life from childhood to the current time. She discovers a major theme that has been important in these phases of life, the theme of “being forgotten”. She richly described childhood memories, where especially her mother did not pay attention to her. But she also feels forgotten in her current life phase: “This was most evident when my husband died two years ago. The family forgets to inquire how I am doing, believing: ‘Well, she will manage.’”

Whereas psychoanalysts would see conflicts in the past as a major force in the development of mental illness, and behaviorists see learning histories as essential, life review therapy assumes that the past is subject to important interpretative processes. People with depressive symptoms tend to ‘forget’ specific positive memories, they have difficulty in construing a positive meaning out of negative memories and they tell a coherent story across life phases that supports the depressive feelings. Life review therapy therefore aims to reconstrue the meaning of the past in light of one’s current and future life.

Among others, Joyce is asked to think of exceptions that contradicted the theme of ‘being forgotten’. She comes up with several specific positive memories where her father learned her how to do all kind of DIY activities that still are important to her nowadays. She concludes: “I always felt very safe when we were together.” Furthermore, she is asked for new interpretations, for example, what she has learned throughout her life, even when being forgotten: “I have become aware of how important it is to stand up for yourself in a good way, as ‘being forgotten’ has taken a prominent place in my life too often.” During the therapy, she is also asked to think of a new theme for her life story: “When I now look back on my life, I feel independent and I strive to be transparent, authentic and respectful in friendships and relations.”

Several studies have been conducted on the effects of life review therapy on depressive symptoms in older adults. As the quality of these studies has improved over time, the time was ripe to bring the best evidence together in a meta-analysis. In the current study we systematically searched the literature and found eleven randomized clinical trials on life review therapy for depressive symptoms. We computed the effects that were found in these eleven studies. Nine studies showed significant effects on depressive symptoms in comparison to different kinds of control groups. On average, the effects were large. As the effects of two studies could be seen as outliers, we also looked at the results without these studies. Now, the effects were moderate. Even though the studies had different design and the forms of therapy varies for example from individual and group face-to-face sessions to online therapy, the results were quite consistent across studies. Hence, it can be concluded that there is a solid evidence base that life review therapy works for depressive symptoms in older adults.

This was also the case for Joyce. After the intervention, she says: “Now it is beginning to become clear to me that over time negative experiences largely make way for clear insights and growth. It is as if I am becoming more and more in balance with myself.” This helped her to deal with the feelings she reported before the intervention: “I have a lasting feeling that my life matters. I no longer experience that activities aren’t real to me, but I now do things purposeful again”.

Reference Article

Westerhof, G. J., & Slatman, S. (2019). In search of the best evidence for life review therapy to reduce depressive symptoms in older adults: A meta‐analysis of randomized controlled trials. Clinical Psychology: Science and Practice, e12301.

Discussion Questions

  1. Are we a victim of our past, or can we gain insights and meanings from our past that can help us to develop further, also in later life?
  2. Do depressive symptoms belong to the aging process, or can they be effectively treated in psychotherapy? 
  3. What would be good indicators to offer life review therapy when treating depressive symptoms?

Author Bio

Gerben J. Westerhof, Ph.D. is Chair of the Department Psychology, Health, and Technology and Director of the Story Lab at the University of Twente, the Netherlands. He studies how life stories are related to mental health, well-being and meaning in life across the lifespan and codeveloped several narrative interventions, for example for life review therapy for older persons with depressive symptoms, and autobiographical writing for people with personality disorder. He is currently President of the Advisory Board of the International Centre for Life Story Innovation and Practice (ICLIP) at the University of Connecticut. 

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