In July, we spoke to Carolyn Chew-Graham, a GP Principal at a large practice in central Manchester, and researcher at Keele University, about the mental health of older people coming out of lockdown. Now, with another national lockdown and the winter months compounding our sense of isolation, we spoke to Carolyn again to get an updated picture of the challenges older people face at this time of year, and how ‘talking therapies’ may help them cope.
What are talking therapies?
Talking therapies are available on the NHS and involve talking to a trained counsellor about what you are going through or feeling. Your counsellor will help you to consider your thoughts and feelings and how they relate to your behaviours. They can help you to think through your problems in a different way.
How do talking therapies work?
“For common mental health problems, such as anxiety and depression, there is evidence that talking therapies such as Cognitive Behavioural Therapy (CBT) or Interpersonal Therapy are effective, with or without antidepressants. Some people may choose to have a talking therapy for mild to moderate depression or for moderate anxiety, as opposed to taking a tablet. CBT can help a person consider their thoughts and feelings and how they relate to their behaviours.”
How do older adults react to talking therapies?
“It’s very variable. Some older adults, particularly those who’ve had recurrent depression, may have experienced talking therapies before, and therefore be more amenable to it.
“There are those older adults who are really reluctant to talk to someone about what’s bothering them, which can be a generational thing. While younger adults would come out and say they’re depressed, older adults may suggest they need a tonic, are having trouble sleeping, or are feeling a bit irritable. The language used by older adults in talking about their feelings can be different to younger adults, so acceptance of treatments, including talking therapies, can be different too.”
How do you deal with reservations older adults have?
“Some of the concern that older adults have around being referred for talking therapies stems from the idea that it’s ‘mental’ and it’s about having to go and see a psychiatrist. We'd therefore have a discussion around the fact it’s not a psychiatrist they’d be seeing but a support worker or mental health practitioner who’s going to help them feel better; they're not going to do psychotherapy or investigate the person’s childhood - they’re going to help you now.”
Which talking therapies are best suited for older adults?
“One of the good evidence-based therapies for older adults is something called Behavioural Activation (BA), which focuses more on behaviour and less on the ‘thinking’ part. It entails helping somebody structure their day, plan activities and set goals. Following that plan improves mood. I try and deliver those strategies in consultations, whether that’s over the phone or face-to-face with patients.
"Older adults respond to it because they don’t think it’s psychologising their problems and it gives them something practical to do. I might encourage somebody to get a diary that they can use to set themselves some tasks. Whether it’s meeting a friend for coffee, reading a book, watching a series on television, or doing the gardening, it can really help. It’s all about the mantra: ‘follow the plan not the mood’. When people do things they enjoy, their mood improves.”
Read our previous interview with Carolyn
In July, we spoke to Carolyn about the mental health of older people readjusting to life after the first national lockdown.
How are people evaluated to establish the therapy that will best suit them?
“It would depend on the person, their condition and whether they’ve had recurrent problems. Patients I’m referring for talking therapies will have an initial assessment by a member of the team, and the person assessing them may signpost them to other resources. IIf you can’t access them, you can speak to your healthcare professional about other resources which are available.
“If the individual’s problem would benefit from a talking therapy then they may be offered 6 sessions or, if the person’s problem is more deep-seated, they may need longer so therefore receive what is called ‘High Intensity Therapy’. That’s an unfortunate term as, to some, it can sound a bit frightening. If people say they’re worried about the name, I explain that it means the sessions would be with a more highly skilled therapist and usually for longer, about 12 or 18 sessions.”
Is there a more effective way for older adults to participate in these therapies – in person? The phone?
“This is likely to be a personal preference and what works for one person may not work for another. At the moment, talking therapies are being provided over the phone or online. Some people may be nervous about that but many older people find this approach useful.
“I’m involved in a study where the therapy is delivered by support workers over the telephone, and in the work we’re doing to evaluate that intervention older adults often say that being on the telephone gives them a degree of anonymity, as they’re not being seen face-to-face, which means they don’t have to feel embarrassed about what they might be saying.”
In-person or video sessions are presumably more insightful, providing the chance to see body language...?
“In our practice we’ve got the ability to speak to people via video calls if patients have a smartphone. If we feel that it’s important to do that then we will set that up, though we’re mindful of the fact it’s more complicated than setting up a phone call, so it may take longer. In terms of talking therapies, there’s a specific video conferencing platform, which is used. This is a secure and safe platform.”
What advice would you offer to an older person who’s experiencing symptoms of anxiety and depression?
“To any older adult who’s experiencing a low mood, or feeling irritable, upset or anxious, I’d encourage them to contact their GP because we can help. That help will depend on whether you’ve had depression before and how severe it is, and on what other medication you might be on. A referral for talking therapies is an option if you don’t want medication. It’s worth being referred and having that initial assessment to see whether a talking therapy would suit you, whether it’s something you’d be comfortable doing, or whether you feel that talking would help express how you’re feeling. Talking therapies can make your mood better, and give you strategies to cope now and in the future. Have a go – the evidence tells us that these treatments can work.”
Ways to keep your spirits up
This winter may be particularly tough, so it's important to ensure we're taking care of ourselves and keeping our spirits up. Here are some tips to help you cope and get through this difficult time.