Role changes such as the transition to retirement, illness, grief over the loss of relatives or friends, and loneliness can trigger depression in old age, exacerbate existing depression, or lead to its chronicity. It is therefore not surprising that—apart from dementia—depression is among the most common mental illnesses in old age. Due to demographic changes, depression is also increasing in old age. Studies indicate that depressive disorders are even more likely to become chronic in old age than in younger age groups (in Germany, approximately 45%; see Gallagher et al., 2013). Since the risk of suicide also increases with age (especially in men), it seems relevant to offer CBASP to older patients suffering from chronic depression.

However, the specific characteristics of old age should be taken into account when implementing CBASP, which means tailoring it to the needs of older adults (see also Bollmann et al., 2017; Maercker, 2015). The theoretical connections between McCullough's etiological assumptions and specific age-related characteristics—e.g., changes in resources (greater difficulties with "Theory of Mind" tasks in later life; Henry et al., 2013) and cohort affiliation (certain experiences of interpersonal neglect and abuse resulting from the parenting styles of the 1930s to 1950s; Koethe et al., 2014)—offer opportunities and implications for working with older chronically depressed patients, particularly through the focus on the interpersonal healing process in CBASP. Specifically, the explicit linking of earlier interpersonal learning experiences with current difficulties in interpersonal behavior can facilitate the realization of the psychodynamic factor of insight, even in work with chronologically older patients.

... More detailed descriptions of the link between general age-related findings and the specific CBASP elements and techniques can be found in Bollmann et al. (2015). For the inpatient program, a four-week, manualized Interpersonal Skills Group (ISG) based on CBASP group therapy elements, comprising a total of eight sessions, was designed and evaluated in a small, open-label pilot study with 13 older patients (M = 77.3, range 66–87 years) (Bollmann et al., 2019). In addition to high patient satisfaction and acceptance of the group, promising outcome data were also found, with a response rate of 100% and a remission rate of 38.4%. The individual components of the ISG are described in detail in a manual for inpatient work, which is not yet published and can certainly be adapted for outpatient work in individual settings.

In the future, the treatment of older (chronically) depressed patients should be further improved through the adaptation of CBASP, using the pilot studies and previous experience.

Simon Bollmann