Background: The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events. Methods: The main goal of this study is to evaluate the effect of LRT for Holocaust survivors (LRT-HS) on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify the characteristics of participants that seem to especially benefit from the treatment. The proposed study is a randomised, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20-25 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place 6 months after the treatment. A sample size of 80 is required (drop-out rate included). Discussion: Efficacious treatments for trauma-related disorders in older people are of high importance, also because the probability of traumatisation and loss increases with age. Because this study is conducted with this specific group of multiply traumatised people, we are convinced that the results can easily transfer to other samples.

Having reached the last phase of their lives, many Holocaust survivors (HS) experience an increase in vulnerability. Despite their remarkable ability to adapt, the process of aging presents them with new challenges, often leading to an increased need for therapy. This is made all the more difficult by the fact that there is little research on trauma therapy in old age. To date, no randomized controlled study has been carried out to examine the effectiveness of psychotherapy in HS. The present case studies report the implementation of life review therapy (LRT-HS) undertaken with two female HS with symptoms of post-traumatic stress disorder (PTSD). The mixed-methods approach sheds light to their individual therapy courses and potential mechanisms of change. Both therapies took place in the context of a randomized controlled study evaluating the efficacy of LRT-HS. This integrative, narrative therapy approach answers the natural need of elderly people to look back on their lives. Patients received about 20 sessions of LRT-HS, including a structured life review, narrative exposure, as well as cognitive and behavioral elements. Patient 1 showed reliable to clinically significant improvements on several quantitative symptom levels and with consistent qualitative findings (e.g., semistructured therapist interview). Symptoms of Patient 2 remained mostly unchanged, while life satisfaction and posttraumatic growth reliably improved and qualitative measures pointed to a reduction of suffering. The studies illustrate that reminiscence can be used in adaptive ways even after the experience of massive traumatization. The coexistence of resilience and vulnerability, complex individual symptom profiles, and influencing factors are discussed.

Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT‐HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent‐to‐treat analyses (LRT‐HS: n = 24, control: n = 25; Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixed models revealed no statistically significant superiority of LRT‐HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, dwithin = 0.70, dbetween = 0.41, but analyses were significant at follow‐up, with large effect sizes, t(79) = 2.89, p = .005, dwithin = 1.20, dbetween = 1.00. LRT‐HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow‐up, t(76) = 1.08, p = .282, with moderate effect sizes, dwithin = 0.46–0.60, dbetween = 0.53–0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age‐appropriate treatment that includes structured life review and narrative exposure.

Young, S. (2000). Trauma, testimony, and the survivor: Calling forth the ghosts of Bosnia-Herzegovina. In M. Rossington & A. Whitehead (Eds.), Between the psych and the polis: Refiguring history in literature and theory (pp. 108 -120). Aldershot, UK: Ashgate.

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