اثربخشی نمایش‌‎درمانی بر شادکامی و امید به زندگی زنان سالمند ساکن در خانه سالمندان

The older adults are subject to loneliness and isolation, and due to physical and mental disabilities, their individual independence is threatened in many cases. The set of these conditions leads to a decrease in the quality of life and ultimately to a decrease in happiness and life expectancy in older adults. As a result, this study aimed to determine the effectiveness of drama therapy on increasing the happiness and life expectancy of older women. This was a quasi-experimental study with pretest-posttest design with a control group. The statistical population included all older women residing in nursing homes in Qom, Iran in 2023, among whom 30 people (65 to 80 years old) were selected using convenience sampling method and with regarded to the inclusion criteria, and randomly assigned into experimental and control groups. The experimental group received eight 90-minute sessions of drama therapy and the control group did not receive any training. The content of the sessions was derived from Moreno's perspective on drama therapy. Participants responsed the Oxford happiness questionnaire and Snyder’s life expectancy test. The data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS-26 software. The results showed that drama therapy led to a significant increase in happiness and life expectancy in the experimental group (P<.01). Based on the results, it is recommended that counselors and psychologists of nursing homes take advantages of drama therapy along with other methods to improve happiness and life expectancy in older adults.
EXTENDED ABSTRACT
 Introduction
Happiness and life expectancy in older adults diminish due to the downward trend of biological processes and the increase in quantitative and qualitative stressors during old age. Despite the implementation of interventions such as drama therapy for targeting depression, death anxiety, social anxiety, social adjustment, and subjective well-being in older adults, the effectiveness of this therapeutic approach concerning both happiness and life expectancy has not been simultaneously investigated in Iran. This is while that the older population poses a fundamental challenge for future of Iran that society will inevitably confront. This study was conducted due to the efficacy of drama therapy as one of the effective methods to enhance happiness and life expectancy, and given the ever-increasing older population, alongside limited research on the impact of drama therapy on the happiness and life expectancy of older adults. Moreover, the results of this research could have practical implications for families with older members, counseling centers, psychological services, and older adults’ care facilities. Based on the results of present study and similar ones, authorities could consider enrolling older individuals in drama therapy workshops to enhance their psychological attributes. Therefore, this study aimed to investigate the effectiveness of drama therapy on increasing the happiness and life expectancy in older women.
Method
This study was a quasi-experimental research with pretest-posttest design with a control group. The statistical population consisted of all older women residing in the nursing homes in Qom, Iran in 2023, among which Fatemieh nursing home was selected using convenience sampling, in which thirty participants were selected according to the inclusion criteria and were randomly assigned into experimental and control groups, each of which had 15 members. Inclusion criteria comprised (1) age between 65 to 80 years, (2) being literate, (3) scoring lower on the Oxford happiness and Snyder’s life expectancy scales, and (4) willingness to participate, while exclusion criteria included (1) the consumption of psychiatric medications, (2) history of receiving drama therapy, and (3) absence for more than one session. Participants filled out the questionnaires. The content of sessions was extracted from Moreno’s perspective on drama therapy. The experimental group received eight 90-minute sessions of drama therapy once a week, while the control group did not receive any intervention. The therapeutic protocol was implemented by the researcher and a theater director using methods such as lectures, question and answer, group discussions, and practical skill exercises in group form in Fatemieh nursing homes. At the end of each session, based on the taught content, tasks were assigned to the older women, which were considered at the beginning of the subsequent session and feedback was given to them. The data obtained from the questionnaires were analyzed using analysis of covariance (ANCOVA) in SPSS-26 software.
Results
Prior to conducting ANCOVA, it was established that the distribution of scores of variables in the experimental and control groups was normal. The results also indicated the homogeneity of variances and regression coefficients. As the assumptions of the ANCOVA were met, ANCOVA was utilized to examine the effectiveness of drama therapy on happiness and life expectancy. The results indicated that in the pretest phase, the mean scores of happiness and life expectancy in two groups had no significant difference before the intervention. However, the mean scores of happiness and life expectancy of the experimental group indicated an increase after the intervention. The results of this analysis are presented in Table 1.
As demonstrated in Table 3, there was a significant difference between the experimental and control groups in terms of happiness. In other words, according to the mean score of happiness in the experimental group (51.53) compared to mean score of happiness in the control group (18.46), drama therapy led to a significant increase in happiness within the experimental group. Therefore, the first hypothesis was confirmed. Plus, there was a significant difference between the experimental and control groups in terms of life expectancy. In other words, considering the mean score of life expectancy in the experimental group (27.33) compared to the mean score of life expectancy in the control group (14.06), drama therapy resulted in a substantial increase in life expectancy in the experimental group. Hence, the second hypothesis was confirmed.
Conclusion
Drama therapy is a performance-centered approach that uses repeated theatrical exercises to facilitate the reconstruction of both positive and negative emotional situations which helps individuals to enhance their positive emotions and reduce their negative ones. Therefore, according to its theatrical play, creative techniques, and attractiveness, drama therapy can contribute to increasing happiness. The efficacy of art therapy in improving older adults’ life expectancy lies in fostering connections among individuals and between individuals and the therapist, enhancing intimacy, self-expression, disclosure, and emotional exploration within an art-based relationship. When these relationships develop within a group setting, it leads to the enhancement of the level of connection and interaction among individuals, the diminishment of negative emotions, and affects the shared objectives in areas of personal functioning, such as interacting with others, which, in turn, result in the increase of the effectiveness of therapy. Drama therapy provides a platform where older adults, who suffer from anxiety-related issues, can indirectly express their emotions and unpleasant experiences they might feel unable to articulate directly, through pantomime, role-playing, and personalization. Hence, drama therapy in comparison with verbal communication can be considered as a more suitable tool for establishing connections, all of which collectively may contribute to an increase of life expectancy.
Ethical Consideration
Ethical Code
This article is extracted from the second author’s master thesis with the code 484027 from ToloueMehr University, Qom.
Financial Support
 This study had no financial support.
Authors’ Contributions
H.G: Writing-Review & editing, project administration, and supervision; Z.M: Conceptualization, methodology, software, validation, formal analysis, visualization, data curation, writing-original draft
Conflict of Interest
 The authors had no conflicts of interest.
Acknowledgments
The researchers hereby express their gratitude and appreciation to the authorities of Fatemieh nursing home in Qom and the older women for their cooperation.
References
Abad, Y., & Haroon Rashidi, H. (2022). The Effectiveness of Mindfulness-Based Cognitive Therapy on Rumination and Existential Anxiety in the Elderly Men. Aging Psychology, 8(1), 10-1. [Persian].https://jap.razi.ac.ir/article_2088.html?lang=fa
Abdullahi Meshkanlo, H., & Khoshgoftar, A. (2018). The effect of drama therapy on happiness and increasing life expectancy in the elderly, the first Iranian congress of positive psychology, Tehran. [Persian] https://civilica.com/doc/1022317
Antoniassi Junior, G., Costa, A. R. S., Beretta, R. C. D. S., & Figueiredo, G. L. A. (2020). Promoting health through psychodrama with a group of seniors attended at the social assistance reference center. Revista Brasileira De Psicodrama, 28(1), 71-76. https://doi.org/10.15329/2318-0498.19103
Argyle, M., & Lu, L. (1990). The happiness of extraverts. Personality and individual differences, 11(10), 1011-1017. https://doi.org/10.1016/0191-8869(90)90128-E
Argyle, M., Martin, M., & Crossland, J. (1989). Happiness as a function of personality and social encounters. Recent advances in social psychology: An international perspective, 189-203.
Axfors, C., & Ioannidis, J. P. (2022). Infection fatality rate of COVID-19 in community-dwelling elderly populations. European Journal of Epidemiology, 37(3), 235-249. https://doi.org/10.1007/s10654-022-00853-w
Barzegar Bafrooei, K., Ahali Abadeh, M., & Mohamadi GHaletaky, S. (2015). The relationship between social support and sense of humor on life expectancy in the elderly Yazd. Journal of geriatric nursing, 1(4), 24-35. [Persian] http://jgn.medilam.ac.ir/article-1-131-fa.html
Bieda, A., Hirschfeld, G., Schönfeld, P., Brailovskaia, J., Lin, M., & Margraf, J. (2019). Happiness, life satisfaction and positive mental health: Investigating reciprocal effects over four years in a Chinese student sample. Journal of Research in Personality, 78, 198-209. https://doi.org/10.1016/j.jrp.2018.11.012
Bosma, H., Jansen, M., Schefman, S., Hajema, K. J., & Feron, F. (2015). Lonely at the bottom: a cross-sectional study on being ill, poor, and lonely. Public Health, 129(2), 185-187. http://dx.doi.org/10.1016/j.puhe.2014.11.016
Carr, A. (2013). Positive psychology: The science of happiness and human strengths. Routledge.
Changizi, F., & Panahali, A. (2016). Effectiveness of group narrative therapy on life expectancy and happiness of the elderly in Tabriz. Journal of Instruction and Evaluation, 9(34), 63-76. [Persian] https://jinev.tabriz.iau.ir/article_523161.html
Cheraghi, F., & NematTavousi, M. (2020). The Effectiveness of psychodrama on social adjustment and subjective well-being in the elderly. Aging Psychology, 6(2), 149-163. [Persian] https://jap.razi.ac.ir/article_1511.html
Ching-Teng, Y., Ya-Ping, Y., & Yu-Chia, C. (2019). Positive effects of art therapy on depression and self-esteem of older adults in nursing homes. Social Work in Health Care, 58(3), 324-338. https://doi.org/10.1080/00981389.2018.1564108
Erbay, L. G., Reyhani, I., Unal, S., Ozcan, C., Ozgocer, T., Ucar, C., & Yıldız, S. (2018). Does psychodrama affect perceived stress, anxiety-depression scores and saliva cortisol in patients with depression? Psychiatry Investigation, 15(10), 970-975. doi: 10.30773/pi.2018.08.11.2
Esmaili Shad, B., Ghasemi, M., & Mortazavi Kiasari, F. (2019). The relationship between health literacy and quality of life with the mediating role of social adjustment in the elderly. Journal of Excellence in counseling and psychotherapy, 8(31), 1-14. [Persian] https://journal-counselling.islamshahr.iau.ir/article_671054.html?lang=fa
Fanning, A. L., & O'Neill, D. W. (2019). The Wellbeing–Consumption paradox: Happiness, health, income, and carbon emissions in growing versus non-growing economies. Journal of Cleaner Production, 212, 810-821. https://doi.org/10.1016/j.jclepro.2018.11.223
Felsman, P., Seifert, C. M., & Himle, J. A. (2019). The use of improvisational theater training to reduce social anxiety in adolescents. The Arts in Psychotherapy, 63, 111-117. https://doi.org/10.1016/j.aip.2018.12.001
Francis, J. (2022). Elder orphans on Facebook: Implications for mattering and social isolation. Computers in Human Behavior, 127, 107023. https://doi.org/10.1016/j.chb.2021.107023
Ghadampour, E., Moradizadeh, S., & Shahkarami, M. (2018). The effectiveness of Mindfulness Training on increasing happiness and improving quality of life in Elderly. Aging Psychology, 4(1), 27-38. [Persian] https://jap.razi.ac.ir/article_900.html
Greenblatt-Kimron, L., Kestler-Peleg, M., Even-Zohar, A., & Lavenda, O. (2021). Death anxiety and loneliness among older adults: Role of parental self-efficacy. International Journal of Environmental Research and Public Health, 18(18), 9857. https://doi.org/10.3390/ijerph18189857
Gurgan, U. (2020). The Effect of Psychodrama Integrated Psycho-Education Program on Resilience and Divorce Adjustment of Children of Divorced Families. World Journal of Education, 10(1), 56-68. URL: https://doi.org/10.5430/wje.v10n1p56
Hamamci, Z. (2006). Integrating psychodrama and cognitive behavioral therapy to treat moderate depression. The Arts in Psychotherapy, 33(3), 199-207. https://doi.org/10.1016/j.aip.2006.02.001
Hernandez, S. C., & Overholser, J. C. (2021). A systematic review of interventions for hope/hopelessness in older adults. Clinical gerontologist, 44(2), 97-111. https://doi.org/ 10.1080/07317115.2019.1711281
Homaei, R., & Pooyanmehr, M. (2018). The relationship between health promoting life styles and sleep quality with social adjustment and life expectancy among elderly. Aging Psychology, 3(4), 271-280. [Persian] https://jap.razi.ac.ir/article_847_en.html?lang=fa
Iranshahi, A., & Ghalehnoee, M. (2017). An Evaluation of the Access of seniors with Physical Disabilities to Required Facilities in Urban Spaces; the Case of Chahar Bagh-e Abbasi Street of Isfahan. Middle Eastern Journal of Disability Studies, 7, 1-11. [Persian] http://jdisabilstud.org/article-1-652-fa.html
Jaaniste, J., Linnell, S., Ollerton, R. L., & Slewa-Younan, S. (2015). Drama therapy with older people with dementia—Does it improve quality of life? The Arts in Psychotherapy, 43, 40-48.  https://doi.org/10.1016/j.aip.2014.12.010
Jenabi, E., Bashirian, S., Ayubi, E., Rafiee, M., & Bashirian, M. (2023). The effect of the art therapy interventions on depression symptoms among older adults: a meta-analysis of controlled clinical trials. Journal of geriatric psychiatry and neurology, 36(3), 185-192. DOI: 10.1177/08919887221130264
Johnson, D. (2012). Psychodrama and the Elderly. Psychodrama and the Elderly, 119-138. http://digital.casalini.it/10.3280/FORU2012-005012 - Casalini id: 2501505
Katmer, A. N., Demir, R., Çekiç, A., & Hamamci, Z. (2020). The Effect of Psychodrama on Subjective Well-Being and Trait Anxiety. Journal of Educational Issues, 6(2), 269-286. DOI: 10.5296/jei.v6i2.17600
Killick, K. (Ed.). (2017). Art therapy for psychosis: Theory and practice. Taylor & Francis.
Kim, S. D., Jang, H. R., & Lee, W. K. (2005). Effects of psychodrama on the elderly patients with dementia. Journal of Korean Geriatric Psychiatry, 9 (1) 57-62. https://pesquisa.bvsalud.org/portal/resource/pt/wpr-141779
Long, K. N., Kim, E. S., Chen, Y., Wilson, M. F., Worthington Jr, E. L., & VanderWeele, T. J. (2020). The role of hope in subsequent health and well-being for older adults: An outcome-wide longitudinal approach. Global Epidemiology, 2, 100018. https://doi.org/10.1016/j.gloepi.2020.100018
Luchesi, B. M., de Oliveira, N. A., de Morais, D., de Paula Pessoa, R. M., Pavarini, S. C. I., & Chagas, M. H. N. (2018). Factors associated with happiness in the elderly persons living in the community. Archives of gerontology and geriatrics, 74, 83-87. https://doi.org/10.1016/j.archger.2017.10.006
Majzoobi, M. R., Momeni, K., Amani, R., & Hojjat Khah, M. (2012). The effectiveness of structured group reminiscence on the enhancement of the elderlt, s life quality and happiness. Developmental Psychology: Iranian psychologists, 9 (34), 182-202. [Persian] https://jip.stb.iau.ir/article_512233.html?lang=fa
Mamatzakis, E. C., & Tsionas, M. G. (2021). Making inference of British household's happiness efficiency: A Bayesian latent model. European Journal of Operational Research, 294(1), 312-326. https://doi.org/10.1016/j.ejor.2021.01.031
Mardi, N., Arefi, M., Momeni, K., & Amiri, H. (2020). The comparison of the effectiveness of psychodrama, reminiscence and rational-emotional and behavioral treatment on death anxiety in the elderly. Aging Psychology, 6(2), 131-148. [Persian] 10.22126/JAP.2020.5456.1436
Mohammadi, A (2015). The Effect of Schema Thrapy of Psychological Wellbeing and Happiness and Hope in the Elderly. Journal of Analytical-Cognitive Psychology,6 (24), 89-81. [Persian] https://psy.garmsar.iau.ir/article_536285.html
Molashahri, M., Noori Pourlayavali, R., Hosseinian, S., Alikhani, M., Rasooli, A., & Tabatabaei, H. (2015). Comprehensive study of elderly's happiness in Zahedan city. Aging Psychology, 1(2), 23-34. [Persian] https://jap.razi.ac.ir/article_293.html
Moradkhani, N., & Khoshnevis, E. (2015). Predicting the relationship between quality of life and happiness of active and inactive elderly in Tehran. 2th Conference on 4 corners of Humanities [Persian] https://civilica.com/doc/604955
Moritz, S., & Woodward, T. S. (2007). Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Current Opinion in Psychiatry, 20(6), 619-625. DOI: 10.1097/YCO.0b013e3282f0b8ed
Nori Pourlayavali, R., Alikhani, M., Hoseynian, S., Soheylizadeh, S., & Mohammadifar, M. (2016). The Effect of group reminiscence on happiness and life expectancy of elderly. Aging Psychology, 1(3), 147-156. [Persian] https://jap.razi.ac.ir/article_329_en.html?lang=fa
Olsson, P. A. (2018). Psychodrama and the treatment of narcissistic and borderline patients. Psychodynamic Psychiatry, 46(2), 252-264. DOI: 10.1521/pdps.2018.46.2.252
Oraki, M., Mehdizadeh, A., & Dortaj, A. (2019). The effectiveness of self-care empowerment training on life expectancy, happiness and quality of life of the elderly in Iranian elderly care centers in Dubai. Iranian Journal of Ageing, 14(3), 320-331. [Persian] http://salmandj.uswr.ac.ir/article-1-1663-en.html
 Osman, O. (2005). The elderly, nursing homes and life voyages: A psychodrama group study. Turk psikiyatri dergisi= Turkish journal of psychiatry, 16(2), 124-132. https://pubmed.ncbi.nlm.nih.gov/15981149/
Pak, T. Y. (2020). Social protection for happiness? The impact of social pension reform on subjective well-being of the Korean elderly. Journal of Policy Modeling, 42(2), 349-366. https://mpra.ub.uni-muenchen.de/115817/
Partridge, E. E. (2022). Art therapy and older adults. In Foundations of Art Therapy (pp. 379-412). Academic Press.
Purrezaian, M., & Purrezaian, H. (2022). Group psychodrama for children with leukemia: A brief report. Journal of Psychosocial Oncology, 40(1), 131-135. DOI: 10.1080/07347332.2021.1900484
Rico-Uribe, L. A., Caballero, F. F., Olaya, B., Tobiasz-Adamczyk, B., Koskinen, S., Leonardi, M., ... & Miret, M. (2016). Loneliness, social networks, and health: a cross-sectional study in three countries. PloS one, 11(1), e0145264. https://doi.org/10.1371/journal.pone.0145264
Snyder, C. R. (Ed.). (2000). Handbook of hope: Theory, measures, and applications. Academic press.
Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., ... & Harney, P. (1991). The will and the ways: development and validation of an individual-differences measure of hope. Journal of personality and social psychology, 60(4), 570. DOI: 10.1037//0022-3514.60.4.570
Sohani, A., & Barghi Irani, Z. (2018). Effectiveness of psychological rehabilitation based on training of positive thinking skills on self-care, happiness and self-efficacy in elderly people with type 2 diabetes. Aging Psychology, 4(3), 235-249. [Persian] https://jap.razi.ac.ir/article_1011.html?lang=fa
Soraya, S., & Masoudinejad, M. (2016). The role of life expectancy in the health of the elderly. Paper presented at the first national conference on theoretical and practical researches in architecture and urban planning, Osku. [Persian] https://civilica.com/doc/710441
Su, Y. S., Lien, D., & Yao, Y. (2022). Economic growth and happiness in China: A Bayesian multilevel age-period-cohort analysis based on the CGSS data 2005–2015. International Review of Economics & Finance, 77, 191-205. DOI: 10.1016/j.iref.2021.09.018
Talati, F., Sharifi, A., & Moshfeghi, M. (2021). Evaluating the Effectiveness of Compassion-Focused Therapy on Happiness and Life Expectancy in Female-Headed Households Supported by the Welfare of Lamerd County. Quarterly Journal of Social Work, 10(3), 58-66. [Persian] http://socialworkmag.ir/article-1-725-en.html
Tayeri, S., Jafari, M., Alimohammadzadeh, K., Hosseini, S. M., & Shahanaghi, K. (2021). A conceptual model for Iranian older women’s health: A review study. Iranian Journal of Ageing, 16(3), 304-329. [Persian] http://salmandj.uswr.ac.ir/article-1-2121-en.html
Testoni, I., Cecchini, C., Zulian, M., Guglielmin, M. S., Ronconi, L., Kirk, K., ... & Cruz, A. S. (2018). Psychodrama in therapeutic communities for drug addiction: A study of four cases investigated using idiographic change process analysis. The Arts in Psychotherapy, 61, 10-20. https://doi.org/10.1016/j.aip.2017.12.007
Tilvis, R. S., Laitala, V., Routasalo, P. E., & Pitkälä, K. H. (2011). Suffering from loneliness indicates significant mortality risk of older people. Journal of aging research, 2011.  https://doi.org/10.4061/2011/534781
Weinberg, M., Besser, A., Zeigler-Hill, V., & Neria, Y. (2016). Bidirectional associations between hope, optimism and social support, and trauma-related symptoms among survivors of terrorism and their spouses. Journal of Research in Personality, 62, 29-38. https://doi.org/10.1016/j.jrp.2016.03.002
Westerhof, G. J., Whitbourne, S. K., & Freeman, G. P. (2012). The aging self in a cultural context: The relation of conceptions of aging to identity processes and self-esteem in the United States and the Netherlands. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 67(1), 52-60. https://doi.org/10.1093/geronb/gbr075
Xu, Y., Wen, H., Li, J., Yang, J., Luo, K., & Chang, L. (2022). The Relationship between sleep disorders, anxiety, depression, and cognitive function with restless legs syndrome (RLS) in the elderly. Sleep and breathing, 26(3), 1309- 1318. https://doi.org/10.1007/s11325-021-02477-y
Yadegari, R., Yousefi Afrashteh, M., Hayati, M., & Ebrahimi, L. (2021). The Relationship of religious orientation with psychological wellbeing in elderly people: The Mediating role of spiritual health. Islamic Life Journal, 5(3), 85-94. [Persian] http://islamiclifej.com/article-1-347-fa.html
Zhang, J., Peng, J., Gao, P., Huang, H., Cao, Y., Zheng, L., & Miao, D. (2019). Relationship between meaning life and death anxiety in the elderly: self-esteem as a mediator. BMC geriatrics, 19, 1-8. https://doi.org/10.1186/s12877-019-1316-7