The Effectiveness of Positive Psychology Strategies Training on Forgiveness and Death Anxiety in Older Women

Document Type : Original Article

Authors

1 Dept. of Psychology, Islamic Azad University, Zarand branch, Zarand, Iran

2 Dept. of Educational Sciences, Farhangian University, Tehran, Iran

Abstract

One of the undeniable realities of aging is the proximity to death and the resulting anxiety, as well as the lack of forgiveness, which is a serious issue in later life. These factors can significantly weaken the adaptability of older adults. Therefore, this study was conducted with the aim of determining the effectiveness of positive psychology strategies training on forgiveness and death anxiety in older women. This was a quasi-experimental study with a pretest-posttest design with a control group. The statistical population included all older women living in Shahrbabak, Iran in 1402, among whom 30 participants (15 in the experimental group and 15 in the control group) were selected using convenience sampling method. Participants filled out Ray et al.’s forgiveness and Templer’s death anxiety questionnaires. The positive psychology training was performed in nine 70-minute sessions, twice a week, for the experimental group, while the control group did not receive any intervention during this period. Data were analyzed using analysis of covariance (ANCOVA) in SPSS-24 software. The results of ANCOVA indicated that positive psychology training had a significant effect on forgiveness and death anxiety in older women (P<.01). Based on the findings, positive psychology training can be applied to increase forgiveness and to reduce the death anxiety in older women.
EXTENDED ABSTRACT
 Introduction
Older adults have limited recuperative abilities and are more susceptible to illnesses, syndromes, and malaise compared to younger adults. A notable characteristic among them is increased irritability and difficulty in forgiving others and themselves. Therefore, forgiveness is a crucial variable to consider in this demographic. Death anxiety is also a prevalent psychological issue in old age, as this stage is filled with various deficits and incapacities. Death anxiety refers to the feelings of anxiety, worry, or fear related to death or dying, which can lead to distress, physical changes, loss of control, feelings of loneliness, and guilt, thereby negatively affecting an individual’s normal life functions. Various treatments have been used to reduce psychological problems in older women, among which positive psychology strategies training is a commonly employed intervention. Given that older adults often think to death due to physical changes, disabilities, and the loss of loved ones, death anxiety seems to be a significant, yet understudied, psychological issue in this population. Forgiveness offers psychological, social, mental, and physical benefits to older adults and can reduce anxiety and depression. Considering the growing older adults’ population and the effectiveness of positive psychology strategies in enhancing psychological attributes, this study aimed to determine the effectiveness of positive psychology strategies training on forgiveness and death anxiety in older women in Shahrbabak, Iran.
Method
This was a quasi-experimental study with a pretest-posttest design and a control group. The statistical population included all older women living in Shahrbabak in 2023. Thirty participants (15 in the experimental group and 15 in the control group) were selected using a convenience sampling method. Inclusion criteria were (1) age over 65 years, (2) scoring below the mean on the forgiveness questionnaire and above the mean on the death anxiety questionnaire, (3) holding at least a high school diploma, and (4) willingness to participate in the study. Exclusion criteria included severe cognitive disorders, physical illness, and concurrent participation in other training programs. Data collection tools were the Ray et al.’s Forgiveness Questionnaire and Templer’s Death Anxiety Questionnaire. The positive psychology strategies training intervention was conducted in nine 70-minute sessions, twice a week, for the experimental group, while the control group received no intervention at the same time. Data were analyzed using analysis of covariance (ANCOVA) in SPSS-24.
Results
Given the study design, ANCOVA was used to analyze the data. The Levene’s test confirmed the homogeneity of variances between the two groups in the posttest stage, validating the homogeneity assumption. Additionally, the homogeneity of regression coefficients assumption was tested by examining the interaction effect of the independent variable and the pretest of each dependent variable on their respective posttests, showing a non-significant F value at the .05 level. The Shapiro-Wilk test confirmed the normal distribution of the dependent variables, the results of which indicated that Z value is non-significant at the .05 level. Descriptive statistics of forgiveness and death anxiety variables in both groups showed significant differences between pretest and posttest scores in the experimental group compared to the control group. ANCOVA results for forgiveness and death anxiety are presented in Table 1. The results presented in Table 1 indicated that, after controlling for the pre-test effect, the intervention of positive psychology strategies significantly increased forgiveness and reduced death anxiety among elderly women (P<.05). The intervention accounted for a 49% increase in forgiveness and a 56% decrease in death anxiety.
Conclusion
Older women often blame themselves for the problems they face and avoid self-forgiveness. Positive psychology interventions help them re-evaluate their cognitive perspectives, recognize their mistakes, and strive for a more logical and accurate understanding. This intervention also facilitates emotional and rational processes, reconciling older adults with themselves and their challenges, transforming negative attachments to past events into positive ones, and thus enhancing forgiveness. positive psychology also helps shift individuals’ perspectives on their life accomplishments, viewing their life and past positively, and reframing death as a natural and hopeful transition. This reduces the anxiety of unknown aspects of death. Thus, positive psychology interventions effectively reduce death anxiety in older women.
Ethical Consideration
Ethical Code
This article has received ethical approval (IR.IAU.KERMAN.REC.1402.089) from the ethics committee of Islamic Azad University, Kerman branch.
Financial Support
This study had no financial support
Authors’ Contributions

K: conceptualization, methodology, writing–original draft preparation; H. M: writing–review & editing, supervision; V. M. T: validation, statistical analysis, data collection

Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors thank all the older women who participated in this study.
References
Alavi, T., Mafakheri, A., & Jahanian, A. (2021). The effectiveness of solution-oriented couple therapy on marital burnout, marital forgiveness and communication styles of couples affected by extramarital relationships. Feyz Medical Sciences Journal25(3), 908-916. [Persian]
Abdian, T., Banaee, E. (2021). The effectiveness of positive psychology of happiness and quality of life of elderly people in elderly care centers. Journal of Gerontology, 6 (1), 8-17. [Persian]
Alnawas, I., Al Khateeb, A., Abu Farha, A., & Ndubisi, N. O. (2023). The effect of service failure severity on brand forgiveness: the Moderating role of interpersonal attachment styles and thinking styles. International Journal of Contemporary Hospitality Management, 35(5), 1691-1712. https://doi.org/10.1108/IJCHM-03-2022-0290
Arab, S., & Mohammadi, A. (2023). The Effectiveness of Cognitive-Behavioral Therapy on Sleep Disorder and Death Anxiety in the Elderly. Aging Psychology9(1), 102-89. [Persian]
Attari, B., Monirpoor, N., & Zargham Hajebi, M. (2020). Role of Aappreciation on Happiness by Mediating Self-Acceptance and Forgiveness in the Elderly. Positive Psychology Research6(1), 67-82. [Persian]
Bayat, H., Zarei, M.A., & Farhadi, M. (2019). Investigating the effectiveness of acceptance and commitment-based therapy (ACT) on forgiveness and resilience of women with conflicts with their spouses who refer to counseling centers in Shiraz. New Advances in Behavioral Sciences, 5 (50), 40-50. [Persian]
Dinarvand, N., Barghi Irani, Z., & Forstmeier, S. (2022). The Comparison of the effectiveness of positive therapy and acceptance and commitment therapy on the anxiety and depression of the elderly living in nursing homes. Aging Psychology, 8(2), 189-203 . [Persian]
Esmaeilpour Dilmaghani, R., Panahali, A., Aghdasi, A. N., & Khademi, A. (2022). The Effectiveness of Group Logo Therapy on Death Anxiety, Feeling of Loneliness and Meaning of Life in the Elderly Women with Fear of Coronavirus. Aging Psychology8(2), 147-135. [Persian]
Fincham, F. D. (2022). Towards a Psychology of divine forgiveness. Psychology of Religion and Spirituality, 14(4), 451-463. http://dx.doi.org/10.1037/rel0000323
Ganesh, H.S., Subramanya, P., Udupa, V. )2021.(Role of yoga therapy in improving digestive health and quality of sleep in an elderly population: A randomized controlled trial. Journal of Bodywork and Movement Therapies. 27,692-697. https://doi.org/10.1016/j.jbmt.2021.04.012
Ghanbari zarandi, Z., Forootan, P., barshan, A., & shariati, R. (2023). The effectiveness of training positive psychology strategies on the resilience and quality of life of elderly retired teachers. Journal of Gerontology, 8 (3), 10-19. [Persian]
Gundogan, S., Arpaci, I. (2024). Depression as a mediator between fear of COVID-19 and death anxiety. Current Psychology, 43, 12990–12997. https://doi.org/10.1007/s12144-022-03120-z
Jamal-livani, H., Jafari, M., & Alimohammadzadeh, K. (2020). The role of social support on elderly death anxiety through self-efficacy mediation. Journal of Gerontology5(1), 11-18 .  [Persian]
Karabağ Aydın, A., & Fidan, H. (2022). The Effect of nurses' death anxiety on life satisfaction during the COVID-19 pandemic in Turkey. Journal of Religion and Health61(1), 811-826. https://doi.org/10.1007/s10943-021-01357-9
Khalvati, M., Babakhanian, M., Khalvati, M., Nafei, A., Khalvati, M., & Ghafuri, R. (2021). Death Anxiety in the Elderly in Iran: A Systematic Review and Meta-analysis. Salmand: Iranian Journal of Ageing, 16 (2),152-171 .  [Persian]
Monirpour, N., Attari, B., & zargham, M. (2019). Explaining forgiveness in the elderly through gratitude, happiness and acceptance with the mediating role of self-empowerment. Counseling Culture and Psycotherapy, 10(39), 123-156.  [Persian]
Monteiro, I., Brito, L., & Pereira, M. G. (2024). Burden and quality of life of family caregivers of Alzheimer’s disease patients: the role of forgiveness as a coping strategy. Aging & Mental Health, 11 (7), 1-8. https://doi.org/10.1080/13607863.2024.2320138
Mroz, J., & Kaleta, K. (2023). Forgive, Let Go, and Stay Well! The Relationship between Forgiveness and Physical and Mental Health in Women and Men: The Mediating Role of Self-Consciousness. International Journal of Environmental Research and Public Health20(13), 622-629. https://doi.org/10.3390/ijerph20136229
Parandin, Sh., & Rahimi, N. (2022). Effect of positivity training on distress emotion tolerance, sleep quality, and resilience in elderly women in Kermanshah. Quarterly Journal of Caspian Health and Aging7(1), 32-43.  [Persian]
Pahlavan, A., & Ahi, G. (2020). Effectiveness of Positive Psychology Interventions on Death anxiety and sleep quality of Female Patients with Multiple Sclerosis (MS). Research in Clinical Psychology and Counseling9(2), 28-42.  [Persian]
Rezaei Dehnavi, S., Tavakkoli, G., & Montajabian, Z. (2020). The Effectiveness of Positive Psychotherapy on Pain Perception and Death Anxiety in the Elderly. Aging Psychology5(4), 321-332 .[Persian]
Rye, M.S., Loiacono, D.M., Folck, C.D., Olszewski, B.T., Heim, T.A., & Madia, B.P. (2001). Evaluation of the psychometric properties of two forgiveness scales. Current psychology, 20(3), 260 -277.
Shin, S. (2021). Meta-analysis of the effect of yoga practice on physical fitness in the Elderly. International journal of Environmental research and Public health, 18(21), Article 11663. https://doi.org/10.3390/ijerph182111663
Siadatian Arani, S. H., Ashori, M., Faramarzi, S., Norouzi, G., & Spencer, L. J. (2021). The Effect of positive psychotherapy program on forgiveness and happiness orientations among mothers of adolescents with hearing loss. Research in Cognitive and Behavioral Sciences11(2), 139-162. [Persian]
Su, L., Pan, L., & Huang, Y. (2023). How does destination crisis event type impact tourist emotion and forgiveness? The moderating role of destination crisis history. Tourism Management94, 104636. https://doi.org/10.1016/j.tourman.2022.104636
Templer, D.I.(1972). Death anxiety in religiously very involved persons. Psychological Reports. 31(2):361-372. https://doi.org/10.2466/pr0.1972.31.2.361
Özer, Ö., Özkan, O., Özmen, S., & Ercoban, N. (2023). Investigation of the effect of COVID-19 perceived risk on death anxiety, satisfaction with life, and psychological well-being. OMEGA-journal of Death and Dying87(2), 572-590. https://doi.org/10.1177/00302228211026169
van der Haak, D. (2021). Death Anxiety, Immortality Projects and Happiness: A Utilitarian Argument Against the Legalization of Euthanasia. Conatus-Journal of Philosophy6(1), 159-174. https://doi.org/10.12681/cjp.24316
Varlı Ü, Alankaya N.(2022). Effect of health anxiety on disease perception and treatment compliance in elderly patients during the COVID-19 pandemic in Turkey. Archives of Psychiatric Nursing. 40,84-90. https://doi.org/10.1016/j.apnu.2022.05.002
Zandipor, T., Azadi, S., & Nahidpor, F. (2011). A Study on the Relationship between Forgiveness, Personality Traits, Mental Health in Couples Who Referred to Hygiene Centers of Gachsaran. Quarterly Journal of Woman and Society2(6), 1-18. [Persian]
Zamani, S., & Zolfaghari, M. (2022). The Relationship Between Mindfulness and Tolerance of Ambiguity with Death Anxiety and Improving Sleep Quality in the Elderly. Aging Psychology8(3), 299-310. [Persian]
Zhu, B., Shi, C., Park, C. G., & Reutrakul, S. (2020). Sleep quality and gestational diabetes in pregnant women: A Systematic review and meta-analysis. Sleep Medicine, 67 (1), 47-55. https://doi.org/10.1016/j.sleep.2019.11.1246

Keywords

Main Subjects


References
Alavi, T., Mafakheri, A., & Jahanian, A. (2021). The effectiveness of solution-oriented couple therapy on marital burnout, marital forgiveness and communication styles of couples affected by extramarital relationships. Feyz Medical Sciences Journal25(3), 908-916. [Persian]
Abdian, T., Banaee, E. (2021). The effectiveness of positive psychology of happiness and quality of life of elderly people in elderly care centers. Journal of Gerontology, 6 (1), 8-17. [Persian]
Alnawas, I., Al Khateeb, A., Abu Farha, A., & Ndubisi, N. O. (2023). The effect of service failure severity on brand forgiveness: the Moderating role of interpersonal attachment styles and thinking styles. International Journal of Contemporary Hospitality Management, 35(5), 1691-1712. https://doi.org/10.1108/IJCHM-03-2022-0290
Arab, S., & Mohammadi, A. (2023). The Effectiveness of Cognitive-Behavioral Therapy on Sleep Disorder and Death Anxiety in the Elderly. Aging Psychology9(1), 102-89. [Persian]
Attari, B., Monirpoor, N., & Zargham Hajebi, M. (2020). Role of Aappreciation on Happiness by Mediating Self-Acceptance and Forgiveness in the Elderly. Positive Psychology Research6(1), 67-82. [Persian]
Bayat, H., Zarei, M.A., & Farhadi, M. (2019). Investigating the effectiveness of acceptance and commitment-based therapy (ACT) on forgiveness and resilience of women with conflicts with their spouses who refer to counseling centers in Shiraz. New Advances in Behavioral Sciences, 5 (50), 40-50. [Persian]
Dinarvand, N., Barghi Irani, Z., & Forstmeier, S. (2022). The Comparison of the effectiveness of positive therapy and acceptance and commitment therapy on the anxiety and depression of the elderly living in nursing homes. Aging Psychology, 8(2), 189-203 . [Persian]
Esmaeilpour Dilmaghani, R., Panahali, A., Aghdasi, A. N., & Khademi, A. (2022). The Effectiveness of Group Logo Therapy on Death Anxiety, Feeling of Loneliness and Meaning of Life in the Elderly Women with Fear of Coronavirus. Aging Psychology8(2), 147-135. [Persian]
Fincham, F. D. (2022). Towards a Psychology of divine forgiveness. Psychology of Religion and Spirituality, 14(4), 451-463. http://dx.doi.org/10.1037/rel0000323
Ganesh, H.S., Subramanya, P., Udupa, V. )2021.(Role of yoga therapy in improving digestive health and quality of sleep in an elderly population: A randomized controlled trial. Journal of Bodywork and Movement Therapies. 27,692-697. https://doi.org/10.1016/j.jbmt.2021.04.012
Ghanbari zarandi, Z., Forootan, P., barshan, A., & shariati, R. (2023). The effectiveness of training positive psychology strategies on the resilience and quality of life of elderly retired teachers. Journal of Gerontology, 8 (3), 10-19. [Persian]
Gundogan, S., Arpaci, I. (2024). Depression as a mediator between fear of COVID-19 and death anxiety. Current Psychology, 43, 12990–12997. https://doi.org/10.1007/s12144-022-03120-z
Jamal-livani, H., Jafari, M., & Alimohammadzadeh, K. (2020). The role of social support on elderly death anxiety through self-efficacy mediation. Journal of Gerontology5(1), 11-18 .  [Persian]
Karabağ Aydın, A., & Fidan, H. (2022). The Effect of nurses' death anxiety on life satisfaction during the COVID-19 pandemic in Turkey. Journal of Religion and Health61(1), 811-826. https://doi.org/10.1007/s10943-021-01357-9
Khalvati, M., Babakhanian, M., Khalvati, M., Nafei, A., Khalvati, M., & Ghafuri, R. (2021). Death Anxiety in the Elderly in Iran: A Systematic Review and Meta-analysis. Salmand: Iranian Journal of Ageing, 16 (2),152-171 .  [Persian]
Monirpour, N., Attari, B., & zargham, M. (2019). Explaining forgiveness in the elderly through gratitude, happiness and acceptance with the mediating role of self-empowerment. Counseling Culture and Psycotherapy, 10(39), 123-156.  [Persian]
Monteiro, I., Brito, L., & Pereira, M. G. (2024). Burden and quality of life of family caregivers of Alzheimer’s disease patients: the role of forgiveness as a coping strategy. Aging & Mental Health, 11 (7), 1-8. https://doi.org/10.1080/13607863.2024.2320138
Mroz, J., & Kaleta, K. (2023). Forgive, Let Go, and Stay Well! The Relationship between Forgiveness and Physical and Mental Health in Women and Men: The Mediating Role of Self-Consciousness. International Journal of Environmental Research and Public Health20(13), 622-629. https://doi.org/10.3390/ijerph20136229
Parandin, Sh., & Rahimi, N. (2022). Effect of positivity training on distress emotion tolerance, sleep quality, and resilience in elderly women in Kermanshah. Quarterly Journal of Caspian Health and Aging7(1), 32-43.  [Persian]
Pahlavan, A., & Ahi, G. (2020). Effectiveness of Positive Psychology Interventions on Death anxiety and sleep quality of Female Patients with Multiple Sclerosis (MS). Research in Clinical Psychology and Counseling9(2), 28-42.  [Persian]
Rezaei Dehnavi, S., Tavakkoli, G., & Montajabian, Z. (2020). The Effectiveness of Positive Psychotherapy on Pain Perception and Death Anxiety in the Elderly. Aging Psychology5(4), 321-332 .[Persian]
Rye, M.S., Loiacono, D.M., Folck, C.D., Olszewski, B.T., Heim, T.A., & Madia, B.P. (2001). Evaluation of the psychometric properties of two forgiveness scales. Current psychology, 20(3), 260 -277.
Shin, S. (2021). Meta-analysis of the effect of yoga practice on physical fitness in the Elderly. International journal of Environmental research and Public health, 18(21), Article 11663. https://doi.org/10.3390/ijerph182111663
Siadatian Arani, S. H., Ashori, M., Faramarzi, S., Norouzi, G., & Spencer, L. J. (2021). The Effect of positive psychotherapy program on forgiveness and happiness orientations among mothers of adolescents with hearing loss. Research in Cognitive and Behavioral Sciences11(2), 139-162. [Persian]
Su, L., Pan, L., & Huang, Y. (2023). How does destination crisis event type impact tourist emotion and forgiveness? The moderating role of destination crisis history. Tourism Management94, 104636. https://doi.org/10.1016/j.tourman.2022.104636
Templer, D.I.(1972). Death anxiety in religiously very involved persons. Psychological Reports. 31(2):361-372. https://doi.org/10.2466/pr0.1972.31.2.361
Özer, Ö., Özkan, O., Özmen, S., & Ercoban, N. (2023). Investigation of the effect of COVID-19 perceived risk on death anxiety, satisfaction with life, and psychological well-being. OMEGA-journal of Death and Dying87(2), 572-590. https://doi.org/10.1177/00302228211026169
van der Haak, D. (2021). Death Anxiety, Immortality Projects and Happiness: A Utilitarian Argument Against the Legalization of Euthanasia. Conatus-Journal of Philosophy6(1), 159-174. https://doi.org/10.12681/cjp.24316
Varlı Ü, Alankaya N.(2022). Effect of health anxiety on disease perception and treatment compliance in elderly patients during the COVID-19 pandemic in Turkey. Archives of Psychiatric Nursing. 40,84-90. https://doi.org/10.1016/j.apnu.2022.05.002
Zandipor, T., Azadi, S., & Nahidpor, F. (2011). A Study on the Relationship between Forgiveness, Personality Traits, Mental Health in Couples Who Referred to Hygiene Centers of Gachsaran. Quarterly Journal of Woman and Society2(6), 1-18. [Persian]
Zamani, S., & Zolfaghari, M. (2022). The Relationship Between Mindfulness and Tolerance of Ambiguity with Death Anxiety and Improving Sleep Quality in the Elderly. Aging Psychology8(3), 299-310. [Persian]
Zhu, B., Shi, C., Park, C. G., & Reutrakul, S. (2020). Sleep quality and gestational diabetes in pregnant women: A Systematic review and meta-analysis. Sleep Medicine, 67 (1), 47-55. https://doi.org/10.1016/j.sleep.2019.11.1246