The Effectiveness of Emotion Focused Therapy on Death Anxiety and Resilience in Older Adults

Aging is a biological process and a sensitive life stage marked by spontaneous, progressive, and irreversible physiological and psychological changes. During this phase, individuals encounter common mental health issues such as death anxiety and resilience, both of which can be improved with appropriate therapeutic interventions. This study aimed to evaluate the effectiveness of emotion-focused therapy (EFT) on death anxiety and resilience in older adults. This was a quasi-experimental study with a pretest-posttest control group design. The statistical population included all older adults residing in all nursing homes in Shiraz. The sample consisted of 30 older adults (aged 60 to 90) residing in the Zagros Residential Care Center, selected through convenience sampling method and based on inclusion and exclusion criteria, and randomly assigned to two groups of 15 (experimental and control) during the winter of 2023. EFT was administered to the experimental group over eight 90-minute sessions, while the control group did not receive this therapy. Data were collected using the Templer Death Anxiety Scale and the Connor-Davidson Resilience Scale. Data were analyzed by ANCOVA in SPSS-26. The findings showed that although EFT reduced resilience in the experimental group in the post-test phase, had no significant effect on death anxiety. In other words, there were significant differences between the experimental and control groups just in terms of resilience and its subscales (P<0.05) after the conduction of EFT. Therefore, EFT was effective in improving resilience among older adults. Hence, EFT is recommended as an effective method to improve the mental health of older adults, particularly in enhancing resilience.
EXTENDED ABSTRACT
 Introduction
Social, economic, technological changes and scientific advancements have led to improved living conditions, increased lifespan, and the phenomenon of aging in societies. The increase in the aging population has become one of the most significant challenges for healthcare providers, family members, and society, particularly in economic, social, and health contexts. As death has never been experienced and no one has vividly encountered it, everyone experiences some degree of death anxiety. However, the intensity varies based on certain factors. Severe death anxiety can weaken effective adaptation. Various psychological components exist that can protect individuals from psychological, emotional, and social harm. One such factor is resilience. Resilience refers to the dynamic process of positive adaptation to adverse and distressing experiences and includes the skills, characteristics, and abilities that enable individuals to cope with life’s difficulties, challenges, and hardships. Different methods have been used to improve death anxiety and resilience, among which emotion-focused therapy (EFT) has been applied in this study due to its structured approach, step-by-step treatment program, and reduced likelihood of relapse. Given the existing gaps in this area, the present study aimed to evaluate the effectiveness of EFT on death anxiety and resilience among older adults.
Method
This was a quasi-experimental study, with a pretest-posttest control group design. The statistical population included all older adults residing in the nursing homes in Shiraz. The sample consisted of 30 people (17 women and 13 men) residing in Zagros Residential Care Center during the winter of 2023, selected by convenience sampling and according to inclusion and exclusion criteria, and randomly assigned to two groups with 15 members (experimental and control). The inclusion criteria were (1) informed consent, (2) age over 60 years, (3) scoring below 6 on the Templer Death Anxiety Scale pretest, (4) scoring below 50 on the Connor-Davidson Resilience Scale pretest, (5) a minimum score of 8 on the AMT short cognitive test, and (6) willingness to participate in the study. The exclusion criteria were: (1) inability to attend sessions, and (2) simultaneous participation in other psychological training classes. The EFT protocol by Greenberg and Watson (2009) was administered to the experimental group over eight 90-minute sessions, while the control group did not receive any therapy. Data were collected using the Templer Death Anxiety Scale and the Connor-Davidson Resilience Scale in both pretest and posttest phases. Data analysis was conducted using Univariate Analysis of Covariance (ANCOVA) test in SPSS version 26.
Results
Prior to hypothesis testing, the main assumptions of ANCOVA, including homogeneity of variances, homogeneity of regression slopes, and normal distribution of the data, were examined and confirmed. Subsequently, ANCOVA was employed to test the hypotheses, and the results are presented in Table 1.
As shown in Table 1, there is no significant difference in death anxiety between the experimental and control groups. In other words, EFT, considering the mean death anxiety in the experimental group (6.600) compared to the control group (7.533), did not cause a significant change in the level of death anxiety in the experimental group, despite a slight reduction. The effect size is 0.048, meaning that 4% of individual differences in death anxiety scores are attributable to the effect of EFT.
Furthermore, as observed in Table 1, there is a significant difference in resilience between the experimental and control groups. In other words, EFT, considering the mean resilience in the experimental group (60) compared to the control group (51.066), led to a significant increase in resilience in the experimental group. The effect size is 0.263, meaning that 26% of individual differences in resilience scores are attributable to the effect of EFT.
Conclusion
The results of the current study revealed that EFT would positively impact resilience in older adults. This can be explained by the fact that EFT, which combines experiential and systemic therapy, is closely associated with reducing psychological problems in individuals. EFT process, conducted individually, involves three overlapping stages: bonding and awareness, evocation and exploration, and emotional reconstruction, carried out in eight steps. Throughout the therapy, the individual is viewed as an expert on their experience, while the therapist acts as a guide and facilitator. In EFT, it is believed that the way individuals organize and process emotional experiences and the interaction patterns they create and reinforce lead to increased resilience. Overall, the results of this study indicated that EFT does not significantly impact death anxiety in older adults but does positively influence resilience. Based on these findings, it is recommended that those responsible for senior centers and other facilities working with older adults consider implementing individual or group EFT sessions to enhance resilience in this population.
Ethical Consideration
Ethical Code
The ethical code was obtained from the Islamic Azad University of Shiraz (IR.IAU.SHIRAZ.REC.1402.152)
Financial Support
This study received no financial support.
Authors’ Contributions
B.Z: Methodology, Software, Validation, Formal Analysis, Data Curation; F.A: Conceptualization, Writing - Original Draft, Writing - Review & Editing, Project Administration, Supervision, Visualization.
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors would like to express their gratitude to the esteemed Research Deputy of the Islamic Azad University, Shiraz branch, for their invaluable support and collaboration in conducting this research. Additionally, heartfelt thanks are extended to all the older adult participants for their participation.
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