اثربخشی معنویت درمانی بر انسجام روانی و شفقت به‌خود سالمندان

Background: Aging is a sensitive period during which examining different dimensions of mental health becomes increasingly important. Psychological coherence and self-compassion are factors that may significantly influence mental health in older adults. Therefore, this study aimed to determine the effectiveness of spiritual therapy on psychological coherence and self-compassion among older adults in Tehran.
Method: This study employed a quasi-experimental pretest–posttest design with a control group. The statistical population included all older adults in Tehran during the first half of 2025. The sample consisted of 30 older adults (aged 65–75 years) who were selected through convenience sampling based on inclusion criteria and randomly assigned to experimental and control groups. The experimental group received a spiritual therapy program (Kamari & Fouladchang, 2016; Richards & Bergin, 2006) in eight weekly 90-minute sessions. The instruments included Neff’s Self-Compassion Scale and Antonovsky’s Sense of Coherence Scale. Data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS version 22.
Results: After controlling for pretest scores, a significant difference was observed between the experimental and control groups at the posttest stage in psychological coherence and self-compassion (p<.001).
Conclusion: The findings indicate that spiritual therapy improves psychological coherence and self-compassion among older adults and may serve as an effective clinical intervention for promoting psychological well-being in older adults.
EXTENDED ABSTRACT
Introduction
Later adulthood is a sensitive developmental period during which examining various dimensions of mental health becomes particularly important. Psychological coherence and self-compassion are among the factors that can exert a substantial influence on the mental health of older adults. The rapidly growing population of older adults, along with the impact of modern lifestyle changes and their associated psychological and social consequences on this age group, has prompted researchers to draw upon newer generations of psychotherapy in order to provide appropriate psychological services for this vulnerable segment of society, particularly in care-oriented service settings such as residential care centers for older adults. Moreover, given that self-compassion and psychological coherence are considered key variables in individuals’ lives, especially among older adults, and that previous studies have examined the effects of spirituality-based therapy on these variables separately across different age groups, no study to date has investigated their combined effects on self-compassion and psychological coherence specifically among older adults. Therefore, considering the limited number of studies conducted in Iran on therapeutic approaches aimed at improving the psychological components of older adults, the present study was conducted to determine the effectiveness of spiritual therapy on self-compassion and psychological coherence among older adults.
Method
In terms of purpose, this study was applied in nature, and in terms of methodology, it employed a quasi-experimental pretest–posttest design with a control group. The statistical population consisted of all older adults aged 65 to 75 years residing in Tehran during the first half of 2025. Using purposive sampling, 30 eligible individuals were selected and randomly assigned in equal numbers to the experimental and control groups. The inclusion criteria were scoring below the mean on the Sense of Coherence Scale and the Self-Compassion Scale, being aged 65 years or older, and having at least a middle school level of education. Exclusion criteria included participation in concurrent therapeutic interventions and the presence of severe cognitive disorders. Data were collected using the Self-Compassion Scale developed by Neff (2016) and the Sense of Coherence Scale developed by Antonovsky (1993). The therapeutic content was adapted from the intervention packages developed by Kamari and Fouladchang (2016) and Richards and Bergin (2006). The intervention was administered by the researcher to the experimental group in eight weekly 90-minute sessions. Each session included an introduction to the objectives and topics, group discussion, and in-session exercises. Data were analyzed using univariate analysis of covariance (ANCOVA). Statistical analyses were conducted in SPSS version 22, with the significance level set at .05.
Results
 ANCOVA was used to analyze the main results. Prior to conducting the analysis, the statistical assumptions were examined. Levene’s test was performed to assess the homogeneity of variances between the two groups at the posttest stage. The results indicated that Levene’s test was not statistically significant for either psychological coherence or self-compassion, confirming the assumption of equal variances. The assumption of homogeneity of regression slopes was tested by examining the interaction between the independent variable and the pretest scores of each dependent variable in predicting their respective posttest scores. The interaction effects were not statistically significant at the .05 level for either psychological coherence or self-compassion, indicating that this assumption was met. The normality of the dependent variables was assessed using the Shapiro–Wilk test. The results showed that the distributions did not significantly deviate from normality (p>.05). Since all assumptions were satisfied, ANCOVA was conducted to examine the effectiveness of spiritual therapy on the total scores of psychological coherence and self-compassion. The results are presented in Table 1.
 The results indicated a statistically significant difference between the experimental and control groups in psychological coherence and self-compassion. Specifically, after controlling for pretest scores, participants in the experimental group showed significantly higher mean scores compared with those in the control group. These findings suggest that spiritual therapy led to significant improvements in psychological coherence and self-compassion among older adults in the experimental group.
Conclusion
In explaining these findings, it may be suggested that when individuals approach life challenges from a faith- and spirituality-based perspective, their experiences are interpreted as more purposeful and meaningful. Such perspectives may strengthen hope and resilience in the face of adversity, enabling individuals to draw upon greater internal resources when encountering stressful situations. This process can contribute to higher levels of psychological coherence and self-compassion. Furthermore, spirituality encompasses various cognitive and reflective strategies that may promote psychological calmness, including enhanced self-awareness, reliance on transcendent beliefs, patience, trust, prayer, and meaning-oriented reflection. Through these mechanisms, individuals may reinterpret negative life events in more adaptive ways. Consequently, spirituality may foster a stronger sense of meaning, which can facilitate adaptation and contribute to increased psychological coherence and self-compassion. The findings of the present study have practical implications for planners, counselors, and professionals working in residential care centers for older adults. It is recommended that psychologists in such settings consider incorporating spirituality-based interventions alongside other therapeutic approaches to enhance psychological well-being among older adults. One limitation of the present study was the absence of a follow-up period. Future research employing longer-term and multi-stage follow-up assessments may provide more comprehensive evidence regarding the durability of treatment effects over time.
Ethical Consideration
Ethical Code
This article was derived from the first author’s doctoral dissertation in psychology at Islamic Azad University, Dezful Branch.
Financial Support
This study did not receive financial support.
Authors’ Contributions
M.KH: Conceptualization, methodology, data curation, software, formal analysis, writing - original draft; H.H.R: Conceptualization, methodology, validation, writing - review & editing, supervision; S.M: Conceptualization, methodology writing - review & editing, supervision
Conflict of Interest
The authors had no conflicts of interest.
Acknowledgments
The authors would like to express their sincere gratitude to all older adults who participated in the present study.
References
Abadian, L., & Adib-Hajbaghery, M. (2023). Self-compassion in nursing: A Concept analysis. Qom University of Medical Sciences Journal, 17, 420-432. http://journal. muq.ac.ir/article-1-3691-fa.html [Persian]
Abbasi, M., Hojati, M., & Bahrami, E. (2024). The Effectiveness of life review on the Sense of coherence and retirement syndrome in older adults. Aging Psychology, 10(1), 1-15. https://doi.org/10.22126/jap.2024.9873.1745 [Persian]
Abbaspour, Z., & Tavakhosh, A.M. (2024). The Effectiveness of spiritual intelligence training on mental health in older men with COVID-19. Aging Psychology, 10(2), 143-129. https://doi.org/10.22126/jap.2024.10102.1750  [Persian]
Aghanasiri, H., & Liaqat, R. (2024, February). The Relationship between self-compassion, meaning of life and death anxiety in the elderly, First National Conference on Social Psychology, Personality and Abnormality with a Special Look at Cyberspace, Ramsar. https://civilica.com/l/152011/ [Persian]
Alipour, A., & Sharif, N. (2012). Validity and reliability of the sense of coherence (SOC) ‎questionnaire in university ‎students. Pajoohande, 17 (1), 50-56. [Persian]
Antonovsky, A. (1993). The Structure and properties of the sense of coherence scale. Social Science Medicine, 36(6), 725-733. https://doi.org/10.1016/0277-9536(93)90033-Z
Azizi, Z., Hasanloo, N., Afsharieh, R. & Jalali, M. (2024). The Effectiveness of spiritual therapy training in psychological self-coherence and psychological well-being of students. Islamic Studies, 8(1), 1-12. https://ish.tums.ac.ir/article_40405.html?lang=en [Persian]
Bakhshi, A., Khalilnejad Narmigh, L., Hosainzehi, H., Zare Tajabadi, N., & Mohebian Far, M. (2023). The Effectiveness of spiritual therapy on psychological hardiness and psychological distress of students. Islamic lifestyle with a focus on health, 7 (supplement), 359-366. [Persian]
Barghi Irani, Z., & Dehghan Saber, L. (2021). The Comparison of the Effectiveness of mindfulness-based therapy and spiritual therapy on irrational beliefs and anxiety in the older women. Aging Psychology, 6(4), 339-321. https://doi.org/10.22126/jap.2021. 5945.1492 [Persian] 
Breitbart, W., Poppito, S.R., & Rosenfeld, B. (2010). Meaning-centered psychotherapy for patients with advanced cancer: A Randomized controlled trial. Psychooncology, 38(15), 1627-1635. https://doi.org/10.1002/pon.1556
Dashtbozorgi, Z., Sevari, K., & Safarzadeh, S. (2016). Effectiveness of Islamic spiritual therapy on the Feeling of loneliness and death anxiety in Elderly people. Aging Psychology, 2(3), 177-186. [Persian]
Delawar, A. (2024). The Book of research methods in psychology and science educational science, Publications. [Persian]
Delkhah, Z., Alivandi Vafa, M., & Moheb, N. (2023). The Relationship between self-compassion and fear of aging in the Elderly: The Mediating role of spiritual health. Journal of Gerontology, 8 (1), 71-79. [Persian]
Dinarvand, N., & Barghi Irani, Z. (2021). The Comparison of the Effectiveness of metacognitive therapy and spiritual therapy on cognitive dissonance and feeling loneliness in the Elderly living in nursing homes. Aging Psychology, 7(2), 197-181. https://doi.org/10.22126/jap.2021.6334.1520 [Persian]
Ebrahimi, A., & Janatian, S. (2024). The Effect of group training based on compassion on psychological flexibility and sleep quality of firefighters in Isfahan city. Clinical Psychology and Personality, 22 (2), 207-216. https://doi.org/10.22070/cpap. 2024. 18943.1515  [Persian]
Eriksson, M., & Lindstrom, B., (2005). Validity of antonovsky sense of coherence scale: A Systematic review. Journal Epidemiol Community Health, 59(6), 460-466. https://doi. org/10.1136/jech.2003.018085
Fayazi, H., Esmaeili, R., Rohani, C., Nasiri, M., & Fayazi, N. (2022). Relationship between sense of coherence and physical function and social support in a sample of Iranian geriatrics with cancer. Koomesh, 24(4), 460-468. SID. https://sid.ir/paper /1059095/ en [Persian]
Frozanfar, F., Jabal Ameli, S., Sltani Zadeh, M., Emami, S.M.H. & Ansari Shahidi, M. (2024). Model of predicting psychosocial adaptation to disease according to perceived stress and sense of coherence with the Mediation role of self-compassion in the Patients with Irritable Bowel Syndrome. Journal of Applied Psychological Research, 15(1), 297-316. https://doi.org/10.22059/japr.2023.338827.644193 [Persian]
Ghadampour E, Roshannia S, Rezaeifar N. (2019). Effectiveness of spiritual therapy on the metacognitive beliefs and dysfunctional attitude in elderly people of Khorramabad City in 2017. Journal of Gerontology, 3 (4), 1-8. URL: http://joge.ir/article-1-214-fa.html [Persian]
Heravi, M., Hatami, M., & Ahadi, H. (2020). The Effectiveness of spiritual therapy on quality of life in the Elderly with acute coronary heart disease, 19 (3), 275-287. URL: http:// payeshjournal.ir/article-1-1345-fa.html[Persian]
Kamari, S., & Fooladchang, M. (2016). Effectiveness of spirituality therapy training based on positivity on life expectancy and life satisfaction in adolescents. Research in Clinical Psychology and Counseling, 6(1), 5-23. https://doi.org/10.22067/ijap.v6i1.41092  [Persian]
MacLeod, R., Wilson, D.M., Crandall, J., & Austin, P. (2019). Death anxiety among New Zealanders: The Predictive roles of religion, spirituality, and family connection. OMEGA-Journal of Death and Dying, 80 (1), 3-19. https://doi.org/10.1177/ 0030222817724307
Majidi, M., Jahan, F., Sabahi, P. & Rezaei, N. (2023). The Effectiveness of health promoting lifestyle education on self-compassion and psychological flexibility of elders. Islamic lifestyle with a focus on health, 7(3), 137-145. https://sid.ir/paper/1130576/en [Persian]
Majidi, M., Jahan, F., Sabahi, P., Rezaei, N.M. (2024). The Effectiveness of positive mindfulness training on the Hardiness of health and self-compassion of the older people. Journal of Disability Studies, 14, 80-88.URL: http://jdisabilstud.org/article-1-3324-fa.html [Persian]
Manookian, A., Navab, E., & Zomorodi, M. (2020). The Relationship between self-compassion and attitude to ageing in middle aged people. Iranian Journal of Nursing Research, 15 (5), 20-28. URL: http://ijnr.ir/article-1-2429-fa.html [Persian]
Mansouri, F., & Pourghane, P. (2023). Spiritual therapy in the Elderly: A Systematic review. Journal of Preventive Medicine, 10 (1), 8-19. URL: http://jpm.hums.ac.ir/article-1-625-fa.html[Persian]
Mahmoudpour, A., & HaghiRahimi, E. (2024). Prediction of self-coherence in the Elderly based emotion regulation, self-compassion and attitudes toward death. Rooyesh, 13(1), 243-254. URL: http://frooyesh.ir/article-1-4629-fa.html [Persian]
Masoudi, F., Nezhad Mohammad Nameghi, A., & Ghodsi, P. (2024). Efficacy of psychological capital training on the Perceived stress and psychological coherence in elderly caregivers. Journal of Modern Psychological Researches, 19(74), 88-97. https://doi.org/10.22034/jmpr.2023.57446.5707 [Persian]
Mohammadali, S., Manavipour, D. & Sedaghatifard, M. (2020). Investigating the Psychometric characteristics (validity and reliability) of the self-compassion scale: Finding empirical evidence for using the Total score and defining the Concept of self-compassion. Applied Psychology, 14(2), 50-29. https://doi.org/10.52547/apsy.14.2.29  [Persian]
Mohammadi, M., & Atadokht, A. (2024). The Relationship between theory of mind and social adequacy in older adults: The Mediating role of life skills. Aging Psychology, 10(2), 181-165. https://doi.org/10.22126/jap.2024.9827.1744 [Persian]
Moin, Z.Z., Abolmaali Alhoseini, K. & Seirafi, M.R. (2023). A Comparison of effectiveness of spiritual therapy and acceptance and commitment therapy (ACT) on reducing existential anxiety in women with breast cancer. Counseling Culture and Psycotherapy, 14(56), 39-66. https://doi.org/10.22054/qccpc.2023.70009.3011 [Persian]
Mazinani, M., Kazemian Moghadam, K., & Shahbazi, M. (2024). The Effectiveness of schema therapy on cognition disorders and sense of coherence in elderly women. Journal of Gerontology; 10 (3), 106-116. [Persian]
Neff, K.D. (2003). The development and validation of a scale to measure self-compassion. Self and identity, 2(3), 223-250. https://doi.org/10.1080/15298860309027
Neff, K.D., (2016). The Selfcompassion scale is a valid and theoretically coherent measure of selfcompassion. Mindfulness, 7(1), 264-274. https://doi.org/10.1007/s12671-015-0479-3
Noroozi Homayoon, M., Sadeghi, M., Sadri Damirchi, E., & Hatami Nejad, M. (2024). The Relationship between sense of coherence and perceived social support with resilience: The Mediating role of adaptive cognitive-emotional regulation strategies in older adults. Aging Psychology, 10(4), 427-405. [Persian]
Pooragha Roodbardeh, F., Nazari Koishahi, M. & Vahabi Mashhour, H. (2023). The Relationship between daily routines, self-efficacy and sense of coherence with internet addiction in teenagers. Research in Child and Adolescent Psychotherapy, 2(2), 17-6. https://doi.org/10.22098/rcap.2024.14239.1040 [Persian]
Rahmati, A., Mousavi Nasab, S.M.H., & Moradi, F. (2020). Cognitive ability in the Elderly: The Role of self-transcendence, self-compassion and positive affect. Aging Psychology, 6(2), 107-117. https://doi.org/10.22126/jap.2020.5457.1435 [Persian]
Raoufi, M., Namani, E., Keshavarz Afshar, H. (2024). The Effectiveness of self-coherence training for elderly in psychological well-being in wlderly women living in Tehran. Journal of Health Promotion Management; 13 (4), 115-131.URL: http://jhpm.ir/article-1-1758-fa.html [Persian]
Richards, P. S., & Bergin, A. E. (2006). A Spiritual strategy for counseling and psychotherapy. American Psychological Association. https://doi.org/10.1037/11214-000
Rostami, M., Bulut, S., Saadati, N., Saadati, S.A, Seyed Alitabar, S.H., Zadhasn, Z., (2025). Relationship of the Sense of coherence and e-health literacy with health anxiety in older women. Salmand: Iranian Journal of Ageing, 20 (3), 386-399. URL: http://salmandj. uswr.ac.ir/article-1-2827-fa.html [Persian]
Sadri Damirchi, E., Mohammadi, N., Ramezani, S., & Amanzad, Z. (2018). The Effectiveness of spirituality group therapy on happiness and hardiness in elderly women. Journal of Pizhuhish Dar din Va Salamat (i.E., Research on Religion & Health), 4(2), 42–53. https://doi.org/10.22037/jrrh.v4i2.15862 [Persian]
Samiei, L., Shojaa Nahand, H., Hosseinpour, M., Samiei, S., & Samiei, R. (2024). Effectiveness of group spirituality therapy on psychological well-being and self-compassion of substance dependent people undergoing maintenance treatment. Journal of Psychology New Ideas, 20 (24), 1-13. URL: http://jnip.ir/article-1-1105-fa.html [Persian]
Siefy, Z., & Haroon Rashidi, H. (2024). The Effectiveness of compassion therapy on cognitive fusion and self-criticism in older adults with post-traumatic stress disorder. Aging Psychology, 9(4), 361-375. https://doi.org/10.22126/jap.2024.9623.1733 [Persian]
Tohidifar, M., Kazemianmoghadam, K. & Haroonrashidi, H. (2021). The Effectiveness of compassion-focused therapy on loneliness and cognitive flexibility in elderly Men. Journal of Psychological Studies, 17 (2), 97-116. https://doi.org/10.22051/psy.2021. 36089.2449  [Persian]
Varaee, P., Momeni, K., & Moradi, A. (2017). The Prediction of psychological well-being based on religiosity and self-compassion in the Elderly. Aging Psychology, 3(1), 45-54. https://jap.razi.ac.ir/article_734.html?lang=en [Persian]
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 in the Elderly. Sleep Breath, 26(3), 1309-1318. doi: 10.1007/s11325-021-02477-y.
Zare Gholcheshmeh, F., Khajevand Khoshli, A., Mirani, A., & Azizi Ziabari, L.S. (2025). The Effectiveness of narrative therapy on death anxiety and sense of coherence in older women. Aging Psychology, 11(1), 92-77. https://doi.org/10.22126/jap.2025.11537.1823 [Persian]
Zhao, X., Yu, J., & Liu, N. (2023). Relationship between specific leisure activities and successful aging among older adults. Journal of Exercise Science & Fitness, 21(1), 111-118. https://doi.org/10.1016/j.jesf.2022.11.006