مقایسه اثربخشی واقعیت‌درمانی و خاطره‌پردازی ساختارمند بر نگرش به زندگی و بهزیستی معنوی در سالمندان

Abstract
Background: Older adults are vulnerable to a compromised quality of life due to an increase in negative attitudes toward life and diminished spiritual well-being. The present study aimed to compare the effectiveness of reality therapy and structured reminiscence on the life attitude and spiritual well-being of older adults.
Method: This was a quasi-experimental study with a pretest-posttest control group design and a follow-up period. The statistical population comprised all older adult women who attended older adult day care centers in Tehran in the winter of 2023-2024. A sample of 36 older adult women (aged 65-70 years) was selected using convenience sampling based on the inclusion criteria. Participants completed the Life Attitude Index (Battista & Almond) and the Spiritual Well-Being Scale for Older Adults (Golparvar et al.). They were then randomly assigned into three groups of reality therapy, structured reminiscence, and control (n = 12 per group). The interventions were conducted in eight 45-minute weekly sessions for the two experimental groups (based on Eskandari’s reality therapy protocol and Stinson’s reminiscence protocol). At the end of the intervention and three months later (follow-up phase), all groups were reassessed using the aforementioned instruments. Data were analyzed utilizing repeated measures ANOVA in SPSS software (version 25).
Results: The results indicated that both reality therapy and structured reminiscence significantly improved life attitude and increased spiritual well-being in older adults. Furthermore, structured reminiscence was a more effective method for enhancing spiritual well-being in older adults compared to reality therapy; however, no significant difference was observed between the effectiveness of reality therapy and structured reminiscence on life attitude.
Conclusion: These findings suggest that reality therapy and structured reminiscence are valuable and preferred interventions for addressing the psychological and spiritual concerns of older adults.
EXTENDED ABSTRACT
 Introduction
Life attitude and spiritual well-being are key components of psychological adjustment in older adults that are directly related to their quality of life and general health. A decline in these two constructs can lead to functional impairment and increased dissatisfaction during this period of life. To address these challenges, interventions emphasizing meaning and the interpretation of experiences become important. In this regard, reality therapy, focusing on responsibility and conscious choices in the present, and structured reminiscence, through the systematic review and reinterpretation of past memories, can also be effective in improving the psychological status of older adults by strengthening a sense of meaning and control. Despite evidence supporting the independent effectiveness of these methods, there is a research gap regarding the direct comparison of their efficacy. Therefore, the present study aimed to compare the effectiveness of reality therapy and structured reminiscence on the life attitude and spiritual well-being of older adults to determine which intervention is more effective in enhancing these variables.
Method
This was an applied study utilizing a quasi-experimental pretest-posttest control group design with a three-month follow-up. The statistical population comprised all older adult women attending older adult day care centers in Tehran in the winter of 2024. The sample size was determined to be 36 individuals (aged 65–70 years). Sampling was conducted using the convenience method. Individuals were screened based on inclusion criteria (literacy) and exclusion criteria (severe mental disorders or dementia) and randomly assigned to three groups of 12 (reality therapy, structured reminiscence, and control).
Data collection instruments included the 28-item Life Attitude Index by Battista and Almond (1973) and the 8-item Spiritual Well-Being Scale for Older Adults by Golparvar et al. (2015), the reliability of which was confirmed in this study. Interventions were implemented over eight weekly 45-minute sessions based on the protocols of Eskandari (reality therapy) and Stinson (reminiscence), while the control group received no treatment. Assessments were conducted in three phases (pretest, posttest, and follow-up), and demographic information was recorded. Finally, data analysis was performed using repeated measures ANCOVA in SPSS version 25.
Results
The results indicated that in the two experimental groups, the mean scores for life attitude and spiritual well-being increased in the posttest and follow-up phases, whereas no similar change was observed in the control group. Prior to conducting the repeated measures ANCOVA, statistical assumptions were evaluated. The Shapiro-Wilk test was used to check the normality of the data distribution; the results showed that the distribution of the dependent variables across the three groups and three phases was normal. Additionally, Levene’s test was performed to assess the homogeneity of variances, confirming that error variances were equal across groups. Furthermore, the assumption of homogeneity of covariance matrices and the sphericity assumption were examined and confirmed using Box’s M and Mauchly’s test. With all assumptions met, the use of repeated measures ANCOVA was justified. Multivariate analysis results showed that the effect of the independent variables on life attitude and spiritual well-being was significant. Moreover, repeated measures ANCOVA revealed that, in addition to the main effects of group and time, the Group × Time interaction effect was significant for both variables. This finding indicates that the changes observed in the experimental groups over time were significantly different from those in the control group.
Bonferroni post hoc test results showed that the mean differences of the variables were significant between the pretest-posttest and pretest-follow-up phases, but not significant between the posttest and follow-up phases. This indicates the stability of the intervention effects over time. Furthermore, the mean differences in the two experimental groups were significant compared to the control group; specifically, the implementation of reality therapy and structured reminiscence led to an increase in the mean scores of life attitude and spiritual well-being. The results showed that the difference between the effects of the two interventions on life attitude was not significant, but it was significant for spiritual well-being; specifically, structured reminiscence increased the mean spiritual well-being more than reality therapy did.
Conclusion
The findings of the present study indicated that both interventions (reality therapy and structured reminiscence) are effective in improving the life attitude and spiritual well-being of older adults. The explanation for these effects can be understood through the fundamental theories underlying these approaches.
Reality therapy is based on Glasser’s choice theory. This approach is founded on the premise that humans have five basic needs (survival, love and belonging, power, freedom, and fun) and choose their behaviors to satisfy these needs. In older adulthood, a decline in independence and changes in social roles can create a sense of loss of control. By fostering personal responsibility and assisting in redefining realistic goals, reality therapy helps older adults regain a sense of control over their lives. This process, coupled with increased hope and active participation, fosters a more positive attitude toward life.
Structured reminiscence is based on the theory of ego integrity (Butler and Erikson). This approach helps older adults construct a coherent narrative of their lives through the systematic review of past memories. This process generates feelings of meaning, purpose, and self-worth. Furthermore, reminiscence strengthens the dimensions of spiritual well-being by activating spiritual memories and enhancing intergenerational connections.
The superiority of structured reminiscence over reality therapy regarding spiritual well-being can be explained as follows: this method focuses directly on the process of meaning-making and identity integration, aligning more closely with the existential needs of older adulthood (such as life review and finding meaning).
Ethical Consideration
Ethical Code
This study was approved and holds the ethics code IR.IAU.R.REC.1403.003.
Funding: This study received no external funding.
Financial Support
This study did not receive financial support.
Authors’ Contributions

R: Data collection, data curation, original draft preparation, project administration; S. R: Conceptualization, methodology, supervision, writing–review and editingmn; R. Kh: Conceptualization, supervision, writing – review and editing.

Conflict of Interest
The authors had no conflicts of interest.
Acknowledgments
The authors express their gratitude to all individuals who cooperated effectively in this research, including the administration of the welfare organization.
References
Afshari, A., Rezaei, R., & Dadres, F. (2019). The effectiveness of structured reminiscence therapy on reducing anxiety and depression in the elderly. Aging psychology, 5 (3), 201-215. [Persian]
Arean, P.A. & Ayalen, L. (2005). Assessment and treatment of depressed older adult in primary care. A Dissertation University of California, Sanfrancisco.
Asadi-Khalili, M., Omidian, S., & Fakhri, M. (2020). Comparing the effectiveness of reality therapy and acceptance and commitment therapy on social anxiety and attitude toward life in female heads of households. Psychiatric nursing, 8 (4), 10-23. [Persian]
Asadollahian, M., & Mousavi, S. (2019). The effectiveness of reality therapy education on psychological well-being and spiritual health of women affected by marital infidelity referring to psychology clinics in Isfahan. Proceedings of the 3rd International Congress on Innovation and Research in humanities and islamic sciences, Tehran, Iran.
Ataei Moghanloo, V., Ataei Moghanloo, R., Pishvaie, M., & Goodarzian, M. (2016). The effectiveness of life review therapy with an emphasis on coherent reminiscence on self-esteem and anxiety of elderly men without a spouse. Journal of Sabzevar university of medical sciences, 23 (3), 422-429. [Persian]
Bakhshipour, A., Niknamshahrak, V., & Jajarmi, M. (2020). Comparing the efficacy of group reality therapy with person-centered group therapy on emotional intelligence and meaning of life in prisoners. Clinical and Counseling Psychology Researches, 10 (2), 123-141. [Persian]
Batajorbeh, M., & Zabihi-Hesari, N. (2021). Investigating the effectiveness of reality therapy on self-care and meaning of life in students suffering from depression [Master’s thesis, PayameNoor University, Mashhad Branch]. [Persian]
Battista, J., & Almond, R. (1973). The development of life regard index. Psychiatry, 36(4), 409-427.
Ching-Teng, Y., Ya-Ping, Y., Chia-Ju, L., & Hsiu-Yueh, L. (2020). Effect of group reminiscence therapy on depression and perceived meaning of life of veterans diagnosed with dementia at veteran homes. Social work in health care, 59(2), 75–90.
Delavar, A. (2017). Research methods in psychology and educational sciences (6th ed.). Virayesh Publication. [Persian]
Dizjani, F., & Kharamin, Sh. (2016). The effect of reality therapy on marital satisfaction and quality of life of women. Armaghan Danesh, 21 (2), 187-199. [Persian]
Erikson, EH. (1963). Childhood and society. 2nd ed. New York: Norton.
Frankl, V. E. (2014). The Will to meaning: Foundations and applications of logo therapy. Penguin.
Gigantone, M. R. (2000). Perceptions of incest and effects of reality therapy and psychospirituality programs on self-esteem and spiritual well-being of adolescent survivors. A Dissertation.
Glasser, W. (2013). Reality therapy: A New approach to psychiatry. New York: Harper & Row.
Golparvar, M., Mosahebi, M., Abedini, H., Adibi, Z., & Abdoli, F. (2015). Construction and validation of spiritual capital and spiritual well-being scale in the elderly. Educational measurement quarterly, 19, 125-145. [Persian]
Hajloo, N., & Jafari, A. (2014). The relationship between spiritual well-being and hope with life satisfaction in the elderly. Aging psychology, 3 (1), 75-90. [Persian]
Hosseini, F., & Moradi, A. (2020). The relationship between meaning of life with life satisfaction and mental health in the elderly of Tehran. Iranian journal of aging, 5 (1), 45-56. [Persian]
Karimi, M., & Naderi, S. (2021). The effect of meaning of life on resilience and hope for life in the elderly. Journal of psychological and social sciences, 8 (2), 77-88. [Persian]
Kasir, S., & Sanoubar, A. (2018, August). Investigating the effectiveness of life skills education based on the World Health Organization (WHO) program on the attitude toward life of student teachers. Proceedings of the 6th Scientific Research Conference on Educational Sciences and Psychology, and Social and Cultural Harms of Iran, Tehran, Iran. https://civilica.com/doc/759844 [Persian]
Majzoobi, M., Momeni, Kh., Amani, R., & Hojjathkhah, M. (2012). The effectiveness of structured group reminiscence therapy on promoting quality of life and happiness in the elderly. https://civilica.com/doc/1319583 [Persian]
Moemeni, F., Zarei Mahmudabadi, H., Dehghani, F., & Afkhami Aghda, F. (2023). The effectiveness of structured reminiscence therapy on improving general health dimensions of elderly women in Yazd. Toloo-e-Behdasht, 22 (4), 74-86. [Persian]
Momeni, Kh., Amani, R., Janjani, P., Majzoobi, M., & Hadian Hamadani, K. (2021). The relationship between attachment styles and positive and negative affects in the elderly: The mediating role of reminiscence styles. Aging psychology, 7 (4), 407-422. https://doi.org/10.22126/jap.2022.7492.1606 [Persian]
Nazari, D., Sivanani, F., & Amirpour, B. (2019). Meta-analysis of studies conducted in the field of coherent reminiscence psychotherapy on improving positive variables in the elderly using CMA-2 software. Journal of elderly studies, 3 (4), 71-79. [Persian]
Nikookar, Y., Jafari, A., Fathi, Gh., & Pooyamesh, J. (2020). The effectiveness of therapeutic approaches on meaning of life and irrational thoughts of women. Social and security studies of women and family, 8 (1), 244-268. [Persian]
Noghani, F., Navvab, A., Mehran, A., & Yaeghoubi, L. (2018). The effect of group reminiscence on loneliness and spiritual health of elderly residents of Kahrizak nursing home. Iranian journal of nursing research, 13 (1), 47-56. [Persian]
Pourabdol, S., Abbasi, M., Pirani, Z., & Abbasi, M. (2015). The relationship between hope for life and psychological well-being with quality of life in the elderly. Aging psychology, 1 (1), 57-65. [Persian]
Rabiei Motamen, M., Ghabeldemirchi, B., & Mohammadi, A. (2022). A comparative study of the effectiveness of acceptance and commitment therapy and Glasser's reality therapy on attitude toward life and social anxiety of female heads of households. New strategies in psychology and educational Sciences, 4 (13), 227-242. [Persian]
Rafiei Saeidi, N., Mashhadi, A., & Ghanbari Hashemabad, B. (2018). The effectiveness of group reality therapy on improving personal identity crisis with an emphasis on life perspective. International journal of Razavi psychiatry, 6 (4), 9-13. [Persian]
Rajabi, S. (2018). Anxiety sensitivity, perfectionism, loneliness, and self-esteem in elderly patients with urinary incontinency and major depression. Aging psychology, 4 (2), 119-129. [Persian]
Rezaei, Z. (2017, November). The effectiveness of group reality therapy on death anxiety in the elderly of Mashhad. Proceedings of the 4th International Conference on Recent Innovations in Psychology, Counseling, and Behavioral Sciences, Tehran, Iran. https://civilica.com/doc/670500 [Persian]
Seraji, M., Shojiazadeh, D., & Rakhshani, F. (2016). The relationship between spiritual well-being and quality of life in the elderly of Zahedan. Journal of elderly health, 2 (2), 84-88. [Persian]
Sedaghi, A., Alimohammadi, A., Mahmooditabar, M., Dinarvand, R., & Dargahi, Z. (2021). The effectiveness of Islamic reality therapy on psychological pressures, spiritual health, and stress coping strategies of female heads of households. Islamic-Iranian family studies journal, 1 (2). [Persian]
Sharifi, S., Moeini, M., Boroumand, S., & Binaei, N. (2019). Investigating the relationship between daily spiritual experiences and general health of elderly members of the Isfahan Retirees Association. Iranian journal of health sciences, 7 (1), 18-25. [Persian]
Statistical Center of Iran. (2025). Retrieved from https://www.amar.org.ir [Persian]
Yousefi, F., Mohammadi, F., Motalebi, A., & Pahlevan Sharif, S. (2020). Does spiritual health predict successful aging? Iranian journal of aging, 15 (2), 246-254. [Persian]
Sales, A. Pinazo-Hernandis, S. & Martinez, D. (2022). Effects of a Reminiscence Program on Meaning of Life, Sense of Coherence and Coping in Older Women Living in Nursing Homes during COVID-19. Healthcare, 10, 188.
Shin, E., Kim, M., Kim, S., & Sok, S. (2023). Effects of reminiscence therapy on quality of life and life satisfaction of the elderly in the community: a systematic review. BMC Geriatrics, 23(1), Article 420. https://doi.org/10.1186/s12877-023-04001-1
Taherkhani, Z., Kaveh, M.H., Mani, A. et al. The effect of positive thinking on resilience and life satisfaction of older adults: a randomized controlled trial. Scientific reports, 13, 3478 (2023). https://doi.org/10.1038/s41598-023-30684-y
Wu, L. F., & Koo, M. (2016). Randomized controlled trial of a six‐week spiritual reminiscence intervention on hope, life satisfaction, and spiritual well‐being in elderly with mild and moderate dementia. International journal of geriatric psychiatry, 31(2), 120–127.