مقایسه اثربخشی درمان متمرکز بر شفقت و معنادرمانی بر اضطراب مرگ سالمندان

Background: Aging is associated with numerous psychological challenges, including death anxiety, which may reduce quality of life. Compassion- and meaning-based psychotherapeutic interventions, as effective approaches for managing negative emotions, may have the potential to reduce death anxiety among older adults.
Method: The present study employed a pretest–posttest–follow-up design with a control group. The statistical population consisted of older adults residing in nursing homes in Karaj in 2025. A total of 45 participants were selected through convenience sampling; however, this number decreased to 42 during the intervention. Participants were then randomly assigned to three groups: compassion-focused therapy (CFT) (n=13; 10 women and 3 men; mean age = 67.31 ± 5.44 years), meaning therapy (n=14; 10 women and 4 men; mean age=67.79 ± 3.91 years), and the control group (n=15; 11 women and 4 men; mean age = 67.27 ± 5.22 years). The interventions were delivered in eight 90-minute group sessions based on Frankl’s meaning therapy protocol and Gilbert’s CFT protocol. Death anxiety was assessed using Templer’s Death Anxiety Scale, and the data were analyzed using univariate analysis of covariance and the LSD post hoc test.
Results: The findings showed that both CFT and meaning therapy significantly reduced death anxiety among older adults compared with the control group at the posttest and follow-up stages (p<.001). The results of the univariate analysis of covariance indicated a significant difference between the experimental and control groups (F=98.50, p<.001). However, the results of the LSD post hoc test showed no significant difference between the effectiveness of CFT and meaning therapy (p=.096). Moreover, the significant maintenance of the intervention effects at the follow-up stage indicated the sustained effectiveness of both therapeutic approaches in reducing death anxiety among older adults.
Conclusion: Therefore, it is recommended that mental health professionals use these therapeutic models to improve quality of life and reduce existential fears in this age group. These findings highlight the importance of compassion- and meaning-focused interventions in the aging process.
EXTENDED ABSTRACT
 Introduction
Death anxiety is one of the most important psychological challenges in old age and may be associated with reduced psychological calmness, a sense of insecurity, concerns about the future, and lower quality of life. Older adults, particularly those living in residential care facilities, may be more vulnerable to death-related thoughts and emotions due to the specific conditions of this stage of life. Therefore, reducing death anxiety, as an important variable in older adults’ mental health, requires serious attention in therapeutic interventions. In this regard, compassion-focused therapy may help reduce death anxiety by decreasing self-criticism, enhancing self-kindness, and improving emotional regulation. Meaning therapy, through its emphasis on finding meaning, purpose, and value in life, may also modify older adults’ attitudes toward suffering, loss, and death and thereby reduce the intensity of death anxiety. It appears that both approaches may be effective in reducing death anxiety among older adults; however, their levels of effectiveness may not be identical, and each may influence this variable through different mechanisms. Accordingly, the present study aimed to compare the effectiveness of compassion-focused therapy and meaning therapy on death anxiety among older adults.
Method
This study employed a quasi-experimental pretest–posttest–follow-up design with a control group. The statistical population included all older adults residing in private and public nursing homes in Karaj during the second half of 2025. Sampling was conducted using a convenience sampling method. Following initial screening, 45 eligible older adults were selected and randomly assigned to three groups: compassion-focused therapy, meaning therapy, and control. Due to attrition, the final number of participants was 13 in the compassion-focused therapy group, 14 in the meaning therapy group, and 15 in the control group. The inclusion criteria were age 65 years or older, sufficient physical health, a score of 24 or higher on the Mini-Mental State Examination (MMSE), and willingness to participate in the study. The exclusion criteria included severe psychiatric disorder or advanced cognitive impairment, use of psychiatric medication during the previous three months, experience of severe stressful life events, and unwillingness to continue participation. The research instrument was Templer’s Death Anxiety Scale, which consists of four main subscales. The interventions included two therapeutic programs: compassion-focused therapy based on Gilbert’s protocol and meaning therapy based on Frankl’s principles. Both interventions were delivered in eight 90-minute group sessions, while the control group received no intervention. All sessions were conducted at the nursing home facilities while observing ethical principles and obtaining informed consent. For data analysis, descriptive indices were first calculated, and then analysis of covariance and the LSD test were used to evaluate the effectiveness of the treatments.
Results
Examination of background variables showed that the groups were homogeneous in terms of age (p = .252), gender (p = .943), education (p = .835), and marital status (p = .814). The assumptions of normality (Z = .981), homogeneity of variances at posttest (p > .05) and follow-up (p > .05), and homogeneity of regression slopes at posttest (p > .05) and follow-up (p > .05) were confirmed. The results of univariate analysis of covariance at the posttest stage, after controlling for pretest scores, showed that the interventions had a significant effect on reducing death anxiety among older adults, F(2, 41) = 98.50, p < .001, η² = .82. The results of the LSD post hoc test at this stage indicated a significant reduction in death anxiety in the compassion-focused therapy group compared with the control group (mean difference = -13.35, p < .001) and in the meaning therapy group compared with the control group (mean difference = -18.11, p < .001). However, the difference between the two experimental groups was not significant (p = .096). At the follow-up stage, the results of analysis of covariance also showed a significant group difference, F (2, 41) = 79.15, p < .001, η² = .82. The LSD test confirmed the maintenance of reduced death anxiety compared with the control group for both the compassion-focused therapy group (mean difference = -12.05, p < .001) and the meaning therapy group (mean difference = -16.15, p < .001), while the difference between the two interventions remained non-significant (p = .115). Overall, both therapeutic approaches demonstrated comparable and sustained effectiveness in reducing death anxiety among older adults.
Conclusion
The present study aimed to compare the effectiveness of compassion-focused therapy and meaning therapy on death anxiety among older adults. The results showed that both therapeutic approaches significantly reduced death anxiety compared with the control group, and these effects were maintained at the follow-up stage. These findings indicate that compassion- and meaning-based psychotherapeutic interventions can play an effective role in reducing death-related existential concerns and fears among older adults and may contribute to improving mental health in this age group.
In explaining these findings, compassion-focused therapy may help older adults cope more adaptively with the limitations and vulnerabilities of aging by strengthening self-kindness, reducing self-criticism, and increasing psychological safety, thereby reducing death-related anxiety. On the other hand, meaning therapy, by emphasizing the discovery of meaning and purpose in life even under difficult circumstances, may help older adults develop a more adaptive attitude toward suffering, limitation, and the end of life. Such an approach may enhance internal control and hope for life and consequently reduce fear of death.
The results also showed that although the overall effectiveness of the two approaches in reducing the total score of death anxiety did not differ significantly, differences were observed in some components of death anxiety, suggesting that these two approaches may operate through different mechanisms. Overall, the findings of the present study indicate that both interventions can be used as effective and practical approaches in psychological programs within nursing homes and may help promote mental health and quality of life among older adults.
Ethical Consideration
Ethical Code
Following ethical approval from Islamic Azad University, Roudehen Branch (IR.IAU.R.REC.1405.007) and authorization from the Alborz Welfare Organization, data collection commenced at elderly care centers in Karaj.
Funding
This study received no financial support.
Authors’ Contributions
Y.P.: Conceptualization, investigation, data curation, writing – original draft, writing – review and editing. M.S.: Methodology, formal analysis, data curation.
A.G.: Software, validation. B.A.: Project administration, supervision, visualization.
Conflict of Interest
 The authors declared no conflicts of interest.
Acknowledgments
The authors sincerely thank all the respected older adults who actively participated in this study and provided their valuable cooperation. The authors also express their sincere gratitude to the honorable officials and staff of the Karaj Welfare Organization for their cooperation and support in facilitating the implementation of this study.
References
Abbasian, S., & Taheri, M. (2021). The effect of logotherapy on increasing life expectancy in the elderly. Quarterly Journal of Mental Health Research, 12(3), 45–60. [Persian]
Abdel-Khalek, A. M. (2019). Death anxiety, happiness, and mental health among older adults. OMEGA - Journal of Death and Dying, 78(2), 139–151. https://doi.org/10.1177/0030222817693134
Abdollahzadeh, H., Mahmoodi, H., & Aghajani, S. (2024). The effectiveness of logotherapy on the sense of energy and spiritual self-esteem of the elderly living in nursing homes. Aging Psychology, 9(4), 343–359.
Afshari, A., Ebrahimi Orang, A., & Ali, E. (2025). The effectiveness of positive psychotherapy on life expectancy and death anxiety among older adults living in nursing homes. Aging Psychology, 11(3), 351–370. https://doi.org/10.22126/jap.2025.12512.1870 [Persian]
Aghanouri, Z., Foroughi, A., Ahmadi, S. M., & Nazari, E. (2026). The effectiveness of compassion-focused therapy on shame and self-criticism in perfectionist students. Rooyesh, 15(1), 71–80. https://doi.org/10.66224/Rooyesh.15.1.71 [Persian]
Aiello-Puchol, A., & García-Alandete, J. (2025). A systematic review on the effects of logotherapy and meaning-centered therapy on psychological and existential symptoms in women with breast and gynecological cancer. Supportive Care in Cancer, 33(6), Article 465.
Amanelahi, A., Tardast, K., & Aslani, Kh. (2015). Prediction of love trauma syndrome based on self-compassion among female students having experienced romantic breakups. Journal of Applied Psychology, 8(4), 43–61. [Persian]
Ardeshirzadeh, F., & Moshtaghi, S. (2026). Comparison of the effectiveness of logotherapy and narrative therapy on loneliness and death anxiety in older women. Journal of Gerontology Education, 11(2), 27–38. [Persian]
Baharvandi, B., Kazemianmoghadam, K., & Haroon Rashidi, H. (2020). The effectiveness of compassion-focused therapy on ambiguity tolerance and death anxiety in the elderly. Aging Psychology, 6(1), 13–26. https://doi.org/10.22126/jap.2020.5148.1409 [Persian]
Brodaty, H., Low, L.-F., Liu, Z., Fletcher, J., Roast, J., Goodenough, B., & Chenoweth, L. (2014). Successful ingredients in the SMILE study: Resident, staff, and management factors influence the effects of humor therapy in residential aged care. The American Journal of Geriatric Psychiatry, 22(12), 1427–1437. https://doi.org/10.1016/j.jagp.2013.08.005
Chanouha, N., Chassevent, A., Macnamara, E. F., Schaa, K., Thoeny, R., & Tansey, J. (2026). Exploring the principles of logotherapy in genetic counseling: Enhancing decision-making, adaptation, and justice. Journal of Genetic Counseling, 35(1), Article e70165. https://doi.org/10.1002/jgc4.70165
Clemson, L., Stark, S., Pighills, A. C., Torgerson, D. J., Sherrington, C., & Lamb, S. E. (2019). Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(2), Article CD013258.
Farhadi, M., Rahimi, H., Zoghi Paydar, M. R., & Yarmohammadi Vasel, M. (2023). The effectiveness of self-compassion-focused therapy on cognitive vulnerability to depression. Iranian Journal of Psychiatry, 18(2), 134–144.
Forouzandeh, Z., Mami, S., & Amani, O. (2020). The effectiveness of group logotherapy on resiliency, depression, and quality of life in elderly. Journal of Gerontology Education, 5(1), 19–29. [Persian]
Gilbert, A. G. (2002). On the mystery of capital and the myths of Hernando de Soto: What difference does legal title make? International Development Planning Review, 24, 1–19. https://doi.org/10.3828/idpr.24.1.1
Gilbert, P. (2009). The compassionate mind: A new approach to life’s challenges. Constable & Robinson.
Hossini, M., Khajehpoor, P., Rezaei Pooya, M., & Aghajani, F. (2026). The effectiveness of reality therapy approach on death anxiety and stress in older adults retired teachers. Journal of Gerontology Education, 10(4), 18–27. [Persian]
Kabirinasab, Y., Bahrainian, S. A., Ahi, G., & Mansouri, A. (2024). Comparison of effectiveness acceptance and commitment therapy and compassion therapy on death obsession and self-care ability in the elderly. Journal of Psychological Science, 23(142), 209–228. https://doi.org/10.61186/jps.23.142.209 [Persian]
Kazemi, N., Hejazi, E., Rasolzadeh, V., Mohammadi, S., & Moradi, R. (2020). The effectiveness of self-compassion treatment on loneliness and life expectancy in elderly women. Rooyesh, 8(12), 73–80. [Persian]
Kızılgeçit, M., Okan, N., Demir, Y., et al. (2025). Spiritual meaning making and trauma recovery: Evaluation of a psycho-social intervention for earthquake survivors in Turkey. Journal of Religion and Health, 64(5), 4147–4168.
Kraft, B. D., Pervan, D., & Gilbert, P. (2011). Compassion-focused therapy and the treatment of depression and anxiety. Clinical Psychology Review, 31(3), 393–405.
Lin, C. C. (2024). Meaning-centered psychotherapy as a potential approach for enhancing elderly psychological well-being: Linking demoralization to late-life depression. Psychogeriatrics, 24(3), 737–738. https://doi.org/10.1111/psyg.13121
Loades, M. E., Perry, G., & Marshall, N. (2025). Investigating Project Care UK, a web-based self-help single-session intervention for youth mental health: Program evaluation. JMIR Mental Health, 12, Article e72077. https://doi.org/10.2196/72077
Madani, S. F., & Farokhzad, P. (2025). Investigating the effectiveness of compassion-focused therapy on caregiver burden and psychological flexibility in caregivers of elderly with Alzheimer disease. Salmand: Iranian Journal of Ageing, 20(1), 122–135. [Persian]
Malayeri, F., & Moghaddamnia, M. M. (2024). Comparison of the effectiveness of compassion-focused therapy and acceptance and commitment therapy on death anxiety in the elderly. In Proceedings of the 2nd National Conference on New Findings in Applied Psychology. [Persian]
Mayer, L. J. P. N., & Mayer, C. H. (2025). Elon Musk 4.0: A psychobiography of transhumanism and Frankl’s existential meaning theory. International Review of Psychiatry, 37(5), 427–444. https://doi.org/10.1080/09540261.2025.2507284
Minoei, M., Fardian, F., & Aboutalebi, N. (2024). The effectiveness of compassion-based therapy on the quality of life and psychological well-being of depressed elderly. Journal of Gerontology Education, 9(2), 9–16. [Persian]
Naghdi, M., Taher, M., Aghaei, H., & Hossein Khanzadeh, A. A. (2023). Comparing the effectiveness of logotherapy and acceptance and commitment therapy on the loneliness of the elderly. Journal of Psychological Science, 22(128), 157–172. https://doi.org/10.52547/JPS.22.128.1663 [Persian]
Nasirnia Samakoush, A. R., & Yousefi, N. (2022). The effectiveness of acceptance and commitment therapy on death anxiety, happiness, and resilience in the elderly. Aging Psychology, 8(2), 149–161.
Rabanipour, N., Roohafza, H., Feizi, A., Rabiei, K., & Sarrafzadegan, N. (2018). The association between mental health and quality of life: A cross-sectional study in a large sample of Isfahan Steel Company’s employees. Fundamentals of Mental Health, 20(5), 321–329. https://doi.org/10.22038/jfmh.2018.11405 [Persian]
Rezaei, A., Bigdeli, M., & Ahmadi, S. (2019). The effectiveness of logotherapy on reducing death anxiety in the elderly. Aging Psychology, 5(2), 157–168. https://doi.org/10.22126/jap.2020.4672.1367 [Persian]
Rezavandi, M., Ariapooran, S., & Karami, J. (2025). The effectiveness of compassion-based therapy on fatigue, self-compassion, and resilience of elderly home nurses. Journal of Modern Psychological Researches, 20(77), 37–47. https://doi.org/10.22034/jmpr.2023.58536.5837 [Persian]
Rezapour-Mirsaleh, Y., Abolhasani, F., Amini, R., Rezai, M. J., Choobforoushzadeh, A., & Shameli, L. (2025). Effects of religious versus non-religious self-compassion interventions on anxiety and quality of life of Iranian infertile women: A randomized controlled trial. Journal of Religion and Health, 64(1), 305–329.
Saffarinia, M., & Dortaj, A. (2018). Effect of group logotherapy on life expectancy and mental and social wellbeing of the female elderly residents of nursing homes in Dubai. Salmand: Iranian Journal of Ageing, 12(4), 482–493. [Persian]
Saraya, O., Miqdadi, A. I., Sinnokrot, S., Fashafsheh, N., Ahmed, G. K., & Elsebaie, S. R. (2025). Effect of a logotherapy-based psychoeducational program on interpersonal guilt, self-efficacy, and resilience in patients with schizophrenia: A quasi-experimental study. BMC Psychiatry.
Seo, K., & Chun, J. (2025). Effectiveness of a grief programme for sudden bereavement: A logotherapy approach. Death Studies.
Seyyedjafari, J., Jeddi, M., Mousavi, R., Hoseyni, E., & Shakibmehr, M. (2020). The effectiveness of compassion-focused therapy on elderly life expectancy. Aging Psychology, 5(2), 157–168. https://doi.org/10.22126/jap.2020.4672.1367 [Persian]
Seyyedjafari, J., Motamedi, A., Mehradsadr, M., Olamaie Kopaei, M., & Hashemian, S. (2017). The effectiveness of acceptance and commitment therapy (ACT) on resilience in elderlies. Aging Psychology, 3(1), 21–29. [Persian]
Shadkam, Z., Haroonrashidi, H., & Moshtaghi, S. (2025). The effectiveness of compassion-based therapy on ego strength and metacognitive beliefs of depressed in the older people. Aging Psychology, 11(2), 27–38. https://doi.org/10.22126/jap.2026.13507.1902 [Persian]
Sharif Nia, H., Pahlavan Sharif, S., Goodarziyan, A., Haghdoost, A., Ebadi, A., & Soleimani, M. (2016). Psychometric evaluation of the extended version of Templer Death Anxiety Scale in a sample of Iranian chemical warfare veterans. Hayat, 22(3), 229–244. [Persian]
Templer, D. I. (1970). The construction and validation of a Death Anxiety Scale. The Journal of General Psychology, 82(2), 165–177.
United Nations Department of Economic and Social Affairs, Population Division. (2024). World Population Prospects 2024: Summary of results (UN DESA/POP/2024/TR/NO. 9).
United Nations Population Fund. (2025). Population ageing and disabilities in the Islamic Republic of Iran.
Valaei, N., & Zalipoor, S. (2015). The effectiveness of logotherapy on death anxiety in the elderly. Aging Psychology, 1(1), 49–55. [Persian]
Vanaki Farahani, Z., Pashang, S., & Hoseinzadeh Taghvaee, M. (2016). Group therapy with the approach of logotherapy on general health of elderlies. Journal of Applied Psychology, 10(2), 35–52.
Xu, L., Goldberg, S. B., Zhang, L., & Hu, C. (2026). The effectiveness of second-generation mindfulness interventions on anxiety and depression: A systematic review and meta-analysis. Clinical Psychology Review, 123, Article 102693.
Xu, L., Li, S., Yan, R., Ni, Y., Wang, Y., & Li, Y. (2023). Effects of reminiscence therapy on psychological outcome among older adults without obvious cognitive impairment: A systematic review and meta-analysis. Frontiers in Psychiatry, 14, Article 1139700.