مقایسه اثربخشی موریتادرمانی و خاطره‌پردازی ساختارمند بر ادراک پیری و کیفیت زندگی سالمندان مبتلا به دیابت نوع دو

Background: Older adults with type 2 diabetes may experience negative perceptions of aging and reduced quality of life (QoL) due to physical health problems associated with the disease. Therefore, this study aimed to compare the effectiveness of Morita therapy and structured reminiscence in improving perception of aging (PoA) and QoL among older adults with type 2 diabetes
Method: This quasi-experimental study employed a pretest-posttest control-group design with a follow-up phase. The study population consisted of all adults aged 65 years and older with type 2 diabetes who attended medical centers and hospitals in Ahvaz in 2025. Using convenience sampling and based on the inclusion and exclusion criteria, 45 participants were selected and then randomly assigned to three groups: Morita therapy (n = 15), structured reminiscence (n = 15), and control (n = 15). Data were collected using the PoA Questionnaire developed by Barker et al. and the LEIPAD Quality of Life Questionnaire developed by De Leo et al. The two experimental groups received eight weekly 90-minute intervention sessions based on established Morita therapy and structured reminiscence protocols. All groups were assessed at baseline, immediately after the intervention, and at a two-month follow-up. Data were analyzed using repeated-measures analysis of variance in SPSS version 24.
Results: The results showed that both Morita therapy and structured reminiscence were effective in improving PoA and QoL among older adults with type 2 diabetes (p < .05). However, no statistically significant differences were observed between the two interventions in their effects on PoA or QoL.
Conclusion: The findings suggest that both Morita therapy and structured reminiscence are effective psychological interventions for improving PoA and QoL among older adults with type 2 diabetes.
EXTENDED ABSTRACT
 Introduction
 Aging is accompanied by physical, psychological, and social changes that can affect how older adults view this stage of life and evaluate their well-being. These challenges may become more pronounced in the presence of chronic illnesses such as type 2 diabetes mellitus (T2DM), which often requires continuous medical care, medication, dietary management, and regular monitoring. Such demands may contribute to a less favorable perception of aging (PoA) and lower quality of life (QoL). PoA reflects how individuals understand and evaluate their own aging process, including their beliefs and expectations about age-related changes. Negative PoA has been associated with poorer physical and psychological outcomes, while a more positive view of aging may support better adjustment. QoL is also an important indicator in later life because it reflects physical, psychological, social, and functional aspects of everyday living. Morita therapy is a psychological approach that emphasizes accepting unpleasant thoughts, emotions, and physical experiences rather than attempting to eliminate them. Individuals are encouraged to redirect their attention toward meaningful and constructive activities. Structured reminiscence, in contrast, involves the organized review of important life experiences. Recalling and discussing meaningful memories may help older adults strengthen their sense of personal continuity, reinterpret previous experiences, and better adjust to their present circumstances. Although both approaches have been used with older adults, direct comparisons between them are limited, particularly among individuals with T2DM. Therefore, this study aimed to compare the effectiveness of Morita therapy and structured reminiscence on PoA and QoL among older adults with T2DM in Ahvaz. Two hypotheses were examined: (1) There is a significant difference between the effectiveness of Morita therapy and structured reminiscence on PoA among older adults with T2DM. (2) There is a significant difference between the effectiveness of Morita therapy and structured reminiscence on QoL among older adults with T2DM.
Method
This applied, quasi-experimental study used a pretest-posttest control-group design with a two-month follow-up. The study population consisted of older adults with T2DM attending treatment clinics and hospitals in Ahvaz. Based on Cohen’s (1988) recommendations, with an effect size of .40, a 95% confidence level, statistical power of .80, and an anticipated attrition rate of 10%, the required sample size was estimated at 15 participants per group. Using convenience sampling, 51 adults aged 65 years or older were initially screened. After administration of the study questionnaires, 45 participants who scored below the specified cutoff points for PoA and QoL and met the inclusion and exclusion criteria were selected. They were randomly assigned to Morita therapy (n = 15), structured reminiscence (n = 15), and control (n = 15) groups. The inclusion criteria were: (1) having T2DM, (2) being 65 years of age or older, (3) obtaining scores below the specified cutoff points on the PoA and QoL measures, and (4) being able to read and write. The exclusion criteria were: (1) current use of psychiatric medication or its use during the previous three months, (2) participation in another therapeutic intervention at the same time, and (3) the presence of acute cognitive disorders. PoA was assessed using the 32-item Aging Perceptions Questionnaire (APQ) developed by Barker et al. (2007). Cronbach’s alpha for the APQ in the present study was .89. QoL was assessed using the 31-item LEIPAD Elderly Quality of Life Questionnaire developed by De Leo et al. (1998), with a Cronbach’s alpha of .81 in the present study. Following the pretest, the first experimental group received Morita therapy based on Morita’s theoretical framework and the protocol described by Sugg et al. (2020). The second experimental group received structured reminiscence based on Stinson’s protocol, adapted into eight sessions. Both interventions consisted of eight weekly 90-minute sessions, while the control group received no psychological intervention. Posttest assessments were conducted immediately after the interventions, and follow-up assessments were completed two months later. Data were analyzed using repeated-measures analysis of variance and Bonferroni pairwise comparisons in SPSS version 24.
Results
Repeated-measures analysis showed a significant effect of time on both outcomes. For PoA, the effect of time was significant (F = 12.970, p = .001, effect size = .95), as was the effect of time on QoL (F = 22.1157, p = .001, effect size = .96). The group × time interaction was also significant for PoA (F = 32.240, p = .001, effect size = .92) and QoL (F = 15.279, p = .001, effect size = .93), indicating that changes across pretest, posttest, and follow-up differed among the three groups. The overall group effect was significant for PoA (F = 9.05, p = .003, effect size = .30) and QoL (F = 12.30, p = .001, effect size = .39). Bonferroni comparisons showed no significant differences among the groups at pretest for either PoA or QoL. At both posttest and follow-up, however, the Morita therapy and structured reminiscence groups had significantly better outcomes than the control group. No significant differences were found between the two intervention groups at either posttest or follow-up. Within both intervention groups, changes from pretest to posttest and from pretest to follow-up were significant, whereas differences between posttest and follow-up were not significant. Thus, improvements following both interventions were maintained over the two-month follow-up period.
Conclusion
The findings showed that both Morita therapy and structured reminiscence improved PoA and QoL among older adults with T2DM, but neither intervention was significantly more effective than the other. The effects of both interventions were also maintained at the two-month follow-up. The similar effectiveness of these approaches may be partly explained by common therapeutic processes despite their different theoretical foundations. Morita therapy encourages individuals to accept difficult thoughts, emotions, and physical experiences while focusing on purposeful action. This may help older adults adapt to chronic illness and age-related changes without excessive effort to control experiences that cannot easily be changed. Structured reminiscence works through the systematic review of meaningful life experiences. Revisiting important relationships, achievements, and life events may help older adults maintain a sense of continuity between past and present and interpret their current situation more positively. Thus, while Morita therapy primarily emphasizes acceptance and action, structured reminiscence emphasizes reflection and meaning-making. Both approaches may reduce excessive focus on the negative aspects of illness and aging and promote better adjustment to present circumstances. From a practical perspective, either intervention may be considered in psychological and counseling services for older adults with chronic illnesses such as T2DM. Since neither approach demonstrated superiority, treatment selection may depend on individual preferences, therapist expertise, and available clinical resources. The findings should be interpreted considering several limitations. The study was conducted in Ahvaz using convenience sampling and included only older adults with T2DM, which may limit generalizability. The use of self-report measures may also introduce response bias, and potentially relevant variables such as socioeconomic status and ethnic or cultural differences were not controlled. Future studies should use larger and more diverse samples and better control potential confounding variables.
Ethical Consideration
Ethical Code
The study was approved by the Research Ethics Committee of Islamic Azad University, Ahvaz Branch (IR.IAU.AHVAZ.REC.1404.046). Written informed consent was obtained from all participants, who were informed of the voluntary nature of participation, confidentiality of their information, and their right to withdraw at any stage. The study was also registered in the Iranian Registry of Clinical Trials (IRCT20250630066309N1).
Funding
This study received no external funding.
Authors’ Contributions
S.S.: Data curation; writing—review and editing. M.N.: Project administration and supervision. M.N. and S.S.: Investigation, methodology, software, formal analysis, and writing—original draft.
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors thank all older adults who participated in the study for their time and cooperation.
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