Volume 13, Issue 1 (4-2018)                   Salmand: Iranian Journal of Ageing 2018, 13(1): 62-73 | Back to browse issues page


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Khezri Moghadam N, Vahidi S, Ashormahani M. Efficiency of Cognitive-Existential Group Therapy on Life Expectancy and Depression of Elderly Residing in Nursing Home. Salmand: Iranian Journal of Ageing. 2018; 13 (1) :62-73
URL: http://salmandj.uswr.ac.ir/article-1-1269-en.html
1- Department of Psychology, Faculty of Literature and Humanities, Shahid Bahonar University of Kerman, Kerman, Iran. , khezri147@yahoo.com
2- Department of Educational Sciences and Psychology, Faculty of Literature and Humanities, Kerman Branch, Islamic Azad University, Kerman, Iran.
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Extended Abstract
1. Objective 

ith elderly population increasing, focusing on their problems and issues is crucial [1]. Old age is a sensitive period of life and paying attention to the issues and needs of this stage is a social necessity. Older individuals have limited social relationships and may occasionally behave negatively; such thoughts would evade them from establishing contacting with others, thereby further increasing the negative thought process about self [2]. It is normal that such withdrawal and reduced relationships push them towards depression. Based on the previous studies, the most common psychiatric disorder among the elderly is depression. Depression and loss of life expectancy are the most common psychological states in the elderly, followed by several possible reactions [3]. Various group therapy approaches are suggested that suitably associate with the psychological issues of the elderly. One of these approaches is the psychology of the authenticity of existence. This is a cure that focuses on the interpersonal and transpersonal dimensions of humanity. Therefore, the present study aimed to investigate the efficiency of group therapy with a cognitive-existential approach to life expectancy and depression in elderly individuals living in nursing homes.
2. Methods and Materials
The present study was an applied and experimental design with pre-test and post-test as well as a control group and random assignation of the subjects. The statistical population of this study included all elderly residents of Kerman's nursing homes, utilizing the stratified random sampling method. Referring to the Welfare Office of Kerman, the list of nursing homes for the elderly was obtained, and two private centers of Amir-Al-Momenin and Mehrazin of Kerman were selected randomly. Then, among the elderly, 30 individuals, who secured a higher score than the cutting edge in the elderly depression questionnaire and a lower score than the cut-off in the life expectancy questionnaire were selected randomly by authorization from the Welfare Office of Kerman. These individuals were randomly divided into two groups: experimental and control group (n=15 each). From the Amir Al-Momenin Center, 6 people were assigned to the experimental group and 5 to the control group, whereas from the Mehrazin Center, 9 were assigned to the experimental group and 10 to the control group. 
During the training period, in order to prevent the transfer effects were prevented by allowing only the members of each and control group to be able to be in contact with each other; this was effectuated by coordination with the authorities of the nursing homes. The elderly in the cognitive-existential experimental group were trained in ten sessions (90 min each). During this period, the control group did not receive any intervention. Before and after testing, both groups completed the Miller’s life expectancy questionnaire (1997), and the depression scale of the elderly (1998) was assessed. The data were analyzed using statistical methods related to frequency, percentage, mean, standard deviation, and multivariate covariance analysis.
3. Result
The cohort consisted of 30 individuals (18 women and 12 men) from the elderly living in two 24-h nursing homes (11 from the Amir Al-Momenin Center and 19 from the Mehrazin Centre) randomly divided into the experimental and control groups (n=15 each). Based on the demographic data, most of the subjects belonged to the 72–74 years age group (36.66%). In this study, about 83% of the elderly were married. Herein, most of the elderly had a low cycle  and education (66.36) (Table 1). As seen in Table 1, the mean scores and standard deviation of the experimental group in post-test was changed dramatically as compared to that in the pre-test. In this study, Levin test was used for investigating the default homogeneity of variance, which was found to be 0.478, albeit without statistical significance (P<0.24), which indicated the homogeneity of variances. To verify the normal distribution of data, Kolmogorov–Smirnov test was used, and significance was detected, which suggested the normal distribution of the pre-test variables. The results of covariance analysis of the experimental and control groups in the life expectancy variable showed a significant difference between the two groups with respect to death anxiety (F=23.98  and P<0.01). Therefore, it can be concluded that presenting an existential cognitive group therapy decreases the life expectancy in the elderly. 
4. Conclusions
Based on the results of this study, the existential cognitive group therapy can be used to reduce depression and increase the life expectancy of the elderly residing in nursing homes, following improved mental health . Existential therapists clarify the value of life for their client with death reminders and making them aware of the situation. In this regard, they also attempt to clarify that the present time is the most valuable asset of any individual. 
The treatment of the authenticity of existence-humanism is feasible superficially between the existence and the theory of humanism and it separates itself from other healthcare schools by emphasizing the concepts such as exposure and presence in the universe, happiness, choice, responsibility, freedom, and the value and meaning of life. Thus, it can be concluded that interventions and methods of meaning therapy for rehabilitation, reducing depression, and increasing the life expectancy of the elderly are tremendously useful. Therefore, gaining meaning and purpose, as well as, encountering concepts and basic issues in life, primarily by the elderly residents of nursing homes, would play a critical role in reducing depression and promoting life expectancy. One of the major findings of this study is the huge emphasis of the cognitive group on challenging the incorrect beliefs and meaning of life for the elderly, which refers to its practical value in promoting the social health of the elderly.
Acknowledgments
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interest
The authors declared no conflicts of interest.


References
  1. Hemmati Alamdarlou G, Dehshiri G, Shojaie S, Hakimi Rad E. [Health and loneliness status of the elderly living in nursing homes versus those living with their families (Persian)]. Iranian Journal of Ageing. 2008; 3(2):557-64. 
  2. Duberstein PR, Palsson SP, Waern M, Skoog I. Personality and risk for depression in a birth cohort of 70-year-olds followed for 15 years. Psychological Medicine. 2008; 38(5):663-71. doi: 10.1017/s0033291707002620 
  3. Ghazi Mohseni M, Soleimanian AA, Heidarnia A. [Examining the effectiveness of hope-based group training on the life quality of the elderly People (Persian)]. Iranian Journal of Ageing. 2016; 11(2):300-309. doi: 10.21859/sija-1102300
  4. Heather M, Addie C, Anthony J. Effectiveness of Cognitive-Behavioral Intervention (CBT) on psycho-sexual adjasment for men with localized prostate cancer. Journal of Psycho-Oncology. 2013; 3(4):48-61.
  5. Qiu J, Chen W, Gao X, Xu Y, Tong H, Yang M, et al. A randomized controlled trial of group cognitive behavioral therapy for Chinese breast cancer patients with major depression. Journal of Psychosomatic Obstetrics & Gynecology. 2013; 34(2):60–7. doi: 10.3109/0167482x.2013.766791 
  6. Casellas Grau A, Font A, Vives J. Positive psychology interventions in breast cancer: A systematic review. Psycho-Oncology. 2013; 23(1):9–19. doi: 10.1002/pon.3353 
  7. International Agency for Research on Cancer. Cancer incidence, mortality and prevalence world wide in 2008, Islamic Republic of Iran. Lyon: International Agency for Research on Cancer; 2009.
  8. Eskandari M, Bahmani B, Hasani F, Dadkhah A, Naghiyayee M. [Effectiveness of group cognitive-existential therapy on depression of parents with children having cancer (Persian)]. Clinical Phsychology & Personality. 2014; 2(10):41-50. 
  9. Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, et al. Cognitive-existential group psychotherapy for women with primary breast cancer: A randomised controlled trial. Psycho-Oncology. 2003; 12(6):532–46. doi: 10.1002/pon.683 
  10. Kissane DW, Love A, Hatton A, Bloch S, Smith G, Clarke DM, et al. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. Journal of Clinical Oncology. 2004; 22(21):4255–60. doi: 10.1200/jco.2004.12.129
  11. Lucas M. Existential regret: A crossroads of existential anxiety and existential guilt. Journal of Humanistic Psychology. 2004; 44(1):58–70. doi: 10.1177/0022167803259752 
  12. Van der Pompe G, Duivenvoorden HJ, Antoni MH, Visser A, Heijnen CJ. Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients: An exploratory study. Journal of Psychosomatic Research. 1997; 42(5):453–66. doi: 10.1016/s0022-3999(96)00393-5 
  13. Hossein Abadi, M. [The Effectiveness of existential therapeutic group humanistic thinking about mental health of prisoners and sharing of contributions self-esteem and feelings of shame on improving mental health (Persian)] [BA thesis]. Mashhad: Ferdowsi University of Mashhad; 2010.
  14. Cramer C. Effectiveness of groupcognitive-behavioral treatment and group therapy in depressed women in community clinics. Behaviour Research and Therapy. 2013; 48(11):45-63.
  15. Hosseini SM. [Relationship of life expectancy and psychological hardiness in male and female students (Persian)] [MSc. thesis]. Gachsaran: Islamic Azad University; 2006.
  16. Malakouti K, Fathollahi P, Mirabzadeh A, Salavati M, Kahani S. [Validation of Geriatric Depression Scale (GDS-15) in Iran (Persian)]. Research in Medicine. 2006; 30(4):361-69.
  17. Spiegel D. Effects of psychosocial support on patients with metastatic breast cancer. Journal of Psychosocial Oncology. 1992; 10(2):113–20. doi: 10.1300/j077v10n02_08 
  18. Frankel B. Existential issues in group psychotherapy. International Journal of Group Psychotherapy. 2002; 52(2):215–31. doi: 10.1521/ijgp.52.2.215.45496 
  19. Jacobsen, B. Invitation to existential psychology: A psychology for the unique human being and its applicants in therapy. New York: John Wiley & sons; 2008.
  20. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine. 2003; 65(4):571–81. doi: 10.1097/01.psy.0000074003.35911.41
Type of Study: Research | Subject: Psychology
Received: 2017/07/29 | Accepted: 2017/12/21 | Published: 2018/04/01

References
1. Hemmati Alamdarlou G, Dehshiri G, Shojaie S, Hakimi Rad E. [Health and loneliness status of the elderly living in nursing homes versus those living with their families (Persian)]. Iranian Journal of Ageing. 2008; 3(2):557-64.
2. Duberstein PR, Palsson SP, Waern M, Skoog I. Personality and risk for depression in a birth cohort of 70-year-olds followed for 15 years. Psychological Medicine. 2008; 38(5):663-71. doi: 10.1017/s0033291707002620 [DOI:10.1017/S0033291707002620]
3. Ghazi Mohseni M, Soleimanian AA, Heidarnia A. [Examining the effectiveness of hope-based group training on the life quality of the elderly People (Per-sian)]. Iranian Journal of Ageing. 2016; 11(2):300-309. doi: 10.21859/sija-1102300 [DOI:10.21859/sija-1102300]
4. Heather M, Addie C, Anthony J. Effectiveness of Cognitive-Behavioral Intervention (CBT) on psycho-sexual adjasment for men with localized prostate can-cer. Journal of Psycho-Oncology. 2013; 3(4):48-61.
5. Qiu J, Chen W, Gao X, Xu Y, Tong H, Yang M, et al. A randomized controlled trial of group cognitive behavioral therapy for Chinese breast cancer pa-tients with major depression. Journal of Psychosomatic Obstetrics & Gynecology. 2013; 34(2):60–7. doi: 10.3109/0167482x.2013.766791 [DOI:10.3109/0167482X.2013.766791]
6. Casellas Grau A, Font A, Vives J. Positive psychology interventions in breast cancer: A systematic review. Psycho-Oncology. 2013; 23(1):9–19. doi: 10.1002/pon.3353 [DOI:10.1002/pon.3353]
7. International Agency for Research on Cancer. Cancer incidence, mortality and prevalence world wide in 2008, Islamic Republic of Iran. Lyon: International Agency for Research on Cancer; 2009.
8. Eskandari M, Bahmani B, Hasani F, Dadkhah A, Naghiyayee M. [Effectiveness of group cognitive-existential therapy on depression of parents with chil-dren having cancer (Persian)]. Clinical Phsychology & Personality. 2014; 2(10):41-50.
9. Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, et al. Cognitive-existential group psychotherapy for women with primary breast cancer: A randomised controlled trial. Psycho-Oncology. 2003; 12(6):532–46. doi: 10.1002/pon.683 [DOI:10.1002/pon.683]
10. Kissane DW, Love A, Hatton A, Bloch S, Smith G, Clarke DM, et al. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. Journal of Clinical Oncology. 2004; 22(21):4255–60. doi: 10.1200/jco.2004.12.129 [DOI:10.1200/JCO.2004.12.129]
11. Lucas M. Existential regret: A crossroads of existential anxiety and existential guilt. Journal of Humanistic Psychology. 2004; 44(1):58–70. doi: 10.1177/0022167803259752 [DOI:10.1177/0022167803259752]
12. Van der Pompe G, Duivenvoorden HJ, Antoni MH, Visser A, Heijnen CJ. Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients: An exploratory study. Journal of Psychosomatic Research. 1997; 42(5):453–66. doi: 10.1016/s0022-3999(96)00393-5 [DOI:10.1016/S0022-3999(96)00393-5]
13. Hossein Abadi, M. [The Effectiveness of existential therapeutic group humanistic thinking about mental health of prisoners and sharing of contributions self-esteem and feelings of shame on improving mental health (Persian)] [BA thesis]. Mashhad: Ferdowsi University of Mashhad; 2010.
14. Cramer C. Effectiveness of groupcognitive-behavioral treatment and group therapy in depressed women in community clinics. Behaviour Research and Therapy. 2013; 48(11):45-63.
15. Hosseini SM. [Relationship of life expectancy and psychological hardiness in male and female students (Persian)] [MSc. thesis]. Gachsaran: Islamic Azad University; 2006.
16. Malakouti K, Fathollahi P, Mirabzadeh A, Salavati M, Kahani S. [Validation of Geriatric Depression Scale (GDS-15) in Iran (Persian)]. Research in Medi-cine. 2006; 30(4):361-69.
17. Spiegel D. Effects of psychosocial support on patients with metastatic breast cancer. Journal of Psychosocial Oncology. 1992; 10(2):113–20. doi: 10.1300/j077v10n02_08 [DOI:10.1300/J077v10n02_08]
18. Frankel B. Existential issues in group psychotherapy. International Journal of Group Psychotherapy. 2002; 52(2):215–31. doi: 10.1521/ijgp.52.2.215.45496 [DOI:10.1521/ijgp.52.2.215.45496]
19. Jacobsen, B. Invitation to existential psychology: A psychology for the unique human being and its applicants in therapy. New York: John Wiley & sons; 2008. [DOI:10.1002/9780470773222]
20. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune pa-rameters in breast and prostate cancer outpatients. Psychosomatic Medicine. 2003; 65(4):571–81. doi: 10.1097/01.psy.0000074003.35911.41 [DOI:10.1097/01.PSY.0000074003.35911.41]

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