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Reminiscence therapy is a form of therapeutic activity designed to prevent deterioration of memory, for example, amongst older adults, particularly those with Alzheimer's disease .

It is used to counsel and support older people, and is an intervention technique with brain-injured patients. This form of therapeutic intervention respects the life and experiences of the individual with the aim to help the patient maintain good mental health.

Often utilised in residential and nursing care settings, reminiscence therapy is also to be found in none-acute hospitals in the United Kingdom for example, especially those specialising in medical care for the elderly. In one approach, participants are guided by a trained person to reflect on a variety of aspects relating to their lives. This may be themed and centre on one period in time or it may be wider and reflect a guided discussion through an issue. The therapist may use music, photographs, replica documents, drama and sensory gardens to stimulate debate and discussion for the participants.

In Reminiscence therapy structured opportunities for reminiscence are provided as a useful tool in supporting very frail and confused people to integrate into new living arrangements by acknowledging and respecting their life history. Participants are often very knowledgable and done in groups becomes a participative learning experience. Reminiscence therapy promotes an older adult's sense of security by reviewing comforting memories.

Reminiscence therapy has been found to be effective in helping the elderly cope with aging and preparation for death. Recent research has found additional positive outcomes relating to other aspects of mental health. The applications of reminiscence therapy have expanded, however, there is still a need for future work in standardizing the methods of this field.

File:1970sfamily1.jpg

What is Reminiscence?

Reminiscence has been described as “the volitional or non-volitional act or process of recollecting memories of oneself in the past”.[1] In other words, it involves the recalling and re-experiencing of one's life events. This involves having an intact autobiographical memory in order to be able to recall certain life events. However meaningful the reminisce process ends up being, depends on how meaningful the memories being recalled are.[2] Different ways to make these memories more meaningful are to ask questions which suggest the importance of the event as well as using historical materials from ones past.[1]

There are different types of reminiscence which can take place. The two main subtypes are intrapersonal and interpersonal reminiscence.[3] Intrapersonal takes a cognitive stance and occurs individually. Interpersonal takes more of a conversational side and is a group-based therapy. Reminiscence can then be further broken down into three specific types which are: information, evaluation, and obsessive.[3] Information reminiscence is done to be able to enjoy the retelling of stories from one’s past.[4] This type can also be used to help someone who may be lacking interest in his or her life and relationships. The ability to recall good memories can help them remember what they do have to be happy about. Evaluative reminiscence is the main type of reminiscence therapy as it is based on Dr. Robert Butler's life review. This process involves recalling memories throughout one’s entire life and sharing these stories with other people.[4] Often this is done within group therapy. Obsessive reminiscence occurs when somebody needs to be able to let go of any stress of guilt that may be lingering.[4] By working through these issues it allows them to be at peace with themselves. Reminiscence has also been used to help people deal with the death of a loved one.[5] By sharing stories about the loved one's life they can remember fond memories and gain a sense of peace with the death.

File:Robert N. Butler 2004.jpg

History of Reminiscence

Before the late 1950s reminiscence was seen as a negative symptom which often lead to mental deterioration. Erik Erikson introduced his concept of the eight stages of psychosocial development which involved the progression of one’s life and development from birth until death. The last stage known as late adulthood, brought up the idea of integrity vs. despair.[3] At this stage it becomes important for one to look back on one’s life with satisfaction before they die. In 1963, Dr. Robert Butler published a paper on the critical points surrounding the importance of life review and reminiscence.[1] Butler is credited with starting the movement of reminiscence therapy.[6] The next advancement in this area was done by Charles Lewis in 1971. Lewis was able to create the first experimental study of reminiscence.[3] Lewis wanted to look at any cognitive changes that may occur from reminiscence as well as how people perceive themselves.[7] This experiment proved to be worthwhile as in the following years this area became very popular to research. In the following years, research on reminiscence was focused on the functions and benefits of reminiscence. In 1978 The Department of Health and Social Security started a project called “The Reminiscence Aids Project”.[8] This project was done in order to start reminiscence as a therapy process. Finally in the 1980s, reminiscence therapy was recognized by institutions and has begun to be used as group therapy. During this time period, there was an increase in the amount of professionals trained in this therapeutic process.[8] Reminiscence therapy has continued to be an area of research to this day. While there have been many studies done on reminiscence therapy lately, Butler and Erikson remain the two researchers most associated with this field of work.

Theories of Reminiscence

There are many theories and pathways through which reminiscence therapy works. Each theory or way of administering therapy to patients has its own merit. Among the most used are disengagement theory, ego integrity theory and continuity theory respectively. The largest debate has been between disengagement theory and ego integrity. Often as people become older they tend to remove themselves from the society around them. Using reminiscence allows them to feel as if they have a purpose in society by sharing their life lessons and stories.[9] Ego integrity is the process by which older people are able to come to an understanding and satisfaction of their life towards the end of it.[3] They are able to look back over their life and be proud of what they have accomplished. Both of these ideas have the ability to work with each other as well as stand on their own. Depending on the type of reminiscence a person needs is the best way to determine which theory is being used. Since different people need different types of reminiscence therapy, it is hard to say which theory is the best overall.

Disengagement Theory

Disengagement theory in reminiscence is used by some therapists and researchers and focuses on the patient withdrawing from social responsibilities.[3] This movement away from social life is encouraged so that the patient (in many cases an elderly person) can brace themselves for the rapid changes associated with the end of life. In withdrawing from interaction with others, disengagement theory aims to prepare the person for the most powerful and taxing separation of death.[3] The hope in using this therapy is that when death comes, it will not be as painful or upsetting an experience as typically thought. The notion can be a comforting one that instead of being fearful patients that participate in the disengagement aspect of reminiscence theory will no longer be afraid but empowered when meeting their end.

Ego Integrity Theory

Ego Integrity Theory is based on the individual having a sense of fulfillment and success when looking back on their life and accomplishments.[10] A person who has achieved ego integrity does not fear the uncertainty that comes with meeting their death. In a successful case of ego integrity theory the patient is at peace with the eventuality of death. This theory was developed from Eric Erikson’s stages of development in which Integrity vs Despair is a crucial stage for later life psychological development.[11]

Continuity Theory

Disengagement and ego-integrity may offer tools helping the elderly or ill deal with the prospect of death but it is thought that Continuity Theory offers more profound insights when trying to fully understand the true meaning of reminiscence theory.[12] A passage from Lin[3] illustrates the concept of continuity the best

"As individuals move from one stage to the next and encounter changes in their lives, they attempt to order and interpret changes by recalling their pasts. This provides an important sense of continuity and facilitates adaptation. Change is linked to the person’s perceived past, producing continuity in inner psychological characteristics and in social behavior and social circumstances."
Reminiscence can provide a mechanism by which individuals adapt to changes that occur throughout life Continuity Theory requires the effective use of remote memory. Reminiscence processes occur in this type of memory which is usually the last memory system to deteriorate. Research has found that frequent exercise of this system improves general cognitive function.[3]

What is Reminiscence Therapy?

Reminiscence therapy makes use of life events by having participants vocally recall episodic memories from their past.[13] It helps provide people with a sense of continuity in terms of their life events.[14] Reminiscence therapy may take place in a group setting, individually,[15] or in pairs depending on the aim of the treatment[14] Reminiscence therapy can also be structured or unstructured within these configurations.[16] While the primary aim of reminiscence therapy is to strengthen cognitive memory components, a secondary goal may be to encourage either intrapersonal development or interpersonal development.[15] These individual needs will determine whether the therapy is conducted in a group setting or alone with a practitioner.[15] Memories are processed chronologically starting at birth and focusing on major, significant life events.[15] The focus is reflection, not simply recall.[15] Reminiscence therapy may use prompts such as photographs, household items, music, or personal recordings.[6]

Applications

Reminiscence Therapy is used predominately in elderly patients[3] This may in part be due to the common disorders reminiscence therapy has been used for are prevalent in the elderly, such as depression.[3] It has often been used in nursing homes or assisted living facilities, as it provides a sense of continuity in one's life and therefore may aid these types of transitions.[14] Patients with chronic conditions may also benefit from reminiscence therapy, as they often suffer socially and emotionally.[14] Other issues have been addressed using reminiscence therapy, including behavioural, social, and cognitive problems.[14] Studies have found group reminiscence therapy sessions may lead to strengthened social relationships and friendships within the group.[14]

Outcomes

To evaluate the changes the patients who undergo reminiscence therapy various behavioural measures are used and recently, brain imaging has begun to be a part of the assessment after treatment.

Behavioural Evaluation

The most frequent characteristics used to measure the outcome of reminiscence therapy on the patients involved are[17]:

  • Depressive symptoms
  • Psychological well-being
  • Ego-integrity
  • Meaning and/or purpose in life
  • Mastery
  • Cognitive performance
  • Social interactions

Neuroimaging

In patients with vascular dementia, a significant increase in cortical glucose metabolism in bilateral anterior cingulate and in the left inferior temporal lobe, which are areas important for social interaction and remote memories, respectively.[18] The use of single photon emission computed tomography on an elderly patient with Alzheimer's Disease revealed greater blood flow to the frontal lobe of the brain, an area that degenerates in those with this disease. This was coupled with positive changes in evaluated behavioural traits.[19]

Influencing Factors

Overall, positive outcomes seem to result from reminiscence therapy, although to differing degrees. The variability in the results is thought to be due to various factors, including the form of reminiscence therapy, the format of the sessions (group versus individual setting), the number of sessions completed, the health, age and gender of the individual, where the patient lives and if the individual had experienced any events that cause major changes in their life.

An evaluation on the forms of reminiscence therapy found life-review therapy had the strongest positive effects on psychological well being when compared to other life review and simple reminiscence.[17][20] Life review has been thought to produce greater positive effects compared to reminiscence therapy, due to the increased organization of methods and purpose of this therapy. The benefits of reminiscence therapy occurs independent of the format of the therapy. Improvement in behaviour occurs whether the therapy is conducted on an individual basis [19] in small or large groups.[13][17][20] The frequency and duration of the therapy program does not seem to alter the effectiveness of reminiscence.[17]

Many specific groups have been targeted for studying the effects of reminiscence therapy and were evaluated using different measures based on their previously existing condition and the problems associated with it. Those ranking higher in their depression rating showed a greater rate of improvement of their symptoms compared to those exhibiting less depressive symptoms before the therapy began, although improvements were seen across depression levels.[20] Across studies, reminiscence therapy positively influenced patients with dementia evaluated using various measures [6] Specifically in vascular dementia, cortical glucose metabolism increase in areas important for social interaction and remote memories.[18] Those with Alzheimer's Disease had improved blood flow to areas in brain, as previously discussed, and positive changes in evaluated behavioural traits.[19] In patients with leprosy, the greatest positive effects were seen in those with depression but reminiscence therapy did not effect the stage of dementia or cognitive scores.[21]

File:Nurse in geriatry.jpg

Initially reminiscence was intended for older adults. However, this therapy my prove to be a valuable tool for adults at earlier stages of their life as well. In the elderly, improvement in satisfaction with life and self, self-esteem, increase in social involvement which led to an improvement in their ability to deal with social situations, lower loneliness and alienation.[22] In addition, depressive symptoms, psychological symptoms, psychological well-being, ego-integrity, meaning of/purpose in life, mastery, cognitive performance, social integration, preparation for death all showed improvements after the therapy was concluded. At a follow up depression, other indicators of mental health, well-being, ego-integrity, cognitive performance, death preparation all remained to be improved from pre treatment.[17] Improvements comparable to those found in the elderly have been found in studies that included younger age brackets.[17] Improvements in depression occur in both females [23] and males.[24] Comparative analysis between males and females on the effects of reminiscence therapy found no evidence for a difference in the success of the therapy between genders.[17] Reminiscence therapy has been conducted in groups composed of residents from group centres and those living in broader communities. Recent analysis suggests that no differences in outcomes from reminiscence exist between the type of community that the individuals are living in during the time of therapy,[17] which contradicts the earlier findings that those living in group homes or care centres benefited less from these programs.[20] Those who experienced various major life events showed improved mental stability including a decrease in depressive symptoms and anxiety.[25] Institutionalized elderly male veterans showed increased self-esteem and life satisfaction and a decrease in symptoms of depression who were involved in a 12 week reminiscence therapy program compared to those that were not.[24]

Most of these factors have appeared to not alter the effect on therapies as was once thought, however; the lack of standardization and replication in the studies may be the cause of the absence of a difference found across these influences.

Future Directions

The effect of reminiscence should be examined further:

  • In young or middle aged adults[17]
  • In those with “unresolved biographical conflicts”[17]
  • How it effects ego-integrity and death preparation[17]
  • The long term effects or duration of the outcomes[17]
  • Using neuroimaging [18]

An important note for the future of this research, is the need for a standardization of methods.[3] As it stands there are currently many different techniques used to achieve reminiscence therapy, as well as different ways to analyze the data.[2] This is where the biggest separation within this field of study seems to occur. This lack of connection between theory and research may stem from Butler's early work in the field. Butler used a psychodynamic perspective which is hard to empirically test.[1] As with any topic of research, it is important for the researcher's to contain to design experiments and test new ideas. Reaching a general level of understanding within this field could show even more positive effects for those using reminiscence therapy.


See also

References & Bibliography

  1. 1.0 1.1 1.2 1.3 Bluck, S., & Levine, L.J. 1998. “Reminiscence as autobiographical memory: a catalyst for Reminiscence Theory Development.” Aging and Society. 18, 185-208.
  2. 2.0 2.1 Martin, J.R. 1940. “Reminiscence and Gestalt Theory” The American Psychological Association. 52, (4), 1-37.
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Lin, Y.C., Dai, Y.T., & Hwang, S.L. August, 2003. “The Effect of Reminiscence on the Elderly Population: A systematic Review.” Public Health Nursing. 20, (4), 297-306
  4. 4.0 4.1 4.2 Gerfo, M.L. 1980. “Three Ways of Reminiscence in Theory and Practice.” The International Journal of Aging and Human Development. 12, (1), 39-48.
  5. Comana, M.T., Brown, V.M., & Thomas, J.D. 1998. “The Effects of Reminiscence Therapy on Family Coping.” Journal of Family Nursing. 4, (2), 182-197.
  6. 6.0 6.1 6.2 Woods, B., Spector, A.E., Jones, C.A., Orell, M., Davies, S.P.2009. "Reminiscence therapy for dementia (Review)." The Cochrane Library. 1: 1-34.
  7. Lewis, C.N. 1971. “Reminiscing and Self-Concept in Old Age.” Journal of Gerontology. 26, (2), 240-243.
  8. 8.0 8.1 Bornat, J. 1989. “Oral History as a Social Movement: Reminiscence and Older People.” Oral History Society. 17, (2), 16-24.
  9. Coleman, P.G. 2005. “Uses of Reminiscence: Functions and Benefits.” Aging and Mental Health. 9, (4), 291-294.
  10. Kasl-Godley, J., & Gatz, M. (2000). "Psychosocial Interventions for Individuals With Dementia: An Integration of Theory, Therapy and Clinical Understanding of Dementia." Clinical Psychology Review, 20(6), 755–782.
  11. Erikson, E. (1959). "Identity and the life cycle: Selected papers." Psychological Issues, 1, 50-100
  12. Butler, R.N. (1963). "The life review: an interpretation of reminiscence in the aged." Psychiatry, 26, 65-76.
  13. 13.0 13.1 Wang, J.J. 2007. "Group reminiscence therapy for cognitive and affective function of demented elderly in Taiwan." International Journal of Geriatric Psychiatry. 22: 1235-1250.
  14. 14.0 14.1 14.2 14.3 14.4 14.5 Jonsdottir, H., Jonsdottir, G., Steingrimsdottir, E., & Tryggvadottir, B. (2001). "Group reminiscence among people with end-stage chronic lung diseases" Journal of Advanced Nursing. 35(1), 79-87
  15. 15.0 15.1 15.2 15.3 15.4 Hsieh, H.F. & Wang, J.(2003. "Group reminiscence therapy for cognitive and affective function of demented elderly in Taiwan" International Journal of Geriatric Psychology40,335-345
  16. Stinson, C.K. & Kirk, E. (2005)."Structured reminiscence: an intervention to decrease depression and increase self-transcendence in older women" Journal of Clinical Nursing. 15, 208-218
  17. 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 Pinquart, M. and Forstmeier, S. 2012. "Effects of reminiscence interventions on psychosocial outcomes: A meta-analysis." Aging and Mental Health. 1-18.
  18. 18.0 18.1 18.2 Akanuma, K., Meguro, K., Meguro, M., Sasaki, E., Chiba, K., Ishii, H., and Tanaka, N. 2010. "Improved social interaction and increased anterior cingulate metabolism after group reminiscence with reality orientation approach for vascular dementia." Psychiatry Research: Neuroimaging. 192: 183–187
  19. 19.0 19.1 19.2 Tanaka, K., Yamada, Y., Kobayashi, Y., Sonohara, K., Machida, A., Nakai, R., Kozaki, K., and Toba. 2007. "Improved cognitive function, mood and brain blood flow in single photon emission computed tomography following individual reminiscence therapy in an elderly patient with Alzheimer's disease." Geriatric Gerontology International. 7: 305–309
  20. 20.0 20.1 20.2 20.3 Bohlmeijer, E., Roemer, M, Phd, P.C and Smit, F. 2007. "The effects of reminiscence on psychological well-being in older adults: A meta-analysis." Aging and Mental Health. 11:3, 291-300
  21. Su, T.S., Wu, L.L., and Lin, C.P. 2012. "The prevalence of dementia and depression in Taiwanese institutionalized leprosy patients and the effectiveness evaluation of reminiscence therapy and longitudinal, single - blind, randomized control study." International Journal of Geriatric Psychiatry. 27: 187 - 196. .
  22. Fujiwara, E., Otsuka, K., Sakai, A., Hoshi, K., Sekiai, S., Kamisaki, M., Ishikawa, Y., Iwato, S. and Chida, F. 2012. "Usefulness of reminiscence therapy for community mental health." Psychiatry and Clinical Neurosciences. 66: 74-79.
  23. Stinson, C.K. 2006. "Structured reminiscence: an intervention to decrease depression and increase self-transcendence in older women." Journal of Clinical Nursing. 15: 208-218.
  24. 24.0 24.1 Wu, L.F. 2011. "Group integrative reminiscence therapy on self-esteem, life satisfaction and depressive symptoms in institutionalized older veterans." Journal of Clinical Nursing. 20. 2195–2203 2195.
  25. Korte, J., Bohlmeijer, E.T, Westerhof, G.J and Pot, A.M. 2011. "Reminiscence and adaptation to critical life events in older adults with mild to moderate depressive symptoms." Aging and Mental Health.15(5):638-646

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