Reminiscence therapy

Reminiscence therapy is used to counsel and support older people, and is an intervention technique with brain-injured patients and those who appear to have "Alzheimer's and other forms of cognitive disease."

A 2018 AARP article about a standalone demonstration project named ''Glenner Town Square'' focused on those who seem to have Alzheimer's or some (other) form of dementia. Glenner's goal is described as "capture the years between 1953 and 1961 so that project participants are calmly back in a time period to recollect ages 10 to 30, when "our strongest memories are formed."

Reminiscence therapy is defined by the American Psychological Association (APA) as "the use of life histories – written, oral, or both – to improve psychological well-being. The therapy is often used with older people." This form of therapeutic intervention respects the life and experiences of the individual with the aim to help the patient maintain good mental health.

The majority of research on reminiscence therapy has been done with the elderly community, especially those suffering from depression, although a few studies have looked at other elderly samples.

Research and implementation has been tried in several areas with diverse cultures
such as Japan, United Kingdom, USA.

Reminiscence

Reminiscence has been described as “the volitional or non-volitional act or process of recollecting memories of oneself in the past”. 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.The meaningfulness of the reminiscence process depends on how meaningful the memories being recalled are. 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.

Reminiscence serves different psychological functions, including the taxonomy presented by Webster. Webster's Reminiscence Functions Scale (RFS) includes eight reasons why people reminisce: boredom reduction, bitterness revival, prepare for death, conversation, identity, intimacy maintenance, problem solving, and teach/inform. Psychologists have looked at using reminiscence therapeutically to improve affect and coping skills, although the effectiveness of this therapy has been debated. From more recent data, as outlined below, the therapy appears to have positive and even lasting results within the elderly community.

There are different types of reminiscence which can take place. The two main subtypes are intrapersonal and interpersonal reminiscence. 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. Information reminiscence is done to be able to enjoy the retelling of stories from one's past. 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. 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. 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. By sharing stories about the loved one's life they can remember fond memories and gain a sense of peace with the death.

Method

Reminiscence therapy is often used in a nursing home or "geriatric health facility." The structure of reminiscence therapy can vary greatly. In one documented session, a therapist played different songs from the 1920s-1960s and asked the patients which songs resonate or have a special meaning. In another session from the same therapist, the participants shared photographs and had a show-and-tell about why the pictures were important to them.

Psychological research has identified two types of reminiscence therapies that are particularly effective: integrative and instrumental.
* Integrative reminiscence therapy is a process in which individuals attempt to accept negative events in the past, resolve past conflicts, reconcile the discrepancy between ideals and reality, identify continuity between past and present, and find meaning and worth in life. An integrative life review provides individuals with the opportunity to examine events in their lives that may disconfirm negative self-evaluations associated with depression. Many depressed people ignore positive information and focus on memories that support their dysfunctional views, so this therapy helps lead clients to seek fuller, more detailed accounts of their life story and more balanced interpretations of past events. Participants review both good and bad experiences within the context of the entire life, which shows them that negative experiences in one life domain can be mediated with positive events in another. Individuals may disconfirm global, negative evaluations of the self that are associated with depression and begin to develop a more realistic, adaptive view of the self that incorporates both positive and negative attributes.
* Instrumental reminiscence therapy helps the elderly recollect past coping activities and strategies, including memories of plans developed to solve difficult situations, goal-directed activities, and the achievement of one's own goals or goals one helped others meet. Instrumental reminiscence therapy may exert a positive effect on individuals’ self-esteem and efficacy by recollection of successful experiences in which individuals acted effectively to control their environment. This approach to reminiscence therapy puts roles and commitments that are no longer rewarding or attainable to the periphery and helps these patients invest in other goals that are more in tune with current conditions of living. This can be especially helpful for the elderly who may not be able to do what they were once capable of doing.

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. 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. Butler is credited with starting the movement of reminiscence therapy.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. The next advancement in this area was done by Charles Lewis in 1971. Lewis was able to create the first experimental study of reminiscence. Lewis wanted to look at any cognitive changes that may occur from reminiscence as well as how people perceive themselves. 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”. 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 number of professionals trained in this therapeutic process. 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

Disengagement theory

Disengagement theory in reminiscence is used by some therapists and researchers and focuses on the patient withdrawing from social responsibilities. 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. 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. 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.

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. A passage from Lin 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.

Reminiscence Therapy

Reminiscence therapy makes use of life events by having participants vocally recall episodic memories from their past. It helps provide people with a sense of continuity in terms of their life events. Reminiscence therapy may take place in a group setting, individually, or in pairs depending on the aim of the treatment Reminiscence therapy can also be structured or unstructured within these configurations. 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. These individual needs will determine whether the therapy is conducted in a group setting or alone with a practitioner. Memories are processed chronologically starting at birth and focusing on major, significant life events. The focus is reflection, not simply recall. Reminiscence therapy may use prompts such as photographs, household items, music, or personal recordings.

Applications of reminiscence therapy

Reminiscence Therapy is used predominately in elderly patients This may in part be due to the common disorders reminiscence therapy has been used for are prevalent in the elderly, such as depression. 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. Patients with chronic conditions may also benefit from reminiscence therapy, as they often suffer socially and emotionally. Other issues have been addressed using reminiscence therapy, including behavioural, social, and cognitive problems. Studies have found group reminiscence therapy sessions may lead to strengthened social relationships and friendships within the group.

Mental health and life improvement

Many studies have examined the effects of reminiscence therapy on overall affect. One group of researchers implemented reminiscence therapy into a community in response to a rash of suicides. The researchers administered the therapy to older adults (predominantly women) at a local community center for the elderly. A questionnaire administered after the group reminiscence therapy session revealed that 97.3% of participants enjoyed the experience of talking, 98.7% enjoyed listening to others, 89.2% felt that the group work with reminiscence therapy would help in their daily life, and 92.6% wished to continue in the program. The researchers suggest their results support the previously reported effects of increased life satisfaction and self-esteem. Another study showed that after one session a week for 12 weeks of integrative reminiscence therapy, institutionalized older veterans in Taiwan experienced significant increases in self-esteem and life satisfaction as compared to the control group. However, there is some evidence that RT can improve quality of life, cognition, communication and possibly mood in people with dementia in some circumstances, although all the benefits were small. More research is needed to understand these differences and to find out who is likely to benefit most from what type of RT. A recent Cochrane review (2018) concluded that reminiscence therapy can improve quality of life, cognition, communication and possibly mood in people with dementia in some circumstances, although all the benefits were small.

Coping skills

A few researchers have posited that the positive effects of reminiscence therapy are the result of increased coping skills. Essentially, these researchers argue reminiscence therapy works because it increases the patient's ability to cope and deal with new situations effectively.

Self-positive reminiscences relate