Usefulness of reminiscence therapy for community mental health
Ema Fujiwara, BA, CP, Department of Neuropsychiatry, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate 020-8505, Japan. Email: firstname.lastname@example.org
Reminiscence therapy workshops for health-care professionals (total, n = 105: four trainees in their 20, seven in their 30s, 13 in their 40s, 30 in their 50s, 41 in their 60, five in their 70s, one in their 80s, and four of unknown age) were held, and group work with reminiscence therapy was provided to local residents (total, n = 151; mean age, 73.6 ± 10.6 years). Comparison of pre- and post-workshop questionnaires showed that rates of interest and understanding of trainees increased after the workshop. Concerning group work, 89.2% of the participants felt that reminiscence therapy would prove helpful in their life. Reminiscence therapy may be useful in improving mental health in local residents.
IN IWATE PREFECTURE, the death rate by suicide has been very high, and the Kuji district has been one of the areas with a particularly high suicide rate in Iwate over the last two decades.1 This led to establishment of a meeting place called Tagukiri (a word in this district's dialect meaning ‘chattering’) for senior citizens who have few opportunities to talk with other residents in the Kuji district, where the rate of suicide by the elderly is high.
Reminiscence therapy has been practiced by a wide range of professionals involved in the care of senior citizens, and several studies have reported its use as part of community activities.2–4 The present study was conducted to determine whether reminiscence therapy is useful in improving mental health in local society.
Training workshop on reminiscence therapy for staff
In the Kuji district, in order to adopt reminiscence therapy in health education programs and the Tagukiri meeting place, psychotherapists and psychiatrists carried out reminiscence therapy workshops for staff. The workshop was held a total of three times.
Lectures at the workshop consisted of basic communication skills for professionals who would provide support to others, the theory of reminiscence therapy, actual procedures in the therapy, how to create the best atmosphere for talking, and how to handle difficulties. The trainees then watched a video of a real example of the therapy, followed by role-playing in a small group.
Before and after the workshop, a self-administered questionnaire was completed (Table 1). The questionnaire was originally prepared by the authors, based on the literature concerning community mental health.
Table 1. Trainee questionnaire results
|Do you think it is important to have someone to talk to when you are depressed?|
| I think so||61/66 (97.0)||62/62 (100.0)|| |
| I don't think so||1/66 (1.5)||0/62 (0.0)|
| I am not sure||1/66 (1.5)||0/62 (0.0)|
|Do you think it is important to be able to talk to local people about your mental health?|
| I think so||63/66 (95.5)||62/62 (100.0)|| |
| I don't think so||0/66 (0%)||0/62 (0.0)|
| I am not sure||3/66 (4.5)||0/62 (0.0)|
|What do you think is useful for education purposes in the following activities?|
| Lectures|| || || |
| I think so||51/91 (56.0)||51/91 (56.0)||1.00|
| I don't think so||40/91 (44.0)||40/91 (46.0)|
| Leaflets|| || || |
| I think so||22/91 (24.2)||24/91 (26.4)||0.727|
| I don't think so||69/91 (75.8)||67/91 (73.6)|
| Video|| || || |
| I think so||40/91 (44.0)||39/91 (42.9)||1.000|
| I don't think so||51/91 (56.0)||52/91 (57.1)|
| Picture story show|| || || |
| I think so||32/91 (35.2)||30/91 (33.0)||0.754|
| I don't think so||59/91 (64.8)||61/91 (67.0)|
| Quiz|| || || |
| I think so||14/91 (15.4)||19/91 (20.9)||0.227|
| I don't think so||77/91 (84.6)||72/91 (79.1)|
| Group work|| || || |
| I think so||45/91 (49.5)||57/91 (62.6)||0.043|
| I don't think so||46/91 (50.5)||34/91 (37.4)|
| Relax method|| || || |
| I think so||43/91 (47.3)||33/91 (36.3)||0.041|
| I don't think so||48/91 (52.3)||58/91 (63.7)|
| Play|| || || |
| I think so||12/91 (13.2)||17/91 (18.7)||0.125|
| I don't think so||79/91 (86.8)||74/91 (81.3)|
| Screening|| || || |
| I think so||21/91 (23.1)||29/91 (31.9)||0.077|
| I don't think so||70/91 (76.9)||62/91 (68.1)|
| Counseling on mental issues|
| I think so||51/91 (56.0)||51/91 (56.0)||1.000|
| I don't think so||40/91 (44.0)||40/91 (44.0)|
|Do you include group work in your education activities?|
| Yes||34/75 (45.3)||39/75 (52.0)||0.582|
| No||25/75 (33.3)||23/75 (30.7)|
| I'm not sure||16/75 (21.3)||13/75 (17.3)|
|Was group work effective for your education activities?|
| Yes||44/76 (57.9)||60/76 (78.9)||0.000|
| No||0/76 (0.0)||0/76 (0.0)|
| I'm not sure||32/76 (42.1)||16/76 (21.1)|
|Do you think reminiscence therapy should be provided in a group?|
| I think so||47/89 (52.8)||80/89 (89.9)||0.000|
| I don't think so||0/89 (0.0)||0/89 (0.0)|
| I am not sure||42/89 (47.2)||9/89 (10.1)|
|Would you like to do reminiscence therapy in group work?|
| I think so||46/85 (54.1)||74/85 (87.1)||0.000|
| I don't think so||0/85 (0.0)||0/85 (0.0)|
| I am not sure||39/85 (45.9)||11/85 (12.9)|
|Is there anything you are not sure about in providing reminiscence therapy?|
| How to organize therapy|
| I am sure||36/69 (52.2)||60/69 (87.0)||0.000|
| I am not sure||33/69 (47.8)||9/69 (13.0)|
| How to introduce therapy|
| I am sure||33/69 (48.9)||60/69 (87.0)||0.000|
| I am not sure||36/69 (51.1)||9/69 (13.0)|
| I am sure||45/69 (65.2)||61/69 (88.4)||0.002|
| I am not sure||24/69 (34.8)||8/69 (11.6)|
| How to provide therapy|
| I am sure||29/69 (42.0)||54/69 (78.3)||0.000|
| I am not sure||40/69 (58.0)||15/69 (21.7)|
| How to handle difficulties|
| I am sure||26/69 (37.7)||26/69 (37.7)||1.000|
| I am not sure||43/69 (62.3)||43/69 (62.3)|
| How to end therapy|
| I am sure||49/65 (71.0)||59/69 (85.5)||0.052|
| I am not sure||20/69 (29.0)||10/69 (14.5)|
|What do you think is important in screening for depression in your region?|
| Important||25/64 (39.1)||34/64 (53.1)||0.035|
| Not important||39/64 (60.9)||30/64 (46.9)|
| Awareness of the person responsible for screening|
| Important||38/64 (59.4)||38/64 (59.4)||1.000|
| Not important||26/64 (40.6)||26/64 (40.6)|
| Liaison for relevant organizations (network)|
| Important||36/64 (56.3)||36/64 (56.3)||1.000|
| Not important||28/64 (43.8)||28/64 (43.8)|
| Support for people engaged in screening|
| Important||24/64 (37.5)||27/64 (42.2)||0.607|
| Not important||40/64 (62.5)||37/64 (57.8)|
| Support for high risk individuals|
| Important||26/64 (40.6)||31/64 (48.4)||0.267|
| Not important||38/64 (59.4)||33/64 (51.6)|
| Follow-up of incidents/accidents|
| Important||19/64 (29.7)||18/64 (28.1)||1.000|
| Not important||45/64 (70.3)||46/64 (71.9)|
|How confident are you in doing group work using reminiscence therapy? Visual analog index 0–100%||27.23 ± 24.51||46.27 ± 23.28||0.000|
|In your opinion, how effective is the group work using reminiscence therapy? Visual analog index 0–100%||55.10 ± 27.55||65.83 ± 22.55||0.000|
|In your opinion, how useful is group work using reminiscence therapy for regional mental health? Visual analog index 0–100%||59.15 ± 25.56||68.44 ± 20.64||0.000|
Reminiscence therapy in health education programs for local residents
A monthly health education class was given in each block of the Kuji district to maintain the mental health of citizens, with the combined efforts of the citizen's network, that is, local public health nurses (PHNs), public health committees, listening volunteers, and dietary habit improvement committees. This was a case of incorporating reminiscence therapy into health education programs sponsored by regional organizations and offering it to local residents.
A total of seven sessions (two health education classes, three classes of disease prevention in future nursing care for the elderly, one Tagukiri meeting, and one Tagukiri meeting outside of the center) were held in 2006, and two sessions (two health education classes as of September) in 2007.
After the reminiscence therapy sessions, the citizens were asked to complete a questionnaire (Table 2). The questionnaire was originally prepared by the authors, based on the literature concerning community mental health.
Table 2. Local citizen questionnaire results
|1. Did you enjoy talking?||146/150 (97.3)|
|2. Did you enjoy listening to other people?||151/149 (98.7)|
|3. How was the experience of talking to other people?|| |
| Enjoyable||119/149 (79.9)|
| Refreshing||49/149 (32.9)|
| Fun||100/149 (67.1)|
| Felt nervous||18/149 (12.1)|
| Hard||0/149 (0.0)|
| Painful||0/149 (0.0)|
| I would like to talk more||34/149 (22.8)|
| I would like to listen more||85/149 (57.0)|
| Satisfying||59/149 (39.6)|
| Interesting||61/149 (40.9)|
| Boring||0/148 (0.0)|
| I feel glad||72/149 (48.3)|
| I feel sad||1/149 (0.7)|
| It cheers me up||96/149 (64.4)|
| Depressing||2/149 (1.3)|
|4. Do you think that the group work will help your daily conversations?||132/148 (89.2)|
|5. How exactly do you think it will help?||I think so (%)|
| How to talk||55/130 (42.3)|
| How to listen||74/130 (56.9)|
| How to find a topic||35/130 (26.9)|
| How to raise a topic||14/130 (10.8)|
| Contents of the talk||36/129 (27.9)|
| How to proceed with the talk||29/130 (22.3)|
|6. Would you like to continue with talking in the group?||137/148 (92.6)|
This intervention study was approved by the Ethics Committee, School of Medicine of Iwate Medical University.
The breakdown of trainees was as follows: 19 PHNs, five nurses, one clinical psychotherapist, one administrative officer, 44 public health committee members, 32 attentive listening volunteers, and three with no description (four men, 91 women, 10 unknown). By age, four trainees were in their 20, seven in their 30s, 13 in their 40s, 30 in their 50s, 41 in their 60s, five in their 70, one in their 80s, and four with age unknown.
The group work was attended by a total of 151 citizens (139 female, seven male, five unknown). The mean age was 73.6 ± 10.6 years.
For statistical analysis, SPSS 16.0J for Windows was used. For comparisons of mean values, the t-test and the Wilcoxon signed-rank test were used, while for comparisons of ratios the McNeamar test was used. The level of significance was set at 5%.
All trainees and general citizens responded to the questionnaire.
As shown in Table 1, the trainees were strongly aware at baseline of the importance of having someone to consult and talk with in maintaining mental health. Both the number of trainees who thought that ‘reminiscence therapy should be provided in group work’ and the number of those who ‘would like to use reminiscence therapy in group work’ considerably increased after the workshop. In addition, rates of understanding by trainees increased after the workshop. Wilcoxon's signed-rank test showed that the numbers of trainees who are ‘confident of working in groups with reminiscence therapy,’ who think that ‘reminiscence therapy is effective,’ and who think that ‘reminiscence therapy is effective in improving community mental health programs’ increased after the workshop.
Concerning the group work for local residents, 97.3% of them enjoyed their experience of talking, and 98.7% enjoyed listening to the other citizens (Table 2). There were many positive comments, such as ‘enjoyable’ or ‘the therapy cheered me up’. A large proportion (89.2%) of the participants felt that the group work with reminiscence therapy would help in their daily life, and 92.6% wished to continue the program.
We believe that the workshop helped to develop trainees' recognition that reminiscence therapy is a useful method for establishing the habit of talking in local society. The workshop included not only lectures but also an active learning process.
Reminiscence therapy has been reported to prevent or reduce depression.5,6 The general citizens in the present study also gave answers on the questionnaire showing the positive effects of treatment on their mood. These findings appear to support the previously reported effects of this therapy, such as increase in satisfaction with daily life, self-esteem, and comfort with self.
The therapy also produces social and interpersonal effects that improve social adaptability and social skills.5,7–9 In response to the group work, many citizens answered positively, suggesting that the group work promoted the elderly citizens' social activities, decreased their sense of loneliness and alienation, and improved their social adaptability.
Reminiscence therapy does not require an expensive facility, and it can be performed anywhere. Once a support system with training or supervision by specialists is established, it is also possible to increase the number of staff involved.
The present findings suggest that a community-based, comprehensive health strategy that can be achieved by adopting a narrative methodology using reminiscence therapy in cooperation with the social resources of local volunteers, as well as of specialists and health-care professionals, may be useful in promoting local mental health.
Part of this work was supported by the Japanese Multimodal Intervention Trials for Suicide Prevention and the Iwate Longevity Society Promotion Foundation (Grant-in-aid for Health and Welfare of the Elderly).