Ernst Thomas Bohlmeijer

Mapping the Future of Reminiscence: A Conceptual Guide for Research and Practice

Nearly 50 years after Butler’s seminal 1963 contribution, the field of reminiscence and life review is entering a more mature stage. Isolated examples of increasingly sophisticated studies have recently emerged that can serve as a sound, cumulative data base. However, the field lacks an overarching conceptual model describing emerging trends, neglected domains, and key linkages among component parts. In the present article, the authors selectively, yet critically, review prior limitations and promising developments and then describe a comprehensive, multifaceted conceptual model that can guide future research and practice. The authors initially situate their model within a particular theoretical orientation (i.e., life-span psychology). They then describe a heuristic model that identifies and discusses triggers, modes, contexts, moderators, functions, and outcomes. Finally, the authors illustrate how these interactive factors influence both theoretical and applied areas.

Improvement in Personal Meaning Mediates the Effects of a Life Review Intervention on Depressive Symptoms in a Randomized Controlled Trial

PURPOSEnThe purpose of the study was to assess the impact of a life review intervention on personal meaning in life and the mediating effect of personal meaning on depressive symptoms as the primary outcome of this form of indicated prevention.nnnDESIGN AND METHODSnA multicenter randomized controlled trial was conducted with one group of older adults obtaining life review (N = 83) and the other watching a video about the art of growing older (N = 88). Measurements took place before and after the intervention as well as 6 months later at follow-up.nnnRESULTSnIt was found that those who followed life review improved more in personal meaning than those in the control group, although at follow-up the difference was no longer significant. Improvements in meaning during the intervention predicted decreases in depressive symptoms later in time and mediated the effects of the program on depressive symptoms.nnnIMPLICATIONSnPersonal meaning is an important asset in contemporary society, which some older adults find difficult to achieve. The findings from this study show that it is possible to support older persons in their search for meaning by means of life review and that this helps in alleviating depressive symptoms.

Creative reminiscence as an early intervention for depression: Results of a pilot project

Reminiscence may help in resolving conflicts from the past and making up the balance of ones life. Life-review may be further enhanced by the creative expression of memories in stories, poems or drawings. In this way people are encouraged to create and discover metaphors, images and stories that symbolically represent the subjective and inner meaning of their lives. In this article, a new intervention, which combines reminiscence and creative expression aimed at early treatment of depression, is described. A pilot project showed that the intervention Searching for the meaning in life may generate small-sized effects in reducing depression. Additionally, it appears to generate effects of medium size in enhancing mastery. Several possible ways to improve the effectiveness of the intervention are described.

Life review therapy for older adults with moderate depressive symptomatology: a pragmatic randomized controlled trial

BACKGROUND. Although there is substantial evidence for the efficacy of life review therapy as an early treatment of depression in later life, its effectiveness in natural settings has not been studied. The present study evaluates an intervention based on life review and narrative therapy in a large multi-site, pragmatic randomized controlled trial(RCT). METHOD. Life review therapy was compared with care as usual. The primary outcome was depressive symptoms;secondary outcomes were anxiety symptoms, positive mental health, quality of life, and current major depressive episode (MDE). To identify groups for whom the intervention was particularly effective, moderator analyses were carried out (on sociodemographic variables, personality traits, reminiscence functions, clinically relevant depressive and anxiety symptoms, and past MDEs). RESULTS. Compared with care as usual (n=102), life review therapy (n=100) was effective in reducing depressive symptoms, at post-treatment (d=0.60, B= -5.3, p<0.001), at 3-month follow-up (d=0.50, B= -5.0, p<0.001) and for the intervention also at 9-month follow-up (t=5.7, p<0.001). The likelihood of a clinically significant change in depressive symptoms was significantly higher [odds ratio (OR) 3.77, p<0.001 at post-treatment ; OR 3.76, p<0.001 at the 3-month follow-up]. Small significant effects were found for symptoms of anxiety and positive mental health.Moderator analyses showed only two significant moderators, the personality trait of extraversion and the reminiscence function of boredom reduction. CONCLUSIONS. This study shows the effectiveness of life review therapy as an early intervention for depression in an ecologically valid context, supporting its applicability to a broad target group. The intervention is also effective in reducing anxiety symptoms and strengthening positive mental health.

The impact of life review on depression in older adults: a randomized controlled trial

BACKGROUNDnWe developed an indicated preventive life-review course, Looking for Meaning, based on the assumption that reminiscence styles influence coping with depressive symptoms. This study describes the impact of this course in a pragmatic randomized controlled trial.nnnMETHODSnInclusion criteria were >50 years, a score of 5 or higher on the Center for Epidemiological Studies Depression Scale (CES-D), and no depressive disorder or psychotropic or psychological treatment. Participants were randomized and stratified by gender: the experimental group (N = 83) was offered the course and the comparison group (N = 88) a movie. There were three measurements: pre-treatment, post-treatment and 6 months after post-treatment. Depressive symptoms constituted the primary outcome. Secondary outcomes were anxiety symptoms, satisfaction with life, mastery and reminiscence styles. All analyses were conducted according to the intention-to-treat principle. Missing values were replaced by regression imputation.nnnRESULTSnThe course reduced depressive symptoms, a decrease that was retained during follow-up. A significant between-group effect size was found (d = 0.58). There was also a reduction in symptoms of anxiety; however, the comparison group showed the same reduction, resulting in a small between-group effect size. Gender and level of depressive symptoms were found to be prognostic factors for the change in depressive symptoms; age was not. Post hoc analyses showed significant between-group effect sizes for females and those with a score above the cut-off of the CES-D.nnnCONCLUSIONnThe course Looking for Meaning can be recommended for people aged over 50 years, females and older adults with a clinically relevant level of depressive symptoms (above cut-off) in particular.

Reminiscence and adaptation to critical life events in older adults with mild to moderate depressive symptoms

Objectives: The role of reminiscence as a way of adapting to critical life events and chronic medical conditions was investigated in older adults with mild to moderate depressive symptoms. Reminiscence is the (non)volitional act or process of recollecting memories of ones self in the past. Method: 171 Dutch older adults with a mean age of 64 years (SDu2009=u20097.4) participated in this study. All of them had mild to moderate depressive symptoms. Participants completed measures on critical life events, chronic medical conditions, depressive symptoms, symptoms of anxiety and satisfaction with life. The reminiscence functions included were: identity, problem solving, bitterness revival and boredom reduction. Results: Critical life events were positively correlated with identity and problem solving. Bitterness revival and boredom reduction were both positively correlated with depressive and anxiety symptoms, and negatively to satisfaction with life. Problem solving had a negative relation with anxiety symptoms. When all the reminiscence functions were included, problem solving was uniquely associated with symptoms of anxiety, and bitterness revival was uniquely associated with depressive symptoms and satisfaction with life. Interestingly, problem solving mediated the relation of critical life events with anxiety. Discussion: This study corroborates the theory that reminiscence plays a role in coping with critical life events, and thereby maintaining mental health. Furthermore, it is recommended that therapists focus on techniques which reduce bitterness revival in people with depressive symptoms, and focus on problem-solving reminiscences among people with anxiety symptoms.

Mediating processes in an effective life-review intervention.

Life review has been established as an evidence-based treatment for depression and anxiety. This paper addresses an important gap in the existing evidence of the working mechanisms of life review. We were able to longitudinally investigate possible mediators of a life-review intervention on depression and anxiety in the context of a large randomized controlled trial. A total of 202 older Dutch adults living in the community participated in this study. They were randomly assigned to either life review or care as usual. Participants were measured in terms of their depressive and anxiety symptoms, reminiscence functions, meaning in life, mastery and positive thoughts at study entry (t0), postintervention (t1; 3 months after study entry), and follow-up (t2; 3 months after the end of the intervention). Findings suggest that processes which have been theoretically and empirically proposed as important processes of change in life review therapy, that is, bitterness revival and boredom reduction reminiscence, mastery and positive thoughts, are indeed mediating the effects of life review on depression and anxiety. It is now recommended to measure these processes during the intervention in order to shed light on the exact process of change and direction of causality.