INTEGRATIVE AND INSTRUMENTAL REMINISCENCE THERAPIES FOR DEPRESSION IN OLDER ADULTS: INTERVENTION STRATEGIES AND TREATMENT EFFECTIVENESS

Reminiscence has been identi® ed as an important contributor to adaptation in later life by gerontologists, developmental theorists and clinical practitioners. Despite its wide acceptance as an intervention, there remains some doubt about its therapeutic efficiency. In order to assess the value of reminiscence for the treatment of depression in older adults, cognitive theories of depression were integrated with reminiscence theory to develop two standardized integrative and instrumental reminiscence interventions. Integrative reminiscence therapy aims at a constructive re-appraisal of interpretations and emotions to past self-de® ning events, whereas instrumental reminiscence uses memories for providing evidence of past successful coping and for identifying appropriate coping strategies. These interventions were implemented in a short-term group format and compared to an active socialization group as the control condition.Twenty-six older adults with moderate to severe depression constituted the sample. Evaluation of the clinical signi® cance of the results showed that both reminiscence therapies led to signi® cant improvements in the symptoms of depression at the end of the intervention. In the integrative group, 58% of clients demonstrated clinically signi® cant improvement at post-test, yielding an effect size (ES) of 0.86. At follow-up three months later, 100% of integrative clients had improved clinically (ES=0.96). In the instrumental group, 56% of clients demonstrated clinically signi® cant improvement at post-test (ES=0.81) and 88% improved at the follow-up (ES=0.89). Recognition of the unique needs and concerns involved in adaptation to the later stages of life has led clinicians to modify traditional interventions,such as cognitive and interpersonal approaches, to address psychological issues of particular relevance to older adults experiencing depression (e.g. Clarke & Lewinsohn, 1989; Cohen, 1990; Hebl & Enright, 1993; Leszcz, 1990; Miller et al., 1994; Moberg & Lazarus, 1990). Unique interventions that are speci® cally designed for use with older adults have also been developed. Reminiscence (or life review) therapy is one intervention which has been developed to provide an alternative to the more traditional approaches to psychotherapy with older adults. The idea that reminiscence plays a major role in successful aging (Butler, 1974) has gained currency among researchers and practitioners (Coleman, 1986; Cook, 1991; Kaminsky, 1984). An increasing number of seniors centres and nursing homes have included some form of life review discussion group as part of their regular programs (Birren & Deutchman, 1991; Kaminsky, 1984). Reports on the clinical value of reminiscence and its attractiveness to the elderly population continue to appear regularly in the literature (see Thornton & Brotchie, 1987 and Haight, 1991 for reviews; Arean et al., 1993; Goldstein, 1987; Magee, 1988; Rybarczk & Auerbach, 1990). After reviewing more than 100 published articles, Haight (1991) concluded that the majority recognized reminiscing as providing a variety of therapeutic bene® ts to older adults. This positive evaluation of reminiscence, however, was based to a great extent on unreplicated single case studies and clinical observations of reminiscence therapy. Several investigations which have empirically evaluated the effectiveness of reminiscence intervention on depression and psychological variables related to depression support the utility of reminiscence as a therapeutic intervention (e.g. Arean et al., 1993; Fry, 1983; Rattenbury & Stones, 1989). In contrast, other studies do not support the effectiveness of reminiscence therapy in the treatment of depression (e.g. Cook, 1991; Fallot, 1979± 80; Perotta & Meacham, 1981± 82; Stevens-Ratchford, 1993). In summary, the research on reminiscenceinterventions is characterized by inconclusive ® ndings. Evaluation of the efficacy of reminiscence will continue to be inconsistent and inconclusive until research is guided by a comprehensive theoretical framework of reminiscencewhich speci® es the content of reminiscence that is critical to adaptation, the function reminiscenceserves for speci® c populations, and the psychological change processes which should be evaluated in reminiscence interventions. A ® rst step Correspondence to: Philippe Cappeliez, School of Psychology, 11 Marie Curie Street, Ottawa, Ontario K1N 6N5, Canada. Tel: + 613 562 5800 ext. 4806. Fax: +613 562 5169. E-mail: pcappeli@uottawa.ca Received for publication 8th May 1999. Accepted 10th January 2000. ISSN 1360± 7863 print/ISSN 1364± 6715 online/00/020166± 12 1⁄2 Taylor & Francis Ltd in this direction is the recognition that reminiscence is not a unitary phenomenon. Webster and Haight (1995) have concluded from their review that taxonomies which have been proposed overlap in major dimensions. Among these classi® cations, the comprehensive system proposed by Watt and Wong (1991) speci® es guidelines for the reliable classi® cation of reminiscence.On the basis of content analysis of reminiscence data collected from 400 seniors, the authors identi® ed six different types of reminiscence: integrative, instrumental, transmissive, narrative, escapist and obsessive. Wong andWatt (1991) investigated the differential relationships of these different types of reminiscence with adaptation and well-being among older adults. Successful elderly people assessed on mental and physical health and adjustment engaged in integrative and instrumental reminiscenceto a greater extent than unsuccessful older adults. The ® nding that integrative and instrumental types of reminiscence were associated with successful aging provided the impetus for further examination of the speci® c cognitive and affective processes invoked by use of these two types of reminiscence in treatment of depression.A theoretical understandingof how these specific types of reminiscence are linked with appropriate target symptoms was attempted in the context of an integration of reminiscence and cognitive models of depression and coping (Watt & Cappeliez, 1995). The theoretical model and intervention strategies for integrative and instrumental reminiscence are developed below. Implementation of integrative reminiscence intervention: a cognitive re-attribution