A self-help process aimed at better understanding and accepting life events benefited depressed middle aged and older adults in a small Dutch trial.
Participants rated the 10-week "life-review" program highly and showed reduced depression and anxiety for up to a year afterwards, researchers say.
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“Life-review is taking perspective,” said Ernst Bohlmiejer, a co-author of the study. “At a certain moment one realizes that life is short and has an ending. Life-review makes you slow down and ask yourself some important questions.”
Life-review, described as a structured evaluation of one’s past, has been found effective against depression among older people, the authors write in The Journals of Gerontology: Series B.
But it was unclear if the approach would help people as young as 40 and if it could work as a guided self-help program rather than a face to face therapy.
The research group, from the University of Twente in Enschede, the Netherlands, recruited applicants age 40 and older with mild to moderate depression symptoms and excluded those currently or previously receiving psychological treatment or medication.
The 174 participants, whose median age was about 57, were then divided into three groups with 58 people in each. One group did the life-review program, another was put on a waiting list for the program to act as a comparison, and a third group was assigned to an expressive writing program as a more active comparison.
The life-review group received the book The Stories We Live By, written by Bohlmiejer, and completed a series of seven modules over the course of ten weeks. The first four modules prompted participants to associate both a positive and a difficult memory with themes such as childhood, family, and friendship, while the last three modules asked them to sum up the experience and focus on the future.
The expressive writing intervention consisted of daily writing about emotional experiences for 15 to 30 minutes on three to four consecutive days. It had seven modules that moved from a focus on negative experiences to a focus on positive ones, and ended with participants writing a letter to a friend.
Both groups also received email guidance from counselors, but to varying degrees. The life-review group received narrative counseling that included specific questions encouraging participants to reframe their negative memories.
The expressive writing group only received positive feedback on the process, keeping the writing exercises open and unstructured.
The researchers, led by Sanne Lamers, measured depression and anxiety symptoms before the interventions and three months later. Both intervention groups showed marked reductions in depression symptoms, although there was little difference between the two.
On a scale of 0 to 60, with a higher score representing worse depression, the life-review participants started with an average score of 24.31, which fell to 15.88 after three months.
The writing group started with an average score of 23.91, which fell to 14.55.
Even the waiting list group showed a small decrease in depression symptoms, from an average score of 22.9 to 18.75.
The results were less dramatic for anxiety symptoms, measured on a scale of 0 to 21. Scores for both the life-review and expressive writing participants fell by more than 2 points, while the waiting list group’s score fell by 1.53.
For the life-review and expressive writing groups, the researchers measured symptoms again at six months and 12 months. The results seemed to waver but remained lower than where the participants began.
The life-review group’s depression symptoms jumped to 17.59 at six months but fell to 15.83 at 12 months, while the expressive writing group score steadily rose to 15.62 after six months and 17.37 at 12 months.
The longer-term measurements fill an important gap in understanding the effects of life-review, Lamers and her colleagues point out in their report.
“Life-review can help depressed people to feel better when they follow a course at home with a self-help book and counseling by e-mail. This is a new insight, because to date life-review was only studied as a face-to-face therapy, either individual or in a group,” Lamers said.
“Life-review not only works for older adults, but also for middle-aged adults of 40 years and over,” she said. “Life-review is mainly applied in older adults and our results show that it is relevant for other age groups as well.”
Bohlmiejer thinks the results show the effectiveness of life-review in reflecting and reconsidering life stories. When you are depressed you can lose sight of the larger picture and focus too much on the negative details, he said. “There are always positive exceptions and memories about positive events. These are starting points for other stories.”
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The World Health Organization says that worldwide more than 350 million people of all ages suffer from depression and that fewer than half of them receive effective treatment. Lamers said life-review is a process that many can easily adopt.
“Recollecting memories is something we all do in our everyday lives. This makes life-review such a great therapy because we can use a relatively easy activity we are all familiar with to make people feel better,” she said.