|
The Effectiveness of
Cognitive-Existential Group Therapy on Reducing
Existential Anxiety in the Elderly
Somayeh Barekati (1)
Bahman Bahmani (2)
Maede Naghiyaaee (3)
Mahgam Afrasiabi (4)
Roya Marsa (5)
(1) MA, Department
of Counseling, University of Social Welfare
and Rehabilitation Sciences, Tehran, Iran
(2) Assistant Professor, Department of Counseling,
University of Social Welfare and Rehabilitation
Sciences, Tehran, Iran
(3) PH.D, Department of Counseling, University
of Social Welfare and Rehabilitation Sciences,
Tehran, Iran
(4) MA, Department of Counseling, University
of Social Welfare and Rehabilitation Sciences,
Tehran, Iran
(5)MA, Department of Counseling, University
of Social Welfare and Rehabilitation Sciences,
Tehran, Iran
Correspondence:
Bahman
Bahmani
Assistant Professor, Department of Counseling,
University of Social Welfare and Rehabilitation
Sciences,
Tehran, Iran
Email:
ba.bahmani@uswr.ac.ir
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Abstract
Introduction and Objective: The
elderly experience significant developmental
changes due to the effects of aging; a
common consequence is the activation of
existential anxieties. In spite of the
natural and constructive nature of existential
anxiety, inappropriate response may lead
to neuroticism. This study aims to investigate
the effectiveness of cognitive-existential
therapy on reducing existential anxiety
in the elderly.
Method: The
present study was carried out using a
pretest-posttest semi-experimental design
with control group and random assignment.
The statistical population included all
the elderly women in Yas Daily Rehabilitation
Center. In this study, 20 people were
selected through non-random sampling and
after answering the Existential Anxiety
Questionnaire (Masoudi Sani, Bahmani,
2015) and Cognitive Distortions Questionnaire
(Abdollahzade et al. 2010 quoted from
Farmani-Shahreza et al. 2016) were randomly
assigned to experimental and control groups
(each group included 10 people). The experimental
group participated in 12 cognitive-emotional
group therapy sessions (each session 90
minutes) once a week in, but the control
group did not receive any intervention.
The collected data were processed using
SPSS-20 software to calculate covariance
analysis.
Results: The
results showed a significant reduction
in the existential anxiety and cognitive
distortions compared to the pretest. Also,
in a two month follow-up session, existential
anxiety and cognitive distortion scores
were significantly reduced compared to
pretest.
Conclusion:
The findings of this research can
be considered as a confirmation of the
basic assumption of the cognitive-existential
approach about the effect of correcting
cognitive distortions that activate non-authentic
responses to the existential anxieties.
Key words:
cognitive-existential group therapy, existential
anxiety, cognitive distortions, the elderly
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Elderliness is a phenomenon that is caused
by changes in biology, physiology, biochemistry
and anatomy in the cells of the body, these
changes affect the function of the cells, and
it begins at age 60. It is not a disease but
a natural process of transformation that cannot
be stopped or reversed (World Health Organization,
2001).
Iran is experiencing the establishment of aging
phenomenon. Statistics show that in 2011, the
population of the elderly over 60 was about
3.8% of the total population of the country
(Iran Statistics Center, 2013), and it is expected
that the number of elderly will reach 10 million
people, that is about 10% of the total population
(Malayeri & Jafari, 2004).
Elderly people experience different consequences
in terms of physical, socio-economic, family,
psychological, and (existential) being dimensions.
In the physical aspect, the elderly experience
several problems, including: 1. chronic physical
illnesses such as high blood pressure and cardiovascular
diseases and diabetes; 2. decreasing abilities
such as vision and hearing; 3. Neuropsychological
disorders, such as dementia, Alzheimer’s
and Depression (Duberstein et al., 2008).
In socioeconomic and family dimensions, problems
such as declining financial status, loss of
job and social status, death or immigration
of close relatives, friends and peers (Wurtman,
1993), and loneliness due to physical weakness
and reduced mobility (Mussen et al., 2005) have
been reported. In the psychological aspect major
problems include: depression (Stuart et al.,
2005), feelings loneliness (Heravi Karimloo
et al. 2007; Wurtman 1993), impatience, anger,
feelings of emptiness, anxiety and concern,
insomnia, tiredness and fatigue ( Kaldi &
Foroughan, 2004).
From other dimensions of aging, one can point
out existential anxieties that are not necessarily
clinical and illness but can be painful and
annoying (Yalom, 1980). The increasing awareness
of the elderly about the finiteness of life
manifests itself with the emergence of the first
signs of aging, and anxiety about the loss of
control, t physical deterioration (Robbins,
1392) which indicates the arrival of the last
stage of life. Diseases such as cancer and heart
disease, among friends and acquaintances of
the same age, inform the person they are entering
this stage. One thinks that he has had limited
time, while he has many unfinished projects
(Wayne Saint, 2003). In the eyes of the elderly,
loneliness is an unpleasant, negative, agonizing,
hard, terrible and painful personal experience
that creates a sense of impatience, uselessness,
frustration, sadness, anxiety and hopelessness
(Heravi Karimloo et al. 2007). Confronting existential
issues including death, feelings of emptiness
and meaninglessness, loneliness, uncertainty
and unpredictability of the future, the elderly
may face problems which provoke existential
anxieties.
Existential anxiety is the result of awareness
of the unstable characteristics of human situations.
Indeed, since each of us desperately needs eternity,
solidity, coexistence and purposefulness of
life, and at the same time, all of us will end
up with the inevitability of death, groundlessness
of existence, loneliness, and absurdity, as
a result of this conflict we experience existential
anxiety (Yalom, 1980)
According to Kierkegaard, the main axes of
anxiety are death, freedom, loneliness and meaning
(Kierkegaard, 1848; Poiman, 1990; Yalom, 1980).
The fundamental conflict that causes the anxiety
of death is the desire for survival, the continuation
of life, and the awareness of mortality and
the inevitability of death (Yalom, 1980, 2008;
May and Yalom, 2000). According to Yalom, responsibility
and choice are the attendants of freedom. The
fundamental contradiction arises from the fact
that human beings need to have a structural
basis for life but there is no basis. The conflict
between groundlessness and the desire to have
a firm base leads to anxiety (Webb, 2008; Sand,
2008). The loneliness anxiety begins where one
loves to be part of a whole; have an honest
relationship with others and be protected by
others, but in the real world he/she finds that
none of these events are realizes and he/she
is unmercifully lonely (Kierkegaard, 1848).
Stager and Frasber (2006) considered the nature
of man to find meaning in life. Because the
basic human need is searching for meaning and
achieving perfection this quest does not necessarily
lead to a meaningful life (Kernan & Lepore,
2009). The existential conflict is created because
we must find meaning for a universe that lacks
any design and semantics by itself, and set
goals for a future that is unpredictable (Yalom,
1980; Sand, 2008).
According to the existential view, genuine
response to existential anxieties depend on
our awareness and acceptance of such anxieties
(Prochaska & Norcross, 1999). All people
experience those anxieties but not all of them
face personality and communication problems
(Blinderman & Cherny., 2005). Misunderstanding
of self as a human being and overlooking the
givens of existence paves the way to neuroticism
(Poiman, 1990).
Pathological anxiety is the product of an individual’s
quest for escaping and overcoming the inevitable
givens of being, through the use of defense
mechanisms, causing self-deceit, self-alienation,
and getting away from the realities of existence.
This type of anxiety is usually out of consciousness
and prevents the individual from movement. Therefore
contrary to the natural anxiety that is constructive,
pathological anxiety is a destructive mental
disorder (Corey, 2005).
Also in the elderly, this process can lead
to the formation or intensification of psychological
problems. The elderly need to have the ability
to respond to fundamental existential problems
and as they get older, responding to these issues
can be a significant contribution to their inherent
and fundamental concerns (Langle & Probst,
2000). If they cannot find genuine answers to
their existential issues they will suffer pathological
anxiety.
A range of psychological interventions have
been used to reduce the psychological problems
of the elderly, which indicates the need for
psychological services for these elderly people.
This range includes: cognitive-behavioral therapies
(Hedayat, 2015; Barghi Irani, 2015), existential
group therapy (Mooziri, 2013), spirituality-based
cognitive therapy (Rahimi, 2014), group logo
therapy (Poorebrahim, 2006; Fakhar, 2007, Yazdan
Bakhsh, 2015); memory telling (Majzoobi, 2012),
and hope therapy (Parvaneh, 2015). The literature
indicates that existential group therapy and
group logo therapy were not effective on the
elderly (Mooziri, 2013; Poorebrahim, 2007; Fakhar,
2007).
Furthermore, the focus of most interventions
for the elderly has been on the treatment of
death anxiety, feelings of loneliness, depression,
and enhancement of life expectancy, happiness,
self-efficacy, mental health, quality of life
and quality of sleep in the elderly. It seems
essential to address the anxieties of being
due to the prevalence, while less attention
has been paid to existential anxieties in the
elderly. Also the studies on existential anxiety
in the elderly have just focused on one of the
four factors of existential anxiety. Therefore,
in this study, the Existential Anxiety Questionnaire
(Masoudi Sani, Bahmani, 2015) has been used
for the first time.
It would be beneficial to find the most effective
and practical intervention method to reduce
existential anxiety subsequent to aging due
to the need to respect the human rights of the
elderly and also to save time, effort and facilities.
In cognitive-existential group therapy, it aims
to use techniques of “cognitive therapy”
to refine some schemas, negative automatic thoughts,
and to correct the cognitive errors that contribute
to the formation of psychological distress caused
by the non-genuine response to existential anxiety.
Moreover, this method pays attention to existential
concerns such as death anxiety, uncertainty,
meaninglessness, loneliness, and uncontrollability
of the world that are intensified by the death
threat in patients. In most intervention methods
such concerns do not receive systematic attention.
Therefore, it is expected that through this
intervention, individuals will find their own
unknown fears and conflicts over the issues
of existence and will be able to cope with them
in a genuine and effective way (Bahmani, 2010).
Previous studies indicate that cognitive-existential
therapy plays an effective role in reducing
psychological distress in different populations
(Bahmani, 2010; Naghyiaee, 2014, Farmani Shahreza,
2014; Eskandari, 2013; Paknia, 2015). In this
regard, we seek to investigate the impact of
this intervention on the elderly and to answer
the question of “whether cognitive-existential
group therapy can reduce existential anxieties
in the elderly?
The study was carried out using a pretest-posttest
semi-experimental design with control group
and random assignment. The statistical population
included all the elderly women in Yas Daily
Rehabilitation Center. The sample included 20
people selected through a non-random sampling
from among the elderly present in the center
during the sampling period (summer 2016) who
were prepared to participate in the group therapy
and were eligible for inclusion criteria. The
sample was divided into experimental and control
groups in a random assignment (10 individuals
in each group).
In this research, the dependent variable is
measured before and after the presentation of
the independent variable, and its design graph
is as follows:
T1 and T¬4 represent the pretest, T2 and
T5 the posttest, T3 and T6 show the follow-up
and X is the Cognitive-Existential Group Therapy.
Instruments
In this research, Existential Anxiety Questionnaire,
developed by Masoudi Sani and Bahmani (2015),
was used to measure existential anxieties. This
questionnaire has 29 statements and 4 subscales:
1- Death anxiety, 2- Responsibility anxiety,
3- Meaning Anxiety, and 4. Loneliness anxiety.
The content validity of the instrument is based
on the opinion of 10 experts, using the ICC
method was 0.95 and the reliability of the instrument
was 0.83 and 0.86, respectively, by Cronbach’s
alpha and test-retest method.
In order to measure cognitive distortions,
the 20-item scale of Cognitive Distortions developed
by Hassan Abdollahzadeh and Maryam Salar (2010)
was used. The standardized Cronbach’s alpha
was 0.80. The questionnaire consists of 20 statements
to measure the cognitive distortions proposed
on the basis of Albert Ellis’s theory and
each irrational thought has 2 statements. Thus,
statements 1 and 2 assess Polarized thinking;
3 and 4, Overgeneralization; 5 and 6, Filtering;
7 and 8, Disqualifying the positive; 9 and 10,
Jumping to conclusions and fortune telling including
mind reading and misconception; 11 and 14, Exaggeration
and Minimization; 12 and 13, Emotional reasoning;
15 and 16, Should statements; 17 and 18, Labeling;
and finally 19 and 20 assess Personalization.
The Higher total score reflects a more positive
thinking; however statement 1 is scored in reverse
(Abdollahzade et al. 2010 quoted from Farmani-Shahreza
et al. 2016).
Procedure
After preliminary studies and preparation of
the protocol, and receiving a referral letter
from the University of Welfare and Rehabilitation
Sciences to the Welfare Organization of Tehran
province, we got the necessary permissions and
referred to the Yas Daily Rehabilitation Center.
The research process began after permission
was gained from the head of the Center. First,
through broadcasting announcements and talks
with the elderly in the Yas Daily Rehabilitation
Center, they were informed of the study. Subsequently,
describing the research goals and obtaining
consent from the elderly and observing the ethical
rules, the conditions for the participation
in the research were prepared. After interviewing
the individuals and completing Existential Anxiety
and Cognitive Distortions questionnaires, twenty
elderly were selected according to inclusion
and exclusion criteria and randomly assigned
to the control and experimental groups. The
inclusion criteria were: age of 60 and over,
having the ability to speak, having no cognitive
problems and a score of over 70 in the Existential
Anxiety Questionnaire. Exclusion criteria included:
having mind and brain disorders such as Parkinson’s
and dementia, having any psychiatric disorders
based on the written contents of their file
in the center and use of any psychotherapy and
counseling services at the time of the research.
Subsequently, cognitive group therapy was performed
for 12 sessions of 90 minutes and once a week
for the experimental group (Table 1), while
the control group received no intervention.
In order to observe ethical issues, after group
treatment with the experimental group, group
therapy was also performed for the control group.
At the last session, the mentioned questionnaires
were repeated on the participants of both groups.
In order to ensure the durability of the therapeutic
results, two months after the completion of
the group therapy in the follow up phase, the
participants again were assessed using questionnaires.
Data from pretest and posttest was entered in
version 21 of SPSS software. After analyzing
the assumptions of covariance analysis, this
statistical method was used to analyze the data.
Covariance analysis limits or eliminates the
effect of the pretest variable and measures
it using the regression equation. Among the
important assumptions of this statistical method
was the homogeneity of variances using Levene’s
test and Normality test by Kolmogorov–Smirnov
test. These assumptions were checked and verified
in the study.
The ethical considerations of this study included
the following topics: 1) the participants in
the research were assured that the information
received would be confidential; 2) scores were
given to those who would like to know their
scores; 3) the planning of group counseling
sessions was carried out in a way that would
not interfere with the programs of the Yas Daily
Rehabilitation Center; 4) The control group
was assured that they would participate in eight
sessions of Cognitive-Existential group therapy
after the end of the research; 5) Any of the
participants could freely leave the program
at any time during the research.
Click here for
Table 1: The protocol for cognitive-existential
group
The
sample
consisted
of
20
elderly
women
with
an
average
age
of
70
who
were
randomly
assigned
into
two
groups
of
10
in
experimental
and
control
groups
(waiting
list).
According
to
the
results
of
the
Mann-Whitney
U
test,
the
two
groups
were
homogeneous
in
demographic
variables
of
age
and
education.
In
addition,
the
assumptions
of
the
covariance
test
for
the
normality
of
the
data
distribution
were
confirmed
by
Kolmogorov-Smirnov
test
and
homogeneity
of
variances
were
confirmed
by
Levin’s
test
of
two
groups
in
dependent
variables
of
existential
anxiety
and
cognitive
distortions.
Clicik
here
for
Table
2:
Mean
and
standard
deviation
of
the
existential
anxiety
scores
and
its
subscales
in
the
experimental
and
control
groups
in
the
pretest,
posttest
and
follow-up
In
Table
2,
the
comparison
of
mean
scores
in
the
pretest,
posttest
and
the
two-month
follow
up
of
the
experimental
group
showed
that
the
scores
in
the
posttest
and
follow-up
were
reduced
compared
to
the
pretest.
Click
here
for
Table
3:
Mean
and
standard
deviation
of
cognitive
distortion
scores
in
pretest,
posttest
and
follow
up
In
Table
3,
the
comparison
of
mean
scores
of
cognitive
distortions
in
the
pretest,
posttest
and
follow-up
tests
showed
that
scores
in
post-test
and
follow-up
were
increased
in
comparison
with
the
pretest.
Considering
that
the
higher
the
number
of
scores,
the
more
positive
the
thinking
is;
the
increase
in
scores
shows
that
the
cognitive
distortions
have
been
decreased.
Click
here
for
Table
4:
The
results
of
covariance
analysis
of
the
comparison
of
the
experimental
group
and
control
group
in
existential
anxiety
and
its
subscales’
post-test
scores
As
shown
in
Table
4,
participation
in
the
cognitive-emotional
group
therapy
has
significantly
decreased
the
existential
anxiety
and
its
subscales
in
the
elderly.
Also
in
the
follow-up
phase,
a
significant
decrease
was
continued.
The
aim
of
this
study
was
to
investigate
the
effectiveness
of
interventions
that
are
more
appropriate
to
the
specific
needs
of
the
elderly
and
to
provide
more
effective
helping
methods
for
reducing
the
concerns
and
the
existential
crises
of
the
elderly.
In
this
regard
we
examined
the
general
assumption
that
“cognitive-existential
group
therapy
reduces
the
existential
anxiety
of
the
elderly”.
As
the
findings
in
Table
4
show,
the
findings
confirm
the
mentioned
hypothesis.
It
seems
that
the
cognitive-existential
group
therapy
and
the
elements
proposed
in
the
treatment
protocol,
as
well
as
the
special
way
of
relations
in
the
sessions
have
been
able
to
create
a
positive
and
significant
change
in
reducing
the
existential
anxiety
and
its
subscales.
It
should
be
considered
that
the
treatment
atmosphere
in
the
cognitive-existential
group
therapy
is
based
on
listening
to
the
subject’s
stories
considering
the
here
and
now,
familiarity
with
the
sufferings
of
others,
the
use
of
emotional
support
and
receiving
feedback
from
different
people
to
reduce
the
feeling
of
being
victim,
the
uniqueness
of
the
problem,
loneliness
and
helplessness,
discrimination
and
oppression,
feeling
of
security,
secrecy,
reflection
and
empathy,
emotional
release,
self-disclosure,
exposure,
feedback,
affection,
acceptance
and
humour;
this
can
be
mentioned
as
a
positive
factor
for
this
approach.
In
this
method,
the
group
continued
the
sessions
assuming
that
the
confidence
and
sympathy
between
the
group
members
persists
and
the
psychological
refinement
was
done
every
session.
Part
of
the
content
of
the
cognitive-existential
group
therapy
helps
understanding
the
phenomenological
world
of
individuals
using
the
prepared
existential
concepts.
Using
such
concepts
helps
individuals
to
encounter
their
existential
anxiety
and
to
communicate
with
their
original
selves
with
all
the
inevitable
existential
anxieties
and
instead
of
denying
and
reprimanding
their
unpleasant
feelings
and
emotions,
experience
them
and
take
responsibility
for
their
feelings,
and
most
importantly,
express
these
feelings
and
emotions.
According
to
Kissan
it
is
a
useful
intervention
method
that
can
deal
with
these
fears
fast
and
clear
enough
and
can
help
reduce
mental
health
problems
(Kissan,
et
al.,
2002;
quoted
from
Bahmani
et
al.,
2010).
During
the
treatment
process,
the
elderly
were
involved
with
their
existential
questions.
These
questions
caused
them
to
activate
and
discharge
their
existential
anxieties.
In
general,
during
the
sessions,
it
became
clear
that
feeling
of
lack
of
a
worthwhile
future
and
lack
of
self-efficacy
to
achieve
it,
inevitability
and
fear
of
death,
lack
of
faith
in
the
future,
feeling
of
hopelessness,
lack
of
meaning
and
purpose,
and
loneliness
deprives
the
elderly
from
the
motivation
to
try.
Existential
crisis
and
disturbances
are
developed
as
a
result
of
fear
of
confrontation
with
existential
anxieties.
So
during
the
group
process,
we
tried
to
help
the
elderly
understand
the
unpredictability
of
the
world
and
the
uncertainty
of
the
universe,
assess
their
thoughts
and
assumptions
about
the
uncontrollability
of
death
and
loss
of
opportunities
in
the
past
and
the
resulting
anxieties,
identify
and
challenge
their
cognitive
distortions
about
the
meaning
of
death
anxiety
(seeing
death
as
the
end
of
everything,
unwillingness
to
track
down
their
illnesses,
fear
of
being
forgotten
after
death,
fear
of
painful
death,
disqualifying
their
efforts
in
their
lives,
fear
of
disability)
and
end
their
fears
by
accepting
the
anxiety
of
unpredictability
and
death.
We
also
tried
to
introduce
the
concept
of
fundamental
loneliness
anxiety
and
help
them
identify
and
challenge
their
cognitive
distortions
about
the
meaning
of
loneliness
(not
being
understood
by
close
people,
especially
their
spouse
and
children,
the
feeling
of
failing
to
understand
others,
the
feeling
of
separation
from
children,
attachment
to
other
individuals
to
escape
loneliness)
and
accept
loneliness
as
a
genuine
experience
to
increase
the
desire
and
motivation
to
be
with
others
and
family
members.
They
were
also
helped
to
challenge
the
meaning
of
their
lives
created
by
psychological
disturbances
and
existential
anxieties,
and
find
a
meaningful
term
for
their
lives,
and
change
their
attitudes
toward
problems
and
tolerance
of
difficulties,
and
through
giving
meaning
to
the
sufferings
and
pains,
change
their
focus
from
what
has
been
lost,
because
the
sense
of
the
new
meaning
and
purpose
in
life
during
the
aging
period
(which
includes
the
ability
to
combine
and
integrate
the
experiences
and
achieve
an
understanding
of
themselves
and
the
world)
is
a
protective
factor
against
meaninglessness.
Also,
in
the
process
of
group
therapy,
elderly
people
tried
to
accept
responsibility
and
freedom
of
choice,
to
identify
and
challenge
their
cognitive
distortions
about
the
anxiety
of
responsibility
and
freedom
of
choice
(assigning
responsibility
for
life
events
to
others
or
social,
cultural,
economic,
etc.
circumstances,
leaving
the
choice
to
others,
believing
in
luck,
trying
to
show
oneself
as
victim
)
and
to
evaluate
their
priorities
and
decisions,
and
accept
their
own
responsibility
for
their
own
destiny.
In
general,
the
group
therapist
tried
to
help
the
elderly
to
accept
cognitive
distortions
that
prevented
them
from
experiencing
existential
anxieties
and
activated
their
defense
mechanisms.
In
general,
according
to
previous
studies,
cognitive-existential
group
therapy
can
be
considered
as
a
suitable
factor
in
reducing
different
types
of
mental
disorders.
Bahmani
et
al.
(2010)
in
their
research
showed
that
cognitive-existential
group
therapy
was
more
effective
than
cognitive
therapy
in
reducing
the
mean
of
depression
and
increasing
the
mean
of
hopefulness.
Previous
studies,
consistent
with
the
present
study,
Kissan
et
al.
(1997)
showed
that
using
this
method
of
treatment
is
helpful
to
reduce
the
amount
of
sadness
and
grief
in
patients
with
cancer,
increase
their
problem
solving
ability
and
also
create
cognitive
strategies.
Breitbart
(2001)
suggested
that
existential
therapies
are
one
of
the
most
appropriate
approaches
to
reduce
depression
and
increase
hope
in
cancer
patients.
In
addition
Kissan
et
al.
(2003)
concluded
that
cognitive-existential
therapy
has
a
positive
effect
in
reducing
overall
symptoms
of
psychological
distress
in
women
with
non-metastatic
breast
cancer.
In
another
study,
Kissan
et
al.
(2004)
concluded
that
this
method
would
greatly
reduce
psychological
distress
and
anxiety,
and
improve
family
relationships.
Therefore,
according
to
the
findings,
the
cognitive-existential
therapy
has
been
able
to
affect
people
with
chronic
conditions
such
as
cancers,
breast
cancer,
human
immunodeficiency
virus,
and
the
elderly.
This
should
be
due
to
the
main
distinguishing
feature
of
this
intervention
method,
namely,
paying
attention
to
the
existential
anxieties
and
considering
here
and
now
during
the
treatment
sessions
as
compared
to
other
methods.
Also,
the
results
of
the
two-month
follow-up
showed
that
cognitive-existential
group
therapy
has
a
lasting
and
stable
effect
on
the
improvement
of
existential
anxiety.
In
explaining
this
finding,
it
can
be
said
that
Cognitive-Existential
psychotherapy
can
lead
to
long-term
changes
in
terms
of
creating
philosophical
insights
and
changing
attitudes
in
individuals.
In
general,
cognitive-existential
group
therapy
due
to
addressing
the
existential
concepts,
especially
for
the
elderly
and
deal
with
these
concepts
and
working
with
the
unreasonable
beliefs
of
individuals
and
substituting
logical
beliefs
can
lead
to
the
reduction
of
psychological
factors
and
existential
anxieties.
Therefore,
this
method
of
intervention
can
be
used
in
the
treatment
of
the
elderly,
since
the
elderly
need
to
continue
their
lives
with
meaning
and
purpose
without
fear
of
confrontation
with
death,
loneliness,
and
existential
concerns.
Limitations
The
most
important
limitation
of
this
study
was
the
use
of
available
sampling
and,
consequently,
semi-experimental
design,
and
that
the
research
was
conducted
only
on
elderly
women,
which
reduced
the
generalization
power
of
the
research.
Suggestions
Given
that
existential
anxiety
is
activated
in
the
elderly
and
addressing
these
anxieties
in
counseling
and
psychotherapy
sessions
can
help
to
improve
the
existential
crisis
of
the
elderly,
it
is
suggested
that
counselors
of
care
centers,
rehabilitation
centers
for
the
elderly
and
counseling
and
psychology
clinics
be
trained
based
on
the
treatment
plan
presented
in
this
study
and
take
advantage
of
it
to
help
the
elderly.
In
addition,
the
results
of
this
study
can
be
used
to
improve
the
design
of
educational
programs
for
health
care
and
rehabilitation
providers,
as
well
as
to
plan
for
prevention
of
existential
crises
and
to
improve
the
health
of
the
elderly
and
to
prevent
serious
problems
such
as
suicide
in
the
elderly.
Also,
it
is
suggested
that
the
effect
of
this
therapeutic
approach
on
other
psychological
variables
be
examined
and
the
effectiveness
of
this
treatment
method
be
compared
with
other
types
of
cognitive
therapies
in
order
to
reduce
the
psychological
problems
of
the
elderly
in
order
to
achieve
the
most
effective
treatment
method
for
this
group.
Acknowledgments
Thanks
to
my
distinguished
professors
and
the
respectable
staff
of
Yas
Daily
Rehabilitation
Center
and
all
the
elderly
who
helped
us
with
this
research.
This
research
is
based
on
the
master’s
thesis
of
Ms.
Somayeh
Barakati
in
counseling
department
of
Tehran
University
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