Toward Centrality Evaluation of Yearning Symptoms for Prolonged Grief Disorder: A Cross-Cultural Approach.

BACKGROUND: The new ICD-11 diagnosis of prolonged grief disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions. METHODS: Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirmatory factor analyses, followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearning were performed. RESULTS: Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the other Europe-Israel region as well as China, it tended to fall into the middle or lower rankings of symptom centrality. Sensitivity values were consistently high, while specificity values indicated moderate levels. DISCUSSION: In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensitive) symptom for individuals in high-risk states for PGD, although it has only moderate specificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cultural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.

Cognitive behavioural treatment for mild Alzheimer's patients and their caregivers (CBTAC): results of a randomised controlled trial.

OBJECTIVES: This study aimed to evaluate the effects of a multicomponent psychotherapy programme for people with mild Alzheimer's dementia (AD) and their caregivers on depression and related neuropsychiatric symptoms. METHOD: The cognitive behavioural therapy (CBT)-based treatment consisted of 25 weekly sessions, including behavioural activation, behaviour management, interventions for the caregiver, reminiscence, couples counselling, and cognitive restructuring. 41 participants and their caregivers were randomised to either the CBT or the control group, which received treatment-as-usual (TAU). Follow-ups took place at 6 and 12 months posttreatment. The primary outcome was depression in the patient with AD. The secondary outcomes were apathy, other neuropsychiatric symptoms, functional abilities, quality of life, and quality of the relationship with the caregiver. RESULTS: Linear mixed models revealed a statistically significant superiority of CBT regarding clinician-rated depression at the 12-month follow-up with large effect sizes (within-subject d = 1.22, between-subject d = 1.00). Effect sizes were only moderate for self-rated depression and small for informant-rated depression. There was also a significant advantage for CBT regarding clinician-rated apathy, relationship quality, and informant-rated quality of life (QoL) but not for the other neuropsychiatric symptoms or self-rated QoL. CONCLUSION: The results are very encouraging and support an adequately powered multicentre study.Trial registration: ClinicalTrials.gov NCT01273272. Date of registration: 3 Jan 2011.

The relationship between acculturative stress and psychological outcomes in international students: a systematic review and meta-analysis.

Introduction: The current systematic review aimed to examine the relationship between acculturative stress (AS) and psychological outcomes in international students to determine the role AS may play in predicting the mental health of international students. Methods: The studies included in the current systematic review and meta-analysis had considered AS and its impact on psychological outcomes among international students studying abroad. After checking the studies found in our primary search through the scientific databases in terms of our eligibility criteria, 29 studies were included, of which 26 were eligible for a meta-analysis (total N = 7,247). Results: Meta-analysis indicated a moderate mean correlation of AS with psychological outcomes like depression, life satisfaction, quality of life, vocational outcome expectations, drinking behaviors, resilience, health promotion behavior, psychological adjustment, psychological distress, negative affect, and mental health symptoms (r = 0.39) and depression (r = 0.41), respectively. Discussion: The review of studies revealed a robust relationship between AS and increased negative psychological outcomes such as depression, psychological distress, and general stress, as well as decreased positive psychological outcomes such as psychological adjustment, mental health, life satisfaction, and quality of life.

The relationship between the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes: The mediating role of loneliness.

The current study aims to investigate the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes through the mediating role of loneliness. The statistical population included all the elderly aged at least 60 years living in Tehran, Qazvin and Zanjan, Iran in 2020, among whom 489 (273 men and 216 women) were selected using convenience sampling method. Participants filled out Steger's Meaning of Life, Ryff and Singer's Psychological Well-Being Scale, Söderhamn et al.'s Self-Care Ability, Nahapiet and Ghoshal's Social capital, Beck's depression, Templer's Death Anxiety, Russell et al.'s Loneliness questionnaires. The results indicated that meaning of life, psychological well-being, self-care, and social capital are negatively associated with loneliness, which in turn, is positively associated to depression. Furthermore, meaning of life, psychological well-being, self-care, and social capital are negatively associated with loneliness, which in turn, is positively associated to death anxiety. Moreover, the results of path analysis revealed that the hypothesized model of the current study has an excellent fit in the study sample. That is, meaning of life, psychological well-being, self-care, and social capital are related to depression and death anxiety through mediating role of loneliness.

Effect of Life Review Therapy for Holocaust Survivors: A randomized controlled trial.

Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT-HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent-to-treat analyses (LRT-HS: n = 24, control: n = 25; Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixed models revealed no statistically significant superiority of LRT-HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, dwithin = 0.70, dbetween = 0.41, but analyses were significant at follow-up, with large effect sizes, t(79) = 2.89, p = .005, dwithin = 1.20, dbetween = 1.00. LRT-HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow-up, t(76) = 1.08, p = .282, with moderate effect sizes, dwithin = 0.46-0.60, dbetween = 0.53-0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age-appropriate treatment that includes structured life review and narrative exposure.

Project DECIDE, part II: decision-making places for people with dementia in Alzheimer's disease: supporting advance decision-making by improving person-environment fit.

BACKGROUND: The UN Convention on the Rights of Persons with Disabilities, and the reformed guardianship law in Germany, require that persons with a disability, including people with dementia in Alzheimer's disease (PwAD), are supported in making self-determined decisions. This support is achieved through communication. While content-related communication is a deficit of PwAD, relational aspects of communication are a resource. Research in supported decision-making (SDM) has investigated the effectiveness of different content-related support strategies for PwAD but has only succeeded in improving understanding, which, although one criterion of capacity to consent, is not sufficient to ensure overall capacity to consent. The aim of the 'spatial intervention study' of the DECIDE project is to examine an innovative resource-oriented SDM approach that focuses on relational aspects. We hypothesise that talking to PwAD in their familiar home setting (as opposed to a clinical setting) will reduce the complexity of the decision-making process and enhance overall capacity to consent. METHODS: People with a suspected or confirmed diagnosis of dementia in Alzheimer's disease will be recruited from two memory clinics (N = 80). We will use a randomised crossover design to investigate the intervention effect of the decision-making place on capacity to consent. Besides reasoning capacity, which is part of overall capacity to consent and will be the primary outcome, various secondary outcomes (e.g., other aspects of capacity to consent, subjective task complexity, decisional conflict) and suspected moderating or mediating variables (e.g., meaning of home, demographic characteristics) will be assessed. DISCUSSION: The results of the study will be used to develop a new SDM strategy that is based on relational resources for PwAD. If a change in location achieves the anticipated improvement in capacity to consent, future research should focus on implementing this SDM strategy in a cost-effective manner in clinical practice. TRIAL REGISTRATION: DRKS00030799 .

Midlife occupational cognitive requirements protect cognitive function in old age by increasing cognitive reserve.

Introduction: Several lifestyle factors promote protection against Alzheimer's disease (AD) throughout a person's lifespan. Although such protective effects have been described for occupational cognitive requirements (OCR) in midlife, it is currently unknown whether they are conveyed by brain maintenance (BM), brain reserve (BR), or cognitive reserve (CR) or a combination of them. Methods: We systematically derived hypotheses for these resilience concepts and tested them in the population-based AgeCoDe cohort and memory clinic-based AD high-risk DELCODE study. The OCR score (OCRS) was measured using job activities based on the O*NET occupational classification system. Four sets of analyses were conducted: (1) the interaction of OCR and APOE-ε4 with regard to cognitive decline (N = 2,369, AgeCoDe), (2) association with differentially shaped retrospective trajectories before the onset of dementia of the Alzheimer's type (DAT; N = 474, AgeCoDe), (3) cross-sectional interaction of the OCR and cerebrospinal fluid (CSF) AD biomarkers and brain structural measures regarding memory function (N = 873, DELCODE), and (4) cross-sectional and longitudinal association of OCR with CSF AD biomarkers and brain structural measures (N = 873, DELCODE). Results: Regarding (1), higher OCRS was associated with a reduced association of APOE-ε4 with cognitive decline (mean follow-up = 6.03 years), consistent with CR and BR. Regarding (2), high OCRS was associated with a later onset but subsequently stronger cognitive decline in individuals converting to DAT, consistent with CR. Regarding (3), higher OCRS was associated with a weaker association of the CSF Aß42/40 ratio and hippocampal volume with memory function, consistent with CR. Regarding (4), OCR was not associated with the levels or changes in CSF AD biomarkers (mean follow-up = 2.61 years). We found a cross-sectional, age-independent association of OCRS with some MRI markers, but no association with 1-year-change. OCR was not associated with the intracranial volume. These results are not completely consistent with those of BR or BM. Discussion: Our results support the link between OCR and CR. Promoting and seeking complex and stimulating work conditions in midlife could therefore contribute to increased resistance to pathologies in old age and might complement prevention measures aimed at reducing pathology.

Experiences with teachers in childhood and their association with wellbeing in adulthood.

BACKGROUND: Prior research mainly focussed on the impact of the teacher-student relationship on teachers emotions and wellbeing. Current data shows a relationship between the quality of the teacher-student relationship and children's mental health. Unfortunately, it has not yet been investigated whether meaningful experiences with teachers also have an impact on students' well-being and whether an effect can still be found in adulthood. This work examines the impact of meaningful experiences with teachers during childhood and adolescence on the well-being of adults. METHODS: The data in this study was collected by using a questionnaire. The current well-being of the participants was assessed with measures of life satisfaction, resilience, anxiety, stress, depressiveness, and self-esteem. Also, participants were asked to briefly write about their most meaningful experiences with teachers and rate them regarding their valence. These experiences were categorized into seven categories using a summarizing content analysis. We then conducted a statistical analysis with the data obtained. RESULTS: The results showed a highly significant correlation between the participants' self-esteem and the valence ratings of their experiences. Furthermore, the experience category had a substantial effect on individual self-esteem. Overall, this study demonstrated that a relationship exists between the well-being of adults and their experiences with teachers during childhood and adolescence. CONCLUSION: The results of this study call for a reflective, fair, authentic, and empathetic approach to students. Accordingly, teachers should be intensively trained to establish a relationship with their students that is characterized by appreciation and empathy.

Attachment styles and happiness in the elderly: the mediating role of reminiscence styles.

BACKGROUND: The current study aims to investigate the relationship between attachment styles and happiness through the mediating role of reminiscence styles in the elderly. METHODS: This was a correlational study of structural equations modelling (SEM) type. The statistical population included all the elderly aged at least 60 years living in Kermanshah province, Iran in 2021, among whom 380 (182 men and 198 women) were selected using convenience sampling method. Participants filled out the questionnaires of Adult Attachment Styles, Oxford Happiness, and Amani et al.'s Reminiscence Styles. RESULTS: The results indicated that secure attachment style has a positive and negative relationship with positive reminiscence (PR) and negative reminiscence (NR), respectively. However, the opposite held true for both avoidant and ambivalent attachment styles. It was also found that secure attachment style has a positive relationship, and avoidant and ambivalent attachment styles have a negative relationship with happiness. Moreover, participants' gender and age had no moderating effect on the mentioned relationships. The results of SEM indicated that secure and ambivalent attachment styles were associated with happiness through both PR and NR, and avoidant attachment style was associated with happiness only through NR. CONCLUSIONS: The findings emphasize the significance of the development of internal working models based on the kind of parent-child's reminiscences and narratives, and the lifelong effects of these models.

Emotional competence, attachment, and parenting styles in children and parents.

The goal of this study was to examine whether a subject's emotional competence correlates to attachment styles and parenting styles in children and their parents. The study was conducted with fifty children (9-11 years old) and their parents, both of whose emotional competence (EKF) and parenting style (PAQ) were measured. The attachment styles of parents and children were measured with the Adult Attachment Scale (AAS) and the Bochumer Bindungstest (BoBiTe), respectively. The findings provide initial support to the assumption that attachment is related to emotional competence in parents. This relationship, however, was not significantly correlated in children. In addition, authoritative parenting and permissive parenting were significantly associated with emotional competence in parents. Emotional competence in children showed to be associated with an authoritative parenting style.

An Islamic Form of Logotherapy in the Treatment of Depression, Anxiety and Stress Symptoms in University Students in Iran.

Previous research demonstrated that spiritually sensitive psychotherapy is an effective treatment for clients with depression or anxiety, with outcomes equivalent to secular control interventions. The goal of this study was to evaluate the efficacy of spiritually sensitive logotherapy intervention in the treatment of depression, anxiety, and stress symptoms in university students in Iran. Sixty students with elevated depression symptoms (Beck Depression Inventory II, BDI-II, 22 or greater) were randomly assigned to either a twelve-session group logotherapy programme or a control group. Results showed that spiritually sensitive logotherapy significantly reduced depression, anxiety, and stress, and significantly more so than in the control group (e.g. interaction effect for BDI-II: F = 56.8, p < 0.001, with a large effect size).

Life review therapy for holocaust survivors: Two systematic case studies.

Having reached the last phase of their lives, many Holocaust survivors (HS) experience an increase in vulnerability. Despite their remarkable ability to adapt, the process of aging presents them with new challenges, often leading to an increased need for therapy. This is made all the more difficult by the fact that there is little research on trauma therapy in old age. To date, no randomized controlled study has been carried out to examine the effectiveness of psychotherapy in HS. The present case studies report the implementation of life review therapy (LRT-HS) undertaken with two female HS with symptoms of post-traumatic stress disorder (PTSD). The mixed-methods approach sheds light to their individual therapy courses and potential mechanisms of change. Both therapies took place in the context of a randomized controlled study evaluating the efficacy of LRT-HS. This integrative, narrative therapy approach answers the natural need of elderly people to look back on their lives. Patients received about 20 sessions of LRT-HS, including a structured life review, narrative exposure, as well as cognitive and behavioral elements. Patient 1 showed reliable to clinically significant improvements on several quantitative symptom levels and with consistent qualitative findings (e.g., semistructured therapist interview). Symptoms of Patient 2 remained mostly unchanged, while life satisfaction and posttraumatic growth reliably improved and qualitative measures pointed to a reduction of suffering. The studies illustrate that reminiscence can be used in adaptive ways even after the experience of massive traumatization. The coexistence of resilience and vulnerability, complex individual symptom profiles, and influencing factors are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Emotional competence, attachment, and parenting styles in children and parents

The goal of this study was to examine whether a subject's emotional competence correlates to attachment styles and parenting styles in children and their parents. The study was conducted with fifty children (9-11 years old) and their parents, both of whose emotional competence (EKF) and parenting style (PAQ) were measured. The attachment styles of parents and children were measured with the Adult Attachment Scale (AAS) and the Bochumer Bindungstest (BoBiTe), respectively. The findings provide initial support to the assumption that attachment is related to emotional competence in parents. This relationship, however, was not significantly correlated in children. In addition, authoritative parenting and permissive parenting were significantly associated with emotional competence in parents. Emotional competence in children showed to be associated with an authoritative parenting style.

Associations and correlates of general versus specific successful ageing components.

The heterogeneity in the operationalisation of successful ageing (SA) hinders a straightforward examination of SA associations and correlates, and in turn, the identification of potentially modifiable predictors of SA. It is unclear which SA associations and correlates influence all facets of the SA construct, and whether psychosocial reserve models developed in neuropathological ageing research can also be linked to SA. It was therefore the aim of this study to disentangle the effect of various previously identified SA associations and correlates on (1) a general SA factor, which represents the shared underpinnings of three SA facets, and (2) more confined, specific factors, using bifactor modelling. The associations and correlates of three recently validated SA operationalisations were compared in 2478 participants from the German AgeCoDe study, aged 75 years and above. Based on participants' main occupation, cognitive reserve (CR) and motivational reserve (MR) models were built. Younger age, male gender, more education, higher socio-economic status, being married or widowed, as well as more physical exercise and cognitive activities in old age were found to correlate positively with the general SA factor, indicating a simultaneous effect on all aspects of SA. Smoking and ApoE-ε4 were related only to the physiological facet of SA. CR models were significantly related to the general SA factor. Among all SA associations and correlates, proxy indicators of lifelong cognitive activity and physical exercise showed the strongest effects on SA. Future intervention studies should assess the influence of the preservation of active lifestyle across the life span on SA.

Health-related quality of life and ego integrity among the oldest old - Evidence from the multicenter AgeCoDe-AgeQualiDe study.

PURPOSE: To investigate the association between health-related quality of life and ego integrity among the oldest old. MATERIALS AND METHODS: Cross-sectional data were taken from follow-up wave 9 of the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe). Our analytical sample comprised n = 495 observations. Mean age was 90.2 years (SD: 2.7 years). Health-related quality of life was quantified using the EQ-5D-3L questionnaire (including the visual analogue scale EQ-VAS). Ego integrity was measured using the Ego Integrity Scale. RESULTS: Regressions showed an association between decreased ego integrity and problems with 'usual activities', 'pain/discomfort' and 'anxiety/depression'. Furthermore, regressions showed a marginally significant association between decreased ego integrity and problems with 'mobility' and a decreased EQ-VAS score. Ego integrity was not significantly associated with problems with 'self-care'. CONCLUSIONS: Findings stress the importance of health-related quality of life for ego integrity among the oldest old. Future studies are required to clarify the underlying mechanisms.

Equine-assisted biographical work (EABW) with individuals in the second half of life: study protocol of a multicentre randomised controlled trial.

BACKGROUND: Equine-assisted therapy is more often practiced with children and adolescents than with the elderly, although individuals in the second half of life could also profit from it. This group, from the age of 50, is characterised by increasing emotional, social, health-related and cognitive changes; a critical life event, such as a neurological illness or loss of a family member, can increase the likelihood of subclinical depression. Individuals who exhibit depressive symptoms not necessarily diagnosed with a major depression may suffer from relevant losses of quality of life (e.g. sleep disorders, memory disorders, feelings of guilt, hopelessness). Despite the fact that the various healthcare systems are in general more frequently used, such individuals often do not receive adequate therapy. The processing of one's biography (reminiscence) is an elementary component of most psychotherapy approaches and has been demonstrated to treat and prevent the development of major depression. In this study, equine-assisted biographical work (EABW), a combination of equine-assisted therapy and biographical work, will be applied with individuals with subclinical depression in the second half of their life. METHODS: This is a multicentre, prospective, randomised, controlled and open phase III study in enrolling participants with subclinical depression. The aim of the study is to evaluate whether a preventive, equine-assisted, age-specific treatment combining elements of equine-assisted intervention with those of biographical work offers better treatment potentials in comparison to a control group with no intervention. Study participants in the intervention group will receive weekly equine-assisted biographical work over a period of 8 weeks. The primary endpoint is the change in Beck Depression Inventory-II (BDI-II) in a pre-post comparison. Secondary endpoints include other health-related questionnaires including quality of life, reminiscence functions and anxiety. DISCUSSION: The present study is the first randomised study examining the efficacy of biographical work with a horse and has the potential to establish an empirically based treatment for individuals in the second half of life and improving the symptoms of subclinical depression. TRIAL REGISTRATION: German Clinical Trials Register DRKS00017010 . Registered on 01 April 2019.

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial.

BACKGROUND: The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events. METHODS: The main goal of this study is to evaluate the effect of LRT for Holocaust survivors (LRT-HS) on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify the characteristics of participants that seem to especially benefit from the treatment. The proposed study is a randomised, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20-25 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place 6 months after the treatment. A sample size of 80 is required (drop-out rate included). DISCUSSION: Efficacious treatments for trauma-related disorders in older people are of high importance, also because the probability of traumatisation and loss increases with age. Because this study is conducted with this specific group of multiply traumatised people, we are convinced that the results can easily transfer to other samples. TRIAL REGISTRATION: ISRCTN, ISRCTN12823306. Registered 31 March 2018 - Retrospectively registered (first participant 22 December 2017).

Quality of the caregiving relationship and quality of life in mild Alzheimer's dementia.

BACKGROUND: The present study aims to investigate the quality of the dyadic relationship between mild Alzheimer patients and their caregivers. The main objective is to evaluate the consistency, agreement and validity of the German version of the Scale for Quality of the Current Relationship in Caregiving (SQCRC). The secondary objective was to examine the association of relationship quality with quality of life (QOL) in patients with mild Alzheimer's disease (AD) and their caregivers. METHODS: In this study, a sample of 50 patients diagnosed with mild AD and their primary caregivers were included. Participants underwent a full neuropsychological evaluation. The quality of the relationship between persons with AD and their caregivers was assessed using the SQCRC. Furthermore, other scales of relationship quality, well-being of the person with AD, and well-being of the caregiver were used. RESULTS: The results showed that the SQCRC has a good internal consistency and high validity. Also, relationship quality as rated by the AD patients (r = 0.37, P < 0.1) and their caregivers (r = 0.51, P < 0.1) was significantly correlated with QOL. CONCLUSIONS: The findings suggest that many persons with mild AD can rate their relationship quality and that the patient's self-rated relationship quality is a substantial predictor of their QOL.

From fragments to identity: reminiscence, life review and well-being of holocaust survivors. An integrative review.

Objectives: Survivors of the Holocaust have reached an age during which it is common for them to look back on their lives. Previous research has shown that reminiscence can take on either adaptive ('self-positive') or detrimental ('self-negative') forms, which in turn are differently linked to psychological well-being. Thus, the question of "why" and "how" Holocaust survivors recall their autobiographical memories may hold important information about the underlying coping processes at play. This review aims to give insight into the current state of research on these questions.Method: A systematic literature search was conducted, looking for articles reporting quantitative and qualitative research on reminiscence and narrative styles, life review and well-being of Holocaust survivors. A methodological quality assessment was undertaken.Results: 23 articles met the criteria for inclusion. These articles focused either on reminiscence functions or on content and structure of life narratives. Such autobiographical reports were shaped by the experience of Holocaust. However, actual well-being was particularly determined by positive life events. Studies found evidence for resilience and ongoing effort to integrate the past into a coherent review. The link between reminiscence and health remains stable even after massive trauma. Contextual influences (such as culture) and age are discussed as possible covariates.Conclusions: The results show that Holocaust survivors are able to use reminiscence in a functional way, though they are increasingly more vulnerable as they reach very old age. The link between past suffering and present well-being gets stronger with age. Other stressful life experiences after the Holocaust must be considered as exacerbating factors. This review also presents the implications for therapy and open research questions are discussed.

Volunteers in a biography project with palliative care patients - a feasibility study.

BACKGROUND: Increasing the quality of life with short interventions for vulnerable patients is one of the objectives of palliative care. Biographical approaches are used in a range of different interventions which may require considerable resources of staff time and energy. This study evaluated the feasibility of training hospice volunteers in biographical interviews of patients confronted with a life-limiting disease. For the purpose of this study, we evaluated resources such as time needed for training, coordination and supervision, outcome such as completion of the intervention in appropriate time and risks such as causing distress in patients or volunteers as major determinants of feasibility. METHODS: Nine volunteers from a hospice service attended an advanced training with an introduction to palliative care, biography work, interview techniques, transcribing and writing. Volunteers interviewed a patient and developed a written narrative from the interview. Volunteers completed a questionnaire before training and were interviewed at the end of the project. The interviews were audiotaped, transcribed, and evaluated using descriptive and qualitative content analysis. RESULTS: Patients provided positive feedback from the intervention. Volunteers felt that their involvement was personally rewarding and were moved by the courage and confidence of the patients. There were no systematic problems or negative experiences reported neither by volunteers nor by patients. CONCLUSIONS: We found the use of volunteers for biography work with patients in palliative care feasible and effective in this study. Volunteers needed supervision and ongoing support in providing this intervention.