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J Korean Acad Psychiatr Ment Health Nurs
Vol. 23 No. 4, 233-241, December 2014
ISSN (Print) 1225-8482
|
ISSN (Online) 2288-4653
http://dx.doi.org/10.12934/jkpmhn.2014.23.4.233
Corresponding author: Kim, Ha Gang
Department of Nursing, Mokpo Catholic University, 697 Youngsan-ro, Mokpo 530-742, Korea.
Tel: +82-61-280-5129, Fax: +82-61-280-5109, E-mail: havesevendreams@hanmail.net
Received: Oct 15, 2014 | Revised: Nov 25, 2014 | Accepted: Dec 20, 2014
This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/
by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effects of a Cinema Therapy-based Group Reminiscence Program on
Depression and Ego Integrity of Nursing Home Elders
Kim, Ha Gang
Department of Nursing, Mokpo Catholic University, Mokpo, Korea
Purpose: The purpose of this study was to evaluate effects of a cinema therapy-based group reminiscence pro-
gram on depression and ego integrity of elderly people in a nursing home. Methods: A nonequivalent control group
pretest posttest design was conducted. The participants were 45 elderly people from one nursing home, 23 in
the experimental group, and 22 in the control group. They were recruited from a nursing home in G city. The cinema
therapy program was provided for 90 minutes once a week for 10 sessions. Data were collected from June to
August, 2013. Data were analyzed using the SPSS/WIN 20.0. Results: After the intervention, the group who partici-
pated in the showed increased self-integrity (t=4.29, p<.001) and decreased depression (t=5.01, p<.001) com-
pared to the control group. Conclusion: The findings of this study suggest that the group reminiscence program
using the cinema as in this study is effective in increasing ego integrity and decreasing depression of elderly people
in nursing homes.
Key Words: Depression, Ego, Elderly, Nursing home
INTRODUCTION
The population of elderly individuals and rates of nu-
clear families, and women's employment have rapidly
increased, and values regarding supporting one's family
have changed in Korea. These factors have raised the
demand on welfare facilities for elderly individuals. The
government introduced the long-term care insurance
system for the elderly in 2008. Moreover, supporting the
elderly became a joint responsibility with the govern-
ment. Consequently, the number of long-term care fa-
cilities has increased from 1,186 in 2007 to 4,475 facili-
ties in 2013, and the number of elderly residents has in-
creased from 61,406 in 2007 to 131,399 in 2013[1]. For
the elderly, a home refers to one's own area and a place
to socialize with friends and neighbors where their iden-
tity and story are reflected. In this sense, moving one's
residence to a nursing home means alienation from the
usual life they have long maintained. This could result in
changes physical location of life space, as well as many
changes in daily life, social support systems, and psy-
chological factors. Furthermore, because some life cri-
ses precede change in residents such as health declines,
financial problems, spouse's death, and weakened phy-
sical functions, moving from a home to a nursing home
often causes stress and fear[2]. As most elderly people
do not want to change their residence and consider liv-
ing with family to be most desirable, facility residences
might exacerbate their depression.
The elderly phase is the phase of finishing life leading
one to reflect on, measure, and find meaning in life[3].
Erikson explained psychological well-being of a suc-
cessful elderly period as obtaining ego integrity[4]. To
obtain ego integrity is to accept one's life without regret
and be satisfied with one's present life. Ultimately, this
results in having no anxiety, even for death, with a bal-
anced view of the past, present, and future. However, a
failure to obtain ego integrity causes despair, which is
preceded by depression and hopelessness. Psychologi-
ⓒ 2014 The Korean Academy of Psychiatric and Mental Health Nursing http://www.mhnursing.or.kr
234
Journal of Korean Academy of Psychiatric and Mental Health Nursing
Kim, Ha Gang
cal factors such as depression and anxiety for death may
have a direct effect on ego integrity[5]. In particular, Eri-
kson indicated that depression is the most important
factor influencing ego integrity among elderly individu-
als. Although elderly-related facilities provide a variety
of programs, few programs exist to manage individual
psychological conflicts, anxiety, separation, or loss[6].
Talking about life stories is therapeutic among elderly
people when they are based on their memories. Life re-
miniscence promotes psychological recomposition and
general reaction to crisis including development crisis
[3]. Through the process of reminiscence, elderly indivi-
duals can recollect their circumstances and role and re-
store themselves. Reminiscence also plays a bridge role
between the present and the past. The elderly can accu-
mulate situational judgement abilities and develop a
new and permanent identity. One ways to achieve ego
integrity is to reflect on the past and have a positive view
of life. With ego integrity, elderly individuals can feel
that they have lived the best and most meaningful life
they could have and are able to reflect on their life with
integrity. They look back at their past life and think of
meaningful past experiences. Then, they attempt to mea-
sure and put their life in order. Therefore, reminiscence
becomes a main means to help achieve ego integrity in
the elderly[7].
Reminiscence is to look back over life to reintegrate,
reorganize, and ultimately resolve painful problems in
the face of changes of experience and individual loss due
to aging. The mechanism of reminiscence can only act
when there is a listener. Thus, thinking quietly and alone
is not enough-a listener is required for its effectiveness.
In this sense, interaction comes to the fore. In the pro-
cess, reminiscence may become a tool to satisfy and ma-
intain one's status and honor. Group reminiscence ther-
apy might provide enhanced sociality and catharsis[3].
Recently, cinema therapy which uses cinema as ther-
apeutic technique has become popular pervasive in the
counseling field. Its effectiveness has been demonstrat-
ed in participants' self-esteem, emotional expression and
understanding, interpersonal relations, depression, and
psychiatric patients' rehabilitation. Cinema therapy pre-
scribes a cinema to an interviewee as the healing pro-
cess. Identification, projection, idealization, modeling,
and vicarious learning are suggested as the psychologi-
cal mechanism of cinema therapy[8]. In cinema therapy,
interviewees enjoy watching a movie and their ther-
apeutic motivation becomes high. They move between
imagination and reality and can explore emotions asso-
ciated with their present problems[9]. The advantage of
cinema is that receivers strongly accept a text as a plau-
sible and possible story. As it powerfully influences the
receiver"s perception by using auditory, visual., and writ-
ten language, it can be a very accessible medium for in-
terviewees. Even interviewees who feel nameless anxi-
ety about psychological therapy can voluntarily partic-
ipate in the therapy given the playfulness that character-
izes cinema therapy. Recipients watch or make a movie
[10] and subsequently feel stability and relief.
Most previous researches found a positive effect of re-
miniscence therapy on psychological variables in eld-
erly individual., Art therapy-based group reminiscence
therapy was found to have an effect on quality of life
and ego integrity among elderly individuals in a nursing
home[11]. Further, reminiscence therapy applying pho-
tography showed a significant effect on memory in eld-
erly individuals with dementia in nursing facilities[12].
However, little research has investigated reminiscence
in elderly individuals using an image. Sim et al.,[13] de-
veloped a depression intervention program that applied
reminiscence therapy using cinema and TV drama for
the general elderly population[13].
Therefore, this study sought to evaluate the effect of
cinema therapy on depression and ego integrity among
elderly individuals in a nursing home.
2. The Purpose and Hypotheses
The purpose of this study was to perform a cinema
therapy-based group reminiscence program and verify its
effects on depression and ego integrity of the elderly in
nursing home. The hypotheses of this study are as follows.
1) Hypothesis 1
The experimental group who participated in the cine-
ma therapy-based group reminiscence program will have
lower depression score than the control group who did
not participate.
2) Hypothesis 2
The experimental group who participated in the cine-
ma therapy-based group reminiscence program will have
higher ego integrity score than the control group who
did not participate.
METHODS
1. Study Design
This study used a nonequivalent control group non-
Vol. 23 No. 4, 2014
235
Effects of a Cinema Therapy-Based Group Reminiscence Program on Depression and Ego Integrity of Nursing Home Elders
synchronized design. and a non-randomized controlled
trial.
2. Participants
Participants were 45 elderly individuals residing in a
nursing home in G city from June to August 2013. Parti-
cipants understood the purpose of the study and agreed
to participate. The purpose of the study, questionnaire
contents, and their ability to withdraw from the study at
any time were explained to the experimental group. The
participants fully understood text in order to sign a writ-
ten consent and complete a the questionnaire. The same
cinema therapy program that was provided to the ex-
perimental group was provided to the control group af-
ter the study was finished.
A total of 24~30 (12~15 for each group) participants
are required according to the table suggested by Cohen
[14] when significance level ⍺ is .05, the number of
groups is 2 (u=1), effect size is .96, and desired power is
.80. Considering potential drop rate, 25 participants were
selected for each group. However, 2 participants of the
experimental group who did not participate continuou-
sly were excluded. In the control group, 3 participants
who participated in the pre-test but did not participate
in the post-test were excluded. Finally, a total of 45 par-
ticipants (experimental group =23 and control group =
22; drop rate=10%) were selected for the study.
3. A Researcher and a Research Assistant
This researcher works as a training director of the
Korea Society for Image-Cinema therapy and a cinema
therapy instructor of the Korean Institute of Film Appli-
cation. This researcher developed cinema therapy pro-
grams for adolescents under a probation in a doctoral
dissertation and for the elderly's depression interven-
tion. This researcher also give lectures on psychiatric
mental health nursing in the college. One research assis-
tant, a psychiatric mental health nurse, who completed
a cinema therapy workshop in the Korean Institute of
Film Application and works as an alcohol hospital coun-
selor, helped conduct the program.
4. The Construction of the Program
The program of this study applied the family life cycle
by Erikson's emotional development theory[15] based
on the program developed by Sim et al.,[13]. The pro-
gram consisted of a total of 10 sessions (warm-up [Ses-
sion 1], reminiscence [Sessions 2~9], and follow-up [Ses-
sion 10]). In each session, participants watched an edit-
ed theme image for 20 minutes and reminisced on their
life using structured questions.
The movie used for this study was 'My Mother, The
Mermaid (Korean).' It is a fantasy movie in which a
young woman is transported back in time and sees her
parents courtship. She lives with her loud, cynical moth-
er and very good but emotionally non-existent father.
One day, her father disappears because he gets ill, and
she goes to her parents' hometown to find him. There,
she - experiences her parents' pure and beautiful love.
The TV drama 'Life Is Beautiful (Korean TV drama)' is
a family story spanning several generations in Jeju-do
about the harmony and love of remarried family.
Two images were selected because they describe the
family members characteristics in detail and deal with
human relationships such as parents -child, couples, fri-
end, and siblings, relationships, as well as conflicts with
husband's family. They also covered a variety of themes
including preciousness of family, reconciliation, forgive-
ness and love, beautiful memories but ugly reality, sound
values, positive way of thinking, and life and death.
The final program was determined after a discussion
among one psychiatric mental health nursing professor,
one geriatric nursing professor, and one head nurse in a
nursing home (Table 1).
1) Warm-up (Session 1)
The warm-up session was intended to form the rela-
tionship between the researcher and participants and
among participants. The purpose of the study was ex-
plained to participants. The researcher and participants
developed rapport through self-introduction and pro-
gram rules were made.
2) Reminiscence (Sessions 2~9)
Reminiscence was intended for rumination on early
childhood, pre-school age, adolescence, and adulthood
by development stage and a consideration of approach-
ing death. During the session, participants watched an
edited theme image for 20 minutes and shared life sto-
ries through structured questions. The focus was on
positive reminiscence of one" s life by human develop-
ment stage within group dynamics by using an image.
3) Follow-up (Session 10)
The follow-up was intended for participants to ex-
press their feelings and thinking after the program and
to positively plan the rest of their days.
236
Journal of Korean Academy of Psychiatric and Mental Health Nursing
Kim, Ha Gang
Table 1. Cinema Therapy based Group Reminiscence Program
Session Theme Program contents
1 * Introducing program
* Formation of Intimacy
- Introduction of program and rules.
- Introduction of moderator and participation
2 [Stage of infant and babyhood]
* Reminiscence of parents and babyhood
- Watching edited film (20 minute) and sharing structured questions
- Sharing memory about parents and brothers
3 [Stage of infant and childhood]
* Recognition of positive experience in
same age relationship
- Watching edited film (20 minute) and sharing structured questions
- Sharing pleasant memory and friends in childhood
4 [Stage of school age child and adolescence]
* Reminiscence of school days
* Giving attachment to effort and dream in
school days
- Watching edited film (20 minute) and sharing structured questions
- Sharing the dream about future
- Sharing the success and frustration
5 [Stage of adulthood I]
* Self -awareness about process of marriage
and the newlywed days
* Thought about being parents for the first
time
- Watching edited film (20 minute) and sharing structured questions
․ Sharing the feeling about partner at first meeting
․ Sharing process of marriage
․ Sharing the birth of first baby
6, 7 [Stage of adulthood II]
* New understanding about parents and
recognition of value about oneself
- Having pride about solving problem
- Watching edited film (20 minute) and sharing structured questions
․ Sharing the experience of pleasant and difficulty in process of
rearing of children
․ Sharing about mind to leave on the children
․ Sharing the most difficult experience
․ Sharing the successful experience
8 [Stage of senescene]
* Successful agedness
* Positive recognition about proceed of
agedness
- Watching edited film (20 minute) and sharing structured questions
․ Sharing the experience about grandparents in childhood
․ Sharing opinion about successful agedness
9 [Death]
* Ready for the death
* Decreasing fear about the death
- Watching edited film (20 minute) and sharing structured questions
․ Sharing opinion about the death in mind.
․ Sharing opinion about an ideal death
10 * Positive reconstruction about the life - Reminiscence of whole life and sharing wish about the future
5. Measurement Tools
1) Depression
The Korean Form of Geriatric Depression Scale (KGDS)
is a Korean version of Geriatric Depression Scale (GDS)
developed by Brink and Yesavage et al.,[16] and stand-
ardized by Kim JS et al[17]. This tool is a dichotomous
scale of responding yes or no and consists of 16 neg-
ative and 14 positive items. Negative items range 0~30
points by reverse-scored conversion ('Yes'=0, 'No'=1).
Given that 14 points are the optimal cut-off score, 14~18
points is classified as subthreshold depression and mild
depression; 19~22, as moderate depression; and over 23
points, as severe depression. Higher scores indicate se-
verer depression. While Cronbach's ⍺ of the tool is .92
at the time of development, and in this study, it is .82.
2) Ego integrity
The ego integrity is developed by Kim, JS[18] based
on the conceptual framework establish by Erikson[19].
This tool consist of a total of 31 items with 15 positive
and 16 negative items. Positive items have a five-point
scale of agree strongly (1), agree somewhat (2), neutral
(3), disagree somewhat (4), and disagree strongly (5).
Negative items are reverse-scored and higher scores in-
dicate high ego integrity. The total score of ego integrity
is 155, ranged from 31 to 155. Cronbach's ⍺ of the tool
is .86 at the time of development, in this study, it is .81.
6. Data Collection
Data were collected from June to August, 2013, par-
ticipants were elderly individuals in a nursing home lo-
Vol. 23 No. 4, 2014
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Effects of a Cinema Therapy-Based Group Reminiscence Program on Depression and Ego Integrity of Nursing Home Elders
cated in G city. Elderly individuals were divided into an
experimental and a control group. The pretest was con-
ducted one week before the program and the posttest
was conducted one week after the program in the same
way as the pre-test.
7. Data Analysis
SPSS/WIN 20.0 program was used to analyze data.
y Participants' general characteristics was analyzed by
Chi-square, Fisher's exact test, and t-test.
y Before the program the pre-test for homogeneity
for dependent variables was analyzed in the expe-
rimental and control groups by Kolmogorov-Smir-
nov test and t-test.
y After the program the between-groups effect test
was analyzed by independent t-test.
RESULTS
1. General Participant Characteristics
The average age of participants was 70~79, in the ex-
perimental and control group respectively. 10 males (43.5
%) and 13 females (56.5%) comprised the experimental
group, while 11 males (5.00%) and 11 females (50.0%)
comprised the control group. Elementary school was
the most common level of education in the experimen-
tal (39.2%) and control (31.9%) groups. Christian was
the most common religion in the experimental (39.2%)
and control (36.4%) groups. Participants with no reli-
gion were 17 (73.9%) and 17 (68.2%), in the experimen-
tal and control groups respectively. Those who had fri-
ends in the facility were 18 (78.3%) and 13 (59.1%), in
the experimental and control groups respectively. Before
the educational program, between-groups homogeneity
was analyzed for general characteristics using chi-squar-
ed, Fisher" s exact and t-tests. There was no significant
difference between groups (
p
>.05). Homogeneity of
variances was confirmed (Table 2).
2. The Homogeneity Test for Dependent Variables
The homogeneity test was conducted for depression
and ego integrity in the experimental and control groups
before the program. The sample size was small in the
experimental and control groups (23 and 22, respecti-
vely). Thus, the Kolmogorov-Smirenov test was con-
ducted to test whether the data met the basic assump-
tion for parametric statistics that is that depression and
ego integrity among two groups were a normally distri-
buted. The result showed a normal distribution for both
groups.
The average difference in depression and ego integri-
ty between groups was analyzed by t-test. There were
no significant difference for any variables (
p
>.05). Ho-
mogeneity was confirmed (Table 3).
3. Ef f ect of Ci n ema The r a py b as ed Gr oup Remi ni sc enc e
Program
The pre-post difference of depression in the two
groups was analyzed. While the experimental group de-
creased from 15.4±2.56 to mean 11.0±2.03, the control
group decreased from 15.1±2.36 to mean 15.0±2.05.
An analysis of independent t-test showed a significant
difference between the two groups (t=5.01,
p
<.001)
The pre-post difference of ego integrity in the two
groups was analyzed. While the experimental group was
increased from 95.3±11.40 to mean 103.8±8.29, the
control group increased from mean 92.7±11.15 to mean
95.5±9.52. A independent t-test showed a significant
difference between groups (t=4.29,
p
<.001).
DISCUSSION
This study was conducted to examine the effects of a
cinema therapy-based group reminiscence therapy on
depression and ego integrity among elderly individuals
in a nursing home.
The results suggested that cinema therapy decreased
depression in the experimental group as compared to
the control group. This program may be effective be-
cause participants could 1) empathize with movie char-
acters and talk about their past stories without feeling
threatened, 2) find positive life advantages and internal
strengths, and 3) have an increased opportunity to ex-
perience positive feelings through group support. In
particular, group reminiscence was more helpful than
individual reminiscence. A greater decrease of depres-
sion was reported in group reminiscence as opposed to
individual reminiscence[20]. When people reminisce
about their life and experience the pain of unsolved con-
flicts about negative emotions such as anger, helpless-
ness, and grief, group support can provide an oppor-
tunity for expression through self acceptance and open-
ing. It can thereby influence a decrease in depression.
Further, group art therapy using reminiscence showed a
positive effect on cognitive functions and depression in
a nursing home elderly individuals with dementia[21]. A
238
Journal of Korean Academy of Psychiatric and Mental Health Nursing
Kim, Ha Gang
Table 2. Homogeneity Test for Characteristics between Experimental and Control Group (N=45)
Characteristics Categories
Exp. (n=23) Cont. (n=22)
x
2
p
n(%) or M±SD n(%) or M±SD
Age
†
(year) ≤59
60~69
70~79
≥80
1(4.5)
5 (21.7)
12 (52.1)
5 (21.7)
0(0.0)
2 (18.2)
13 (59.1)
5 (22.7)
3.56 .469
Gender Male
Female
10 (43.5)
13 (56.5)
11 (50.0)
11 (50.0)
0.19 .661
Education
†
Elementary
Middle school
High school
≥University
None
9 (39.2)
3 (13.0)
4 (17.4)
3 (13.0)
4 (17.4)
7 (31.9)
4 (18.2)
5 (22.7)
3 (13.6)
3 (13.6)
0.63 .960
Religion
†
Catholic
Christian
Buddhism
None
2(8.7)
9 (39.2)
5 (21.7)
7 (30.4)
3 (13.6)
8 (36.4)
4 (18.2)
7 (31.8)
1.25 .840
Health condition
†
Very good
Good
Normal
Bad
Very bad
1(4.3)
1(4,3)
6 (26.1)
10 (43.5)
5 (21.8)
1(4.5)
3(13,6)
7 (31.8)
5 (22.7)
6 (27.4)
2.81 .589
Supporter
economic
†
Very dissatisfaction
Dissatisfaction
Normal
Satisfaction
Very satisfaction
1(4.4)
3 (13.0)
13 (56.6)
3 (13.0)
3 (13.0)
1(4.5)
3 (13.6)
11 (50.0)
5 (22.8)
2(9.1)
0.85 .932
Family, friends
visiting
†
Once a six months
Once a three months
Once a month
Twice or three times a month
Once more a week
4 (17.4)
1(4.3)
4 (17.4)
3 (13.1)
11 (47.8)
6 (27.3)
0(0.0)
5 (22.7)
7 (31.8)
4 (18.2)
10.63 .101
Friend in nursing
home
Yes
None
18 (78.3)
5 (21.7)
13 (59.1)
9 (40.9)
1.93 .165
Exp.=Experimental group; Cont.=Control group;
†
Fisher's exact test.
Table 3. Homogeneity Test for Depression and Self-integrity (N=45)
Variables
Exp. (n=23) Cont. (n=22)
t
p
M±SD M±SD
Depression 15.4±2.56 15.1±2.36 0.34 .732
Self-integrity 95.3±11.40 92.6±11.15 0.79 .432
Exp.=Experimental group; Cont.=Control group.
group reminiscence program using music improved in-
terpersonal relationships and self-esteem and decreased
depression in elderly inpatients[22].
Depression is the most common and frequent psy-
chological problem in elderly individuals. Elderly in-
dividuals with depression often focus on the negative
aspects of their life. They are not concerned with about
positive elements because of life regrets and unsolved
tasks. They regard themselves as losers, and they lose
life values because they perceive their reality more neg-
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Effects of a Cinema Therapy-Based Group Reminiscence Program on Depression and Ego Integrity of Nursing Home Elders
Table 4. Effect of Cinema Therapy based Group Reminiscence Program on Depression and Self-integrity between Experimental
and Control Group (N=45)
Variables Groups
Pretest Posttest Difference
t
p
M±SD M±SD M±SD
Depression Exp. (n=23)
Cont. (n=22)
15.4±2.56
15.2±2.36
11.1±2.03
15.0±2.05
-4.3±1.31
-0.2±0.70
5.01 ＜.001
Self-integrity Exp. (n=23)
Cont. (n=22)
95.4±11.40
92.7±11.15
103.8±8.29
95.5±9.52
8.5±11.74
2.8±7.94
4.29 ＜.001
Exp.=Experimental group ; Cont.=Control group.
atively[23]. Reminiscence on achievements and success
is helpful toward building confidence and restoring po-
sitivity. Finally, it can decrease depression. In this study,
elderly individuals in a nursing home shared negative
feelings on their life with several people, which showed
an ability to decrease depression. A movie is more effec-
tive an the emotional level than it is on an intellectual
level. It is helpful in reducing suppression and other de-
fense[24]. It is also effective for helping elderly indi-
viduals with verbal difficulties express their feelings and
solve conflicts and problems.
The results also indicated that ego integrity was in-
creased in the experimental group compared with the
control group. The program of this study improved par-
ticipants " ego integrity because they could share their
negative feelings on life with honesty, be aware of their
biases, and ruminate and understand their life from dif-
ferent angles. The function of reminiscence is closely as-
sociated with ego integrity[24]. With regard to reminis-
cence, ego integrity is positively correlated with finding
the meaning of life, understanding self, and reviewing
one's past life. A reminiscence-based group counseling
program positively affected ego integrity[25], and remi-
niscence-focused play with a sand box showed improv-
ed ego integrity[26] among elderly individuals in a nurs-
ing home.
Reminiscence in the elderly can facilitate solution for
negative emotions such as anger, grief, and helplessness
and improve psychological adaptation. As psychological
counseling using reminiscence can bring new insights
and passion in the elderly, it can be used as a means to
maintain and improve mental health in the elderly.
Therefore, depression and ego integrity should be si-
multaneously addressed in counseling and therapy pro-
grams for elderly individuals to improve ego integrity,
which is a developmental task in later life[5].
Sessions of the reminiscence program are organized
to look back over one's life and explore wisdom they
have obtain or grown to understand during their life.
This may contribute to the improvement of the elderly's
ego integrity.
This study used a movie that was edited for a session
theme to increase the effect of the group reminiscence
program. The therapeutic mechanism of a movie is the
virtual world that fosters judgement of a variety of ele-
ments that can occur in a real situation. Participants have
broad opportunities to exchange thoughts, plan and
compromise their behaviors, and reflect upon their
works through cinema therapy[10]. Participants first
hesitated to share their lives when expressing individual
experience after watching a movie. However they un-
derstood that movie characters and other group mem-
bers had experienced similar troubles as their own.
Some even suggested solutions to other members based
on their experiences. We also think that participants ge-
nerally responded to structured questions with positive
feelings and impression after watching a movie. Although
it was difficult to express their thoughts and feelings at
the beginning of the program, they identified themsel-
ves with movie contents and characters and actively re-
acted over time. Therefore, if such an intervention is of-
fered regularly rather than temporarily, it might be ex-
tremely helpful for positive life integration among eld-
erly individuals in nursing homes.
A visual image created in the mind of people watch-
ing a movie is fluid and changing. It influences personal
painful experiences and has a cathartic function. A mov-
ie can enrich the lives of modern people who feel alien-
ated across realms of life, rather than only in an art gen-
re. It functions as a means of building social relation-
ships. A movie has therapeutic potential because those
watching a movie can recognize their own problems,
match their reality to problems from the movie, and find
solutions for themselves[9]. Participants responded as
follows after watching a movie: "I understand the main
character but he (she) is too harsh. Then he (she) would
regret like me and his (her). Family would get hurt," " We
do not express well between family members, and many
240
Journal of Korean Academy of Psychiatric and Mental Health Nursing
Kim, Ha Gang
misunderstandings have grown. But I led a busy life and
could not think like that," and "Here, sometimes, I be-
come uncomfortable, as many things come back to my
mind. I thought it was so late but I have the courage to
talk with my children when they come."
Therefore, it is necessary to develop systematic pro-
grams and provides policy programs suitable for the
characteristics of elderly individuals in a nursing home.
It has been reported that programs are more effective if
their contents are accompanied by artistic experience
[27]. Thus, this study introduced the advantages of cine-
ma therapy to maximize the effects of a group reminis-
cence program. It is noteworthy that this study is the first
to utilize group reminiscence using cinema to address
depression and ego integrity among elderly individuals
in a nursing home. The results of this study be used to
improve the quality of life of this population.
Based on the conclusions, the following suggestions
can be made. First, as this study was conducted with the
elderly in a nursing home located in one area, the study
area should be expanded and resulting the effect should
be examined. Second, an in-depth interview should be
conducted to identify aspects of the program that have
significant effects and whether these effects differ by gen-
der. Third, in the development of a program, sufficient
sessions should be included and separates by gender.
CONCLUSION
This study was a non-equivalent control group pre-
post test quasi-experimental study to examine the effects
of the cinema therapy-based group reminiscence pro-
gram on depression and ego integrity of the elderly resi-
ding in a nursing home. The results showed the decrea-
se in a depression score and the increase in an ego inte-
grity score in a nursing home elderly after the program,
indicating the positive effect of the program. Therefore, the
program of this study can reduce depression and increase
ego integrity in the elderly of the nursing home elderly
who are increasingly growing. Based on this, much more
programs for the nursing home elderly should be devel-
oped, applied, and activated continuously.
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