Effectiveness Life Review on Life Satisfaction among Adolescents under the Supervision of Qazvin Well-Being Center

Objective: The aim of this study was to determine Effectiveness Life Review on Life Satisfaction among Adolescents under the Supervision of Qazvin Well-being Center 2012-2013. Method: This study was a quasi-experimental research including experimental and control groups with a pretest-posttest design. The statistical population consisted of all 12 18 years old male students who were nurtured in Qazvin Well-being Center, among whom 16 individuals were selected through applying purposive sampling method and were randomly divided into experimental and control groups with equal number of subjects. The investigation was done using Diener’s (1985) Satisfaction with Life Scale (SWLS) Questionnaire. The experimental group received life review therapy in 6 sessions (90 minutes per session). Data were analyzed by using Analysis of Covariance (ANCOVA), using SPSS software. Results: Results indicated that life review therapy was effective in increasing male adolescents’ life satisfaction living in the welfare center. Conclusion: Life review therapy improves quality of life and life satisfaction; therefore, this treatment can be used as an effective method to improve the living conditions of young people.


Introduction
Life satisfaction is a common variable in statistical studies and also is a determinant of the level of individuals' health.Regarding the importance of this issue, it should be pointed out that human being is a purposeful creature and always seeks to assess his/her life status and does not feel satisfaction until he/she reaches what he/she wants.It may likely be noted that the ultimate ambition of each human being is the realization of her/his goals and aspirations.However, the level of goals and aspirations roots in conditions obtained in interaction with others and the status quo.Therefore, nowadays every developed society thinks about its citizens' satisfaction, since life satisfaction is highly congruent and correlated with social and economic developments [1].On the other hand, due to the central role of life satisfaction in individuals' health and well-being, this issue has been extensively psychologically discussed and psychology has greatly attempted to identify factors affecting life satisfaction in order to improve it.However, the main focus of the recent and past points of view in this field has been the treatment of diseases, rescuing human from mental illnesses and reduction of deleterious factors and less attention has been paid to positive health indicators [2].
Life satisfaction is a subjective concept, unique to each person, which along with positive and negative effects, consists of three basic components of mental well-being that generally refer to an individual's cognitive appraisal of his/her life [3].Life satisfaction denotes cognitive and conscious assessment by the individual of his/her quality of life as a whole which is based on personal criteria [4].Accordingly, life satisfaction reflects the positive attitude of the individual towards the world in which he/she lives and indeed it is the same sense of joy which he/she spent a lot of time to achieve.It is the underlying concept consciously selected by the individual and unconsciously kept in his/her mind [5].
Recently, a large body of research has been conducted on life satisfaction both objectively and subjectively.The objective perspective considers external conditions such as income, housing quality, friendship networks, and access to health services.In contrast, the subjective perspective emphasizes people's judgments about life satisfaction considering their life as a whole or some special areas such as satisfaction with friends, family, and educational experiences [6].Stoeber and Stoeber [7] found that age, gender and life satisfaction are correlated with various spheres of employment, education and physical and mental health.Moreover, Zullig, et al. [6] explored quality of life related to adolescents' health and life satisfaction and found that whenever the levels of physical and mental health of adolescents were low and their activities were limited, their life satisfaction decreased.Likewise, Adamiak [8] in his studies found a relationship between life satisfaction and mental health in adolescents and stated that low life satisfaction was associated with a variety of mental disorders, especially depression and anxiety.In addition, research studies have shown a direct relationship between adolescents' selfefficacy and life satisfaction.In other words, adolescents who considered themselves more self-efficient experienced more satisfaction with their lives [9].
Although, research conducted on life satisfaction has mostly discussed topics such as marriage, work, and aging, recently, exploring the structure of life satisfaction in children and adolescents has been addressed [10].Hence, identifying variables involved in life satisfaction is very important in planning for improvement of life satisfaction.Variables such as age, income, physical and mental health, education, interpersonal relationships, personality and life review have been recognized as significant factors affecting life satisfaction.Among these variables, life review therapy, given its therapeutic purposes, seems to be able to increase the level of life satisfaction.
Butler [11] introduced the term life review in his historical research.Butler considered life review as a natural action as well as a public process during which the individual recalls, thinks of, and evaluates his/her past experiences, and in order to achieve more autognosis, deeply reflects it.Additionally, providing a framework for this developmental task, Butler made it more purposeful, gave it a therapeutic shape, and defined it as a step-by-step retrospection for being aware of early experiences that can be re-appraised to alleviate previous contradictions.Hence, this developmental task gives a new meaning to an individual's life.On the other hand, Butler considered the process of pondering over the past and correlating the present and past life with each other as life review [12].In a clarifying definition, Common Language for Psychotherapy (CLP) defines life review therapy as a structured way to remind an individual's past life using therapeutic principles.
Life review originates from eight social-mental stages introduced in Ericsson's theory.Robert Butler was the first scientist who used life review therapy to help patients, especially the elderly.Acknowledging the Ericsson's social-mental development, Butler believes that life review can be useful to assist clients who have failed to resolve conflicts related to one or some steps of the Ericsson's social-mental development.Life review provides an opportunity to rebuild social-mental development by retelling the story of one's life, mentioning memories of the early life.Accordingly, life review is useful in determining the cases in which the client cannot remember or refuses to talk about the experiences.For example, although the clients may respond to questions about their childhood easily and freely, they may respond to questions related to adolescence vaguely and confusingly.In addition, in the eighth stage, the individual attempts to use integration.The final stage which is mostly applied in old ages is the integration stage.The psychological conflict of this period is the integration of ego against despair which includes compromising life.People who achieve integration feel perfection and satisfaction with their achievements.Sense of integration due to retrospection is achieved through life review.Accordingly, life review can help individuals accept their unique life cycle (Karimi, Esmaeili & Arian, 2010).In addition, in reminding or determining some parts of the clients' life story, which are difficult to be discussed, life review provides the therapist with clues on unresolved developmental conflicts.The life review also provides an opportunity to resolve conflicts in the early stages of the clients' lives through determination of them based on the reported stories by clients [13].
In implementation of the life review process, mental health professionals should be aware of two factors during the activities: first, the type of content that is expressed and a positive change must be created in it, and second, interpersonal relations between the consultant and the client, since the most effective element of development is amity and one-to-one understanding and close relationship which are essential factors in life review therapy.In this regard, it could be argued that life review therapy leads to optimum results faster compared to old and clinical interviews, because the client is aware of the content of personal memories and there is no need to learn a new skill [14].Weiss (2010) compared life review group therapy with other group therapies and reported the superiority of its therapeutic power over other group therapies.
Haight, Michel and Hendrix (2008) have conducted studies on the effectiveness of life review group therapy in reducing anxiety.In addition, the results of a case study showed that the technique of life review is effective in the treatment of posttraumatic stress disorder (PTSD) (Mearcker, 2009).On the other hand, Kazemian and Delavar [15] indicated that life review therapy is effective in increasing self-treatment drug addicts' general health, or in other words, reducing its subscales i.e. somatic symptoms, anxiety and insomnia, social dysfunction and depression symptoms.Moreover, the results demonstrated that using life review therapy is remarkably effective in improving the mental health of drug addicts who attempt to withdrawal.Moreover, Zalpour, et al. [16] found that group therapy through combining two techniques of hot chair and life review is effective in reducing anger in male adolescents with behavioral disorders and provides better results.However, life review therapy and remembrance of memories have had the highest effects on elderly people [17].Therefore, based on the literature review on the life review and little of research in this area, this issue was raised by the researcher to find out whether or not the method of life review therapy can be effective in significant influence on life satisfaction among adolescents living in well-being centers.

Methods
This study was quasi-experimental research with experimental and control groups and a pretest-posttest design, in which life review was considered as the independent variable and life satisfaction as the dependent variable.The population consisted of all 12 -18-year-old male students who were living in Qazvin Well-being Center.With regard to the special conditions of these students, the sample was selected among those students who had a low level of life satisfaction.The sample size included 16 individuals selected through applying availability sampling method among 30 students who obtained the lowest scores on the life satisfaction test.The sample was randomly divided into experimental and control groups; each group containing 8 individuals.The inclusion criteria of the current study included not suffering from any special physical illnesses and living in the well-being center for at least one year.Finally, research data was analyzed through applying descriptive statistics (frequency, central tendencies) and inferential statistics (analysis of covariance) using SPSS software.

Instrument
Diener's Satisfaction with Life Scale (SWLS): This five-item scale was developed by Diener, et al. [3] to measure the overall life satisfaction.Dienerand his colleagues reported a good convergent and discriminant validity as well as a good reliability (Cronbach's alpha: 0.85) for the scale.For each item in the scale, a seven-point Likert-type scale from totally disagree (1) to strongly agree ( 7) is provided which measures the individual's satisfaction with life.Scores range from 5 to 35.Higher scores indicate higher satisfaction with life.Jawkar [18], in a research carried out on 577 high school students, obtained Cronbach's alpha coefficient as 0.80 for the scale and calculated the validity using factor analysis.The result indicated the existence of an overall factor in the scale explaining more than 54% of the variance.In the present study, the Cronbach's alpha reliability was estimated which was 0.78.

Procedure
The data has collected as per the details given in the design and sample of the study.In the first part, questionnaire of Diener's Satisfaction with Life Scale (SWLS) has administered to number of participants, after scoring; only those male students were included in the sample who reported low level of Satisfaction with Life.Thus a total of 16 subjects have been chosen which is divided into two groups i.e. control group (a1), N = 8 and the experimental group (a2), N = 8.In the two groups formed i.e.Control and experimental, Experimental groups receiving life review therapy.Standard procedures of life review therapy have followed.Each subject of the experimental group has been engaged in 6 talking sessions of 90 minutes duration each.After completion of life review therapy intervention, Diener's Satisfaction with Life Scale (SWLS), have been administered to both the groups after 6 sessions.And percentage changes have been obtained with respect to the base scores.

First session Introduction and acquaintance with students, statement of goals, description of methods and sessions
Second session Discussion about the importance of memoirs and life review

Third session
Reviewing the memoirs of the childhood and solving the unsolved conflicts of that period

Fifth session
Challenging the matter that how has been your life?
Sixth session Re-naming and positive interpretation of negative aspects of the individual's memoirs with emphasis on positive memoirs by cognitive restoration Post-test Assessment; acknowledging the participants

Statistical Analyses
Statistical analysis for the present study was done with the help of SPSS v. 16.0 for Windows.Descriptive statistics has reported.Also the data for the two groups (experimental and control) have been compared by using Ancova and outcomes is summarized in results.However, exact tests that were used in analyzing the data are mentioned in followed and respective chapters in the respective sections.

Results
Using mean and standard deviation, descriptive analysis was performed.In the inferential level, ANCOVA was used.The results are represented in Table 1 and Table 2.
According to the above table, it is observed that the mean value of the control group's scores on the pretest is 10.50 which reduced by 1.5 units on the posttest, and has reached 9.00.However, the mean value of the experimental group's scores on the pretest is 10.88, which is not significantly different from that of the control group.However, this value has reached 18.77 on the posttest which is significantly different from the pretest.To assess the significance of these differences, ANCOVA was used.
As the results of the covariance in the above table show, by eliminating the effect of pre-test and considering the calculated F factor, it is observed that there is a significant difference between the modified scores of the participants' life satisfaction in terms of "control and experimental" group membership at post-test stage (P < 0.05).Therefore, we conclude that the null hypothesis is rejected and the intervention in the participants of experimental group has had more impacts on life satisfaction than control group.The rate of this impact of "practical significance" has been 0.43, that is, 43% of the whole variances or individual differences in life satisfaction have been related to intervention.

Discussion
The results of the present study revealed that life review therapy is effective and useful in increasing the level of life satisfaction it in the level of 0/05.At the same time, we must keep in mind that obtaining good results from treatments and psychological interventions depends on important factors such as cultural, religious, socioeconomic, family and personal factors of the cases under study, all of which are better be considered as cause and effect factors to achieve more positive and useful results by such interventions.On the other hand, this research, like other research studies conducted in the field of behavioral sciences and psychology, faced some limitations among which available subjects and lack of control for intervening variables can be mentioned.Thus, caution should be taken in generalizing the results.

Conclusions
The findings revealed that life review therapy increased individuals' life satisfaction.A similar research in the field of life review therapy has not been yet conducted in Iran; however, at the international level, the results of the present study are consistent with the results obtained by Holland (2011), Weiss (2000), Haight et al. [19], and Hirsch and Mouratoglou [20].In line with the above finding, Haight and Webster [21] reported that among 100 life review therapy cases, only 7% of these cases had negative outcomes.In general, as Watt and Cappeliez (2010) pointed out, life review therapy treated faster than traditional clinical treatments, because it is a better known method for clients.The client is well aware of the content of his life and does not need to learn a new skill.Additionally, invitation of the adolescents living in the well-being center to discuss their past experiences is an appealing activity and when a consultant assists them to become aware of their own inner positive strengths, their life satisfaction increases.Haight et al. [19] presented evidence for propagation of life review group therapy and its effectiveness.The result of the present study is consistent with the results obtained by Weiss (2010) and Haight et al. [19] who emphasized the superiority of life review group therapy over other group therapies.The reason for this claim may be that in life review therapy, people's lost but effective experiences are revealed, negative experiences are reasonably evaluated and positive experiences are reminded and thereby the sense of usefulness and effectiveness is extended and consequently life satisfaction increases.When this treatment is performed in groups, an opportunity is provided for feedback by others, as well as an opportunity for the clients to see themselves as an integrated personality, and thus the clients' feeling of loneliness and isolation reduces and the sense of efficacy increases.On the other hand, since the present study was conducted in Iran, its results are in line with those of other studies conducted in other countries.Moreover, the claim of Butler (2002) who considered life review as a general psychological process as well as a global and normal phenomenon is confirmed.
Positive results of life review therapy in this research are consistent with the results obtained by Watt and Cappeliez (2000), Mearcker (2009) who reported the effectiveness of life review therapy in people with PTSD and also with the results obtained by Kazemian and Delavar [15] who reported the effectiveness of life review therapy in increasing general health of self-treatment drug addicts.Moreover, this finding is in line with the results of Kazemian [15] indicating the effectiveness of life review therapy in reducing the anxiety of young girls whose parents were divorced.The results are also consistent with the results of Haight et al. [19] who reported the effectiveness of this treatment compared to other cognitive treatments.Therefore, it could be concluded that not only life review therapy increases life satisfaction but also it is in harmony with other cognitive therapy approaches and with cognitive reconstruction of negative experiences of the clients, which is among common techniques of cognitive treatments.Also, another limitation of the present research is the selection of male subjects that we should take cautions in generalization of the results.
Finally, since life review therapy per se is a therapeutic process which is accompanied with more insight and understanding about self and is also an effective and modified psychological treatment, it is suggested that different methods of this treatment be standardized according to the Iranian community.Additionally, it is recommended that some measures be taken to introduce and train this treatment technique to staff in various institutions, including institutions for the elderly and well-being centers.Conducting more research on the effectiveness of life review therapy on various psychological variables (identity crisis in adolescence, self-esteem, and self-confidence) in different age groups is highly recommended.

Table 1 .
Pretest and posttest mean scores and standard deviation on life satisfaction of experimental and control groups.

Table 2 .
Results of covariance analysis compares life satisfaction groups.