Spice up reminiscence with virtual reality

How to advance therapeutic recreation

In conventional therapeutic approaches, adults coping with situations that negatively affect mood or well-being often get relief through social and psychological interventions and/or antidepressant medications.

For elders who also manage chronic medical conditions, healthcare providers favor non-pharmaceutical interventions designed to stimulate beneficial cognitive activity, such as recreational therapy.¹

Recreational therapy activities are relatively affordable, accessible, and may be facilitated by different types of caregivers in many home- and community-based settings.

Recreational therapy activities may include:

• Physical exercise
• Yoga
• Meditation and guided imagery
• Music therapy
• Arts therapy
• Pet therapy
• Reminiscence therapy

How reminiscence therapy works

Designed initially for older adults experiencing cognitive decline, reminiscence therapy (also known as life-review therapy) may be used to help individuals cope with physical impairment, major life transitions, and social isolation.

Reminiscence activities have been shown to help increase life satisfaction, improve self-care and self-esteem, and to provide emotional support to individuals coping with difficult situations, such as illness and loss.²

This technique:
– involves using imagery and/or music and other materials to help trigger positive memories;
– can be used by and with a variety of individuals in a range of settings; and
– typically involves 4 to 12 sessions³

Research findings from a randomized controlled trial show that the integration of “autobiographical retrieval practice,” which uses photographs, music, conversation, etc., within life-review therapy is an effective intervention tool for depressive older adults. Patient satisfaction levels, according to the study, changed following a six-week series of life-review therapy sessions. Findings show that life-review intervention can lead to an increase in well-being.⁴

Earlier research conducted in an assisted living facility shows that group reminiscence activities, such as the sharing of memories, life events, family history, and personal accomplishments, have led to improvements in depression and loneliness.⁵

In another study involving individuals living with cognitive impairment, researchers concluded, “Regular reminiscence therapy should be considered for inclusion as routine care for the improvement of cognitive functions, depressive symptoms, and quality of life in elderly people with Alzheimer’s disease.”⁶

The emergence of virtual reality-based reminiscence therapy over the past decade has enabled research into its feasibility and the use of immersive therapeutics in recreational therapy in general.^7-9

“Reminiscence Therapy has some positive effects on people with dementia in the domains of quality of life [QoL], cognition, communication and mood. [Studies in assisted living communities] show the widest range of benefits, including QoL, cognition and communication. Individual reminiscence therapy is associated with probable benefits for cognition and mood. Group reminiscence therapy and a community setting are associated with probable improvements in communication.”³

Alternatives to face-to-face therapy

Reminiscence therapy sessions can take place in many different settings. It often is most effective when an individual can reminisce in the company of a relative, friend, or trusted care partner. However, many older adults are separated by distance or other factors preventing personal visits.

The increasing use of video meetings and screen-sharing suggests that remote consultations and virtual interactions are feasible to implement in most home- and community-based and residential care settings.

Individuals who use video to connect to clinicians, clergy, and caregivers can share memories and emotions sparked by images and sounds of family, friends, and places. Anyone grieving a loss, for example, may benefit from real-time video interactions that support the grief process, honoring the person’s relationship with a lost family member, friend, or pet.

Only recently have the infrastructure, tools, and funding pathways needed for tele-therapy become accessible and accepted:
According to 2021 research data, 75% of Americans over age 65 have used the internet.¹⁰
More people of all ages have used Internet video to communicate. In 2020, video conferencing on the Zoom® app alone saw a 535% rise in daily traffic¹¹; Christmas 2020 saw a record-breaking number of video calls through Apple FaceTime®.¹²

Medicare now reimburses clinicians for providing patients with telehealth consultations — including mental health services delivered by psychologists and social workers.¹³

---

Implementation and discussion items

Based on research findings:

• Immersive virtual reality can be used to support the use of reminiscence therapy activities
• Choosing applications that enable virtual world travel, a care partner can initiate discussion about places of interest, such as family vacation spots and other personally relevant cultural, natural, and geographical places
• A care partner can invite an individual to share memories, and guide them to describe emotions
• A 4- to 6-week series of structured immersive sessions, each lasting five to ten minutes in length, can be planned to engage individuals in virtual travel experiences and discussion.

“In the case of family history for a reminiscence activity, it may be more natural to start with images of a particular location or landmark rather than asking a question about memories in general,” says my friend and colleague Skip Rizzo, noted neuropsychologist and gerontology research professor who directs medical VR research at University of Southern California. “The care partner would then engage the individual with standardized open-ended questions about the content (‘Who is in this scene?’ ‘Where is it?’ ‘When were you visiting there?’).” (Albert “Skip” Rizzo, Ph.D., email communication, August 26, 2021.)

Conclusion & Key Points

Gerontologists who study the psychological process of “ego transcendence” are raising awareness that older adults who are encouraged to see beyond themselves and maintain a healthy interest in other people are more likely to view themselves and their lives in a positive light. Reminiscence therapy potentially can support this engagement effort and potentially mitigate isolation. Humans of any age, even while living with impairment, can thrive if they feel supported and engaged.¹⁴

Benefits of Reminiscence Therapy

“Studies report some immediate and longer-term psychosocial benefits of individual reminiscence work, as the result of a life-review process or personalized reminiscence work.
These benefits included mood, well-being and aspects of cognitive function.”

Subramaniam P, Woods B. The impact of individual reminiscence therapy for people with dementia: systematic review. Expert Rev Neurother. 2012;12(5):545-555. doi:10.1586/ ern.12.35

References

1. National Council for Therapeutic Recreation Certification. NCTRC CTRS Fast Facts: Why should you hire a certified therapeutic recreation specialist (CTRS)? Client Brochure. https:// www.nctrc.org/publications-forms/. Accessed September 3, 2021.
2. American Psychological Association, Society of Clinical Psychology. Reminiscence / life review therapy for depression status: modest research support. https://div12.org/treatment/ reminiscence-life-review-therapy-for-depression/. Accessed June 27, 2021.
3. Woods B, O’Philbin L, Farrell EM, Spector AE, Orrell M. Reminiscence therapy for dementia. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD001120. doi: 10.1002/14651858.CD001120.pub3. Accessed August 23, 2021.
4. Preschl B, Maercker A, Wagner B, et al. Life-review therapy with computer supplements for depression in the elderly: a randomized controlled trial. Aging Ment Health. 2012;16(8):964- 974. doi:10.1080/13607863.2012.702726
5. Chiang, K, et al. The effects of reminiscence therapy on psychological well-being, depression, and loneliness among the institutionalized aged. Int. J. Geriatr. Psychiatry. 2010;25(4):380-8. doi: 10.1002/gps.2350
6. Lök N, Bademli K, Selçuk-Tosun A. The effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer patients: randomized controlled trial. Int J Geriatr Psychiatry. 2019 Jan;34(1):47-53. doi: 10.1002/gps.4980. Epub 2018 Sep 24. PMID: 30246408.
7. Saredakis D, Keage HA, Corlis M, Loetscher T. Using virtual reality to improve apathy in residential aged care: mixed methods study. J Med Internet Res. 2020;22(6):e17632. doi:10.2196/17632
8. Tominari M, Uozumi R, Becker C, Kinoshita A. Reminiscence therapy using virtual reality technology affects cognitive function and morale of elderly with dementia. Alzheimer’s Dement. 2020;16:e047538. https://doi.org/10.1002/alz.047538. Accessed September 13, 2021.
9. Niki K, Yahara M, Inagaki M, Takahashi N, Watanabe A, Okuda T, Ueda M, Iwai D, Sato K, Ito T. Immersive virtual reality reminiscence reduces anxiety in the oldest-old without causing serious side effects: a single-center, pilot, and randomized crossover study. Front Hum Neurosci. 2021 Jan 18;14:598161. doi: 10.3389/fnhum.2020.598161.
10. Pew Research Center. Internet/Broadband Fact Sheet. https://www.pewresearch.org/
    internet/fact-sheet/internet-broadband/. Accessed September 9, 2021.
11. Digital in the Round. 20 Astonishing Video Conferencing Statistics for 2021. https:// digitalintheround.com/video-conferencing-statistics/. Accessed September 9, 2021.
12. iMore.com. Christmas saw a record-breaking number of FaceTime calls. https://www.imore. com/christmas-saw-record-breaking-number-facetime-calls. Accessed September 9, 2021.
13. Medicare.gov. Your Medicare Coverage: Telehealth. https://www.medicare.gov/coverage/ telehealth. Accessed September 9, 2021.
14. Saxon SV, Etten MJ, Perkins EA. Physical change and aging: a guide for the helpings professions. 6th ed. Springer Publishing Co.; 2014.
15. Kunz J, Soltys FG. Transformational reminiscence: life story work. 1st ed. Springer Publishing Co.; 2007.
16. Syed Elias SM, Neville C, Scott T. The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: a systematic review. Geriatr Nurs. 2015 Sep-Oct;36(5):372-80. doi: 10.1016/j.gerinurse.2015.05.004. Epub 2015 Jun 19.
17. National Academies of Sciences, Engineering, and Medicine. 2020. Social isolation and loneliness in older adults: opportunities for the health care system. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663