Remembering For Resilience: Brief Cognitivereminiscence Therapy Improves Psychological Resources And Mental Well-being in Young Adults Part 3

Procedures

Before recruitment, the study received ethical approval from the Deakin University Human Ethics Advisory Group (Approval ID: HEAG-H 82_2020). Participants registered interest through online advertisements. 

Ethics counseling is a professional service that helps people resolve moral and ethical issues. Memory is one of a person's cognitive abilities and plays a vital role in one's study, work, and daily life. Although ethics counseling and memory may seem unrelated, there is a relationship between them.

First, ethics counseling can improve a person's memory. During the ethics consultation process, people need to think deeply and analyze themselves and the things around them. This way of thinking helps people activate their brains and thereby strengthen their memory. At the same time, ethics consultation can also help people better understand various complex ethical and moral issues, which helps to improve people's cognitive level and thus further enhance their memory.

Secondly, ethics consultation can also promote an individual's mental health, thereby improving memory. Ethics counseling is an effective form of psychological treatment that can help people solve psychological problems and relieve negative emotions such as depression and anxiety, thereby reducing stress and anxiety and improving memory. In addition, there is a strong connection between mental health and memory, because when a person feels happy and in a good mood, his brain releases more neurotransmitters, which promotes the formation and consolidation of memories.

Finally, ethics consultation can also improve an individual's productivity, thereby indirectly improving memory. Ethics consultation can help people solve various moral and ethical issues encountered at work, avoid disputes and conflicts at work, and thereby improve personal work efficiency and concentration. A high-efficiency working state helps improve the brain's cognitive abilities, thereby further enhancing memory.

To sum up, there is a link between ethics consultation and memory. Ethics counseling can improve an individual's cognitive level and psychological well-being, thereby enhancing memory. And good memory can also help people better absorb and understand various ethical and moral issues, and thus participate in ethics consultations more effectively. Therefore, we should pay attention to ethical consultation and the development of memory, to better promote personal physical and mental health and overall development. It can be seen that we need to improve memory, and Cistanche deserticola can significantly improve memory because Cistanche deserticola is a traditional Chinese medicinal material that has many unique effects, one of which is to improve memory. The efficacy of minced meat comes from the various active ingredients it contains, including acid, polysaccharides, flavonoids, etc. These ingredients can promote brain health in a variety of ways.

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They were then assessed for eligibility, and after providing informed consent, participants were randomized into a condition using a computer-based algorithm (www.randomizer.org) with a 1:1 ratio. Participants in the CRT condition were emailed homework sheets to complete before each session. Starting approximately 1 week after baseline, participants engaged in group sessions delivered over 3 weeks using a teleconference platform. 

The groups ranged in size from 3 to 5. One participant was unable to attend one of the sessions, and two participants received individual sessions to make up for missed group sessions. The sessions were primarily facilitated by five students as part of completing their thesis for their fourth year of undergraduate psychological studies. The first author provided training and supervision on providing CRT. 

Regarding fidelity, the facilitators followed a simple checklist indicating the tasks they were to complete in each session (outlined above). Fidelity was good during sessions that were observed by the first author, and fidelity was checked for in supervision sessions to ensure that facilitators delivered the prescribed intervention.

Participants were emailed links to complete the study measures after the third session, and again 2 weeks later. The measures were estimated as taking approximately 30 min to complete. Once the study was completed, participants in the wait-list condition were offered the opportunity to engage in the same CRT program. All participants who completed the study were offered a $10 retail voucher.

Data analysis plan

IBM SPSS Statistics Version 27 was used for all statistical analyses. Descriptive statistics were generated for variables at each time point. Pearson correlations were computed to examine the zero-order association of variables at baseline. 

MacDonald's ω is used above to assess the internal reliability of the multi-item measurement scales, having superior properties and performance than Cronbach's alpha such as not (erroneously) assuming that each item measures the latent variable with equivalent precision (see Hayes & Coutts, 2020). To test the main hypotheses, analysis of covariance (ANCOVA) tests were used to obtain a valid estimation of the intervention effect, defined by differences between the groups at post-session and follow-up while adjusting for the baseline scores ((Frison & Pocock, 1992; Twisk & Proper, 2004; van Breukelen, 2013; Vickers & Altman, 2001). 

Estimation of the intervention effect through means and standard errors adjusted for baseline scores reflected the group-by-time interaction. To control for Type 1 errors, with α set at .05, the results from the ANCOVA analyses were subject to the false discovery rate procedure (Benjamini, 2010). Relative to multiple comparison corrections that control the familywise error rate to avoid making a single type I error, this procedure provides more statistical power to identify effects by aiming to control only the proportion of significant results that are Type I errors. 

A corrected significance level is provided after the procedure (q). Standardized mean difference score, Cohen's d, was used as a measure of effect size and interpretation followed Cohen's (Cohen, 1992) guidelines (small = .2, medium = .5, large = .8). The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

RESULTS

The baseline correlations between the variables are reported in Table 2 while the descriptive statistics and results of inferential tests are reported in Table 3. All study variables were generally significantly correlated with one another, from small to moderate to large magnitudes. The exception was the awareness of narrative identity which had no significant correlations with other variables but did have non-trivial (but non-significant) associations with meaning in life and cognitive reappraisal. 

A series of t-tests showed there were no significant differences between outcome variables at baseline (all t's < 1.74, all p's > .087).

The results of the ANCOVA analyses, which adjusted for baseline scores, showed the CRT group was significantly higher in all four measures of psychological resources than the control group after the last session of CRT and at the 2-week follow-up. The effects were moderate in size for self-esteem, meaning in life, and optimism and large for self-efficacy at follow-up. 

The findings for the change processes were largely the same, with significantly higher scores in the CRT compared with the control group after the last session of CRT and at the 2-week follow-up. The effects of change processes of negative automatic thoughts, awareness of narrative identity, and cognitive reappraisal were of a moderate to large magnitude. For depression, anxiety, and stress symptoms, the CRT group reported significantly lower scores compared with the control group after the last session of CRT and at the follow-up, with large effects for depressive and anxiety symptoms and moderate to large for stress at the follow-up.

DISCUSSION

This study aimed to examine whether a brief CRT protocol, focused on positive memories and conducted online in a teleconference format, would improve psychological resources in young adults relative to a control group. Further, it aimed to examine whether CRT would have effects on hypothesized change processes and mental well-being as assessed by depression, anxiety, and stress symptoms.

The hypothesis that psychological resources would be improved by CRT, relative to a control group, was supported by significantly higher self-esteem, self-efficacy, meaning in life, and optimism reported at post-CRT and follow-up. The effects were generally moderate by the 2-week follow-up, although the effect on self-efficacy remained large. 

These findings are consistent with previous studies of CRT in young adults with clinically significant depressive symptoms (Hallford & Mellor, 2016a, 2016b, 2016c) and extend on this by showing that a brief form of this intervention is effective for psychological resources in community samples of young adults. CRT also improved mental well-being as assessed by depression, anxiety, and stress scores. 

The magnitude of these effects was somewhat surprising given the sample had, on average, only mildly elevated scores on these indices relative to adults in the Australian general population (Crawford et al., 2011). However, this may be due to the reduction in the standard deviation between baseline and subsequent time points. This relatively smaller dispersion of scores around the mean would have been a factor in increased effect size using Cohen's d. Regardless, the results indicate that brief CRT can be effective for emerging adults in reducing mildly elevated symptoms of depression, anxiety, and stress.

This study is one of few to date that have specifically tested a reminiscence-based intervention approach with young adults. Further, it provides support for the effectiveness of reminiscence-based therapies in an online, teleconference group format. Although it is not clear if an in-person approach would be more effective, the size of the observed effects in this study and the high accessibility and low resource burden of the online format have significant merit. Unfortunately, no evaluation data was collected, however, previous interview-based research has indicated that this approach is viewed as acceptable for young adults (Hallford et al., 2019).

The findings regarding automatic negative thoughts, awareness of narrative identity, and cognitive reappraisal further our knowledge of the processes of change in CRT. Congruent with our rationale, the tendency to experience automatic negative thoughts about oneself is reduced after CRT. This is consistent with the aim of CRT to explore various emotionally valenced experiences to balance appraisals of one's self-concept. In particular, in this brief version, there was a focus on the positive aspects of experiences and how this related to one's self-worth. 

The awareness of narrative identity also increased following CRT. This was indicated by young adults in a previous study (Hallford et al., 2019), but assessed quantitatively here for the first time. This awareness may have occurred by participants being prompted to consider the overall significance and meaning of the experiences that were discussed about one's identity, as well as whether they identified any themes about their lives that emerged. Listening to other participants' discussions of their personal experiences may have also triggered other memories or an abstraction of memories increasing this awareness of "stories" about one's life. 

This process of identification is common to group interventions, and possibly a factor in other effects in this study too. Cognitive reappraisal was also found to increase, which is consistent with how people were asked to reflect on how they felt at the time of experiences, how they might think about them, how they might think about them differently, and how this might affect how they subsequently emotionally felt about them. In a sense, this constitutes implicit training in the effect of changing one's thinking to regulate their emotion. Of course, all three of these "change" processes could be considered to be positive outcomes themselves, but were conceptualized as change processes given, that they were identified as such by young adults (Hallford et al., 2019).

There were several limitations to the study and its generalisability. Without an active control group, it is difficult to untangle specific CRT processes from other, common processes in empathic and supportive group settings. Future research could use a "simple reminiscence" intervention involving free-form discussion about past experiences. This would help assess whether specific techniques within CRT produce stronger effects on psychological resources and well-being, relative to general conversation about positive experiences. 

Although guided, theoretically-driven reminiscence interventions have been shown to produce stronger effects than these "simple reminiscence" interventions (Pinquart & Forstmeier, 2012), a direct empirical test of this with CRT is needed. Adopting outcome measures such as life satisfaction in the future would also allow for the assessment of effects on how young people more generally perceive their lives, especially given that such effects are observed in samples of older adults (Tam et al., 2021). 

Other measures could include specific forms of resilience in the face of adversity. A longer follow-up is also needed to assess longer-term effects than the 2-week, short-term effects assessed here. Maintenance of effects might be predicted given previous findings that effects last at least 3 months among youth with depression (Hallford & Mellor, 2016a, 2016b, 2016c), and more generally are maintained in reminiscence therapies at follow-ups (Pinquart & Forstmeier, 2012). It would also be interesting to see if CRT had prophylactic effects on the development of clinical depression, given it did reduce depressive symptoms, and these psychological resources are themselves protective against future depressive symptoms. 

Correspondingly, further information on the sample characteristics, such as how many people may have had clinical disorders, would have aided somewhat in describing the sample. The study relied solely on self-report which, although appropriate for assessing personal knowledge such as emotions and self-concept, might be supplanted in the future by behavioral measures (such as amount or duration of engagement in meaningful activities) or observational outcomes by third parties such as friends or family.

It is noteworthy that this study was conducted during the COVID-19 pandemic, particularly at a time of widespread restrictions in Australia. An intervention such as CRT that focuses on reviewing past events rather than goal-directed behavioral change might have been highly appropriate during a time of restrictions on possibilities for socializing, and meaningful activities, and possibly demoralization and an increased sense of isolation and hopelessness. The outcomes of the study do suggest that in a period such as this, during which people may benefit greatly from increased resilience, an intervention that uses retrospection might be useful and appropriate.

In conclusion, this brief, positive-focused, teleconference-delivered version of cognitive-reminiscence therapy was effective in increasing psychological resources and mental well-being in young adults.

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