Jimenez Et Al Final Manuscript

UNIVERSITY OF SANTO TOMAS COLLEGE OF SCIENCE
Mindfulness-based Cognitive Enhancement Program:

Efficacy on the Ego-integrity of Institutionalized Elderly
A Research Paper Submitted to the

Department of Psychology
College of Science
University of Santo Tomas
In partial fulfillment of the requirements for the degree Bachelor of Science in

Psychology
By
Klein D. Concepcion
Trisha V. dela Cueva
Chloey Joy T. Jimenez
Justine J. Lumbo
March 2017
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APPROVAL SHEET
This Thesis entitled:
Mindfulness-based Cognitive Enhancement Program: Efficacy on the

Ego-integrity of Institutionalized Elderly
prepared and submitted by Klein D. Concepcion, Trisha V. dela Cueva, Chloey

Joy T. Jimenez, and Justine J. Lumbo has been approved and accepted as partial
fulfillment of the requirements for the degree of Bachelor of Science in Psychology
on March 7, 2017 with a grade of
PANEL OF EXAMINERS
Lucila O. Bance, Ph.D.

Chairman
Rodel C. Canlas, Ph.D.

Member
Karen Katrina V. Trinidad, Ph.D.

Member
Cecille Ann C. Pilapil, M.S., M.A.

Adviser
Ma. Claudette A. Agnes, Ph.D.

Department Chair
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UST-CS-P-2014-001

Klein D. Concepcion, Trisha V. dela Cueva, Chloey Joy T. Jimenez, Justine J.

Lumbo, and 1Cecille Ann C. Pilapil
1
Department of Psychology, College of Science
University of Santo Tomas, Manila, Philippines
ABSTRACT
Ego-integrity is defined as the fundamental acceptance of one’s life as having been

inevitable, appropriate, and meaningful. Being the final stage of Erikson’s
psychosocial theory, it is said that ego-integrity is present in individuals who are
currently having issues regarding aging, assimilating one’s life experiences, and
making sense of life and death. Being the least studied among Erikson’s stages of
development, the researchers made use of Mindfulness-based cognitive enhancement
program (MBCEP) to know its efficacy on the level of ego-integrity of the elderly.
Quasi-experimental design and Wilcoxon Signed-Rank test and Mann-Whitney U
test were used in this research. Results showed that the MBCEP had a significant
effect on the level of ego-integrity of the elderly (Zobt= 0.00; p=0.02). The
mindfulness-based cognitive enhancement program is proven to enrich the ego-
integrity of the elderlies.
Cite this Thesis Abstract:
Concepcion, K., dela Cueva, T., Jimenez, C., & Lumbo, J. (2017). Mindfulness-
based Cognitive Enhancement Program: Efficacy on the Ego-integrity of
Institutionalized Elderly. (Undergraduate Thesis), University of Santo Tomas –
College of Science. Retrieved from UST-CS-P-2017-001 Theses Database. (UST-
CS-P-2017-001).
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Acknowledgement
We would like to express our greatest appreciation to Segal, Williams and
Teasdale for allowing our group to use their Mindfulness-Based Cognitive Therapy
Manual for free as our foundation, for without them we would not be able to conduct
our enhancement program. Also, we would like to show our gratitude to Darling-
Fisher for letting us utilize a particular subscale of her Modified Eriksonian
Psychosocial Stage Inventory with its corresponding score manual. We are deeply
thankful for the help of Dr. Cely Magpantay for being the main consultant of our
own enhancement program. Our group is wholeheartedly thanking Ms. Teresita of
Little Sisters of the Abandoned Elderly for allowing our thesis group to conduct our
enhancement program in their institution and also to the participants whom we were
able to conduct it with. We are also sending our gratitude to our professors, family,
and friends for all their unwavering support and help before, during the gathering of
our data and until the very end. And lastly, without the help of our very supportive
thesis adviser, Ms. Cecille Ann Pilapil, we could not have done this study.
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Background of the study
Instances of abandoned elderly are expanding globally. According to the
Philippine Statistics Authority, there are almost 4.6 million elderlies as of the year
2000 in the Philippines. These elderly experience sudden change in lifestyle and
also relinquishment by their families. Subsequently, numerous elderly are
constrained into living in nursing homes for the rest of their lives (de Guzman,
2012). In the Philippines, there are several issues of the elderly mentioned by Carlos
(1999). These are security in old age, occurrence of abuse committed against the
elderly, health status, and the impact of aging. In addition to this, Rabins and Black
(2010) stated that some of the ethical issues faced by the elderly are caregiving, elder
abuse, group centrism, safety, self-neglect, cognitive decline, decision-making and
end-of-life-issues. Lastly, one of the most prevalent issues concerned with the mental
health is geriatric depression which is associated with a problem that generally
affects one's family, and community.
Of all the issues regarding the elderly, another concern that should be
addressed is the level of ego-integrity. According to Erikson (1975), this is the last
stage of human development. Haber (2006) mentioned that ego-integrity is defined
as a basic acceptance of one's life as having been inevitable, appropriate, and
meaningful. Erikson (1963) as cited by James and Zarrett (2006) stated that ego-
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integrity is present in individuals who are currently having issues regarding with
aging, assimilating one’s life experiences, and making sense of life and death. In
addition to this, James and Zarrett (2006) mentioned that based on the theory of
Erikson, resolving these challenges is essential to one’s psychological well-being in
the latter part of life. With that, the researchers aim to strengthen the level of ego-
integrity of the participants by using an enhancement program which is grounded on
the mindfulness-based cognitive therapy.
Mindfulness is a way of living one’s life so that one may become more aware
of the present moment more often. Also, it enables a person to appreciate one’s life
rather than rushing through it and not trying to be somewhere else. In line with this,
Mindfulness-based cognitive therapy developed by Segal, William, and Teasdale
(2002) stated that with this therapy, its primary aim is to help people to be more
present-oriented rather than being past or future-oriented. Being mindful is very
important as one ages. Based on the psychosocial theory of Erikson, the stage of
ego-integrity states that adults in this must deal with their past and must discover the
importance in their lives despite mortality. A research by Dezutter, Toussaint and
Leijssen (2014) shows that the pivotal errand is to come to sense of self uprightness,
which includes a process whereby people must deal with the lives that they have
lived and in the population they are in (Torges, Stewart, & Duncan, 2008). As such,
the elderly must basically accept their current status, how they have lived their lives,
and whoever they chose to be with. However, some elderly adults would dwell on
their past that would lead them regretting and contemplating about what went
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"wrong" with their lives.; while some elderly grown-ups can acknowledge their past
as unchangeable and they attempt to determine life laments.
This study aims to help alleviate the elderly’s feelings of worthlessness and regret;
have a better perspective in life; avoid regrets due to past experience and mistakes;
learn how to accept things that cannot be changed and to promote and improve the
participant’s psychological well-being. Ego-integrity as being an integral part for the
elderly, however, remains to be one of the least studied constructs in this field; as a
result, the researchers strive to produce a study that will be able to contribute to this
topic.
Literature review
For this part, several studies, both foreign and local, have been reviewed to give
more in depth explanation to the study of the researchers. The literature is arranged
from discussing information about the elderly, their current population, common
problems; to be followed by studies on ego-integrity, life satisfaction, acceptance
which are all related to the elderly, and lastly, studies about the mindfulness based
cognitive therapy and its other adaptations and how it is applicable to various
situations in one’s life.
Elderly
Old age is regularly said to start at 65, which is an average retirement age. In
a few sections of the world, where life expectancy is lower, a man may be viewed as
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old at 35 or 40 (Adegoke, 2014). Adegoke (2009) gave the explanation behind this
that old age is a significant drawn out stretch of time, including many stages and
changes. When one ages, physical changes begin to be noticeable such as
thewrinkling of skin, change in posture, floppiness of muscles and diminished vision
and listening skills, and a diminished productivity of cardiovascular framework.
Dhara and Jogsan (2013) added that the theme of this age period is loss, which may
be recognized like loss of physical abilities, loss of intellectual and cognitive
processes, loss of work role and occupational identification, loss of intimate ties,
such as death of spouse, friends, and different acquaintances.
In terms of statistics, the aging population of the world has dramatically been
increasing thereby creating the need to assess and address the emotional feelings of
the elderly (de Guzman, 2012). The aging world has turned into a female world.
Feminization of the older population has been seen all around the globe as well as in
our nation. Since 1980, the elderly ladies have been greater in terms of number than
the males. This occurrence might be because of women having longer life
expectancy by five to seven years than men, therefore, elderly women has greater
possibility to outlast them (Carlos, 1999). Keller, Singh, and Winton (2013) also
added some reasons behind the increasing population of the elderly which are the
increasing growing population of the baby boomers, longevity, and the decreasing
rate of fertility. Frailty, sorrow and death are confronted by people in later life. Being
physically ill or been induced with disease also affects the deterioration in functional
domains such as their psychological and social functioning (James & Zarrett, 2006).
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Dixon (2007), for her part, points out that having outlets in life is imperative
for geriatric people to facilitate their sense of purpose and meaning. These outlets
include extracurricular activities, day-to-day responsibilities, spiritual or religious
connections, and relationships with friends and family. Adegoke (2009) also added
further explanation behind the well-being of the elderly. According to him, in
Nigeria, family care played a significant role in the psychosocial well-being of the
elderly in that; families have been the major resource and there are always contact
relationships between older people and their families or relatives. Several studies
found that wellness is a perspective of health that underlines the condition of the
whole being and its continuous improvement. Wellness, accordingly, incorporates
better comprehension of ideas like wellbeing practices, most profound sense of
being, family, environment, work, cash and security, health services, social support
and relaxation (Weissman et al., 1996; Dhara & Jogsan, 2013).It is indeed very
relevant and important to keep one’s being well balanced. However, old age is still
exceptionally a difficult life stage one may go through. Elderly people are often
struggling with their own finality and meaning of life in light of a shortened life
perspective. There have been some issues concerning them; these are concerns about
security in old age, occurrence of abuse committed against the elderly, health, status
and the impact of aging (Carlos, 1999). As mentioned by Dhara and Jogsan (2013),
psychological well-being was studied comprehensively as there is a need to improve
the state of mental conditions of people. In addition to that, Dezutter, Toussaint, and
Leijessen (2014), stated that depression is prevalent among elderly individuals living
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in nursing homes (Westerhof, Bohlmeijer, van Beljouw, & Margriet, 2010). Chimich
& Nekolaichuck (2004) also stated that 10% - 15% suffers from a major depression
and 20% - 30% experiences significant depressive symptoms especially those living
in institutional settings.
The above mentioned explains the physiological and psychological changes,
well-being of the elderly, and their common problems. Despite all the suggested
activities to further give meaning and life to elderly’s well-being, such as keeping
social interaction, spiritual or religious connections and definitely, the association
with the basic unit of society, family, still, it is inevitable that there are problems that
may arise. As for the elderly, it is best to know more about their inner thoughts
regarding themselves, and their realizations in life, whether they are satisfied or the
other way around. Erikson called this stage as ego-integrity versus despair. In this
way, we can understand them better and address their concerns.
Elderly in institutionalized care facilities
The need and demand for formal and institutionalized care facilities are
increasing globally. The objective of nursing homes or institutionalized care
facilities is to provide elderly people with a healthy environment and to help meet
their social and psychological needs (Duyan, Sahin-Kara, Duyan, O¨zdemir, &
Megahead, 2016).Even though these older patients do not have severe health
problems and limited communication with their family, isolation and struggle in
adaptation to the new environment can be psychologically and emotionally
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challenging (O¨zer, 2004; Duyan, 2016). Therefore, living in an institutionalized
facility can be both an advantage and a disadvantage.
Along with the quality of life, psychosocial well-being of the institutionalized
elderly is crucial and interventions to enhance their psychosocial well-being
therapeutic interventions are essential (Duyan, 2016).
Ego-integrity
Ego-integrity is at the last stage of the psychosocial stages of development by
Erik Erikson. This stage is usually where the individuals contemplate and review
their lives and reflect whether they are contented or dissatisfied with how their life
went (Vogel-Scibilia, McNulty, Baxter, Miller, & Frese, 2009). Also, according to
the study of Jeong and Oh (2015), Erikson proposed ego-integration as a developing
aim in maturity and this means incorporating one’s past with the present and future.
This may lead to positive psychological attitudes such as satisfaction with reality if
ego-integration is achieved. On the other hand, a lowered quality of life may be
experienced if ego-integration will not be met. This study is similar to the study of
Erikson (1968) as cited by Torges, Stewart, and Duncan (2008) which states that the
tendency to review and restructure one’s past becomes prominent in old age. At this
point, he suggests that people are more focused on reviewing their past than they
were earlier in life, and their developmental task is to come to terms with the lives
they have lived and the people they have become. In addition to that, ego-integrity is
a stage where an individual’s life is arranged. This stage is also evident in
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individuals who are particular in issues with life experiences and aging. In order to
achieve the psychological well-being in the later life, issues surrounding acceptance,
feeling of loss of time, not fearing death and life satisfaction must be met (James &
Zarrett, 2006).
Elderlies usually reevaluate their lives by reflecting and resolving the conflict
between ego integrity and despair (Erikson, 1982). As they grow older, they try to
look for the things they have done and also to the things they have not done and the
mistakes they have committed. It is very common for the elderlies that when they
reach their old age and realized they are not satisfied with their life, there are
chances of that they may lead to having depression or the other pole of Erikson’s last
stage which is called “despair” (Crain, 2011). On the other hand, if the elderly is
satisfied with what he or she has done in his or her early life and tends to accept that
the past is unchangeable, then, ego-integrity is present. However, it still depends on
the person on how he can achieve a balance between the two poles and according to
Torges, Stewart, and Duncan (2008), in order to successfully navigate on the last
psychosocial stage of Erik Erikson, one should lean more towards “ego-integrity”.
Another point stated was the idea of Landman (1993), in which according to him, in
order to resolve early regrets in life, an individual must acknowledge past
circumstances and no longer experience emotional distress when related thoughts
come out (Torges, Stewart & Duncan, 2008). Ego-integrity has several components
and these are self-perception, self-acceptance, despair, self-worth and life
satisfaction. Bem (1964) mentioned that self-perception is the ability to know one’s
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own emotions, behavior, and attitudes. In addition, he also stated that a person who
has high level of self-perception behaves like a hypothetical observer; they usually
survey and ask themselves about the essential task and the nature of their own
attitudes and behaviors. It is believed by Moser et al., (2011) that having negative
self-perception can predict disability and future physical illness; on the other hand,
survivability and better functioning health may be predicted by positive self-
perception (Wurm, & Benyamini, 2014). Another factor that may contribute to one’s
ego-integrity is self-acceptance. People who experience self-acceptance,
appropriately evaluate themselves, live without pretense and do not live in others’
expectations. People who have high level of ego-integrity know how to accept things
the way they are (Carson & Langer, 2006). Hearn, Saulnier, Strayer, Glenham,
Koopman, and Marci (2012) mentioned that despair is often times experienced by
many, but it is more prevalent in the elderly. Failure to have self-fulfillment, self-
acceptance, self-worth or self-esteem, and life satisfaction will then lead to feelings
of despair where in the person feels so much pain, regrets and sadness. However, a
person with high ego-integrity tends to be very optimistic and does not dwell on too
much negativity (Marcia, 2004; Hearn et al., 2012).For self-worth, Robins,
Trzesniewski, Tracy, Gosling & Potter (2002) said that people in old age tend to be
wiser and more comfortable with themselves. They also mentioned that Erikson
provided an alternative interpretation of the self-esteem drop: the elderly usually
accept what they have done wrong and have a reduced need for self-promotion and
self-aggrandizement, and that defense mechanisms such as denial, might not inflate
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feelings of worth. Self-worth is indeed another factor to be observed in a person who
has ego-integrity. As the study goes along, Rajhans (2015) stated that life satisfaction
among more educated elderly is significantly greater than that among less elderly
and good education might lead to gainful employment, which offers a number of
benefits such as establishing an identity, opportunities for social interaction and
support, purpose in life, time filling, problems that are engaging problems, and
possibilities for status aside from their supply of income.
Furthermore, based on de Guzman et al. (2011), they found interesting findings from
their three-phase data analysis. They have identified four activators of ego-integrity.
The first of these is work. It constituted the diverse occupations members have
entered all through their youth until their present age. It was noticed that all
members had reacted positively about the significance of work to their lives. The
second one is family. Family is considered to be one of the most significant and
strongest influences in one’s life. There may have been other factors along the way,
still, the roots of an individual prevail along with the changes as he or she grows
older. The third activator is belief in self. This activator was attributed to how the
person keeps the faith in himself or herself despite all the shortcomings or
deterioration of his usual capabilities. And the last activator, but definitely not the
least, is belief in God. Among all the activators, spiritual aspect showed marked
effect in ego-integrity’s formation.
As from the related studies, for ego-integrity to be achieved by the elderly, a lot of
factors must be met and considered at hand such as being able to accept what has
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transpired in one’s life, avoiding regretful experiences to linger in the mind, having a
positive outlook in life. Consequently, the researchers strongly believe that with the
help of mindfulness, the elderly will be able to attain ego-integrity.
Mindfulness-Based Cognitive Therapy
Mindfulness-based cognitive therapy (MBCT) was developed by Segal,
Williams, and Teasdale (Segal et al., 2002) to address the prevalence of significant
depression relapse, fortunately, MBCT is not only limited to this.
According to Kabat - Zinn (1994), the definition of mindfulness is that which
is commonly used: “paying attention in a particular way: on purpose, in the present
moment, and non-judgmentally” Thus, accepting and acknowledging the problem,
without getting caught up in thoughts about the situation or emotional reactions to it.
Mindfulness-based interventions are empowering multi-component interventions
which aim to increase self-efficacy to respond to life stressors and may have
application for informal palliative caregivers (Jaffray, Bridgman, Stephens, &
Skinner, 2016). Furthermore, Jaffray et al. (2016) stated that, Mindfulness-based
interventions (MBIs) are growing popular nowadays and are confirmed to provide
many benefits specifically for the physical and psychological health of a person. It is
said to reduce depression, anxiety and perceived stress.
A Buddhist practice called “vipasanna”, which means “to see in special way”
inspired the first mindfulness meditation (Ong & Sholtes, 2010) and mindfulness is
characterized by being aware of one’s thoughts, bodily sensations and movements
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(Perez - Blasco, Sales, & Mayordomo, 2016) just almost similar to yoga practices. It
can also be described as a psychological trait, a state of awareness, or a
psychological process. As indicated by Hasson (2013), mindfulness makes you
appreciate and experience life to the fullest. An individual tends to see things
differently and more vibrantly. When problems arise, you would know how to
handle it calmly and not let the problem enter within your system. Dealing with the
past or worrying about the future can be stressful and can lead to depression and
anxiety. People feel overwhelmed by the past or future when they feel that the
present or living in the now is taken away from them (Hasson, 2013).
Today, there are available diverse ranges of Mindfulness-Based Interventions (MBI)
with varied protocols including the Mindfulness-Based Cognitive Therapy (Jaffray
et al., 2016).
This study would anchor the intervention program on the Mindfulness-Based
Cognitive Therapy (MBCT) that would help the elderly in dealing with their anxiety
and for those who are suffering from depression. Mindfulness-Based Cognitive
Therapy (MBCT) also helps prevent the relapse of major depressive episodes (Segal,
Williams, & Teasdale, 2002). MBCT is a group-based therapy merging thorough
training in meditative practices with cognitive-behavioral elements targeted at
depression (Forkmann, Brakemeier, Teismann, Schramm, & Michalak, 2016).The
MBCT manual is composed of eight weekly sessions that would last from two to
two and a half hours. For the eight sessions, every session has a certain topic to be
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focused on. The eight sessions made by Segal, Williams and Teasdale (2002) tackle
on different areas and topics.
Mindfulness based cognitive approach for seniors (MBCAS)
This program is based on MBSR, MBCT and MBRP. According to Keller,
Singh, and Winton (2013), this program is designed for seniors, defined as people
who are of 65 years of age or older, and who are healthy or mostly healthy. The main
objectives of this program are to teach the elderly to observe current experiences
with nonjudgmental awareness, identify automatic behaviors or reactions to current
experiences that are potentially nonadaptive and enhance and reinforce positive
coping with typical difficulties that they face in their daily lives. MBCAS uses group
training which is suited for seniors (Keller, Singh, & Winton, 2013). During the
course of the program, the elderlies can have more socialization hence, giving them
different views of life, diverse ideas, and build friendship as well. Since a lot of
seniors are usually living alone in their homes, group training can provide an
opportunity for social interaction. The mindfulness training is a group process in
which the instructor and the participants meet regularly to learn and practice. It is the
core of any mindfulness program to help the participant have a connection to his or
her inner world.
In summary, the literature explains that as one ages, there will surely be
several alterations; may it be physical changes, emotional changes, and the like.
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Being considered as an elderly, this will not make an individual immune and
insusceptible to different challenges; still, trials and issues are about to surprise you.
One must be able to conquer the unwanted thoughts and feelings just like depressive
episodes, to have a better outlook in life. Conversely, in order to achieve ego-
integrity, one must be able to accept different experiences in life, may it be
considered good or bad. Similarly, one should be pleased and gratified and have a
sense of fulfillment for what has been attained. Ego- integrity is also said to be met
when one is able to know oneself greatly and values his or her well-being. However,
there will still be a setback if ego-integrity is not attained which is despair. In order
to avoid that, one must retaliate. Mindfulness-based cognitive intervention program
(MBCIP) designed by the researchers which is anchored to MBCT and MBCAS,
aims to equip a patient with skills to modify distorted underlying beliefs principally
through techniques of identifying the problem and not letting the problem penetrate
the mind and the body. This intervention program is problem-focused and relies on
an active collaboration between client and therapist. The researchers strongly assert
that MBCIP will be very significant for the lives of the elderly.
The present study
Research questions and hypotheses
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The purpose of the study is to determine the efficacy of the mindfulness-
based cognitive enhancement program on the ego-integrity of the institutionalized
elderly. This research aims to answer the following questions:
1. What are the pre-test and post-test mean scores and standard deviations of the
participants’ level of ego-integrity based on the Modified Eriksonian Psychosocial
Stage Inventory?
2. Is there a significant difference between the pre-test scores of the experimental
and control group's level of ego-integrity?
3. Is there a significant difference between the post-test scores of the experimental
and control group’s level of ego-integrity?
4. Is there a significant difference between the pre-test and post-test scores of the
experimental group’s level of ego-integrity?
5. Is there a significant difference between the pre-test and post-test scores of the
control group’s level of ego-integrity?
6. If the mindfulness cognitive based intervention program has an effect on the ego-
integrity level of the elderly, to what extent is this effect?
In line with the research questions of the study, these hypotheses were
formulated and tested at 0.05 level of significance.
1. The mindfulness based cognitive intervention program is significantly
efficacious on the level of ego-integrity of the elderly in Little Sisters of the
Abandoned Elderly.
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2. There is significant difference between the pre-test scores of the
experimental and control group.
3. There is significant difference between the post-test scores of the
experimental and control group.
4. There is significant difference between the pre-test and post-test scores of the
experimental group.
5. There is significant difference between the pre-test and post-test scores of the
control group.
Theoretical and conceptual framework
This study was anchored on Mindfulness (Kabat-Zinn, 1994); Activity
Theory (Havighurst, 1961); and Psychosocial Stages of Development Theory
(Erikson, 1963, 1968).
With the emergent number of the elderly in different parts of the world, there
are a lot of issues that must be resolved regarding this matter. Moreover, the focal
concern of every adult when they reach the age of 65 and above happens to be the
deterioration of their health. In addition to this, different problems start to occur
including memory loss and weakening of bones, which will result to an exertion in
joining physical activities. Furthermore, the elderly are faced with wide-ranging
physical, psychological and social changes that defy their sense of self and also their
capability to live well. Being that, a theory that may support this are the Erikson’s
Psychosocial Stages of Development and Activity Theory.
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Erikson’s Psychosocial Stages of Development Theory
Erikson (1963, 1968) suggests that the human life cycle involves eight
stages. These stages occur and correspond to a series of crises that a person faces as
he develops and matures from infancy through childhood to adulthood (Munley,
1977). The eight stage crises outlined by Erikson are: basic trust versus mistrust,
autonomy versus shame and doubt, initiative versus guilt, industry versus inferiority,
identity versus identity confusion, intimacy versus isolation, generativity versus
stagnation, and ego integrity versus despair. Each crisis, according to Erikson, has its
distinctive time of domination. An example for this is the crisis faced by babies,
which is basic trust versus mistrust. This is when the baby is established to trust the
parent, and if not, mistrust will arise. Another one is the identity crisis. This crisis
typically rise during adolescence, whereas generativity as a crisis of mature
adulthood (Munley, 1977). For this study, the researchers focus more on the eighth
stage of psychosocial development which is ego-integrity versus despair. This stage
is usually where the individuals contemplate and review their lives and reflect
whether they are contented or dissatisfied with how their life went (Vogel-Scibilia,
McNulty, Baxter, Miller, & Frese, 2009). In order to achieve the psychological well-
being in the later life, issues surrounding acceptance, feeling of loss of time, not
fearing death and life satisfaction must be met (James & Zarrett, 2006).It is very
common for the elderlies that when they reach their old age and realize that they are
not satisfied with their life, there are chances that they may lead to having depression
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or the other pole of Erikson’s last stage which is called “despair”. Having that said,
the researchers would like to help the elderly lean toward the positive pole, which is
the ego-integrity.
Activity Theory
Havighurst (1961) explained that the Activity theory also known as Implicit
theory, the more active and involved older adults are, the more likely they are to be
satisfied with their lives. The purpose of the theory is to find the best solution for
handling challenges of aging and bringing an ease and improvement to the lives of
the elderly (Tabet, 2016). Based on the researchers, when elderlies are active,
energetic, productive and maintain social interactions, they age more successfully
and are happier than if they detach from society. Additionally, it states that the
ageing process is slowed down and the quality of life or lifestyle is upgraded when
the elderly remains socially active. According to this theory, in order to achieve a
greater life satisfaction one must continue their middle-adulthood role into late
adulthood. If these roles are taken away from them, it is important for them to find
other roles that will keep them active and involved (Santrock, 2011). This theory
proposes that, successful ageing happens when older adults stay vigorous and when
they keep maintaining their social interactions with others. Havighurst (1961) stated
that older adults based on this theory will be more satisfied with their lives if they
continue to be active even when they reach 65 and above (Johnson, Menne &
Whitlatch, 2013).
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In the formulation of the conceptual framework, the elderlies or senior adults
undergoing developmental issues and or talks or described by Erik Erikson’s eight
stage on integrity versus despair. The researchers focused on improving the ego-
integrity of elderlies by using the lens of the activity theory where there is an
assumption of a positive relationship between activity and life satisfaction. The
Activity theory supports the mindfulness based intervention program thus will
enable the elderlies to practice the mind by living in the present or now thus
engaging in social interactions that may lead to an improvement of their ego-
integrity. Mindfulness based cognitive intervention program will last for about two
weeks; this will be a great opportunity for the elderly to keep their minds constantly
at work. A number of exercises will be executed during the whole program and these
exercises are in the forms of meditation, breathing exercises, and a lot more. These
activities will somehow help them avoid and refrain from negative thoughts and
relive past experiences that have unfavorable impact on them. Reevaluating one’s
life and concluding that it has not been spent well may lead to the negative pole of
this psychosocial stage which is despair.
The schematic diagram of probable explanations of the level of ego integrity
and how mindfulness based cognitive intervention program would facilitate change
with the former mentioned is seen in Figure 1.
23
Figure 1. Conceptual framework
The researchers identify the participants’ current level of ego-integrity. As
part of Erikson’s psychosocial stage of development, ego-integrity talks about how
an elderly is satisfied with one’s life, hence, he or she is not regretful of his or her
past experiences. Once the initial evaluation has been finished, the elderly
participants will proceed to the exposure of the intervention program. The
Mindfulness-based cognitive enhancement program (MBCEP) designed by the
researchers is anchored on Mindfulness by Kabat-Zinn (1994) which is defined as:
“paying attention in a particular way: on purpose, in the present moment, and non-
judgmentally”. Thus, accepting and acknowledging the problem, without getting
caught up in thoughts about the situation or emotional reactions to it. This
intervention program aims to increase the level of ego-integrity of the elderly and is
also derived from the mindfulness-based cognitive intervention therapy (MBCT).
The researchers also added activities to the mindfulness-based intervention program
which was directed by the Activity Theory that intends to make the elderly fulfilled
with their life by keeping it moving or not being stagnant. Therefore, a rise on the
24
level of ego-integrity is expected to be seen after the intervention program
correspondingly.
Method
Design
This study made use of a quasi-experimental design. This experiment used a
between groups design, specifically pre-test and post-test design to measure the level
of ego-integrity of the institutionalized elderly before and after the enhancement
program. The statistical test used was Wilcoxon T Signed-rank test and Mann-
Whitney U test. The independent variable of this study is mindfulness-based
cognitive enhancement program and the dependent variable is the level of ego-
integrity of the elderly. There were two groups for this study; the control group and
the experimental group.
Participants
The participants for this study were seven female elderly from Little Sisters
of the Abandoned Elderly in San Juan, Manila. Keller, Singh and Winton (2014)
specifically mentioned that the age range of the elderly who are considered to be
senior citizens is from 65 years old and above. Only the female elderly participated
in this study given the fact that the institution is exclusive only for female. Purposive
sampling was used by the researchers in this study to know if the enhancement
25
program will have an effect on the ego-integrity. The participants were divided into
two groups, one having higher ego-integrity over the other.
Research instruments
The data needed were gathered using the following instruments:
Personal Data Sheet. This was used by the researchers to get the
demographics of the participants which included the name, age, gender, religion, and
length of stay in the institution.
The Integrity Subscale of the Modified Eriksonian Psychosocial Stage
Inventory - Filipino Version (MEPSI). This is a modified version of the Erikson
Psychosocial Stage Inventory. This test measures the strength of psychosocial
attributes of the elderly participants. The test consists of 80 items with which there
are 10 items for each of the eight subscales. The norming sample was 168
participants; 112 women and 56 men, with an age range of 19-86 years of age.
According to Darling and Leidy (1988), the scores of the ego-integrity subscale is
interpreted by: 10-20 low ego-integrity, 21-39 medium ego-integrity, 40-50 high
ego-integrity. According to Erikson, (1968), people who are low in ego-integrity are
those that feel despair. They show characteristics of sadness, regret, and guilt. On the
other hand, people who are high in ego-integrity tend to be very optimistic and does
not dwell on too much negativity. They believe that they are satisfied with their lives
and they feel a sense of fulfillment. And lastly, people who scored medium in ego-
integrity show that they are somewhat experiencing despair and ego-integrity. At
26
times, they feel gloomy and sad then suddenly feels enthusiastic and driven in their
lives. This test also has a 0.97 as a global scale for its alpha reliability coefficient.
The reliability of the ego- integrity vs. despair subscale was used in this test with an
alpha reliability coefficient score of 0.80.The construct validity was indicated by
positive correlations between chronological age and the attributes associated with
adulthood, an increase in mean generativity and ego integrity levels with age, and an
association between the strength of attributes and participation in regular exercise.
Reliability and validity of this modified inventory were supported. This test was
used to measure the level of ego-integrity of the participants.
Mindfulness-based cognitive enhancement program. It is the enhancement
program used in this study. This is a modified program by the researchers which
were anchored from the works of Segal, Williams and Teasdale (2012), and Bartley
(2012). The handouts are based on Segal, Williams, and Teasdale (2002) and the
program flow is based on Bartley (2012). The enhancement program will have three
sessions and duration of an hour and a half hours per session which was based on the
MBCAS by Keller, Singh and Winton (2013) (See Appendix A).
Research procedures
Phase 1 – Pre-experimental Phase
The researchers designed the enhancement program inspired by the MBCT
and MBCAS, which is called MBCEP, with the guidance of a psychologist who is an
expert in this field. The researchers were guided and the final program was validated
27
by a consultant in the said field, MBCT. After which, the researchers did a back
translation of the MEPSI to cater to the needs of the answer in Filipino. The back
translation was validated by Filipino and English teachers.
Before the researchers conducted the actual program to the assigned
participants, the mindfulness-based cognitive enhancement program was pilot tested
to a group of elderly. Six senior citizens participated in the pilot testing and it was
held in a living room of one of the researchers’ colleague. After finishing the
program, the researchers made sure they executed the program based on the time
schedule in order to know what to focus and improve more. Also, recommendations
were given to help the researchers decide on what was needed to be focused and
improved.
The researchers performed a screening procedure for the participants to be
included in the study. Informed consents were given to the elderly. The inclusion
criteria involved two things. First, the staff in the institution validated and gave the
researchers a preliminary list of elderly who are fit for the program particularly those
who were physically and mentally fit; and those that do not have health problems
such as heart related illnesses, stroke and other concerns that might affect the
individual during the program. Lastly, those individuals who scored low to medium
on the Integrity Subscale of the Modified Eriksonian Psychosocial Stage Inventory
are included in the program.
Phase 2 – Experimental Phase
28
This phase made use of the mindfulness-based cognitive enhancement
program. This phase lasted for three sessions with one hour to one hour and a half
per session. The experimenters gave a list of participants to the coordinator and had
them called one by one as they entered the room. Two sessions took place in one of
the private rooms in the institution while the last session was moved to a different
room because of other activities in the institution. Also this was done to prevent
other extraneous variables such as uncontrollable noises and distractions alike to the
pilot testing. There was not enough ventilation in the room, yet, the sessions went
good. The participants seated comfortably on their leather chairs, and are in a semi-
circle position, having the main experimenter at the middle.
There were different activities that occurred per session but it was mainly the
use of mindfulness breathing exercises, audio guided meditations, and group
reflections. During the phase, some elderly became emotional as the audio
recordings were played; signaling the researchers that what has been heard by the
participant triggered an issue within them. However, some remained neutral just as
how the session began. From the beginning, down to the last session, the elderly
were enthusiastic in participating in the program.
Phase 3 - Post-experimental Phase
After the implementation of all the sessions, the post-test for MEPSI was
administered to the group. The researchers debriefed the participants about the entire
experiment. The results were computed by the researchers in order to know the
29
effect of the intervention administered to the elderly and to show if there really was a
change. On the last day, tokens of appreciation were given to the participants.
Ethical Considerations
To ensure adherence to standard ethical practices in research, the researchers
intend to do the following:
Since the study dealt with the elderly, there were precautionary procedures
that were involved such as being more patient and more understanding about the
feelings that might be triggered during the interview or debriefing of the
psychological instruments. Also, during the intervention sessions which will last for
one to one and a half hours, the participants might experience fatigue since the
activities would require physical, emotional and mental effort. Before the start of the
intervention, the participants were given an informed consent and it is stated there
that they may decline or withdraw from the sessions anytime. The participation of
the participants may be terminated due to the following: if they are sick or have
acquired an illness, if they can no longer participate in the activities and voluntary
withdrawal. Also, a suitable room was provided to the participants that were being
tested. After the administered testing and interview, the participants were debriefed.
Data analysis
To determine the efficacy of the mindfulness-based cognitive enhancement
program on the ego-integrity of the elderly, the researchers used 0.05 level of
significance, Microsoft Excel and SPSS software.
30
The statistical test used was Wilcoxon T signed-rank test, Mann Whitney U test and
descriptive statistics. The main purpose of the Wilcoxon T Signed-Rank test is to
determine the distribution of differences within pairs to be similar or the same
(Oyeka, & Ebuh, 2012) while the Mann-Whitney U test is for comparing the two
scores of the two groups. The mean and standard deviation of scores were used to
see the pre-test and post-test scores of the participants. In this way, the researchers
knew the efficacy of the MBCEP on the level of ego integrity of the elderlies.
Results
In Table 1, the data reveal that the experimental group’s mean score for pre-
test (M=26.29) and post-test (M=35.29) are lower than the control group’s mean
score for pre-test (M=37.00) and post-test (M=41.14).This indicates that the
experimental group has lower level of ego integrity than the control group for both
pre-test and post-test. Even the mean scores of the experimental group for both
pretest and post-test are lower than of the control group’s, both groups show medium
level of ego-integrity.
Table 1
Pre-test Mean Scores and Standard Deviation of the MEPSI of the Experimental
and Control Group
Pre-test Post-test
M SD M SD
Experimental 26.29 4.23 35.29 4.23
Control 37.00 5.83 41.14 3.24
Note: 10-20 low ego-integrity, 21-39 medium ego-integrity, 40-50 high ego-
integrity
N = 14
31
In Table 2, the data reveal the comparison for the sum of ranks of both
control and experimental group. To analyze the difference between the scores,
Mann-Whitney U test was used. The analysis for the pre-test shows that there is a
significant difference between the scores of the experimental and control group. The
obtained data from the Mann-Whitney U test (Ustat=4.00) is lower than the critical
value (Ucrit=8.00).
Table 2
Pre-test Sum of Ranks of Experimental and Control Group, U Value and Probability
On the other hand, Table 3 reveals the comparison for the post-test sum of
Sum of ranks U p
Experimental 24.00
4.00 .009
Control 18.50
Note: Ucrit = 8; α = 0.05; p > .05
ranks for the experimental and control group. Same as the pre-test, Mann-Whitney U
test is used to analyze the difference between the post-test sum of ranks. The
analysis shows that there is significant difference the post-test results of both groups.
The obtained data from the Mann-Whitney U test (Ustat=3.00) is lower than the
critical value (Ucrit=8.00).
Table 3
Post-test Sum of rank of Experimental and Control Group, t Value and Probability
32
Sum of ranks U p
Experimental 25.00
3.00 0.010
Control 21.50
Note: Ucrit = 8; α = 0.05; p > .05
In Table 4, the data reveal the comparison for the pre-test and post-test of the
experimental group. The Wilcoxon Signed Rank Test analysis shows that there is a
significant difference between the pre-test and post-test scores of the experimental
group. The obtained data from the stat test (Zobt=0.00) is lower than the critical
value (Zcrit=2.00). This indicates that after the implementation of the MBCEP, the
level of ego-integrity of the experimental group increased.
Table 4
Pre-test and Post-test Sum of Ranks of the Experimental Group, z value, and
Probabililty
Sum of ranks Z p
Negative ranks 18.00
0.00 0.02
Positive ranks 0.00
Note: Zcrit = 2; α = 0.05; p > .05
In Table 5, the data show the comparison for the control group’s pre-test and post-
test mean score. Table 5 shows that even without the implementation of the
MBCEP, the control group’s level of ego-integrity also increased. The scores were
also analyzed using Wilcoxon Signed Rank Test. The obtained data from the
33
statistical test (Zobt=4.00) is lower than the critical value (Zcrit=2).The results show
that there is no significant difference between the pre-test and the post-test level of
ego integrity even it increased.
Table 5
Pre-test and Post-test Sum of Ranks of the Control Group, Z value, and Probability
Sum of ranks Z p
Negative ranks 14.00
4 0.223
Positive ranks 4.00
Note: Zcrit = 2; α = 0.05; p > .05
Discussion
The results of the study showed that Mindfulness-based cognitive
enhancement program is efficacious on the level of ego-integrity of elderlies. This
finding agrees with the study of Jaffray et al. (2016), which states that MBIs are
beneficial to the psychological health of an individual. Additionally, the outcome of
this study supports the research done by Keller et al. (2x013), wherein the MBCAS
program was proven to be effective for seniors.
This agrees with the Activity Theory by Havighurst (1961) that elderlies who
engage in more activities, tend to be more optimistic and have a better psychological
well-being. Furthermore, the mean score of the post-test is significantly higher than
the pre-test. However, the results showed that the participants remained to have
medium ego-integrity which means that they still do feel sad, gloomy, and regretful;
despair at times, hence, they also feel alive and optimistic on other times. This is in
34
line with the observations of the researchers that some of the participants were
emotional at some point during the program, but then later on, they became joyous
and very interactive.
The researchers had other keen observations during the course of the
enhancement program. First, it has been proven by the researchers that group
sessions were efficacious for the elderly as they showed enthusiasm during the
whole implementation. They were also able to have more interaction with each
other, hence, leading them to look forward for having more interactive sessions.
This observation is supported by the study of Duyan et al. (2016), in which group
work improved the spontaneity, creativity, and empathy of the elderly for it gives
way for improved interpersonal communication and self-expression.
In addition to this, according to the feedback of the elderlies, the activities
that were conducted during the sessions specifically the meditation part, helped them
relax and think of pleasant thoughts. It also became an avenue for them to keep their
minds at work, making them feel productive. The researchers made use of the
Mindfulness-based cognitive enhancement program and as mentioned by Duyan
(2016), the psychological well-being together with the quality of life of the
institutionalized elderly is critical and an enhancement program is important to
improve their psychosocial well-being. As mentioned by Keller, Singh and Winton
(2013), Mindfulness-based cognitive approach for seniors offers a low intensity and
peaceful approach in order to develop mindfulness because there is no medical
motivation needed to engage in such program. Also, the study of Keller, Singh and
35
Winton (2013) mentioned that most participants included in their study appreciated
having the time to truly acquire and exercise different ways of being rather than
doing. In study of Jeong and Oh (2015), age was used as a general characteristic to
have an impact on ego-integrity where it is said that ego-integrity increases as one
ages.
This research is not free from any limitations: there were ongoing activities
in the institution during the month of December. First, the usual activities in the
institution such as praying the rosary, Bible studies, which happened simultaneously
with the MBCEP caused them to be distracted. The noise produced by these
recreational activities is also considered an extraneous variable. Second, since the
program did not have a fixed interval between the sessions, cognitive decay
occurred. Third, due to other regular activities catered by the institution: morning
and afternoon activities, based on the observation of the researchers, the participants
experienced fatigue. Fourth, the room that was used for the implementation of the
intervention program was also not consistent due to the other activities that were also
happening at the institution. Lastly, according to the MBCT of Segal et al. (2002),
there should be eight sessions for the therapy to have an effect. However, this study
made use of three sessions only due to the availability of the institution. Still, the
enhancement program is efficacious.
Conclusion and Recommendation
36
In conclusion, the mindfulness-based cognitive enhancement program is
efficacious on the level of ego-integrity of institutionalized elderlies. It should not be
implemented around the time of holidays to lessen the chances of the participants to
be distracted and to avoid fatigue. Also, the mindfulness-based cognitive
enhancement program should not only be implemented to elderlies but also to people
who currently struggle and have difficulties with their lives. It may also be utilized
to male elderlies to see if there will be gender differences. Future studies should also
try the enhancement program on other age groups. It is also suggested that the next
researchers will use a bigger sample size for more generalizability. Lastly, the
researchers would like to emphasize that more studies should focus not only on the
physical health but also on the mental health of the elderly.
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Appendix A
MBCEP Structure
MINDFULNESS BASED COGNITIVE ENHANCEMENT PROGRAM
Pre-Session 1 A:
- Screening of Participants
- Informed Consent
42
- Interview of the staff

- Testing: Modified Eriksonian Psychosocial Inventory Scale
Session 1, Be Aware
On automatic pilot, we are more likely to have our “buttons pressed”: Events
around us and thoughts, feelings, and sensations in the mind (of which we may be
only dimly aware) can trigger old habits of thinking that are often unhelpful and may
lead to worsening mood. (Segal, Williams, & Teasdale, 2002).
For this session, awareness is highlighted, especially about the feelings,
thoughts and body sensations from time to time and which lead to the possibility of
greater freedom and choice; no more "mental ruts” that may have caused problems
in the past.
Session 1: Be Aware
Materials Content Time Activity

Allotted
mins 5 Opening
Prayer
Introduction of Facilitators ● mins 5 Opening

Orientation ● Remarks
Ground Rules ●
Setting of the Mood ●
My Firsts ● mins 5 Icebreaker:

First pet - My Firsts
43
First candy tasted -

First trip out of town -
Favorite activity as a child -
Favorite teacher -
Mechanics: Group activity, individual
sharing
Paper and pencil Mood Scale (Smileys) ● mins 5 Testing:

Mood Scale
Introduction of Participants ● mins 35 Session

By pairs - Proper
Name, one word that would -
best describe yourself
Teaching about Mindfulness ●

Definition -
Purpose -
Procedure -
Guided ● Mindfulness Meditation Body Scan by mins 15 Practice:

Body Scan Mark Williams: (15mins) Body Scan
Meditation
Audio https://www.youtube.com/watch?
v=CyKhfUdOEgs
Discussion and sharing of ● mins 10 Synthesis

experience

Mood Scale
The Bells ● mins 5 Closing

The ring of a bell will signal - Remarks
the end of the session and Closing
Prayer
Session 2, Accept and Let Go
44
The basic guideline in this practice is to become mindfully aware of
whatever is most predominant in our moment-by-moment experience and to accept
that thoughts are empty, essentially impersonal, and impermanent. This phase will
focus on acceptance and is considered a vital step. Before the session comes to an
end, the practitioner will leave a homework to the participants.
Session 2: Accept and Let Go

Allotted
mins 5 Opening
Prayer

Ground Rules ● Remarks
Speakers ● Divided in two groups - mins 5 Icebreaker:

Music ● The song will be played for - Name That
Timer ● 10-15 seconds and the players Tune
Score ● will have to guess what song it
board is. If the group doesn’t get to
answer, the other group may
steal. If both teams don’t get
the answer neither of the teams
.will get a point
:Source
http://www.sophie-
world.com/games/name-tune

Mood
Scale/Brief
Mood
Introspection
45
Scale
Paper ● The Sea of Reactions ● mins 50 Session

Markers ● Guided Meditation for ● Proper
Kindness and Receiving Love
(40mins)
●
https://www.youtube.com/watch?
annotation_id=annotation_352397328
3&feature=iv&src_vid=64ZU2UCQd
mQ&v=c2iCoEluq8A

experience

Mood
Scale/Brief
Mood
Introspection
Scale

The ring of a bell will signal - Remarks and
the end of the session Closing
Prayer
The Sea of Reactions
Bringing to mind a difficult situation that you have experienced, write your
one word reactions (feelings or behaviors) on the paper in big writing. Choose one
word that you feel drawn to, that describes what you do or how you feel when things
are difficult. It might be one of the words that you have written or someone else’s. It
doesn’t matter.
46
Session 3 Taking Care of Myself
The core theme of this session is to basically know how to make choices that
will support and enhance someone’s well-being now, and in the future and in good
times when tough days return (Bartley, 2012).
Session 3: Taking Care of Myself

Allotted
mins 5 Opening
Prayer

Ground Rules ● Remarks
Music mins 15 Icebreaker:

Exercise/Dan
ce
Paper and Mood Scale (Smileys) ● mins 5 Testing:

pencil Mood
Scale/Brief
Mood
Introspection
Scale
Review of the past sessions ● mins 40 Session

Healthy Living Tips and Trivia ● Proper
Loving Kindness Meditation ●
(5mins)
https://www.youtube.com/watch?
v=VjfCS88Gc7Q

experience
47
Paper and Mood Scale (Smileys) ● mins 5 Testing:

pencil Mood Scale

The ring of a bell will signal the - Remarks and
end of the session Closing
Prayer
Break
Debriefing (After Session 3)
- Debriefing of experiment
- Post Test (Modified Eriksonian Psychosocial Inventory Scale)
- Giving of tokens
Appendix B
Participants’ Personal Data Sheet
48
PARTICIPANT AGE GENDER RELIGION

1 72 years old Female Roman Catholic

EXPERIMENTAL GROUP
CONTROL GROUP
49
PARTICIPANT AGE GENDER RELIGION

2 67 years old Female Christian

Appendix C
Raw Score of Participants
Experimental Group
Participants Pre-test Post-test
1 32 42
2 27 36
3 23 33
4 25 28
5 22 37
6 23 36
7 32 35
Control Group
Participants Pre-test Post-test
1 29 43
50
2 40 39
3 46 46
4 35 44
5 40 40
6 38 37
7 31 39
51

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UNIVERSITY OF SANTO TOMAS COLLEGE OF SCIENCE

Mindfulness-based Cognitive Enhancement Program:

A Research Paper Submitted to the

In partial fulfillment of the requirements for the degree Bachelor of Science in

This Thesis entitled:

Mindfulness-based Cognitive Enhancement Program: Efficacy on the

prepared and submitted by Klein D. Concepcion, Trisha V. dela Cueva, Chloey

Lucila O. Bance, Ph.D.

Rodel C. Canlas, Ph.D.

Karen Katrina V. Trinidad, Ph.D.

Cecille Ann C. Pilapil, M.S., M.A.

Ma. Claudette A. Agnes, Ph.D.

Mindfulness-based Cognitive Enhancement Program:

Klein D. Concepcion, Trisha V. dela Cueva, Chloey Joy T. Jimenez, Justine J.

Ego-integrity is defined as the fundamental acceptance of one’s life as having been

Cite this Thesis Abstract:

We would like to express our greatest appreciation to Segal, Williams and

Fisher for letting us utilize a particular subscale of her Modified Eriksonian

own enhancement program. Our group is wholeheartedly thanking Ms. Teresita of

Mindfulness-based Cognitive Enhancement Program:

Efficacy on the Ego-integrity of Institutionalized Elderly

Background of the study

Instances of abandoned elderly are expanding globally. According to the

also relinquishment by their families. Subsequently, numerous elderly are

abuse, group centrism, safety, self-neglect, cognitive decline, decision-making and

health is geriatric depression which is associated with a problem that generally

affects one's family, and community.

stage of human development. Haber (2006) mentioned that ego-integrity is defined

as a basic acceptance of one's life as having been inevitable, appropriate, and

Erikson, resolving these challenges is essential to one’s psychological well-being in

integrity of the participants by using an enhancement program which is grounded on

the mindfulness-based cognitive therapy.

Mindfulness-based cognitive therapy developed by Segal, William, and Teasdale

present-oriented rather than being past or future-oriented. Being mindful is very

importance in their lives despite mortality. A research by Dezutter, Toussaint and

as unchangeable and they attempt to determine life laments.

participant’s psychological well-being. Ego-integrity as being an integral part for the

problems; to be followed by studies on ego-integrity, life satisfaction, acceptance

situations in one’s life.

changes. When one ages, physical changes begin to be noticeable such as

thewrinkling of skin, change in posture, floppiness of muscles and diminished vision

and listening skills, and a diminished productivity of cardiovascular framework.

be recognized like loss of physical abilities, loss of intellectual and cognitive

such as death of spouse, friends, and different acquaintances.

include extracurricular activities, day-to-day responsibilities, spiritual or religious

further explanation behind the well-being of the elderly. According to him, in

whole being and its continuous improvement. Wellness, accordingly, incorporates

better comprehension of ideas like wellbeing practices, most profound sense of

psychological well-being was studied comprehensively as there is a need to improve

The above mentioned explains the physiological and psychological changes,

social interaction, spiritual or religious connections and definitely, the association

way, we can understand them better and address their concerns.

Elderly in institutionalized care facilities

increasing globally. The objective of nursing homes or institutionalized care

adaptation to the new environment can be psychologically and emotionally

challenging (O¨zer, 2004; Duyan, 2016). Therefore, living in an institutionalized

facility can be both an advantage and a disadvantage.

Along with the quality of life, psychosocial well-being of the institutionalized

elderly is crucial and interventions to enhance their psychosocial well-being

therapeutic interventions are essential (Duyan, 2016).

Ego-integrity is at the last stage of the psychosocial stages of development by

the study of Jeong and Oh (2015), Erikson proposed ego-integration as a developing

ego-integration is achieved. On the other hand, a lowered quality of life may be