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Sustained mood improvement by the positive photo appreciation program in older adults

The challenge of preventing depression among older adults is a pressing issue worldwide. Hence, we developed the Positive Photo Appreciation (PPA) program which aims at preventing depressive mood by enhancing positive emotion, autonomy, and intrinsic motivation based on positive psychotherapy (PPT) and positive self‐ expression through photography. The PPA program confirmed safety and a significant short‐term mood improvement effect using a randomized controlled design. However, the duration of the effect remains unclear—if this is sustained, it could be used to effectively and efficiently improve the mood of older adults with relatively little cost and time. Consistent with the PPT intervention studies reporting the long‐ term effects on positive emotions via gratitude expression and the potential self, we hypothesize that the PPA program would have the effects of sustained mood improvement. In this letter, we report three‐point transitions of participants' mood scores from the baseline to the three months follow‐up of the PPA program intervention. The participants in the intervention group in a pilot‐randomized trial included 25 community‐dwelling men and women aged 65–84 years Those in the control group were excluded because the PPA program was implemented for them after the post‐intervention assessment. Detailed information of the intervention study was presented elsewhere. A 90‐min program was conducted 12 times, once a week. The combination of three photography (30 min) and appreciation (1 h) sessions and one collage production session (production time: 1 h; viewing time: 30 min) were repeated for three terms. In the photography session, participants took photographs based on their preferences; these were then projected and everyone selected their favorite photos for appreciation. During the collage production, the participants created collages using their smiling photos and magazine clippings, provided titles, and presented them to the group. To maintain positive emotions, the participants did homework each day before going to bed: they imagined a positive image and recited three words of gratitude. Mood improvement effects were measured using the Japanese version of the 20 items Center for Epidemiologic Studies Depression (CES‐D) scale (primary outcome) and the Japanese version of the Kessler 6‐item Psychological Distress Scale (K6). The data were analyzed with IBM SPSS version 23.0J using general linear modeling (repeated measurement) that estimated the difference among the scores at three time points. The study was approved by the Ethics Committee of the National Center for Gerontology and Geriatrics, and the protocol was in accordance with the Declaration of Helsinki. The participants' mean age was 74.5 years (standard deviation: 5.9), and 72.0% were female. We observed that CES‐D scores were significantly lower at the post‐test and three ‐month follow‐up compared to the baseline (p< .001 in the global test; Table 1). Although theK6 scoreafter threemonthswas lower than that of thepre‐test, the difference was not statistically significant (p = .061; Table 1). Although the current study design does not allow us conclude a sustained, mood‐improving effects of the PPA program, our findings support its possibility, consistent with previous studies on PPT. Positive emotions may sustained through habituating positive behaviors and mindset via the program. Furthermore, the photography and positive expression employed in this study may improve this effect. Satisfaction with the program was high—participants found the activities fun, and some even proactively and voluntarily organized similar group‐based activities after the program; such actions may explain its sustained effects. The limitations of this study are as follows. Although the study suggests a possibility of 3‐month sustained effects of the PPA program, further long‐term effects should be examined. Because this study employed a one‐arm design, its evidence level is limited. However, considering that our previous study (Ishihara et al., 2018) demonstrated few changes in the control group's CES‐D score during the three‐month waiting period, similar results may be obtained even with an RCT design. The findings suggest that the PPA program has a potential as safe, non‐pharmacological therapy for older adults; we will further validate the effectiveness of the PPA program by applying it to clinical settings. We believe that dementia patients, their family caregivers, and other populations with high mood improvement needs may benefit from this program.