In brief
A small quasi-experimental Iranian study found that ten psychodrama sessions significantly improved older adults' subjective well-being but did not significantly improve their social adjustment.
What this article is about
Quick Answer
A small quasi-experimental Iranian study found that ten psychodrama sessions significantly improved older adults' subjective well-being but did not significantly improve their social adjustment.
Student takeaways
Key Takeaways
- In this quasi-experimental study of older adults in Tehran daily nursing homes, ten 90-minute psychodrama sessions produced a significant positive effect on subjective well-being compared with a no-treatment control group.
- Psychodrama did not have a statistically significant effect on the social adjustment of the older adults.
- The study used a pre-test/post-test design with a control group, selecting the 30 lowest-scoring participants and randomly assigning them to two groups of 15.
- Outcomes were measured with validated tools: Bell's Social Adjustment Inventory, Diener's life satisfaction scale, and the Lyubomirsky and Lepper happiness scale, analyzed using ANCOVA.
- The authors interpret the well-being benefit as coming from role-playing that let participants release hidden thoughts, motivations, and emotions and express inner needs.
Student summary
Why This Research Matters
This study, published in 2020 in an Iranian aging-psychology journal, tested whether psychodrama, a group therapy that uses guided role-playing, could improve two things in older adults: their social adjustment and their subjective well-being. Subjective well-being refers to how satisfied and happy people feel about their own lives. Unlike an opinion essay, this is a quasi-experimental study, meaning the researchers actually delivered an intervention and measured outcomes, so its results are real data, though from a small sample.
The reasoning behind the study is that as people age, they can gradually lose some physical, psychological, and social abilities. The authors argue that mental and emotional health strongly shape how well older adults keep functioning socially, so improving mood and emotional state might help them stay socially active despite physical decline. Psychodrama is offered as one possible way to do this, because acting out situations can help people express hidden feelings such as anger, sadness, and happiness, and reveal inner thoughts and needs.
The design was a pre-test/post-test study with a control group. The population was older adults attending daily nursing homes in Tehran during 2019 to 2020. Participants completed three questionnaires: Bell's Social Adjustment Inventory, Diener's life satisfaction scale, and the Lyubomirsky and Lepper happiness scale. From these, the 30 people with the lowest scores were selected and then randomly assigned into two groups of 15. The experimental group received ten psychodrama sessions, each lasting 90 minutes, while the control group received no intervention during the same period. The researchers then compared the groups using a statistical method called analysis of covariance, or ANCOVA, which helps account for differences that existed before treatment.
The results were mixed, and this is the most important part to understand accurately. Psychodrama had a significant positive effect on the subjective well-being of the older adults. In other words, the group that took part in psychodrama reported meaningfully better well-being than the control group. However, psychodrama did not have a significant effect on social adjustment. The improvement the researchers hoped to see in how well participants adjusted socially was not statistically supported. It is important not to overstate the study: it did not show that psychodrama improves social adjustment, only well-being, in this sample.
The authors interpret the well-being benefit by suggesting that psychodrama gave participants a safe way, through role-playing, to release hidden thoughts, motivations, and emotional states, and to express their inner demands. They conclude that psychodrama could be an appropriate method to increase well-being in older adults.
For nursing students, several lessons stand out. First, group creative therapies like psychodrama are examples of non-drug approaches that may support the emotional health of older adults, which matters because this population often lives with loss, isolation, and multiple health problems. Second, this study is a good reminder that an intervention can help one outcome while not helping another; good clinical judgment means matching a therapy to the specific goal it actually supports. Third, the study models careful appraisal: it used validated questionnaires, a control group, and random assignment, which strengthen confidence, but the sample was very small.
Several cautions apply. The study included only 30 people, all recruited because they had the lowest baseline scores, and all from daily nursing homes in one city, so the results may not generalize to other older adults. The abstract does not report the exact numbers, effect sizes, or how long any benefit lasted, so we cannot say how large or durable the improvement in well-being was. A quasi-experimental design with a no-treatment control also cannot rule out that simply gathering in a supportive group, rather than psychodrama specifically, contributed to the benefit. Finally, psychodrama involves emotionally intense role-play; in vulnerable older adults it should be led by trained facilitators who can support participants if difficult emotions surface. Overall, this study offers encouraging but preliminary support for psychodrama as a well-being intervention for older adults, while showing it did not improve social adjustment in this group.
Source abstract
Study Overview
At the onset of aging, people gradually lose some of their physical, psychological and social functions. Mental health and emotional status seem to be the most important factors in predicting the level of performance of the elderly, and improving the mental and emotional state of the elderly helps them maintain their optimal social performance despite physical problems. Therefore, this study aimed to investigate the effectiveness of psychodrama on social adjustment and subjective well-being in the elderly. The research was a quasi-experimental included pre-test and post-test design with control group. The statistical population of this study was the elderly of daily nursing homes of Tehran in 2019 to 2020. Having Completed Bell’s Social Adjustment Inventory, Diner’s Life Satisfaction Scale and the Lubmirsky & Leper’s Actual happiness scale, 30 elderlies with the lowest score in each item were selected and randomly assigned into experimental and control groups (15 people in each group). The experimental group receive ten 90-minute sessions of psychodrama training, and the control group did not receive any intervention at the same time. The results of Univariate Covariance Analysis (ANCOVA) showed significant positive effect of psychodrama on the subjective well-being of the elderly, but its effect on social adjustment of the elderly was not significant. Based on the findings of this study, psychodrama could be used as an appropriate method to increase the well-being of the elderly as psychodrama allowed people through role-playing to release their thoughts, hidden motivation and emotional states such as anger, sadness and happiness. 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Evidence appraisal
Main Findings
- In this quasi-experimental study of older adults in Tehran daily nursing homes, ten 90-minute psychodrama sessions produced a significant positive effect on subjective well-being compared with a no-treatment control group.
- Psychodrama did not have a statistically significant effect on the social adjustment of the older adults.
- The study used a pre-test/post-test design with a control group, selecting the 30 lowest-scoring participants and randomly assigning them to two groups of 15.
- Outcomes were measured with validated tools: Bell's Social Adjustment Inventory, Diener's life satisfaction scale, and the Lyubomirsky and Lepper happiness scale, analyzed using ANCOVA.
- The authors interpret the well-being benefit as coming from role-playing that let participants release hidden thoughts, motivations, and emotions and express inner needs.
Practice transfer
Clinical Relevance
- Psychodrama may be a useful non-pharmacological option to support the subjective well-being of older adults in residential or day-program settings.
- Because the study did not show a benefit for social adjustment, nurses should match the therapy to its supported goal, well-being, rather than assume it improves all social outcomes.
- Group creative therapies can offer older adults a structured, safe outlet for emotions such as anger, sadness, and happiness, which may help those coping with loss or isolation.
- Given the emotional intensity of role-play, psychodrama for vulnerable older adults should be led by trained facilitators prepared to support distress if it arises.
- Nurses should treat this as encouraging but preliminary evidence and combine it with individualized assessment rather than adopting it as a proven, one-size-fits-all intervention.
Faculty notes
Educational Relevance
This quasi-experimental study is a compact teaching tool for research appraisal and for non-pharmacological mental health care in aging. Use it to help students read a pre-test/post-test design with a control group: 30 older adults from Tehran daily nursing homes, selected for lowest baseline scores, randomly assigned to ten 90-minute psychodrama sessions or no intervention, with outcomes measured by validated well-being and adjustment scales and analyzed with ANCOVA. The headline teaching point is the split result: psychodrama significantly improved subjective well-being but did not significantly improve social adjustment. This is an excellent prompt for discussing why an intervention may affect one outcome and not another, and why students must not overgeneralize a positive study. Emphasize appraisal of small samples, selection of only the lowest scorers, single-site recruitment, and the absence of reported effect sizes or follow-up in the abstract. The therapy itself supports a discussion of expressive, group-based approaches to emotional health in older adults and the need for trained facilitation given the emotional intensity of role-play. Ask students to translate the finding into a realistic, goal-matched care recommendation rather than a blanket endorsement of psychodrama.
Critical appraisal
Limitations
- The sample was very small, only 30 participants across two groups of 15, limiting the strength and generalizability of the findings.
- Participants were selected specifically because they had the lowest baseline scores and came from daily nursing homes in a single city, so results may not apply to other older adults.
- The abstract does not report exact numbers, effect sizes, or any follow-up period, so the size and durability of the well-being benefit are unknown.
Classroom use
Discussion Questions
- What is psychodrama, and why might role-playing help older adults express difficult emotions?
- Why is it important that psychodrama improved well-being but not social adjustment, and how should that shape a care recommendation?
- How do random assignment and a control group strengthen confidence in this study's results?
- What are the risks of selecting only the participants with the lowest baseline scores?
- How might the small sample size and single-city setting limit how far these results can be applied?
- Why does the absence of reported effect sizes and follow-up matter when judging this study?
- Could simply gathering in a supportive group, rather than psychodrama itself, explain the well-being benefit? How would you test that?
- What safeguards should be in place before offering emotionally intense role-play to vulnerable older adults?
- How does emotional and mental health relate to older adults' ability to stay socially engaged, according to the authors' rationale?
- How would you explain this study's mixed results to a care team considering starting a psychodrama group?
Knowledge check
Quiz
1. What study design did the researchers use?
- A systematic review
- A quasi-experimental pre-test/post-test design with a control group
- A single case report
- A cross-sectional survey
Rationale: The abstract states it was a quasi-experimental study with pre-test and post-test measures and a control group.
2. What was the main positive result of the study?
- Psychodrama improved social adjustment
- Psychodrama significantly improved subjective well-being
- Psychodrama improved physical mobility
- Psychodrama reduced medication use
Rationale: ANCOVA showed a significant positive effect of psychodrama on subjective well-being.
3. What effect did psychodrama have on social adjustment?
- A large significant improvement
- No statistically significant effect
- A significant worsening
- The study did not measure it
Rationale: The study found psychodrama's effect on social adjustment was not significant.
4. How many participants were in the study, and how were they divided?
- 100 participants in four groups
- 30 participants in two groups of 15
- 60 participants in two groups of 30
- 15 participants in one group
Rationale: Thirty older adults with the lowest scores were randomly assigned to experimental and control groups of 15 each.
5. Who made up the study population?
- Hospital inpatients with dementia
- Older adults attending daily nursing homes in Tehran
- University students in Iran
- Community-dwelling teenagers
Rationale: The population was the elderly of daily nursing homes of Tehran in 2019 to 2020.
6. How many psychodrama sessions did the experimental group receive, and how long were they?
- Five 30-minute sessions
- Ten 90-minute sessions
- Twenty 60-minute sessions
- Three 2-hour sessions
Rationale: The experimental group received ten 90-minute sessions of psychodrama training.
7. Which statistical method was used to compare the groups?
- Chi-square test
- Analysis of covariance (ANCOVA)
- Simple correlation
- Thematic analysis
Rationale: The results were analyzed using univariate analysis of covariance (ANCOVA).
8. How were participants selected for the study?
- Volunteers with the highest well-being
- The 30 people with the lowest scores on the questionnaires
- A random national sample
- Only participants with dementia
Rationale: Those with the lowest scores on the inventories were selected, which is a limitation for generalizability.
9. How do the authors explain psychodrama's benefit to well-being?
- It provided medication adjustments
- Role-playing let participants release hidden emotions and express inner needs
- It improved participants' physical strength
- It replaced their social relationships
Rationale: The authors attribute the benefit to role-playing that allowed release of thoughts, motivations, and emotions.
10. What is a key limitation of this study?
- It used no control group
- It had a very small sample of only 30 participants
- It followed participants for ten years
- It tested a drug rather than a therapy
Rationale: The small, selectively recruited, single-site sample limits the strength and generalizability of the findings.
Study cards
Flashcards
What is psychodrama?
A group therapy that uses guided role-playing to help people express hidden thoughts, motivations, and emotions.
What two outcomes did this study test?
Social adjustment and subjective well-being in older adults.
What is subjective well-being?
How satisfied and happy people feel about their own lives.
What study design was used?
A quasi-experimental pre-test/post-test design with a control group.
Where and when was the study conducted?
Among older adults in daily nursing homes in Tehran, Iran, during 2019 to 2020.
How many participants took part, and how were they grouped?
30 older adults, randomly assigned to an experimental group of 15 and a control group of 15.
How were participants selected?
The 30 people with the lowest scores on the study questionnaires were chosen.
What did the experimental group receive?
Ten 90-minute sessions of psychodrama training.
What did the control group receive?
No intervention during the same period.
Which three measurement tools were used?
Bell's Social Adjustment Inventory, Diener's life satisfaction scale, and the Lyubomirsky and Lepper happiness scale.
Which statistical method analyzed the results?
Analysis of covariance (ANCOVA).
What was the main positive finding?
Psychodrama significantly improved subjective well-being.
What was the null finding?
Psychodrama did not significantly improve social adjustment.
How did the authors explain the well-being benefit?
Role-playing gave participants a safe way to release hidden emotions and express inner needs.
What did the authors conclude psychodrama could be used for?
As an appropriate method to increase well-being in older adults.
Why is the sample a limitation?
It was very small (30 people), selected for lowest scores, and drawn from one city.
What key numbers are missing from the abstract?
Exact effect sizes and any follow-up period, so the size and durability of the benefit are unknown.
Why might a no-treatment control be a limitation here?
It cannot separate the effect of psychodrama itself from simply participating in a supportive group.
What safety consideration applies to psychodrama with older adults?
Because role-play can be emotionally intense, it should be led by trained facilitators ready to support distress.
What is the correct nursing takeaway from the mixed results?
Recommend psychodrama for its supported goal (well-being), not for social adjustment, and treat the evidence as preliminary.
Search-ready answers
Frequently asked questions
Did psychodrama help older adults in this study?
It significantly improved their subjective well-being, but it did not significantly improve their social adjustment.
Is this a strong, definitive study?
No. It is a small quasi-experimental study of 30 people from one city, so its results are preliminary.
What is psychodrama used for here?
As a group role-playing therapy meant to help older adults express emotions and improve well-being.
Why did it not improve social adjustment?
The abstract does not explain why; it only reports the effect was not statistically significant.
How were the two groups treated differently?
One group received ten 90-minute psychodrama sessions while the control group received nothing.
Can these results be applied to all older adults?
Not confidently. Participants were the lowest scorers from Tehran daily nursing homes, so generalization is limited.
How large was the well-being improvement?
The abstract reports it as statistically significant but does not give exact effect sizes.
Is psychodrama safe for older adults?
It can be, but because role-play stirs strong emotions it should be led by trained facilitators who can support participants.
What should a nurse take away from this study?
Psychodrama may support well-being in older adults, but it should be matched to that goal and used alongside individualized care.
Does more social participation automatically follow from better well-being?
Not according to this study, which found improved well-being without a significant change in social adjustment.