The present study was conducted to investigate effectiveness of reality therapy on social relationships and distress tolerance in the elderly. The current study was a experimental application with a pre-test-post-test design with a control group and a two-month follow-up period. The statistical population of the present study included elderly people over 65 years of age living in Isfahan in 2024. In this research, 33 elderly were selected by purposeful sampling and randomly assigned to experimental and control groups (17 elderly in the experimental group and 16 elderly in the control group). The elderly in the experimental group received the coherent reminiscence group therapy during eight weeks in eight 75-minute sessions. Social Relations Questionnaire (SRQ) and Distress Tolerance Questionnaire (DTQ) were used in the present study. The data were analyzed through mixed ANOVA via SPSS23 software. The results showed that reality therapy has significant effect on the social relationships (p<0.0001) and distress tolerance (p<0.0001) in the elderly. Based on the research findings, it can be concluded that reality therapy can be used as an efficient method to improve social relationships and tolerate distress in the elderly by familiarizing the elderly with the theory of choice and the five basic needs, teaching the components of behavior, creating a healthy spirit for establishing relationships, learning methods of self-restraint and self-control of behavior, and creating responsible behavior.