@2024 Afarand., IRAN

---

ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(2):125-131

Background
Multiple Sclerosis (MS) is a progressive central nervous system disorder that destroys myelin sheath and forms plaques in some areas of the white matter of the brain and the spinal cord and involves subcortical areas [1].
Previous Studies
... [2-5]. According to the recent studies by the American Academy of Neurology, stress is one of the important factors in increase and recurrence of multiple sclerosis symptoms [6]. It can be occurred at the age of 20 to 40 years. The age of the onset of the disease is often the ages of. Immunological, genetic, environmental, strike and stress factors are effective for its occurrence [7]. ... [8-17]. Compassion-Focused Therapy (CFT) is one of the new therapeutic interventions that can be effective in improving the mental health of MS patients. CFT was developed by Paul Gilbert when he observed that many people, especially those who have high self-criticism and shame, have had difficulty for traditional therapies to make kind internal and self-supporting noise CFT focuses on the four areas, including past and historical experiences, fundamental fears, strategies for sense of security and outcomes and unexpected results [18]. CFT is based on an evolutionary approach to psychological functions. Based on this approach, the motivations and capabilities of compassion are related to evolved brain systems that are underpinned by attachment behaviors, friendship and compassion. The natural function of compassion is also making compliant behaviors, providing opportunities for interconnection, security, relief, participation, persuasion, and support [19]. ... [20-26].
Aim(s)
The present study aimed at investigating the effectiveness of CFT on mental health of women with multiple sclerosis.
Research type
The present research is a semi-experimental intervention with pretest-posttest design using the control group.
Research society, place and time
The research population included all the women with active case file in MS association of Tehran in 2016.
Sampling method and number
30 female patients who scored more in general health questionnaire and had low levels of mental health compared with other subjects were selected by available sampling method and divided into the control and experimental groups (n=15).
Used devices&materials
Necessary coordination was made with authorities of the association and the sessions schedule was introduced for the patients and those who met the inclusion and exclusion criteria of the study following an initial screening were selected and divided into different groups. According to the sample size for interventional studies, the sample size for each group was considered 15 to 20 subjects (n=15 for each group). The inclusion criteria included age range of 20-45 years, at least secondary school education, MS confirmed by a physician, the results of diagnostic tests, such as MRI in the MS Society, no severe and acute phase of MS, at least one year of suffering from MS, the informed consent indicating voluntary participation in the training sessions, and no participation in individual counseling services other than intervention. Diagnostic factors indicating significant psychiatric disorders based on clinical interviews, suffering from physical disorders affecting the results of the study were also considered as exclusion criteria. This study was performed in accordance with the Helsinki Declaration, including an explanation of the research objectives, obtaining the informed consent from the subjects, the right to withdraw from the study, no adverse effects of participation, and answering the questions and presenting the results if desired [27]. The Goldberg General Health Questionnaire was completed by the participants in both groups, and the CFT sessions were held in eight 2-hour sessions by weekly group discussion method for participants in the experimental group; however the control group did not receive any intervention. Therapeutic sessions were designed based on CFT by Gilbert [20]. After therapeutic sessions, two groups were re-evaluated by a questionnaire. The therapeutic sessions were also considered for the control group after post-test to observe ethical considerations in the research as well as for appreciation of their cooperation. The data collection tool was the General Health Questionnaire developed by Goldberg and standardized by Hooman. It is used to measure non-psychotic disorders and also in normal populations for the diagnosis of mild psychiatric disorders. Questions are scored on a 3-point Likert scale. (It should be noted that high scores in this test are indicative of low health status). The 28-item form of the General Health Questionnaire has four subscales, including physical symptoms, anxiety, social function disorder and depression. A total score indicating the health of individuals is obtained from the sum of these four sub-scales [28]. In a study, the Cronbach's alpha coefficient for the questionnaire was obtained 0.89 and 0.83 for diabetic and non-diabetic groups, respectively [29]. The Cronbach's alpha in this study yielded 0.74. The collected data was analyzed using SPSS 18 software. The Kolmogorov-Smirnov test was used to ensure the normal distribution of data. Covariance analysis was used to examine the effect of CFT on the dependent variable (mental health) in the groups and to control the effect of the pre-test variable.
Findings by Text
The mean mental health scores of the experimental and control groups in the pre-test were 66.8±11.49 and 62.61±14.12, respectively. In the post-test and after intervention, mean mental health scores in the experimental and control groups were 48.98±11.7 and 61.37±9.97, respectively and there was a significant decrease in the mean of mental health scores in the experimental group compared with the control group (lower scores in the general health questionnaire indicate better mental health). Also, according to the results of covariance analysis, the effectiveness of CFT in the post-test stage was 0.62, which means that 0.62 of personal differences in the post-test scores of the mental health were associated with the effect of intervention (group membership).
Main comparison to the similar studies
No study completely consistent with the findings of this study was found, however the obtained results in this study were indirectly consistent with the findings of studies by Lucre & Corten [25], Braehler et al. [26], Ashworth et al. [18], Raes [30], Leaviss &Uttley [31], Imrie &Troop [32], Noorbala et al. [33], Lincoln et al. [21], Boersma et al. [23], Gale et al. [24] and Judge et al. [34] on the efficacy of CFT. Mindfulness is another factor effective in CFT. Self-compassion can be an emotional-focused strategy, since mindfulness of our emotions avoidance of painful and distressing feelings, affinity along with kindness, and understanding and the sense of human participation are needed for Self-compassion. In fact, in this model, people first using mindfulness, are informed about their emotional experience, and then find a positive attitude toward their negative emotions [35]. … [36].
Suggestions
It is suggested that Iran Multiple Sclerosis Association employ this therapeutic approach to improve the mental health of chronic patients.
Limitations
This study was done on MS patients of Tehran, so the results can not be generalized to other cities.
Conclusions
CFT can result in a reduction in psychological problems and improving mental health of patients with multiple sclerosis through the increased internal awareness, nonjudgmental acceptance, empathy and consistent attention to internal emotions.
Acknowledgments
The research team is grateful to the authorities Tehran Society of Multiple Sclerosis and all patients who sincerely helped the researchers.
Conflict of interest
None declared.
Ethical Permissions
None declared.
Funding Sources
This study was not supported by any specific institution.