@2024 Afarand., IRAN

---

ISSN: 2008-2630    Iranian Journal of War & Public Health 2017;9(4):217-223

Background
… [1-3]. PTSD (Post-Traumatic Stress Disorder) is a serious psychiatric disorder, including the thoughts and memories of a traumatic event, the prevention of harm-induced stimuli, changes in cognitive, psychological, and anti-vascular symptoms that comes directly or indirectly after exposure to a harmful event (which is related to actual death or threat, serious injury, or sexual relationship) [4, 5].
Previous Studies
… [6-13]. Over the last 25 years since the end of war and the long-term disability of veterans, their wives, who have been called war victims, have long suffered from numerous responsibilities such as nursing spouse, parenting, life-related problems, and reducing the actual burnout incidence and they need psychological services [14]. … [15-24]. Previous studies have shown that ACT treatment (Acceptance and Commitment Therapy) has improved anxiety, depression, PTSD symptoms, and improved general and maternal function [25-27]. … [28-30]. In the context of MBCT (Mindfulness-Based Cognitive Therapy), research has also shown that meditation improves mood-mindfulness and its short-term training reduces fatigue and anxiety. It also improves the quality of life and reduces depression in students [31, 32]. Mindfulness has positive relationship with mental and psychological well-being and mental health [33-37]. … [38-44].
Aim(s)
The purpose of this study was to investigate the effectiveness of intervention of ACT and MBCT treatments on psychological well-being of spouses of war veterans with PTSD.
Research type
This is a quasi-experimental study with pretest, posttest design with control group and follow-up phase after a month.
Research society, place and time
This study was conducted among 170 wives of veterans with Post Traumatic Stress Disorder (PTSD) in Kohdasht City in 2016.
Sampling method and number
Of these people, 100 people were randomly selected and invited to cooperate that finally 45 people were willing to cooperate in the project. Of these, 15 were randomly selected in the acceptance and commitment group; 15 were in the mindfulness cognitive therapy group and 15 were in the control group. Finally, two cases of each group were discarded. These people entered the study on the basis of attending meetings, having a minimum secondary education for accountability, a common couple's life, non-admission of a spouse to a nursing home and monogamy. Exit criteria also included simultaneous psychiatric treatment and the use of psychiatric medications. The criteria were asked in the first session as self-explanatory.
Used devices&materials
The research tool was Ryff Scale of Psychological Well-Being-Short Form (RSPWB-SF). The short form of the 18 questions of the Ryff Scale of Psychological Well-Being-Short Form, was designed by Ryff in 1898 and it was revised in 2001. This version consists of six factors: self-acceptance, environmental dominance, positive relationship with others, goal-oriented living, personal growth and independence which is answered in a continuum of “totally agreeable” to “totally disagreeable” (with a score of one to 6) that a higher score indicates better psychological well-being. The results of the 18-item version in the past studies indicated a relatively high correlation between the factors of the version (from 0.70 to 0.89) [45]. In Iran, the internal consistency of this scale using Cronbach's alpha in the six factors of self-acceptance, environmental dominance, positive relationship with others, having a goal in life, personal growth, and independence were respectively 0.51, 0.76, 0.75, 0.52, 0.73, and 0.72 respectively and it was 0.71 for the whole scale [46]. After coordinating with the treatment centers and obtaining the consent and satisfaction of the subjects, the purpose of the research was first expressed to them and they were asked to participate in the program. In the pretest phase, the 18-question Ryff Scale of Psychological Well-Being-Short Form was provided to the participants and they were asked to carefully read the questions and select the responses according to their characteristics and answer to the all questions as far as possible. Veterans' spouses were randomly assigned into two experimental groups and a control group and each of the two experimental groups received treatment in group-based form in eight 90-minute sessions. One of these groups was treated with Acceptance and Commitment Treatment (ACT) [20] and other group received Mindfulness-Based Cognitive Therapy (MBCT) [47]. However, the control group received no treatment. After the completion of the training course, posttest was performed in both the treated and control groups (Table 1). Data were analyzed by SPSS 18 using variance analysis tests with repeated measure variance analysis, multiple analysis of variance, and Shafa's post hoc test.
Findings by Text
18 participants in the study had a diploma, and post-diploma degree. 10 had associate degree, and 17 had a bachelor's degree. Also, the length of the marriage was between 14 and 25 years. The difference between the mean scores of the groups in the pretest was not significant and the groups were similar in the pretest stage (p>0.05). The difference in mean scores was significant in the three stages of pretest, posttest, and follow-up in the ACT group (F (2, 11) =43.8) and MBCT group (F (2, 11) =26.5) (p<0.01). In bifurcation comparison of the groups in the posttest stage, the mean difference of the ACT group with the control group (20.83) and MBCT group with the control group (21.90) was significant (p<0.01). However, the MBCT and ACT groups did not have a significant difference with each other (p>0.05). In the follow up phase, the mean difference between the ACT and control group (18.27) and MBCT and control group (20.73) was significant (p<0.01). However, the two groups of MBCT and ACT did not have any significant difference with each other (p>0.05; Table 2).
Main comparison to the similar studies
The findings showed that the two approaches had a positive effect on improving psychological well-being. Previous studies also had the similar results [25-27, 34, 35, and 37]. In this regard, studies have shown that acceptance and commitment strategies and its functions have improved adaptability, stress, and anxiety and psychological well-being [24]. Also, in previous studies, the positive impact of acceptance and committed treatment on the psychological well-being and self-esteem has been mentioned [28-30]. Research in the field of mindfulness showed that education of cognitive mindfulness has improved the psychological, physical, emotional and spiritual well-being and improved mood as well [38]. Also, some studies have shown the effect of mindfulness on the increase of psychological well-being and consequently increases the satisfaction of life. As a results of increased well-being, anxiety, depression, negative affection, and psychological symptoms decreases, and self-esteem, optimism, and positive affection increases [31, 32].
Suggestions
It is suggested that the same research be repeated in other communities because the use of repeated measurement schemes, in which follow-up with longer interval to ensure the reliability of the impact of intervention is necessary, will demonstrate the impact of training more clearly. It is also suggested that attention be paid to the importance of the role of acceptance and commitment-mindfulness-based learning in improving psychological well-being and mental health-related variables in the spouses and veterans with PTSD and in follow-up research, acceptance and commitment-based and mindfulness in the veterans and their families also be studied.
Limitations
One of the limitations of this research was its implementation in a city that cultural issues and a small number of samples may have affected the results. Therefore, the generalization of the findings of this study should be carried out with caution. Also, due to the researcher's limitation on increasing the interval between posttest and follow-up and increasing the likelihood of loss and lack of access to the samples over time, this period was considered as one month.
Conclusions
The education of acceptance and commitment and cognitive-mindfulness-based cognitive therapy are effective on increasing the psychological well-being of veterans' wives with PTSD.
Acknowledgments
We are grateful to the cooperation and assistance of the respectable officials of the Foundation of Martyrs and Veterans Affairs of Koohdasht City and honorable family of devoted veterans.
Conflict of interest
Non-declared
Ethical Permissions
Prior to the implementation of the research, coordination with the Foundation of Martyrs and Veterans Affairs was carried out and the consent of the samples was obtained.
Funding Sources
The source of funding for this research is from the authors' personal expenses.

TABLES and CHARTS

Show attach file