@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2018;10(3):115-120

Background
Effective treatment for Post-Traumatic Stress Disorder (PTSD) is necessary, as approximately 8% of these patients will show PTSD symptoms during their life [1].
Previous Studies
In fact, quality of life is an ideal goal of health care and evaluates the impact of health on one's life. Therefore, a treatment is useful when it increases the quality of life [2]. Today quality of life of patients is considered as a framework for the provision of appropriate services [3] ... [4, 5]. Meta-analysis data has shown that cognitive-behavioral therapy treats about 67% of these patients [6]. However, data have shown that about one third of these patients do not respond to cognitive-behavioral therapy. In addition, treatment rejection and cessation of the treatment process are common in these patients [7]. One of the alternative treatments for these patients is the Acceptance and Commitment Treatment (ACT) approach [8]. ... [9]. In recent years, emotional avoidance has been introduced as a functional dimension that goes beyond the traditional diagnostic criteria [10]. In addition, one of the best treatments for PTSD patients is their emotional avoidance [11]. Hence, a treatment that can reduce the emotional avoidance of PTSD patients can be beneficial. One of the treatments designed specifically for emotional avoidance and improving quality of life and cognitive impairment is ACT [12, 13]. ... [14]. Although limited experimental studies have been conducted on the efficacy of ACT in patients with PTSD, this treatment is appropriate for those PTSD patients who reject exposure therapy [8, 11].
Aim(s)
Few studies have been conducted on the effectiveness of ACT in patients with PTSD. Therefore, the present study was conducted with the aim of evaluating the efficacy of acceptance and commitment therapy on quality of life and thought control strategy in veterans with post-traumatic stress disorder.
Research type
The current applied research is experimental with pre-test, post-test and follow-up with the control group.
Research society, place and time
This research was conducted among veterans with posttraumatic stress disorder in the Foundation of the Martyrs and Veterans Affairs in the city of Sari in 2016-17. Of the 3,000 veterans, 150 were diagnosed with post-traumatic stress disorder.
Sampling method and number
A sample of 28 people was selected through convenience sampling method and randomly divided into two experimental and control groups (each group was 14). The criteria for entering the research included veterans with PTSD diagnosis based on the Medical Commission of the Foundation of the Martyrs and Veterans Affairs, having at least the third level of junior high school or the ability to read and write, filling out the consent form of the presence in the research, and not having the simultaneous experience of a psychological intervention. Exit criteria also included a severe psychiatric disorder such as schizophrenia, bipolar disorder, disorders related to addiction, and reluctance to participate in the study.
Used devices&materials
A sample of 28 people was selected through convenience sampling method and randomly divided into two experimental and control groups (each group was 14). The criteria for entering the research included veterans with PTSD diagnosis based on the Medical Commission of the Foundation of the Martyrs and Veterans Affairs, having at least the third level of junior high school or the ability to read and write, filling out the consent form of the presence in the research, and not having the simultaneous experience of a psychological intervention. Exit criteria also included a severe psychiatric disorder such as schizophrenia, bipolar disorder, disorders related to addiction, and reluctance to participate in the study.The control group did not receive any training and was placed on the waiting list for further treatment courses. After the sessions were completed, the post-test was carried out and followed up after three months. Data analysis was performed by SPSS 20 using Kolmogorov-Smirnov and Shapiro-Wilk tests to examine the natural distribution of variables and the multivariate covariance analysis to examine the difference between the groups in the groups and the Tukey post hoc test to examine the pre-test and post-test prevalence, as well as pre-test and follow-up.
Findings by Text
The age range of 21.4% of respondents was 45-49 years; 39.3% had the age range of 50.54 years old; the age range of 21.4% of the respondents was 55-59 years old and in 17.9% of the respondents the age range was 60-64 years old. 96.4% of the respondents were married and 3.6% were divorced. 7.7% had primary school education, 35.7% had a diploma, 7.1 % had a postgraduate diploma, 35.7% had a bachelor's degree, and 14.3% had a master's degree or higher. In addition, 50.0% of respondents had a good economic situation and 50.1% had a moderate economic situation. The percentage of injuries in 32.1%, 25%, 17.9%, 10.7%, and 14.3 of respondents was 10-20%, 21-30%, 31-40%, 41-50% and 51-60% respectively. By controlling the pre-test effects, there was a significant difference between the mean scores of quality of life and the control strategies of the experimental and control groups in post-test and follow-up (Table 2).Mean scores of quality of life in pre-test and post-test groups were significantly different (p = 0.003, P = 11.281) and follow-up scores were significantly higher than pre-test (P = 0.027; F = 541.5). Also, in thinking control strategies, there was a significant difference between pre-test and post-test scores (P = 0.0001, P = 38.016), and post-test scores showed a significant increase (P = 0.0001, F = 39.796). Main comparison to the similar studies The results indicated that at the end of treatment, the quality of life scores of the intervention group was significantly higher than the control group, which indicated the effectiveness of ACT therapy on the quality of life in war-related PTSD individuals. Afkari et al., in a study entitled "Effectiveness of an Acceptance and Commitment based approach to Improving Quality of Life and Self-efficacy of Veterans", showed that the treated group had better functioning and better quality of life, and the improvement of physical, psychological and social functions were observed. Also, the quality of life and self-efficacy variables in the injured veterans were increased and their flexibility and acceptance increased [18]. In addition, research results have shown that acceptance and commitment therapy has been effective on veterans' quality of life [19], which was consistent with this study. The present study was consistent with the findings of similar studies in the field of commitment education [20-23]. On the other hand, the results indicate the efficacy and survival of the treatment in improving the quality of life of patients with PTSD, which was consistent with other studies [24, 25]. Other similar studies on the impact of admission in improving quality of life [26-29] also acknowledge that attempting to deny illness or the feeling of being victimized against disease and avoiding symptoms does not help the patient, but appropriate admissions and exposure improves the process of disease and improves the quality of life treatment process. ... [30, 31]. Also, the results showed that ACT treatment significantly improved the control strategies of PTSD individuals in post-test. In other words, ACT therapy was continued at follow up, and significantly improved the strategies for controlling PTSD thought. This result was consistent with the findings of previous studies [24, 32, and 33].
Main comparison to the similar studies

Suggestions
It is suggested that similar studies be conducted for other psychosocial disturbances and chronic diseases with a larger sample size.
Limitations
From the limitations of the present study, short follow-up and low sample size can be mentioned and this study was conducted only in the male population of this disorder and therefore cannot be generalized to the female population.
Conclusions
Acceptance and Commitment Therapy is effective in improving quality of life and reducing thought control strategies in veterans suffering from post-traumatic stress disorder.
Acknowledgments
The researchers thank the efforts of all the clients participating in this research as well as Foundation of Martyrs and Veterans Affairs of Mazandaran province of Sari City.
Conflict of interest
There was no conflict of interest.
Ethical Permissions
Ethical principles of research were observed. Among them, one can explain the research goals and obtain informed consent from the units studied, the right to participate in the research, the right to withdraw from the study, without harming the intervention, answering the questions, and obtaining the results if desired.
Funding Sources
There was no financial support from anyone.

TABLES and CHARTS

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