@2024 Afarand., IRAN
ISSN: 2252-0805 The Horizon of Medical Sciences 2017;23(2):135-140
ISSN: 2252-0805 The Horizon of Medical Sciences 2017;23(2):135-140
Acceptance and Commitment Based Therapy on Disease Perception and Psychological Capital in Patients with Type II Diabetes
ARTICLE INFO
Article Type
Original ResearchAuthors
Baghban Baghestan A. (1)Aerab Sheibani Kh. (*)
Javedani Masrur M. (2)
(*) Psychology Department, Humanities Faculty, Payam-e-Noor University, Tehran, Iran
(1) Psychology Department, Humanities Faculty, Payam-e-Noor University, Tehran, Iran
(2) Obstetrics & Gynecology Department, Medicine Faculty, Iran University of Medical Sciences, Tehran, Iran
Correspondence
Address: Humanities Faculty, Payam-E-Noor University, Alghadir Square, Ferdows City, South Khorasan, Iran. Postal Code: 9771853144Phone: +98 (56) 32721800
Fax: +98 (56) 32727999
shakiba_a_shaibani@yahoo.com
Article History
Received: May 19, 2016Accepted: December 20, 2016
ePublished: March 25, 2017
BRIEF TEXT
Diabetes is one of the most chronic diseases that disturbs the regular flow of life and can have important psychological consequences [1]. … [2-8]. Recognition of patients from their disease is defined as the perception of disease or the cognitive representation of the disease by the patient and based on the absorption of information from various sources and patients beliefs. This factor can affect mental health and the individual`s ability to adopt to the diseases [9].
… [10-13]. In Luthans`s view, psychological capital is a hybrid instrument that integrates four cognitive-perceptive components that is hope, optimism, self-efficacy, and resilience [14]. These components, in an interactive and evaluative process, gives meaning to one`s life [15], preserve an individual`s effort to change the pressure conditions [1], prepare the person for entry into the scene of action [17] and guarantee the person`s resilience and perseverance in realization of the goals [18]. … [19-31].
The purpose of this study was to determine the effect of acceptance and commitment intervention on the perception of disease and psychological capital in type 2 diabetic patients.
This is a quasi-experimental study, with pretest and posttest design with control group.
This research was conducted in winter 2012 in Shaheed Dr. Mostafa Chamran Hospital in Ferdows City on all patients with type 2 diabetes.
34 patients with type 2 diabetes with a range of 40 to 60 years old were selected by convenience sampling.
… [33-37]. The instruments were short illness perception questionnaire, and Luthans’ psychological capital questionnaire. The short illness perception questionnaire is 9-item questionnaire designed by Bardbent et al. for assessing the emotional and cognitive imaging of a disease [33]. Cronbach`s alpha for this questionnaire was 0.80 and test-retest reliability coefficient in 6 weeks interval has been reported 0.42 to 0.75 for various questions. Bazazian and Besharat in their research, reported the reliability of this questionnaire 0.53 using Cronbach`s alpha method [34]. To measure the psychological capital, Luthans`s psychological capital questionnaire was used. This questionnaire consists of 24 questions and four subscales of hope, resilience, optimism and self-efficacy that each subscale has 6 items, and the responder responds each item on the six grade Likert scale (from the totally agree to totally disagree). In order to obtain a score of psychological capital, the score of each subscales was first obtained separately, and then their sum was considered as the total score of psychological capital. The chi-square ratio of this test is 24.6 and the parameters of CFI (Comparative Fit Index) and RMSEA (Root Mean Square Error of Approximation), in this model, are respectively 0.97 and 0.08 respectively [35]. Also, the reliability of this questionnaire was obtained 0.85 based on Cronbach`s alpha coefficient in the study by Hashemi et al. [36]. At first, patients completed the questionnaire of perception of diseases as well as the psychological capital questionnaire under the supervision of therapist. Admission and commitment intervention were performed on 8 weekly 60-minute sessions in the experimental group [37] (Table 1). At the last group meeting, the posttest was repeated to measure the impact of the independent variable. Statistical analysis: After collecting data, data were analyzed by SPSS 18 software and by using descriptive statistics, mean and standard deviation of data were calculated. Kolmogorov-Smirnov test was used to ensure the normal distribution of data. Covariance analysis was used to investigate the effect of acceptance and commitment-based intervention on dependent variables namely perception of the disease and psychological commitment in patients with type 2 diabetes in both control and experimental groups.
The effect of admission and commitment therapy training on improving the perception of the disease and all the subscales of outcome, treatment control, nature, concern, cognition, and emotional response in type 2 diabetic patients were significant after adjusting for pretest scores (p=0.0001) and the difference i.e. Etax square was 0.474. However, this therapeutic approach was not significant on the improvement of the subscale of personal control in patients with type 2 diabetes (p=0.062). Also, the effect of admission and commitment therapy training on the increase of psychological capital and its subscales in patients with type 2 diabetes after modulation of pretest scores was significant (p=0.0001) that this difference i.e. eta square was 0.625 (Table 2).
These results are consistent with the result of Wales and McCrackan`s research on the efficacy of admission and commitment therapy treatment on the treatment of patients with chronic pain and the results of Hor et al. study [31] on the role of admission and commitment therapy in reducing depression in type 2 diabetic patients. Effort and Hefner in the study, also, demonstrated the effectiveness of this treatment on improving life quality and a significant reduction in anxiety and depression which is consistent with the results of this study [38]. Effort and Hefner argue that acceptance-based approaches, rather than emphasizing anxiety, increase the tendency to experience it and facilitate exposure to these unpleasant emotions by identifying values and connecting with personal values and goals [38]. … [39].
It is suggested that in the future studies, this treatment be done on the other physical and psychological disorders and other clinical population as well as other psychological problems of people with chronic discomfort, and long-term follow-up tests be conducted to determine the extent to which treatment effects persist.
This study was without a follow-up and it is unclear how long the therapeutic effects will last in the long run. Also, caution should be considered in generalizing the findings of this study to patients with other chronic diseases.
Admission and commitment-based interventions can significantly improve the perception of the disease and the psychological capital of people with type 2 diabetes which can improve their quality of life.
The authors of this article need to appreciate and thank all the officials of the Dr. Chamran Hospital in Ferdows City and all patients who with their participation in this training course provided the possibility of doing this research.
Non-declared
In order to observe the ethical consideration of the research, before distributing the questionnaires, a brief description of the questionnaire was given to the patients and a written consent form was obtained from the patients and they were assured that the responses would remain confidential.
This article has no funding source.
TABLES and CHARTS
Show attach fileCITIATION LINKS
[1]Aerab Sheibani K, Akhondi N, Javedani Masrour M, Riahi madvar M. Promotion of psychological capital model in diabetic pation:an explanation of the role of quality of life. J Health Psychol. 2016;5(18):35-51. [Persian]
[2]Van Dijk SE, Pols AD, Adriaanse MC, Bosmans JE, Elders PJ, van Marwijk HW, et al. Costeffectivenessof a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial. BMC Psychiatry. 2013;13:128.
[3]Azimi H, Yekkeh Fallah L, Ghorbani A. Comparing effects of walking and yoga exercise on quality of life in patients with type 2 diabetes. Prev Care Nurs Midwifery J. 2015;5(1):46-58.
[4]Sharma M, Knowlden AP. Role of yoga in preventing and controlling type 2 diabetes mellitus. J Evid Based Complement Altern Med. 2012;17(2):88-95.
[5]Azimi-Nezhad M, Ghayour-Mobarhan M, Parizadeh MR, Safarian M, Esmaeili H, Parizadeh SM, et al. Prevalence of type 2 diabetes mellitus in Iran and its relationship with gender, urbanisation, education, marital status and occupation. Singapore Med J. 2008;49(7):571-6.
[6]Innes KE, Vincent HK. The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. Evid Based Complement Alternat Med. 2007;4(4):469-86.
[7]Graham JE, Stoebner-May DG, Ostir GV, Snih SA, Peek MK, Markides K, et al. Health related quality of life in older Mexican Americans with diabetes: A cross-sectional study. Health Qual Life Outcomes. 2007;5:39.
[8]Lee JR, Kim SA, Yoo JW, Kang YK. The present status of diabetes education and the role recognition as a diabetes educator of nurses in Korea. Diabetes Res Clin Pract. 2007;77(Suppl 1):S199-204.
[9]Afshar H, Bagherian Sararodi R, Foroozandeh N, Khorramian N, Daghaghzadeh H, Marasy MR, et al. The Relationship between illness perception and symptom severity in patients with Irritable bowel syndrome. J Isfahan Med Sch. 2011:29(137):526-36. [Persian]
[10]van Ittersum MW, van Wilgen CP, Hilberdink WK, Groothoff JW, van der Schans CP. Illness perception inpatients with fibromyalgia. Patient Educ Couns. 2009;74(1):53-60.
[11]Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev. 2009;29(2):141-53.
[12]Clarke D, Goosen T. The mediating effects of coping strategies in the relationship between automatic negative thoughts and depression in a clinical sample of diabetes patients. Personal Individ Differ. 2009;46(4): 460-4.
[13]Scharloo M, Kaptein AA, Weinman J, Bergman W, Vermeer BJ, Roojimans HG. Patient illness perceptions and coping as predictors of functional status in psoriasis: A 1 year follow up. Br J Dermatol. 2000;142(5):899-907.
[14]Luthans F. The need for and meaning of positive organizational behavior. J Organ Behav. 2002;23(6):695-706.
[15]Wood SE, Wood EG. The world of psychology. 2nd edition. USA: Allyn and Bacon; 1996.
[16]Erez A, Judge TA. Relationship of core self-evaluations to goal setting, motivation, and performance. J Appl Psychol. 2001;86(6):1270-9.
[17]Judge TA, Bono JE. Relationship of core self-evaluations traits –self-esteem, generalized self-efficacy, locus of control, and emotional stability–with job satisfaction and job performance: A meta-analysis. J Appl Psychol. 2001;86(1):80-92.
[18]Parker CP, Baltes BB, Young SA, Huff JW, Altmann RA, Lacost HA, et al. Relationships between psychological climate perceptions and work outcomes: A meta-analytic review. J Organ Behav. 2003;24(4):389-416.
[19]Creed PA, Machin M, Hicks R. Improving mental health status and coping abilities for long-term unemployed youth using cognitive-behavior therapy based training interventions. J Organ Behav. 1999;20(6):963-78.
[20]Robbins S, Waters-Marsh T, Caccioppe R, Millet B. Organisational behaviour. Australia: Pretince Hall; 1994.
[21]Killgore WD, Kahn-Greene ET, Lipizzi EL, Newman RA, Kamimori GH, Balkin TJ. Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Med. 2008;9(5):517-26.
[22]Rajabi S, Yazdkhasti F. The effectiveness of acceptance and commitment group therapy on anxiety and depression in women with MS who were referred to the MS Association. J Clin Psychol. 2014;6(1):29-39. [Persian]
[23]Hayes SC, Luoma JB, Bond FW, Frank WB, Masuda A, Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25.
[24]Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1-9.
[25]Uman LS. Systematic review and meta-analysis. J Can Acad Child Adolesc Psychiatry. 2011;20(1):57-9.
[26]Masuda A, Tully EC. The role of mindfulness and psychological flexibility insomatization, depression, anxiety, and general psychological distress in a nonclinical college sample. J Evid Based Complement Altern Med. 2012;17(1):66-71.
[27]Vowles KE, McCracken LM. Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. J Consul Clin Psychol. 2008;76(3):397-407.
[28]Wicksell RK, Ahlqvist J, Bring A, Melin L, Olsson GL. Can exposure strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD0? a randomized controlled trial. Cogn Behav Ther. 2008;37(3):169-82.
[29]Jourdain RL, Dulin PL. “Giving It Space” a case study examining acceptance and commitment therapy for health anxiety in an older male previously exposed to nuclear testing. Clin Case Stud. 2009;8(3):210-25.
[30]Johnston M, Foster M, Shennan J, Starkey N, Johnson A. The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain. Clin J Pain. 2010;26(5):393-402.
[31]Hor M, Aghaei A, Abedi A, Attari A. The effectiveness of acceptance and commitment therapy on depression in patients with type 2 diabetes. J Res Behav Sci 2013;11(2):121-8. [Persian]
[32]Borg W, Gall M, Gall J. Quantitative and qualitative research methods in Psychology. Nasr AR, Areyzi HR, Abolqasemi M, Pakseresht MJ, Kiamanesh AR, Bagheri Kh, et al, translators. Tehran: Samt Publication; 2015.
[33]Bardbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60(6):631-7.
[34]Bazzazian S, Besharat MA, Bahrami Ehsan H, Rajab A. The Moderating Role of Coping Strategies in Relationship Between Illness Perception, Quality of Life and HbA1c in Patients with Type I Diabetes. Iran J Endocrinol Metab. 2010;12(3):213-21. [Persian]
[35]Luthans F, Avolio B, Avey J, Norman S. Positive psychological capital: Measurement and relationship with performance and satisfaction. Person Psychol. 2007;60(3):138-46.
[36]Hashemi Nosratabad T, Babapour Khairuddin J, Bahadari Khosroshahi J. Role of psychological capital in psychological wellbeing by considering the moderating effects of social capital. Soc Psychol Res. 2012;1(4):123-44. [Persian]
[37]Abedi MR, Izadi R. Acceptance and commitment therapy. 4th edition. Tehran: Jangal Press; 2015. [Persian]
[38]Eifert GH, Heffner M. The effects of acceptance versus control contexts on avoidance of panic-related symptoms. J Behav Ther Exp Psychiatry. 2003;34(3-4):293-312.
[39]Hayes SC, Masuda A, Bissett RT, Luoma J, Guerrero LF. DBT, FAP and ACT: How empirically oriented are the new behavior therapy technologies?. Behav Ther. 2004;35(1):35-54.
[2]Van Dijk SE, Pols AD, Adriaanse MC, Bosmans JE, Elders PJ, van Marwijk HW, et al. Costeffectivenessof a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial. BMC Psychiatry. 2013;13:128.
[3]Azimi H, Yekkeh Fallah L, Ghorbani A. Comparing effects of walking and yoga exercise on quality of life in patients with type 2 diabetes. Prev Care Nurs Midwifery J. 2015;5(1):46-58.
[4]Sharma M, Knowlden AP. Role of yoga in preventing and controlling type 2 diabetes mellitus. J Evid Based Complement Altern Med. 2012;17(2):88-95.
[5]Azimi-Nezhad M, Ghayour-Mobarhan M, Parizadeh MR, Safarian M, Esmaeili H, Parizadeh SM, et al. Prevalence of type 2 diabetes mellitus in Iran and its relationship with gender, urbanisation, education, marital status and occupation. Singapore Med J. 2008;49(7):571-6.
[6]Innes KE, Vincent HK. The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. Evid Based Complement Alternat Med. 2007;4(4):469-86.
[7]Graham JE, Stoebner-May DG, Ostir GV, Snih SA, Peek MK, Markides K, et al. Health related quality of life in older Mexican Americans with diabetes: A cross-sectional study. Health Qual Life Outcomes. 2007;5:39.
[8]Lee JR, Kim SA, Yoo JW, Kang YK. The present status of diabetes education and the role recognition as a diabetes educator of nurses in Korea. Diabetes Res Clin Pract. 2007;77(Suppl 1):S199-204.
[9]Afshar H, Bagherian Sararodi R, Foroozandeh N, Khorramian N, Daghaghzadeh H, Marasy MR, et al. The Relationship between illness perception and symptom severity in patients with Irritable bowel syndrome. J Isfahan Med Sch. 2011:29(137):526-36. [Persian]
[10]van Ittersum MW, van Wilgen CP, Hilberdink WK, Groothoff JW, van der Schans CP. Illness perception inpatients with fibromyalgia. Patient Educ Couns. 2009;74(1):53-60.
[11]Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev. 2009;29(2):141-53.
[12]Clarke D, Goosen T. The mediating effects of coping strategies in the relationship between automatic negative thoughts and depression in a clinical sample of diabetes patients. Personal Individ Differ. 2009;46(4): 460-4.
[13]Scharloo M, Kaptein AA, Weinman J, Bergman W, Vermeer BJ, Roojimans HG. Patient illness perceptions and coping as predictors of functional status in psoriasis: A 1 year follow up. Br J Dermatol. 2000;142(5):899-907.
[14]Luthans F. The need for and meaning of positive organizational behavior. J Organ Behav. 2002;23(6):695-706.
[15]Wood SE, Wood EG. The world of psychology. 2nd edition. USA: Allyn and Bacon; 1996.
[16]Erez A, Judge TA. Relationship of core self-evaluations to goal setting, motivation, and performance. J Appl Psychol. 2001;86(6):1270-9.
[17]Judge TA, Bono JE. Relationship of core self-evaluations traits –self-esteem, generalized self-efficacy, locus of control, and emotional stability–with job satisfaction and job performance: A meta-analysis. J Appl Psychol. 2001;86(1):80-92.
[18]Parker CP, Baltes BB, Young SA, Huff JW, Altmann RA, Lacost HA, et al. Relationships between psychological climate perceptions and work outcomes: A meta-analytic review. J Organ Behav. 2003;24(4):389-416.
[19]Creed PA, Machin M, Hicks R. Improving mental health status and coping abilities for long-term unemployed youth using cognitive-behavior therapy based training interventions. J Organ Behav. 1999;20(6):963-78.
[20]Robbins S, Waters-Marsh T, Caccioppe R, Millet B. Organisational behaviour. Australia: Pretince Hall; 1994.
[21]Killgore WD, Kahn-Greene ET, Lipizzi EL, Newman RA, Kamimori GH, Balkin TJ. Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Med. 2008;9(5):517-26.
[22]Rajabi S, Yazdkhasti F. The effectiveness of acceptance and commitment group therapy on anxiety and depression in women with MS who were referred to the MS Association. J Clin Psychol. 2014;6(1):29-39. [Persian]
[23]Hayes SC, Luoma JB, Bond FW, Frank WB, Masuda A, Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25.
[24]Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1-9.
[25]Uman LS. Systematic review and meta-analysis. J Can Acad Child Adolesc Psychiatry. 2011;20(1):57-9.
[26]Masuda A, Tully EC. The role of mindfulness and psychological flexibility insomatization, depression, anxiety, and general psychological distress in a nonclinical college sample. J Evid Based Complement Altern Med. 2012;17(1):66-71.
[27]Vowles KE, McCracken LM. Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. J Consul Clin Psychol. 2008;76(3):397-407.
[28]Wicksell RK, Ahlqvist J, Bring A, Melin L, Olsson GL. Can exposure strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD0? a randomized controlled trial. Cogn Behav Ther. 2008;37(3):169-82.
[29]Jourdain RL, Dulin PL. “Giving It Space” a case study examining acceptance and commitment therapy for health anxiety in an older male previously exposed to nuclear testing. Clin Case Stud. 2009;8(3):210-25.
[30]Johnston M, Foster M, Shennan J, Starkey N, Johnson A. The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain. Clin J Pain. 2010;26(5):393-402.
[31]Hor M, Aghaei A, Abedi A, Attari A. The effectiveness of acceptance and commitment therapy on depression in patients with type 2 diabetes. J Res Behav Sci 2013;11(2):121-8. [Persian]
[32]Borg W, Gall M, Gall J. Quantitative and qualitative research methods in Psychology. Nasr AR, Areyzi HR, Abolqasemi M, Pakseresht MJ, Kiamanesh AR, Bagheri Kh, et al, translators. Tehran: Samt Publication; 2015.
[33]Bardbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60(6):631-7.
[34]Bazzazian S, Besharat MA, Bahrami Ehsan H, Rajab A. The Moderating Role of Coping Strategies in Relationship Between Illness Perception, Quality of Life and HbA1c in Patients with Type I Diabetes. Iran J Endocrinol Metab. 2010;12(3):213-21. [Persian]
[35]Luthans F, Avolio B, Avey J, Norman S. Positive psychological capital: Measurement and relationship with performance and satisfaction. Person Psychol. 2007;60(3):138-46.
[36]Hashemi Nosratabad T, Babapour Khairuddin J, Bahadari Khosroshahi J. Role of psychological capital in psychological wellbeing by considering the moderating effects of social capital. Soc Psychol Res. 2012;1(4):123-44. [Persian]
[37]Abedi MR, Izadi R. Acceptance and commitment therapy. 4th edition. Tehran: Jangal Press; 2015. [Persian]
[38]Eifert GH, Heffner M. The effects of acceptance versus control contexts on avoidance of panic-related symptoms. J Behav Ther Exp Psychiatry. 2003;34(3-4):293-312.
[39]Hayes SC, Masuda A, Bissett RT, Luoma J, Guerrero LF. DBT, FAP and ACT: How empirically oriented are the new behavior therapy technologies?. Behav Ther. 2004;35(1):35-54.