@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(3):182-192

Background
Systemic Sclerosis is a chronic, complex, and multiorgan disorder that affects the connective tissue and causes vascular damage, immune dysfunction, abnormal fibrotic processes, and micro-vascular damage [1, 2].
Previous Studies
… [3-10]. In a study, 547 Canadian women with systemic sclerosis were evaluated for sexual function, more than 60% of whom had sexual dysfunction and 17% were sexually inactive [11]. … [12, 13]. One of the psychotherapeutic approaches that can be applied to problems related to physical and psychological health is the integrative approach based on 4 common factors (therapeutic relationship, hope and anticipation of treatment, increasing awareness, and behavioral ordering) [14]. … [15]. Research on integrative psychotherapy has shown that this approach has reduced mental distress, increased self-esteem [17], and ordered behaviors [18] in women with cancer.
Aim(s)
The aim of this study was to determine the effect of integrative psychotherapy based on 4 common factors on sexual function and its 6 areas (sexual desire, sexual arousal, vaginal moisture, orgasm, sexual satisfaction, and pain) in women with systemic sclerosis.
Research type
This research is a semi-experimental study with pre-test and post-test design with follow-up.
Research society, place and time
The statistical population included all women with systemic sclerosis referring to Shariati Hospital (affiliated to Tehran University of Medical Sciences) and Rheumatology Center of Iran in the second half of 2016.
Sampling method and number
Using the records in hospital and center offices, and after conducting the primary interview (introduction and clinical psychological diagnosis) with each patient, 60 patients had inclusion and exclusion criteria and, finally, 30 volunteers with systemic sclerosis were selected by available and purposive sampling method and randomly divided into two experimental and control groups. In this study, Cohen Table with respect to alpha of 0.05, large effect size (F=0.4), and statistical power of 0.6 [19] were used to estimate the sample size. The inclusion criteria included women with systemic sclerosis with at least 1 year of diagnosis, being married, being 25-50 years old, having at least reading and writing skills, living in and suburb, lack of diagnosis of psychological disorders consistent with DSM V, and no psychotropic drug use during the past 3 months. Exclusion criteria also included 3 absences in intervention sessions.
Used devices&materials
… [20-23]. The questionnaires were completed before the intervention, after the intervention, and 3 months after the last intervention in both experimental and control groups. Intervention of integrative psychotherapy focusing on 4 common factors for the experimental group was conducted for 9 sessions (1 session a week each taking 90 minutes) at the Rheumatology Center of Iran. The instrument of this study was Female Sexual Function Index (FSFI) questionnaire with 19 questions. In Iran, the correlation between the whole scale of questions in the experimental and control groups, as well as the all individuals was 0.85 or higher, using the Cronbach's alpha coefficient [24]. In the present study, the reliability of the FSFI questionnaire, using Cronbach's alpha coefficient, was 0.903. The data were analyzed by SPSS 24 software for separate observation of changes in the time trend (pre-test, post-test, and follow-up) of the subjects as well as intergroup changes (control and experimental) with repeated measures ANOVA.
Findings by Text
The mean scores of sexual function increased from 16.99 (SD=5.49) in the pre-test to 27.46 (SD=3.50) in the post-test and this difference was statistically significant. However, there was no significant change in the mean of these scores in the follow-up compared to the post-test (Table 1). The significance of the effect of psychotherapy showed that there was a significant difference between the mean scores of the control and experimental groups. The mean changes in mean scores in the control and experimental groups were different during the pre-test, post-test, and follow-up. In the case of sexual function index, Eta coefficient was 0.41, indicating that the intervention of psychotherapy improved this index by 41% compared to the mean scores in the pre-test (Table 2). In the control group, a significant decrease was observed in the sexual function score and sexual arousal sexual and satisfaction in the follow-up in compared with the pre-test. In the experimental group, the mean sexual function score and all its sub-components in the post-test and follow-up were significantly higher than the pre-test. Also, there was no significant difference between the mean scores in the follow-up and the post-test (Table 3).
Main comparison to the similar studies
… [25]. The findings of this study were in line with findings obtained by Candi's research on patients with cancer [26], Hamel’s study on patients with breast cancer [27], and Domahl’s research on the case of patients with rectal and anal cancer [28], showing the impact of providing psychological interventions on increasing sexual function and quality of life in patients. … [29]. Legana et al. managed to eliminate sexual dysfunctions of a couple (one of them with cancer) and provide them with marital satisfaction by group therapy focusing on couple therapy [30]. Behavioral therapy intervention and motivational interviewing in patients with diabetes increased exercise performance. Therefore, in Adina et al. showed that these patients could manage the diabetic sexual dysfunction [20]. Also, in other studies, the implementation of psychological interventions increased sexual self-esteem and sexual function in chronic patients [17, 31-33]. … [34-38].
Suggestions
It is suggested that this study be conducted online with applicable and appropriate guidelines to improve sexual function, on those patients who are at distant locations and have limited mobility.
Limitations
None declared by the authors.
Conclusions
Integrative psychotherapy is effective in increasing the sexual function of patients with systemic sclerosis and can play a significant role in improving the quality of life of these people.
Acknowledgments
The joint professors and counsel, the great professor Dr. Farhad Gharibdoost and all the honorable staff of the Shariati Hospital, the Rheumatology Research Center, Rheumatology Center of Iran, as well as the ladies who participated in this research, are highly appreciated.
Conflict of interest
None declared by the authors.
Ethical Permissions
The participants of this research provided informed consent. This research has an ethical approval under the code IRCT20171125037622N1 at the Control Center for Clinical Trials, Iran University of Medical Sciences.
Funding Sources
This research is a part of Ph.D. dissertation in the field of health psychology.

TABLES and CHARTS

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