@2024 Afarand., IRAN
ISSN: 2008-2630 Iranian Journal of War & Public Health 2020;12(3):165-172
ISSN: 2008-2630 Iranian Journal of War & Public Health 2020;12(3):165-172
Comparison of the Effectiveness of Two Religious–Spiritual and Hope Interventions on Reducing Stress, Anxiety and Depression of Spouses of Veterans with PTSD
ARTICLE INFO
Article Type
Original ResearchAuthors
Taghavi M. (*1)Hashemian K. (1)
Bolhari J. (2)
(*1) Department of Psychology, Faculty of Psychology and Social Sciences, Roudehen Branch, Islamic Azad University, Roudehen, Iran
(2) Spiritual Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
Correspondence
Address: University Complex of Islamic Azad University, Roudehen, Iran Postal Code: 3973188981Phone: +98 (21) 76506887
Fax: +98 (21) 76507639
m.taghavi125@gmail.com
Article History
Received: August 4, 2020Accepted: June 5, 2020
ePublished: March 14, 2021
ABSTRACT
Aims
The present study aimed to compare the effects of religious-spiritual intervention and hope therapy on reducing stress, anxiety, and depression of spouses of veterans with the post-traumatic stress disorder (PTSD).
Materials & Methods Using the pretest-posttest design with a control group and follow-up, this quasi-experimental study was conducted among spouses of veterans who had referred to Sadr hospital in Tehran since 2003 to 2016. The participants were randomly assigned into two experimental groups and one control group (each group 17 persons). The data were collected using the Secondary Traumatic Stress Scale (STSS-17) and Depression, Anxiety, Stress Scale (DASS-21). The experimental groups 1 and 2 were trained three times a week in eight sessions. A week after termination of training sessions, posttest was administered for the two experimental groups and the control group. Three months after termination of training program, participants were tested again to follow up the training effects. To compare the effectiveness of the approaches, two-way multivariate analysis of variance (MANOVA) mixed design was used.
Findings Both religious-spiritual and hope interventions significantly reduced stress, anxiety, and depression of spouses of veterans with PTSD compared to the control group and also the effects have been stable after a three-month follow-up (p<0.01). Whereas, there was no significant difference between the effectiveness of these two interventions on reducing stress, anxiety, and depression of spouses of veterans compared to the control group (p>0.05).
Conclusion The two religious-spiritual and hope approaches are effective as interactive interventions on reducing stress, anxiety, and depression of spouses of veterans with PTSD, and there is no reference between them.
Materials & Methods Using the pretest-posttest design with a control group and follow-up, this quasi-experimental study was conducted among spouses of veterans who had referred to Sadr hospital in Tehran since 2003 to 2016. The participants were randomly assigned into two experimental groups and one control group (each group 17 persons). The data were collected using the Secondary Traumatic Stress Scale (STSS-17) and Depression, Anxiety, Stress Scale (DASS-21). The experimental groups 1 and 2 were trained three times a week in eight sessions. A week after termination of training sessions, posttest was administered for the two experimental groups and the control group. Three months after termination of training program, participants were tested again to follow up the training effects. To compare the effectiveness of the approaches, two-way multivariate analysis of variance (MANOVA) mixed design was used.
Findings Both religious-spiritual and hope interventions significantly reduced stress, anxiety, and depression of spouses of veterans with PTSD compared to the control group and also the effects have been stable after a three-month follow-up (p<0.01). Whereas, there was no significant difference between the effectiveness of these two interventions on reducing stress, anxiety, and depression of spouses of veterans compared to the control group (p>0.05).
Conclusion The two religious-spiritual and hope approaches are effective as interactive interventions on reducing stress, anxiety, and depression of spouses of veterans with PTSD, and there is no reference between them.
CITATION LINKS
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[4]Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: A validational study. J Traumatic Stress. 2002;15(5):423-32.
[5]Klaric M, Franciskovic T, Obrdalj EC, Petric D, Britvic D, Zovko N. Psychiatric and health impact of primary and secondary traumatization in wives of veterans with posttraumatic stress disorder. Psychiatr Danub. 2012;24(3):280-6.
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[8]Arzi NB, Solomon Z, Dekel R. Secondary traumatization among wives of veterans with PTSD and posterior-concussion casualties: Distress, caregiver's burden, and psychological separation. Brain Inj. 2000;14(8):725-36.
[9]Klaric M, Franciskovic T, Pernar M, Nembic Moro I, Milicevic R, Cerni Obrdalj E, et al. Caregiver burden and burnout in partners of war veterans with post-traumatic stress disorder. Coll Antropol. 2010;(34 Suppl 1):15-21.
[10]Gorman LA, Blow AJ, Ames BD, Reed PL. National guard families after combat: Mental health, use of mental health service, and perceived treatment barriers. Psychiatr Serv. 2011;62(1):28-34.
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[12]Mikulineer M, Florian V, Solomon Z. Marital intimacy, family support, and secondary traumatization: A study on wives of veterans with and anxiety reactions. Anxiety Stress Coping. 1995;8(3):203-13.
[13]Rafieepour A, Farahani S, Mazloomal-Hosseini N, Eshagi Moghadam F. The relationship between personality traits and the desire for divorce in disabled veterans: The mediating role of post-traumatic stress. Sci J Mil Psychol. 2020;10(40):33-44. [Persian]
[14]Turgoose D, Murphy D. A systemic review of interventions for supporting partners of military veterans with PTSD. J Mil Veteran Fam Health. 2019;5(2):195-208.
[15]Abolmaali K, Aghaeepour-Ghoasaraee M, Kamal A. Comparison of the effectiveness of cognitive-behavioral techniques training and schema-based training on modulating the symptoms of secondary trauma in the spouses of veterans with post-traumatic stress disorder. Jundishapour Med Sci J. 2014;15(2):187-200. [Persian]
[16]Kamal A, Abolmaali K. The effectiveness of instruction based on schema therapy in reducing STSD. Iran J War Public Health. 2015;7(1):21-8. [Persian]
[17]Bride BE, Robinson MM, Yegidis D, Figley CR. Development and validation of the secondary traumatic stress scale. Res Soc Work Pract. 2004;14(1):27-35.
[18]Ahmadi K, Rezapour Y, Davoodi F, Saberi M. Investigate of validity and reliability of secondary trauma stress scale for evaluation of PTSD Symptoms in samples of warfare victims’ wives. Iran J War Public Health. 2013;5(3):47-57. [Persian]
[19]Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scale (DASS) with the Beck depression and anxiety inventories. Behav Res Ther. 1995;33:335-43.
[20]Sahebi A, Asghari MJ, Salari RS. Reliability and validity of the depression anxiety stress scale (DASS-21) for Iranian population. Q Period Iran Psychol. 2005;1(4):36-54. [Persian]
[21]Frankl VE. Psychiatry and man’s quest for meaning. J Relig Health. 1962;1:93-103.
[22]Frankl VE. Logotherapy and existentialism. Psychother Theor Res Pract. 1967;4(3):138-42.
[23]Richards PS, Bergin AE. Casebook for a spiritual strategy in counselling and psychotherapy. Washington: American Psychiatric Association; 2004.
[24]Snyder CR. Target Article: Hope Theory: Rainbows in the mind. Psychol Inquiry J. 2002;13(4):249-75.
[25]Snyder CR. Hand book of hope: Theory, measures and applications. Cambridge: Academic Press; 2000.
[26]Worthington EL, Hight TL, Ripley JS, Perrone KM, Kurusu TA, Jones DR. Strategic hopefocused relationship-enrichment counseling with individual couples. J Couns Psychol. 1997;44:381-89.
[27]McConnell KM, Pargament KI. Examining the links between spiritual struggles and symptoms of psychopathology in a national sample. J Clin Psychol. 2006;62(12):1469-84.
[28]Moritz S, Kelly MT, Xu TJ, Rickhi B. A spirituality teaching program for depression: Qualitative finding on cognitive and emotional changes. Complement Ther Med. 2011;19(4):201-7.
[29]Harris JI, Erbes CR, Engdahl BE, Thuras P, Murray-Swank N, Grace D, et al. The effectiveness of spiritually integrated intervention in veterans exposed to trauma. J Clin Psychol. 2011;67(4):425-38.
[30]Amirarjmandi SZ, Hashemian K, Niknam M. Effect of spiritual group training on decreasing depression and increasing marital satisfaction among married woman in Tehran, region 5. Educ Psychol. 2015;11(35):137-58. [Persian]
[31]Richards PS, Potts RW. Using spiritual interventions in psychotherapy: practices, successes, failures and ethical concerns of Mormon psychotherapy. Prof Psychol Res Pract. 1995;26(2):163-70.
[32]Bolhari J, Mohsenikabir M. Compiling and evaluating educational package of spiritual skills for university students. Iran J Psychiatry Clin Pschol. 2019;25(2):210-21. [Persian]
[33]Taylor PB, Ferszt GG. Spiritual healing. Holist Nurs Pract. 1990;4(4):32-8.
[34]Snyder CR. Hope and depression: A light in the darkness. J Soc Clin Psychol. 2004;23(3):347-51.
[35]Mehmet C, Michael R. You have got hope, studies show “hopetherapy” fights depression. Atlanta: New SRX Science; 2009.
[36]Cheavens JS, Feldman DB, Gum A, Michael ST, Snyder CR. Hope therapy in a Community sample: A pilot investigation. Soc Indicators Res. 2006;77(1):61-78.
[37]Manouchehri M, Golzari M, Kordmirza-Nikoozadeh E. The effectiveness of hope therapy training on the use of positive coping methods with stress in women with addicted spouses. Q Clin Psychol Stud. 2015;6(21):78-90. [Persian]
[38]Azhar MZ, Varma SL, Dharap AS. Religious psychotherapy in anxiety disorder patients. Acta Psychiatr Scand. 1994;90(1):1-3.
[39]Elison CG, Burdette AM, Hill TD. Blessed assurance: Religion, anxiety, and tranquility among U.S. adults. Soc Sci Res. 2009;3(38):656-67.
[40]Yagoobi H, Sohrabi F, Mohammadzadeh A. The comparison of cognitive-behavior therapy and Islamic based spiritual-religion psychotherapy on reducing of students overt anxiety. J Res Behav Sci. 2012;10(2).
[41]Wong PTP. Meaning therapy: An integrative and positive psychotherapy. J Contemp Psychother. 2010;40(2):85-93.
[42]West W. Psychotherapy and spirituality: Crossing the line between therapy and religion. Thousand Oaks: SAGE; 2000.
[43]German JN, Leonard D, Heath CL, Stewart SM, Leavey PJ. Hope as a predictor of anxiety and depressive symptoms following pediatric cancer diagnosis. J Pediatr Psychol. 2018;43(2):152-61.
[44]Michael ST. Hope conquers fear: Overcoming anxiety and panic attacks. Handb Hope. 2000;301-19.
[45]Rajandram RK, MY HO S, Samman N, Chan N, Mc Grath C, Zwahlen RA. Interaction of hope and optimism with anxiety and depression in a specific group of cancer survivors: A preliminary study. BMC Res Notes. 2011;4:519.
[46]Lowell EP, Tonnsen BL, Bailey DB, Roberts JE. The effects of optimism, religion, and hope on mood and anxiety disorders in women with the FMR1 premutation. J Intellect Disabil Res. 2017;61(10):916-27.
[47]Gallagher MW, Long LJ, Richardson A, Dsouza J, Boswell JF, Farchion TJ, et al. Examining hope as a trans diagnostic mechanism of change across anxiety disorders and CBT treatment protocols. Behav Ther. 2020;51(1):190-202.
[48]Harvey MR. An ecological view of psychological trauma and recovery. J Trauma Stress. 1996;9(1):3-23.
[49]Synder CR, Lehman KA, Kluck B, Monsson Y. Hope for rehabilitation and vice versa. Rehabilit Psychol. 2006;51(2):89-112.
[50]Lopez SJ, Floyd RK, Ulven JC, Snyder CR. Hope therapy: Helping clients build a house of hope. In: Snyder CR, editor, Handbook of hope: Theory, measures, and applications. Unknown city: Academic Press; 2000.
[51]Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative religious coping with major life stressors. J Sci Stud Relig. 1998;37(4):710-24.
[52]Beigi A, Mohammadifar MA, Eisa Morad Rudbaneh A, Najafi M. The role of spirituality in predicting coping styles with stress. J Couns Cult Psychother. 2013;4(14). [Persian]
[53]Pearce MJ, Medoff D, Lawrence RE. Religious coping among adults caring for family members with serious mental illness. Community Ment Health J. 2016;52(2):194-202.
[54]Worthington EL, Scherer M. Forgiveness is an emotion-focused coping strategy that can reduce health risks and promote health and resilience: Theory, review, and hypotheses. Psychol Health. 2004;19(3):385-405.
[55]Ehteshamzadeh P, Mekvandi B, Bagheri A. Relationship among forgiveness, perfectionism, and intimacy with marital satisfaction in military veterans and their spouses. Journal of Social Psychology (New Findings In Psychology). 2009;4(12):123-36.
[56]Snyder CR, Lopez SJ. Handbook of positive psychology. Oxford: Oxford University Press; 2002.
[57]Rustoen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on Levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs. 2011;15(4):351-7.
[58]Antony DO, Edwards LM, Bergman CS. Hope as a source of resilience in later adulthood. Personal Individ Differ. 2006;41(7):1263-73.
[2]American psychiatric association. Diagnostic and statistical manual of mental disorders. Washington: American Psychiatric Association; 2013.
[3]Galvoski T, Lyons JA. Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran’s family and possible interventions. Aggres Violent Behav. 2004;9(5):477-501.
[4]Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: A validational study. J Traumatic Stress. 2002;15(5):423-32.
[5]Klaric M, Franciskovic T, Obrdalj EC, Petric D, Britvic D, Zovko N. Psychiatric and health impact of primary and secondary traumatization in wives of veterans with posttraumatic stress disorder. Psychiatr Danub. 2012;24(3):280-6.
[6]Harvey A, Bryant R. The relationship between acute stress disorder and posttraumatic stress disorder: A prospective evaluation of motor vehicle accident survivors. J Consult Clin Psychol. 1998;66(3):507-12.
[7]O'Doonel ML, Creamer M, Pattison P. Post-traumatic stress disorder and depression following trauma: Understanding comorbidity. Am J Psychiatry. 2004;161(8):1390-6.
[8]Arzi NB, Solomon Z, Dekel R. Secondary traumatization among wives of veterans with PTSD and posterior-concussion casualties: Distress, caregiver's burden, and psychological separation. Brain Inj. 2000;14(8):725-36.
[9]Klaric M, Franciskovic T, Pernar M, Nembic Moro I, Milicevic R, Cerni Obrdalj E, et al. Caregiver burden and burnout in partners of war veterans with post-traumatic stress disorder. Coll Antropol. 2010;(34 Suppl 1):15-21.
[10]Gorman LA, Blow AJ, Ames BD, Reed PL. National guard families after combat: Mental health, use of mental health service, and perceived treatment barriers. Psychiatr Serv. 2011;62(1):28-34.
[11]Ahmadi K, Reshadatijou M, Karami G Comparison of depression, anxiety and stress in chemical victims with healthy people in Sardasht. J Babol Univ Med Sci. 2008;12(1):44-50. [Persian]
[12]Mikulineer M, Florian V, Solomon Z. Marital intimacy, family support, and secondary traumatization: A study on wives of veterans with and anxiety reactions. Anxiety Stress Coping. 1995;8(3):203-13.
[13]Rafieepour A, Farahani S, Mazloomal-Hosseini N, Eshagi Moghadam F. The relationship between personality traits and the desire for divorce in disabled veterans: The mediating role of post-traumatic stress. Sci J Mil Psychol. 2020;10(40):33-44. [Persian]
[14]Turgoose D, Murphy D. A systemic review of interventions for supporting partners of military veterans with PTSD. J Mil Veteran Fam Health. 2019;5(2):195-208.
[15]Abolmaali K, Aghaeepour-Ghoasaraee M, Kamal A. Comparison of the effectiveness of cognitive-behavioral techniques training and schema-based training on modulating the symptoms of secondary trauma in the spouses of veterans with post-traumatic stress disorder. Jundishapour Med Sci J. 2014;15(2):187-200. [Persian]
[16]Kamal A, Abolmaali K. The effectiveness of instruction based on schema therapy in reducing STSD. Iran J War Public Health. 2015;7(1):21-8. [Persian]
[17]Bride BE, Robinson MM, Yegidis D, Figley CR. Development and validation of the secondary traumatic stress scale. Res Soc Work Pract. 2004;14(1):27-35.
[18]Ahmadi K, Rezapour Y, Davoodi F, Saberi M. Investigate of validity and reliability of secondary trauma stress scale for evaluation of PTSD Symptoms in samples of warfare victims’ wives. Iran J War Public Health. 2013;5(3):47-57. [Persian]
[19]Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scale (DASS) with the Beck depression and anxiety inventories. Behav Res Ther. 1995;33:335-43.
[20]Sahebi A, Asghari MJ, Salari RS. Reliability and validity of the depression anxiety stress scale (DASS-21) for Iranian population. Q Period Iran Psychol. 2005;1(4):36-54. [Persian]
[21]Frankl VE. Psychiatry and man’s quest for meaning. J Relig Health. 1962;1:93-103.
[22]Frankl VE. Logotherapy and existentialism. Psychother Theor Res Pract. 1967;4(3):138-42.
[23]Richards PS, Bergin AE. Casebook for a spiritual strategy in counselling and psychotherapy. Washington: American Psychiatric Association; 2004.
[24]Snyder CR. Target Article: Hope Theory: Rainbows in the mind. Psychol Inquiry J. 2002;13(4):249-75.
[25]Snyder CR. Hand book of hope: Theory, measures and applications. Cambridge: Academic Press; 2000.
[26]Worthington EL, Hight TL, Ripley JS, Perrone KM, Kurusu TA, Jones DR. Strategic hopefocused relationship-enrichment counseling with individual couples. J Couns Psychol. 1997;44:381-89.
[27]McConnell KM, Pargament KI. Examining the links between spiritual struggles and symptoms of psychopathology in a national sample. J Clin Psychol. 2006;62(12):1469-84.
[28]Moritz S, Kelly MT, Xu TJ, Rickhi B. A spirituality teaching program for depression: Qualitative finding on cognitive and emotional changes. Complement Ther Med. 2011;19(4):201-7.
[29]Harris JI, Erbes CR, Engdahl BE, Thuras P, Murray-Swank N, Grace D, et al. The effectiveness of spiritually integrated intervention in veterans exposed to trauma. J Clin Psychol. 2011;67(4):425-38.
[30]Amirarjmandi SZ, Hashemian K, Niknam M. Effect of spiritual group training on decreasing depression and increasing marital satisfaction among married woman in Tehran, region 5. Educ Psychol. 2015;11(35):137-58. [Persian]
[31]Richards PS, Potts RW. Using spiritual interventions in psychotherapy: practices, successes, failures and ethical concerns of Mormon psychotherapy. Prof Psychol Res Pract. 1995;26(2):163-70.
[32]Bolhari J, Mohsenikabir M. Compiling and evaluating educational package of spiritual skills for university students. Iran J Psychiatry Clin Pschol. 2019;25(2):210-21. [Persian]
[33]Taylor PB, Ferszt GG. Spiritual healing. Holist Nurs Pract. 1990;4(4):32-8.
[34]Snyder CR. Hope and depression: A light in the darkness. J Soc Clin Psychol. 2004;23(3):347-51.
[35]Mehmet C, Michael R. You have got hope, studies show “hopetherapy” fights depression. Atlanta: New SRX Science; 2009.
[36]Cheavens JS, Feldman DB, Gum A, Michael ST, Snyder CR. Hope therapy in a Community sample: A pilot investigation. Soc Indicators Res. 2006;77(1):61-78.
[37]Manouchehri M, Golzari M, Kordmirza-Nikoozadeh E. The effectiveness of hope therapy training on the use of positive coping methods with stress in women with addicted spouses. Q Clin Psychol Stud. 2015;6(21):78-90. [Persian]
[38]Azhar MZ, Varma SL, Dharap AS. Religious psychotherapy in anxiety disorder patients. Acta Psychiatr Scand. 1994;90(1):1-3.
[39]Elison CG, Burdette AM, Hill TD. Blessed assurance: Religion, anxiety, and tranquility among U.S. adults. Soc Sci Res. 2009;3(38):656-67.
[40]Yagoobi H, Sohrabi F, Mohammadzadeh A. The comparison of cognitive-behavior therapy and Islamic based spiritual-religion psychotherapy on reducing of students overt anxiety. J Res Behav Sci. 2012;10(2).
[41]Wong PTP. Meaning therapy: An integrative and positive psychotherapy. J Contemp Psychother. 2010;40(2):85-93.
[42]West W. Psychotherapy and spirituality: Crossing the line between therapy and religion. Thousand Oaks: SAGE; 2000.
[43]German JN, Leonard D, Heath CL, Stewart SM, Leavey PJ. Hope as a predictor of anxiety and depressive symptoms following pediatric cancer diagnosis. J Pediatr Psychol. 2018;43(2):152-61.
[44]Michael ST. Hope conquers fear: Overcoming anxiety and panic attacks. Handb Hope. 2000;301-19.
[45]Rajandram RK, MY HO S, Samman N, Chan N, Mc Grath C, Zwahlen RA. Interaction of hope and optimism with anxiety and depression in a specific group of cancer survivors: A preliminary study. BMC Res Notes. 2011;4:519.
[46]Lowell EP, Tonnsen BL, Bailey DB, Roberts JE. The effects of optimism, religion, and hope on mood and anxiety disorders in women with the FMR1 premutation. J Intellect Disabil Res. 2017;61(10):916-27.
[47]Gallagher MW, Long LJ, Richardson A, Dsouza J, Boswell JF, Farchion TJ, et al. Examining hope as a trans diagnostic mechanism of change across anxiety disorders and CBT treatment protocols. Behav Ther. 2020;51(1):190-202.
[48]Harvey MR. An ecological view of psychological trauma and recovery. J Trauma Stress. 1996;9(1):3-23.
[49]Synder CR, Lehman KA, Kluck B, Monsson Y. Hope for rehabilitation and vice versa. Rehabilit Psychol. 2006;51(2):89-112.
[50]Lopez SJ, Floyd RK, Ulven JC, Snyder CR. Hope therapy: Helping clients build a house of hope. In: Snyder CR, editor, Handbook of hope: Theory, measures, and applications. Unknown city: Academic Press; 2000.
[51]Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative religious coping with major life stressors. J Sci Stud Relig. 1998;37(4):710-24.
[52]Beigi A, Mohammadifar MA, Eisa Morad Rudbaneh A, Najafi M. The role of spirituality in predicting coping styles with stress. J Couns Cult Psychother. 2013;4(14). [Persian]
[53]Pearce MJ, Medoff D, Lawrence RE. Religious coping among adults caring for family members with serious mental illness. Community Ment Health J. 2016;52(2):194-202.
[54]Worthington EL, Scherer M. Forgiveness is an emotion-focused coping strategy that can reduce health risks and promote health and resilience: Theory, review, and hypotheses. Psychol Health. 2004;19(3):385-405.
[55]Ehteshamzadeh P, Mekvandi B, Bagheri A. Relationship among forgiveness, perfectionism, and intimacy with marital satisfaction in military veterans and their spouses. Journal of Social Psychology (New Findings In Psychology). 2009;4(12):123-36.
[56]Snyder CR, Lopez SJ. Handbook of positive psychology. Oxford: Oxford University Press; 2002.
[57]Rustoen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on Levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs. 2011;15(4):351-7.
[58]Antony DO, Edwards LM, Bergman CS. Hope as a source of resilience in later adulthood. Personal Individ Differ. 2006;41(7):1263-73.