Comparison of the Effectiveness of a Mindfulness-Based Cognitive Intervention with a Metacognitive Intervention in Reducing Anxiety Symptoms and Rumination in Women with Multiple Sclerosis

Document Type : Research Paper

Authors

1 Department of Clinical Psychology, School of Medicine, Islamic Azad University, Sari Branch, Sari, Iran

2 Department of Psychology, Faculty of Psychology and Educational Sciences, Farvardin Higher Education Institute, Ghaemshahr, Iran

Abstract

The purpose of this study was to compare the effectiveness of a mindfulness-based cognitive intervention and a metacognitive intervention on anxiety symptoms and rumination in patients with multiple sclerosis. The method of this study was based on the purpose and research design and was quasi-experimental and pretest-posttest with a control group. For this purpose, among all women with MS under the auspices of MS Association of Mazandaran Province year 2019, residing in Sari, 45 individuals were selected through purposive sampling and randomly divided into three groups (2 intervention groups and one control group). Members of the intervention groups were trained in 8 one-hour sessions. Participants answered the Self Rating Anxiety Scale (SAS) and the Ruminative Response Scale (RRS) once before the intervention and once after the intervention. Data were then analyzed using SPSS version 26. The results of multivariate analysis of covariance showed that the difference between the two groups of mindfulness-based cognitive therapy and metacognitive therapy on anxiety and rumination was significant (p <0.05) and that mindfulness therapy had a greater effect on metacognitive therapy than reducing anxiety and rumination. Considering the importance that the mental health of patients with multiple sclerosis has in controlling the disease and its consequences, the use of the above treatments seems to be useful and fruitful. Therefore, therapists are recommended to use these two interventions, especially mindfulness-based interventions, to promote the mental health of these patients.

Keywords


خرم‌نیا، ص.، فروغی، ع. ا.، گودرزی، گ.، بهاری، م.، و طاهری، ا. ع. (1399). بررسی نقش شفقت به خود و نشخوار ذهنی در پیش‌بینی افسردگی مزمن. روان‌شناسی و روانپزشکی شناخت. 7(5)، 29-15.
خضری‌مقدم، ن.، قربانی، ن.، بهرامی احسان.، و رستمی، ر. (1391). بررسی اثربخشی کاهش استرس بهوشیاری‌محور بر علائم روان‌شناختی بیماران مولتیپل اسکلروزیس. مجلۀ تحقیقات علوم رفتاری. 10(7)، 608-597.
م‍ح‍م‍دخ‍ان‍ی‌، پ.، ت‍م‍ن‍ائ‍ی‌ف‍ر، ش.، و ج‍ه‍ان‍ی‌ ت‍اب‍ش، ع. (1384).‌ درمان شناختی مبتنی بر ذهن‌آگاهی برای افسردگی: رویکردی برای جلوگیری از عود. تهران: فرادید.
فرهادی، م.، و پسندیده، م. م. (1396). اثربخشی درمان شناختی مبتنی بر ذهن‌آگاهی (MBSR) در کاهش استرس، اضطراب و افسردگی و افزایش خودکارآمدی در بیماران مبتلا به مولتیپل اسکلروزیس. دوفصلنامۀ روان‌شناسی بالینی و شخصیت. 15(2)، 15-7.
مهدوی، س.، و میرزاوند، ج. (1399). رابطۀ علی تعارض والد-فرزند، اضطراب، احساس تنهایی و کنترل شخصی به‌عنوان پیشایندهای گرایش به مصرف مواد مخدر در نوجوانان. فصلنامۀ علمی اعتیادپژوهی، ۱۴(۵۵)، ۱۳۲-۱۱۵.
Behzadpoor, S., Sohrabi, F., & Borjali, A. (2016). The role of attentional control and resilience in predicting the rumination in patients with obsessive-compulsive disorder. Zahedan Journal of Medicine Sciences, 18(3), 1-5.
Beiske, A. G., Svensson, E., Sandanger, I., Czujko, B., Pedersen, E. D., Aarseth, J. H., & Myhr, K. M. (2008). Depression and anxiety amongst multiple sclerosis patients. European Journal of Neurology15(3), 239-245.
Blankespoor, R. J., Schellekens, M. P., Vos, S. H., Speckens, A. E., & de Jong, B. A. (2017). The effectiveness of mindfulness-based stress reduction on psychological distress and cognitive functioning in patients with multiple sclerosis: A pilot study. Mindfulness8(5), 1251-1258
Boeschoten, R. E., Braamse, A. M., Beekman, A. T., Cuijpers, P., van Oppen, P., Dekker, J., & Uitdehaag, B. M. (2017). Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. Journal of the Neurological Sciences11(372), 331-341.
Brenner, P., & Piehl, F. (2016). Fatigue and depression in multiple sclerosis: pharmacological and non‐pharmacological interventions. Acta Neurologica Scandinavica, 134(200), 47-54.
Brosschot, J. F. (2010). Markers of chronic stress: Prolonged physiological activation and (un) conscious perseverative cognition. Neuroscience & Biobehavioral Reviews35(1), 46-50.
Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2004). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology29(4), 448-474.
Chaskalson, M. (2011). The mindful workplace: developing resilient individuals and resonant organizations with MBSR. New York: John Wiley & Sons.
Choobforoushzadeh, A., & Mohammadpanah Ardakan, A. (2019). Effect of mindfulness-based therapy on pain and depression in multiple sclerosis patients. Practice in Clinical Psychology7(4), 271-280.
Crane, R. S., Brewer, J., Feldman, C., Kabat-Zinn, J., Santorelli, S., & Williams, J. M., Kuyken, W. (2017). What defines mindfulness-based programs? The warp and the weft. Psychological Medicine, 47(6), 990-999.
DeLuca, J., & Nocentini, U. (2011). Neuropsychological, medical and rehabilitative management of persons with multiple sclerosis. NeuroRehabilitation, 29(3), 197-219.
Disanto, G., Benkert, P., Lorscheider, J., Mueller, S., Vehoff, J., Zecca, C., ... & SMSC Scientific Board. (2016). The Swiss multiple sclerosis cohort-study (SMSC): A prospective Swiss wide investigation of key phases in disease evolution and new treatment options. PloS One11(3), 1-13.
Edwards, M. J., Tang, N. K., Wright, A. M., Salkovskis, P. M., & Timberlake, C. M. (2011). Thinking about thinking about pain: A qualitative investigation of rumination in chronic pain. Pain Management1(4), 311-323.
Ensan, N. (2020). The effectiveness of mindfulness-based stress reduction in fatigue severity among patients with multiple sclerosis. Journal of Medical Sciences Studies, 31(2), 137-145.‌
Feinstein, A., Magalhaes, S., Richard, J. F., Audet, B., & Moore, C. (2014). The link between multiple sclerosis and depression. Nature Reviews Neurology10(9), 507-517.
Fisher, P., & Wells, A. (2009). Metacognitive therapy: Distinctive features. Hove, Routledge.
Ghahvechi, H. F., Fathi, A. A., & Satkin, M. (2015). Comparing metacognitive therapy with cognitive therapy on reducing test anxiety and meta-worry in students. Practice in Clinical Psychology, 3(3), 213-218.
Glover, N. G., Sylvers, P. D., Shearer, E. M., Kane, M. C., Clasen, P. C., Epler, A. J., ... & Jakupcak, M. (2016). The efficacy of focused acceptance and commitment therapy in VA primary care. Psychological Services13(2), 156.
Gotink, R. A., Chu, P., Busschbach, J. J., Benson, H., Fricchione, G. L., & Hunink, M. M. (2015). Standardized mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PloS one10(4), e0124344.
Hartoonian, N., Terrill, A. L., Beier, M. L., Turner, A. P., Day, M. A., & Alschuler, K. N. (2015). Predictors of anxiety in multiple sclerosis. Rehabilitation psychology60(1), 91-98.
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process‐based care. World Psychiatry16(3), 245-246.
Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-based interventions for anxiety and depression. Psychiatric Clinics40(4), 739-749.
Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science6(6), 537-559.
Javadi, T. H. S., Tajikzadeh, F., Bayat, H., Eshraghi, N., Roshandel, Z., & Rahmani, S. (2018). Comparison of effectiveness of the mindfulness-based cognitive therapy and the metacognition treatment on anxiety, depression and stress among breast cancer patients. International Clinical Neuroscience Journal5(2), 62-66.
Junkin, S. E. (2007). Yoga and self-esteem: Exploring change in middle-aged women. Ph.D. Dissertation, niversity of Saskatchewan Saskatoon.
Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. (15th anniversary ed.). Delta Trade Paperback/Bantam Dell.
Kahl, K. G., Winter, L., & Schweiger, U. (2012). The third wave of cognitive behavioral therapies: What is new and what is effective? Current Opinion in Psychiatry25(6), 522-528.
Kolahkaj, B., Zargar, F., & Majdinasab, N. (2019). The effect of mindfulness-based stress reduction (MBSR) therapy on quality of life in women with multiple sclerosis, Ahvaz, Iran. Journal of Caring Sciences8(4), 213-217.
Korostil, M., & Feinstein, A. (2007). Anxiety disorders and their clinical correlates in multiple sclerosis patients. Multiple Sclerosis Journal13(1), 67-72.
Krieger, S. C., Cook, K., De Nino, S., & Fletcher, M. (2016). The topographical model of multiple sclerosis: A dynamic visualization of disease course. Neurology-Neuroimmunology Neuroinflammation3(5), 1-9.
Luminet, O. (2003). 10 Measurement of depressive rumination and associated constructs. New York: Wiley. PP. 187-215.
Papageorgiu, C. & Wells, A. (2004). Depressive Rumination. Chichester: Wiley & Sons.
Maazinezhad, M., Arefi, M., & Farnoodi, F. (2018). The effectiveness of mindfulness-based cognitive group therapy in reducing perceived stress in patients with multiple sclerosis. Journal of Clinical Research in Paramedical Sciences7(1), 1-5.
McCabe, M. P., McKern, S., & McDonald, E. (2004). Coping and psychological adjustment among people with multiple sclerosis. Journal of Psychosomatic Research56(3), 355-361.
Mohebi, F., Eskandarieh, S., Mansournia, M. A., Mohajer, B., & Sahraian, M. A. (2019). Multiple sclerosis in Tehran: rising prevalence alongside stabilizing incidence–true increase or enhanced diagnosis?. Archives of Iranian Medicine22(8), 429-434.
Mohr, D. C., Lovera, J., Brown, T., Cohen, B., Neylan, T., Henry, R., ... & Pelletier, D. (2012). A randomized trial of stress management for the prevention of new brain lesions in MS. Neurology79(5), 412-419.
Moore, R., Jensen, M., Hatch, J., Duranczyk, I., Staats, S., & Koch, L. (2003). Showing up: The importance of class attendance for academic success in introductory science courses. The American Biology Teacher, 65(5), 325-330.
Nobakht, H., & Nikmanesh, Z. (2019). The effectiveness of mindfulness-based stress reduction group therapy in rumination among multiple sclerosis patients. Jundishapur Journal of Chronic Disease Care8(2), 1-5.
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.
Papageorgiou, C., & Wells, A. (2001). Positive beliefs about depressive rumination: Development and preliminary validation of a self-report scale. Behavior Therapy32(1), 13-26.
Paparrigopoulos, T., Ferentinos, P., Kouzoupis, A., Koutsis, G., & Papadimitriou, G. N. (2010). The neuropsychiatry of multiple sclerosis: Focus on disorders of mood, affect and behavior. International Review of Psychiatry22(1), 14-21.
Perestelo-Perez, L., Barraca, J., Penate, W., Rivero-Santana, A., & Alvarez-Perez, Y. (2017). Mindfulness-based interventions for the treatment of depressive rumination: Systematic review and meta-analysis. International Journal of Clinical and Health Psychology17(3), 282-295.
Pöttgen, J., Lau, S., Penner, I., Heesen, C., & Moritz, S. (2015). Managing neuropsychological impairment in multiple sclerosis: Pilot study on a standardized metacognitive intervention. International Journal of MS Care17(3), 130-137.
Quattropani, M. C., Lenzo, V., & Filastro, A. (2018). The role of metacognition in multiple sclerosis: A clinical study and assessment of possible correlation with anxiety, depression and coping strategies. Euromediterranean Biomedical Journal13(9), 39-45.
Scherder, R, Kant, N, Wolf, ET, Pijnenburg, B, & Scherder, EJ., (2018). Psychiatric and physical comorbidities and pain in patients with multiple sclerosis. Journal of Pain Research, 11, 325–334.
Shapero, B. G., Greenberg, J., Pedrelli, P., De Jong, M., & Desbordes, G. (2018). Focus (American Psychiatric Association Publishing), 16(1), 32-9.
Simpson, R., Booth, J., Lawrence, M., Byrne, S., Mair, F., & Mercer, S. (2014). Mindfulness based interventions in multiple sclerosis-a systematic review. BMC Neurology14(1), 1-9.
Sparaco, M., Lavorgna, L., & Bonavita, S. (2019). Psychiatric disorders in multiple sclerosis. Journal of Neurology, journal pre-proof: 1-16.
Stahl, B., & Goldstein, E. (2019). A mindfulness-based stress reduction workbook. Oakland, New Harbinger Publications.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness–based cognitive therapy. Journal of Consulting and Clinical Psychology68(4), 615-623.
Thomas, P. W., Thomas, S., Hillier, C., Galvin, K., & Baker, R. (2006). Psychological interventions for multiple sclerosis. Cochrane Database of Systematic Reviews, 1(31), 1-56.
Wells, A. (2000). Emotional Disorders and Metacognition: A practical manual and conceptual guide. 236 pages. Newjersy: Wiley.
Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, Erlbaum.
Wells, A., & Sembi, S. (2004). Metacognitive therapy for PTSD: A preliminary investigation of a new brief treatment. Journal of Behavior Therapy and Experimental Psychiatry35(4), 307-318.
Wells, A., Capobianco, L., Matthews, G., & Nordahl, H. M. (2020). Metacognitive therapy: Science and practice of a paradigm. Frontiers in Psychology, 11, 1-4.
Zung, W. W. (1971). A rating instrument for anxiety disorders. Psychosomatics12(6), 371-379.
Volume 13, Issue 2
2022
Pages 403-419
  • Receive Date: 12 May 2021
  • Revise Date: 18 June 2021
  • Accept Date: 02 August 2021
  • First Publish Date: 23 August 2022
  • Publish Date: 23 August 2022