Efficacy of Acceptance and Commitment Therapy on the Perceived Stress and Sense of Coherence in the Patients with Ulcerative Colitis

Document Type : Research Paper

Authors

1 Department of Psychology of Exceptional Children, Faculty of Humanity Sciences, Najafabad Branch, Islamic Azad University, Najafabad, Iran

2 Department of Psychology, Faculty of Humanity Sciences, Najafabad Branch, Islamic Azad University, Najafabad, Iran.

3 Department of Psychiatry, School of Medicine and Psychosomatic Research Center, Khorshid Educational and Medical Center, Isfahan University of Medical Sciences, Isfahan, Iran.

4 Department Internal Medicine, Isfahan Gastroenterology and Liver Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

The present study was conducted to investigate the efficacy of ACT (Acceptance and Commitment Therapy) on the perceived stress and enhancing a sense of coherence among individuals diagnosed with ulcerative colitis. A quasi-experimental design comprising a pre-test, post-test, control group, and a two-month follow-up period was utilized for the study. The statistical cohort comprised all patients diagnosed with ulcerative colitis who were referred to the Digestion and Liver Research Center during  the autumn and winter of 2019-20, under the supervision of Alzahra Hospital. A total of 25 patients who were diagnosed with ulcerative colitis were chosen using a purposive sampling method and assigned at random to either the experimental or control group. Over the course of two months, the experimental group participated in ten ACT sessions, each lasting seventy-five minutes. The applied questionnaires utilized in this study comprised the Perceived Stress Scale (PSS) and Sense of Coherence Questionnaire (SCQ). The data obtained from the study were subjected to analysis using mixed ANOVA via SPSS-23. Patients with ulcerative colitis (p<0.001) experience a significant reduction in perceived tension and sense of coherence, as indicated by the findings. According to the findings, it can be concluded that ACT has the potential to serve as a successful intervention to decrease perceived stress and improvement of sense of coherence among individuals diagnosed with ulcerative colitis. This is achieved through the utilization of six primary processes: acceptance, diffusion, context as self, relationship with the present moment, values, and committed activities.
 

Keywords


اصلی‌آزاد، م.، فرهادی، ط.، و خاکی، س. (1400). اثربخشی واقعیت درمانی آنلاین بر استرس ادراک‌شده و اجتناب تجربه‌ای بهبودیافتگان کووید-19. فصلنامۀ روان‌شناسی سلامت. 10(38)، 156-141. https://doi.org/10.30473/hpj.2021.55771.4990
اصلی‌آزاد، م.، منشئی، غ.، و قمرانی، ا. (1398). اثربخشی درمانگری مبتنی بر پذیرش و تعهد بر نشانگان وسواس-ناخودداری و درآمیختگی فکر و عمل در دانش‌آموزان مبتلا به اختلال وسواس-ناخودداری. فصلنامۀ علمی-پژوهشی علوم روان‌شناختی. ۱۸(۷۳)، 76-67. http://dorl.net/dor/20.1001.1.17357462.1398.18.73.9.4
بابایی، ع. (1393). نقش عملکرد خانواده و احساس انسجام در انگیزش پیشرفت تحصیلی دانش‌آموزان دختر. پایان‌نامۀ کارشناسی ارشد روان‌شناسی تربیتی. دانشکدۀ علوم تربیتی و روان‌شناسی، دانشگاه فردوسی مشهد.
پاشنگ، س.، و خوش‌لهجه صدق، ا. (1398). مقایسۀ اثربخشی درمان مبتنی بر پذیرش و تعهد و درمان فراشناختی بر کاهش علائم، سرمایۀ روان‌شناختی و کیفیت زندگی بیماران مبتلا به سندرم رودۀ تحریک‌پذیر. مجلۀ علوم پزشکی دانشگاه آزاد اسلامی. 29(2)، 190-181. http://dx.doi.org/10.29252/iau.29.2.181
رویین‌تن، س.، آزادی، ش.، افشین، ه‍.، و امینی، ن. (1398). اثربخشی درمان ترکیبی مبتنی بر پذیرش و تعهد و امیددرمانی بر کیفیت زندگی در بیماران سرطانی. فرهنگ مشاوره و روان‌درمانی (فرهنگ مشاوره). 10(2)، 242-221. https://doi.org/10.22054/qccpc.2019.38404.2043
سعادت، س.، اصغری، ف.، و جزایری، ر. (1394). رابطۀ خودکارآمدی تحصیلی با استرس ادراک‌شده، راهبردهای مقابله‌ای و حمایت‌های اجتماعی ادراک‌شده در دانشجویان دانشگاه گیلان. مجلۀ ایرانی آموزش در علوم پزشکی. 15(12)، 78-67. http://ijme.mui.ac.ir/article-1-3531-fa.html
سلیمانی، پ.، کاظمی، ر.، تکلوی، س.، و نریمانی، م. (1399). اثربخشی درمان گروهی مبتنی بر پذیرش و تعهد بر استرس ادراک‌شده و ادراک درد زنان مبتلا به فیبرومیالژیا. بیهوشی و درد. 11(2)، 79-68. http://jap.iums.ac.ir/article-1-5487-fa.html
شهابی، ع.، احتشام‌زاده، پ.، عسگری، پ.، و مکوندی، ب. (1399). مقایسۀ اثربخشی درمان مبتنی بر پذیرش و تعهد و تصویرسازی ذهنی هدایت‌شده بر تاب‌آوری بیماران قلبی مراجعه‌کننده به بخش بازتوانی قلب. افق دانش. 26(3)، 297-276. http://dx.doi.org/10.32598/hms.26.3.3184.1
فتحی، س.، پویامنش، ج.، قمری، م.، و فتحی اقدم، ق. (1399). مقایسۀ اثربخشی درمان هیجان‌مدار و درمان مبتنی بر پذیرش و تعهد بر کیفیت زندگی زنان مبتلا به سردرد مزمن. فیض. 24(3)، 311-302. http://feyz.kaums.ac.ir/article-1-4145-fa.html
فرخزادیان، ع.، احمدیان، ف.، و عندلیب، ل. (1398). اثربخشی درمان مبتنی بر پذیرش و تعهد بر شدت علائم و کیفیت زندگی سربازان مبتلا به نشانگان رودۀ تحریک‌پذیر. مجله طب نظامی، 21(1)، 52-44. https://militarymedj.bmsu.ac.ir/article_1000800.html
کاویانی، ز.، بختیارپور، س.، حیدری، ع.، عسگری، پ.، و افتخارصعادی، ز. (1399). بررسی تأثیر درمان مبتنی بر پذیرش و تعهد (ACT)، بر تاب‌آوری و نگرش‌های ناکارآمد زنان مبتلا به ام‌اس شهر تهران. دانش و پژوهش در روان‌شناسی کاربردی. 21(1)، 92-84. https://doi.org/10.30486/jsrp.2019.581585.1627
محمدی‌زاده، س.، خلعتبری، ج.، احدی، ح.، و حاتمی، ح. (1399). مقایسۀ اثربخشی درمان مبتنی بر پذیرش و تعهد، درمان شناختی-رفتاری و معنویت‌درمانی بر استرس ادراک‌شده، تصویر بدنی و کیفیت زندگی زنان مبتلا به سرطان پستان. اندیشه و رفتار در روان‌شناسی بالینی. 14(55)، 16-7. https://jtbcp.riau.ac.ir/article_1734.html
هاشمی، ز.، افشاری، ع.، و عینی، س. (1399). اثربخشی آموزش مبتنی بر پذیرش و تعهد بر ارتقای سلامت روان و کیفیت زندگی سالمندان مبتلا به سرطان. آموزش بهداشت و ارتقای سلامت ایران. 8(2)، 171-160. http://dx.doi.org/10.29252/ijhehp.8.2.160
References
Abd Elmaksoud, H. A., Motawea, M. H., Desoky, A. A., Elharrif, M. G., & Ibrahimi, A. (2021). Hydroxytyrosol alleviate intestinal inflammation, oxidative stress and apoptosis resulted in ulcerative colitis. Biomedicine & Pharmacotherapy, 142, 112073. https://doi.org/10.1016/j.biopha.2021.112073
Andalib, L., & Farokhzadian, A. A. (2019). The effectiveness of acceptance and commitment therapy on the severity of symptoms and quality of life in soldiers with irritable bowel syndrome. Journal of Military Medicine, 21(1), 44-52. (In Persian)
Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science & Medicine, 36(6), 725-733. https://doi.org/10.1016/0277-9536(93)90033-Z
Asli Azad, M., Farhadi, T., & Khaki, S. (2021). Efficiency of online reality therapy on perceived stress and experiential avoidance in the covid 19-improved patients. Health Psychology, 10(38), 141-156. https://doi.org/10.30473/hpj.2021.55771.4990 (In Persian)
 Asli Azad, M., Manshaei, G. R., & Ghamarani, A. (2019). Effectiveness of acceptance and commitment therapy on the signs of obsessive-compulsive disorder and thought-action fusion in the students with obsessive-compulsive disorder. Journal of Psychological Science, 18(73), 67-76. http://psychologicalscience.ir/article-1-135-en.html (In Persian)
Babaei, A. (2013). The role of family functioning and sense of cohesion in motivating the academic progress of female students. Master's thesis in educational psychology. Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad. (In Persian)
Bahattab, M., & AlHadi, A. N. (2021). Acceptance and commitment group therapy among Saudi Muslim females with mental health disorders. Journal of Contextual Behavioral Science, 19, 86-91. https://doi.org/10.1016/j.jcbs.2021.01.005
Berger, E., Garcia, Y., Catagnus, R., & Temple, J. (2021). The effect of acceptance and commitment training on improving physical activity during the COVID-19 pandemic. Journal of Contextual Behavioral Science, 20, 70-78. https://doi.org/10.1016/j.jcbs.2021.02.005
Carlén, K., Suominen, S., Lindmark, U., Saarinen, M. M., Aromaa, M., Rautava, P., & Sillanpää, M. (2020). Sense of coherence predicts adolescent mental health. Journal of Affective Disorders, 274, 1206-1210. https://doi.org/10.1016/j.jad.2020.04.023
Carney, K. M. B., Guite, J. W., Young, E. E., & Starkweather, A. R. (2021). Investigating key predictors of persistent low back pain: A focus on psychological stress. Applied Nursing Research,  58, 151406. https://doi.org/10.1016/j.apnr.2021.151406
Cohen, S., & Williamson, G. (1998). Perceived stress in a probability sample of the US. In: Spacapam, S., Oskamp, S., editors. The Social Psychology of Health: Claremont Symposium on Applied Social Psychology.
Fathi, S., Poyamanesh, J., Ghamari, M., & FathiAgdam, G. (2020). Comparison of the effectiveness of an emotion-based therapy and a treatment based on acceptance and commitment on the quality of life of women with chronic headache. Feyz Medical Sciences Journal, 24(3), 302-311. http://feyz.kaums.ac.ir/article-1-4145-fa.html (In Persian)
Ferguson, S., & Davis, D. (2019). ‘I'm having a baby not a labour’: Sense of coherence and women's attitudes towards labour and birth. Midwifery, 79, 102529. https://doi.org/10.1016/j.midw.2019.102529
Feuerstein, J. D., Moss, A. C., & Farraye, F. A. (2019). Ulcerative Colitis. Mayo Clinic Proceedings, 94(7), 1357-1373. https://doi.org/10.1016/j.mayocp.2019.01.018
Flensborg-Madsen, T., Ventegodt, S., & Merrick, J. (2006). Sense of coherence and health. The construction of an amendment to Antonovsky's sense of coherence scale (SOC II). The Scientific World Journal6, 2133–2139. https://doi.org/10.1100/tsw.2006.342
Geva, N., & Defrin, R. (2018). Opposite effects of stress on pain modulation depend on the magnitude of individual stress response. The Journal of Pain, 19(4), 360-371. https://doi.org/10.1016/j.jpain.2017.11.011
Ghorbani, N., Bing, M. N., Watson, P. J., Davison, H. K., & Mack, D. A. (2002). Self-reported emotional intelligence: Construct similarity and functional dissimilarity of higher-order processing in Iran and the United States. International Journal of Psychology, 37(5), 297-308. https://doi.org/10.1080/00207590244000098
Hashemi, Z., Afshari, A., & Einy, S. (2020). The effectiveness of acceptance and commitment education on improving the mental health and quality of life of elderly people with cancer. Iranian Journal of Health Education and Health Promotion, 8(2), 160-171. https://doi.org/10.29252/ijhehp.8.2.160 (In Persian)
Hesser, H., Hedman-Lagerlöf, E., Lindfors, P., Andersson, E., & Ljótsson, B. (2021). Behavioral avoidance moderates the effect of exposure therapy for irritable bowel syndrome: A secondary analysis of results from a randomized component trial. Behaviour Research and Therapy, 141, 103862. https://doi.org/10.1016/j.brat.2021.103862
Jankovic, M., Sijtsema, J. J., Reitz, A. K., Masthoff, E. D., & Bogaerts, S. (2021). Workplace violence, post-traumatic stress disorder symptoms, and personality. Personality and Individual Differences, 168, 110410. https://doi.org/10.1016/j.paid.2020.110410
Kaenkumchorn, T., & Wahbeh, G. (2020). Ulcerative Colitis: Making the Diagnosis. Gastroenterology Clinics of North America, 49(4), 655-669. https://doi.org/10.1016/j.gtc.2020.07.001
Kaviani, Z., BakhtiarPoor, S., Heidari, A., Askary, P., & Eftekhar, Z. (2020). The effect of treatment based on acceptance and commitment (ACT), on resiliency and dysfunctional attitudes of MS female patients in Tehran. Knowledge & Research in Applied Psychology, 21(1), 84-92. (In Persian)
Kim, H. S., Nho, J., & Nam, J-H. (2021). A serial multiple mediator model of sense of coherence, coping strategies, depression, and quality of life among gynecologic cancer patients undergoing chemotherapy. European Journal of Oncology Nursing, 54, 102014. https://doi.org/10.1016/j.ejon.2021.102014
Koch, A.K., Schöls, M., Langhorst, J., Dobos, J., & Cramer, H. (2020). Perceived stress mediates the effect of yoga on quality of life and disease activity in ulcerative colitis. Secondary analysis of a randomized controlled trial. Journal of Psychosomatic Research, 130, 109917. https://doi.org/10.1016/j.jpsychores.2019.109917
 Larsson, K., Lööf, L., & Nordin, K. (2017). Stress, coping and support needs of patients with ulcerative colitis or Crohn’s disease: A qualitative descriptive study. Journal of Clinical Nursing, 26(5–6), 648–657. https://doi.org/10.1111/jocn.13581
Li, H., Wong, C. L., Jin, X., Chen, J., Chong, Y. Y., & Bai, Y. (2021). Effects of Acceptance and Commitment Therapy on health-related outcomes for patients with advanced cancer: A systematic review. International Journal of Nursing Studies, 115, 103876. https://doi.org/10.1016/j.ijnurstu.2021.103876
Ma, Y., Chen, X., Nunez, A., Yan, M., Zhang, B., & Zhao, F. (2020). Influences of parenting on adolescents’ empathy through the intervening effects of self-integrity and sense of coherence. Children and Youth Services Review, 116, 105246. https://doi.org/10.1016/j.childyouth.2020.105246
Mohammadizadeh, S., Khalatbari, J., Ahadi, H., & Hatami, H. R. (2020). Comparison of the effectiveness of acceptance and commitment-based therapy, cognitive-behavioral therapy and spiritual therapy on perceived stress, body image and the quality of life of women with breast cancer. Thoughts and Behavior in Clinical Psychology, 15(55), 7-16. https://jtbcp.riau.ac.ir/article_1734_bdb61d03545bd5e4553fee593622a674.pdf  (In Persian)
Morgan, T. A., Dalrymple, K., D’Avanzato, C., Zimage, S., Balling, C., Ward, M., & Zimmerman, M. (2021). Conducting outcomes research in a clinical practice setting: the effectiveness and acceptability of acceptance and commitment therapy (ACT) in a partial hospital program. Behavior Therapy, 52(2), 272–285. https://doi.org/10.1016/j.beth.2020.08.004
Murthy, S. K., Feuerstein, J. D., Nguyen, G. C., & Velayos, F. S. (2021). AGA clinical practice update on endoscopic surveillance and management of colorectal dysplasia in inflammatory bowel diseases: expert review. Gastroenterology, 161(3), 1043-1051. https://doi.org/10.1053/j.gastro.2021.05.063
 Pashing, S., & Khosh Lahjeh Sedgh, A. (2019). Comparison of effectiveness of acceptance commitment therapy and metacognitive therapy on reducing symptoms, psychological capital and quality of life of patients suffering from irritable bowel syndrome. Medical Science Journal of Islamic Azad Univesity-Tehran Medical Branch, 29(2), 181-190.  (In Persian)
Peng, Y., Zhou, H., Zhang, B., Mao, H., Hu, R., & Jiang, H. (2022). Perceived stress and mobile phone addiction among college students during the 2019 coronavirus disease: The mediating roles of rumination and the moderating role of self-control. Personality and Individual Differences, 185, 111222. https://doi.org/10.1016/j.paid.2021.111222
Pisula, E., & Kossakowska, Z. (2010). Sense of coherence and coping with stress among mothers and fathers of children with autism. Journal of Autism and Developmental Disorders, 40(12), 1485-1494. https://doi.org/10.1007/s10803-010-1001-3
Roientan, S., Azadi, S., Mahmoodi, A., Hosseini, M., & Sadegh, R. (2019). The effectiveness of acceptance, commitment, and group therapy based on hope therapy approach to depression in cancer patients. Armaghane Danesh, 24(5), 841-852. https://doi.org/10.52547/armaghanj.24.5.841 (In Persian)
Saadat, S., Asghari, F., & Jazayeri, R. (2015). The relationship between academic self-efficacy with perceived stress, coping strategies and perceived social support among students of University of Guilan. Iranian Journal of Medical Education, 15, 67-78. (In Persian)
Senatore, F., Bhurwal, A., Pakala, T., Pioppo, L., & Seril, D.N. (2020). Sa1802 national trends in anxiety and depression in patients admitted with ulcerative colitis. Gastroenterology, 158(6), 431-435. http://dx.doi.org/10.1016/S0016-5085(20)31763-7
Shahabi, A., Ehteshamzadeh, P., Asgari, P., & Makvandi, B. (2020). Comparison of the effectiveness of acceptance and commitment therapy and guided imagery on the resilience of cardiac disease patients referring to the heart rehabilitation department. Internal Medicine Today, 26(3), 276-297. https://doi.org/10.32598/hms.26.3.3184.1 (In Persian)
Soleymani, P., Kazami, R., Taklavi, S., & Narimani, M. (2020). Effectiveness of group acceptance and commitment therapy on perceived stress and pain perception of women with fibromyalgia. Anesthesiology and Pain, 11(2), 68-79. http://jap.iums.ac.ir/article-1-5487-en.html (In Persian)
Spencer, E. A., & Dubinsky, M.C. (2021). Precision Medicine in Pediatric Inflammatory Bowel Disease. Pediatric Clinics of North America, 68(6), 1171-1190. https://doi.org/10.1016/j.pcl.2021.07.011
Trikos, L., & Jojic, N. (2016). Impact of gender and number of relapses on levels of anxiety and depression among patients with ulcerative colitis. European Neuropsychopharmacology, 26(2), S631-S632. https://doi.org/10.1016/S0924-977X(16)31725-4
Turkiewicz, J., Bhatt, R., Gupta, A., Bernstein, C. N., & Mayer, E. A. (2019). Sa1883 – alterations in functional and microstructural default mode network connectivity in ulcerative colitis and irritable bowel syndrome patients compared to healthy controls correlates with anxiety measures. Gastroenterology, 156(6), S441. https://doi.org/10.1016/S0016-5085(19)37949-1
Wu, Y., Yang, X., Li, G., & Liu, X. (2021). Molecular mechanism of Huaihuasan in treatment of ulcerative colitis based on network pharmacology and molecular docking. Phytomedicine Plus, 1(3), 100081. https://doi.org/10.1016/j.phyplu.2021.100081
Xu, W., Shen, W., & Wang, S. (2021). Intervention of adolescent' mental health during the outbreak of COVID-19 using aerobic exercise combined with acceptance and commitment therapy. Children and Youth Services Review, 124, 105960. https://doi.org/10.1016/j.childyouth.2021.105960
Zhao, C., Lai, L., Zhang, L., Cai, Z., Ren, Z., Shi, C., Luo, W., & Yan, Y. (2021). The effects of acceptance and commitment therapy on the psychological and physical outcomes among cancer patients: A meta-analysis with trial sequential analysis. Journal of Psychosomatic Research, 140, 110-304. https://doi.org/10.1016/j.jpsychores.2020.110304
 
 
Volume 14, Issue 3
2023
Pages 273-288
  • Receive Date: 05 November 2021
  • Revise Date: 04 December 2021
  • Accept Date: 21 December 2021
  • First Publish Date: 28 October 2023
  • Publish Date: 28 October 2023