Journal of Applied Psychological Research

The Effectiveness of Paradox Therapy on Improving Mental Health and Ego Strength in Diabetic Patients type 1 and 2

Document Type : Research Paper

Authors

1 Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.

2 Professor, Department of Psychology, Faculty of Psychology and Education , University of Tehran, Tehran, Iran.

3 ,Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.

Abstract

The objective of this study was to examine the efficacy of paradox therapy in enhancing mental health and enhancing ego fortitude in diabetic patients. A quasi-experimental design was employed to conduct this applied study, which included pre-test, post-test, and one- and three-month follow-up phases. All diabetic patients who were referred to endocrinology clinics in Yazd, Iran, in 2023 were statistically included in the population. The purposeful selection of 36 individuals with anxiety symptoms was made from 157 screened patients. The Mental Health Inventory-28 (MHI-28) and the Ego Strength Scale (ESS) were implemented. The intervention included six biweekly sessions, a post-test, and two follow-up assessments. The data were analyzed in SPSS using repeated measures ANOVA. The intervention resulted in a significant reduction in psychological distress and an increase in psychological well-being, as indicated by the results. Ego strength scores also improved significantly, and these positive outcomes remained stable during the one- and three-month follow-ups. Both patients and the therapist expressed favorable assessments of the therapeutic modifications.  Paradox therapy offers a cost-effective, short-term approach to improving the quality of life and psychological well-being of diabetic patients by bolstering ego fortitude.

Keywords

بشارت، م. ع. (1382). ساخت مقیاس درجه‌بندی ذهنی نتایج درمان.(TOSRS) گزارش پژوهشی. دانشگاه تهران.
بشارت، م. ع. (1388). پایایی و روایی فرم 28 سوالی مقیاس سلامت روانی در جمعیت ایرانی. مجله علمی پزشکی قانونی، 15(2)، 91-87. https://sjfm.ir/article-1-185-fa.html
بشارت، م. ع. (1395). ساخت و درستی آزمایی مقیاس استحکام من: یک مطالعۀ مقدماتی. مجله علوم روانشناختی، 15(60)، 467-445. http://psychologicalscience.ir/article-1-163-fa.html
بیگدلی، ر.، چین آوه، م. و جعفری، د. (1404). اثربخشی درمان هیجان‌مدار بر اضطراب و رضایت از زندگی، خودتنظیمی هیجانی و خودکارآمدی زنان مبتلا به دیابت نوع دو. فصل‌نامه پژوهش‌های کاربردی روانشناختی، (آماده انتشار). https://doi.org/10.22059/japr.2025.365764.644736
تقی‌لو، ل.، عزیزی ضیابری، ل. س.، خواجوند خوشلی، ا.، و دامغانی میر محله، م. (1402). مقایسۀ اثربخشی درمان مبتنی بر تعهد و پذیرش (ACT) و درمان برنامۀ زمانی پارادوکسی (PTC) بر بهزیستی روان‌شناختی پرستاران. فصلنامه علمی پژوهشی ابن سینا، 25(3)، 24-16. http://ebnesina.ajaums.ac.ir/article-1-1283-fa.html
زندی، م.، محمد خانی، ش. و حاتمی، م. (1403). مقایسۀ اثربخشی و مکانیسم اثر درمان مبتنی بر پذیرش و تعهد و درمان متمرکز بر هیجان بر سلامت جنسی بیماران مبتلا به دیابت نوع 2: نقش انعطاف‌پذیری روان‌شناختی و کارآمدی هیجانی. فصل‌نامه پژوهش‌های کاربردی روانشناختی، 15(4)، 283-300. https://doi.org/10.22059/japr.2024.322990.643828
سعیدی نژاد، ن.، فروزنده، ا.، بشارت، م. ع.، نیکورز، م.، و بنی طبا، س. م. (1403). اثربخشی پارادوکس‌درمانی بر اضطراب و استحکام من مادران دارای نوزاد نارس. رویش روان‌شناسی، 13(۷) ،۷۰-۶۱. https://frooyesh.ir/article-1-5627-fa.html
طاهرنژاد جوزم، ز.، بشارت، م. ع.، بلیاد، م.ر.، حسین‌زاده تقوایی، م. و پیوندی، پ. (1401). سنجش و مقایسۀ اثربخشی پارادوکس‌درمانی و واقعیت درمانی بر نشانه‌های استحکام من و خودشناسی انسجامی در زنان ۲۰ تا ۴۰ ساله دارای ضایعه نخاعی. مجله مطالعات ناتوانی، 214(12)، 11-1. http:/jdisabilstud.org/article-1-2545-fa.html
کرمی، س.، انصاری شهیدی، م.، غضنفری، ا.، جبل عاملی، ش. و راه نجات، ا. ح. (1402). اثربخشی روان‌درمانی مثبت‌نگر بر رفتارهای ارتقادهندۀ سلامت و سرمایه‌های روان‌شناختی بیماران مبتلا به دیابت نوع دو. فصل‌نامه پژوهش‌های کاربردی روانشناختی،14(3)، 237-219. https://japr.ut.ac.ir/article_94466.html
محمد پور، م. و اسلمی، ا. (1401). بررسی اثربخشی پارادوکس‌درمانی بر مؤلفه‌های بهزیستی روان‌شناختی زوجین متعارض. ایده‌های نوین روان‌شناسی، 14(18)، 1-24. http://jnip.ir/article-1-812-fa.html
References
American Diabetes Association: Professional Practice Committee (2024). 2. Diagnosis and classification of diabetes: Standards of care in diabetes. Diabetes Care 1, 47 (Supplement_1), S20-S42. https://doi.org/10.2337/dc24-S002
Basiri, R., Seidu, B., & Rudich, M. (2023). Exploring the interrelationships between diabetes, nutrition, anxiety, and depression: Implications for treatment and prevention strategies. Nutrients, 15(19), 4226. https://doi.org/10.3390/nu15194226
Besharat, M. A. (2004). Treatment Outcome Subjective Rating Scale (TOSRS). Unpublished research report. University of Tehran. (In Persian)
Besharat, M. A. (2009). Reliability and validity of a short form of the Mental Health Inventory in an Iranian population. Iranian Journal of Forensic Medicine, 15(2), 87-91. http://sjfm.ir/article-1-185-en.html (In Persian)
Besharat, M. A. (2017). Development and validation of ego strength scale: A preliminary study. Journal of Psychological Science, 15(60), 445-467. http://psychologicalscience.ir/article-1-163-en.html (In Persian)
Besharat, M. A. (2023). Paradoxical psychotherapy: A practitioner’s guide. Berlin: Springer Nature.
Bigdeli, R., Chinaveh, M., & Jafari, D. (2025). The effectiveness of emotion-focused therapy on anxiety, life satisfaction, emotional self-regulation and diabetes management self efficacy in women with type 2 diabetes. Journal of Applied Psychological Research, (In Press), 1-10. https://doi.org/10.22059/japr.2025.365764.644736 (In Persian)
Eatesamipour, R., Moghadam, K. R., & Amirpour, B. (2021). Effectiveness of paradox therapy on COVID-19 anxiety in adult population in Jahrom. Modern Care Journal, 18(4), e121920. https://doi.org/10.5812/modernc.121920
Evans, M. A., Vesco, A. T., &. Weissberg-Benchell, J. (2020). Depression, diabetes related distress, and anxiety in pediatric diabetes. In A. M. Delamater & D. G. Marrero (Eds.), Behavioral diabetes: diabetes: Social ecological perspectives for pediatric and adult populations (pp. 49–65). Springer Nature Switzerland AG. https://doi.org/10.1007/978-3-030-33286-0_5
Fisher, V., Li, W. W., & Malabu, U. (2023). The effectiveness of mindfulness-based stress reduction (MBSR) on the mental health, HbA1C, and mindfulness of diabetes patients: A systematic review and meta-analysis of randomised controlled trials. Applied Psychology: Health and Well-Being, 15(4), 1733–1749. https://doi.org/10.1111/aphw.12441
Karami, S., Ansari Shahidi, M., Ghazanfari, A., Jebel Ameli, S., & Rahenejat, A. (2023). Efficacy of positive psychotherapy on health promotion behaviors and psychological capitals among Type 2 Diabetes Patients. Journal of Applied Psychological Research, 14(3), 219-237. https://doi.org/10.22059/japr.2023.332991.644055  (In Persian)
Lustman, P. J., Griffith, L. S., Freedland, K. E., Kissel, S. S., Clouse, R. E. (2020). Cognitive behavioral therapy for depression in type 2 diabetes mellitus. A randomized, cantroll trial. Ann intern Med, 129, 613-621. https://doi.org/10.7326/0003-4819-129-8-199810150-00005
Mardani, M., Besharat, M. A., Firoozi, M. & Vosoughi, T., (2025). Investigating the effectiveness of paradox therapy on death anxiety in female patients with cancer. Client-Centered Nursing Care, 11(1), 75-86. https://doi.org/10.32598/JCCNC.11.1.702.1
Mohammadpour, M., & Aslami, E. (2022). Evaluating the effectiveness of paradox therapy on components of psychological well-Bing of Conflicting Couples. Journal of Psychology New Ideas, 14(18), 1-24. http://jnip.ir/article-1-812-en.html (In Persian)
Mongkolsucharitkul, P., Surawit, A., Manosan, T., Ophakas, S., … & Mayurasakorn, k. (2024) Metabolic and genetic risk factors associated with pre-diabetes and type 2 diabetes in Thai healthcare employees: A long-term study from the Siriraj Health (SIH) cohort study. PLoS ONE, 19(6), e0303085. https://doi.org/10.1371/journal.pone.0303085
Paudel, S., Khanal, S. P., Gautam, S., Chalise, A., Koirala, T. N., & Marahatta, S. B. (2023). Anxiety and depression among people with type 2 diabetes visiting diabetes clinics of Pokhara Metropolitan, Nepal: A cross-sectional study. BMJ Open, 13(1), 49-64. https://doi.org/10.1136/bmjopen-2022-064490
Saeedinejad, N., Foroozandeh, E., Besharat, M. A., Nikvarz, M., & Bani Taba, S. M. (2024). The effectiveness of paradox therapy on the anxiety and ego strength of mothers with premature babies. Rooyesh. 13(7), 61-70. https://frooyesh.ir/article-1-5627-fa.html (In Persian)
Singh, C., & Singh, G. (2022). Measuring the impact of ego strength among Type 2 Diabetes. Journal of Positive School Psychology, 10, 5940-5953. https://journalppw.com/index.php/jpsp/article/view/7931
Sridhar, G. R. (2020). On Psychology and psychiatry in diabetes. Indian Journal of Endocrinology and Metabolism, 24(5), 379-387. https://doi.org/10.4103/ijem.ijem_188_20
Taghilo, L., Azizi Ziabari, L. S., Khajevand Khoshli, A., & Damgani Mirmahaleh, M. (2023). Comparing the effectiveness of acceptance and commitment therapy (ACT) and paradoxical time table therapy (PTC) on the psychological well-being of nurses. EBNESINA, 25(3),14-24. http://dx.doi.org/10.22034/25.3.14  (In Persian)
Tahernejad Javz am, Z., Besharat, M. A., Belyad, M. R., Hosseinzadeh Taghvaei, M., & Peyvandi, P. (2022). Evaluating and comparing the effectiveness of paradox therapy and reality therapy on ego strength and integrative self-knowledge in 20-40 years old women with spinal cord injury. Middle Eastern Journal of Disability Studies, 12 ,214-214. http://jdisabilstud.org/article-1-2545-fa.html (In Persian)
Veit, C.T. & Ware, J.E. (1983). The structure of psychological distress and well being in general population. Journal of Consulting and Clinical Psychology, 51(5), 730-742. https://doi.org/10.1037/0022-006X.51.5.730
 
 
Journal of Applied Psychological Research
Volume 17, Issue 2
July 2026
Pages 17-30
  • Receive Date: 12 June 2025
  • Revise Date: 16 September 2025
  • Accept Date: 14 October 2025
  • First Publish Date: 26 April 2026
  • Publish Date: 01 July 2026