Volume 26, Issue 4 (Winter 2021)                   IJPCP 2021, 26(4): 418-431 | Back to browse issues page


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Shareh H, Robati Z. Effect of Cognitive-Behavioral Group Therapy on Pain Self-efficacy, Fatigue, Life Expectancy and Depression in Patients With Multiple Sclerosis: A Randomized Controlled Clinical Trial. IJPCP 2021; 26 (4) :418-431
URL: http://ijpcp.iums.ac.ir/article-1-3065-en.html
1- Department of Educational Sciences, Faculty of Letters and Humanities, Hakim Sabzevari University, Sabzevar, Iran. , h.shareh@hsu.ac.ir
2- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran.
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1. Introduction
ultiple Sclerosis (MS) is one of the most important and common diseases of the central nervous system, which causes various clinical symptoms among patients due to inflammation and destruction of myelin sheaths and electrical failure of nerve impulses in the central nervous system and depending on the site of involvement. Depression is more common than chronic neurological diseases in MS patients. Fatigue also is the most debilitating symptom of this disease. Pain self-efficacy can predict performance and coping with chronic pain as well as psychological adjustment in MS patients and is related to self-esteem, depression and self-worth. One of the important concepts in the positive psychology approach is life expectancy. Snyder and Anderson [21] showed that the increased hope can improve the quality of life and promote self-care and general health of patients with chronic physical disorders.
One of the effective methods for treatment of psychological problems in patients with chronic diseases is cognitive-behavioral individual/group therapy. Cognitive-behavioral therapy is a short-term treatment and, by challenging negative automatic thoughts and identifying and modifying cognitive errors, provides the opportunity for the patients to be freed from the shackles of dos and don’ts and idealistic thoughts, to accept the disease face it in a rational way, and to be able to adopt a new and flexible strategy for dealing with the disease symptoms instead of focusing on disabilities and feeling hopelessness about the future.
Given the effect of psychological factors on chronic diseases and the role of chronic diseases such as MS in exacerbating psychological problems, and considering the effectiveness of cognitive-behavioral interventions in patients with chronic diseases, cognitive-behavioral therapy can be able to improve pain self-efficacy, fatigue and depression and increase life expectancy in MS patients. In this regard, this study aims to evaluate the effectiveness of Cognitive-Behavioral Group Therapy (CBGT) in improving pain self-efficacy, fatigue, depression and life expectancy in patients suffering from MS.
2. Methods
This is a quasi-experimental clinical trial with a pretest/posttest design. Participants were 68 patients with MS referred to MS clinics in Razavi Khorasan Province of Iran, who were selected using a convenience sampling technique and based on the inclusion criteria. They were randomly assigned into intervention (n=34) and control (n=34) groups. The data collection tools were Pain Self-Efficacy Questionnaire (PSEQ), Fatigue Severity Scale (FSS), Snyder’s ‎Adult Hope Scale (AHS)‎ ‎and Beck Depression Inventory-Second Edition (BDI-II). The patients in the intervention group participated in ten 2-hour sessions of CBGT, while the control group received no treatment. To analyze the collected data, one-way Analysis of Covariance (ANCOVA) was used in SPSS v. 24 software. 
3. Results
Depression was at severe level in both groups at baseline, but changed to a mild level after treatment in the intervention group. The ANCOVA results of comparing the two study groups in terms of study variables after controlling the pretest scores are presented in Table 1


The results showed that CBGT led to increased pain self-efficacy and life expectancy and reduced fatigue and depression in MS patients.
4. Discussion 
The present study showed that CBGT can increase the pain self-efficacy and life expectancy and reduce fatigue and depression in MS patients. Self-efficacy beliefs as part of one’s self-concept are cognitive constructs that arise from life-long learning experiences. In CBGT, through learning emotion regulation skills and cognitive reappraisal, individuals gain the ability to generate positive emotions and modulate negative emotions, which is likely to lead to improved self-efficacy in MS patients. The main techniques of CBGT such as replacing negative thoughts with rational beliefs, imagining, exposure, and cognitive reconstruction can also reduce anxiety and depression and improve life expectancy in MS patients. CBGT reduce fatigue severity and increase its tolerance level by increasing the patient’ awareness of negative thoughts and cognitive errors and by emphasizing active coping strategies such as attempt to perform tasks despite fatigue and disregard for it. Hence, it can be said that the use of various CBGT techniques such as problem-solving have a significant role in reducing fatigue in MS patients. 
The use of a convenience sampling technique and the lack of sufficient time to follow-up the treatment results limited the generalizability of the results. Further studies by using a larger sample size, random sampling technique and a follow-up phase can help generalize the results and confirm the stability of the findings over time. Overall, it can be concluded that the CBGT can significantly affect the pain self-efficacy, fatigue, life expectancy and depression in patients with MS. It can be used along with pain management methods to improve the psychological problems of MS patients and is an effective way to reduce medication therapy and its side effects.

Ethical Considerations
Compliance with ethical guidelines

In order to observe ethical principles, after explaining the study objectives and methods to the participants, a written informed consent was obtained from them. They were assured of the confidentiality of their information. This study obtained its ethical approval from the Research Ethics Committee of Hakim Sabzevari University (Code: IR.HSU.REC.1397.018) and was registered by the Iranian Registry of Clinical Trials (Code: IRCT20150413021727N3).

Funding
The research received funding from the Deputy for Research of Hakim Sabzevari University in Sabzevar, Iran.

Authors contributions
Conceptualization, methodology, editing, finalization of writing, supervision and project management: Hossein Shareh; validation, research, sources and visualization: Both authors; Drafting: Zahra Robati.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to thanks to the Neurologists for patient referral, the Physicians and Personnel of Medical Centers for their cooperation, the MS ‎Association staff in Razavi Khorasan province,‎ and all the patients who participated in this study.



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Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2019/08/13 | Accepted: 2020/01/13 | Published: 2021/01/1

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