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URL: http://ijpcp.iums.ac.ir/article-1-3081-en.html
, Mohammad Bagher Kajbaf 2, Hamid Reza Oraizi1 , Mohammad Reza Abedi1 , Fariborz Mokarian3
2- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran. ,
3- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
1. Introduction
According to the International Agency for Research on Cancer report in 2018, it is predicted that the rate of increase in the number of cancer patients in Iran will reach 35% until 2025 [1]. One of psychological problems that the cancer patients have to deal with, particularly during metastasis, is death anxiety. The purpose of Acceptance and Commitment Therapy (ACT) is to help patients replace the constructive behaviors with dysfunctional and problematic behaviors with no goal to change the intensity or frequency of negative emotions [10].
Studies conducted in foreign countries have reported the positive impact of acceptance strategies [13-15], living a value-based life [16], and psychological flexibility [17-20] on mental health and quality of life of cancer patients. Similar studies in Iran have also reported the significant effect of ACT therapy on decreasing death anxiety (in HIV samples) [21], anxiety symptoms [26-29], depression [30-33], stress [34], anxiety-related pain [35], and quality of life [22-25] of cancer patients.
2. Method
Package design
This package is designed based on ACT and mainly focuses on dealing with ‘death anxiety’ in cancer patients. This package was prepared by the researcher (a PhD. candidate from Isfahan University) and under the supervision of Dr. Steven Hayes in the department of psychology at the University of Nevada. The researcher participated in several seminars, workshops, and projects in Iran and United States to learn ACT theory and practice. He interviewed 12 psychologists and psychiatrists at the University of Nevada discussing the package design and possible paragraphs. The initial design of package was developed with 77 written paragraphs. Dr. Hayes and seven PhD students at the University of Nevada examined and confirmed the consistency of paragraphs with the main ACT paragraphs. In the end, the paragraphs with a Content Validity Ratio (CVR) of less than 0.62 were removed and 60 approved paragraphs were remained.
Package implementation
The study was implemented on 28 cancer patients (19 females and 9 males aged 26-71 years). The inclusion criteria were: having at least 18 years old, not being under any other psychological treatments, having reading and writing ability, ability to be present physically in the sessions, having consent for participating in the sessions, and having an introduction letter from Seyedoshohada Hospital in Isfahan. After selecting participants based on their medical records, they were randomly assigned to intervention (n=14) and control (n=14) groups. It should be mentioned that two participants were excluded from the study due to hospitalization and traveling, and the final sample size was then reduced to 26.
The intervention group received therapy at 7 sessions, once a week, based on the designed ACT package with a focus on attitude towards death, while the control group received some writing exercises as placebo. World Health Organization Quality of Life-BREF, Death Attitude Profile-Revised, and Acceptance and Action Questionnaire were used as data collection tools before intervention, after intervention, and in a two-month follow-up period. MANOVA was used for data analysis in SPSS V. 21 software.
3. Results
The MANOVA results showed that the intervention and control groups were meaningfully different in terms of fear of death, death avoidance and mental health (P<0.001), but not in other dimensions of quality of life and psychological flexibility variable (P>0.001) at pretest, posttest, and follow-up stages (Table 1). In overall, the ACT significantly increased the mental health (P<0.001) and decreased the death avoidance and fear of death (P<0.001). It could 32.9% of variance in mental health, 20.9% in avoidance of death, and 28% in fear of death was due to the ACT-based intervention.
4. Discussion
ACT-based intervention could significantly decrease the fear of death and avoidance of death and improve the mental health of cancer patients. The main therapeutic goal of ACT is to decrease avoidance behaviors and increase the tendency towards experiencing disturbing feelings and thoughts. The results showed that the designed ACT package can meet this therapeutic goal.
Ethical Considerations
Compliance with ethical guidelines
This study obtained its ethical approval from the University of Isfahan (Code: IR.UI.REC.1396.047) and was conducted in cooperation with the Cancer Prevention Research Center of Isfahan University of Medical Sciences. Participants were assured of the confidentiality of their information. The purpose of study was explained to them and signed a written consent form. They were free to leave the study at anytime.
Funding
This research was extracted from the PhD. thesis of second author approved by the Department of Education and Psychology, University of Isfahan in Isfahan, Iran.
Authors contributions
Conceptualization: Mohammad Bagher Kajbaf & Seyed Ali Kolahdouzan; Methodology: Mohammad Bagher Kajbaf; validation, data analysis, editing, project administration: All authors; Investigation & resources: Seyed Ali Kolahdouzan; Draft preparation, writing & review: Seyed Ali Kolahdouzan.
Conflicts of interest
The author declared no conflict of interest
Acknowledgements
The authors would like to thank Cancer Prevention Research Center of Isfahan's Seyedoshohada Hospital for their contribution in this research.
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Received: 2019/09/3 | Accepted: 2019/12/7 | Published: 2020/04/1
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