Volume 28, Issue 2 (Summer 2022)                   IJPCP 2022, 28(2): 222-235 | Back to browse issues page

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Mansouri Koryani R, Bassak Nejad S, Mehrabizadeh Honarmand M, Majdinasab N. Effectiveness of Compassion Focused Acceptance and Commitment Therapy on Psychological Flexibility and Psychological Distress in Patients With Multiple Sclerosis. IJPCP 2022; 28 (2) :222-235
URL: http://ijpcp.iums.ac.ir/article-1-3417-en.html
Effectiveness of Compassion Focused Acceptance and Commitment Therapy on Psychological Flexibility and Psychological Distress in Patients With Multiple Sclerosis
Reza Mansouri Koryani1 , Soodabeh Bassak Nejad 2, Mahnaz Mehrabizadeh Honarmand1 , Nastaran Majdinasab3
1- Department of Psychology, School of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
2- Department of Psychology, School of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran. , s.bassak@scu.ac.ir
3- Department of Neurology, Musculoskeletal Rehabilitation Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Keywords: Compassion-focused acceptance and commitment therapy, Psychological flexibility, Psychological distress, Multiple sclerosis
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Introduction
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) in which the myelin sheath of the CNS, including the brain and spinal cord, is damaged. Individuals with MS experience relatively high rates of stress, anxiety, and depression. One variable that can be improved to reduce the psychological symptoms in these patients is psychological flexibility.
Psychological flexibility is considered a fundamental aspect of health and is defined as the ability to contact the present moment more fully as a conscious human being and to change or persist the behavior while serving the valued ends. Psychological flexibility is established through 6 core acceptance and commitment therapy (ACT) processes. Each of these areas is conceptualized as a positive psychological skill, not merely a method of avoiding psychopathology.
Psychological distress that describes unpleasant feelings or emotions is one of the most common clinical features in people with MS. These factors negatively impact the health-related quality of life.
Compassion-focused ACT (CFACT) is obtained from integrating compassion-focused therapy (CFT) with ACT. Many studies have confirmed the effectiveness of the 2 approaches that make up CFACT in reducing symptoms and improving the quality of life of different patients. Therefore, the present study aims to explore the effectiveness of CFACT on psychological flexibility and psychological distress in patients with MS.
Methods
This was an experimental study with pretest-posttest, follow-up, and control group design. The statistical population of the study included all the MS patients who were a member of the Khuzestan MS Society and living in Ahvaz City, Iran. From this population, 50 patients were selected by the simple random sampling method. Then, 32 patients were randomly selected according to the inclusion and exclusion criteria and assigned to the control group (n=16) and the experimental group (n=16). The experimental group was randomly divided into two groups of 8 patients. The experimental groups received ten 90-min sessions of CFACT twice a week. The data were collected using the open and engaged state questionnaire and psychological distress scale at 3 time points: before the intervention, immediately after the intervention, and 2 months after the follow-up. The obtained data were analyzed via multivariate analysis of covariance (MANCOVA) in the SPSS software, v. 24.
Results
The results of the MANCOVA showed a significant difference between the experimental group and the control group in terms of the dependent variables at the level of P<0.001. Accordingly, there is a significant difference between the two groups at least in one of the dependent variables (psychological flexibility and psychological distress) (Table 1).


To analyze the difference, the analysis of covariance (ANCOVA) was carried out in the context of MANCOVA and the results showed that CFACT increased psychological flexibility (P<0.001) and reduced psychological distress (P<0.001) in the experimental group compared to the control group at the posttest stage (Table 2).


This treatment is effective on the psychological flexibility and psychological distress of the subjects. In the posttest stage, the effect on psychological flexibility was 0.54 and 0.52 for psychological distress, i.e., 54% of psychological flexibility variance and 52% of the variance of psychological distress are because of CFACT. In the follow-up stage, the effect on the psychological flexibility was 0.57 and 0.55 for psychological distress, i.e., 54% of PF variance and 52% of the variance of psychological distress are because of CFACT. Accordingly, the research hypothesis was confirmed. The statistical power of the test for the variables is 1, which indicates the adequacy of the sample size.
4. Discussion
In this study, the effectiveness of CFACT on psychological flexibility and psychological distress in patients with MS was studied. The results showed that CFACT could significantly increase psychological flexibility and decrease psychological distress in patients with MS. Furthermore, in this study, to control the potential biases, patient sampling and placement in the experimental and control groups were carried out randomly. However, there were some limitations. First, the results can only be generalized to patients in the age range of 18 to 52 years and caution must be observed for other populations. The use of self-report tools and patients that have a score within the range of 0 to 5 on the expanded disability status scale are the other limitations. We suggest that the results of this research be used in medical and psychological institutions and schools to help patients with MS.

Ethical Considerations
Compliance with ethical guidelines
This study obtained its ethical approval from the Shahid Chamran University of Ahwaz (Ethics Code: EE/98.24.3.58272/scu.ac.ir) and was conducted in cooperation with Khuzestan MS Society. The participants were assured of the confidentiality of their information. The purpose of the study was explained to them and they signed a written consent form. They were free to leave the study at any time.

Funding
This research was extracted from the MSc thesis of the first author, in the Department of Clinical Psychology, Faculty of Psychology, Shahid Chamran University of Ahwaz, Ahwaz, Iran.

Authors contributions
Conceptualization, methodology, validation, analysis, investigation, sources and writing-review: Reza Mansouri Koryani; Editing and reviewing: Mahnaz Mehrabizadeh honarmand; Finalizing and project administration: All authors.

Conflicts of interest
The authors declare no conflict of interests.

Acknowledgements
We would like to thank the personnel of Khuzestan MS, especially Ms. Bahareh Nadamat, and the patients who agreed to participate in this study.
 
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Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2021/01/12 | Accepted: 2021/12/4 | Published: 2022/07/1
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