Comparison of the Effectiveness of Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Therapy (CBT) on Psychological Hardiness, Caring Behavior and Coping Strategies in Patients with Type 2 Diabetes

Document Type : Original Research

Authors

1 Counseling Group, University of Social Welfare and Rehabilitation, Tehran, Iran

2 Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Behavioral Sciences Research Center, Life style institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Background and Aim: Increasing the prevalence of diabetes requires a change in concepts related to diabetes management and treatment programs. This change must be switch from the physical variables to psychosocial factors. The aim of this study was to compare the effectiveness of the Acceptance and Commitment Training (ACT) and Cognitive Behavioral Therapy (CBT) on psychological hardiness, caring behavior and coping styles of patients with type 2 diabetes.
Methods: The present study was a quasi-experimental pre-test-post-test intervention with a control group. The population consisted of diabetic patients who were referred to Besat Hospital in Tehran, Iran in 2020. Patients were randomly assigned into three groups of 20 people. One group trained by using the ACT approach in eight 2-hour sessions. Other groups trained by the CBT approach in eight 1-hour sessions training. The control group didn't receive any training. The data collection tools consisted of the Kobasa psychological hardiness questionnaire (1976), the Endler & Parker coping styles (1990), and the Tobert & Glasgow self-care questionnaire (2000).
Results: The CBT and ACT interventions are effective in increasing the psychological hardiness and self-care behavior and improving coping styles in the experimental groups (P<0.05). Also, the CBT intervention had a greater effect than ACT on the variables of psychological hardiness and self-care behavior in the experimental group. In the variable of coping styles, the ACT intervention had a greater effect on the avoidance and excitement components than the CBT intervention.
Conclusion: In conclusion, it can be said that the CBT and ACT interventions can effectively increase the mental health of patients with type 2 diabetes and help them control their symptoms. It is recommended using these interventions to improve the psychological status of patients with diabetes.

Keywords


1. Abasian M, Delorianzade M. Investigation of diabetes in patients referenced to diabetes Clinic in Shahrood city. Journal of Knowledge and Health of Shahrood University. 2008;4(1):15-9. 2. Organization WH. Classification of diabetes mellitus. 2019. 3. Taylor SE, Sirois FM. Health Psychology (Second Canadian Edition). Toronto, Canada: McGraw-Hill Ryerson; 2012. 4. Masten AS. Ordinary magic: Resilience processes in development. American psychologist. 2001;56(3):227. doi:10.1037/0003-066X.56.3.227 5. Vasli P, Eshghbaz F. Survey condition regarding self-caring of children suffering from diabetes type 1 and it’s relation with family reaction. J Mazandaran University Med Sci. 2009;19(69):38-44. 6. Wolf ZR. The caring concept and nurse identified caring behaviors. Topics in Clinical Nursing. 1986;8 (2):84. 7. Mobini S. Education of immunization with stress. Third ed. Tehran, Iran: Roshd publication; 1997. 8. Kalafi Y, Peshdad G, Bagheri S. Comparison of behavioral patterns among type 1 and 2 of diabetic patients. J Iran endocrine gland metab. 2002;2:85-8. 9. Maxwell M, Harris F, Hibberd C, Donaghy E, Pratt R, Williams C, et al. A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK. BMC family practice. 2013;14(1):46. doi:10.1186/1471-2296-14-46 10. Yousefy A, KhayamNekouei Z. Basis of Cognitive-Behavioral Trainings and its Applications in Recovery of Chronic Diseases. Iranian J Med Educa. 2011;10(5): 792-800. 11. Oei TP, Dingle G. The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. J Affective Disorders. 2008;107(1):5-21. doi:10.1016/j.jad.2007.07.018 12. Zahir AA, Hosseini M, Semnani Y. Prevalence of depression and its related factors in high school students of Firouzkouh. Journa of Pejouhandeh 2004;9(2):61-4. 13. Farhani AMZ, Naderi F, Rajab A, Ahadi H, Kraskian A. Effectiveness of Cognitive-Behavioral Therapy on Psychological Problems and Blood Glucose Control in Children with Diabetes Mellitus Type I. 2018. 14. Seyed Nour S, Homaei R. Effectiveness of Group Cognitive-Behavioral Therapy on the Self-Care Behaviors, Psychological Wellbeing, and Hope of Patients with Type II Diabetes. J Clin Nursing Midwifery. 2019;8(1):265-75. 15. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy. 2016;47(6):869-85. doi:10.1016/j.beth.2016.11.006 16. Ossman WA, Wilson KG, Storaasli RD, McNeill JW. A preliminary investigation of the use of acceptance and commitment therapy in group treatment for social phobia. International J Psychology Psychol Therapy. 2006;6(3). 17. Bigdeli R, Dehghan F. The Effectiveness of Acceptance and Commitment Therapy (ACT) on Psychological Symptoms and Life Satisfaction in Patients with Type-2 Diabetes. Iranian J Rehabilitation Res Nursing. 2019;5(4):34-42. 18. Moshkabid Haghigati M, Pooryousefi M. The effectiveness of acceptance and commitment therapy on psychological hardiness and anxiety of mothers with children with anxiety problems. Contemporary Psychology. 2015;12(1):1595-600 19. Hulbert‐Williams NJ, Storey L, Wilson KG. Psychological interventions for patients with cancer: psychological flexibility and the potential utility of Acceptance and Commitment Therapy. European j cancer care. 2015;24 (1): 15 -27. doi:10.1111/ecc.12223 20. Bastami M, Goodarzi N, Dowran B, Dabaghi P, Bastami M. effectiveness of acceptance and commitment therapy (ACT) to increase their quality of life of military personnel with type 2 diabetes mellitus. Nurse and Physician within War. 2016;4(12):119-26. 21. Lali OK. the effectiveness of acceptance and commitment therapy on psychological hardness and social adjustment in girl students of Rivash city. The 4th National Consultation and Mental Health Conference. 2017. 22. Behrouz B, Bavali F, Heidarizadeh N, Farhadi M. The Effectiveness of Acceptance and Commitment Therapy on Psychological Symptoms, Coping Styles, and Quality of Life in Patients with Type-2 Diabetes. J Health. 2016;7(2):236-53. 23. Abniki E, Abolghasemi A, Abbasi M, Moazzez R, Jalali R. The Effect of Group Cognitive-Behavioral Intervention in Stress Management on Improved Hardiness and Self-control in Depressed Women. Clinical Psychology Studies 2015;5(19):99-118. 24. Samadzade N, Poursharifi H, Poursharifi J. The effect of cognitive-behavioral therapy on the self-care behaviors and symptoms of depression and anxiety in women with type 2 diabetes: a case study. Feyz J Kashan Univ Med Sci. 2015;19(3):255-64. 25. Lappalainen R, Lehtonen T, Skarp E, Taubert E, Ojanen M, Hayes SC. The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification. 2007;31(4):488-511. doi:10.1177/0145445506298436 26. Delavar A. Theoretical and practical research in the humanities and social sciences. Tehran: growth. 2014. 27. Kobasa SC. Stressful life events, personality, and health: an inquiry into hardiness. J personality social psychol. 1979;37(1):1. doi:10.1037/0022-3514.37.1.1 28. Jalali M, Rahim M. The relationship between psychological hardiness and social support in women with breast cancer. Avicenna J Neuro Psycho Physiology. 2019; 6(4): 159-164. doi:10.32598/ajnpp.6.4.1. 29. Kermanshahi MH, Shahbazirad A, Soleymani M, Amiri B, Azargoon F. The relationship between hardiness, and perfectionism with coping strategies with stress. International Journal of Humanities and Cultural Studies (IJHCS). 2016:393-400. 30. Ghoreyshi RF. validation of Endler and Parker coping scale of stressful situations. J Behav Sci. 2010; 4(1):1–7. 31. Zareban I, Niknami S, Hidarnia A, Rakhshani F. Predictors of self-care behavior and its effective factors among women's with type 2 diabetes patients in Zahedan via Health Belief model. J Health Syst Res. 2014:1797-805. 32. Mohajeri-Tehrani MR. Risk factors associated with depression in type 2 diabetics. KAUMS J (FEYZ). 2012;16(3):261-72. 33. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes care. 2000;23(7):943-50. doi:10.2337/diacare.23.7.943 34. Hayes SC, Pistorello J, Levin ME. Acceptance and Commitment Therapy as a Unified Model of Behavior Change Ψ. Counseling Psychologist. 2012;40(7):976-1002. doi:10.1177/0011000012460836 35. Wright JH, Brown GK, Thase ME, Basco MR. Learning cognitive-behavior therapy: An illustrated guide: American Psychiatric Pub; 2017. 36. Mosalanejad L, Koolaee AK, Jamali S. Effect of cognitive behavioral therapy in mental health and hardiness of infertile women receiving assisted reproductive therapy (ART). Iranian j reproductive med. 2012;10(5):483. 37. Delahaij R, Gaillard AW, van Dam K. Hardiness and the response to stressful situations: Investigating mediating processes. Personality and Individual Differences. 2010;49(5):386-90. doi:10.1016/j.paid.2010.04.002 38. Ferreira N. Hardiness in relation to organisational commitment in the human resource management field. SA J Human Resource Management. 2012;10(2):1-10. doi:10.4102/sajhrm.v10i2.418 39. Cohn A, Pakenham K. Efficacy of a cognitive-behavioral program to improve psychological adjustment among soldiers in recruit training. Military med. 2008;173(12):1151-7. doi:10.7205/MILMED.173.12.1151 40. Karlin BE, Brown GK, Trockel M, Cunning D, Zeiss AM, Taylor CB. National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs health care system: therapist and patient-level outcomes. J Consult Clinical Psychol. 2012;80(5):707. doi:10.1037/a0029328 41. Evyatar A, Stern M, Schem-Tov M, Groswasser Z. Hypothesis forming and computerized cognitive therapy. Cognitive Rehabilitation in Perspective: Routledge; 2018. p. 147-63. doi:10.4324/9780429490088-11 42. Twohig MP, Levin ME. Acceptance and commitment therapy as a treatment for anxiety and depression: A review. Psychiatric Clinics. 2017;40(4):751-70. doi:10.1016/j.psc.2017.08.009 43. Shayeghian Z, Amiri P, Beshrat MA. Effectiveness of acceptance and commitment group therapy on improvement of glaycated hemoglobin and self-care activities in patients with type II diabetes. J Contemporary Psychol. 2016;10(2):41-50. 44. Makvand Hoseini S, Rezaee A, Azadi M. Effectiveness of acceptance and commitment group therapy on the self-management of type 2 diabetes patients. Clin Psychol. 2014;5(4):55-62. 45. Ismail K, Thomas SM, Maissi E, Chalder T, Schmidt U, Bartlett J, et al. Motivational Enhancement Therapy with and without Cognitive Behavior Therapy to Treat Type 1 DiabetesA Randomized TrialMotivational Enhancement Therapy and Control of Type 1 Diabetes. Annals internal med. 2008;149(10):708-19. doi:10.7326/0003-4819-149-10-200811180-00005 46. Beck JS, Beck A. Cognitive behavior therapy. New York: Basics and beyond Guilford Publication. 2011. 47. Abbsian F, Najimi A, Ghasemi G, Afshar H, Meftah SD. Effectiveness of Stress Management Training by Cognitive-Behavioral Method in Women with Depression. J Health System Res.2012;8(6):1050-7. 48. Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. Jo consulting clin psychol. 2007;75(2):336. doi:10.1037/0022-006X.75.2.336 49. Wetherell JL, Afari N, Rutledge T, Sorrell JT, Stoddard JA, Petkus AJ, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain. 2011;152(9):2098-107. doi:10.1016/j.pain.2011.05.016 50. Batten S. Essentials of acceptance and commitment therapy: Sage Publications; 2011