اثربخشی طرحواره درمانی بر اضطراب بیماری در بیماران مبتلا به سرطان سینه

The effectiveness of schema therapy on disease anxiety in patients with breast cancer

Aram Bujari,[1] Sina Janalizadeh Chenari^*,[2] Maryam Shamsifar,[3] Roksana Nakhaei Moghadam,[4] Samira Sadat Taghdisi Heydarian[5]

[1] - Doctoral student of general psychology, Kish International Campus, University of Tehran, Tehran, Iran.

[2]- Corresponding author, Master of Family Counseling, University of Gilan, Gilan, Iran ina.janalizade.1374@gmail.com

[3] - PhD in educational psychology, Lorestan University, Lorestan, Iran

[4] - PhD student in clinical psychology, Islamic Azad University, Tehran, Iran

[5] - Master of Clinical Psychology, Semnan University, Semnan, Iran

Abstract

Introduction: When someone gets cancer, it is not only her body that is affected by the disease. The complex course of the disease and cancer treatment exposes the patient and his family to pressure and psychological damage; therefore, the aim of this study was to investigate the effectiveness of schema therapy on disease anxiety in breast cancer patients.

Research method: The quasi-experimental research method was a pre-test-post-test with a control group, the study population consisted of all women diagnosed with breast cancer who referred to one of the hospitals in Tehran, who were selected from among 60 people by sampling method in available or voluntarily selected. Then they were randomly assigned in two groups of 30 people, experimental and control. A twelve-session Yang schema therapy protocol was implemented on the experimental group. Both groups completed the Kettle anxiety questionnaire in the pre-test and post-test stages.

Findings: The research results showed that schema therapy had an effect on disease anxiety in breast cancer patients.

Conclusion: Considering the effectiveness of schema therapy, it is suggested that treatment centers, including clinics and hospitals, use this treatment program to help the treatment process.

Keywords: breast cancer, disease anxiety, schema therapy

Received: 2/ August/ 2022                  Accepted: 14/ October/ 2022

Introduction:

Cancer is one of the common diseases in today's civilized world, and the number of people suffering from it is increasing day by day (1). Cancer is defined as the uncontrolled growth of abnormal cells, which produces tumors called neoplasms. There are two types of tumors: a benign tumor that does not spread throughout the body, and a malignant tumor, which shows metastasis or metastases. In 2008, cancer was responsible for the death of 7.6 million people worldwide (about 13% of all deaths) and is now the leading cause of death. It is estimated that cancer deaths worldwide will reach more than 11 million people in 2030. (2) After cardiovascular diseases and accidents, cancer is the third cause of death in Iran. More than 30,000 Iranians die of cancer every year. It is estimated that more than 80,000 new cases of cancer occur in the country every year (3).

Breast and prostate cancer are still the most common types of cancer in women and men, respectively. Cases of lung cancer in women are increasing. Also, cases of esophageal tumors caused by reactive acids caused by obesity are now more common in medical centers. Cancer in the head and neck areas caused by a virus is on the rise. It is said that oral sex is the main cause of transmission of this type of virus. According to new studies, the increase in life expectancy means that people will live longer and therefore more of them will be affected by this disease. But a better lifestyle, such as losing weight and not smoking, can have an important effect on not getting this disease.

The most important cancer treatments today are: 1) surgery 2) chemotherapy 3) anti-neoplastic drugs 4) radiation therapy 5) hormone therapy, during which the function of some hormones is disrupted in some way (drug or surgery) each of which can affect the psychological adaptation of patients. (4). Anxiety usually appears as uncontrollable worry; Intense fear that causes panic attacks, disturbing dreams, or restlessness, excessive awakenings, insomnia, difficult and uncomfortable breathing, shortness of breath, numbness, fatigue, or muscle tension. Anxiety may arise after receiving a cancer diagnosis during the treatment phase or during the disease control phase (5). Anxiety when accompanied by a cancer diagnosis can lower the pain threshold and disrupt a person's sleep pattern stimulate a person's digestive symptoms; Therefore, it significantly disrupts the quality of a person's life (6). However, many clinical trials have emphasized the combined state of anxiety and depression. (7) Based on the type of therapeutic interventions used, these symptoms may be modulated. Research shows that more than 50% of women may experience anxiety or depression in the first year after the diagnosis of early stage breast cancer. During the following years, this percentage will decrease; although more than 15% of women may still experience these symptoms in the fifth year after diagnosis (8). Symptoms related to cancer treatment, such as fatigue and pain, increase the risk of developing anxiety and depression; In addition, treatment methods such as chemotherapy and hormone therapy are known as methods that cause chemical changes in the brain, which will increase the risk of anxiety and depression (9). Accurate control of all negative emotions, especially illness anxiety, is an essential need in health care, due to their known disorders and impact on the process and effectiveness of treatment.

Among many different approaches that have been proposed to treat the symptoms of anxiety and depression caused by cancer, the "third wave" psychotherapies have attracted a lot of attention during the last two decades. These approaches represent an innovation in the framework of cognitive-behavioral behavior, because they do not seek to improve symptoms as their only goal, but also emphasize issues such as mindfulness, compassion, cognitive fusion, acceptance, and schema therapy (10). Mindfulness-based interventions, compassion-focused therapy, and schema therapy are examples of "third wave" psychotherapies that have been proven to be effective in treating various illnesses, mainly depression and anxiety disorders (11). In this regard, one of the approaches that can be considered is the schema-based approach. In this approach, schemas of structures, frameworks or patterns of cognitive content are considered as an underlying cognitive plan that guides information interpretation and problem solving (12). Schema therapy deals with the deepest level of cognition and targets the primary maladaptive schemas and by using cognitive, experiential (emotional), behavioral and interpersonal strategies, it helps patients to overcome the said schemas. The primary goal of this psychotherapy model is to create psychological awareness and increase conscious control over schemas, and its ultimate goal is to improve schemas and coping styles (13).

The results of Moezni, Gholamrezaei and Rezaei's research (14) showed that schema therapy sessions reduced the severity of depression and suicidal thoughts in patients suffering from treatment-resistant depression. The results of Taghiyar's research (15) showed that teaching the schema therapy approach has reduced women's marital frustration. Qadri, Kalantari and Mehrabi (16) showed in a research that schema therapy is effective for correcting initial maladaptive schemas and reducing the symptoms of social anxiety disorder. Dmitrescu and Rousseau showed that levels of early maladaptive schemas could predict levels of marital satisfaction. In their findings, researchers have confirmed the effectiveness of schema therapy in increasing the quality and satisfaction of life and improving the initial maladaptive schemas (17-18-19).

It has been found in many researches that schema therapy can improve or moderate the symptoms of depression and anxiety. Most of those researches were conducted in communities that did not suffer from certain physical problems such as cancer. Based on this, according to the studies conducted and the theories presented in this research, the effectiveness of schema therapy on disease anxiety in patients with breast cancer was noticed, so the researcher is looking for an answer to the question of whether schema therapy has an effect on disease anxiety in patients with breast cancer. Does it affect breast cancer?

Research method:

The quasi-experimental research method was pre-test-post-test with a control group, the study population consisted of all women diagnosed with breast cancer who referred to one of the hospitals in Tehran city, out of 60 people, through available or voluntary sampling were chosen. Then they were randomly assigned in two groups of 30 people, experimental and control. A twelve-session Yang schema therapy protocol was implemented on the experimental group. Both groups completed the Kettle anxiety questionnaire in the pre-test and post-test stages. Entry criteria were age between 18 and 60 years, voluntary participation, absence of mental illnesses, hospitalization in the chemotherapy department, at least two weeks since the onset of the disease. Exclusion criteria were death of the patient, failure to participate in at least two psychotherapy sessions. Research tool:

Kettle Anxiety Questionnaire: This questionnaire was designed by Kotel. This tool contains 40 three-choice items that are scored based on a three-point Likert scale from one to three. People whose score is above 45 are considered "anxious". Cattel reported the total validity of the questionnaire according to Cronbach's alpha method equal to 0.83. In Iran, Shahjooi reported the validity of the entire questionnaire with Cronbach's alpha method of 0.88. (20).

Common methods of descriptive statistics such as: frequency distribution, dispersion indices and other methods of this type of statistical analysis were used. Inferential statistical method: statistical processing is done with univariate analysis of covariance (ANCOVA) and using SPSS software be made

Findings:

The participants were 60 breast cancer patients from Farabi Hospital, whose average age was 32.35 years. In this research, we did not have any missing samples and questionnaires, which was due to proper communication with the clients and careful control of the questionnaires after they were completed by the participants. Before analyzing the data by univariate covariance analysis, the presuppositions of univariate covariance analysis were evaluated. The results of the Kolmogorov-Smirnov test were not significant for the research variable, which indicates that the assumption of normality is valid. Also, the results of M box test and Levine's test were not significant, these findings respectively indicate that the assumption of equality of covariance matrices and the assumption of equality of variances are established. The mean and standard deviation of the anxiety variable in the two groups of schema therapy training and the control group, separated by pre-test and post-test, are shown in Table (1).

Table (1): Mean and standard deviation of anxiety variable

As seen in Table 1, changes in pre- Test, post-test in disease anxiety variable occurred in schema therapy group. In schema therapy, the mean and standard deviation of anxiety scores in the post-test were significantly reduced compared to the pre-test. In this research, the statistical test of covariance was used due to its suitability and compatibility with the research hypothesis.

Table (2): Comparison of the difference in post-test and pre-test scores of anxiety in two groups of schema therapy and control

According to the results of Table 2, after adjusting the pre-test scores, the difference between the groups is significant at the alpha level of 0.05; Therefore, the hypothesis of the research about the effectiveness of schema therapy on disease anxiety in patients with breast cancer and the difference between the groups in the post-test is confirmed.

Discussion and conclusion:

The present study was conducted with the aim of investigating the effectiveness of schema therapy on disease anxiety in patients with breast cancer. The results obtained from the comparison of the anxiety post-test in the two groups indicate that after participating in the schema therapy sessions, the mean variable scores mentioned in the post-test stage have decreased compared to the pre-test stage, so the schema therapy reduces disease anxiety symptoms in patients with breast cancer. It has had a significant impact. The findings of this research are similar to those of Yousefi (21), Shakhmgar (22), Aghaei, Hatamipour and Ashuri (23), Panahifar, Yousefi and Armani (24), Moezni, Gholamrezaei and Rezaei (15), Qadri, Kalantari and Mehrabi (16) is aligned. The results of the findings show that schema therapy causes changes in cognitive and experimental, emotional and behavioral fields. This approach has been effective by challenging incompatible schemas and ineffective responses and replacing them with appropriate and healthier thoughts and responses. By improving some basic and destructive components such as emotions and negative thoughts, schema therapy seems to be able to improve psychological health in general and thus mental health in people. Schema therapy techniques help the patient to improve schemas by emotional reorganization, self-evaluation of new learning, interpersonal emotion regulation, and self-relaxation. These schemas operate at the deepest level of cognition, usually outside the level of consciousness (25). In further explanation of these findings, it can be said that the schema therapy approach is an approach consisting of cognitive, behavioral, interpersonal, attachment and experimental approaches in the form of an integrated therapeutic model that uses four main cognitive, behavioral, relational and experimental techniques in people in addition to the following Questioning incompatible schemas, which is the main cause of the formation of ineffective and irrational thoughts, emotionally drains buried negative emotions and emotions, such as anger caused by not satisfying the needs of spontaneity and secure attachment to others in childhood, which can lead to peace and reduce anxiety. Low negative rumination results in fewer experiences of physical arousal, which can be a beneficial determinant of health.

Ethical Considerations:

After the necessary approvals and obtaining permission from the university, in order to complete the questionnaires, the goals and working methods were explained to all the people participating in the study, and their consent was obtained and they were assured that the results of the research will be available to them if they wish. They will be placed. Also, people were assured that they are free to participate or not participate in the research, and in case of non-participation and cooperation, their treatment or care will not be effective and will be followed up as usual. People were assured that they can decide to withdraw from the research at any stage of the research and this will not have any negative consequences for them.

Limitations of the research:

This research, like other researches, had limitations, and one of these limitations was the mental and emotional state of the patients when answering the questions, which may affect the accuracy and accuracy of their answers, and this limitation was uncontrollable.

Conflict of interest:

The authors hereby declare that this work is the result of an independent research and does not have any conflict of interest with other organizations and persons.

Acknowledgment:

The authors of the article express their gratitude to all the participants in the research.

References: