پژوهشهای علوم شناختی و رفتاری (Feb 2024)
Comparing the Effectiveness of Unified Transdiagnostic Treatment of Barlow and Acceptance and Commitment Therapy on Rumination and Intolerance of Uncertainty in Corona Victims' Wives
Abstract
The prevalence of the corona virus and the deaths caused by it and the lack of a comprehensive mourning reaction have various psychological effects on the survivors. This research was conducted with the aim of comparing the effectiveness of unified transdiagnostic treatment of Barlow and acceptance and commitment therapy on Rumination and intolerance of uncertainty in corona victims' wives. The semi-test research method was with the pre-test-post-test and 2-month follow-up. The statistical population included the corona victims' wives, referring to Imam Khomeini Hospital in Tehran in 2022, using convenience sampling methods, 51 people, and were randomly placed in three groups of 17. Due to the subject drop in the acceptance and commitment therapy group, one person was randomly removed from the other two groups. Therefore, in each group, 16 data were analyzed. The first experimental groups received acceptance and commitment therapy and the second experimental group transdiagnostic treatment in 9 sessions 90 minute once a week. The research tools were the rumination questionnaire and the uncertainty intolerance questionnaire. Data were analyzed using repeated measurement ANOVA. The results showed that both interventions were effective on the rumination and intolerance and the treatment effect was stable in the follow-up phase (P<0.001) and there is no difference between the effectiveness of the two interventions on rumination and intolerance of uncertainty. Considering the effectiveness of both interventions on rumination and uncertainty intolerance in corona victims' wives, it is suggested that psychotherapists use these treatment approaches in the treatment of psychological problems caused by bereavement.IntroductionDuring the coronavirus epidemic, millions of people around the world experienced the loss of one of their loved ones (Padhan & Prabheesh, 2021). Meanwhile, it seems that the spouse of the Corona victim is very vulnerable to psychological disorders (Javadi & Sajjadian, 2019). Therefore, in such conditions, these people experience psychological problems such as anxiety, depression, confusion, loneliness, and intolerance of uncertainty (Satici et al., 2022). Intolerance of uncertainty is one of the cognitive components of mental disturbance and one of the psychological structures related to bereavement in the wives of Corona victims (Javadi & Sajjadian, 2019). In this regard, research shows that among the cognitive components effective in anxiety and mood disorders, intolerance of uncertainty has had a significant contribution to the experience of worry in the affected people (Jenkinson et al., 2020). Rumination is a factor that plays a vital role in the creation and continuation of depression in the wives of Corona victims. Rumination is defined as a thinking style with repetitive, recurrent, disturbing, and uncontrollable thoughts (Nolen-Hoeksema et al, 2008). Rumination causes damage such as strong negative emotions, depressive symptoms, negative ruminative thinking, poor problem-solving, disturbed concentration and cognition, and more mental pressure (Egan & Smith, 2020). Until now, various treatment approaches have been used to help the survivors of Corona victims (Daneshmand et al, 2023). Meanwhile, to reach an effective and selective treatment approach, comparing interventions such as transdiagnostic therapy that uses mindfulness as a key component (Grossman & Ehrenreich-May, 2020) and accepting commitment therapy that emphasizes acceptance and mindfulness as the basis of change processes (Hayes & Hofmann, 2017), are of particular importance. These interventions are based on the hypothesis that psychological damage is caused by trying to control or avoid negative thoughts and emotions (Krimian et al., 1402). Therefore, according to what was stated, the main goal of this study was to compare the effectiveness of unified transdiagnostic treatment of Barlow and acceptance and commitment therapy on the intolerance of uncertainty and rumination in the wives of Corona victims. MethodThe study was semi-experimental with a pre-test-post-test design with a control group and a two-month follow-up phase. The research community included wives of corona victims who had been admitted to Imam Khomeini Hospital in Tehran. A number of 51 spouses of corona victims were selected by convenience sampling and assigned to two experimental and control groups. Due to the drop in the number of subjects in each group, the data of 16 subjects were analyzed. The research tool was the Nolen-Hoeksema and Morrow rumination scale (Nolen-Hoeksema & Morrow, 1991) and the Intolerance of Uncertainty Scale (Freeston & et al, 1994). The participants of the experimental groups received nine 90-minute sessions of Hayes et al.'s acceptance and commitment therapy (Hayes et al., 2004) and Barlow's unified transdiagnostic therapy separately (Barlow et al., 2017).ResultsAnalysis of variance with repeated measures was used to investigate the difference between pre-test, post-test, and follow-up scores in rumination and uncertainty intolerance. Table 1. Repeated measures for rumination and intolerance of uncertainty Effect sizepFMean of squaresdfSum of squaredSourceEffectsVariable0.7780.0001157.3274264.7861.0344411.431TimeWithin-subjectRumination0.6540.000145.2471226.5472.0692437.444Time × group0.4160.000116.0182390.63224781.264GroupBetween subjects0.7940.0001173.7432142.0461.5203255.597TimeWithin-subjectIntolerance of uncertainty0.6680.000145.181557.0253.0401603.194Time × group0.4600.000119.1681366.34022732.681GroupBetween subjects According to Table 1, Within-subject effects, the main effect of the group in research variables was significant (p < 0.001). The results have shown that 41.6% of individual differences in rumination and 46% in intolerance of uncertainty are related to the differences between the three groups. The results of within-subject effects also showed that the main effect of time in the research variables is significant (p <0.001). The results of the Bonferroni post hoc test showed that there is a significant difference between the experimental groups and the control group in rumination and intolerance of uncertainty(p <0.001), which indicated the effectiveness of the two treatment methods. However, no significant difference was observed between the effectiveness of the two interventions. DiscussionThe study was conducted to compare the effectiveness of acceptance and commitment therapy and transdiagnostic treatment on rumination and uncertainty intolerance. In explaining the effectiveness of acceptance and commitment therapy on rumination, it can be stated that acceptance and commitment therapy through techniques such as mindfulness and cognitive diffusion help a person to find their way to deal with calamities. As a result, they can experience physical relaxation, reduction of mental tension, intolerance of uncertainty, and rumination. Regarding the effectiveness of transdiagnostic treatment, it should be said that the main hypothesis of transdiagnostic treatment is that people with emotional disorders use maladaptive emotional regulation strategies such as blaming themselves and others, catastrophizing, and rumination (Barlow et al., 2017). Therefore, the effectiveness of unified transdiagnostic treatment on rumination and intolerance of uncertainty can be explained by therapeutic processes such as emotional experience, mindfulness, awareness of the here and now, not eliminating and suppressing negative thoughts, challenging negative evaluations, and increasing flexibility.One of the limitations of the current study was the lack of using random sampling methods. Therefore, it is suggested to use the random sampling method to increase the generalizability of the results. Also, at the practical level, it is suggested that psychologists and counselors use these two methods of intervention as a selective treatment in improving psychological disorders caused by the bereavement of spouses of coronavirus victims.
Keywords
