Razi Journal of Medical Sciences

Extended Abstract

Background and purpose: Alopecia areata is a complex genetic disease with an immune system that targets anagen hair follicles (1). The prevalence of mental disorders, especially mood and anxiety disorders in these patients is significantly higher than other people (2). The etiology of alopecia areata is not completely known But this disorder is an autoimmune disease caused by a combination of genetics and environmental factors (3). Among the environmental factors that have the highest abundance in the initiation of alopecia areata, It is psychological stress (4). Recent studies have shown that 74% of the examined patients with alopecia areata had at least one psychiatric diagnosis during their lifetime (6). The psycho-physical origin of skin diseases has also been emphasized and stress factors have been mentioned as the most important factors that initiate or aggravate the disease process (10). The stress factor plays a dual role in this: either it occurs before the appearance of skin disease and the person suffers from skin discomfort after dealing with many stressful factors, or the appearance of skin problems and manifestations It causes stress in the person, which in turn aggravates the problem (11). There is a relationship between the amount of blood cortisol (stress hormone) and the duration of skin diseases and the severity of the disease symptoms (15). Considering the problems of life in the modern world, one of the reasons for causing alopecia is the problem in the functioning of the adrenal gland and the secretion of adrenaline and cortisol, which is necessary to deal with stressful situations, especially in the modern world, for many reasons, including (heavy traffic, noise a lot, emergencies and time constraints, air pollution) or greater damages such as illness or The death of loved ones is secreted, which all causes wear and tear and disturb the balance of these hormones (16). The positive effect of psychological interventions in reducing symptoms and improving psychosomatic disorders is not hidden from anyone (17). Metacognitive treatments and cognitive therapy based on mindfulness work directly on modulating these positive and negative emotions (19). With the development and evolution of psychological treatments, metacognitive therapy (MCT) was also proposed by Adrian Wells (20). Metacognition tries to change the place of the two categories of reasoning and emotion in the brain during the stages of treatment (recovery) through exercises and applications. This means that before any behavior (in which emotion usually plays a more prominent role), we should reason first (21). Another approach that can improve and improve the psycho-emotional performance of people with skin disorders is mindfulness-based cognitive therapy (MBCT). This treatment was first introduced by Segal et al. in 2002 to prevent the recurrence of depression and anxiety. Mindfulness includes a receptive and judgment-free awareness of current events (22). Therefore, this study was conducted with the aim of comparing the effectiveness of metacognitive therapy and cognitive therapy based on mindfulness on depression and blood cortisol levels in patients with alopecia areata.

Methodology: This was a semi-experimental study with a pre-test, post-test and control group design with a three-month follow-up. The statistical population included all patients with alopecia areata who referred to specialized skin and hair clinics in Tehran and Iranian Alopecia Society in 1401, which was done with the purposeful sampling method at a time interval of 2 months and with the help of the treatment staff in these centers. Among the mentioned patients, 63 patients who were eligible to participate in the study were selected. First, the self-report tool used in the research was distributed among them; In the next step, according to the cooperation and complete completion of the research tool and reconsidering the inclusion criteria, 49 people were selected, and finally 46 people remained in the study until the end. These people were replaced by a simple random method,  in 3 groups, including two experimental groups and one control group. Then, for the people of the experimental groups, therapeutic interventions were carried out online and during different days of the week by a therapist with experience in the relevant treatment method and at the personal expense of the researcher in one of the rooms of the relevant treatment center, but the people of the control group received conventional treatment in the field. received skin and hair and did not receive psychological interventions during this period. At the end of the intervention sessions, the post-test was taken again with the same self-report tools from the three groups. At the end of the intervention, in order to comply with the ethical principles, one of the aforementioned interventional methods, i.e., metacognitive therapy, was implemented free of charge for the control group. To collect information, in addition to the demographic information checklist-researcher-made form, Beck's depression questionnaire and clinical tests of blood cortisol were used. Therapeutic interventions were applied to the experimental groups during 9 sessions of 90 minutes. The data was analyzed by SPSS statistical software and analysis of variance with repeated measurements.

Findings: In the present study, 46 patients with alopecia areata were divided into three groups: metacognitive therapy (7 women and 9 men), cognitive therapy based on mindfulness (9 women and 6 men), and control (8 women and 7 men) they got. In the metacognitive therapy group, the average and standard deviation of the age of the participants were 31.88 and 6.82 years, respectively, in the mindfulness-based cognitive therapy group, 30.93 and 5.95 years, respectively, and in the control group, respectively It was 29.73 and 7.07 years. In the metacognitive therapy group, the level of education of 3 participants was diploma, 3 were post-graduate, 8 were bachelor's and 2 were post-graduate and above. In the group of cognitive therapy based on mindfulness, the level of education of 2 participants was diploma, 2 were post-graduate, 8 were bachelor's and 3 were post-graduate and above. In the control group, the level of education of 4 participants was diploma, 3 were post-graduate, 6 were bachelor's and 2 were post-graduate and above. In this research, the assumption of normality of data distribution was investigated using the evaluation of Shapiro-Wilk values, and the results showed that the distribution of data related to both dependent variables in three groups and in three implementation stages is normal. The findings showed that metacognitive therapy and cognitive therapy based on mindfulness decreased the mean depression(p=0/001) scores and blood cortisol levels(p=0/012) in patients with alopecia areata (P<0.05). The changes caused by metacognitive therapy and cognitive therapy based on mindfulness on depression and blood cortisol were still maintained after three months of intervention. The difference in the effect of two treatment methods on depression was significant (p=0.031), so that metacognitive therapy reduced depression more compared to cognitive therapy based on mindfulness; But the effect of two treatments on blood cortisol levels was not significant.

Conclusion: Based on the results of the present study, it can be said that metacognitive therapy and cognitive therapy based on mindfulness are effective for reducing depression and blood cortisol levels in patients with alopecia areata, along with medical and pharmaceutical teams and treatments.
Keywords: metacognitive therapy, cognitive therapy based on mindfulness, depression, blood cortisol level, alopecia areata