Razi Journal of Medical Sciences

fa مقایسه اثربخشی روان درمانی گروهی روان پویشی و کاهش استرس براساس بهوشیاری بر حس انسجام و اضطراب مرگ در بیماران مبتلا به سرطان روده بزرگ Comparing the Effectiveness of Psychodynamic Group Psychotherapy and Mindfulness-Based Stress Reduction on the Sense of Coherence and Death Anxiety in Patients with Colon Cancer روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: سرطان روده بزرگ سومین سرطان شایع تشخیص داده شده و چهارمین علت شایع مرگ ناشی از سرطان است. هدف پژوهش حاضر مقایسه اثربخشی روان درمانی گروهی روان پویشی و کاهش استرس بر اساس بهوشیاری بر حس انسجام و اضطراب مرگ در بیماران مبتلا به سرطان روده بزرگ بود. روش کار: طرح پژوهش از نوع نیمه آزمایشی با پیش‌آزمون- پس‌آزمون و گروه کنترل و مرحله‌ی پیگیری بود. جامعه آماری پژوهش تمامی بیماران مبتلا به سرطان روده بزرگ مراکز درمانی پورسینا شهر اصفهان در بهار 1401 بودند که 42 نفر به‌ شیوه نمونه‌‌گیری هدفمند انتخاب و به طور تصادفی در سه گروه 14 نفری کاهش استرس بر اساس بهوشیاری (8 جلسه) و روان درمانی گروهی روان پویشی (12 جلسه) و کنترل جایگزین شدند. ابزار پژوهش شامل پرسش نامههای حس انسجام آنتونووسکی (1993) و اضطراب مرگ تمپلر (1۹۷۰) بود. داده‌‌های پژوهش با استفاده از روش تحلیل واریانس با طرح ترکیبی و آزمون تعقیبی بونفرنی در نرم افزار SPSS-26 تحلیل شد. یافتهها: نتایج نشان داد که هر دو شیوه به طور موثر و یکسانی سبب افزایش حس انسجام بیماران شده و اثر آن در طول زمان پایدار باقی مانده (05/0>P)، درحالی که تنها روان درمانی گروهی پویشی به طور موثری سبب کاهش اضطراب مرگ بیماران شده (05/0>P)، اما اثر آن در طول زمان پایدار باقی نمانده است (05/0<P). نتیجهگیری: براساس نتایج پژوهش روان درمانی گروهی روانپویشی و کاهش استرس براساس بهوشیاری میتوانند بر حس انسجام درونی و اضطراب مرگ بیماران مبتلا به سرطان روده بزرگ تاثیر گذارد و به سازگاری بیماران کمک نماید.</div> <div style="text-align: justify;">Background & Aims: Colon cancer, being a prevalent and life-threatening illness, has consistently garnered the attention of healthcare centers. According to statistics published by the World Health Organization, 2.8 million deaths in 2018 were attributed to this disease, making it the second leading cause of cancer-related deaths (1). The diagnosis of cancer is often accompanied by an increased risk of common mental disorders, which may negatively impact treatment, recovery, quality of life, and survival (3). It may also lead to psychological coherence breakdown (4). Antonovsky introduced the concept of a sense of coherence in 1970 (5). Through a sense of coherence, it can be explained why an individual can withstand high-stress levels and remain healthy (7). Additionally, one of the psychological problems in cancer patients is death anxiety (10). According to Hong et al., cancer patients are at a high risk of death anxiety in facing various challenges, with 32% of advanced cancer patients showing death anxiety. Abnormally high levels of death anxiety can lead to psychological disorders and the avoidance of medical care (12). Accordingly, mindfulness is one of the psychological interventions with extensive evidence supporting its effectiveness in improving mental functioning in clinical and non-clinical populations (14). This treatment enables individuals to understand their experiences without judgment and change their relationships with others by accepting their beliefs and emotions (17). The use of group therapy is also a common therapeutic approach to reduce psychological distress and improve physical functioning in chronic patients (21). The goal of the Psychodynamics approach is to bring unconscious levels to consciousness. Dynamic therapists often bridge between reality and imagination, unconscious and conscious, logical and illogical, and thoughts and emotions (22). According to this approach, the presence of others increases the possibility of self-disclosure and provides an opportunity to observe internal problems (23). So far, no systematic study has been conducted in Iran on the impact of two dynamic group psychotherapy interventions on the sense of coherence and death anxiety in patients with colon cancer. Therefore, this research aims to determine whether there exists a difference between the effectiveness of dynamic group psychotherapy and mindfulness-based stress reduction therapy on the sense of coherence and death anxiety in patients with colon cancer. Methods: This quasi-experimental research adopted a pretest-posttest control group design with follow-up. The statistical population included all patients with colon cancer treated at the Poursina-Hakim Treatment Center in Isfahan during the spring of 2022. Among them, 42 were selected using Purposive sampling and assigned randomly to one of three 14-member groups: the mindfulness-based stress reduction group (receiving 8 treatment sessions), the psychodynamic therapy group (receiving 12 treatment sessions), and the control group. The research instruments included the Sense of Coherence (SOC) Scale and the Death Anxiety Scale (DAS). The research data were analyzed using repeated measures ANOVA and the Bonferroni post hoc test in SPSS version 26. Results: The results demonstrated a significant difference in the average scores of the resource between the experimental and control groups in the post-test (F=5.68, P=0.007) and follow-up (F=4.72, P=0.015) assessments of sense of coherence, as well as in the post-test (F=4.37, P=0.020) assessment of death anxiety after eliminating pre-test effects . Additionally, the Bonferroni follow-up test revealed that both interventions effectively and equally increased the sense of coherence in patients, with these positive effects persisting over time (P<0.05). However, only dynamic group psychotherapy significantly reduced patients' death anxiety (P<0.05), although this effect did not remain stable over time. Conclusion: To explain the effectiveness of mindfulness-based stress reduction therapy in improving the sense of coherence among cancer patients, it is important to note that mindfulness aims to cultivate non-judgmental awareness of the present moment. This can lead to considerable changes in the lives of patients and their psychological functioning. Developing defense mechanisms, and confronting and accepting physical and psychological challenges resulting from the illness, also contributes to improving psychological well-being and increasing internal coherence (38). Consequently, mindfulness moderates emotions without judgment increases cancer patients’ awareness of their mental and physical experiences, and helps them clearly see and accept their emotions and physical challenges as they occur (40). To elucidate the research findings on the effectiveness of dynamic group psychotherapy on cancer patient's sense of coherence and death anxiety, it's worth noting that the primary aim of group analytical therapy is to promote interaction among group members and enhance their awareness of group dynamics and individual intrapsychic conflicts (23). Group psychotherapy, in fact, encourages patients to access their true emotions by addressing their defense mechanisms, which often involve avoiding genuine emotional experiences and emotional intimacy due to past unsuccessful encounters. Indeed, a group serves as an environment that encourages participants to tap into their coping resources and, through self-disclosure, share their conflicts and stress-related experiences with others. This process helps dismantle emotional resistance and unveil ineffective defense mechanisms. One limitation of this study is its focus on colon cancer patients. Hence, caution should be exercised when generalizing the results to other patients with specific and chronic illnesses. Finally, considering the obtained results, it is recommended to conduct dynamic group psychotherapy sessions and mindfulness-based stress reduction therapy in hospitals, clinics, and medical centers to enhance coherence and psychological well-being and reduce anxiety disorders in cancer patients.</div> روان درمانی روان پویشی, کاهش استرس براساس بهوشیاری, حس انسجام, اضطراب مرگ Psychodynamic psychotherapy, Stress reduction based on mindfulness, Sense of coherence, Death anxiety 138 150 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7317-1&slc_lang=fa&sid=1 Leila Andalib لیلا عندلیب 3900319475328460076016 3900319475328460076016 No PhD Student in Health Psychology, Department of Health Psychology, Faculty of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran دانشجوی دکترای روانشناسی سلامت، گروه روانشناسی سلامت، دانشکده پزشکی، واحد نجف آباد، دانشگاه آزاد اسلامی، نجف آباد، ایران Hassan Rezayi Jamaloui حسن رضایی جمالویی h.rezayi2@yahoo.com 3900319475328460076017 3900319475328460076017 Yes Assistant Professor, Department of Health Psychology, Faculty of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran استادیار، گروه روانشناسی سلامت، دانشکده پزشکی، واحد نجف آباد، دانشگاه آزاد اسلامی، نجف آباد، ایران Seyed Mohammad Hassan Emami سید محمد حسن امامی 3900319475328460076018 3900319475328460076018 No Internist, Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran فوق تخصص داخلی، مرکز تحقیقات بیماری‌های گوارش پورسینای حکیم، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران Mojtaba Ansarishahidi مجتبی انصاری شهیدی 3900319475328460076019 3900319475328460076019 No Assistant Professor Department of Health Psychology, Faculty of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran استادیار، گروه روانشناسی سلامت، دانشکده پزشکی، واحد نجف آباد، دانشگاه آزاد اسلامی، نجف آباد، ایران