Comparison of Acceptance and Commitment Therapy and Spiritual Therapy in Reducing Fear of Relapse among Patients with Breast Cancer
SALĀMAT-I IJTIMĀĪ (Community Health),
Vol. 8 No. 3,
11 July 2021
,
Page 413-426
https://doi.org/10.22037/ch.v8i3.31223
Abstract
Background and Objective: Among different types of cancers, breast cancer is the most common cancer in women that causes many physical and psychological problems among patients. The objective of this study was to compare the effect of acceptance and commitment therapy and spiritual therapy on reducing the fear of relapse among women with breast cancer.
Materials and Methods: This study was quasi-experimental with pre-test and post-test and control group. Participants included 45women with breast cancer who were referred to the cancer treatment clinic in February 2019, who were selected by convenience sampling method and were divided into three groups based on acceptance and commitment, spiritual therapy and control group (15 people each). The first experimental group underwent acceptance and commitment therapy in eight 90-minute sessions per week. The second experimental group, under spiritual therapy. Participated in nine 90-minute sessions per week. The control group did not receive any intervention. The instrument used in this study was a shortened 12-item fear of recurrence questionnaire. Data were analyzed using univariate analysis of covariance via SPSS software version 22.
Results: In the acceptance and commitment therapy group, the mean (SD) score of fear of relapse decreased from 40.2 (9.2) in the pre-test to 36.4 (9.3) in the post-test, P<0.001. In the spiritual therapy group, the mean (SD) score of fear of relapse decreased from 41.2 (12.5) in the pre-test to 39.1 (12.6) in the post-test, P<0.001. However, in the control group, the mean (SD) score of fear of disease recurrence decreased from 37.7 (9.8) in the pre-test to 38.1 (10.2) in the post-test, but this difference was not statistically significant.
Conclusion: The study showed that acceptance and commitment therapy and spirituality therapy both reduced the fear of relapse in women with breast cancer; however, the effect of acceptance and commitment therapy was greater than spiritual therapy.
How to cite this article: Ahmadi A,Vaziri S, Ahi G, Kashani F, Akbari M. Comparison of Acceptance and Commitment Therapy and Spiritual Therapy in Reducing Fear of Relapse among Patients with Breast Cancer. Salāmat-i ijtimā̒ī (Community Health). 2021; 8(3):404-414. DOI: http://doi.org/10.22037/ch.v8i3.31223.
Corresponding Author: ShahramVaziri, Email: vaziri@riau.ac.ir
Extended Abstract
Introduction: Among different types of cancers, breast cancer is the most common cancer in women that causes many physical and psychological problems among patients. One of the most troubling factors that affect patients is the recurrence of breast surgery, which may cause severe anxiety among patients. Fear of recurrence is a complication that could occur in more than 77% of cancer survivors (1). Despite the known adverse effects of fear of cancer recurrence on mental health and quality of life, few studies have examined the interventions on the fear of cancer recurrence (2). However, studies have shown that fear of cancer recurrence is associated with lower emotional health and quality of life, higher physical and mental fatigue, and more anxiety and depression in cancer survivors (3). Therefore, therapists come to aid these patients with two approaches of pharmacological and psychological therapies, which include therapies based on psychological methods and pharmacological therapies (4). One of these new psychological approaches that effectively reduce psychological distress is acceptance and commitment-based therapy (5), which focuses on psychological events and processes such as thought and emotion and a strong emphasis on purposeful values and flexible behaviors (6). Spirituality can also play an essential role in having a purposeful life in accordance with the patient's values. In order for the therapist to have a positive and decisive effect on the patient’s physical and mental health, he must also address the patient's spiritual issues in the treatment process. In the experience of living with cancer, spirituality is considered an important and prominent dimension of a healthy life and it seems that the threatening nature of cancer increases the spiritual needs of patients (7). The objective of this study was to compare the effect of acceptance and commitment therapy and spiritual therapy on reducing the fear of relapse among women with breast cancer.
Materials and methods: This study was quasi-experimental with a pre-test and post-test, and control group. Participants included 45women with breast cancer who were referred to the cancer treatment clinic in February 2019, who were selected by convenience sampling method and were divided into three groups based on acceptance and commitment, spiritual therapy and control group (15 people each). The first experimental group underwent acceptance and commitment therapy in eight 90-minute sessions per week. The second experimental group, under spiritual therapy, participated in nine 90-minute sessions per week. The control group did not receive any intervention. The instrument used in this study was a shortened 12-item fear of recurrence questionnaire (8). Data were analyzed using univariate analysis of covariance via SPSS software version 22.
Results: In the acceptance and commitment therapy group, the mean (SD) score of fear of relapse decreased from 40.2 (9.2) in the pre-test to 36.4 (9.3) in the post-test, P<0.001. In the spiritual therapy group, the mean (SD) score of fear of relapse decreased from 41.2 (12.5) in the pre-test to 39.1 (12.6) in the post-test, P<0.001. However, in the control group, the mean (SD) score of fear of disease recurrence decreased from 37.7 (9.8) in the pre-test to 38.1 (10.2) in the post-test, but this difference was not statistically significant.
Discussion: Acceptance and commitment therapy reduces the fear of disease recurrence in women with breast cancer. This finding was consistent with the results of another study (9) on the effectiveness of acceptance and commitment therapy on fear of cancer recurrence and post-traumatic stress disorder among breast cancer patients. Acceptance and commitment therapy reduces the fear of cancer recurrence by helping patients to accept existing conditions and act responsibly. In addition, spiritual therapy reduces the fear of relapse in women with breast cancer. This finding was consistent with the results of another study (10) on the effect of group spiritual therapy on cognitive emotion regulation in women with breast cancer. Acceptance and commitment therapy had a more significant effect on reducing the fear of relapse in women with breast cancer compared to spiritual therapy. Acceptance and commitment therapy seems to reduce the fear of cancer recurrence by helping patients to accept existing conditions and act responsibly. Given that cancer is a chronic disease and affects a person's life, it seems that this psychological intervention by changing the perspective on the suffering of the disease and its acceptance and committed action to personal values can reduce negative thoughts and emotions in these patients and reduce the psychological consequences of the disease and improve patients' well-being (11).
Conclusion: The study showed that acceptance and commitment therapy and spirituality therapy both reduced the fear of relapse in women with breast cancer; however, the effect of acceptance and commitment therapy was greater than spiritual therapy.
Acknowledgment: This study was derived from the doctoral dissertation of Seyyed Ali Ahmadi. Authors would like to thank all participants of the study.
Conflict of Interest: None of the authors has any conflict of interest to disclose.
Ethical publication statement: We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Ethical code: IR.BUMS.REC.1399.238.
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[This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License]
- Acceptance and commitment therapy; Spiritual therapy; Breast cancer; Fear of recurrence
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References
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