In collaboration with Payame Noor University and Iranian Health Psychology

Document Type : research

Authors

1 Ph.D Candidte of Halth Psychology, Islamic Azad University, Central Tehran Branch, Tehran, Iran

2 Assosiate Professor, Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran,

3 Assosiate Professor, Department o Psychology, Payame Nour University, Tehran, Iran

4 Assistante Professor, Department o Psychology, Sari Branch, Islamic Azad University, Sari, Iran

Abstract

Objectives: Diabetes is a chronic, multifaceted and threatening disease which has significant psychological complications. The purpose of this study was comparing the efficacy of Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy Skills Training (DBT-ST) on cognitive emotion regulation in patients with type II diabetes.
Method: The design of this quasi-experimental research was a pretest-posttest with a control group. The statistical population of the study included all patients with type II diabetes referred to Baghban (Touba) Medical Clinic in Sari in 2019, among whom 45 patients were selected through the convenience sampling method and then randomly assigned into three groups. The first group received ACT, the second group received DBT-ST, and the third group was considered as a control group. Data were collected using a 36-item Cognitive Emotion Regulation Questionnaire (Garnefsky et al., 2001) in three stages of pre-test, post-test, and follow-up, and were analyzed by repeated measurement variance analysis.
Results: The results showed that ACT and DBT-ST were significantly more effective on cognitive emotion regulation for the experimental groups compared to the control group (effect sizes 0.911 & 0.967, respectively). The effectiveness of DBT-ST compared to ACT was more significant on cognitive emotion regulation scores (effect sizes 0.967) at (P>0.01).
Conclusion: Based on the results of this study, it can be concluded that ACT improved psychological indexes and mental health of patients with type II diabetes due to acceptance of unfavorable emotions and thoughts, commitment, and DBT-ST for emotion regulation and mindfulness components.

Keywords

Article Title [Persian]

مقایسه اثر بخشی درمان مبتنی بر پذیرش و تعهد ACT و مهارت اموزی مبتنی بر رفتار درمانی دیالکتیکی (DBT-ST) برتنظیم شناختی هیجان در بیماران مبتلا به دیابت

Authors [Persian]

  • بهاره منتظرنیا 1
  • شیرین کوشکی 2
  • محمد اورکی 3
  • بهرام میرزاییان 4

1 Ph.D Candidte of Halth Psychology, Islamic Azad University, Central Tehran Branch, Tehran, Iran

2 Assosiate Professor, Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran,

3 Assosiate Professor, Department o Psychology, Payame Nour University, Tehran, Iran

4 Assistante Professor, Department o Psychology, Sari Branch, Islamic Azad University, Sari, Iran

Abstract [Persian]

دیابت بیماری با ماهیت مزمن، چند وجهی، تهدیدکننده و دارای پیامدهای روانشناختی قابل ملاحظه است. هدف این مطالعه مقایسه اثربخشی درمان مبتنی بر پذیرش و تعهد و مهارت آموزی مبتنی بر رفتار درمانی دیالکتیکی بر تنظیم شناختی هیجان در بیماران مبتلا به دیابت نوع 2 بود. روش‌: طرح پژوهش حاضر نیمه آزمایشی، از نوع پیش آزمون_ پس آزمون با گروه کنترل بود. جامعة آماری پژوهش حاضر تمامی بیماران مبتلا به دیابت نوع 2 مراجعه‌کننده به کلینیک پزشکی باغبان( طوبی) در شهر ساری بودند. از بین آن‌ها 45 نفر به شکل در دسترس انتخاب شدند و به طور تصادفی در دو گروه آزمایشی ACT و DBT-ST و یک گروه کنترل جای داده شدند.داده ها با استفاده از پرسشنامه تنظیم شناختی هیجان (گارنفسکی، 2001) گردآوری و با روش تحلیل ورایانس با اندازه گیری مکرر تجزیه و تحلیل شدند. یافته ها: نتایج نشان داد که هم ACT و هم DBT-ST منجر به افزایش تنظیم شناختی هیجان شده است(اندازه اثر به ترتیب 0/991 و 0/967 ). تاثیر DBT-ST نسبت به ACT بر نمرات تنظیم شناختی هیجان بیشتر بود( اندازه اثر 0/967 با P>0.01 ). نتیجه: بر اساس نتایج این مطالعه، می توان گفت ACT از طریق پذیرش احساسات و افکار ناخوشایند و تعهد و DBT-ST از طریق تنظیم هیجانی و ذهن آگاهی می توانند منجر به بهبود شاخص های روانشناختی و ارتقاء سلامت روانی بیماران مبتلا به دیابت نوع 2 شود.

Keywords [Persian]

  • ACT
  • DBT
  • تنظیم شناختی هیجان
  • دیابت
  • سلالمت
  1. Abdullah Pour, Morteza (2011). The Effectiveness of Life Skills Training on Changing the Attitude of High School Students in Sirjan City toward Drug Abuse, Master’s Thesis, Tehran, Allameh Tabatabaei University, School of Psychology and Education.

    Ahovan, Masood.; Balali, Saeede.; Abedi Shargh, Najmeh.; Doostian., Younes. (2016). Efficacy of Dialectical Behavior Therapy on Clinical Signs and Emotion Regulation in Patients with Obsessive-Compulsive Disorder. Mediterranean Journal of Social Sciences. Vol 7, No 4, 412-418.

    Alberti, S.; Spadella, CT.; Francischone TR.; Assis GF, Cestari, TM.; Taveira, LA. (2003). Exfoliative cytology of the oral mucosa in type II diabetic patients: morphology and cytomorphometry. Journal of Oral Pathology and Medicine. Oct; 32 (9): 538-43.

    Aldao, A.; Dixon-Gordon, K. L. (2014). Broadening the scope of research on emotion regulation strategies and psychopathology. Cognitive Behaviour Therapy. 43, 22–33.

    Aldao A.; Nolen-Hoeksema, S.; Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: a meta-analytic review. Clinical Psychology Review. 30, 217–237.

    Amini, Arezo,. Shariatmadar, Asiyeh.(2018) The effect of group dialectical behavioral therapy on catastrophe and rumination in mothers of mental retardation children. Quarterly of counseling culture and Psychotherapy Allameh Tabataba’i University.Vol. 9, No. 34, 171

    Amini, M.; Parvaresh E. (2009). Prevalence of macro- and microvascular complications among patients with type 2 diabetes in Iran: a systematic review. Diabetes research and clinical practice; 83: 18 – 25.

    Bahrebar, Saadeh., Ahadi,Hasan,. Aghayousefi, Alireza. (2019). The Effectiveness of Emotional Regulation and Coping Therapy Training on Life Style of Adolescent at Risk of Drug Abus. Iranian Journal of Health Psychology. Vol. 2, No. 1, p. 79-94.

    Baigan, K.; Khoshkonesh, A.; Habibi Askarabad, M.; Fallahzade, H. (206) Effectiveness of dialectical behavioral group therapy in alexithymia, stress, and diabetes symptoms among type 2 diabetes patients. J Diabetes Nurs. 4 (3) :8-18.

    Besharat, MA.; Bazzazian, S. (2014). Psychometri properties of the cognitive emotion regulation questionnaire in a sample of Iranian population]. Advances in Nursing & Midwifery, Volume: 24 Issue: 84, 2014. 61- 70.

    Blackledge, JT.; Hayes, SC.(2001). Emotion regulation in acceptance and commitment therapy. Journal of Clinical Psychology. 57(2):243-55.

    Bonora, Enzo, DeFronzo, Ralph A. (2018). Diabetes Complications, Comorbidities and Related Disorders. New York: Springer International Publishing.

    1. CDC. National diabetes statistics report. (2017). Atlanta, GA: US Department of Health and Human Services, CDC; 2017.https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.

    Chang, K. (2010). Comorbidities, quality of life and patients' willingness to pay for a cure for type 2 diabetes in Taiwan. Public Health. 124(5):284-94.

    Da Rocha, Fernandes J.; Ogurtsova, K.; Linnenkamp, U.; Guariguata, L.; Seuring, T.; Zhang, P.; Cavan, D.; Makaroff, LE. (2016). IDF Diabetes Atlas estimates of 2014 global health expenditures on diabetes. Diabetes Res Clin Pract; 117:48-54. 6.

    Darvish Baseri, L.; Dasht Bozorgi, Z. (2017). Effectiveness of Group Therapy Based on Acceptance and Commitment on Cognitive Emotion Regulation and Alexithymia of Patients with Type 2 Diabetes. Iranian Journal of Psychiatric Nursing (IJPN). 5 (1):7-14.

     Domaradzka, Ewa.; and  Fajkowska, Małgorzata.(2018).Cognitive Emotion Regulation Strategies in Anxiety and Depression Understood as Types of Personality. Frontiers Psychology. Jun 12.

    Fajkowska, M. (2013). Personality Coherence and Incoherence. A Perspective on Anxiety and Depression. New York: Eliot Werner Publications.

     Flaxman, Paul Edward.;   Blackledge, J. T.;  Bond, Frank W.(2011). Acceptance and Commitment Therapy: Distinctive Features. London: Taylor & Francis.

    Garnefski, N.; Kraaij, V.; & Spinhoven, P. (2001). Negative life events, cognitive emotion regulation and depression. Personality and Individual Differences, 30, 1311-1327.

    Garnefski, N.; Teerds, J.; Kraaij, V.; Legerstee, J.; & van den Kommer, T. (2004). Cognitive emotion regulation strategies and depressive symptoms: Differences between males and females. Personality and Individual Differences, 36, 267-276.

    George, RE.; Joseph, S. (2014). A review of newer treatment approaches for type-2 diabetes: Focusing safety and efficacy of incretin based therapy. Saudi Pharm J. 22(5):403-10.

    Ghiasvand, M., Ghorbani, M. Effectiveness of Emotion Regulation Training in Improving Emotion Regulation Strategies and Control Glycemic in Type 2 Diabetes Patients. Iranian Journal of Endocrinology and Metabolism. 2015; 17 (4):299-307.

    Gordon, Timothy; Borushok, Jessica. (2017). The ACT approach: A Comprehensive Guide for Acceptance and Commitment Therapy. Eau Claire: PESI Publishing & Media.

    Gross, James J.; Jazaieri, Hooria. (2014). Emotion, Emotion Regulation, and Psychopathology: An Affective Science Perspective. Clinical Psychological Science, Vol 2(4), 387–401.

    Gross, J. J.; John, O. P. (2003). Individual differences in to emotion regulation processes: implications for affect, relationships, and well-being. Journal of personality and social psychology. 85(2): 348.

    Hamidi Poor, Rahim; Ghotbian, Nayyereh.(2017). The Effectiveness of Acceptance and Commitment-Based Therapy (ACT) on Cognitive Emotion Regulation in Women with Glass Abuse in Arak. 4th International Conference on Recent Innovation in Psychology, Counseling and Behavioral Sciences.

    Hasani, jafar. (2010). The Psychometric Properties of the Cognitive Emotion Regulation Questionnaire (CERQ).  Journal of clinical psychology. Volume 2, Issue 3 - Serial Number 7. Pages 73-84.

    Hasani, jafar. (2011). The reliability and validity of the short form of the Persian version of the Cognitive Emotion Regulation Questionnaire. Journal of research of in behavioural sciences.  Volume 9 , Number 4 (20); Page(s) 229 - 240.

    Hayes, Steven C.; Strosahl, Kirk D.; & Wilson, Kelly G. (2012). Acceptance and Commitment Therapy, Second Edition: The Process and Practice. New York: Guilfford Press.  

    Hayes, S.C.; Levin, M.E, Plumb-Vilardaga, J, Villatte, J.L, Pistorello J. (2013). Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther ;44(2):180-98.

    Iri, Hamideh.; Makvandi, Behnam.; Bakhtiarpour, Saeed.; & Hafezi, Fariba.(2019). Comparison of the effectiveness of Acceptance and Commitment Therapy and Dialectical Behavioral Therapy on health anxiety, psychosocial adjustment and cognitive emotion regulation of divorced women. Medical Journal of Mashhad University of Medical Sciences. Vol. 61, Special Issue1 P: 88 -97.

    Kazemi Rezaei, V.; Kakabraee, K.; Hosseini, S S. (2019). The Effectiveness of teaching Emotion Regulation Skill Based on dialectical behavioral therapy on Psychological Distress and Cognitive Flexibility Cardiovascular Patients. IJPN. 7 (3) :31-40.

    Kiani, Ahmad Reza. Ghasmi, Neammoddin,. Poor Abbas, Ali. (2012). Comparison of the effectiveness of acceptance and commitment group psychotherapy and mindfulness on the degree of craving and cognitive regulation of emotion in Methamphetamin consumers. Quarterly Journal of Research on Addiction, Vol. 6, No. 24.

    Linehan, M.M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.

    Luoma, Jason B.; Hayes, Steven C.; Walser, Robyn D. (2017). Learning ACT: An Acceptance & Commitment Therapy Skills Training Manual for Therapists. Oakland: New Harbinger Publications, Inc.

    McKay M.; Wood J. C.; Brantley J. (2007). The Dialectical Behavior Therapy skills workbook: practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation & distress tolerance. Oakland: New Harbinger publication.

    Miller A.L.; Rathus J.H.; Linehan M.M. (2006). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.

    Mohammadi, L.; Salehzade, M.; Nasirian, M. (2015). Effectiveness of Acceptance and Commitment Therapy on Cognitive Emotion Regulation in Men under Methadone Treatment. J Shahid Sadoughi Univ Med Sci. 23(9): 853-61.

    Nash, Jen. (2013). Diabetes and Wellbeing: Managing the psychological and emotional challenges of diabetes types 1 and 2. New York: John Wiley & Sons.

    Ochsner, K.N.; Gross, J.J. (2005). The cognitive control of emotion. Trends in Cognitive Sciences. 9(5):242-9.

    Peykari, N. (2015). A comprehensive study on national and sub-national trends, burden, and in-equality of Fasting Plasma Glucose and Diabetes prevalence in Iranian population (1990 – 2013). Epidemiological Science, PhD [ thesis]. Tehran(Iran): EMRI, Tehran University of Medical Sciences.

    Poretsky, Leonid. (2017). Principles of Diabetes Mellitus. New York: Springer International Publishing.

    Richman, Smart L.; Kubzansky, L.; Maselko, J. (2005).  Positive Emotion and Health: Going Beyond the Negative. Journal of Health Psychology.  24: 422-9.

    Schneider, H.; Shaw, J.; Zimmet, P. (2003). Guidelines for the detection of diabetes mellitus - diagnostic criteria and rationale for screening. Clinical Biochemist Reviews. Aug; 24 (3): 77-80.

     Sheets, Melanie Gordon. (2009). Out-of-Control: A Dialectical Behavior Therapy (DBT) - Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior. New York: Recovery Works Publications.

    Snock, FJ.; Nicols, CW.; Ven, VD.; Lubach, C. (1999). Cognitive Behavioral Group Training for Poorly Controlled Type 1 Diabetes Patients: A Psychoeducational Approach. Diabetes Spectrum. 12: 147-9.

    Sturt J, Dennick K.; Due-Christensen, M.; McCarthy, K. (2015). The detection and management of diabetes distress in people with type 1 diabetes. Current Diabetes Reports. 15(11):101.

    Tamannaeifar, Shima.; Gharraee, Banafsheh.; Birashk, Behrooz.; Habibi, Mojtaba. (2014). A Comparative Effectiveness of Acceptance and Commitment Therapy and Group Cognitive Therapy for Major Depressive Disorder. Zahedan Journal of Research in Medical Sciences (ZJRMS). 2014 Oct; 16(Suppl 1): 60-63

    White, Graig A. (2001). Cognitive behaviour therapy for chronic medical problems: a guide to assesment and treatment in practice. New York:Wiley.

    Yamagishi, Sho-ichi. (2018). Diabetes and Aging-related Complications. New York: Springer.

    Yaraghchi, A.; Jomehri F.; Seyrafi, M.; Kraskian Mujembari, A.; Mohammadi Farsani, G. (2019). The Effectiveness of Acceptance and Commitment Therapy on Weight Loss and Cognitive Emotion Regulation in Obese Individuals. Iran J Health Educ Health Promot7 (2):192-201.

    Yazdi, Mashaallah., Saffarnia, Majid, and Zare, Hossein (2020). Comparison of the Effectiveness of Quality of Life Based Therapy and Emotion Regulation Therapy on Biomarkers (HbA1C and Blood Glucose) in Patients with Type2 Diabete. Quarterly Journal of Health Psychology. Vol. 9, No. 1, 61-78.