Volume 23, Issue 5 (12-2024)
TB 2024, 23(5): 50-65 |
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Ethics code: IR.KMU.REC.1402.300
Clinical trials code: IRCT20230212057396N1
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Mehrinejad A, Mehrinejad A, khosravi Z, kamali H. The Effectiveness of Mindfulness Integrated Cognitive Behavioral Therapy on Negative Emotions and Cognitive Regulation of Emotions in Patients with Multiple Sclerosis: A Clinical Trial Study. TB 2024; 23 (5) :50-65
URL: http://tbj.ssu.ac.ir/article-1-3678-en.html
URL: http://tbj.ssu.ac.ir/article-1-3678-en.html
University of Alzahra Tehran , S.mehrinejad@alzahra.ac.ir
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The Effectiveness of Mindfulness Integrated Cognitive Behavioral Therapy on Negative Emotions and Cognitive Regulation of Emotions in Patients with Multiple Sclerosis: A Clinical Trial Study
Atefeh Fakhrmand(Ph.D.s)1, Seyyed Abolghasem Mehrinejad(Ph.D.)2, Zohre khosravi(Ph.D.)3,
Hoda kamali(M.D)4
1.Ph.D. student Psychology, Department of Psychology, University of Alzahra, Tehran, Iran.
2.Corresponding Author: Associate Professor Department of Psychology, Faculty of Education and Psychology, University of Alzahra, Tehran, Iran. Email: s.mehrinejad@alzahra.ac.ir Tel: +98-21-85692303
3.Professor Department of Psychology, Faculty of Education and Psychology, University of Alzahra, Tehran, Iran.
4.Assistant Professor Department of Neurology, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Introduction: Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system. Patients with MS suffer from problems such as negative emotions and poor emotion regulation. The present study investigated the effectiveness of mindfulness integrated cognitive behavioral therapy (MICBT) on negative emotions and emotion regulation in patients with MS.
Methods: This research was a semi-experimental study using a pre-test-post-test with a control group. A total of 52 patients with MS referring to Shafa Hospital in Kerman city, were selected by the convenience sampling method in 2023 and were randomly divided into two experimental (26 people) and control (26 people) groups. Patients completed the questionnaire of depression, anxiety and stress scale-21 items (DASS-21) and cognitive emotion regulation questionnaire of Garnefski in the pre-test and post-test. The data were analyzed in the descriptive section using independent t-test and chi-square tests, and in the inferential section using multivariate analysis of covariance, using SPSS-24 software.
Results: The results of covariance analysis showed that there was a significant difference between the groups in depression, stress, anxiety, positive and negative emotional strategies in the post-test (P< 0/001). Comparison of mean values showed that in the MICBT group, depression (14/46), stress (16/85) and anxiety (11/38) and negative emotion regulation strategies (M=35/38) decreased, while positive emotion regulation strategies (M=75/35) increased significantly.
Conclusion: MICBT is suggested as an effective method in reducing depression, stress, anxiety and improving cognitive regulation of emotions in patients with MS.
Keywords :Multiple Sclerosis, Emotions, Depression, Emotion Regulation, Mindfulness
1-Komar A, Dickson K, Alavinia M & et al. Effects of mindfulness-based interventions on cognition in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Psychiatry. 2024;15:1339851.
2-Klineova S, Lublin FD. Clinical course of multiple sclerosis. Cold Spring Harbor perspectives in medicine. 2018;8(9):a028928.
3-Siger M. Magnetic resonance imaging in primary progressive multiple sclerosis patients. Clinical Neuroradiology. 2022;32(3):625-41.
4-Taghizadeh ME. Miralaei MS The study of the efectiveness of group spirituality therapy on resilience of woman with multiple sclerosis, city of Isfahan. Health Psychol. 2013;2:82-102. [Persian]
5-Voskuhl RR, Patel K, Paul F & et al. Sex differences in brain atrophy in multiple sclerosis. Biology of sex Differences. 2020;11:1-0.
6-Nobakht H, Nourimoghadam S, Nikmanesh Z. The Effectiveness-Based Stress Reduction group Therapy in Emotion Regulation Among Multiple Sclerosis Patients. Medical-Surgical Nursing Journal. 2021;10(3).
7-Dacosta-Aguayo R, Genova H, Chiaravalloti ND & et al. Neuroimaging and rehabilitation in multiple sclerosis. Cognitive Rehabilitation and Neuroimaging: Examining the Evidence from Brain to Behavior. 2020:117-38.
8-Gómez-López A, Benito-León J, Labiano-Fontcuberta A & et al. Impact of a specific consultation for patients with progressive forms of multiple sclerosis on the response to their unmet care needs: a cross-sectional study. Multiple Sclerosis and Related Disorders. 2023;72:104609.
9-Sparaco M, Lavorgna L, Bonavita S. Psychiatric disorders in multiple sclerosis. Journal of neurology. 2021;268:45-60.
10-Karimi M, Salimi SH. The Comparative Scrutiny of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) Impacts on Depression amongst the Multiple Sclerosis (MS) Patients. Nurse and Physician Within War. 2019;7(22):74-80.
11-Mujidin M, Nuryoto S, Rustam HK, Hildaratri A & et al. The role of emotion regulation and empathy in students displaying cyberbullying. Humanitas: Indonesian Psychological Journal. 2023:21-8.
12-Milyavsky M, Webber D, Fernandez JR & et al. To reappraise or not to reappraise? Emotion regulation choice and cognitive energetics. Emotion. 2019;19(6):964.
13-Eggermont K, Raymaekers K, Claes L & et al. Impairment in personality functioning throughout adolescence and co-development with personality traits, emotion regulation strategies, and psychopathology. Journal of Research in Personality. 2023;104:104380.
14-Meidahl H. The Impact of Emotion Regulation on ADHD and Depressive Symptoms in Emerging Adults.
15-Tarrant R. An examination of emotion regulation and health-related quality of life in patients with Multiple Sclerosis (Doctoral dissertation, Memorial University of Newfoundland).
16-Nauta IM, van Dam M, Bertens D & et al. Improved quality of life and psychological symptoms following mindfulness and cognitive rehabilitation in multiple sclerosis and their mediating role for cognition: a randomized controlled trial. Journal of neurology. 2024:1-2.
17-McIntosh GE, Liu ES, Allan M & et al. Clinical practice guidelines for the detection and treatment of depression in multiple sclerosis: a systematic review. Neurology: Clinical Practice. 20
;13(3):e200154.
18-Kalb R, Beier M, Benedict RH & et al. Recommendations for cognitive screening and management in multiple sclerosis care. Multiple Sclerosis Journal. 2018;24(13):1665-80.
19-FazilatPour M, Nasab SH, Ebrahimi HA. Effectiveness of mindfulness integrated cognitive behavioral therapy on the emotional states and quality of life of patients with multiple sclerosis: A clinical trial study. Koomesh. 2024;22(3):446-51.[Persian]
20-Kruse JA, Seng EK. Changes in cognitive appraisal in a randomized controlled trial of mindfulness based cognitive therapy for patients with migraine. Headache: The Journal of Head and Face Pain. 2023;63(10):1403-11.
21-Kang JY, Lee MK, Fairchild EM & et al. Relationships among organizational values, employee engagement, and patient satisfaction in an academic medical center. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2020;4(1):8-20.
22-Strauss C, Bibby-Jones AM, Jones F& et al. Clinical effectiveness and cost-effectiveness of supported mindfulness-based cognitive therapy self-help compared with supported cognitive behavioral therapy self-help for adults experiencing depression: the Low-Intensity Guided Help Through Mindfulness (LIGHTMind) randomized clinical trial. JAMA psychiatry. 2023;80(5):415-24.
23-Cayoun BA. Mindfulness-integrated CBT: Principles and practice. John Wiley & Sons; 2011.
24-Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. Hachette UK; 2023.
25-Eaton AD, Rourke SB, Craig SL& et al. Mindfulness and cognitive training interventions that address intersecting cognitive and aging needs of older adults. Journal of Social Work. 2024;24(1):126-45.
26-Raugh IM, Strauss GP. Integrating mindfulness into the extended process model of emotion regulation: The dual-mode model of mindful emotion regulation. Emotion. 2023:16.
27-Grossman P, Kappos L, Gensicke H & et al. MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial.Neurology. 2010 75(13):1141–1149.
28-Aliehkolaei MN, Ghalandari E, Mostafavi E. Effectiveness of Mindfulness-Based Therapy on Emotion Regulation and Perception of Rejection in Women with Multiple Sclerosis. Health Nexus. 2023;1(3):106-13.
29-Mantero V, Abate L, Balgera R & et al. Clinical application of 2017 McDonald diagnostic criteria for multiple sclerosis. Journal of clinical neurology (Seoul, Korea). 2018;14(3):387.
30-Rocha LF, Hernandez JA, Falcone EM. Latent structure evidence of the Depression, Anxiety and Stress Scales-Short Form. Estudos de Psicologia (Campinas). 2021;38:e190103.
31-Kakemam E, Albelbeisi AH, Zavieh SA & et al. Prevalence of depression, anxiety, and stress among Iranian nurses during the COVID-19 outbreak and their related factors. Israa University Journal of Applied Science. 2022;6(2):118-38.
32-Duru E, Balkıs M. COVID-19 related negative life events and psychological distress: the role of emotion and cognitive emotion regulation strategies. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2024;42(1):69-91.
33-Francis SE, Shawyer F, Cayoun BA & et al. Differentiating mindfulness-integrated cognitive behavior therapy and mindfulness-based cognitive therapy clinically: the why, how, and what of evidence-based practice. Frontiers in Psychology. 2024;15:1342592.
34-Pouyanfard S, Mohammadpour M, ParviziFard AA & et al. Effectiveness of mindfulness-integrated cognitive behavior therapy on anxiety, depression and hope in multiple sclerosis patients: a randomized clinical trial. Trends in psychiatry and psychotherapy. 2020;42(1):55-63.
35-Nobakht H, Nourimoghadam S, Nikmanesh Z. The Effectiveness of Mindfulness-Based Stress Reduction Group Therapy in Emotion Regulation Among Multiple Sclerosis Patients. Medical-Surgical Nursing Journal. 2021;10(3).
36-Akbarzadeh M, Sabahi P, Moradi A. Effectiveness of mindfulness-based cognitive therapy and transcranial direct-current stimulation on worry and emotion regulation in fibromyalgia patients. Koomesh. 2022;24(5):648-60.
37-Ghodspour Z, Najafi M, Rahimian Boogar I. Effectiveness of mindfulness-based cognitive therapy on psychological aspects of quality of life, depression, anxiety, and stress among patients with multiple sclerosis. PCP 2018; 6. [Persian]
38-Baumeister A, Böger S, Schindler L & et al. Effectiveness of an abbreviated version of the automated attention training technique (ATT) for stress reduction in a non-clinical sample—A randomized controlled trial. Journal of Contextual Behavioral Science. 2024;32:100772.
39-Zargar F, Fahim A, Nikgoftar N & et al. Comparing the effect of internet-delivered short-term progressive muscle relaxation and psychoeducation on mindful ability, visceral hypersensitivity and symptoms of patients with irritable bowel syndrome. Journal of Education and Health Promotion. 2023;12(1):259.
Atefeh Fakhrmand(Ph.D.s)1, Seyyed Abolghasem Mehrinejad(Ph.D.)2, Zohre khosravi(Ph.D.)3,
Hoda kamali(M.D)4
1.Ph.D. student Psychology, Department of Psychology, University of Alzahra, Tehran, Iran.
2.Corresponding Author: Associate Professor Department of Psychology, Faculty of Education and Psychology, University of Alzahra, Tehran, Iran. Email: s.mehrinejad@alzahra.ac.ir Tel: +98-21-85692303
3.Professor Department of Psychology, Faculty of Education and Psychology, University of Alzahra, Tehran, Iran.
4.Assistant Professor Department of Neurology, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Introduction: Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system. Patients with MS suffer from problems such as negative emotions and poor emotion regulation. The present study investigated the effectiveness of mindfulness integrated cognitive behavioral therapy (MICBT) on negative emotions and emotion regulation in patients with MS.
Methods: This research was a semi-experimental study using a pre-test-post-test with a control group. A total of 52 patients with MS referring to Shafa Hospital in Kerman city, were selected by the convenience sampling method in 2023 and were randomly divided into two experimental (26 people) and control (26 people) groups. Patients completed the questionnaire of depression, anxiety and stress scale-21 items (DASS-21) and cognitive emotion regulation questionnaire of Garnefski in the pre-test and post-test. The data were analyzed in the descriptive section using independent t-test and chi-square tests, and in the inferential section using multivariate analysis of covariance, using SPSS-24 software.
Results: The results of covariance analysis showed that there was a significant difference between the groups in depression, stress, anxiety, positive and negative emotional strategies in the post-test (P< 0/001). Comparison of mean values showed that in the MICBT group, depression (14/46), stress (16/85) and anxiety (11/38) and negative emotion regulation strategies (M=35/38) decreased, while positive emotion regulation strategies (M=75/35) increased significantly.
Conclusion: MICBT is suggested as an effective method in reducing depression, stress, anxiety and improving cognitive regulation of emotions in patients with MS.
Keywords :Multiple Sclerosis, Emotions, Depression, Emotion Regulation, Mindfulness
1-Komar A, Dickson K, Alavinia M & et al. Effects of mindfulness-based interventions on cognition in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Psychiatry. 2024;15:1339851.
2-Klineova S, Lublin FD. Clinical course of multiple sclerosis. Cold Spring Harbor perspectives in medicine. 2018;8(9):a028928.
3-Siger M. Magnetic resonance imaging in primary progressive multiple sclerosis patients. Clinical Neuroradiology. 2022;32(3):625-41.
4-Taghizadeh ME. Miralaei MS The study of the efectiveness of group spirituality therapy on resilience of woman with multiple sclerosis, city of Isfahan. Health Psychol. 2013;2:82-102. [Persian]
5-Voskuhl RR, Patel K, Paul F & et al. Sex differences in brain atrophy in multiple sclerosis. Biology of sex Differences. 2020;11:1-0.
6-Nobakht H, Nourimoghadam S, Nikmanesh Z. The Effectiveness-Based Stress Reduction group Therapy in Emotion Regulation Among Multiple Sclerosis Patients. Medical-Surgical Nursing Journal. 2021;10(3).
7-Dacosta-Aguayo R, Genova H, Chiaravalloti ND & et al. Neuroimaging and rehabilitation in multiple sclerosis. Cognitive Rehabilitation and Neuroimaging: Examining the Evidence from Brain to Behavior. 2020:117-38.
8-Gómez-López A, Benito-León J, Labiano-Fontcuberta A & et al. Impact of a specific consultation for patients with progressive forms of multiple sclerosis on the response to their unmet care needs: a cross-sectional study. Multiple Sclerosis and Related Disorders. 2023;72:104609.
9-Sparaco M, Lavorgna L, Bonavita S. Psychiatric disorders in multiple sclerosis. Journal of neurology. 2021;268:45-60.
10-Karimi M, Salimi SH. The Comparative Scrutiny of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) Impacts on Depression amongst the Multiple Sclerosis (MS) Patients. Nurse and Physician Within War. 2019;7(22):74-80.
11-Mujidin M, Nuryoto S, Rustam HK, Hildaratri A & et al. The role of emotion regulation and empathy in students displaying cyberbullying. Humanitas: Indonesian Psychological Journal. 2023:21-8.
12-Milyavsky M, Webber D, Fernandez JR & et al. To reappraise or not to reappraise? Emotion regulation choice and cognitive energetics. Emotion. 2019;19(6):964.
13-Eggermont K, Raymaekers K, Claes L & et al. Impairment in personality functioning throughout adolescence and co-development with personality traits, emotion regulation strategies, and psychopathology. Journal of Research in Personality. 2023;104:104380.
14-Meidahl H. The Impact of Emotion Regulation on ADHD and Depressive Symptoms in Emerging Adults.
15-Tarrant R. An examination of emotion regulation and health-related quality of life in patients with Multiple Sclerosis (Doctoral dissertation, Memorial University of Newfoundland).
16-Nauta IM, van Dam M, Bertens D & et al. Improved quality of life and psychological symptoms following mindfulness and cognitive rehabilitation in multiple sclerosis and their mediating role for cognition: a randomized controlled trial. Journal of neurology. 2024:1-2.
17-McIntosh GE, Liu ES, Allan M & et al. Clinical practice guidelines for the detection and treatment of depression in multiple sclerosis: a systematic review. Neurology: Clinical Practice. 20
;13(3):e200154.
18-Kalb R, Beier M, Benedict RH & et al. Recommendations for cognitive screening and management in multiple sclerosis care. Multiple Sclerosis Journal. 2018;24(13):1665-80.
19-FazilatPour M, Nasab SH, Ebrahimi HA. Effectiveness of mindfulness integrated cognitive behavioral therapy on the emotional states and quality of life of patients with multiple sclerosis: A clinical trial study. Koomesh. 2024;22(3):446-51.[Persian]
20-Kruse JA, Seng EK. Changes in cognitive appraisal in a randomized controlled trial of mindfulness based cognitive therapy for patients with migraine. Headache: The Journal of Head and Face Pain. 2023;63(10):1403-11.
21-Kang JY, Lee MK, Fairchild EM & et al. Relationships among organizational values, employee engagement, and patient satisfaction in an academic medical center. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2020;4(1):8-20.
22-Strauss C, Bibby-Jones AM, Jones F& et al. Clinical effectiveness and cost-effectiveness of supported mindfulness-based cognitive therapy self-help compared with supported cognitive behavioral therapy self-help for adults experiencing depression: the Low-Intensity Guided Help Through Mindfulness (LIGHTMind) randomized clinical trial. JAMA psychiatry. 2023;80(5):415-24.
23-Cayoun BA. Mindfulness-integrated CBT: Principles and practice. John Wiley & Sons; 2011.
24-Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. Hachette UK; 2023.
25-Eaton AD, Rourke SB, Craig SL& et al. Mindfulness and cognitive training interventions that address intersecting cognitive and aging needs of older adults. Journal of Social Work. 2024;24(1):126-45.
26-Raugh IM, Strauss GP. Integrating mindfulness into the extended process model of emotion regulation: The dual-mode model of mindful emotion regulation. Emotion. 2023:16.
27-Grossman P, Kappos L, Gensicke H & et al. MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial.Neurology. 2010 75(13):1141–1149.
28-Aliehkolaei MN, Ghalandari E, Mostafavi E. Effectiveness of Mindfulness-Based Therapy on Emotion Regulation and Perception of Rejection in Women with Multiple Sclerosis. Health Nexus. 2023;1(3):106-13.
29-Mantero V, Abate L, Balgera R & et al. Clinical application of 2017 McDonald diagnostic criteria for multiple sclerosis. Journal of clinical neurology (Seoul, Korea). 2018;14(3):387.
30-Rocha LF, Hernandez JA, Falcone EM. Latent structure evidence of the Depression, Anxiety and Stress Scales-Short Form. Estudos de Psicologia (Campinas). 2021;38:e190103.
31-Kakemam E, Albelbeisi AH, Zavieh SA & et al. Prevalence of depression, anxiety, and stress among Iranian nurses during the COVID-19 outbreak and their related factors. Israa University Journal of Applied Science. 2022;6(2):118-38.
32-Duru E, Balkıs M. COVID-19 related negative life events and psychological distress: the role of emotion and cognitive emotion regulation strategies. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2024;42(1):69-91.
33-Francis SE, Shawyer F, Cayoun BA & et al. Differentiating mindfulness-integrated cognitive behavior therapy and mindfulness-based cognitive therapy clinically: the why, how, and what of evidence-based practice. Frontiers in Psychology. 2024;15:1342592.
34-Pouyanfard S, Mohammadpour M, ParviziFard AA & et al. Effectiveness of mindfulness-integrated cognitive behavior therapy on anxiety, depression and hope in multiple sclerosis patients: a randomized clinical trial. Trends in psychiatry and psychotherapy. 2020;42(1):55-63.
35-Nobakht H, Nourimoghadam S, Nikmanesh Z. The Effectiveness of Mindfulness-Based Stress Reduction Group Therapy in Emotion Regulation Among Multiple Sclerosis Patients. Medical-Surgical Nursing Journal. 2021;10(3).
36-Akbarzadeh M, Sabahi P, Moradi A. Effectiveness of mindfulness-based cognitive therapy and transcranial direct-current stimulation on worry and emotion regulation in fibromyalgia patients. Koomesh. 2022;24(5):648-60.
37-Ghodspour Z, Najafi M, Rahimian Boogar I. Effectiveness of mindfulness-based cognitive therapy on psychological aspects of quality of life, depression, anxiety, and stress among patients with multiple sclerosis. PCP 2018; 6. [Persian]
38-Baumeister A, Böger S, Schindler L & et al. Effectiveness of an abbreviated version of the automated attention training technique (ATT) for stress reduction in a non-clinical sample—A randomized controlled trial. Journal of Contextual Behavioral Science. 2024;32:100772.
39-Zargar F, Fahim A, Nikgoftar N & et al. Comparing the effect of internet-delivered short-term progressive muscle relaxation and psychoeducation on mindful ability, visceral hypersensitivity and symptoms of patients with irritable bowel syndrome. Journal of Education and Health Promotion. 2023;12(1):259.
Type of Study: Research |
Subject:
Psychology
Received: 2024/08/5 | Accepted: 2024/10/27 | Published: 2024/12/30
Received: 2024/08/5 | Accepted: 2024/10/27 | Published: 2024/12/30
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