Volume 24, Issue 5 (7-2026)
TB 2026, 24(5): 91-107 |
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Bagheri Sheykhangafshe F, Rezaei N, Azarian Ghurtlar M, Panahi M, Fathi Ashtiani A. The Effectiveness of Group Reality Therapy on Spiritual Health, Perceived Social Support and Mental Toughness in Colon Cancer Patients. TB 2026; 24 (5) :91-107
URL: http://tbj.ssu.ac.ir/article-1-3869-en.html
URL: http://tbj.ssu.ac.ir/article-1-3869-en.html
Farzin Bagheri Sheykhangafshe * 
, Nahid Rezaei , Mina Azarian Ghurtlar , Maryam Panahi , Ali Fathi Ashtiani
, Nahid Rezaei , Mina Azarian Ghurtlar , Maryam Panahi , Ali Fathi Ashtiani
Ph.D., Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran , farzinbagheri73@gmail.com
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The Effectiveness of Group Reality Therapy on Spiritual Health, Perceived Social Support and Mental Toughness in Colon Cancer Patients
Farzin Bagheri Sheykhangafshe (Ph.D.)1, Nahid Rezaei (M.A.)2, Mina Azarian Ghurtlar (M.A.)3, Maryam Panahi (M.A.)4, Ali Fathi Ashtiani (Ph.D.)5
1.Corresponding author: Ph.D., Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran. Email: farzinbagheri@modares.ac.ir Tel: +982182885048
2.M.A in General Psychology, Faculty of Humanities, Islamic Azad University, Shiraz Branch, Shiraz, Iran
3.M.A in Clinical Psychology, Faculty of Humanities, Islamic Azad University, Ardabil Branch, Ardabil, Iran
4.Master of Clinical Psychology, Islamic Azad University, Ardabil Branch, Ardabil, Iran
5.Professor, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Abstract
Introduction: Colorectal cancer is a life-threatening disease that affects not only physical health but also the psychological and social well-being of patients. This study aimed to investigate the effectiveness of group reality therapy on spiritual health, perceived social support, and mental toughness in patients with colorectal cancer.
Methods: This study employed a quasi‑experimental design with a pretest–posttest and a control group. The statistical population consisted of patients who referred to cancer treatment and support centers in Tehran in 2024. A total of 36 patients who had received a confirmed diagnosis of colorectal cancer from a specialist were selected through convenience sampling and randomly assigned to the experimental group (n=18) and the control group (n=18). Data collection instruments included the Spiritual Health Scale, the Multidimensional Scale of Perceived Social Support, and the Mental Toughness Scale. The experimental group received 10 sessions of 60minute group reality therapy. Data were analyzed using multivariate analysis of covariance.
Results: Findings indicated that group reality therapy significantly improved religious health (F= 42/73), existential health (F=61/44), family support (F=45/98), friends’ support (F=53/77), support from other important people(F= 43/88), and mental toughness (F=48/01) in patients with colorectal cancer (p< 0/001).
Conclusion: Group reality therapy may be effective in enhancing psychological capacities, strengthening social support resources, and increasing resilience in patients facing life-threatening illnesses. This approach, by emphasizing personal responsibility and improving interpersonal relationships, may help patients better adapt to the disease and the treatment process.
Keywords: Group Reality Therapy, Spiritual Health, Social Support, Mental Toughness, Colon Cancer
Conflict of interest: The authors declared no conflict of interest.
References
1-Kazemi E, Zayeri F, Baghestani A & at al. Trends of colorectal cancer incidence, prevalence and mortality in worldwide from 1990 to 2017. Iranian Journal of Public Health. 2023;52(2):436.
2-Majano SB, Lyratzopoulos G, de Wit NJ & et al. Mental health morbidities and time to cancer diagnosis among adults with colon cancer in England. JAMA network open. 2022;5(10):e2238569.
3-Xia S. Effect of cognitive behavioral stress management on anxiety, depression, and quality of life in colorectal cancer patients post tumor resection: a randomized, controlled study. Irish Journal of Medical Science. 2023;192(4):1637-44.
4-Rahimi F, Rezayatmand R, Tabesh E & at al. Incidence of colorectal cancer in Iran: A systematic review and meta-analysis. Journal of Research in Medical Sciences. 2024;29(1):65.
5-Okere CA, Sak Dankosky N, Yerris V & et al. Spiritual interventions: Improving the lives of colorectal cancer survivors-A systematic literature review. Journal of Advanced Nursing. 2024;80(12):4758-76.
6-Cheng Q, Lu W, Duan Y & et al. Spiritual well-being and its association with hope and meaning in life among gastrointestinal cancer patients: a cross-sectional study. Supportive Care in Cancer. 2023;31(4):243.
7-Son J, Lee J, Hwang S & ae al. Exploring the spiritual detriments of the quality of life among patients with advanced cancers undergoing palliative chemotherapy. Cancer Research. 2026;86(7):1233.
8-Atlas M, Hart TL. Appraisals of cancer, religious/spiritual coping, and hope in patients with colorectal cancer. Journal of psychosocial oncology. 2023;41(3):337-54.
9-Jetan M, Daifallah A, Rabayaa MK & et al. The impact of spiritual well-being on the quality of
life of cancer patients: A cross-sectional study. Integrative Cancer Therapies. 2023;22:15347354231210841.
10-Bou-Samra P, Scott P, Cheng H & et al. Social support is associated with survival in patients diagnosed with gastrointestinal cancer. Journal of gastrointestinal cancer. 2022;53(4):854-61.
11-Li Q, Liu L, Gu Z & et al. Sense of coherence mediates perceived social support and depressive and anxiety symptoms in cervical cancer patients: a cross-sectional study. BMC psychiatry. 2023;23(1):312.
12-Dun L, Xian-Yi W, Si-Ting H. Effects of cognitive training and social support on cancer-related fatigue and quality of life in colorectal cancer survivors: a systematic review and meta-analysis. Integrative cancer therapies. 2022;21:15347354221081271.
13-Pasek M, Goździalska A, Jochymek M & et al. Social support in a cancer patient-informal caregiver dyad: a scoping review. Cancers. 2023;15(6):1754.
14-Zou J, Jia H, Wang J & et al. Social isolation as a significant risk factor for depression in colorectal cancer patients post-colostomy: a cross-sectional study. Frontiers in Psychiatry. 2025;16:1588314.
15-Lin C, Diao YE, Dong Z & et al. The effect of attention and interpretation therapy on psychological resilience, cancer-related fatigue, and negative emotions of patients after colon cancer surgery. Annals of palliative medicine. 2020;9(5):3261270-3270.
16-Zou Y, Yang Q, Guan B & et al. Survey on mental health status and quality of life and correlation among patients with permanent stoma of colorectal tumor. Computational and mathematical methods in medicine. 2022;2022(1):5792312.
17-Yu H, Ryu E. The Role of Inner Strength in Korean Colorectal Cancer Survivors on the Journey from Treatment to New Normal: A Qualitative Study. Korean Journal of Adult Nursing. 2025;37(3):332-43.
18-Lin X, Zhang Y, Zhang R & et al. Post Surgery Loneliness and Its Influencing Factors in Elderly Patients With Breast Cancer: A Cross Sectional Study. Journal of Evaluation in Clinical Practice. 2025;31(5):e70177.
19-Luo D, Eicher M, White K. Resilience in adults with colorectal cancer: Refining a conceptual model using a descriptive qualitative approach. Journal of advanced nursing. 2023;79(1):254-68.
20-Dong J, Guo J. Effects of comprehensive noise reduction management combined with reality therapy on anxiety and depression in hospitalised patients with breast cancer. Noise and Health. 2023;25(119):211-9.
21-Chow H, Hon J, Chua W & et al. Effect of virtual reality therapy in reducing pain and anxiety for cancer-related medical procedures: a systematic narrative review. Journal of pain and symptom management. 2021;61(2):384-94.
22-Garrett BM, Tao G, Taverner T & et al. Patients perceptions of virtual reality therapy in the management of chronic cancer pain. Heliyon. 2020;6(5):e03916.
23-Chen Y, Meng H, Chen Q & et al. Virtual reality therapy in managing cancer pain in middle-aged and elderly: a systematic review and meta-analysis. PeerJ. 2024;12:e18701.
24-Li M, Yu Z, Li H & et al. Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial. JMIR Serious Games. 2024;12(1):e53825.
25-Biskupiak Z, Ha VV, Rohaj A & et al. Digital therapeutics for improving effectiveness of pharmaceutical drugs and biological products: preclinical and clinical studies supporting development of drug+ digital combination therapies for chronic diseases. Journal of clinical medicine. 2024;13(2):403.
26-Tian MY, Lee MH, Kim JH & et al. Effectiveness of Virtual Reality Therapy on Static Postural Control and Dynamic Balance in Stroke Patients: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials. Medicina. 2025;62(1):90.
27-Seiler A, Schettle M, Amann M & et al. Virtual reality therapy in palliative care: a case series. Journal of Palliative Care. 2026;41(1):19-27.
28-Chuan A, Hatty M, Shelley M & et al. Feasibility of virtual realitydelivered pain psychology therapy for cancer‐related neuropathic pain: a pilot randomised controlled trial. Anaesthesia. 2023;78(4):449-57.
29-Li M, Yu Z, Li H & et al. Correction: Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial. JMIR Serious Games. 2024;12:e67718.
30-Paloutzian RF, Ellison CW. Loneliness, spiritual well‑being and the quality of life. In: Peplau LA, Perlman D, editors. Loneliness: A sourcebook of current theory, research and therapy. New York: Wiley; 1982; 224–237.
31-Dehshiri G, Sohrabi F, Jafari E & et al. Students assess the psychometric properties of the scale of spiritual well-being. Psychological writings. 2008;4(3):129-44.[Persian]
32-Zimet GD, Dahlem NW, Zimet SG & et al. The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment. 1988; 52(1): 30–41.
33-Bagheri Sheykhangafshe F, Shabahang R, Savabi Niri V & et al. Employee Parenting Energy Correlations of Working Mothers: Perceived Social Support, Job Stress, and Perceived Discrimination. TB; 2022; 21 (1) :28-42.[Persian]
34-Sheard M, Golby J, Van Wersch A. Progress toward construct validation of the Sports Mental Toughness Questionnaire (SMTQ). European Journal of Psychological Assessment. 2009;25(3):186-93.
35-Sheykhangafshe FB., Abolghasemi A., Kafi Masouleh S. M. Comparison Dark Triad Traits of Personality, Cognitive Decision-Making and Mental Toughness in Natural, Supplement and Steroid Bodybuilders. Sport Psychology Studies, 2019; 8(29): 19-38.[Persian]
36-Glasser W. Choice theory: A new psychology of personal freedom. New York: Harper Perennial; 1999.
Farzin Bagheri Sheykhangafshe (Ph.D.)1, Nahid Rezaei (M.A.)2, Mina Azarian Ghurtlar (M.A.)3, Maryam Panahi (M.A.)4, Ali Fathi Ashtiani (Ph.D.)5
1.Corresponding author: Ph.D., Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran. Email: farzinbagheri@modares.ac.ir Tel: +982182885048
2.M.A in General Psychology, Faculty of Humanities, Islamic Azad University, Shiraz Branch, Shiraz, Iran
3.M.A in Clinical Psychology, Faculty of Humanities, Islamic Azad University, Ardabil Branch, Ardabil, Iran
4.Master of Clinical Psychology, Islamic Azad University, Ardabil Branch, Ardabil, Iran
5.Professor, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Abstract
Introduction: Colorectal cancer is a life-threatening disease that affects not only physical health but also the psychological and social well-being of patients. This study aimed to investigate the effectiveness of group reality therapy on spiritual health, perceived social support, and mental toughness in patients with colorectal cancer.
Methods: This study employed a quasi‑experimental design with a pretest–posttest and a control group. The statistical population consisted of patients who referred to cancer treatment and support centers in Tehran in 2024. A total of 36 patients who had received a confirmed diagnosis of colorectal cancer from a specialist were selected through convenience sampling and randomly assigned to the experimental group (n=18) and the control group (n=18). Data collection instruments included the Spiritual Health Scale, the Multidimensional Scale of Perceived Social Support, and the Mental Toughness Scale. The experimental group received 10 sessions of 60minute group reality therapy. Data were analyzed using multivariate analysis of covariance.
Results: Findings indicated that group reality therapy significantly improved religious health (F= 42/73), existential health (F=61/44), family support (F=45/98), friends’ support (F=53/77), support from other important people(F= 43/88), and mental toughness (F=48/01) in patients with colorectal cancer (p< 0/001).
Conclusion: Group reality therapy may be effective in enhancing psychological capacities, strengthening social support resources, and increasing resilience in patients facing life-threatening illnesses. This approach, by emphasizing personal responsibility and improving interpersonal relationships, may help patients better adapt to the disease and the treatment process.
Keywords: Group Reality Therapy, Spiritual Health, Social Support, Mental Toughness, Colon Cancer
Conflict of interest: The authors declared no conflict of interest.
References
1-Kazemi E, Zayeri F, Baghestani A & at al. Trends of colorectal cancer incidence, prevalence and mortality in worldwide from 1990 to 2017. Iranian Journal of Public Health. 2023;52(2):436.
2-Majano SB, Lyratzopoulos G, de Wit NJ & et al. Mental health morbidities and time to cancer diagnosis among adults with colon cancer in England. JAMA network open. 2022;5(10):e2238569.
3-Xia S. Effect of cognitive behavioral stress management on anxiety, depression, and quality of life in colorectal cancer patients post tumor resection: a randomized, controlled study. Irish Journal of Medical Science. 2023;192(4):1637-44.
4-Rahimi F, Rezayatmand R, Tabesh E & at al. Incidence of colorectal cancer in Iran: A systematic review and meta-analysis. Journal of Research in Medical Sciences. 2024;29(1):65.
5-Okere CA, Sak Dankosky N, Yerris V & et al. Spiritual interventions: Improving the lives of colorectal cancer survivors-A systematic literature review. Journal of Advanced Nursing. 2024;80(12):4758-76.
6-Cheng Q, Lu W, Duan Y & et al. Spiritual well-being and its association with hope and meaning in life among gastrointestinal cancer patients: a cross-sectional study. Supportive Care in Cancer. 2023;31(4):243.
7-Son J, Lee J, Hwang S & ae al. Exploring the spiritual detriments of the quality of life among patients with advanced cancers undergoing palliative chemotherapy. Cancer Research. 2026;86(7):1233.
8-Atlas M, Hart TL. Appraisals of cancer, religious/spiritual coping, and hope in patients with colorectal cancer. Journal of psychosocial oncology. 2023;41(3):337-54.
9-Jetan M, Daifallah A, Rabayaa MK & et al. The impact of spiritual well-being on the quality of
life of cancer patients: A cross-sectional study. Integrative Cancer Therapies. 2023;22:15347354231210841.
10-Bou-Samra P, Scott P, Cheng H & et al. Social support is associated with survival in patients diagnosed with gastrointestinal cancer. Journal of gastrointestinal cancer. 2022;53(4):854-61.
11-Li Q, Liu L, Gu Z & et al. Sense of coherence mediates perceived social support and depressive and anxiety symptoms in cervical cancer patients: a cross-sectional study. BMC psychiatry. 2023;23(1):312.
12-Dun L, Xian-Yi W, Si-Ting H. Effects of cognitive training and social support on cancer-related fatigue and quality of life in colorectal cancer survivors: a systematic review and meta-analysis. Integrative cancer therapies. 2022;21:15347354221081271.
13-Pasek M, Goździalska A, Jochymek M & et al. Social support in a cancer patient-informal caregiver dyad: a scoping review. Cancers. 2023;15(6):1754.
14-Zou J, Jia H, Wang J & et al. Social isolation as a significant risk factor for depression in colorectal cancer patients post-colostomy: a cross-sectional study. Frontiers in Psychiatry. 2025;16:1588314.
15-Lin C, Diao YE, Dong Z & et al. The effect of attention and interpretation therapy on psychological resilience, cancer-related fatigue, and negative emotions of patients after colon cancer surgery. Annals of palliative medicine. 2020;9(5):3261270-3270.
16-Zou Y, Yang Q, Guan B & et al. Survey on mental health status and quality of life and correlation among patients with permanent stoma of colorectal tumor. Computational and mathematical methods in medicine. 2022;2022(1):5792312.
17-Yu H, Ryu E. The Role of Inner Strength in Korean Colorectal Cancer Survivors on the Journey from Treatment to New Normal: A Qualitative Study. Korean Journal of Adult Nursing. 2025;37(3):332-43.
18-Lin X, Zhang Y, Zhang R & et al. Post Surgery Loneliness and Its Influencing Factors in Elderly Patients With Breast Cancer: A Cross Sectional Study. Journal of Evaluation in Clinical Practice. 2025;31(5):e70177.
19-Luo D, Eicher M, White K. Resilience in adults with colorectal cancer: Refining a conceptual model using a descriptive qualitative approach. Journal of advanced nursing. 2023;79(1):254-68.
20-Dong J, Guo J. Effects of comprehensive noise reduction management combined with reality therapy on anxiety and depression in hospitalised patients with breast cancer. Noise and Health. 2023;25(119):211-9.
21-Chow H, Hon J, Chua W & et al. Effect of virtual reality therapy in reducing pain and anxiety for cancer-related medical procedures: a systematic narrative review. Journal of pain and symptom management. 2021;61(2):384-94.
22-Garrett BM, Tao G, Taverner T & et al. Patients perceptions of virtual reality therapy in the management of chronic cancer pain. Heliyon. 2020;6(5):e03916.
23-Chen Y, Meng H, Chen Q & et al. Virtual reality therapy in managing cancer pain in middle-aged and elderly: a systematic review and meta-analysis. PeerJ. 2024;12:e18701.
24-Li M, Yu Z, Li H & et al. Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial. JMIR Serious Games. 2024;12(1):e53825.
25-Biskupiak Z, Ha VV, Rohaj A & et al. Digital therapeutics for improving effectiveness of pharmaceutical drugs and biological products: preclinical and clinical studies supporting development of drug+ digital combination therapies for chronic diseases. Journal of clinical medicine. 2024;13(2):403.
26-Tian MY, Lee MH, Kim JH & et al. Effectiveness of Virtual Reality Therapy on Static Postural Control and Dynamic Balance in Stroke Patients: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials. Medicina. 2025;62(1):90.
27-Seiler A, Schettle M, Amann M & et al. Virtual reality therapy in palliative care: a case series. Journal of Palliative Care. 2026;41(1):19-27.
28-Chuan A, Hatty M, Shelley M & et al. Feasibility of virtual realitydelivered pain psychology therapy for cancer‐related neuropathic pain: a pilot randomised controlled trial. Anaesthesia. 2023;78(4):449-57.
29-Li M, Yu Z, Li H & et al. Correction: Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial. JMIR Serious Games. 2024;12:e67718.
30-Paloutzian RF, Ellison CW. Loneliness, spiritual well‑being and the quality of life. In: Peplau LA, Perlman D, editors. Loneliness: A sourcebook of current theory, research and therapy. New York: Wiley; 1982; 224–237.
31-Dehshiri G, Sohrabi F, Jafari E & et al. Students assess the psychometric properties of the scale of spiritual well-being. Psychological writings. 2008;4(3):129-44.[Persian]
32-Zimet GD, Dahlem NW, Zimet SG & et al. The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment. 1988; 52(1): 30–41.
33-Bagheri Sheykhangafshe F, Shabahang R, Savabi Niri V & et al. Employee Parenting Energy Correlations of Working Mothers: Perceived Social Support, Job Stress, and Perceived Discrimination. TB; 2022; 21 (1) :28-42.[Persian]
34-Sheard M, Golby J, Van Wersch A. Progress toward construct validation of the Sports Mental Toughness Questionnaire (SMTQ). European Journal of Psychological Assessment. 2009;25(3):186-93.
35-Sheykhangafshe FB., Abolghasemi A., Kafi Masouleh S. M. Comparison Dark Triad Traits of Personality, Cognitive Decision-Making and Mental Toughness in Natural, Supplement and Steroid Bodybuilders. Sport Psychology Studies, 2019; 8(29): 19-38.[Persian]
36-Glasser W. Choice theory: A new psychology of personal freedom. New York: Harper Perennial; 1999.
Type of Study: Research |
Subject:
Psychology
Received: 2025/07/8 | Accepted: 2025/09/16 | Published: 2025/11/19
Received: 2025/07/8 | Accepted: 2025/09/16 | Published: 2025/11/19
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