اثر بخشی آموزش مدیریت استرس به شیوه شناختی رفتاری بر هیجانات منفی و کیفیت زندگی زنان مبتلا به سرطان پستان

نویسندگان

1 استادیار روان پزشکی، مرکز تحقیقات روان پزشکی و علوم رفتاری، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 پزشک عمومی، مرکز تحقیقات روان پزشکی و علوم رفتاری، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 کارشناس ارشد روانشناسی بالینی، مرکز تحقیقات روان پزشکی و علوم رفتاری، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

چکیده

مقدمه: بیشتر مبتلایان به سرطان، یک دوره فشار روانی را تجربه می کنند. یکی ‌از بیماری‌هایی‌که با سلامت روانی ارتباط زیادی دارد، سرطان است. شواهد متعددی وجود دارد که نشان می دهد درمان استرس تأثیر مثبتی بر نتایج درمان سرطان دارد. مطالعه حاضر با هدف تعیین اثربخشیآموزش مدیریت استرس به شیوه شناختی رفتاری بر استرس، اضطراب، افسردگی و کیفیت زندگی زنان مبتلا به سرطان پستان انجام شد.
روش کار: این مطالعه کاربردی در سال 1391 بر روی 32 نفر از زنان تازه تشخیص داده شده در مرحله یک و دو سرطان سینه مراجعه کننده به مرکز درمانی امام رضا (ع) شهر مشهد انجام شد. افراد به طور تصادفی در دو گروه آزمون ‌و کنترل قرار گرفتند.گروه‌ آزمون تحت 10 هفته آموزش مدیریت استرس به شیوه شناختی رفتاری توسط یک روانشناس با تجربه در این حوزه قرار گرفتند. پرسشنامه افسردگی، اضطراب و استرس  DASSو پرسشنامه کیفیت زندگی 36SF به عنوان ابزار در پیش‌آزمون و پس‌آزمون استفاده شدند. تجزیه و تحلیل داده ها با استفاده از نرم افزار آماری SPSS (نسخه 11) و آزمون های تی مستقل، آزمون f لوین و تحلیل کواریانس انجام شد. میزان p کمتر از 05/0 معنادار در نظر گرفته شد.
یافته‌ها: تغییرات استرس و اضطراب در پس‌آزمون بین گروه های مداخله و کنترل معنادار بود (01/0=p). در مورد افسردگی، تفاوت معناداری بین دو گروه پس از مداخله مشاهده نشد (به ترتیب60/0=p، 50/0=p)، در گروه مداخله پس از انجام مداخله تفاوت معناداری بین نمرات پیش آزمون و پس آزمون مقیاس کیفیت زندگی در نمرات کیفیت زندگی مشاهده شد (02/0=p).
نتیجه‌گیری: آموزش مدیریت استرس به شیوه شناختی رفتاری بر استرس، اضطراب و کیفیت زندگی در زنان مبتلا به سرطان مؤثر است.

کلیدواژه‌ها


عنوان مقاله [English]

Cognitive behavioral stress management effects on quality of life and negative emotions in women with breast cancer

نویسندگان [English]

  • Amir Rezaei Ardani 1
  • Farhad Farid Hoseini 1
  • Mahdieh Borhani Moghani 2
  • Hamid Seyfi 3
1 Assistant Professor, Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Ibn-e-Sina Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 General physician, Psychiatry and Behavioral Sciences Research Center, Ibn-e-Sina Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 M.Sc. of Clinical Psychology, Psychiatry and Behavioral Sciences Research Center, Ibn-e-Sina Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده [English]

Introduction: Most people with cancer experience a period of mental stress. Cancer is one of the diseases which is highly related with mental health. There is much evidence that stress management can have a positive impact on the results of cancer treatment. The present study was performed with aim to investigate the efficacy of cognitive behavioral stress management training on stress, anxiety, depression and quality of life in women with breast cancer.
Methods: This applicable study was performed on 32 woman recently diagnosed with stage I& II of breast cancer referred to Mashhad Imam Reza treatment center in 2012. They were randomly divided in two intervention and control groups. The intervention group received 10 weeks of cognitive behavioral stress management training by an experienced psychologist. Depression, anxiety, stress questionnaire (DASS) and quality of life questionnaire of SF36 were used as tools in pre-test and post-test. Data were analyzed by SPSS software (version 11) and independent-t test, f Lovin test, and Covariance analysis. PResults: there are significant differences between intervention and control groups in terms of stress and anxiety changes in post-test (P=0.01). No significant difference was observed between both two groups in terms of depression after the intervention (P=0.60, P=0.50). Significant differences were observed between the scores of post-test and pre-test of quality of life in the intervention group after the intervention (P=0.02).
Conclusions: The cognitive behavioral stress management training is effective on stress, anxiety, and quality of life in women with cancer.

کلیدواژه‌ها [English]

  • Anxiety
  • Cancer
  • Cognitive - behavioral therapy
  • Depression
  • Quality of life
  • stress
  • stress management
  1. Garssen, B., Boomsma, M.F., Meezenbroek, Ede.D. J, Porsild, T., Berkhof, J,. Berbee, M., Visser, A. Meijer, S. and  Beelen, R.H.J (2012) .et al. Stress management training for breast cancer surgery patients. Psychoo-Oncology. 2013;22(3):572-80.
  2. Bamshad Z, SafkhaniF. Assessment of mental health of women with breast cancer. Abstract Book of National congress of cancer in special diseases. Ahvaz Univ Med Sci 2006; 56. (Persian.(
  3. Cancer Facts & Figures,(2013). American Cancer Society. Available from:<http://wwwcancer.org]
  4. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in woman with early Breast cancer: five year observational cohort study. BMJ 2005; 330(7493): 702.
  5. Bussing A, Fischr J, Ostermann T, Matthiessen PF. Reliance on God's 'help,. depression and fatigue in female cancer patients. Int j J psychiatry Psychiatry Med 2008; 38(3): 357-72. 
  6. Wasteson E, Brenne E, Higgins on IJ, Hotop fM, Liody – Williams M, Kaasa S, et al. Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliate Med 2002; 23(8): 729-53. 
  7. Brintzenhofe-Szoc KM, Levin TT, Li Y, Kissane DW, Zabora JR. Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type. Psychosomatics 2009; 50(4): 383–91.
  8. Smith EM. Gomm SA, Pichens Dickens CM. Assessing the inpendent contribution to quality of life from anxiety and depression in patients with advanced cancer. Palliative mMedicine  2003; 17(6): 509-13.
  9. Hoffman CJ, Ersser SJ, Hopkinson JB, Nicholls PG, Harrington JE, Thomas PW. Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. J Clin Oncol. .( 2012) Apr; 30(12): 1335-42.
  10. RejeskeRejeski, WJ, Mihalko SL. Physical activity Activity and quality Quality of life Life in older Older adultAdult. J of Gerontology A Biol Sci Med Sci 2001; 56(suppl 2): 23-35.
  11. Drossman DA, Patrick DL, Whitehead WE, Toner BB, Diamant NE, Hu Y, et al. Further validation of the IBS-QOL: A dieses- specific Quality- of- life Questionnaire. Am J Gastroenterology 2000; 95(4): 999- 1007.
  12. Issa BA, Baiyewu O. Quality of life Life patients Patients with diabetes Diabetes mellitus Mellitus in a Nigerian teaching Teaching hospitalHospital. J Hon Kong J  Psychiatry 2006; 16: 27-33.
  13. Price MA, Bell ML, Sommeijer DW, Friedlander M, Stockler MR, Defazio , et al.A,and Webb PM; .(2013) Physical symptoms, coping styles and quality of life in recurrent ovarian cancer: a prospective population-based study over the last year of life. Gynecol Oncol. 2013 Jul; 130(1): 162-8. 
  14. Fata L, Mootabi F, Bolhari J, Kazemzadeh Atoofi M. Stress management, guide of workshop education. Tehran: Danjeh; 2008. (Persian(
  15. Saleh HM, Salem SAM, El-Sheshetawy RS, El-Samei AMA. Comparative study of psychiatric morbidity and quality of life in psoriasis, vitiligo and alopecia areata. Egyptian Dermatology Online J 2008; 4(1):1-28 [cited 2008 Oct10], Available from:  http://www.edoj.org.eg/ vol004/ 0401/002/01.htm.
  16. Lechner SC, Antonl MH, Lydston D, Laperrlere A, Ishll M, Devleux J, et al. Cognitive-behavioral interventions improve quality of life in women with AIDS. J Psychosomatic Research 2003; 54(3): 253-61.
  17. Penedo FJ, Dahn JR, Molton I, Gonzalez JS, Kinsinger D, Roos BA, et al. Cognitive behavioral stress management improve es stress-management skills and quality of life in men recovering from treatment of prostate carcinoma. J Cancer 2003; 100(1): 192-200.
  18. Penedo FJ, Traeger L, Dahn J, Molton I, Gonzalez JS, Schneiderman N, et al. Cognitive behavioral stress management Intervention Improves Quality of Life in Spanish monolingual hispanic men treated for localized prostate cancer: results of a randomized controlled trial. International J of Behavioral Medicine 2007; 14(3): 164 - 72.
  19. Mohlman J, Gorman JM. The role of executive functioning in CBT: A a pilot study with anxious older adults. Behav Res Ther 2005; 43(4): 447-65.
  20. Green B, Blanchard EB. Cognitive behavior therapy for irritable bowel syndrome. J Consult Clin Psychol 1994; 62(3): 576-82.
  21. Price JR, Couper J. Cognitive behavior therapy for adults with chronic fatigue syndrome. Cochrane Database Syst Rev 2000; (2): CD001027.
  22. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 1999; 80(1-2): 1-13.
  23. Lechner SC, Antoni MH, Lydston D, Laperriere A, Ishoo M, Devieux J, et al. Cognitive- behavioral interventions improve quality of life in women with AIDS. J Psychosom Res 2003; 54(3): 253-261.
  24. Osborn RL, Demoncada AC, Feuerstein M. Psychosocial interventions for depression, anxiety,  anxiety and quality of life in cancer survivors: Meta-analyses. Into J Psychiatry Med 2006; 36(1): 13-34.
  25. AnnMarie Groarke A, Ruth Curtisand R ,Michael Kerin M,. Cognitive-behavioural stress management enhances adjustment in women with breast cancer,. British Journal of  Health Psyc hology (2013 ),; 18(3),: 623–641.
  26. Hopko DR, Bell JL, Armento M, Robertson S, Mullance C, Wolf N, et al. Cognitive -behavior therapy for depressed cancer patients in a medical care setting. Behav Ther 2008; 39(2): 126-136.
  27. So WK, Marsh G, Ling WM, Leung FY, Lo JC, Yeung M, Li GK.WinnieKW. Anxiety depression and quality of life among Chinese breast cancer patients during adjuvant therapy. Eur J Oncol NursEur J Cancer 201009; 14(1):17-226(1):47-49.
  28. Ransom S, Jacobsen PB, Schmidt JE, and Andrykowski MA. Relationship of problem focused coping strategies to change in quality of life following treatment for early stage breast cancer. J Pain Symptom Manage 2008; 30(3): 243-253.
  29. Wilmoth MC. The Aftermath of Breast Cancer: An Altered Sexual Self. Cancer Nursing 2001;24(4):278-86.
  30. 3Ware Jr JE Jr, Sherbourne CD. The MOS 36-Item Short – Form Health Survey (SF-36) I : conceptual framework and item selection . Med Care 1992; 30(6): 473-83.
  31. Montazeri A, Goshtasebi AR, Vahdaninia MS, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian versionTranslation, validity and reliability of Persian version of SF-36. Quality Life Res Payesh 20054; 514: 49875-5682. (Persian).
  32. Lovibond, P.F, Lovibond, S.H. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res TherBehavior Research ana Therapy. . (1995).; 33(3): 335-343.
  33. Samani S, Jokar B. Assessment of validity and reliability of short form of depression, anxiety and stress. Journal of social and human sciences of Shiraz University 2007 ; 3: 65-76. (Persian.(
  34. Anthony M, Irwenson G, Schnider N. Workbook of stress management through cognitive-behavior method. Al-e-Mohammad J, Jokar S, Neshatdoost H. (translators). Tehran: Jihad; 2009.(Persian.(
  35. Pedram M, Mohammadi M, Naziri GH, Aeinparast N. Effectiveness of Cognitive-Behavioral Group Therapy on the Treatment of Anxiety and Depression Disorders and on Raising Hope in Women with Breast Cancer. Journal of Woman and SocietySociology Women 2011; 1(4): 61-75. [In Persian].
  36. Mehrinejad SA, Khosrovani Shariati SH, Hossein Abad Shapouri MH. Stress in Women with Breast Cancer Compared to the Healthy Ones. Daneshvar RaftarClin Psychology Personality 2010; 17(43): 49-56.
  37. Sajadi Hezaveh M, Salehi B, Moshfeghi K. Comparison effect of drug therapy and drug-cognitive therapy on decreasing depression in women with breast cancer. J Arak Univ Med Sci J Arak Univ Med Sci 2008; 11(3): 55-6.
  38. Miller K, Massie MJ. Depression and anxiety. Cancer J 2006; 12(5): 388-97.
  39. Aghebati N, Mohammadi E, Pour Esmaeil ZP. The effect of relaxation on anxiety and stress of patients with cancer during hospitalization. Iran J Nurs 2010; 23(65): 15-22. [In Persian].
  40. Corner J, Bailey CD. Cancer Nursing: Care in Context. New Jersey: John Wiley & Sons p. 546; 2008
  41. Antoni, M. H., Lechner, S. C., Kazi, A., Wimberly, S. R., Sifre, T., Urcuyo, K. R, et al. Carver, C. S.. How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol Journal  of Consulting and Clinical Psychology (2006),; 74(6),: 1143 –1152. doi:10.1037/0022-006X.74.6.1143
  42. Cohen M, Fried G.Cohen, M., & Fried, G.. Comparing relaxation training and cognitive-behavioural group therapy for women with breast cancer. Research on Social Work Practice, (2007); 17(3): , 313 –323. doi:10. 1177/1049731506293741
  43. Andersen BL, Farrar WB, Golden-Kreutz DM, Glaser R, Emery CF, Crespin TR, et al.Andersen, B. L., Farrar, W. B., Golden-Kreutz, D. M., Glaser, R., Emery, C. F., Crespin, T. R., … Carson III, W. E. Psychological, behavioural, and immune changes after a psychological intervention: aA clinical trial. J Clin OncolJournal of Clinical Oncology,  (2004); 22(17): 3570-80.3, 6083 –6096. doi:10.1200/JC0. 2004.06.030
  44. Edelman, S., Bell, D. R., & Kidman, A. D. Group CBT Versus Supportive Therapy With Patients Who Have Primary Breast Cancer. . Group CBT versus supportive therapy with patients who have primary breast cancer.  Journal of Cognitive Psychotherapy , (1999;). 13(3),: 189–202.
  45. Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, et al.- Kissane, D. W., Bloch, S., Smith, G. C., Miach, P., Clarke, D. M., Ikin, J., … McKenzie, D.. Cognitive-existential group psychotherapy for women with primary breast cancer: Aa randomised controlled trial. Psycho-Oncology, (2003); 12(6): , 532 –546. doi:10.1002/pon.683
  46. Antoni, M. H., Lehman, J. M., Kilbourn, K. M., Boyers, A. E., Culver, J. L., Alferi, S. M., et al.Carver, C. S.. Cognitive-behavioural stress management intervention decreases prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, (2001); 20(1): ,20–32. doi:10.1037/0278-6133.20.1.20
  47. Savard J, Simard S, Ivers H, Morin CM. Savard, J., Simard, S., Ivers, H., & Morin, C. M.. Randomized study on the efficacy of cognitive-behavioural therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. J Clin OncolJournal of Clinical Oncology, (2005); 23(25) ,: 6083 –6096. doi:10.1200/JCO.2005.09.548