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Volume 19, Issue 2 (Iranian Journal of Breast Diseases 2026)
ijbd 2026, 19(2): 38-52 |
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Ethics code: IR.IAU.R.REC.1402.008
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Rasouluiazad S, Lotfikashani F, Vaziri S. Comparing the Effectiveness of Spiritual Therapy and Cognitive-Behavioral Therapy on Anxiety about Illness and Body Image in Women Recovered from Breast Cancer. ijbd 2026; 19 (2) :38-52
URL: http://ijbd.ir/article-1-1172-en.html
URL: http://ijbd.ir/article-1-1172-en.html
1- Department of Health Psychology, RO.C., Islamic Azad University, Roudehen, Iran
2- Department of Clinical Psychology, TMS, Islamic Azad University, Tehran, Iran ,f.lotfi@iau.ir
3- Department of Clinical Psychology, TMS, Islamic Azad University, Tehran, Iran
2- Department of Clinical Psychology, TMS, Islamic Azad University, Tehran, Iran ,
3- Department of Clinical Psychology, TMS, Islamic Azad University, Tehran, Iran
Abstract: (773 Views)
Introduction: Women who have recovered from breast cancer may continue to experience persistent psychological consequences even after completing medical treatment. Worry about illness recurrence and body image disturbance are among the most common psychological problems in this population and may adversely affect quality of life, psychological adjustment, and social functioning. Therefore, identifying effective psychological interventions for these women is of considerable clinical importance. The present study aimed to compare the effectiveness of Spiritual Therapy and Cognitive-Behavioral Therapy (CBT) on worry about illness and body image in women recovered from breast cancer.
Methods: This interventional study used a semi-experimental pretest-posttest design with two experimental groups and one control group. The statistical population consisted of women aged 30-50 years who had recovered from breast cancer and whose recovery had been confirmed by a specialist physician within the previous 1-4 years. A total of 45 participants were selected through convenience sampling and randomly assigned to three groups: Cognitive-Behavioral Therapy, Spiritual Therapy, and control (15 participants per group). Data were collected using the Penn State Worry Questionnaire and Cash’s Body Image Disturbance Questionnaire. The two intervention groups each received eight weekly 90-minute sessions, while the control group received no intervention during the study period. Data were analyzed using univariate and multivariate analysis of covariance in SPSS version 26, with the significance level set at 0.05.
Results: The findings showed that both Cognitive-Behavioral Therapy and Spiritual Therapy significantly reduced worry about illness and improved body image compared with the control group. After controlling for pretest scores, a significant difference was observed among the groups in worry about illness (F=45.04, P<0.001, η²=0.68, Power=1.000). Bonferroni post hoc comparisons indicated that both intervention groups differed significantly from the control group, whereas the difference between Cognitive-Behavioral Therapy and Spiritual Therapy was not statistically significant. Regarding body image, a significant difference was also observed among the groups (F=15.03, P<0.001, η²=0.33, Power=1.000). Both interventions were more effective than the control group, and Spiritual Therapy showed greater improvement in some dimensions of body image disturbance.
Conclusion: The results suggest that both Cognitive-Behavioral Therapy and Spiritual Therapy can be beneficial psychological interventions for women recovered from breast cancer. These approaches may help reduce worry about illness and improve body image. The patient’s predominant psychological concerns may therefore guide the choice of intervention; however, further studies with larger samples and follow-up assessments are needed to clarify the comparative effectiveness and long-term outcomes of these interventions.
Methods: This interventional study used a semi-experimental pretest-posttest design with two experimental groups and one control group. The statistical population consisted of women aged 30-50 years who had recovered from breast cancer and whose recovery had been confirmed by a specialist physician within the previous 1-4 years. A total of 45 participants were selected through convenience sampling and randomly assigned to three groups: Cognitive-Behavioral Therapy, Spiritual Therapy, and control (15 participants per group). Data were collected using the Penn State Worry Questionnaire and Cash’s Body Image Disturbance Questionnaire. The two intervention groups each received eight weekly 90-minute sessions, while the control group received no intervention during the study period. Data were analyzed using univariate and multivariate analysis of covariance in SPSS version 26, with the significance level set at 0.05.
Results: The findings showed that both Cognitive-Behavioral Therapy and Spiritual Therapy significantly reduced worry about illness and improved body image compared with the control group. After controlling for pretest scores, a significant difference was observed among the groups in worry about illness (F=45.04, P<0.001, η²=0.68, Power=1.000). Bonferroni post hoc comparisons indicated that both intervention groups differed significantly from the control group, whereas the difference between Cognitive-Behavioral Therapy and Spiritual Therapy was not statistically significant. Regarding body image, a significant difference was also observed among the groups (F=15.03, P<0.001, η²=0.33, Power=1.000). Both interventions were more effective than the control group, and Spiritual Therapy showed greater improvement in some dimensions of body image disturbance.
Conclusion: The results suggest that both Cognitive-Behavioral Therapy and Spiritual Therapy can be beneficial psychological interventions for women recovered from breast cancer. These approaches may help reduce worry about illness and improve body image. The patient’s predominant psychological concerns may therefore guide the choice of intervention; however, further studies with larger samples and follow-up assessments are needed to clarify the comparative effectiveness and long-term outcomes of these interventions.
Keywords: Spiritual Therapy, Cognitive-Behavioral Therapy, Worry about Illness, Body Image, Breast Cancer
Type of Study: Research |
Subject:
Nutrition, psychology, sport
Received: 2026/01/31 | Accepted: 2026/05/31 | Published: 2026/07/26
Received: 2026/01/31 | Accepted: 2026/05/31 | Published: 2026/07/26
References
1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. doi:10.3322/caac.21660. [DOI:10.3322/caac.21660] [PMID]
2. Zahedi A, Rafiemanesh H, Enayatrad M, Ghoncheh M, Salehiniya H, Makhsosi BR. Incidence, trends and epidemiology of cancers in North West of Iran. Asian Pac J Cancer Prev. 2015;16(16):7189-93. doi:10.7314/APJCP.2015.16.16.7189. [DOI:10.7314/APJCP.2015.16.16.7189] [PMID]
3. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763. [DOI:10.3322/caac.21763] [PMID] [PMCID]
4. Cincidda C, Pizzoli SFM, Pravettoni G, Castelnuovo G. Fear of cancer recurrence: A systematic review of psychological interventions. Front Psychol. 2022
5. 13:836017. doi:10.3389/fpsyg. 2022.836017. [DOI:10.3389/fpsyg]
6. Maheu C, Lebel S, Courbasson C, Lefebvre M, Neron S, Fields A, et al. Randomized trial of therapist-guided and self-guided internet-delivered cognitive-behavioral therapy for fear of cancer recurrence. Psychooncology. 2023;32(6):890-9. doi:10.1002/pon.6123. [DOI:10.1002/pon.6123] [PMID] [PMCID]
7. Cash TF, Grasso K. The norms and stability of new measures of the multidimensional body image construct. Body Image. 2005;2(2):199-203. doi: 10.1016/j.bodyim.2005.03.007. [DOI:10.1016/j.bodyim.2005.03.007] [PMID]
8. Sebri V, Durosini I, Triberti S, Pravettoni G, Castelnuovo G. Body image disorders in cancer patients: A systematic review. Support Care Cancer. 2021;29(6):2509-23. doi:10.1007/s00520-020-05788-5.
9. Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189-97. doi:10.1016/S0959-8049(00)00353-1. [DOI:10.1016/S0959-8049(00)00353-1] [PMID]
10. Fingeret MC, Teo I, Epner DE. Managing body image difficulties of adult cancer patients: Lessons from available research. J Clin Psychol Med Settings. 2014;21(4):309-23. doi:10.1007/s10880-014-9418-6.
11. Lebel S, Ozakinci G, Humphris G, Thewes B, Prins J, Dinkel A, et al. From normal response to clinical problem: Definition and clinical features of fear of cancer recurrence. Support Care Cancer. 2016;24(8):3265-8. doi:10.1007/s00520-016-3272-5. [DOI:10.1007/s00520-016-3272-5] [PMID]
12. Simard S, Savard J. Fear of Cancer Recurrence Inventory: Development and initial validation. J Cancer Surviv. 2009;3(1):1-11. doi:10.1007/s11764-008-0072-y. [DOI:10.1037/t70955-000]
13. Jim HSL, Pustejovsky JE, Park CL, Danhauer SC, Sherman AC, Fitchett G, et al. Religion, spirituality, and physical health in cancer patients: A meta-analysis. Cancer. 2015;121(21):3760-8. doi:10.1002/cncr.29353. [DOI:10.1002/cncr.29353] [PMID] [PMCID]
14. Bouwhuis-Van Keulen M, Vertommen T, van den Akker O. Spiritual well-being interventions in cancer care: A systematic review and meta-analysis. Psychooncology. 2024;33(1):12-25. doi:10.1002/pon.6234. [DOI:10.1002/pon.6234] [PMID]
15. Salsman JM, Fitchett G, Merluzzi TV, Sherman AC, Park CL. Religious, spiritual, and secular faith practices in predicting health outcomes among cancer survivors. J Clin Oncol. 2015;33(12):1421-7. doi:10.1200/JCO.2014.59.9125.
16. Saalabi Fard S, Aghajani M, Farahani H. Effectiveness of spiritual therapy on psychological distress in women with breast cancer. Iran J Cancer Care. 2020;2(3):45-53. doi:10.52547/ijca.2.3.45.
17. Beck JS. Cognitive behavior therapy: Basics and beyond. 2nd ed. New York: Guilford Press; 2011.
18. Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cogn Ther Res. 2012;36(5):427-40. doi:10.1007/s10608-012-9476-1. [DOI:10.1007/s10608-012-9476-1] [PMID]
19. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
20. Cash TF. Cognitive-behavioral perspectives on body image. In: Cash TF, Smolak L, editors. Body image: A handbook of science, practice, and prevention. New York: Guilford Press; 2011. p. 39-47.
21. Nezu AM, Nezu CM, D'Zurilla TJ. Problem-solving therapy: A treatment manual. New York: Springer; 2013. [DOI:10.1891/9780826109415]
22. Molina S, Borkovec TD. The Penn State Worry Questionnaire: Psychometric properties. In: Davey GCL, Tallis F, editors. Worrying: Perspectives on theory, assessment and treatment. Wiley, 1994. p. 265-83.
23. Cash TF, Phillips KA, Santos MT, Hrabosky JI. Measuring "negative body image": Validation of the Body Image Disturbance Questionnaire in a nonclinical population. Body Image. 2004;1(4):363-72. doi:10.1016/j.bodyim.2004.06.001. [DOI:10.1016/j.bodyim.2004.06.001] [PMID]
24. Lin C, Tian H, Chen L, Yang Q, Wu J, Ji Z, et al. The efficacy of cognitive behavioral therapy for cancer: A scientometric analysis. Front Psychiatry. 2022 [DOI:10.3389/fpsyt.2022.1030630] [PMID] [PMCID]
25. 13:1030630. doi:10.3389/fpsyt. 2022.1030630.
26. Salkovskis PM, Kirk J, Clark DM, Houghton K. Cognitive behavioral therapy. Ghasemzadeh H, translator. Tehran: Arjomand Publications; 2018.
27. Sajjadian AS, Zahrakar K, Asadpour E. The effect of transpersonal therapy intervention (spiritual therapy, yoga meditation) on reducing fear of recurrence in breast cancer survivors: A clinical trial. Iran Breast Dis J. 2021;14(2):50-63. doi:10.52547/ibd.14.2.50. [DOI:10.30699/ijbd.14.2.50]
28. Zanganeh Gheshlaghi M, Shayegan Manesh Z, Bankdari N. The effectiveness of cognitive-behavioral therapy on depression and anxiety in women with breast cancer. Mashhad J Med Sci. 2021. doi:10.22038/mjms. 2021.17869.
29. Saalabi Fard S, Tajeri Buk M, Rafiei Pour A. The effect of spiritual therapy on post-traumatic growth, self-compassion, and hope in women with breast cancer. J Health Promot Manag. 2020;9(6):37-48. doi:10.52547/jhpm.ir.9.6.37.
30. Kaplan JL, Porter RS. Information on medical care for women. Zolanvary M, translator. Tehran: Myayarelm Publications; 2006.
31. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Pineros M, Znaor A, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021;149(4):778-89. doi:10.1002/ijc. 33588. [DOI:10.1002/ijc.33588] [PMID]
32. Salsman JM, Fitchett G, Merluzzi TV, Sherman AC, Park CL. Religion, spirituality, and health outcomes in cancer: A case for a meta-analytic investigation. Cancer. 2015;121(21):3754-9. doi:10.1002/cncr.29349. [DOI:10.1002/cncr.29349] [PMID] [PMCID]
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