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Volume 17, Issue 4 (Iranian Journal of Breast Diseases 2025)                   ijbd 2025, 17(4): 151-170 | Back to browse issues page

Ethics code: IR.IAU.AHVAZ.REC.1403.004


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Jalalpour F, Safarzadeh S. Comparing the Effectiveness of Acceptance and Commitment Therapy and Cognitive-Existential Therapy on the Psychological Flexibility of Women with Breast Cancer. ijbd 2025; 17 (4) :151-170
URL: http://ijbd.ir/article-1-1131-en.html
1- Department of Clinical Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
2- Department of Clinical Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran , safarzadeh1152@yahoo.com
Abstract:   (629 Views)
Introduction: Improving the quality of life of women with breast cancer requires psychological interventions. The purpose of this research was to compare the effectiveness of acceptance and commitment therapy and cognitive-existential therapy on psychological flexibility in women with breast cancer in Ahvaz.
Methods: The current research employed a pre-test-post-test design that included a control group and a three-month follow-up phase. The statistical population consisted of all women diagnosed with breast cancer in Ahvaz city in 2024. From this population, a sample of 45 participants was selected using a convenience sampling method. These participants were subsequently assigned to three groups, each comprising 15 individuals: two experimental groups and one control group. Their age was between 18 to 45 years old, and all of them were under medication treatment. For the first experimental group, psychotherapy protocol based on acceptance and commitment (Izadi & Abedi, 2015) and the second experimental group, Kissan cognitive-existential therapy (Bahmani, 2010), but the control group was not subjected to any psychological intervention. The research tool included the psychological flexibility questionnaire of Dennis and Vanderwaal (2010). Analysis of variance with repeated measures was used to analyze the data.
Results: The results showed that both treatments, treatment based on acceptance and commitment and cognitive-existential therapy are significantly effective on the psychological flexibility of women with breast cancer (p<0.01). Also, no significant difference was seen between the effectiveness of acceptance and commitment therapy and cognitive-existential therapy on psychological flexibility.
Conclusion: The findings of this study indicated that both acceptance and commitment therapy (ACT) and cognitive-existential therapy (CET) effectively enhance psychological flexibility in women with breast cancer.
Full-Text [PDF 551 kb]   (215 Downloads)    
Type of Study: Applicable | Subject: Nutrition, psychology, sport
Received: 2024/08/18 | Accepted: 2024/10/26 | Published: 2024/12/27

References
1. Mahmoodi H, Karbalaee Bagheri Z. Effectiveness of Acceptance and Commitment Therapy on a Sense of Hope and Belief to the Just World in Patients with Breast Cancer. J Health Psycho. 2020; 9(34): 155-70. https://journals.pnu.ac.ir/article_6973_f29571fe5052a6a1f6b91e180e9bfcba.pdf
2. Allahqoli L, Mazidimoradi A, Momenimovahed Z, Rahmani A, Hakimi S, Tiznobaik A, Gharacheh M, Salehiniya H, Babaey F, Alkatout I. The global incidence, mortality, and burden of breast cancer in 2019: correlation with smoking, drinking, and drug use. Frontiers in Oncology. 2022;12:921015. [DOI:10.3389/fonc.2022.921015] [PMID] []
3. Li W, Wang S, Li S, Qian X, Gu F, Guo X, Zhang X, Fu L. Increased LZTS1 expression is associated with a good response to paclitaxel-based chemotherapy in breast cancer. Pathology-Research and Practice. 2022; 234: 153915. [DOI:10.1016/j.prp.2022.153915] [PMID]
4. Aghili M, Laal Haghani F, Babaee E. The Effectiveness of Treatment Based on Acceptance and Commitment on Stressful Life Events and the level of Resilience in Women with Breast Cancer. IJCA. 2024; 2(4): 50-8. http://ijca.ir/files/site1/user_files_df077d/dr_aghili-A-10-466-1-46057ed.pdf
5. Breast Cancer Research Foundation. Breast cancer statistics and resources. 2024. https://www.bcrf.org/breastcancer-statistics-and-resources/
6. Proctor CJ, Reiman A, Best LA. Working after cancer: psychological flexibility and the quality of working life. J Cancer Survivorship. 2024; 18(1): 196-206. https://link.springer.com/article/10.1007/s11764-023-01364-7 [DOI:10.1007/s11764-023-01364-7] [PMID]
7. Haghighat S, Omidi Z, Ghanbari-Motlagh A. Trend of Breast Cancer Incidence in Iran During A Fifteen-Year Interval According To National Cancer Registry Reports. IJBD. 2022; 15(2): 4-17. http://ijbd.ir/article-1-996-fa.html [DOI:10.30699/ijbd.15.2.4]
8. Hosseini H, Loripoor M, Roeintan F. The effect of palliative-care education on quality of life of women with breast cancer. Iranian J Cancer Care. 2020; 1(2): 31-8. http://ijca.ir/article-1-80-en.html [DOI:10.29252/ijca.1.2.31]
9. Bagherzadeh R, Sohrabineghad R, Vahedparast H. Comparison of Sexual Dysfunction Between Women with Breast Cancer and Healthy Women in Bushehr. IJBD. 2020; 13(3):20-9. https://link.springer.com/article/10.1186/s41239-020-00194-2 [DOI:10.30699/ijbd.13.3.20]
10. Rafiee M, Masoudi S, Khakpour M. The effectiveness of schema therapy on cognitive flexibility, marital frustration and post-traumatic growth in women with cancer in Mashhad. MJMUMS. 2024;67(2): 558-568. 10.22038/mjms.2024.24591
11. Fidalgo P, Thormann J, Kulyk O, Lencastre JA. Students' perceptions on distance education :A multinational study. International journal of educational Technology in Higher Education. 2020;17(1):1-18. https://educationaltechnologyjournal.springeropen.com/articles/10.1186/s41239-020-00194-2 [DOI:10.1186/s41239-020-00194-2]
12. Burton NW, Pakenham KI, Brown WJ. Feasibility and effectiveness of psychosocial resilience training: a pilot study of the READY program. Psycho, Health & Medic. 2010; 15(3): 266-77. [DOI:10.1080/13548501003758710] [PMID]
13. Phillips EL. Resilience, mental flexibility, and cortisol response to the Montreal imaging stress task in unemployed men (Doctoral dissertation, University of Michigan). 2011. https://deepblue.lib.umich.edu/bitstream/handle/2027.42/84486/elphilli_1.pdf;sequence=1
14. Proctor CJ, Reiman AJ, Brunelle C, Best LA. Intimacy and sexual functioning after cancer: The intersection with psychological flexibility. PLOS Mental Health. 2024 Jun 12;1(1):e0000001. [DOI:10.1371/journal.pmen.0000001]
15. Jelodari S, Sodagar Sh, Bahrami Hidaji M. The effectiveness of Acceptance and Commitment Therapy (ACT) on psychological flexibility and cognitive emotion regulation in women with breast cancer. J Appl Psychol. 2020; 13(4): 527-548. https://apsy.sbu.ac.ir/article_97266.html?lang=en
16. Orki M, Mehdizade A, Dortaj A. Comparing the effectiveness of emotion regulation-focused cognitive-behavior therapy and acceptance and commitment therapy on reducing the backache symptoms and depression and increasing life satisfaction in women suffering from chronic backache with commorbid major depressive disorder. Psychol Health. 2018; 7(26): 25-43. https://hpj.journals.pnu.ac.ir/article_4969.html
17. Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013;44:180-98. [DOI:10.1016/j.beth.2009.08.002] [PMID] []
18. Ahmadi V, Valizadeh H. The effectiveness of acceptance and commitment-based therapy on the quality of life and death anxiety in the elderly. Aging Psychology. 2021; 7(2): 166-53. 10.22126/JAP.2021.6370.1528
19. Feyzolahi S, Narimani M, Mousazadeh T. The Comparison of the Effectiveness of Schema Therapy and Acceptance and Commitment Therapy on Emotion Cog nitive Regulation and Early Maladaptive Schemas in Women with Suicidal Ideation (with Emphasis on Culture). J Woman Cultural Psychology. 2023;15(57):1-7.
20. Ferreira MG, Mariano LI, de Rezende JV, Caramelli P, Kishita N. Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Appl Psychol. 2022; 309: 297-308. [DOI:10.1016/j.jad.2022.04.134] [PMID]
21. Macri JA, Rogge RD. Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review. Clini Psycho Revi. 2024:102432. [DOI:10.1016/j.cpr.2024.102432] [PMID]
22. Ksiksou J, Maskour L, Alaoui S. Effect of acceptance and commitment therapy on depression, anxiety, stress, and psychological flexibility in women with breast cancer. Kontakt 2024;26(2):104. https://kont.zsf.jcu.cz/pdfs/knt/2024/02/02.pdf [DOI:10.32725/kont.2024.023]
23. Bahmani B, Etemadi A, Shafiabadi A, Delavar A, Ghanbari Motlaq A. Cognitive-existential Group therapy and cognitive instructional therapy for breast cancer patients. IPIPJ 2010; 6(23): 201-213. http://ensani.ir/file/download/article/20120328160822-2028-2.pdf
24. Kissane DW. Psychospritual and existential distress. Austrailian Fam Physician. 2000; (29): 1022-25.
25. Kissane DW, Bloch S, Miach P, Smith GC, Seddon A, Keks N. Cognitive‐existential group therapy for patients with primary breast cancer-techniques and themes. Psycho‐Oncology 1997;6(1):25-33. https://www.chicom.be/sites/default/files/1997_cegt_psychoonc_kissane.pdf https://doi.org/10.1002/(SICI)1099-1611(199703)6:1<25::AID-PON240>3.3.CO;2-E [DOI:10.1002/(SICI)1099-1611(199703)6:13.3.CO;2-E]
26. da Ponte G, Ouakinin S, Santo JE, Amorim I, Gameiro Z, Fitz-Henley M, et al. Process of therapeutic changes in meaning-centered group psychotherapy adapted to the portuguese language: a narrative analysis. Palliative Supportive Care 2020; 18(3):254-62. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332394/ [DOI:10.1017/S147895151900110X] [PMID] []
27. Kissane DW, Lave A, Hatton A, Bloch S, Smith G, Clarke DM, at al. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. J Clin Oncol 2004; 22(21):4255-60. https://pubmed.ncbi.nlm.nih.gov/15452189/ [DOI:10.1200/JCO.2004.12.129] [PMID]
28. Lebel S, Maheu C, Tomei C, Mutsaers B, Bernstein LJ, Courbasson C, Ferguson SE, Harris C, Jolicoeur L, Lefebvre M, Muraca L. Mechanisms of change of a cognitive-existential group intervention for fear of cancer recurrence: Mediation analyses of the FORT trial. J Psychosoc Oncology Rese & Pract. 2022;4(3). https://journals.lww.com/jporp/fulltext/2022/09000/mechanisms_of_change_of_a_cognitive_existential.5.aspx [DOI:10.1097/OR9.0000000000000077]
29. Holtmaat K, van der Spek N, Lissenberg‐Witte B, Breitbart W, Cuijpers P, Verdonck‐de Leeuw I. Long‐term efficacy of meaning‐centered group psychotherapy for cancer survivors: 2‐Year follow‐up results of a randomized controlled trial. Psycho‐oncology. 2020;29(4):711-8. [DOI:10.1002/pon.5323] [PMID] []
30. Kissane DW, Lave A, Hatton A, Bloch S, Smith G, Clarke DM, at al. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. J Clin Oncol 2004; 22(21):4255-60. https://ascopubs.org/doi/abs/10.1200/jco.2004.12.129 [DOI:10.1200/JCO.2004.12.129] [PMID]
31. Delavar A. Theoretical and practical foundations of research in humanities and social sciences. Tehran: Roshd Publication. 2015. https://www.sciepub.com/reference/118129
32. Kline RB. Principles and practice of structural equation modeling. Ed 2. New York & London: Guilford press 2016. pp: 89. https://pdfs.semanticscholar.org/9f61/4aefcc38de8aa425a190560055dff40fabed.pdf
33. Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cogni Therapy & Rese. 2010; 34: 241-53. http://dx.doi.org/10.1007/s10608-009-9276-4 [DOI:10.1007/s10608-009-9276-4]
34. Soltani E, Shareh H, Bahrainian S A M, Farmani A. The mediating role of cognitive flexibility in correlation of coping styles and resilience with depression. Pajoohande. 2013; 18(2): 88-96
35. URL: http://pajoohande.sbmu.ac.ir/article-1-1518-fa.html
36. Ali Akbari Dehcordi M, Bitaneh M. The Effectiveness of Psychological Capital Elements Training on Psychological Flexibility and Psychological Distress on the Women with Breast Cancer. Heal. Psycho. 2021;10(38):7-22. https://hpj.journals.pnu.ac.ir/article_7998.html
37. Wang Y, Yang Y, Xiao W-T, Su Q. Validity and reliability of the Chinese version of the Cognitive Flexibility Inventory in college students. Chinese Mental Health J. 2016 :30(1): 58-62. https://psycnet.apa.org/record/2016-06986-011
38. Borji M, Arabzadeh M, Zahed S. The relationship between Metacognitive Strategies and Academic Buoyancy in students: Mediating role of Cognitive Flexibility. Rooyesh. 2024; 13(3): 55-64. http://frooyesh.ir/article-1-4964-fa.html
39. Karbalaie M, Yazdanbakhsh K, Karimi P. Predicting Psychological Well-Being Based on Emotion Regulation, Cognitive Flexibility and Mindfulness in Cancer Patients. Health Psycho. 2021 May 22;10(37):141-60. https://hpj.journals.pnu.ac.ir/article_7773.html
40. Yazidi R, Abedi M R. Acceptance and Commitment Therapy. 5th edition, Jungle Kavashiar Publications. Tehran. 2015. https://www.gisoom.com/book/11244183/
41. Bahmani B. Comparison the effectiveness of two methods of "cognitive therapy-based teaching style Michael Ferry" and "Group Therapy Cognitive / Existential" the hope, self-esteem and quality of life in women after treatment for breast cancer, non-reported symptoms of depression have demonstrated [Dissertation]. Tehran: University of Allameh Tabatabai. 2010. https://ganj.irandoc.ac.ir//#/articles/3d9fcf4e39d99459b34029c70f69b163
42. Mohammadizadeh S, Khaltabari J, Ahadi H, Hatami H. Comparing the effectiveness of treatment based on acceptance and commitment, cognitive-behavioral therapy and spiritual therapy on perceived stress, body image and quality of life of women with breast cancer. Thought and behavior in clinical psychology. 2020; 15(55): 7-16. https://sanad.iau.ir/Journal/jtbcp/Article/1118151
43. Zhang Y, Ding Y, Chen X, Li Y, Li J, Hu X. Effectiveness of acceptance and commitment therapy on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer: A meta‐analysis of randomized controlled trials. Worldviews on Evidence‐Based Nursing 2023 Dec;20(6):582-92. [DOI:10.1111/wvn.12652] [PMID]
44. Fang P, Tan L, Cui J, Yu L. Effectiveness of Acceptance and Commitment Therapy for people with advanced cancer: a systematic review and meta‐analysis of randomized controlled trials. Journal of Advanced Nursing. 2023 Feb;79(2):519-38. https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.15543 [DOI:10.1111/jan.15543] [PMID]
45. Kissane DW, Clark DM, Street AF. Demoralization syndrome. A relevant psychiatric diagnosis for palliative care. J Palliate care. 2001; (7): 12-21. https://journals.sagepub.com/doi/abs/10.1177/082585970101700103 [DOI:10.1177/082585970101700103] [PMID]
46. Farmani Shahreza S, Khani S, Ghaedaniay Jahromi A, Imani S. Effectiveness of Cognitive-Existential Therapy on Fatigue, Demoralization Syndrome and Perceived Stress in Patients with Multiple Sclerosis (MS). Alborz University Medical Journal. 2019; 8(2): 135-49. 10.29252/aums.8.2.135 [DOI:10.29252/aums.8.2.135]
47. Lin J, Klatt LI, McCracken LM, Baumeister H. Psychological flexibility mediates the effect of an online-based acceptance and commitment therapy for chronic pain: an investigation of change processes. Pain. 2018; 159(4): 663-72. https:// doi.org/10.1097/j.pain.0000000000001134 [DOI:10.1097/j.pain.0000000000001134] [PMID]
48. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy. 2004; 35(4): 639-65. https://scholarwolf.unr.edu/home [DOI:10.1016/S0005-7894(04)80013-3]
49. MahmodiTabar M, Safarzadeh S. Comparison of the Effectiveness of Integrated Meta-Diagnostic Treatment and Positive Thinking Skills Training on Adherence to Treatment and Coronavirus Anxiety in Patients with Type 2 Diabetes. IJPN. 2021; 9 (5): 87-98. http://ijpn.ir/article-1-1846-fa.html
50. Mahdavifar N, Pakzad R, Ghoncheh M, Pakzad I, Moudi A, Salehiniya H. Spatial analysis of breast cancer incidence in Iran. Asian Pacific J Cancer Prevention. 2016;17(S3):59-64. http://dx.doi.org/10.7314/APJCP.2016.17.S3.59 [DOI:10.7314/APJCP.2016.17.S3.59] [PMID]
51. Sajadian A, Motaharinasab A, heydari L, Farokhi D, Haghighat S, Hashemi E. Effect of logotherapy treatment alone or in combination with yoga on anxiety, depression, and happiness after breast cancer: A clinical Trial. IJBD 2024; 16 (4) :34-49. http://ijbd.ir/article-1-1078-fa.html [DOI:10.61186/ijbd.16.4.34]

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