In collaboration with Payame Noor University and Iranian Health Psychology Association

Document Type : Scientific Research

Authors

1 Ph.D Student, Department of Psychology, Bojnord Branch, Islamic Azad University, Bojnord, Iran.

2 Assistant Professor, Department of Psychology, Payame Noor University, Tehran, Iran.

3 Associate Professor, Department of Psychology, Qochan Branch, Islamic Azad University, Qochan, Iran.

10.30473/hpj.2024.70061.5978

Abstract

Objective: Eating disorders are one of the common mental and psychosomatic disorders that cause many problems in the physical health and mental performance of a person. Many people with bulimia have mental rumination regarding their body type. Patients who engage in mental rumination consider it a way to gain insight into their problem and through it they focus on themselves, the problematic situation and their feelings. In other words, they think that mental rumination helps them to solve their problems, while answering problems through mental rumination causes more tension and problems. On the other hand, self-acceptance in these people is lower than others. A person with low agreeableness tends to seek isolation and is afraid of and avoids communication with others. The purpose of this research was to compare the effectiveness of therapeutic schema training in comparison with acceptance and commitment therapy (ACT) with self-acceptance and rumination in women with diabetes and anorexia nervosa. Method: This is a semi-experimental study with a pre-test-post-test design and a control group with a two-month follow-up. The statistical population was all women with simultaneous disorder of diabetes and psychogenic anorexia in Mashhad city in the first half of 1402 who had referred to medical centers. 45 people were selected by purposeful sampling and randomly divided into three groups: schema therapy (15 people), acceptance and commitment therapy (15 people) and control group (15 people). Chamberland and Haga (2001) questionnaire was used to evaluate self-efficacy, and Trinoor et al. The therapeutic schema experimental group underwent the educational package intervention of Yang et al. (2003) and the acceptance and commitment experimental group underwent the therapeutic intervention of Hizo colleagues (2012) for ten one-hour sessions. The data was analyzed by the statistical method of analysis of variance with repeated measurements. Results:  The results showed that the intervention of therapeutic schema and acceptance and commitment is effective on mental rumination (P<0.01), (F=29.63) and self-acceptance (P<0.01), (F=49.83) and this The effect is stable in the follow-up phase. The results of Shefe's follow-up test showed that there is a significant difference in self-acceptance and rumination between the two groups of acceptance and commitment and therapeutic schema (P<0.05); Therefore, acceptance and commitment have had a greater effect on reducing rumination and increasing women's self-acceptance. Conclusion:  According to the results, it can be said that by teaching psychological treatment approaches such as schema and acceptance and commitment therapy, women can be helped in controlling diabetes and preventing their nervous overeating. Also, by controlling binge eating, they can be protected from the side effects of physical, psychological and social damage of binge eating, and thus have healthier mothers and a healthier society.

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Main Subjects

Afzali, Reza, Ehtshamzadeh, Parvin, Asgari, Parviz, Naderi, Farah. (1401). The effectiveness of schema therapy on craving for food consumption, cognitive flexibility and attention bias towards food in people with binge eating disorder. Health Psychology, 11(41), 27-46. (in persian)
Aghakhani, Ali. (2016). Comparison of resilience, dyslexia and self-reliance of homeless people and healthy people. Master's thesis. Islamic Azad University, Ahar branch. (in persian)
Ahmadi, Ezzatullah and Mardani, Latifah Sadat. (2018). Structural relationships of dysfunctional thoughts and rumination with eating disorder symptoms with the mediation of avoidance performance. Thought and Behavior in Clinical Psychology, 14(53), 56-47. (in persian)
AllaHyari, Mohammad and Khaleghi, Samia. (1400). Effectiveness of acceptance and commitment therapy in bulimia nervosa and maladaptive strategies of worry in women. The second national conference of psychopathology, Ardabil. (in persian)
Amanzad, Zahra, and Hosseinian, Simin. (2017). Effectiveness of group counseling based on existential approach on life attitude and spiritual health of patients with type 2 diabetes. Women and Family Studies, 6(1 (consecutive 11)), 49-67. (in persian)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington: American Psychiatric Publisher.
Ashrafi, Sahar; Bahrainian, Abdul Majeed; Haji Alizadeh, Kobri and Delavar, Ali. (2019). The effectiveness of acceptance and commitment therapy on bulimia nervosa in overweight women. Behavioral Science Research, 18(2), 191-182. (in persian)
Ayar, D. & Sabanciogullari, S. (2021) The effect of a solution‐oriented approach in depressive patients on social functioning levels and suicide probability. Perspectives in psychiatric care, 57(1), 235-245.
Bagherinejad, Bagherinejad, Salehi Federdi, Salehi Federdi, & Tabatabai (2009). The relationship between rumination and depression in a sample of Iranian students. Researches in clinical psychology and counseling, 011(1). (in persian)
Boterhoven de Haan, K. L., Fassbinder, E., Hayes, C., & Lee, C. W. (2019). A schema therapy approach to the treatment of posttraumatic stress disorder. Journal of Psychotherapy Integration, 29(1), 54.
Chamberlain JM, Haaga DA. Unconditional selfacceptance and psychological health. Journal of Rational-Emotive and Cognitive-Behavior Therapy. 2001; 19(3): 163-76.
Cherrington, A., Wallston, K. A., & Rothman, R. L.(2015) Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. Journal of behavioral medicine, 33(1), 81-89.
Dong, C., Kou, T., Liu, Y., Zou, Y., Sun, L., Tian, H.,& Wang, Q. (2019). Study on the effect of smoking on the risk of active pulmonary tuberculosis in patients with type 2 diabetes mellitus.Chronic Diseases Prevention Review. 10 (6), 36-41.
Ellis, D. A., Carcone, A. I., Slatcher, R., Naar‐King, S., Hains, A., Graham, A., & Sibinga, E. (2019). Efficacy of Acceptance and Commitment Therapy (ACT) in emerging adults with poorly controlled, type 1 diabetes: A pilot randomized controlled trial. Pediatric diabetes, 20(2), 226-234.
Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL.Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. J Consult Clin Psychol. 2014; 75(2):336-43.
Haji Ali Akbari, Nikan, 2015, comparison of unconditional self-acceptance, feeling of loneliness and source of control in co-dependent and non-codependent women, first international comprehensive conference of psychology, educational sciences and social sciences, Tehran. (in persian)
Harrington, C., Carter-Templeton, H., & Appel, S.(2017). Diabetes self-management education and self-efficacy among African American women living with type 2 diabetes in rural primary care. Journal of Doctoral Nursing Practice, 10(1), 11-16.
Hashemi, Masoud, Faruzandeh, Elham, Heydarpour, Maryam. (1402). The effectiveness of treatment based on acceptance and commitment on emotional distress and commitment to treatment in diabetic patients with depression. Health  psychology (46) 12; 111-130. (in persian)
Heydari, Alireza, Pasha, Gholamreza, Mami, Shahram, and Ateshpour, Seyedhamid. (1384). The prevalence of eating disorders and its relationship with self-esteem, self-concept and depression in female students of Ilam University of Medical Sciences. Knowledge and Research in Applied Psychology, 7(26), 1-16. (in persian)
Hayes SC, Strosahl KD, Wilson KG. (2012)Acceptance and commitment therapy: The process and practice of mindful change. New York: Guilford Press.
Ismaili, Sahar and Khosravi, Sadraleh. (2017). The effect of treatment based on acceptance and commitment on binge eating and difficulty in regulating emotions in binge eating disorder sufferers. National conference of new ideas in psychology and educational sciences with emphasis on recent scientific researches, Tehran.(in persian)
Jan, S. M. (2019). The effect of non-surgical phase on fasting sugar level in type 2 diabetic patients with generalized chronic periodontitis. Paripex-Indian Journal of Research, 8(4).
Lev, A., & McKay, M. (2017). Acceptance and Commitment Therapy for Couples: A Clinician’s Guide to Using Mindfulness, Values, and Schema Awareness to Rebuild Relationships. New Harbinger Publications.
Miller CA, Golden NH. An introduction to eating disorders: clinical presentation, epidemiology, and prognosis. Nutr Clin Pract. 2010 Apr; 25(2): 110-5.
Martin, L. T., & Tesser, A. (1996). Some ruminative thoughts. In: Wyer R. S., (Ed). Ruminative thoughts, 1–47. Hillsdale, New Jersey: Erlbaum.
Mao, A., Brockman, R., Neo, H. L. M., Siu, S. H. C., Liu, X., & Rhodes, P. (2022). A qualitative inquiry into the acceptability of schema therapy in Hong Kong and Singapore: implications for cultural responsiveness in the practice of schema therapy. Clinical Psychologist, 1-10.
Muhaddith Shakuri Ganjavi, Leila, Ahadi, Hassan, Jamhari, Farhad, and Khaltabari, Javad. (2019). The effectiveness of treatment based on commitment and acceptance on fasting blood sugar level and self-efficacy in women with type II diabetes. Knowledge and research in applied psychology, 21(4 (serial 82)), 46-59. (in persian)
Ostadian Khani Zahra, Hosni Fariba, Sepah Mansour Mozhgan, Farnaz Senior Agriculture. The effectiveness of acceptance and commitment therapy on body image flexibility and emotion control in women with binge eating disorder. Journal of rehabilitation research in nursing. 1399; 6 (3): 94-102. (in persian)
Roozebooin, W.D. (2014). Solution – Focused Counseling .Encyclopedia of Psychology and Religion, 1625-75.
Smith, J., & Alloy, L. (2009). A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clinical Psychology Review, 29 (2), 116- 128.
Taheri, Noorale, Qajri, Haideh, and Shahbazi, Hassan. (2017). Relationship between health literacy and self-efficacy and self-care in patients with type 2 diabetes. Iranian Journal of Endocrinology and Metabolism, 20(3), 135-141. (in persian)
Wassenaar E, Friedman J, Mehler PS. Medical complications of binge eating disorder. Psychiatr Clin North Am. 2019;42(2):275-86.
Young, J.E., Klosko, J.S. & Weishaar, M.E. (2003). Schema therapy: A practitioners guide. New york, Guilford Press. https://books.google.com