The Effect of Metacognitive Therapy on Depression and Resilience of Cancer Patients in Selected Hosp

Research Article

Clinics of Oncology

ISSN: 2640-1037 Volume 4

The Effect of Metacognitive Therapy on Depression and Resilience of Cancer Patients in Selected Hospitals of Shahid Beheshti University of Medical Sciences

Zahedi A1, Mohtashami J2* and Nasrabadi T3

1Department of Nursing & Midwifery, Islamic Azad University of Medical Sciences, M.Sc. Student of Psychiatric Nursing, Iran

2Shahid Beheshti University of Medical Sciences, and Islamic Azad University, Medical Sciences of Tehran branch, Iran

3Department of Nursing & Midwifery Medical Sciences of Tehran branch, Islamic Azad University, Iran

*Corresponding author: Mohtashami J, Shahid Beheshti University of Medical Sciences, and Islamic Azad University, Medical Sciences of Tehran branch, Tehran, Iran, E-mail: j_mohtashami@sbmu.ac.ir

Keywords:

Metacognitive therapy; Depression; Resilience; cancer

1. Abstract

Received: 25 Feb 2021

Accepted: 12 Mar 2021

Published: 17 Mar 2021

Copyright: ©2021 Mohtashami J, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.

Citation:

Mohtashami J, The Effect of Metacognitive Therapy on Depression and Resilience of Cancer Patients in Selected Hospitals of Shahid Beheshti University of Medical Sciences. Clin Onco. 2021; 4(3): 1-7

1.1. Background and Aim: while cancer causing physical problems for patients, also causes many social and psychological problems. Crisis resulting from cancer causes disturbance in balance and psychological coordination, including sense of despair and depression. The aim of this study was to investigate the effectiveness of meta-cognitive therapy on depression and resilience of cancer patients in selected hospitals of Shahid Beheshti University of Medical Sciences.

1.2. Materials and Methods: This research was a semi-experimental study and population included 40 patients with cancer in Taleghani hospital in 2018. Patients were randomly divided into intervention and control groups. The intervention group received treatment for 4 weeks and the control group received routine treatment. Participants completed demographic questionnaire, Beck Depression Inventory (BDI), Connor- Davidson resilience Scale (CD-RISC) before the first session, the end and one month after intervention. To analysis data, descriptive statistics, and inferential analysis of data to determine differences and paired t-test before and after training were used.

1.3. Results: The highest difference between depression and resilience between the group before and one month after the intervention was 13.75, 18.95 respectively, which showed a significant reduction in depression and increased resilience of the patients (p <0.0001).

1.4. Conclusion: The results showed that meta-cognitive therapy was effective in depression and resilience of cancer patients immediately and one month after intervention. Therefore, it is advisable to help the patient recovery process by establishing and promoting counseling and psychotherapy centers in hospitals and health centers.

2. Introduction

Cancer is characterized by abnormal cell deformation and loss of cellular differentiation which causes cells proliferate abnormally and grow in the environment irregularly [1]. Cancer is one of the most prevalent diseases in the modern civilized world, with the number of people affected by that day increasing [2]. Cancer after cardiovascular disease is the second cause of death [3]. Generally, about two-thirds of the cancers occur in developing countries, where only 5% of cancer control tools are available [4]. According to the World Health Organization (WHO) in 2015, non-communicable diseases with a death rate of about 2166000 people every year more than double the deaths from infectious and nutritional diseases, which represent almost 60% of total mortality In the Mediterranean region of the East. Among these, 15% will be because of malignancies and cancers, while more than a third of cancers can be prevented [5].

Cancer causes interaction between cells and tissues. Patients diagnosed with cancer are one of the most shocking and influential events in their lives. Despite of the prognosis of the disease, this

diagnosis changes the mental image of the patient and changes the role of the home or work environment [3]. Because of the chronic nature of the cancer, the patient should accept long-term treatment with chemotherapy drugs. The treatment lasts weeks or months and its side effects can be nausea, hair loss, fatigue, muscle aches, skin burns, weight changes, and psychological problems [6]. Moreover, it causes many social and psychological problems, while causing physical problems for patients. Crisis caused by cancer causes disturbance in the balance and coordination of thought, body and soul, but the most common in this period for the patient is the sense of despair, despair and depression [7]. Depression is very harmful to cancer patients because it needs submission to disease. Other depressed people do not try to survive, and they miss better opportunities to live in the remainder of their lives [8]. The components that affect the incidence and severity of depression are Resilience. Resilience is one of the most significant positive psychologists, which is defined as a dynamic process positive and significant adaptation in dangerous conditions [9]. Resilience is defined as an act of self-restoration and of the conformity of behavior and actions in order to overcome the dangerous situations and promote life [10]. Many treatments for depression have been used in these patients. One of these treatments is metacognitive therapy in group therapy. The use of metacognitive therapy is considered as a group of several directions. First, in group therapy, patients do not need to be put on long waiting lists and therapists can use them better than their own time [11]. Second, the group environment offers other advantages to patients, such as the experience of being the same, modeling peer and peer support [12]. Karami et al. (2014) concluded that there was a negative significant relationship between metacognitive beliefs and mental health, and there was a positive significant relationship between metacognitive beliefs and self-esteem [13]. Also, the results of Mohammad Pour et al (2016) in the research on the effectiveness of the participating in the metacognitive therapy group on meta-cognitive beliefs in women with breast cancer revealed that metacognitive therapy with pretest control had a significant effect on the reduction of symptoms associated with the meta-cognitive factors of positive beliefs in concern, uncontrollability, risk and the need to control thoughts in women with breast cancer [14]. But a review of the literature suggests that rare studies have concentrated on the effectiveness of meta-cognitive therapy on depression and the Resilience of cancer patients. Thus, more investigation is required about the effect of the treatment. The aim of this study was to examine the effectiveness of meta-cognitive therapy on depression and the Resilience of cancer patients.

3. Materials and Methods

A semi-experimental study with intervention and control group was performed and research population was 40 persons with cancer who referred to Taleghani Hospital affiliated of Shahid Behesh-

ti University of Medical Sciences in 2018. Sampling was firstly based on the objective and then simple random method. Inclusion criteria were not having a known psychological disorder, insight toward of their cancer, duration at least 6 months from the diagnosis of cancer, and obtaining a score of 11 up from Beck Depression Inventory (BDI). The samples who did not participate more than two sessions exited from study. The sample size in each group was also confirmed based on the following assumptions: power = 0.80, α= 0.05, and Ơ=0.65 (20 for each group). The patients were randomly assigned into intervention and control groups. Data were collected using a socio-demographic questionnaire (included age, gender, education level, insurance type and promotion system, the duration of cancer, and type of cancer), Beck Depression Inventory (BDI), and Connor- Davidson resilience Scale (CD-RISC).

3.1. Beck Depression Inventory (BDI)

This scale is included 21 items. Items receive a rating of zero to three to reflect their intensity and are summed linearly to create a score which ranges from 0 to 63. The 21 items included reflect a variety of symptoms and attitudes commonly found among clinically depressed individuals. The BDI is interpreted through the use of cut-off scores. Cut-off scores may be derived based on the use of the instrument (i.e., if a clinician wishes to identify very severe depression, then the cut-off score would be set high). Scores from 0 through 9 indicate no or minimal depression; scores from 10 through 18 indicate mild to moderate depression; scores from 19 through 29 indicate moderate to severe depression; and scores from 30 through 63 indicate severe depression [15].

3.2. Connor- Davidson resilience Scale (CD-RISC)

Conner -Davidson Resilience Scale is designed by Connor and Davidson in 2003 in the United States, which has 25 items and 5 components; personal competence / solidity, trust in instincts / tolerance of negative emotions, positive acceptance of changes / relationships, safety, inhibition, and spirituality. The CD-RISC contains 25 items, all of which carry a 5-point range of responses, as follows: not true at all (0), rarely true (1), sometimes true (2), often true (3), and true nearly all of the time (4). The scale is rated based on how the subject has felt over the past month. The total score ranges from 0–100, with higher scores reflecting greater resilience.

In order to obtain the total score of the questionnaire, the total score of all questions is calculated; the higher the score, the greater the respondent's level of resilience will be, and vice versa, the cutoff point of the questionnaire is 50 points. In other words, the score above 50 will be for higher Resilience.

Partovi, 1974; Wahhabzadeh, 1972 and Chegini in 2002 reported that the reliability of the questionnaire was high and the maximum was 90% [16]. In the research of Basharat (2007), the validity and reliability of the Conor and Davidson questionnaire was confirmed [17]. In the research of Haghranjbar et al (2011) the reliability of

Conor and Davidson questionnaire was tested using Cronbach's alpha coefficient test, which obtained 0.84 for this questionnaire [16].

In this study, the internal consistency reliability was performed using Cronbach's alpha coefficient that was calculated for Beck Depression Inventory (0.90) and Conor Davidson Questionnaire (0.88).

3.3. Intervention Method

At first, 40 patients with cancer were selected based on inclusion criteria. Then, the objectives and benefits of participating in the study were explained to patients and, if agreeing, written informed consent was obtained. Patients were assured that the company was volunteering and their information would be kept confidential. All participants were completed questionnaires and after that they were randomly divided into two groups, intervention(n==20) and control (n=20) group. The metacognitive therapy group comprised

Session Subjects

1ST

2ND

3RD

4TH

5TH

9 women and 11 men, control group including 10 women and 10 men. At the beginning intervention group, a meta cognitive group therapy based on Adrian Wells [18] eight sessions (two sessions per week) was being held in hospital by first researcher. Each session took 90 minutes. Table 1 presents the content of each treatment session separately.

Immediately after the completion of the intervention and one month later, the participants in both groups simultaneously completed the study’s questionnaire again. Participants in the control group received the educational package too, but one month after the end of the intervention.

The ethical considerations for this research have been done to get the approval of the Ethics Committee of Islamic Azad University of Medical Sciences with ethics Code of IR.IAU.TMU. REC.1396.143 and obtain the essential permissions and coordination with the authorities of the research community.

Make Case Formulation. Introduction of model and preparation, identification and naming of rumination courses (increased knowledge). Attenuation Training Technique Practice (ATT). Complete the ATT Training Summary. Homemade homework: Practicing attentive instruction technique (twice a day), daily recording of the practice of teaching attentive techniques

Review homework and MDD-S scale, especially rumination and unbeliever beliefs. Introducing and rumination as a test for uncontrollability Homemade homework: ATT instruction exercises, deployment A mind-boggling consciousness and postponement of rumination

Review homework and MDD-S scale, especially rumination and unbeliever beliefs. Challenging meta-cognitive impairment (for example, modulation testing), Technician's practice, and the use of mind-boggling consciousness (DM) (counteracting active rumination by performing postponement of rumination in the treatment session). Attitudinal Education (ATT). Surveying the level of activity and avoidance of homework: ATT training, the use of flaccid consciousness (DM), and postponement of rumination (in the case of all inducers) Increases activity level

Review of homework and MDD-S scale, especially rumination time, uncontrollable belief, level of activity, and maladaptive check-up, postponement of rumination about at least 75% of instigators and more than 2 minutes of non-period Rhymes (Enhanced Application)

Challenge with Positive Beliefs about Ruminating Attitude Training Technique Practice (ATT) Homework: Attention Training Technique (ATT), Extending the Application of Fuzzy Mindfulness and Delaying Rhyming, Activity Planning

Review homework and MDD-S scale, especially rumination time, positive beliefs, level of activity and maladaptive coping, review of widespread and sustainable use of Diffused Mind (DM) Continue the challenge with positive beliefs about rumination Assessing the level of activity and providing recommendations for its improvement (examination and prohibition of other maladaptive coping methods such as excessive sleep, alcohol consumption), Attention Training Technique (ATT) Homemade homework: ATT instruction exercises, delayed rumination, increased activity levels

6TH homework and MDD-S scale review, especially rumination time, positive beliefs, activity level Investigating and Challenging with Negative Beliefs on Excitement / Depression Practicing Attention Training Technique (ATT) (Increasing Difficulty) Homework: Practicing Attention Training Technique

7TH

Review homework and MDD-S scale, especially rumination, misconceptions and coping.Work on the development of new programs (completion of the summary sheet of the program and presentation of a copy to the patient) Investigating and changing the fear of returning symptoms, ATT training practice homework: ATT instruction exercises, new program execution, Start work on developing a general treatment plan

8TH homework and MDD-S scale review, prevent recurrence (complete the treatment plan) Work on meta-cognitive beliefs, anticipating future stimuli and discussing how to use the new program of reinforcement session planning

3.4. Statistical Analysis

In order to analyze the data, descriptive statistics (central indicators and dispersion) and inferential statistics used. To define the quantitative data, the mean, standard deviation, percentage and

frequency were used. To determine the differences before and after education, t-test was used. All statistical tests were performed at a significance level of 0.05 and data were analyzed using SPSS software version 19.

Table 1: Intervention Sessions Features

4. Findings

Of the 40 participants in the study, 20 participants were placed in the intervention or meta-cognitive therapy group (9 men and 11 women) and 20 participants in the control group (10 men and 10 women). Table 2 shows the mean and standard deviation of age of the participations in two groups. According to findings the distribution of cancer patients in the two groups of control and intervention in terms of age variables were no significant differences. Also, other variables are presented at Table 3. The distribution of cancer patients in terms of sex, education level and type of insurance, were also no significant differences between control and intervention groups. In addition, the two groups were homogeneous. Also, results showed that the mean of depression in the control,

immediately after and one month after therapy in the intervention group was 18.25, 14.40 and 2.30 respectively. Moreover, the level of resilience in the control group, immediately after and one month after the intervention was 69.45, 74 and 88.35 respectively (Table 4).

According to Table 5 the highest mean difference between the cases before intervention one month after the intervention was 13.75. So, the rate of depression has decreased significantly and metacognitive therapy has been effective. Table 5 showed that the highest mean difference between the case before intervention and one month after the intervention 18.95, that shows an increase in the doping of the subjects in the intervention group who have undergone metacognitive treatment.

Table 2: the average age of patients in both intervention and control group

Table 3: Distribution of education level, insurance type and gender in both control and intervention group

Table 4: Depression and Resilience rate in control and intervention groups, before, immediately and one month after therapy

5. Discussion

The aim of this study was to study the effectiveness of metacognitive therapy on depression and resilience of cancer patients. In this study, 40 cancer patients were studied in both experimental and control groups, each of which was 20. The results of this study on meta-cognitive therapy on the rate of depression in patients with cancer indicated that there was a significant difference in depression in the control and control groups. Furthermore, meta-cognitive therapy is effective in decreasing the incidence of depression in cancer patients. Comparison of mean depression scores before and after intervention in control group did not show statistically significant difference.

But the mean comparison of this variable after meta-cognitive therapy presented a significant difference in depression; telling increased mental health and increasing the use of strategies to reduce depression in the experimental group. In the follow up study, the results after 1 month of metacognitive therapy, an improvement in the rate of depression reduction were obtained. The finding that metacognitive therapy reduces depression is similar to that of study by Zhang et al [19] Kuyken et al [20], Bergersen [21], and Parhoon et al [22]. Parhoon et al. in a similar explanation state that metacognitive therapy leads to the control of the underlying mechanisms of cognitive, emotional and behavioral symptoms because of the reduction of meta-cognitive beliefs involved in the continuation of depression symptoms. Wells et al [23] presented that 75% of depressed patients recovered after meta-cognitive therapy and 66% of them after a 6-month follow-up. In a study done by Ghahari et al [24], the effect of cognitive-behavioral intervention on decreasing depression and anxiety in women with breast cancer was not confirmed, which is not consistent with the results of this study.

In a research by Sadeghi firoozabadi et al [25], supplementary psychotherapy was effective in reducing the amount of anxiety and depression in patients. Furthermore, in the follow up to a month, the level of anxiety and depression remained constant. It can be determined that the training techniques helped patients to manage

their thoughts and mental conditions when confronted with anxiety events that were consistent with the present study. Only in one study, supplementary psychotherapy did not affect anxiety and depression in patients with prostate cancer [26], which did not match the results of the present study.

The results of one-month follow-up also showed that there was a significant difference between the persistency levels in the control and control groups. Besides, meta-cognitive therapy is effective on the Resilience of cancer patients. The study of Hosseini Ghomi et al [27] indicated that survival education in mothers with a cancerous child who experienced a specified education has been related to increased survival and reduced stress compared to those who did not have these training. They have made better progress in controlling their mental conditions and their families and their families, which is corresponding to the results of this study. Zamiri nejad and colleagues [28] indicated that the method of group vibration training plus cognitive therapy causes girl students depressed and is consistent with the results of this study.

Based on the findings of the study by Almasi et al [29], it has been found that training coping skills with stress has a positive effect on maternal relief and the degree of Resilience in them has increased after training. So the maternal Resilience scores increased significantly after 8 sessions of education (p <0.001), which is consistent with the results of the present study. It appears that in clarifying the significant relationship between vibration and emotional stresses of depression and stress, it can be concluded that the focus of programs and psychological interventions on increasing the Resilience of people with cancer can be a strategy infrastructure to decrease the emotional distress of these patients. This research had several limitations. Including time constraints, low sample sizes, tracking results only in the four-week period can be mentioned. Because of obstacles for further extensive research, it is recommended that future research study the effect of this treatment on other variables, such as adaptation to cancer. If there is a possibility to follow the results of meta-cognitive therapy in the long term (3 months and 6 months), it is probable that the effectiveness of this type of treat-

5: Difference in average level of Depression and Resilience of intervention groups, before, immediately and one month after therapy

ment for depressive disorder can be more persuasive.

6. Conclusion

The results indicate that metacognitive therapy has been effective in depression and resilience of cancer patients after the intervention and one month after the intervention. It is important to prevent emotional disorders such as depression in people with cancer. Therefore, according to the results, it can be said that the use of metacognitive therapy is a useful intervention for r patients with cancer. Because cancer has psychological dimensions and complications, metacognitive therapeutic behavior is not only effective in curing many chronic diseases but also helps patients to minimize the negative psychological effects of their disease. Therefore, reducing psychological symptoms is not only effective in treatments and future advances, but also in promoting supportive, coping, and rehabilitation programs. Therefore, it is recommended that by establishing and upgrading counseling and psychotherapy centers in hospitals and centers, effective assistance be provided in the improving process of these patients.

This research has faced several limitations. For example, time constraints, low sample size, follow-up of results only in the fourweek period can be mentioned. Due to the existence of barriers to the wider implementation of research, it is suggested that in future research, the effect of this treatment on other variables such as adaptation to cancer will be investigated. If it is possible to follow the results of metacognitive therapy in the long term (3 months and 6 months), we can probably speak more effectively about the effectiveness of this type of treatment for depressive disorder.

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