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Advances in Cognitive Sciences 2023, 25(1): 1-14 |
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Esmailyan Z, Rahmani M A, Tizdast T. The effectiveness of acceptance and commitment therapy on self-care and hemoglobin glycolysis in patients with type 2 diabetes. Advances in Cognitive Sciences 2023; 25 (1) :1-14
URL: http://icssjournal.ir/article-1-1458-en.html
URL: http://icssjournal.ir/article-1-1458-en.html
1- PhD Student of General Psychology, Department of Psychology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
2- Assistant Professor, Department of Psychology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
3- Associate Professor, Department of Psychology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
2- Assistant Professor, Department of Psychology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
3- Associate Professor, Department of Psychology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
Abstract: (1076 Views)
Introduction
Chronic increase in blood sugar is responsible for the major cause of acute short-term and long-term complications of this disease, affectingall systems and organs of the body. Diabetes affects the production or use of insulin in the body. The increasing the prevalence of diabetes is due to continuous changes in lifestyle, such as poor diet, physical inactivity, obesity and stress, which are often associated with urbanization, mechanization, and industrialization. Chronic increase in blood sugar is responsible for the major acute short-term and long-term complications of the disease, affecting all body systems' ogans.
Methods
The present study was a semi-experimental study in which a pre-test and post-test design with a control group was used in the present study. All patients with type II diabetes were referred to the Iranian Diabetes Association in Tehran during January to May 2020. The sampling method in this study was available and goal-based sampling. According to Basa (1995), changes were observed inthe average HbA1c before and three months after an intervention program at the rate of (8.8-7.1=1.7) and for deviation. The assistant calculated the amount (2.2) (α=0.05 and β=0.2), and the volume of Monet was calculated for15 people using the Cohen formula. After approving the proposal and obtaining a written license from the Educational Deputy of Tonekabon University, the researcher referred to the Association of Diabetic Patients in Tehran province. While introducing themselves and expressing the purpose of the research, patients who were eligible to participate (specified taxes) were identified. The patients were harmonized in terms of age, education, and marital status so that there was an ability to compare the two groups, and the confounding factors decreased as much as possible. Then, both patients were randomly matched in double blocks, the treatment group was allocated based on acceptance and commitment, and the group without control group training was assigned. After obtaining written and verbal consent from participants, Mullah, who entered the age of 30-55 years, had type 2 diabetes; based on ADA evidence, for at least six months, he was diagnosed by a specialist. Higher education rate than cycle, no acute or chronic medical disease that causes problems in bloodletting, it is necessary for subjects to perform psychotherapy programs and change medications during the research. This study used no educational or treatment interventions. Exclusion criteria included other types of diabetes and severe diabetic complications that limited the study. Lack of cooperation and weekly task were the other criteria. At the beginning of the study, demographic information questionnaires, adherence to the treatment scale of self-care activities, and self-regulation scale (pre-test) were provided to patients. The mentioned interventions were performed in eight group sessions, one session per 40-minute weekly (for the experimental group only), and the training period was two months. The ninth session was performed again from experimental and post-test groups. After three months, follow-up was performed in both groups. In addition, in order to re-establish the questionnaires used in the present study, the mentioned questionnaires were checked again on thirty test items.
Results
The assumption of homogeneity of error variance was investigated using the Loon test. The results of this analysis revealed that this assumption was not established for self-care components (P>0.05) and hemoglobin (P<0.05). The results of multivariate tests showed that providing acceptance-based therapy and self-compassion-based commitment in group factor (Pillais trace=0.971, F=210/108, P<0.001, ƞ2=0.971) and in time factor (Pillais trace=0.987, F=194/589, P<0.001, ƞ2=0.987) and interactive effect of time and group (Pillais trace=0.982, F=146/805, P<0.001, ƞ2=0.982) were significant. These results showed that the intervention of the treatment model is based on acceptance and commitment to the studied dimensions. The results of the intergroup effect test to investigate the effects on each dimension under study indicated that in the control and experimental groups, the variable self-care (P<0.001, F=561.086) and glycosylated hemoglobin (F). There was a significant difference between the experimental and control groups (P<0.001, F=304.953), and the comparison of the means indicated an increase in the mean of self-care and a decrease in hemoglobin in the experimental group compared to the control group. Furthermore, the results of the intragroup effect test to compare the groups during the test stages showed that the effect of time factor for self-care variables (FGG1/28=251/648, P<0.001, ƞ2=0.834), glycosylated hemoglobin (FGG1/73=87/455, P<0.001, ƞ2=0.636) was significant. The results of this study demonstrated that the intervention based on acceptance and commitment therapy was effective on the dimensions studied in the experimental group compared to the control group, and comparing the means of the two groups in the post-test and follow-up stages indicated the stability of the effect of the intervention in the experimental group.
Conclusion
The more people control and level their life environment, particularly stressful life conditions, the more their sense of inner satisfaction, self-efficacy and self-confidence, and psychological well-being are more desirable, unlike those who suffer from diabetes due to stressful life situations, since they lack cognitive and behavioral skills in controlling stressful events, they usually hesitate to see doubts. They look at their ability and are always concerned about other people's negative evaluations of themselves and their behaviors. Therefore, reducing stress, anxiety, and depression in physical, mental, and social dimensions is one of the crucial treatment goals.
Ethical Considerations
Compliance with ethical guidelines
All subjects received information about the research. They were assured that all information would remain confidential and only be used for research. The subjects’ specifications were not recorded to respect privacy. In the end, all of them were conveniently satisfied. This research has received the Code of Ethics from the Ethics Committee of the Islamic Azad University, Tonekabon branch, with the number IR.IAU.K.REC.1398.021.
Authors’ contributions
Zahra Esmailyan and Mohammad Ali Rahmani: Involved in selecting the subject, the study design, and the definition of concepts. All authors searched literature and research background. Zahra Esmailyan: Collecting and analyzing data. Taher Tizdast: Writing and preparing a draft. All the authors discussed the results and participated in the article's final version.
Funding
No financial assistance has been received from any organization.
Acknowledgments The authors sincerely appreciate the Research Deputy of the Islamic Azad University of Tonekabon, and all employees of the Iranian Diabetes Association, and patients assisting in the project.
Conflict of Interest
This study did not have any conflict for the authors.
Chronic increase in blood sugar is responsible for the major cause of acute short-term and long-term complications of this disease, affectingall systems and organs of the body. Diabetes affects the production or use of insulin in the body. The increasing the prevalence of diabetes is due to continuous changes in lifestyle, such as poor diet, physical inactivity, obesity and stress, which are often associated with urbanization, mechanization, and industrialization. Chronic increase in blood sugar is responsible for the major acute short-term and long-term complications of the disease, affecting all body systems' ogans.
Methods
The present study was a semi-experimental study in which a pre-test and post-test design with a control group was used in the present study. All patients with type II diabetes were referred to the Iranian Diabetes Association in Tehran during January to May 2020. The sampling method in this study was available and goal-based sampling. According to Basa (1995), changes were observed inthe average HbA1c before and three months after an intervention program at the rate of (8.8-7.1=1.7) and for deviation. The assistant calculated the amount (2.2) (α=0.05 and β=0.2), and the volume of Monet was calculated for15 people using the Cohen formula. After approving the proposal and obtaining a written license from the Educational Deputy of Tonekabon University, the researcher referred to the Association of Diabetic Patients in Tehran province. While introducing themselves and expressing the purpose of the research, patients who were eligible to participate (specified taxes) were identified. The patients were harmonized in terms of age, education, and marital status so that there was an ability to compare the two groups, and the confounding factors decreased as much as possible. Then, both patients were randomly matched in double blocks, the treatment group was allocated based on acceptance and commitment, and the group without control group training was assigned. After obtaining written and verbal consent from participants, Mullah, who entered the age of 30-55 years, had type 2 diabetes; based on ADA evidence, for at least six months, he was diagnosed by a specialist. Higher education rate than cycle, no acute or chronic medical disease that causes problems in bloodletting, it is necessary for subjects to perform psychotherapy programs and change medications during the research. This study used no educational or treatment interventions. Exclusion criteria included other types of diabetes and severe diabetic complications that limited the study. Lack of cooperation and weekly task were the other criteria. At the beginning of the study, demographic information questionnaires, adherence to the treatment scale of self-care activities, and self-regulation scale (pre-test) were provided to patients. The mentioned interventions were performed in eight group sessions, one session per 40-minute weekly (for the experimental group only), and the training period was two months. The ninth session was performed again from experimental and post-test groups. After three months, follow-up was performed in both groups. In addition, in order to re-establish the questionnaires used in the present study, the mentioned questionnaires were checked again on thirty test items.
Results
The assumption of homogeneity of error variance was investigated using the Loon test. The results of this analysis revealed that this assumption was not established for self-care components (P>0.05) and hemoglobin (P<0.05). The results of multivariate tests showed that providing acceptance-based therapy and self-compassion-based commitment in group factor (Pillais trace=0.971, F=210/108, P<0.001, ƞ2=0.971) and in time factor (Pillais trace=0.987, F=194/589, P<0.001, ƞ2=0.987) and interactive effect of time and group (Pillais trace=0.982, F=146/805, P<0.001, ƞ2=0.982) were significant. These results showed that the intervention of the treatment model is based on acceptance and commitment to the studied dimensions. The results of the intergroup effect test to investigate the effects on each dimension under study indicated that in the control and experimental groups, the variable self-care (P<0.001, F=561.086) and glycosylated hemoglobin (F). There was a significant difference between the experimental and control groups (P<0.001, F=304.953), and the comparison of the means indicated an increase in the mean of self-care and a decrease in hemoglobin in the experimental group compared to the control group. Furthermore, the results of the intragroup effect test to compare the groups during the test stages showed that the effect of time factor for self-care variables (FGG1/28=251/648, P<0.001, ƞ2=0.834), glycosylated hemoglobin (FGG1/73=87/455, P<0.001, ƞ2=0.636) was significant. The results of this study demonstrated that the intervention based on acceptance and commitment therapy was effective on the dimensions studied in the experimental group compared to the control group, and comparing the means of the two groups in the post-test and follow-up stages indicated the stability of the effect of the intervention in the experimental group.
Conclusion
The more people control and level their life environment, particularly stressful life conditions, the more their sense of inner satisfaction, self-efficacy and self-confidence, and psychological well-being are more desirable, unlike those who suffer from diabetes due to stressful life situations, since they lack cognitive and behavioral skills in controlling stressful events, they usually hesitate to see doubts. They look at their ability and are always concerned about other people's negative evaluations of themselves and their behaviors. Therefore, reducing stress, anxiety, and depression in physical, mental, and social dimensions is one of the crucial treatment goals.
Ethical Considerations
Compliance with ethical guidelines
All subjects received information about the research. They were assured that all information would remain confidential and only be used for research. The subjects’ specifications were not recorded to respect privacy. In the end, all of them were conveniently satisfied. This research has received the Code of Ethics from the Ethics Committee of the Islamic Azad University, Tonekabon branch, with the number IR.IAU.K.REC.1398.021.
Authors’ contributions
Zahra Esmailyan and Mohammad Ali Rahmani: Involved in selecting the subject, the study design, and the definition of concepts. All authors searched literature and research background. Zahra Esmailyan: Collecting and analyzing data. Taher Tizdast: Writing and preparing a draft. All the authors discussed the results and participated in the article's final version.
Funding
No financial assistance has been received from any organization.
Acknowledgments The authors sincerely appreciate the Research Deputy of the Islamic Azad University of Tonekabon, and all employees of the Iranian Diabetes Association, and patients assisting in the project.
Conflict of Interest
This study did not have any conflict for the authors.
Keywords: Self-care, Type 2 diabetes, Acceptance and commitment-based treatment, Hemoglobin glycolysis
Type of Study: Research |
Received: 2022/08/21 | Accepted: 2023/01/31 | Published: 2023/07/10
Received: 2022/08/21 | Accepted: 2023/01/31 | Published: 2023/07/10
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