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Volume 24, Issue 4 (Winter 2023)
Advances in Cognitive Sciences 2023, 24(4): 44-58 |
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Khanjany A, Moradi A, Hasani J, Mohammadkhani S. Efficacy of memory flexibility training on resilience and emotion regulation in cancer caregivers. Advances in Cognitive Sciences 2023; 24 (4) :44-58
URL: http://icssjournal.ir/article-1-1413-en.html
URL: http://icssjournal.ir/article-1-1413-en.html
1- PhD Student in Health Psychology, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
2- Professor of Clinical Psychology, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
3- Associate Professor, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
2- Professor of Clinical Psychology, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
3- Associate Professor, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
Abstract: (759 Views)
Introduction
Cancer is one of the most critical and challenging diseases in the current age. Caregivers play an essential and critical role and are known as a key factor in cancer treatment. Providing care to cancer patients is a complex, serious, challenging, multi-directional, and burned-out responsibility. This role imposes a heavy cognitive and emotional burden on caregivers, overshadowing various aspects of their lives, including physical and psychological health, emotional, cognitive, and behavioral elements, and quality of life. Cancer caregivers suffer distress, depression, anxiety, fatigue, stress, and emotional burn-out and experience low levels of satisfaction and quality of life. While the negative impact of caregiving has been widely addressed, much less attention has been given to the ways in which such adverse outcomes may be avoided or reduced. The objective of this study is focused on helping cancer caregivers improve their life experiences through psychological methods. Based on the primary caregiver’s problems, in this research improving emotion regulation skills and increasing resilience are addressed, which can lead to increased quality of life, mental health, and adaptation in caregivers. Cancer develops financial problems for caregivers, and providing all caregiving tasks takes lots of time. Accordingly, this research is carried out MemFlex as a low-cost and short-term intervention that matches caregivers’ exceptional circumstances and aims to determine its effectiveness on resilience and emotion regulation in cancer caregivers.
Methods
This survey is an applied research using a quasi-experiment design that applies repeated measurement (pre-test/post-test/follow-up) control group. The study population consisted of all caregivers to cancer patients who are diagnosed in Tehran hospitals and medical care centers. Sixty caregivers were recruited by convenience sampling method. They were informed there were no obligations to participate in this study, and they can choose to leave it in any phase. They were reassured that their personal information was completely confidential and signed an informed consent form. The participants were randomly categorized into experimental (intervention) and control groups, and each group consisted of 30 participants. Caregivers’ demographic data was gathered through a semi-structured clinical interview, and they were asked to fill Resilience Scale (CD‐RISC) and Cognitive Emotion Regulation Questionnaire (CERQ). Experimental group participants received MemFlex in nine sessions. In the initial session, experimental participants were instructed to complete eight MemFlex sessions for four weeks (two sessions per week). They were in touch with the researcher to follow instructions and ask their questions. At the end of the four weeks, the researcher contacted them to check that all workbooks were completed and to book the post-test. After that, both the experimental and control group refilled CD‐RISC and CERQ. Three months later, participants refilled questionnaires as a follow-up test. To provide ethics principles, participants in the control group received the psychological intervention. Gathered data were analyzed by mixed variance analysis on the pre-test, post-test, and follow-up scores by SPSS-24 after completing all research phases.
Results
The mean and standard deviation of the participants’ age was 37.80±7.93 in the experimental group and 39.13±7.01 in the control group. The results showed increasement in Resilience scores mean from pre-test to post-test in the experimental group overall and each factor scores: personal competence and sense of self-efficacy, emotional and cognitive control under pressure self-control, positive acceptance of change, and spirituality; while no significant changes were found in the control group’s scores. The changes were steady in the follow-up phase for the experimental group. Considering emotion regulation scores mean, the results showed increasement in Adaptive Strategies factors: Acceptance, Positive refocusing, refocus on planning, positive reappraisal, and putting into perspective, and decreasement in maladaptive strategies factors: self-blame, rumination, catastrophizing, and other-blame; while scores did not change for the control group. In order to investigate the effectiveness of MemFlex on resilience and emotion regulation, data were analyzed by mixed variance analysis (MANOVA). The normality of data distribution was checked and confirmed. The homogeneity of variances distribution was checked and confirmed using the Levene’s test. According to Pillai's Trace, resilience scores (personal competence and sense of self-efficacy, emotional and cognitive control under pressure self-control, positive acceptance of change, and spirituality) and adaptive emotion regulation Strategies scores (acceptance, positive refocusing, refocus on planning, positive reappraisal, and putting into perspective) increased significantly compared to the control group. It also showed that the scores of maladaptive emotion regulation strategies (self-blame, rumination, catastrophizing, and other-blame) decreased significantly compared to the control group. The Bonferroni test was applied to confirm the results.
Conclusion
The results showed that participants in the memory flexibility training group had higher adherence than the control group. Furthermore, higher scores in adaptive emotion regulation strategies and lower scores in maladaptive strategies were observed in the experimental group than in the control group. Thus, it is concluded that memory flexibility training leads to increasing adherence and improving emotion regulation strategies in cancer caregivers. Considering the results of this research, it is recommended to study autobiographical memory playing a role in developing and contributing to psychological disorders. Malfunctioning of autobiographical memory (overgeneralization, missing specificity, and the like) is a significant point in distributing anxiety, depression, and distress, so it will be valuable and advantageous to conduct more studies regarding autobiographical memory. Furthermore, it is recommended to apply and study memory flexibility training on other significant factors that improve mental health and quality of life in all caregivers and patients.
Ethical Considerations
Compliance with ethical guidelines
Research Ethics Committees approve this research with a code of IR.KHU.REC.1401.011. The participants signed the informed consent form and had the right to leave the study during any process of conducting this research. This research meets guidelines for ethical conduct and report of examination. All participants received information about the research process and were assured about the confidentiality of the information and its use only for research purposes.
Authors’ contributions
Conceptualization, designing, and references: Alireza Moradi and Atusa Khanjany; Performing, writing, and drafting manuscript: Atusa Khanjany; Data Analysis and Process: Jafar Hasani, Shahram Mohammadkhani; Review and editing: Alireza Moradi. All authors reviewed and approved the final version of the manuscript.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Acknowledgments
This research is extracted from the PhD dissertation of the first author in the Clinical Psychology Department, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran. The authors are so grateful to all participants and everyone who contributed to this research being implemented.
Conflicts of interest
The authors declared no conflict of interest.
Cancer is one of the most critical and challenging diseases in the current age. Caregivers play an essential and critical role and are known as a key factor in cancer treatment. Providing care to cancer patients is a complex, serious, challenging, multi-directional, and burned-out responsibility. This role imposes a heavy cognitive and emotional burden on caregivers, overshadowing various aspects of their lives, including physical and psychological health, emotional, cognitive, and behavioral elements, and quality of life. Cancer caregivers suffer distress, depression, anxiety, fatigue, stress, and emotional burn-out and experience low levels of satisfaction and quality of life. While the negative impact of caregiving has been widely addressed, much less attention has been given to the ways in which such adverse outcomes may be avoided or reduced. The objective of this study is focused on helping cancer caregivers improve their life experiences through psychological methods. Based on the primary caregiver’s problems, in this research improving emotion regulation skills and increasing resilience are addressed, which can lead to increased quality of life, mental health, and adaptation in caregivers. Cancer develops financial problems for caregivers, and providing all caregiving tasks takes lots of time. Accordingly, this research is carried out MemFlex as a low-cost and short-term intervention that matches caregivers’ exceptional circumstances and aims to determine its effectiveness on resilience and emotion regulation in cancer caregivers.
Methods
This survey is an applied research using a quasi-experiment design that applies repeated measurement (pre-test/post-test/follow-up) control group. The study population consisted of all caregivers to cancer patients who are diagnosed in Tehran hospitals and medical care centers. Sixty caregivers were recruited by convenience sampling method. They were informed there were no obligations to participate in this study, and they can choose to leave it in any phase. They were reassured that their personal information was completely confidential and signed an informed consent form. The participants were randomly categorized into experimental (intervention) and control groups, and each group consisted of 30 participants. Caregivers’ demographic data was gathered through a semi-structured clinical interview, and they were asked to fill Resilience Scale (CD‐RISC) and Cognitive Emotion Regulation Questionnaire (CERQ). Experimental group participants received MemFlex in nine sessions. In the initial session, experimental participants were instructed to complete eight MemFlex sessions for four weeks (two sessions per week). They were in touch with the researcher to follow instructions and ask their questions. At the end of the four weeks, the researcher contacted them to check that all workbooks were completed and to book the post-test. After that, both the experimental and control group refilled CD‐RISC and CERQ. Three months later, participants refilled questionnaires as a follow-up test. To provide ethics principles, participants in the control group received the psychological intervention. Gathered data were analyzed by mixed variance analysis on the pre-test, post-test, and follow-up scores by SPSS-24 after completing all research phases.
Results
The mean and standard deviation of the participants’ age was 37.80±7.93 in the experimental group and 39.13±7.01 in the control group. The results showed increasement in Resilience scores mean from pre-test to post-test in the experimental group overall and each factor scores: personal competence and sense of self-efficacy, emotional and cognitive control under pressure self-control, positive acceptance of change, and spirituality; while no significant changes were found in the control group’s scores. The changes were steady in the follow-up phase for the experimental group. Considering emotion regulation scores mean, the results showed increasement in Adaptive Strategies factors: Acceptance, Positive refocusing, refocus on planning, positive reappraisal, and putting into perspective, and decreasement in maladaptive strategies factors: self-blame, rumination, catastrophizing, and other-blame; while scores did not change for the control group. In order to investigate the effectiveness of MemFlex on resilience and emotion regulation, data were analyzed by mixed variance analysis (MANOVA). The normality of data distribution was checked and confirmed. The homogeneity of variances distribution was checked and confirmed using the Levene’s test. According to Pillai's Trace, resilience scores (personal competence and sense of self-efficacy, emotional and cognitive control under pressure self-control, positive acceptance of change, and spirituality) and adaptive emotion regulation Strategies scores (acceptance, positive refocusing, refocus on planning, positive reappraisal, and putting into perspective) increased significantly compared to the control group. It also showed that the scores of maladaptive emotion regulation strategies (self-blame, rumination, catastrophizing, and other-blame) decreased significantly compared to the control group. The Bonferroni test was applied to confirm the results.
Conclusion
The results showed that participants in the memory flexibility training group had higher adherence than the control group. Furthermore, higher scores in adaptive emotion regulation strategies and lower scores in maladaptive strategies were observed in the experimental group than in the control group. Thus, it is concluded that memory flexibility training leads to increasing adherence and improving emotion regulation strategies in cancer caregivers. Considering the results of this research, it is recommended to study autobiographical memory playing a role in developing and contributing to psychological disorders. Malfunctioning of autobiographical memory (overgeneralization, missing specificity, and the like) is a significant point in distributing anxiety, depression, and distress, so it will be valuable and advantageous to conduct more studies regarding autobiographical memory. Furthermore, it is recommended to apply and study memory flexibility training on other significant factors that improve mental health and quality of life in all caregivers and patients.
Ethical Considerations
Compliance with ethical guidelines
Research Ethics Committees approve this research with a code of IR.KHU.REC.1401.011. The participants signed the informed consent form and had the right to leave the study during any process of conducting this research. This research meets guidelines for ethical conduct and report of examination. All participants received information about the research process and were assured about the confidentiality of the information and its use only for research purposes.
Authors’ contributions
Conceptualization, designing, and references: Alireza Moradi and Atusa Khanjany; Performing, writing, and drafting manuscript: Atusa Khanjany; Data Analysis and Process: Jafar Hasani, Shahram Mohammadkhani; Review and editing: Alireza Moradi. All authors reviewed and approved the final version of the manuscript.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Acknowledgments
This research is extracted from the PhD dissertation of the first author in the Clinical Psychology Department, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran. The authors are so grateful to all participants and everyone who contributed to this research being implemented.
Conflicts of interest
The authors declared no conflict of interest.
Type of Study: Research |
Received: 2022/04/12 | Accepted: 2022/09/12 | Published: 2023/02/19
Received: 2022/04/12 | Accepted: 2022/09/12 | Published: 2023/02/19
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