اثر بخشي درمان شناختي - رفتاري مبتني‌ بر ذهن‌ آگاهي بر بهزيستي روان‌ شناختي، اميدواري و كيفيت زندگي بيماران مبتلا به ديابت نوع دو

The Effects of Mindfulness-Based Cognitive-Behavioral Therapy on Psychological Wellbeing, Hope, and Quality of Life in Patients With Type 2 Diabetes

زمينه و هدف: ديابت يكي از شايع‌ترين بيماري‌هاي مزمني است كه عوامل روان‌شناختي نقش مهمي در اداره و كنترل آن ايفا مي‌كند. هدف پژوهش حاضر، تعيين اثربخشي درمان شناختي-رفتاري مبتني‌بر ذهن‌آگاهي بر بهزيستي روان‌شناختي، اميدواري و كيفيت زندگي بيماران مبتلا به ديابت نوع دو بود. روش‌ بررسي: روش پژوهش، نيمه‌آزمايشي با طرح پيش‌آزمون-پس‌آزمون و پيگيري دوماهه همراه با گروه گواه بود. جامعهٔ آماري اين پژوهش را تمامي بيماران مبتلا به ديابت نوع دو مراجعه‌كننده به مراكز درماني و انجمن ديابت شهر تهران در سال 1398 تشكيل دادند. نمونه‌گيري به‌روش داوطلبانه و دردسترس صورت گرفت و نمونه‌ها با شيوهٔ تصادفي در دو گروه درمان شناختي-رفتاري مبتني‌بر ذهن‌آگاهي (15=n) و گواه (15=n) قرار گرفتند. گروه آزمايش طي هشت جلسهٔ 90‌دقيقه‌اي به‌صورت هفتگي تحت درمان شناختي-رفتاري مبتني‌بر ذهن‌آگاهي قرار گرفت. داده‌ها با استفاده از مقياس بهزيستي روان‌شناختي ريف (1989)، پرسشنامهٔ كيفيت زندگي سازمان بهداشت جهاني (1996) و مقياس اميدواري (اشنايدر، 1991) جمع‌آوري شدند. سپس داده‌ها با روش تحليل واريانس با اندازه‌گيري مكرر و نرم‌افزار SPSS نسخهٔ 22 تحليل شدند. سطح معناداري آزمون‌ها 0٫05 در نظر گرفته شد. يافته‌ها: نتايج نشان داد كه اثربخشي درمان شناختي-رفتاري مبتني‌بر ذهن‌آگاهي بر بهزيستي روان‌شناختي (0٫001>p)، اميدواري (0٫001>p) و كيفيت زندگي (0٫001>p) بيماران مبتلا به ديابت مؤثر است و اين تأثير تا دورهٔ پيگيري ماندگار بوده است (0٫001>p). نتيجه‌گيري: براساس يافته‌هاي اين پژوهش مي‌توان گفت اثربخشي درمان شناختي-رفتاري مبتني‌بر ذهن‌آگاهي بر بهزيستي روان‌شناختي، اميدواري و كيفيت زندگي بيماران مبتلا به ديابت نوع دو مؤثر است.

Background & Objectives: Diabetes consists of a group of metabolic diseases. The incidence of diabetes disrupts the regular flow of life and affects individuals’ Quality of Life (QoL) in various dimensions. Therefore, improving the patients’ QoL is essential for numerous therapists, including psychologists. Psychological wellbeing is a psychological component of QoL, i.e., defined as individuals’ perception of their lives respecting emotional behaviors and mental functions, and mental health dimensions. Hope also significantly impacts stressful life events. It is necessary to assist individuals with diabetes to solve problems related to their condition, by recognizing the factors affecting psychological wellbeing, hope, and QoL; these elements can be improved by various approaches. The present study aimed to determine the effects of Mindfulness-Based Cognitive-Behavioral Therapy (MBCBT) on psychological wellbeing, hope, and QoL in patients with diabetes. Methods: This was a quasi-experimental study with a pretest-posttest-follow-up and a control group design. The statistical population of the study included patients with type 2 diabetes referring to medical centers and the Tehran Diabetes Association, in 2019. The sample size of the present study was measured by Cohen's table to determine the sample size in experimental studies, and by considering the effect size of 0.7, test power of 0.91, and the significance level of 0.05; the minimum sample size for each group was 15 subjects. Considering sample dropout, 20 individuals were allocated per group. The study samples were selected by convenience sampling method and participated voluntarily in this research. They were randomly divided into two groups of MBCBT and control (n=15/group). The inclusion criteria were having type 2 diabetes with physician approval for ≥1 year, the age range of 20-50 years, having a minimum-cycle education, not receiving psychological treatment since diagnosis, the lack of acute or chronic medical diseases, like epilepsy and skeletal conditions (based on medical records), and not having severe mental illnesses (based on the diagnosis of a clinical psychologist). Severe complications of diabetes, leading to hospitalization (based on the diagnosis of a physician), absence from >2 treatment sessions, and major stresses caused by unconceived accidents were also considered as the exclusion criteria. MBCBT protocol was performed in eight 90-minute sessions (one weekly session) based on Kabat-Zinn’s (2011) training package. The required data were collected using the Ryff Psychological Well-Being Scale (1989), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) (1996), and the Hope Scale (Schneider, 1991); then, they were analyzed by repeated-measures Analysis of Variance (ANOVA) in SPSS. The significance level of the tests was considered 0.05. Results: ANOVA data regarding the QoL were significant for the intra-group factor (time) (p<0.001), and the inter-group factor (p<0.045). Besides, ANOVA results concerning psychological wellbeing was significant for intra-group (time) (p<0.001) and inter-group (p<0.019) factors. Moreover, ANOVA data on hope was significant for intra-group (time) (p<0.001), and inter-group (p<0.001) factors. The posttest scores of QoL in the experimental group were higher than those of the pretest (p<0.001). Furthermore, the follow-up QoL scores were significantly different from those of the pretest stage (p<0.001). There was no significant difference between the scores of the posttest and follow-up stages (p=0.105). The results also suggested that psychological wellbeing posttest scores in the experimental group were higher than those of the pretest step (p<0.001). Additionally, psychological wellbeing follow-up values were significantly different from the pretest stage (p<0.001). There was no significant difference between the scores of the posttest and follow-up stages (p=0.804). The obtained results revealed that hope posttest scores in the experimental group were higher than those of the pretest (p<0.001); hope follow-up values were significantly different from those of the pretest stage (p<0.001). There was no significant difference between the scores of the posttest and follow-up stages (p=0.804). Conclusion: The present study findings suggested the effectiveness of MBCBT on psychological wellbeing, hope, and QoL in patients with type 2 diabetes.