The effectiveness of cognitive-behavioral therapy on rumination, cognitive flexibility in people with post-traumatic stress disorder

fariha dosti ¹ ( )
seyedeh monavar yazdi ² ( Professor, Department of Psychology, Alzahra University )
morvarid ahadi ³ ( Assistant Professor, Department of Psychiatry, Razi Psychiatry Teaching Hospital, Tehran, Iran )
سیمین حسینیان ⁴ ( استاد گروه مشاوره، دانشگاه الزهرا، تهران، ایران )

Submited date : 2024-11-17 Accepted date : 2024-12-21

Keywords: post-traumatic stress disorder, cognitive flexibility, cognitive-behavioral therapy, rumination.,

Abstract :

Background and purpose: People with post-traumatic stress disorder often suffer from problems such as rumination and lack of cognitive flexibility, and cognitive behavioral therapy as a method of dealing with intrapersonal problems can be effective in solving problems. Thus, the research was conducted with the aim of the effectiveness of cognitive-behavioral therapy on rumination, cognitive flexibility in people suffering from post-traumatic stress disorder.

Materials and methods: applied research method and semi-experimental design, pre-test-post-test and three-month follow-up with the control group. The statistical population of people suffering from post-traumatic stress disorder, aged 20 to 45 years, referred to psychological centers in Kish Island in 1402. A sample of 30 people who were selected by purposeful sampling were randomly replaced in 2 groups (15 people in each group). The research tools were post-traumatic stress disorder questionnaires, cognitive flexibility questionnaire of Dennis and Vand Roal, rumination response style of Nolen Hoxima and Moreau. The cognitive-behavioral therapy intervention group underwent 8 sessions of 90-minute treatment. The method of analysis of variance with repeated measurements was applied to the data.

Findings: The results showed that there is a significant difference in rumination and cognitive flexibility in the post-test stage (P < 0.01).

Conclusion: It can be concluded that cognitive-behavioral therapy is effective on rumination, cognitive flexibility of people suffering from post-traumatic stress disorder

 

References:

An, Q., Yu, Z., Sun, F., Chen, J., Zhang, A. (2023). The Effectiveness of Cognitive Behavioral Therapy for Depression Among Individuals with Diabetes: a Systematic Review and Meta-Analysis. Curr Diab Rep. 23(9):245-252. doi: 10.1007/s11892-023-01517-z. Epub 2023 Jun 17. PMID: 37329442.
Ansari, B., Tasbihsazan, S.R, Khademi, A.L, Rezaei, K. (2021). evaluation of the effectiveness of cognitive-behavioral therapy on worry, rumination, and asthma control in patients with asthma. nursing and midwifery journal, 19 (4) :287-298 http://unmf.umsu.ac.ir/article-1-4253-fa.html
Antanaitis, R., Juozaitienė, V., Džermeikaitė, K., Bačėninaitė, D., Šertvytytė, G., Danyla, E., Rutkauskas, A., Viora, L., Baumgartner, W. (2023). Change in Rumination Behavior Parameters around Calving in Cows with Subclinical Ketosis Diagnosed during 30 Days after Calving. Animals (Basel). 2023 Feb 8;13(4):595. doi: 10.3390/ani13040595.
Boelen PA, Lenferink LIM. (2020). Associations of depressive rumination and positive affect regulation with emotional distress after the death of a loved one. Clin Psychol Psychother. 2020 Nov;27(6):955-964. doi: 10.1002/cpp.2482.
Brewin, C, Cloitre, M., Hyland, P., Shevlin, M., Maercker,. A., Bryant R.(2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev. 58:1–15. doi: 10.1016/j.cpr.2017.09.001.
Buechner, B., Traylor, M., Feldman, R. (2023). Examining Relationships between Cognitive Flexibility, Exercise Perceptions, and Cardiovascular Disease Risk Factors. Eur J Investig Health Psychol Educ. 17;13(10):2276-2289. doi: 10.3390/ejihpe13100161.
Dajani, D., Uddin, L. (2015). Demystifying cognitive flexibility: Implications for clinical and developmental neuroscience. Trends Neurosci 2015; 38: 571–578.
Dennis, J. P., & Vander Wal, J. S. (2010). The Cognitive Flexibility Inventory: Instrument Development and Estimates of Reliability and Validity. Cognitive Therapy and Research, 34, 241-253.http://dx.doi.org/10.1007/s10608-009-9276-4
Dennis, JP., VanderWal, JS. (2020). The cognitive flexibility inventory: instrument development and estimates of reliability and validity. Cognitive therapy and research, 34(3), 241-53. https://doi.org/10.1007/s10608-009-9276-4.
Du, J., Diao, H., Zhou, X., Zhang, C. (2022). Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. Med Rev. 2;2(3):219-243. doi: 10.1515/mr-2022-0012. PMID: 37724188; PMCID: PMC10388753.
Gabrys RL, Tabri N, Anisman H, Matheson K. (2018). Cognitive Control and Flexibility in the Context of Stress and Depressive Symptoms: The Cognitive Control and Flexibility Questionnaire. Front Psychol. 19;9:2219. doi: 10.3389/fpsyg.2018.02219.
Howlett, C., Stanford, T., Berryman, C., Karran, EL, B. (2024). Investigating self-report and neuropsychological assessments of cognitive flexibility in people with and without persistent pain: An online, cross-sectional, observational study. Br J Pain.18(2):176-196. doi: 10.1177/20494637231215260. Epub 2023 Nov 21.
Huh, HJ., Kim, KH., Lee, HK., Chae, JH. (2020). Attachment Style, Complicated Grief and Post-Traumatic Growth in Traumatic Loss: The Role of Intrusive and Deliberate Rumination. Psychiatry Investig. 17(7):636-644. doi: 10.30773/pi.2019.0291. Epub 2020 Jul 8.
Hvenegaard, M., Watkins, E. R., Poulsen, S., Rosenberg, N. K., Gondan, M., Grafton, B., Austin, S. F., Howard, H., & Moeller, S. B. (2015). Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial. Trials, 16, 344. https://doi.org/10.1186/s13063-015-0875-y
Kohandani, M., Abolmaali Alhosseini, K. (2017). Factor structure and psychometric properties of Persian version of cognitive flexibility of Dennis, Vander Wal and Jillon. Psychological Models and Methods, 8(29): 53-70.
Lackner, J., Gudleski, G., Radziwon, C., Krasner, S. (2022). Cognitive flexibility improves in cognitive behavioral therapy for irritable bowel syndrome but not nonspecific education/support. Behav Res Ther. 2022 Jul;154:104033. doi: 10.1016/j.brat.2022.104033. Epub 2022 Jan 10. PMID: 35653934.
Nagata,. S, Seki, Y., Shibuya, T., Yokoo, M., Murata, T., Hiramatsu, Y. (2018). Does cognitive behavioral therapy alter mental defeat and cognitive flexibility in patients with panic disorder? BMC Res Notes. 12;11(1):23. doi: 10.1186/s13104-018-3130-2. PMID: 29329597; PMCID: PMC5767061.
Nolen-Hoeksema, S., Wisco, B, (2008). Lyubomirsky S. Rethinking Rumination. Perspect Psychol Sci. 3(5):400-24. https://doi.org/10.1111/j.1745-6924.2008.00088.x.
North CS, Suris AM, Smith RP, King RV. (2016). The evolution of PTSD criteria across editions of DSM. Ann Clin Psychiatr. 28:197–208.
Prov, D., Mohammadkhni, P., Dolatshahi, B., Moshtagh, N. (2012). Effectiveness of a Two-Minute Session of Written Emotional Disclosure in Depression, Anxiety and Stress among the Students Suffering from Trauma. Thoughts and Behavior in Clinical Psychology, 7(26): 7-16.
Psychiatric Association American. (2013). Diagnostic and statistical manual of mental disorders : DSM-5™. Washington DC: American Psychiatric Publishing.
Rees O. (2020). We need to talk about Epizelus: ‘PTSD’ and the ancient world. Med Humanit. 46:46–54. doi: 10.1136/medhum-2018-011557.
Shalev, A, Liberzon I, Marmar C. (2017). Post-traumatic stress disorder. N Engl J Med. 376:2459–69. doi: 10.1056/nejmra1612499.
Simon, N., Robertson, L., Lewis, C., Roberts, N., Bethell, A., (2021). Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. 20;5(5):CD011710. doi: 10.1002/14651858.CD011710.pub3. PMID: 34015141; PMCID: PMC8136365.
Tu PC. (2022). The effects of trait resilience and rumination on psychological adaptation to breast cancer. Health Psychol Open. 11;9(2):20551029221140765. doi: 10.1177/20551029221140765.
Visser, E., Gosens, T., Den Oudsten, B., De Vries, J. (2017). The course, prediction, and treatment of acute and posttraumatic stress in trauma patients: a systematic review. J Trauma Acute Care. 2017;82:1158–83. doi: 10.1097/ta.0000000000001447.
Xu, Y., Ni, Y., Yang, J., Wu, J. (2024). The relationship between the psychological resilience and post-traumatic growth of college students during the COVID-19 pandemic: a model of conditioned processes mediated by negative emotions and moderated by deliberate rumination. BMC Psychol. 19;12(1):357. doi: 10.1186/s40359-024-01853-z.
Zand Irani, M., Jones, M., Halland, M. (2021). Prevalence, symptoms and risk factor profile of rumination syndrome and functional dyspepsia: a population-based study. Aliment Pharmacol Ther. 2021 Dec;54(11-12):1416-1431. doi: 10.1111/apt.16630. Epub 2021 Oct 9.