Comparison of the Effectiveness of Cognitive Behavioral Therapy and Emotion-Focused Therapy on Anxiety and Distress Tolerance in Women with Coronary Artery Disease

Subject Areas : women health

Fariba Aliyari Khanshan Vatan ¹ , حسن احدی ² , Maryam Kalhornia golkar ³ , Mastooreh Sedaghat ⁴

1 - Ph.D. student in Psychology, Department of Psychology, Emirates Branch, Islamic Azad University, Dubai, United Arab Emirates, Email: [e-mail]
2 - استاد مدعو، گروه روان‌شناسی، واحد امارات، دانشگاه آزاد اسلامی، دبی، امارات متحده عربی
3 - Assistant Professor, Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran. Email: [e-mail]
4 - Assistant Professor, Department of Psychology, South Tehran Branch, Islamic Azad University, Tehran, Iran, Email: [e-mail]

Received: 2022-12-31 Accepted : 2023-03-12 Published : 2023-09-23

Keywords: anxiety, Coronary Artery Disease, Cognitive Behavioral Therapy, distress tolerance, Emotion-Focused Therapy ,

Abstract :

Abstract Introduction: Cardiovascular disease is one of the most common heart complications and is known as a chronic, progressive and debilitating disorder. This study aimed to compare the effectiveness of cognitive behavioral therapy and emotion-focused therapy on anxiety and distress tolerance in women with coronary artery disease. Methods: This was a semi-experimental study with a pre-test-post-test design with a control group and a follow-up stage. The statistical population included all women suffering from coronary artery disease referring to the specialized center of Shahid Lavasani Hospital in Tehran in summer 2021. A total of 45 people were selected voluntarily and randomly and were divided into two experimental groups (n=30) and control groups (n=15). Measurement tools included Beck et al Anxiety Inventory and Simons and Gaher’s distress tolerance scale. One experimental group received cognitive behavioral intervention and the other group received emotion-focused intervention. The first experimental group underwent intervention in ten 90-minute in person sessions in ten weeks and the second experimental group in nine 90-minute in person sessions in nine weeks and the control group received the conventional intervention. SPSS 16 and repeated measures intergroup ANOVA were used at the significance level of =0.05 to analyze the data. Results: Results showed that the effectiveness of cognitive-behavioral and emotion-focused therapy in reducing anxiety was not significantly different and their effect was identical (p<0.05). However cognitive behavioral therapy was more effective in distress tolerance component (p<0.05). Conclusion: Results of this research can become the basis for interventions to help coronary artery disease patients.

References:

References
1. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovascular diabetology. 2018; 17(1): 1-19. https://doi.org/10.1186/s12933-018-0728-6
2. Ranjbaran R, Aliakbari Dehkordi M, Saffarinia M, Alipour A. Effect of health promoting lifestyle training on vitality, psychological well-being and blood pressure of women with cardiovascular disease. Cardiovascular Nursing Journal. 2019; 8(1): 98-109. (Persian) http://journal.icns.org.ir/article-1-620-en.html.
3. Azimian J, Soleimany Ma, Pahlevan Sharif S, Banihashemi H. The Effect of Spiritual Care Program on Death Anxiety of Cardiac Patients: A Randomized Clinical Trial. Avicenna Journal of Nursing and Midwifery Care. 2019; 27(1): 1-10. (Persian) https://doi.org/10.30699/ajnmc.27.1.1
4. Babamohamadi H, Kadkhodaei-Elyaderani H, Ebrahimian A, Ghorbani R. The effect of spiritual care based on the sound heart model on the spiritual health of patients with acute myocardial infarction. Journal of religion and health. 2020; 59(5): 2638-53. (Persian) https://doi.org/10.1007/s10943-020-01003-w
5. Hinkle JL, Cheever KH. Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer India Pvt Ltd, 2018.
6. Malekpour Golsefidi Z, Nasrollahi B, Darandegan K. The Relationship between Anxiety and Depression with Cardiovascular Disease after Open Heart Surgery. Iranian Journal of Surgery. 2017; 25(2): 54-61. (Persian)
7. Tully PJ, Harrison NJ, Cheung P, Cosh S. Anxiety and cardiovascular disease risk: a review. Current cardiology reports. 2016; 18(12): 1-8. https://doi.org/10.1007/s11886-016-0800-3
8. Cohen BE, Edmondson D, Kronish IM. State of the art review: depression, stress, anxiety, and cardiovascular disease. American journal of hypertension. 2015; 28(11): 1295-302. https://doi.org/10.1093/ajh/hpv047
9. Zi J, Yi oF, Dong C, Zhao Y, Li D, Tan Q. Anxiety administrated by Dexmedetomidine to prevent new-onset of postoperative atrial fibrillation in patients undergoing off-pump coronary artery bypass graft. International heart journal. 2020; 61(2): 263-72. https://doi.org/10.1536/ihj.19-132
10. Ezadi tame A, Sadeghi R, Safari M, Esmaeili-douki Z. Effect of Verbal and audio methods of training on presurgery anxiety of patients. Journal of Inflammatory Disease. 2011; 15(1): 21-25.
11. Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, et al. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosomatic medicine. 2004; 66(3): 305-15. https://doi.org/10.1097/01.psy.0000126207.43307.c0
12. Pimple P, Lima BB, Hammadah M ,Wilmot K, Ramadan R, Levantsevych O, et al. Psychological distress and subsequent cardiovascular events in individuals with coronary artery disease. Journal of the American Heart Association. 2019; 8(9): e011866. https://doi.org/10.1161/JAHA.118.011866
13. Stansfeld SA, Fuhrer R, Shipley MJ, Marmot MG. Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study. International journal of epidemiology. 2002; 31(1): 248-55. https://doi.org/10.1093/ije/31.1.248
14. Daughters SB, Ross TJ, Bell RP, Yi JY, Ryan J, Stein EA. Distress tolerance among substance users is associated with functional connectivity between prefrontal regions during a distress tolerance task. Addiction biology. 2017; 22(5): 1378-90. https://doi.org/10.1111/adb.12396
15. Manning K, Rogers AH, Bakhshaie J, Hogan JB, Buckner JD, Ditre JW, et al. The association between perceived distress tolerance and cannabis use problems, cannabis withdrawal symptoms, and self-efficacy for quitting cannabis: The explanatory role of pain-related affective distress. Addictive behaviors. 2018; 85: 1-7. https://doi.org/10.1016/j.addbeh.2018.05.009.
16. Leyro TM, Zvolensky MJ, Bernstein A .Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychological bulletin. 2010; 136(4): 576. https://doi.org/10.1037/a0019712
17. Gallego A, McHugh L, Villatte M, Lappalainen R. Examining the relationship between public speaking anxiety, distress tolerance and psychological flexibility. Journal of Contextual Behavioral Science. 2020; 16: 128-33. https://doi.org/10.1016/j.jcbs.2020.04.003
18. Veilleux JC. The relationship between distress tolerance and cigarette smoking: A systematic review and synthesis. Clinical psychology review. 2019; 71: 78-89. https://doi.org/10.1016/j.cpr.2019.01.003
19. Mohammadpour A, Mohammadian B, Basiri Moghadam M, Nematollahi MR. The effects of topical heat therapy on chest pain in patients with acute coronary syndrome: a randomised double‐blind placebo‐controlled clinical trial. Journal of clinical nursing. 2014; 23(23-24): 3460-7. (Persian)
20. Shortis E, Warrington D, Whittaker P. The efficacy of cognitive behavioral therapy for the treatment of antenatal depression: A systematic review. Journal of affective disorders. 2020; 272:4 85-95. https://doi.org/10.1016/j.jad.2020.03.067
21. McFarlane FA, Allcott-Watson H, Hadji-Michael M, McAllister E, Stark D, Reilly C, et al. Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: a case series. European Journal of Paediatric Neurology. 2019; 23(2): 317-28. https://doi.org/10.1016/j.ejpn.2018.12.002
22. Lorenzo-Luaces L, Keefe JR, DeRubeis RJ. Cognitive-Behavioral Therapy: Nature and relation to non-cognitive behavioral therapy. Behavior Therapy. 2016; 47(6):785-803. https://doi.org/10.1016/j.beth.2016.02.012
23. Peters L, Romano M, Byrow Y, Gregory B, McLellan LF, Brockveld K, et al. Motivational interviewing prior to cognitive behavioural treatment for social anxiety disorder: A randomised controlled trial. Journal of affective disorders. 2019; 256: 70-8. https://doi.org/10.1016/j.jad.2019.05.042
24. Vakili M, Ahmadian H, Hadizadeh N. The Effect of Cognitive-Behavioral Stress Management Training on Anxiety, Depression, and Resilience Level in Male with Coronary Artery Disease. Community Health Journal. 2021; 15(1): 40-9. (Persian) https://doi.org/10.22123/chj.2021.246459.1570
25. Soleymany Kahreh Z, Hosseini SS, Afsharinia K. The Comparison of the Effectiveness of Cognitive-Behavioral Therapy, Music Therapy and Relaxation Therapy on Reducing Anxiety and Depression in Coronary Artery Disease Patients. Scientific magazine yafte. 2019; 21(3): 129-43. (Persian) http://yafte.lums.ac.ir/article-1-2851-en.html
26. Bayazi M. The effectiveness of a short cognitive behavioral group intervention on depression, anxiety and stress in patients with chronic coronary heart disease: A randomized controlled trail. Journal of Fundamentals of Mental Health. 2012; 14(54): 21-110. (Persian) https://doi.org/10.22038/jfmh.2012.981
27. Khodai S, Khazai K, Kazemi T, Ali Abadi Z. The Effect of Cognitive- Behavioral Group Therapy on Depression and anxiety in Patients with myocardial infarction. Modern Care Journal. 2013; 9(4): 364-70. (Persian)
28. Kolivand P, Nazari Mahin A, Jafari R. The Effectiveness of Cognitive Behavioral Therapy on Decrease of the Distress in Patients with Chronic Pain. The Neuroscience Journal of Shefaye Khatam. 2015; 3(3): 63-9. doi.org/10.18869/acadpub.shefa.3.3.63 (Persian)
29. Baratpour S, Dasht Bozorgi Z. The effect of well-being therapy on hope, distress tolerance and death anxiety in people with cardiovascular disease after getting a coronavirus disease 2019 (COVID-19). Cardiovascular Nursing Journal. 2020; 9(1):90-9. (Persian) http://journal.icns.org.ir/article-1-645-en.html
30. Shirali S, DashtBozorgi Z. Effect of Acceptance and Commitment-based Group Therapy on Existential Anxiety, Distress Tolerance, and Meta-worry in Elderly Women with Cardiovascular Disease in Mehr Hospital of Ahvaz City in 2018. Community Health Journal. 2019; 13(4): 1-11. (Persian) https://doi.org/10.22123/chj.2020.196985.1334
31. Zarabi S, Tabatabaei Nejad FS, Latifi Z. Comparison of the Effectiveness of Cognitive-Behavioral Therapy and Self-Healing Therapy on the Distress Tolerance of Women with Bulimia Nervosa. Journal of Research in Behavioural Sciences. 2021; 19(2): 369-80. (Persian) http://rbs.mui.ac.ir/article-1-1055-en.html
32. Alipour A, Rezai A, Hashemi T, yousefpour N. The effectiveness of cognitive behavioral therapy focused on lifestyle modification to increase monitoring vital signs and coronary heart disease and psychological well-being. Quarterly Journal of Health Psychology. 2017; 5(20): 125-36. (Persian)
33. Zahrabnia E, Sanaie B, Kiyamanesh A, Zahrakar K. Comparison of the Effectiveness of Emotion-Focused Therapy and Cognitive-Behavior Therapy on Emotional Regulation and Psychological Well-Being of Divorced Women. Journal of Family and Health. 2021; 11(2): 44-76. http://journal.astara.ir/article_245480.html (Persian)
34. Asvadi M, Bakhshipoor A, Razavitabadegan B. Comparison the effectiveness of emotional focused couple therapy and cognitive-behavioral couple therapy on marital intimacy of women affected by infidelity. Journal of Family and Health. 2021; 11(2): 11-27. http://journal.astara.ir/article_245397.html (Persian)
35. Johnson S, Zuccarini D. Integrating sex and attachment in emotionally focused couple therapy. J Marital Fam Ther. 2010; 36(4): 431-45. https://doi.org/10.1111/j.1752-0606.2009.00155.x
36. Denton WH, Wittenborn AK, Golden RN. Augmenting antidepressant medication treatment of depressed women with emotionally focused therapy for couples: a randomized pilot study. J Marital Fam Ther. 2012; 1(1): 23-38. https://doi.org/10.1111/j.1752-0606.2012.00291.x
37. Sanagavi Moharrar Gh, Shirazi M, Mohammadi R, Maghsoodloo F. Effectiveness of Emotional Therapy on Reducing Anxiety and Depression in Patients with Multiple Sclerosis. MUMS. 2019; 61(1): 190-200. mjms.mums.ac.ir/article_14605.html?lang=fa (Persian)
38. Khosravi Asl M, Nasirian M, Bakhshayesh A. The Impact of Emotion-focused Therapy on Anxiety and Depression among Female-Headed Households in Imam Khomeini Relief Committee. JCHR. 2018; 7(3): 173-182. http://jhr.ssu.ac.ir/article-1-396-fa.html (Persian)
39. Beck AT, Steer R. Beck anxiety inventory (BAI). Überblick über Reliabilitäts-und Validitätsbefunde von klinischen und außerklinischen Selbst-und Fremdbeurteilungsverfahren. 1988: 7-8.
40. Kaviani H, Mousavi A S. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University Medical Journal. 2008; 66(2): 136-140. (Persian)
41. Simons JS, Gaher RM. The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and emotion. 2005; 29(2): 83-102. https://doi.org/10.1007/s11031-005-7955-3
42. Shams J, Azizi A, Mirzaei A. Correlation between Distress Tolerance and Emotional Regulation with Students Smoking Dependence. Hakim Health Systems research journal. 2010; 13(1):11-8. (Persian)
43. Hazlett-Stevens H. Psychological approaches to generalized anxiety disorder: A clinician's guide to assessment and treatment: Springer Science & Business Media; 2008.
44. Dehshiri G-R. The Effectiveness of Cognitive-Behavior Therapy on Anxiety and Worry of People with Generalized Anxiety Disorder. Journal of Clinical Psychology. 2012; 4(2): 19-28. (Persian)
45. Emami M, Askarizade G, Faziltpour M. Effectiveness of Cognitive – Behavioral Stress Management Group Therapy on Resilience and Hope in Women with Breast Cancer. Positive Psychology Research. 2018; 3(4): 1-14. (Persian) https://doi.org/10.22108/ppls.2018.106094.1217
46. Johnson SM. The practice of emotionally focused coupled therapy (2nd ed.). New York: Brunner-Routledge, 2004.
47. Taghipour R, siahpoosh S, kazemi dalivand F, Sadeghi P, Farjadtehrani T. Comparison of the Effect of Cognitive-Behavioral Therapy and Narrative Therapy in Improving Death Related Distress and Psychological Hardiness in Female Patients with Breast Cancer. medical journal of mashhad university of medical sciences. 2019; 62(4): 1-1. (Persian) https://doi.org/10.22038/mjms.2019.17677
48. Evyatar A, Stern M, Schem-Tov M, Groswasser Z. Hypothesis forming and computerized cognitive therapy. Cognitive Rehabilitation in Perspective. Routledge, 2018.