Comparing the effectiveness of schema therapy with cognitive-behavioral therapy and drug therapy in reducing pain in patients with rheumatoid arthritis who have anxiety and depression and inconsistent coping strategies
Subject Areas : general PsychologyPeyman Aramesh Seddigh 1 , Majid Bahreinian 2 , Ahmad Mansoori 3
1 - PhD student, Islamic Azad University, Birjand Branch, Birjand, IranEmail: peyman.aramesh1970@gmail.com , tell: 09124094375
2 - ( Corresponding author), Professor, Department of Clinical Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran, tell: 09127786737, bahrainian@birjand.iau.ac.ir
3 - Assistant Professor, Department of Psychology, Neishabour Branch, Islamic Azad University, Neishabour, Iran, a.mansouri@iau-neyshabur.ac.ir
Keywords: anxiety, cognitive behavioral therapy, coping strategies, depression, Rheumatoid arthritis, schema therapy,
Abstract :
Abstract Introduction: Rheumatoid arthritis is the most common chronic inflammatory autoimmune disease. Social factors and prolonged stress have an effect on Rheumatoid arthritis. Limitation of movement in these patients can cause mental disorders, especially anxiety and depression. The purpose of this study is to compare the effectiveness of short-term dynamic psychotherapy, schema therapy, cognitive behavioral therapy with drug therapy in reducing pain and pain dimensions in patients with rheumatoid arthritis with anxiety, depression and coping strategies. Research method: The research method was semi-experimental with a pre-test and post-test design and follow-up with the control group. The statistical population was all patients with rheumatoid arthritis with anxiety and depression in Tehran, who referred to the rheumatology clinics of Imam Khomeini Hospital in Tehran in the spring of 2014. There are 60 volunteers selecting by purposive sampling technique. According to Cohen's table the sample were divided into group of 20 people. We use Standard Depression questionnaires, anxiety, and Revised McGill pain questionnaire for collecting data. Data analysis has been done by using multivariate analysis of variance with repeated measurement at a significant level of 0.05 through SPSS version 26. Results: The results showed that psychotherapies are effective in reducing pain, and schema therapy was the most effective method in reducing cognitive pain and various pain in patients with rheumatoid arthritis who have anxiety and depression and inconsistent coping strategies Conclusion: The use of psychotherapies along with drug therapy can be more effective than drug therapy alone and can help reduce the pain of patients with rheumatoid arthritis by treating anxiety and depression and correcting coping strategies.
1. Smolen JS, Redlich K. Rheumatoid Arthritis. The Autoimmune Diseases Fifth ed, 2014: 511-23.
2. Rahmani Aram O, Gurban Shiroudi Sh, Khalatbari J, Haji Abbasi A. Investigating depression and anxiety in patients with rheumatoid arthritis. Journal of Gilan University of Medical Sciences. 2013;22(85):15-22. URL: http://journal.gums.ac.ir/article-1-66-fa.html
3. Gatchel R, Turk D. Psychological approaches to pain management: A practitioner’s handbook. The Guildford Press. 1996.
4. Craig KD. Emotional acpects of pain. In: P.D. Wall R, editor. Melzak Text book of pain. UK: Longman Group; 1991.
5. Turner JA, Jensen MP, Romano JM. Do beliefs, coping, an catastrophizing independently predict functioning in patients with chronic pain? Journal of Pain. 2000;85:115-25.
6. Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. Journal of Consulting Clinical Psychology. 2002;70:678- 90.
7. Young J, Klosko J, Weishaar M. Schema Therupy: a practitioner's guide, first volume. Translated by Hamidpour H, Indoz Z. Tehran: Arajmand 2014.Schema Therupy: a practitioner's guide
8. Arnow B, Hart S, Hayward C, Dea R, Taylor CB. Severity of child Maltreatment, pain complaints and medical ulilization among women. Journal of psychiatric Research. 2000;34:412–21.
9. Brown J, Berenson K, Cohen P. Documented and selfreported childhood abuse and adult pain in a community sample. Clinical Journal of Pain. 2005;21:374–7.
10. Davis D, Luecken L, Zautra A. Are reports of child hood abuse related to the experience of coronic pain in adulthood A menta-analytic review of the litreature. Clinical journal of pain. 2010;21:398-405.
11. Saariaho T, Saariaho A, Karila I, Joukamaa M. Early maladaptive schemas in Finnish adult chronic pain patients and a control sample. Scandinavian Journal of Psychology. 2011;52:146-53.
12. Attapour J, Shakibi M, Rajabizadeh Q, Sarvotreigi M. Investigating the relationship between the level of depression and the level of disability in patients with rheumatoid arthritis in Kerman, 1379-80. Journal of Kerman University of Medical Sciences. 1381;9(2):79-85. https://www.sid.ir/paper/103/fa
13. Soltanifar A, Bina M. Investigating the prevalence of depressive symptoms among 9-11-year-old elementary school children in Tehran and its relationship with family functioning. Quarterly Journal of Principles of Mental Health. 2016;9(33):7-14. https://www.sid.ir/paper/88432/fa
14. Dozois D, Rnic K. Core beliefs and self-schematic structure in depression. Current Opinion in Psychology. 2015;4:98-103.
15. Carter JD, McIntosh VV, Jordan J, Porter RJ, Frampton CM, Joyce PR. Psychotherapy for depression: a randomized clinical trial comparing schema therapy and cognitive behavior therapy. J Affect Disord 2013; 151(2): 500-5. https://daneshyari.com/article/preview/6233908.pdf.
16. Saadat Momini N, Aghayousfi A, Khajevand Khoshli A, Rostamian A. Comparing the effectiveness of coping therapy and cognitive-behavioral therapy in immunological indicators and mental well-being of patients with rheumatoid arthritis referred to Imam Khomeini Hospital in Tehran. Journal of Qom University of Medical Sciences. 2019;14(8):39-49. http://journal.muq.ac.ir/article-1-2911-fa.html
17. Sirfi M, Namjo Sara, Thabit Mehrdad. The effect of cognitive behavioral therapy on depression, adherence to medical recommendations and negative perceptions of the disease in people with rheumatoid arthritis: a randomized clinical trial. Scientific journal of Qazvin University of Medical Sciences. 2017;22, 2(97):48-62. . Efficacy of cognitive-behavioral therapy for adherence, depression and negativity
18. Ali Fathi - Ashtiani. Psychological tests: personality and mental health.
19. Beck A, Rush J. Cognitive therapy of depression. New York: Gilford Press; 2000.
20. Beak AT, Steer RA, Brown Gk. Beck Depression Inventory for measuring depression. Arch Gen psychol. 1996;4:561-71.
21- Faraji Rabab, Faraji Parviz, Sonia Dederoshani, Nasrullah Ketayoun. Comparison of anxiety and depression in students with high and low anxiety sensitivity. Proceedings of the Fifth National Seminar on Student Mental Health 2019. https://eprints.arums.ac.ir/2852/1/depression.pdf
22.Tanhaee Z, Fathi-Ashtiani A, Amini M, Vahedi H, Shaghaghi F. Validation of a Revised Version of the Short-form Mc- Gill Pain Questionnaire (SF-MPQ-2) for IBS Patients. Govaresh 2012; 17: 91-7. http://www.govaresh.org/index.php/dd/article/view/921
23. Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, Peirce-Sandner S,et al. Development and initial validation of an expanded and revised version of the Short-form McGill
Pain Questionnaire (SF-MPQ-2). Pain 2009; 144: 35-42. https://pubmed.ncbi.nlm.nih.gov/19356853/
24. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975; 1(3): 277-99.
25. Keith Houghton, Kirk Young, Clarke David. Cognitive behavioral therapy. A practical guide in the treatment of mental disorders. Translated by Habibullah Ghasemzadeh. Tehran: Arajmand; 2018.
26. Young G, Klosko J, Wishar M. Schema therapy (a practical guide for clinicians). Translated by Hassan Hamidpour and Zahra Andoz. 2014. Tehran: Arjmand; 2004.
27. Young JE. The relationship between appearance schema, self – esteem,and non dirct aggression among college women Dissertation Oklahoma state university; 2007.
28. Moghaghaki Hossein, Kharghani Parviz. The effect of schema therapy on anxiety, depression and primary dysfunctional schemas of people with substance use disorder. Scientific Quarterly Journal of Addiction Research. 1400;15(60):299-324. https://etiadpajohi.ir/article-1-2470-fa.html
29. Zamani Narges, Jahangir Amirhossein. Investigating the effect of treatment schema on depression and anxiety of patients with obsessive-compulsive disorder. Journal of health research. 2017;3(4):10-204. Investigating the effect of schema therapy
30. Rezaei F. Comparison of the effect of emotion-focused cognitive behavioral therapy and schema therapy on the amount of pain, catastrophic perceptions of pain, difficulty in regulating emotions and quality of life in patients with rheumatoid arthritis: Isfahan University; 2012.
31. Renner F, DeRubeis R, Arntz A, Peeters F, Huibers M.J.H. (2018). Exploring mechanisms of change in schema therapy for chronic depression. Journal of Behavior Therapy and Experimental Psychiatry 2018; 58: 97-105.https://pubmed.ncbi.nlm.nih.gov/29035800/
32. Lorenzo-Luaces L, Driessen E, DeRubeis R.J, Van H.L, Dekker J. Moderation of the Alliance-Outcome Association by Prior Depressive Episodes: Differential Effects in Cognitive-Behavioral Therapy and Short-Term Psychodynamic Supportive Psychotherapy. Behavior Therapy 2017; 48 (5): 581-595.https://pubmed.ncbi.nlm.nih.gov/28711109/
33. Daneshmandi S, Izdikhah Z, Kazemi H, Mehrabi H. The effectiveness of the treatment of emotional schemas on the emotional schemas of women victims of child abuse and neglect. Journal of Shahid Sadougi University of Medical Sciences and Healthcare Services, Yazd. 2013;22(5):1481-94.
34. Neshat Dost HT, Yousufzadeh M, Hashemi M, Talebi H, Taheri M, Momenzadeh S. Comparing the effectiveness of cognitive-behavioral therapy and schema therapy on reducing pain catastrophizing cognitive error and increasing pain self-efficacy in patients with chronic back pain in Tehran. Anesthesia and pain. 2019;11(2):26-43. https://jssu.ssu.ac.ir/browse.php?a_id=2652&sid=1&slc_lang=fa
35. Hosseini M, Ahadi H, Jamehri F, Karaskian-Mujambari A, Ahadi M. Evaluation of the effectiveness of group therapy of emotional schemas on the level of pain and depression in patients with rheumatoid arthritis. Psychological methods and models. 2018;10(35):119-35. file:///C:/Users/ShahrNet/Downloads/6010913983507.pdf
36. Montazeri MS, Neshat Dost HT, Abedi MR, Abedi A. The effectiveness of therapeutic schema on reducing the severity of depressive symptoms and obsessive-compulsive personality disorder: a single case study. Clinical Psychology. 2012;1(17):35-45. https://jcp.semnan.ac.ir/article_2114.html?lang=fa
37. Wicksell R, Olsson G, Melin J, Klosko J, Weishaarm M. Schema Therapy: A Practitioner, scuide, cuilford. NewYork2009.
38. Veehof M, Oskam M, ET B. Acceptance based interventions For the treatment of chronic pain a systematic review and meta-analysis. Pain. 2011;152(3):533-42.
39. Vahidhimet Alireza, Safairad Iraj. The effect of group-based cognitive-behavioral therapy on reducing symptoms of anxiety (attribute and state), stress and improving the quality of life of secondary school students with rheumatoid arthritis in Hamedan. New ideas of psychology quarterly. 2019;6(10):1-13. http://jnip.ir/article-1-340-fa.html
40. Nesset M, Bjørngaard H.J, Whittington R, Palmstierna T. Does cognitive behavioural therapy or mindfulness-based therapy improve mental health and emotion regulation among men who perpetrate intimate partner violence? A andomized controlled trial. International Journal of Nursing Studies 2021: 113, 103795.https://pubmed.ncbi.nlm.nih.gov/33120137/
41. Blaney C, Hitchon A.C. Marri A.R, Gabalawy R. Support for a non-therapist assisted, Internet-based cognitive-behavioral therapy (iCBT) intervention for mental health in rheumatoid arthritis patients. Internet Interventions 2021 April; 100385.https://pubmed.ncbi.nlm.nih.gov/33912401/
42. Mansuriya Nastern. The effect of cognitive behavioral therapy on reducing pain and depression in women with rheumatoid arthritis. The 6th Congress of the Iranian Psychological Association; Tehran 2016, https://civilica.com/doc/732469/
43. Knittle K, Maes S, De Gucht V. Psychological interventions for rheumatoid arthritis: Examining the role of self‐regulation with a systematic review and meta ‐analysis of randomized controlled trials. Arthritis care & research 2010; 62: 1460-72.https://pubmed.ncbi.nlm.nih.gov/20506175/
44. Francesco Chiara-Simonedi, Rudiger Eckard, Stevens Bruce A. Schema therapy for couples. Translated by Elham Aram Nia and Nadia Ali Akbarkhah. Tehran: Samam Publications; 2018.
45. Karimipour Firouzeh, Fayazi Siddiqa, Mola Karim, Latifi Seyed Mahmoud. The effect of acupressure on the pain intensity of rheumatoid arthritis patients. Jahrom Journal of Medical Sciences. 1390;7(8):19-25.
46. Arnow AB, Blasely CM, Lee J, Fireman B, Hunkeler EM, Dea R, et al. Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs. Psychiatr serv. 2009;60(3):344-50. https://pubmed.ncbi.nlm.nih.gov/19252047/
47. Davaniloo H. Intensive short-term dynamic psychotherapy: spectrum of psychoneurotic disorder. Int J Short Term Psychother. 1995;10:121-55.
48. Edwards D, Arntz A. Schema therapy in historical perspective. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell handbook of Schema Therapy: Theory, research and practice UK: Oxford, Wiley-Blackwell; 2012.
49. Hewlett S, Ambler N, Almeida C, Blair P.S, choy E, Dures E, et al. Protocol for a randomized Controlled trial for Reducing ArthritisFatigue by clinical Teams (RAFT) using cognitive- behavioral approaches 2015, DoI:10.1136/bmjopen-009061. https://pubmed.ncbi.nlm.nih.gov/26251413/
50. Petersen A, Compas B, Brooks-Gunn J, Stemmler M, Ey S, Grant K. Depression in adolescence Am Psychol. 1993;48(2):155-68.
51. Sarriaho T, Saariah A, Karila E, Jouka M. Early Malada Ptive Schemas in finish Adult Chronic Pain Patients and a control sample. Scandinavain journal of psychology. 2011;52(2):146-53.
52. Young JE, Klosko JS, Weishaar ME. Schema Therapy: A Practitioner,s Guide. New York: Guilford 2003; 436 .https://www.guilford.com/books/Schema-Therapy/Young-Klosko-Weishaar/9781593853723