Document Type : Research Article


1 Department of Health Psychology, Khorramshahr International Branch, Islamic Azad University, Khorramshahr, Iran

2 Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran

3 Department of Psychology, Dezful Branch, Islamic Azad University, Dezful, Iran


Background: Considered as a major health concern worldwide, breast cancer (BC) is the most prevalent cancer among women. The present study aimed to investigate the effects of gestalt group therapy and reality therapy on perceived self-efficacy in women with BC.
Methods: This quasi-experimental research adopted a pretest and posttest with a control group and follow-up period. The statistical population included all the women with BC visiting the subspecialty clinic of cancer in Yasuj, Iran, in 2021. We selected 60 patients via convenience sampling method. Afterwards, using a random number table, we placed them in two experimental groups and a control group (n=20 women in each group). The first experimental group received gestalt therapy (10 sessions of 60 minutes; once a week) while the second experimental group received reality therapy (based on choice theory) (10 sessions of 60 minutes; once a week). The control group was placed on the waiting list. We used the general self-efficacy scale for data collection. The data were analyzed with repeated measures ANOVA in SPSS version 25.
Results: Mean and standard deviation of the perceived self-efficacy for gestalt therapy, reality therapy, and control groups in the posttest were 52.06±8.83, 55.93±8.66, and 39.33±7.56, respectively. The results indicated that the gestalt group therapy and the reality therapy affected the perceived self-efficacy of women with BC (P<0.001). Moreover, the findings depicted no significant differences between the gestalt group therapy and the reality theory. The effects persisted in the follow-up (P<0.001).
Conclusions: According to the results, the gestalt group therapy and the reality therapy could improve the psychological capacity and adaptability of women with BC in different personal and social aspects. Hence, psychotherapists are advised to employ gestalt group therapy and reality therapy in counseling centers in order to enhance perceived self-efficacy in women with BC.


How to Cite: Nazari I, Makvandi B, Saraj Khorrami N, Heidari AR. Effects of Gestalt Group Therapy and Reality Therapy on Perceived Self-Efficacy in Women with Breast Cancer. Women. Health. Bull. 2023;10(1):52-60. doi: 10.30476/WHB.2023.97501.1210.


1. Lei S, Zheng R, Zhang S, Wang S, Chen R, Sun K, et al. Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond). 2021;41(11):1183-1194. doi: 10.1002/cac2.12207. PubMed PMID: 34399040; PubMed Central PMCID: PMC8626596. ## 2. Kianpour Barjoee L, Amini N, Keykhosrovani M, Shafiabadi A. The Effect of Positive Thinking Skills Training and Acceptance and Commitment Therapy on Perceived Stress among Women with Breast Cancer. Women Health Bull. 2022;9(1):9-16. doi: 10.30476/whb.2022.93905.1159. ## 3. Reiner AS, Sisti J, John EM, Lynch CF, Brooks JD, Mellemkjær L, et al. Breast Cancer Family History and Contralateral Breast Cancer Risk in Young Women: An Update from the Women's Environmental Cancer and Radiation Epidemiology Study. J Clin Oncol. 2018;36(15):1513-1520. doi: 10.1200/jco.2017.77.3424. PubMed PMID: 29620998; PubMed Central PMCID: PMC5959199. ## 4. Salmanian K, Marashian FS. Association of Coping Strategies with Death Anxiety through Mediating Role of Disease Perception in Patients with Breast Cancer. Arch Breast Cancer. 2021;8(3):226-32. doi: 10.32768/abc.202183226-232. ## 5. Kianpour Barjoee L, Amini N, Keykhosrovani M, Shafiabadi A. Effectiveness of Positive Thinking Training on Perceived Stress, Metacognitive Beliefs, and Death Anxiety in Women with Breast Cancer: Perceived Stress in Women with Breast Cancer. Arch Breast Cancer. 2022;9(2):195-203. doi: 10.32768/abc.202292195-203. ## 6. Fortin J, Leblanc M, Elgbeili G, Cordova MJ, Marin MF, Brunet A. The mental health impacts of receiving a breast cancer diagnosis: A meta-analysis. Br J Cancer. 2021;125(11):1582-1592. doi: 10.1038/s41416-021-01542-3. PubMed PMID: 34482373; PubMed Central PMCID: PMC8608836. ## 7. White LL, Cohen MZ, Berger AM, Kupzyk KA, Swore-Fletcher BA, Bierman PJ. Perceived Self-Efficacy: A Concept Analysis for Symptom Management in Patients with Cancer. Clin J Oncol Nurs. 2017;21(6):E272-E279. doi: 10.1188/17.Cjon.E272-e279. PubMed PMID: 29149118. ## 8. Kaeppler AK, Erath SA. Linking Social Anxiety with Social Competence in Early Adolescence: Physiological and Coping Moderators. J Abnorm Child Psychol. 2017;45(2):371-384. doi: 10.1007/s10802-016-0173-5. PubMed PMID: 27282759. ## 9. Oluma A, Abadiga M, Mosisa G, Fekadu G, Turi E. Perceived Self-Efficacy and Associated Factors Among Adult Patients with Type 2 Diabetes Mellitus at Public Hospitals of Western Ethiopia, 2020. Patient Prefer Adherence. 2020;14:1689-1698. doi: 10.2147/ppa.S275887. PubMed PMID: 33061312; PubMed Central PMCID: PMC7522517. ## 10. Leung GSM, Khor SH. Gestalt Intervention Groups for Anxious Parents in Hong Kong: A Quasi-Experimental Design. J Evid Inf Soc Work. 2017;14(3):183-200. doi: 10.1080/23761407.2017.1311814. PubMed PMID: 28441104. ## 11. Roubal J, Hytych R, Čevelíček M, Řiháček T. Personal therapeutic approach in Gestalt therapists working with clients suffering from medically unexplained psychosomatic symptoms. Res Psychother. 2021;24(3):535. doi: 10.4081/ripppo.2021.535. PubMed PMID: 35047424; PubMed Central PMCID: PMC8715264. ## 12. Holzinger B, Nierwetberg F, Cosentino L, Mayer L. DreamSenseMemory - a Gestalt-based dream-work approach embracing all our senses. Res Psychother. 2021;24(2):529. doi: 10.4081/ripppo.2021.529. PubMed PMID: 34568103; PubMed Central PMCID: PMC8451216. ## 13. Dizaj Khalili M, Makvand Hosseini S, Sabahi P. The Effect of Imagery Rescripting and Mindfulness-Based Cognitive Therapy on Emotional Exhaustion in Women with Multiple Sclerosis in Tehran, Iran. Women Health Bull. 2022;9(3):164-71. doi: 10.30476/whb.2022.95439.1181. ## 14. Aiach Dominitz V. Gestalt Therapy Applied: A Case Study with an Inpatient Diagnosed with Substance Use and Bipolar Disorders. Clin Psychol Psychother. 2017;24(1):36-47. doi: 10.1002/cpp.2016. PubMed PMID: 27098212. ## 15. Koleshtajani EJ, Zabihi R, Yekta MA. The effectiveness of reality therapy on sexual satisfaction and marital intimacy of infertile women. J Educ Health Promot. 2022;11:275. doi: 10.4103/jehp.jehp_1106_21. PubMed PMID: 36325233; PubMed Central PMCID: PMC9621354. ## 16. Kheramin S, Sahebi A, Shirazi YG, Malekzadeh M, Mohseni S, Shirazi HRG. Construct and Psychometric Properties of a New Version Quality of Life Scale Based on Choice Theory. Open Access Maced J Med Sci. 2019;7(3):440-445. doi: 10.3889/oamjms.2019.075. PubMed PMID: 30834017; PubMed Central PMCID: PMC6390164. ## 17. Karimyar Jahromi M, Mosallanejad L. The impact of reality therapy on metacognition, stress and hope in addicts. Glob J Health Sci. 2014;6(6):281-7. doi: 10.5539/gjhs.v6n6p281. PubMed PMID: 25363118; PubMed Central PMCID: PMC4825487. ## 18. Fereidouni H, Omidi A, Tamannaeifar S. The Effectiveness of Choice Theory Education on Happiness and Self-Esteem in University Students. PCP. 2019;7(3):207-214. doi: 10.32598/jpcp.7.3.207. ## 19. Sade G, Noferesti A, Fahimdanesh F. The Effectiveness of Choice Theory and Reality Therapy Training in Reducing Aggression and Negative Emotion of Female Adolescents. Journal of Applied Psychological Research. 2022;13(1):217-29. doi: 10.22059/japr.2022.324308.643851. Persian. ## 20. Shishefar S, Kazemi F, Pezeshk SH. The effectiveness of reality therapy training to increase happiness and responsibility in the mothers of children with Autism disorder. Quarterly of Psychology of Exceptional Individuals. 2017;7(27):53-77. doi: 10.22054/jpe.2018.18761.1487. Persian. ## 21. Farhadi A, Salehin S, Aghayan S, Keramat A, Talebi S. The Effectiveness of Reality Therapy Based on Choice Theory on Marital Intimacy and Sexual Satisfaction of Newly Married Women. Avicenna J Nurs Midwifery Care. 2020;28(2):83-92. doi: 10.30699/ajnmc.28.2.83. ## 22. Kang H. Sample size determination and power analysis using the G*Power software. J Educ Eval Health Prof. 2021;18:17. doi: 10.3352/jeehp.2021.18.17. PubMed PMID: 34325496; PubMed Central PMCID: PMC8441096. ## 23. Sherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. The Self-efficacy Scale: Construction and validation. Psychological Reports. 1982;51(2):663-671. doi: 10.2466/pr0.1982.51.2.663. ## 24. Farnia V, Asadi R, Abdoli N, Radmehr F, Alikhani M, Khodamoradi M, et al. Psychometric properties of the Persian version of General Self-Efficacy Scale (GSES) among substance abusers the year 2019–2020 in Kermanshah city. Clinical Epidemiology and Global Health. 2020;8(3):949-53. doi: 10.1016/j.cegh.2020.03.002. ## 25. Perls F, Hefferline R, Goodman P, Gestalt therapy. Excitement and growth in the human personality. Highland, NY: Gestalt Journal Press; 1951. ## 26. Glasser W. Counseling with choice theory: The new reality therapy; 2006. ## 27. Tabarzan S, Hooman F, Bakhtiarpour S. Investigating the Relationship among the Quality of Married Life, Internet Addiction, and Mindfulness in Women with Breast Cancer: The Mediating Role of Sexual Satisfaction. Women Health Bull. 2022;9(4):251-258. doi: 10.30476/whb.2022.96842.1195. ## 28. Dinapoli L, Colloca G, Di Capua B, Valentini V. Psychological Aspects to Consider in Breast Cancer Diagnosis and Treatment. Curr Oncol Rep. 2021;23(3):38. doi: 10.1007/s11912-021-01049-3. PubMed PMID: 33709235; PubMed Central PMCID: PMC7952347. ##