Document Type : Research Article

Authors

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

Abstract

Background: Mastectomy damages self-concept and sexual identity and also increases the risk of depression due to changes in the physical appearance of patients. The present study aimed to investigate the effectiveness of cognitive rehabilitation therapy (CRT) on psychological distress and self-compassion in mastectomized women with depression.
Methods: The research was a quasi-experimental study based on a pretest-posttest design with control and experimental groups. The study population consisted of mastectomized women with depression who visited counseling and psychological services centers and clinics in 2021, of whom 40 patients were selected through purposive sampling. The participants were randomly assigned into two groups of 20 members using a table of random numbers. Participants in the experimental group attended ten 90-minute sessions of CRT (two sessions per week). The research instruments included the Kessler Psychological Distress Scale (K10) and Self-Compassion Scale (SCS). The data were statistically analyzed using analysis of covariance in SPSS version 19.
Results: The findings indicated that there was no significant difference between the two groups in the pretest in terms of psychological distress and self-compassion. The mean±SD of psychological distress in the posttest of the CRT group was 15.26±3.43, which was significantly different from the control group (19.26±3.65) (P<0.001). The mean±SD of self-compassion in the experimental and control groups were 79.13±7.38 and 71.67±8.39, respectively, which was statistically significant (P=0.005). In other words, CRT significantly reduced psychological distress and increased self-compassion in mastectomized women with depression (P<0.001).
Conclusion: The study findings suggested the effectiveness of CRT in reducing psychological distress and increasing the selfcompassion of mastectomized women with depression. Therapists and health professionals are hence recommended to apply CRT, along with other interventions and therapies, to reduce psychological distress and increase the self-compassion of such patients.

Highlights

How to Cite: Pourfereydoun MH, Dasht Bozorgi Z. Effectiveness of Cognitive Rehabilitation Therapy on Psychological Distress and Self-Compassion in Mastectomized Women with Depression. Women. Health. Bull. 2023;10(2):87-95. doi: 10.30476/WHB.2023.97735.1219.

Keywords

1. Davey A, Chilcot J, Driscoll E, McCracken LM. Psychological flexibility, self-compassion and daily functioning in chronic pain. Journal of Contextual Behavioral Science. 2020;17:79-85. ## 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. Lhenaff M, Tunon de Lara C, Fournier M, Charitansky H, Brouste V, Mathoulin-Pelissier S, et al. A single-center study on total mastectomy versus skin-sparing mastectomy in case of pure ductal carcinoma in situ of the breast. Eur J Surg Oncol. 2019;45(6):950-5. doi: 10.1016/j.ejso.2019.01.014. ## 4. Fortunato L, Loreti A, Cortese G, Spallone D, Toto V, Cavaliere F, et al. Regret and Quality of Life After Mastectomy with or Without Reconstruction. Clin Breast Cancer. 2021;21(3):162-169. doi: 10.1016/j.clbc.2019.11.005. PubMed PMID: 33744100. ## 5. Drinane JJ, Pham TH, Schalet G, Rezak K. Depression is associated with worse outcomes among women undergoing breast reconstruction following mastectomy. J Plast Reconstr Aesthet Surg. 2019;72(8):1292-1298. doi: 10.1016/j.bjps.2019.03.036. PubMed PMID: 31056434. ## 6. Hirsch CR, Krahé C, Whyte J, Loizou S, Bridge L, Norton S, et al. Interpretation training to target repetitive negative thinking in generalized anxiety disorder and depression. J Consult Clin Psychol. 2018;86(12):1017-1030. doi: 10.1037/ccp0000310. PubMed PMID: 30507227. ## 7. Kuehner C. Why is depression more common among women than among men? Lancet Psychiatry. 2017;4(2):146-158. doi: 10.1016/S2215-0366(16)30263-2. PubMed PMID: 27856392. ## 8. Burt VK, Stein K. Epidemiology of depression throughout the female life cycle. J Clin Psychiatry. 2002;63:9-15. PubMed PMID: 11995779. ## 9. Yalın Sapmaz Ş, Şen S, Özkan Y, Kandemir H. Relationship between Toxoplasma gondii seropositivity and depression in children and adolescents. Psychiatry Res. 2019;278:263-267. doi: 10.1016/j.psychres.2019.06.031. PubMed PMID: 31238296. ## 10. Warner E, Nannarone M, Manuel D, Lashewicz B, Patten S, Schmitz N, et al. Self-help behaviors partially mediate the relationship between personalized depression risk disclosure and psychological distress: A mediation analysis using data from a randomized controlled trial. J Psychiatr Res. 2021;140:7-14. doi: 10.1016/j.jpsychires.2021.05.047. PubMed PMID: 34087753. ## 11. Dana A, Abdi K, Salehian M, Mokari Saei S. Psychosocial Distress among Teenage Girls within the Coronavirus Outbreak: The Role of Physical Activity and Sedentary Time. Women Health Bull. 2022;9(3):150-155. doi: 10.30476/whb.2022.94886.1173. ## 12. Feng D, Kong W, Zhao W, Li Z, Wang L. The mediating role of perceived prejudice in the relationship between self-esteem and psychological distress among Chinese male nursing students. J Prof Nurs. 2019;35(6):505-511. doi: 10.1016/j.profnurs.2019.05.003. PubMed PMID: 31857062. ## 13. Tian S, Zhang T, Chen X, Pan CW. Substance use and psychological distress among school-going adolescents in 41 low-income and middle-income countries. J Affect Disord. 2021;291:254-260. doi: 10.1016/j.jad.2021.05.024. PubMed PMID: 34052748. ## 14. Harvey R, Andriopoulou P, Grogan S. Perceived mechanisms of change in therapeutic yoga targeting psychological distress. J Bodyw Mov Ther. 2020;24(1):274-280. doi: 10.1016/j.jbmt.2019.06.014. PubMed PMID: 31987557. ## 15. Light RS, Chilcot J, McBride E. Psychological Distress in Women Living with Polycystic Ovary Syndrome: The Role of Illness Perceptions. Womens Health Issues. 2021;31(2):177-184. doi: 10.1016/j.whi.2020.11.003. PubMed PMID: 33303354. ## 16. Tao J, He K, Xu J. The mediating effect of self-compassion on the relationship between childhood maltreatment and depression. J Affect Disord. 2021;291:288-293. doi: 10.1016/j.jad.2021.05.019. PubMed PMID: 34062396. ## 17. Rahmani s, Mansoobifar M, Sirifi MR, Ashayeri H, Bermas H. Effectiveness of Family Empowerment Therapy Based on Self-Compassion on Self-Care and Glycosylated Hemoglobin in Female Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Clinical Trial. Women Health Bull. 2020;7(2):33-42. doi: 10.30476/whb.2020.85543.1043. ## 18. Kreemers LM, van Hooft EAJ, van Vianen AEM. Dealing with negative job search experiences: The beneficial role of self-compassion for job seekers' affective responses. Journal of Vocational Behavior. 2018;106:165-179. ## 19. Fletcher K, Yang Y, Johnson SL, Berk M, Perich T, Cotton S, et al. Buffering against maladaptive perfectionism in bipolar disorder: The role of self-compassion. J Affect Disord. 2019;250:132-139. doi: 10.1016/j.jad.2019.03.003. PubMed PMID: 30852365. ## 20. Dunkley-Smith AJ, Reupert AE, Ling M, Sheen JA. Experiences and perspectives of self-compassion from young adult children of parents with mental illness. J Adolesc. 2021;89:183-193. doi: 10.1016/j.adolescence.2021.05.001. PubMed PMID: 34022447. ## 21. Valgento J, Mueller K, Williams P, Finch A, Denney L. Self-compassion and Compassion for others in Physical Therapy Students, Faculty and Clinical Instructors. Health Professions Education. 2019;5(4):313-320. doi: 10.1016/j.hpe.2018.12.004. ## 22. Montoya-Murillo G, Ibarretxe-Bilbao N, Peña J, Ojeda N. Effects of Cognitive Rehabilitation on Cognition, Apathy, Quality of Life, and Subjective Complaints in the Elderly: A Randomized Controlled Trial. Am J Geriatr Psychiatry. 2020;28(5):518-529. doi: 10.1016/j.jagp.2019.10.011. PubMed PMID: 31735487. ## 23. Samuelson KW, Engle K, Bartel A, Jordan JT, Powers T, Abadjian L, et al. The power of appraisals in predicting PTSD symptom improvement following cognitive rehabilitation: A randomized clinical trial. J Affect Disord. 2021;282:561-573. doi: 10.1016/j.jad.2020.12.067. PubMed PMID: 33440301. ## 24. Rosso G, Frisiello A, Trizio M, Mosso CO, Bazzani M. Learning from professionals: Exploring cognitive rehabilitation strategies for the definition of the functional requirements of a telerehabilitation platform. Comput Biol Med. 2018;95:288-297. doi: 10.1016/j.compbiomed.2017.08.009. PubMed PMID: 28859839. ## 25. Myers JS, Cook-Wiens G, Baynes R, Jo MY, Bailey C, Krigel S, et al. Emerging From the Haze: A Multicenter, Controlled Pilot Study of a Multidimensional, Psychoeducation-Based Cognitive Rehabilitation Intervention for Breast Cancer Survivors Delivered With Telehealth Conferencing. Arch Phys Med Rehabil. 2020;101(6):948-959. doi: 10.1016/j.apmr.2020.01.021. PubMed PMID: 32179067. ## 26. Maggio MG, De Luca R, Molonia F, Porcari B, Destro M, Casella C, et al. Cognitive rehabilitation in patients with traumatic brain injury: A narrative review on the emerging use of virtual reality. J Clin Neurosci. 2019;61:1-4. doi: 10.1016/j.jocn.2018.12.020. PubMed PMID: 30616874. ## 27. Rashidi-Asl H, Ashori M. Cognitive Rehabilitation Program Training on Intelligence Capacity and Cognitive Emotion Regulation in Students with Hearing Impairment. MEJDS. 2020;10:91. Persian. ## 28. Sayadi M, Eftekhar Saadi Z, Makvandi B, Hafezi F. Effect of Cognitive Rehabilitation Training on Anxiety, Depression and Emotion Regulation in Women with Postpartum Depression. IJRN. 2019;5(2):25-32. Persian. ## 29. Sakamoto H, Maki N, Utsugi A, Takata Y, Kubota T, Nakamura S, et al. The effect of cognitive rehabilitation for post-stroke depression in long-term care health facilities: A randomized controlled trial. Clin Med Invest. 2018;3. doi: 10.15761/CMI.1000157. ## 30. Malmberg Gavelin H, Eskilsson T, Boraxbekk CJ, Josefsson M, Stigsdotter Neely A, Slunga Järvholm L. Rehabilitation for improved cognition in patients with stress-related exhaustion disorder: RECO - a randomized clinical trial. Stress. 2018;21(4):279-291. doi: 10.1080/10253890.2018.1461833. PubMed PMID: 29693483. ## 31. Rahmati A, Mousavi Nasab SMH, Moradi F. Cognitive Ability in the Elderly: The Role of Self-Transcendence, Self-Compassion and Positive Affect. Aging Psychology. 2020;6(2):107-117. Persian. ## 32. Hashemi N, Babakhani F, Sheikhhoseini R. The Effect of Water Yoga Exercises on the Intensity and Pain Duration in Girls with Primary Dysmenorrhea. Women Health Bull. 2022;9(2):61-69. doi: 10.30476/whb.2022.92560.1144. ## 33. Halajani F, Jameinezhad F, DashtBozorgi Z, Peymani Foroshani R, EsmaeiliShad B. The Effect of Cognitive Rehabilitation Group Training on Perceived Stress, Depression and Quality of Life among Primigravid Women with Pregnancy Anxiety. IJRN. 2019;6(1):10-17. Persian. ## 34. Sohlberg MM, Mateer CA. Cognitive rehabilitation: An integrative neuropsychological approach. New York: Guilford Press; 2001. ## 35. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184-9. doi: 10.1001/archpsyc.60.2.184. PubMed PMID: 12578436. ## 36. Ataei J, Shamshirgaran SM-, Iranparvar M, Safaeian A, Malek A. Reliability and validity of the Persian version of the Kessler psychological distress scale among patients with type 2 diabetes. J Anal Res Clin Med. 2015;3(2):99-106. doi: 10.15171/jarcm.2015.015. ## 37. Mandizadeh A, Homaei R. The casual relationship Stigma infertility and psychological distress with quality of marital relationship through the mediation of meta-emotion in infertile women. Journal of Family Research. 2020;16:55-76. Persian. ## 38. Neff KD. The Self-Compassion Scale is a Valid and Theoretically Coherent Measure of Self-Compassion. Mindfulness. 2016;7(1):264-74. ## 39. Azizi A, Mohammadkhani P, Foroughi AA, Lotfi S, Bahramkhani M. The Validity and Reliability of the Iranian Version of the Self-Compassion Scale. PCP. 2013;1(3):149-155. ## 40. Mohammadali S., Manavipor D., Sedaghatifard M. Investigating the Psychometric Characteristics (Validity and Reliability) of the Self-Compassion Scale: Finding Empirical Evidence for Using the Total Score and defining the Concept of Self-Compassion. Journal Oof Applied Psychology. 2020;14(2(54)):29-50. doi: 10.52547/apsy.14.2.29. Persian. ## 41. Baratpour1 S, DashtBozorgi Z. The Effectiveness of Cognitive Rehabilitation on Quality of Life, Psychological Flexibility and Health Worry in Patients with Panic Disorder. IJRN. 2021;7(2):10-19. doi: 10.29252/ijrn.7.2.10. ##