Group based acceptance and commitment therapy on quality of life and psychological flexibility in patients with non-cardiac chest pain

Chest pain is one of the most common reasons for referring people to cardiovascular clinics. The cause of chest pain with non–cardiac origin can be physical or mental. Because mental causes are less of a concern for specialists, therefore, they are more important for diagnosis and treatment. The aim of this study was to determine the effectiveness of acceptance and commitment therapy on quality of life and psychological flexibility in patients with non–cardiac chest pain.

This study was a semi–experimental and clinical intervention, pre–test, post–test, and follow up test (two months later), with the control group. The statistical population of this study included all patients with non–cardiac chest pain referring to Dr. Heshmat Hospital in Rasht city (Northern of Iran) in 2017–2018. All of them were residents of Rasht city. During referrals within three months prior to the beginning of this study, a list of patients referred to the emergency department and echocardiography were extracted. The 40 samples were selected by convenience sampling and randomly divided into two groups. Participants responded to two questionnaires: SF–36 and AAQ–II. The experimental group received 8 sessions of training for 90 minutes based on acceptance and commitment. The psychological flexibility and quality of life of these individuals were first assessed (pre–test), after the end of the sessions (post–test) and again two months later in the next follow–up. The required information was collected by questionnaires as well as the results of the medical examinations of these people. The control group responded to all the questionnaires at the third time, but they did not receive any treatment. The summary of the content of the sessions and activities performed in the ACT group is as follows: Session 1: Introduction and treatment agenda (including familiarity and introduction of exercises); Session 2: Options and setting a course of treatment (behavior change and mindfulness); Session 3: Learning to live with chronic pain (acceptance, values, and mindfulness); Session 4: Clarification of values and objectives; Session 5: Motivation, thoughts and emotions (initiating plans and acting); Session 6: Desire to act, move forward; Session 7: Commitment; Session 8: Practicing and retaining therapeutic achievements throughout life. After collecting data, results were analyzed by T test with independent groups, variance with repeated measurements and Bonferroni method and, using SPSS version 23 software.

Mean scores of psychological quality of life scale and physical quality of life scale and psychological flexibility in the treatment group have increased. The results of repeated–measures variance analysis for these three variables in three stages of pre–test, post–test and follow–up showed there was a significant difference in the treatment based on acceptance and commitment on the psychological quality of life (F=7.23, p<0.001‏), physical quality of life (F=13.15, p<0.001) and psychological flexibility (F=74.52, p<0.001). The results of the Bonferroni test for the experimental group showed that there was a significant difference in the psychological quality of life between the two methods (p<0.001), pre–test–post–test (p<0.001), and pre–test–follow–up (p<0.027) but there was no significant difference between the mean post–test and follow–up stages. In the variable of physical quality of life, there was a significant difference between the two pre–test and post–test phases (p<0.001) and pre–test–follow–up (p<0.016), but in comparison no significant difference was observed between the post–test and follow–up stages. In addition, in the case of psychological flexibility, there was a significant difference between the comparison between two pre–test, post–test and pre–test–follow–up (p<0.001). However, no significant difference was observed between the mean post–test and follow–up stages.

Overall, the findings of this study showed that admission and commitment therapy is an effective approach to improving the physical and psychological quality of life and increasing the psychological flexibility of patients with non–cardiac chest pain; and can be used as a therapeutic therapy Supplemented with medication.