Comparing the Effects of Acceptance and Commitment Therapy and Spiritual Therapy on Psychological Distress in Patients With Breast Cancer

Breast Cancer (BC) causes numerous biopsychological complications that require appropriate interventions. The number of cancer patients is increasingly higher than before worldwide; thus, this chronic disease is a major problem for individuals’ health. A therapy used in the present study was Acceptance and Commitment Therapy (ACT) to facilitate decreasing distress in patients with breast cancer. This aim was achieved by helping them to reach a level of psychological flexibility to accept what they cannot change and try to modify the changeable matters, to improve their health condition. The present study also implemented Spiritual Therapy (ST) to help these patients find meaning in life and follow their lives according to the values in the most tragic circumstances. Such interventions could significantly help to reduce distress among this group. Therefore, the present study aimed to compare the effects of ACT and ST on psychological distress (anxiety, depression, stress) in women with breast cancer to enjoy a better life.

This was a quasi-experimental research with pretest-posttest and a control group design. The statistical population of this study included all patients with BC, referring to Dr. Gholami's Clinic in Kashmar City, Iran, in February 2020. Forty-Five eligible volunteers entered the study; they were randomly divided into 3 groups (n=15); two experimental (ACT & ST), and one control groups. The inclusion criteria of the study were patients with BC (according to oncologists’ diagnosis), the age of 18-65 years, receiving chemotherapy for ≥1 month, no history of mental illness, having at least primary education (reading & writing abilities), no co-morbid physical illness, and patients’ consent and ability to attend all treatment sessions. The Depression, Anxiety, and Stress Scales (Lavibund and Lavibund, 1995) were used in pretest and posttest phases to define and measure anxiety, depression, and stress in the study subjects. The ACT group received eight 75-minute training sessions two days a week according to a protocol developed by Hayes and associates (2006). The ST group participated in nine 75-minute training sessions two days a week. The protocol used in the ST group was adapted from the protocol developed by Richard and Bergin (2005). However, the controls received no intervention. The obtained data were analyzed by descriptive statistics, including mean and standard deviation and inferential statistics, including univariate Analysis of Covariance (ANCOVA) and Bonferroni posthoc test in SPSS at the significance level of 0.05.

The mean posttest scores of depression, anxiety, and stress (after controlling the pretest scores) were significantly higher in both research groups; thus, ACT and ST could effectively reduce depression (p<0.001), anxiety (p<0.001), and stress (p<0.001) in the study subjects. The ETA-squared value indicated that respectively >61%, >56%, and >66% of changes in the depression, anxiety, and stress components in women with BC could be explained by ACT and ST. Bonferroni test data suggested that in depression, the difference between the experimental groups and the control group (p=0.001) and the difference between the ACT and ST groups was significant (p=0.030). Moreover, respecting anxiety, the difference between the two experimental groups and the controls (p=0.001 & p=0.008, respectively) and the difference between the ACT and ST groups was significant (p=0.006). Furthermore, there were significant differences concerning stress between the ACT and ST groups and the control group (p=0.001) as well as between the ACT and ST groups (p=0.026).

Based on the present study findings, ACT and ST effectively reduced psychological distress in the examined women with BC; however, ACT was more effective than spiritual therapy in this respect.