Determining the Effectiveness of Cognitive-Behavioral Therapy on Anxiety, Perceived Stress, and Coping Strategies in Patients With Leukemia

Cancer is a group of diseases characterized by uncontrolled growth and abnormal cell proliferation. Besides physical consequences, people with cancer suffer from psychological complications, such as depression, anxiety, cognitive impairment, negative thoughts, fear of relapse and death, loneliness, sexual problems, and body image. One of the most common cancers is leukemia. This cancer is further divided into myeloid and lymphoid according to the cellular origin and chronic or acute course of the disease. According to the cognitive–interactive model of stress, people's assessments of their relationships with the environment play a decisive role in creating stress. If people consider their environment too stressful and feel unable to cope with difficult situations, their stress will increase, but if they know that they can cope with stressful events, they will feel less stress. The most common psychiatric disorder in these patients is adaptation disorder with anxiety, depression, or both depression and anxiety. So, this study aimed to determine the effectiveness of cognitive–behavioral therapy on anxiety, perceived stress, and pain management strategies for patients with leukemia.

This applied research was a quasi–experimental study with a pretest–posttest design with a control group. The study's statistical population included all patients with confirmed leukemia hospitalized in Seyed Al–Shohada Hospital in Isfahan City, Iran, between April and June 2019. The sample consisted of 30 people from the statistical population selected using the convenient sampling method. They were randomly assigned to experimental and control groups. The inclusion criteria included having full consent to participate in the study; having a confirmed diagnosis of leukemia by specialists; having at least a secondary education, lacking another chronic illness, physical and mental disabilities; and having a maximum age of 80 years. The exclusion criteria were having any chronic diseases such as diabetes, heart and lung diseases, any physical and mental disabilities; using any drugs or sedatives, having a history of psychiatric diseases, and being absent in more than three treatment sessions. The study data were obtained using Perceived Stress Scale (Cohen et al., 1983), Beck Anxiety Inventory (Beck et al., 1988), and Coping Strategies Questionnaire (Rosenstiel & Keefe, 1983). The obtained data were analyzed using descriptive statistics (mean, standard deviation) and inferential statistics (univariate analysis of covariance) in SPSS software version 22. The significance level of the tests was set at 0.05.

The results showed that by controlling the pretest scores, there was a significant difference between the experimental group and the control group in terms of anxiety (p<0.001), perceived stress (p<0.001), and coping strategies (p<0.001).

According to findings, cognitive–behavioral therapy reduces anxiety and perceived stress and increases pain coping strategies in patients with leukemia. Therefore, cognitive–behavioral therapy can decrease the psychological problems of patients with leukemia.