The Effect of Act and Meta-Diagnosis Treatment on Experiential Avoidance and Quality of Life in Patients with Systemic Lupus Erythematosus

Background &

Systemic lupus erythematosus is a chronic, autoimmune, multisystem inflammatory disease that can cause skin lesions, inflammation of the joints and membranes covering the lungs and heart, nephritis, cardiovascular, hematological, gastrointestinal, and neurological diseases. In this way, the symptoms can appear slowly and gradually or quickly and change with the stages of activity and recovery (1). This disease significantly affects the quality of life in physical, emotional and social aspects (2).
On the other hand, the results show that about 80% of lupus patients complain of psychological problems that cause damage to their lives (7). In the meantime, the use of experiential avoidance is known as a maladaptive strategy that is the product and continuation of anxiety and depression (8). Research shows that the set of inflexible emotional avoidance measures is a factor of vulnerability and psychological risk factor for the development, persistence and exacerbation of psychological symptoms (10) and significantly reduces the quality of life (9). Therefore, for these patients, treatment methods or therapies are used to minimize the consequences of the disease and improve the quality of life and psychological symptoms. Performing effective interventions aimed at reducing the psychological and cognitive consequences of these patients can be effective in improving the quality of life as well as psychological symptoms such as experiential avoidance of these people. In this regard, one of the effective psychological therapies that has been able to be effective on a wide range of emotional disorders and anxiety, is Barlow integrated meta-diagnostic therapy. Transdiagnostic intervention focuses on emotion regulation, but sometimes due to lack of emotional control, there are approaches that do not target emotion regulation and behavioral change is targeted, including act intervention. Acceptance and commitment therapy or act is a behavioral therapy that focuses on valuable involvement in life.
The results showed that act-based therapy was effective in reducing depression, anxiety, and increasing quality of life (14,15,16). In general, due to the effectiveness of act in the treatment of anxiety and depression, this treatment is used for patients with systemic lupus erythematosus. Therefore, this study, in continuation of the evolution of non-drug therapies effective in reducing the symptoms and psychological symptoms of lupus erythematosus, systematically intends to study these two treatments (act and meta-diagnosis). Therefore, the present study seeks to ask whether the treatment of acceptance and commitment (act) and integrated meta-diagnosis affect the quality of life and cognitive symptoms of patients with systemic lupus erythematosus?

The research was a quasi-experimental study with a pretest-posttest design with a control group. The statistical population of the study included all patients with systemic lupus erythematosus in 2019 in the rheumatology clinic of Imam Ali hospital in Zahedan and private rheumatology clinics, 45 people were replaced in two experimental groups (act and meta-diagnosis) and one group (control) based on purposive sampling method.  The Lupus McIlham et al. (2007) Quality of Life Scale and the experience avoidance acceptance and practice of Bones et al. (2011) were used to collect data. Act Hayes et al. (2011) and integrated transdiagnostic therapy of Barlow et al. (2017) including were used 10 sessions of 60 minutes twice in a week.

The results showed a significant difference between the post-test means of the experimental and control groups; This means that act therapy and meta-diagnosis training can improve the level of experiential avoidance as well (p <0.001).

The results showed that in comparison with the control group, both treatments were effective in reducing the experimental avoidance and quality of life of lupus patients. However, a comparison of the two treatments showed that there was no significant difference between the effectiveness of these two treatments in reducing experimental avoidance and increasing the quality of life of lupus patients. The results are consistent with the results of studies that measure the effectiveness of act therapy on quality of life (24.18), depression (25) and anxiety and dysfunctional attitudes of patients with systemic lupus erythematosus (25) as well as the effectiveness of meta-diagnosis on health and emotion regulation (19). It seems that acceptance and commitment training, instead of ignoring emotions and inner experiences, leads the patient to become aware of feelings, inner and emotional experiences, accepting them and using them properly and instead, causing the patient to Establish appropriate situations and interactions and experience them with a fresh perspective. In addition, from the perspective of acceptance and commitment therapy, it avoids experiences of the traumatic process. Although short-term experience avoidance has a mitigating effect on unpleasant experiences, it has many destructive effects in the long run and can lead to inflexibility and functional impairment. On the other hand, acceptance and commitment therapy based on patients' quality of life through factors such as acceptance without judgment, being in the moment, coping with inner experiences without avoiding, suppressing or trying to change them, improving emotion regulation or mechanisms such as vulnerability to emotions Negative improves. Because this treatment causes patients with systemic lupus erythematosus to accept their feelings, emotions and thoughts in spite of being unpleasant and reduce hypersensitivity to the disease and thus increase their satisfaction and quality of life. Perhaps another reason for improving the experiential avoidance and quality of life in these patients is to clarify values and address important life values and goals rather than addressing everyday symptoms and issues. In other words, the goal here is to help the person to do what is important to him in life and in line with his values, instead of responding to the physical and psychological symptoms of his illness (29.30.31). Trans-diagnostic therapy helps patients deal with their negative emotions and respond to their emotions in a more adaptive way. This approach emphasizes changing emotional regulation habits to reduce the frequency and severity of maladaptive emotional habits, reduce harm, and increase performance. Dynamic interaction between thoughts, feelings and behaviors and their role in emotional experience has been considered in all meta-diagnostic approaches (34). In fact, this approach strengthens cognitive and behavioral control in the individual by interacting with thoughts, feelings and behaviors. Improving cognitive and behavioral control, in turn, leads to the use of thought and practical processes to moderate the effects of stress on patients, and in turn improves the quality of life and reduces experiential avoidance. It can be inferred that the present study has a positive strength that can be said that the treatment of act and meta-diagnosis has an important role in increasing the quality of life and reducing the experience avoidance of patients with systemic lupus erythematosus. A drug used these methods. There are some limitations for it, such as the statistical population of this study, which were only related to lupus patients, and in generalizing the results to other patients, caution should be observed. It is suggested that in future researches, statistical population and more diverse patients be used to select the sample. The results of this study are considered as important consequences of education and mental health promotion in patients with systemic lupus erythematosus. As a result, it is suggested to use acceptance and commitment-based therapy along with post-diagnosis educational treatment along with other treatment methods to improve the quality of life and cognitive symptoms, including experiential avoidance.