Adaptation of Psycho-Visual and Cognitive-Behavioral Interventions on Body Image in Patients with Breast Cancer (Mastectomy)

One of the major problems of today's societies is chronic diseases that have created many tensions along with the heavy costs that impose on the economies of countries. Among these chronic diseases is cancer, which, by disrupting human life, overshadows the cultural, family, and social dimensions. Breast cancer is a common malignant disease that affects women in many communities. Diagnosis and treatment of this disease have changes in sexual function, negative self-image, communication problems, and the like, and thus has special effects on the well-being of life and mental health. Human society has always valued the beauty of the human body, but this beauty has not been defined in all cultures and throughout history. Body image is partly the result of personal experiences, personality, and various social and cultural factors, including the definition of beauty. A person's feelings about his or her physical appearance in the eyes of others or the cultural ideals in which he or she lives shape his or her body image. It is important to know that a person's perception of their appearance can be different from others' perception of their appearance or social standards. Body image also has a wide range of psychological and physical effects on the individual. Body image is one of the important categories in the formation of individual identity and the concept of "self". People who have a positive body image accept and love their body as it is, and are more resilient to the pressures that are unrealistically available for girls to be slimmer and boys to be more muscular, resulting in less depression. By having a positive body image, a person accepts his body as it is, and this enables him to focus his mind and energy on the growth and expansion of other aspects of his life. The cognitive-behavioral model is introduced by Beck for the first time. Beck's model explains how emotional problems can arise through patterns of negative thoughts, and also shows that such problems can be addressed by altering thought processes. The cognitive-behavioral model combines the role of human behavior in the development and maintenance of such problems. Corrections such as cognitive and cognitive-behavioral are sometimes used interchangeably in different articles. In general, cognitive therapy has educational, cognitive, and behavioral aspects. The educational aspects include explaining cognitive triangles, schemas, and wrong logic to the patient. The therapist should explain to the patient that they are formulating hypotheses together and testing them during treatment. Cognitive therapy requires a complete description of the relationship between depression and thinking, emotions, and behavior, as well as the philosophy of all aspects of therapy. Behavioral aspects of treatment include the use of relaxation training, regular desensitization, self-control training, self-review, role modeling, behavior modification, assertiveness training, role-playing and reverse role-play, homework, exercise, and more. According to the studies, it seems that both therapeutic approaches have been effective on breast cancer separately, and on the other hand, because no research has shown the effectiveness of these two approaches on the body image level in patients, according to the researcher. Has not been studied in breast cancer, so the research question is how to compare the effectiveness of cognitive-behavioral therapy and psycho-display on the level of body image in women with breast cancer and which type of treatment is more effective? 

This quasi-experimental study was designed with pre-test, post-test, and two-month follow-up with a control group that was approved by the code of ethics with the number IR.IAU.Dubai.REC.1399.017 from the Islamic Azad University of Dubai. The researchers also followed the ethical protocols of Helsinki Studies, and the subjects' information remained anonymous, and all of this information will remain secure after the study. The study population was women with breast cancer who were referred to Shohada Tajrish Hospital in Tehran in 2009-2010. The sample of the present study included 45 people (15 people for each group; that is, 15 people in the experimental group 1 and 15 people in the experimental group 2 and 15 people in the control group). In this study, the available sampling method was used; among the patients who were referred to the Cancer Research Center at Shohada Tajrish Hospital and underwent a mastectomy, 45 were selected and again randomly assigned to three groups and 15 experimental (two groups) in each group waiting for treatment. The protocols were psychotherapy (Ghotbi Nejad et al., 2019) and cognitive-behavioral therapy Kharazi et al. (2018) (sixty minutes per session). For data collection, in addition to the demographic information form, including age, the Fisher's body image test was developed by Fisher in 1970 and contains 46 items. A mixed analysis of variance was used to analyze the data. 

The results showed that the two methods of group therapy, psychoactive and cognitive-behavioral, had a significant effect on body image after the test. There was also a difference between body image scores in the three stages of pre-test, post-test, and follow-up, regardless of group. 

The results showed that among the methods of cognitive-behavioral therapy and psychotherapy, group cognitive-behavioral therapy was more effective in improving the body image of women with breast cancer. Cognitive-behavioral therapy with components affecting the improvement of body image can enable the ability to effectively cope with challenges and stressful situations, which is one of the most important types of coping, meaningful situations. Achieving this capability is the main goal of the cognitive-behavioral approach because the main premise of this approach is to change the cognition of a person's entire behavioral and emotional system. In this approach, the person removes the control of his psychological system from the domination of subconscious factors such as negative automatic thoughts and consciously and actively determines his mood and behavioral system through direct control of his cognitive system. Therefore, during treatment, more adaptive cognitions based on unconditional self-acceptance and self-esteem and in accordance with logical facts and norms replace distorted and excessive images and thoughts about body image, self-esteem, decreased awareness, and fear of negative evaluations and thoughts and cognitions. They will be negative and ultimately improve the body image, and on the other hand, negative cognitive dimensions are a natural part of the mental system of individuals.