The Effectiveness of Treatment Based on Schema Therapy on Psychological Distress Infertility Self-Efficacy and Quality of Life of Infertile Women

Background &

Infertility makes people susceptible to mental illnesses such as depression and anxiety (3). Failure to pay attention to mental disorders and their symptoms such as interpersonal relationship problems, marital dissatisfaction, and decreased sexual desire creates a vicious cycle that reduces the possibility of infertility treatment and also leads to divorce (4). In societies where cultural norms value women more than the role of motherhood, infertility causes instability in cohabitation, domestic violence, and isolation (5). Infertility, because it causes a woman's inability to achieve the desired social role, is often associated with psychological distress (6) and affects their psychological, physical, social well-being and life expectancy (5).
But among the various factors, one of the most important variables in infertile women is psychological distress. In a general definition, psychological distress is emotional suffering that may have a negative impact on people's social functions and daily life (7) and is characterized by symptoms of depression and anxiety (8). Another important variable in the society of infertile women is infertility self-efficacy (9). Infertility self-efficacy means infertile people's perception of their abilities to use behavioral, emotional and cognitive capabilities in facing the diagnosis and medical treatment of infertility (11).
Finally, the quality of life is a broad concept that includes different areas of human life, including health (12). Quality of life is people's sense of their abilities regarding physical, emotional and social functions, and today it is considered as one of the indicators of development, which is very important to improve (14).
Due to the importance of infertility and the negative consequences of infertility in women, many interventions with different approaches have been formulated to reduce the psychological problems of infertile women. One of the therapeutic approaches that can be effective in psychological distress, infertility self-efficacy and also the quality of life of infertile women is schema therapy (15). Schema therapy is one of the most widely used third wave treatments, which was proposed by Jeffrey Young (16). The basis of schema theory is the principle of coordination. People are motivated to perpetuate their self-consistent view of the world and themselves and tend to interpret situations in such a way that their schemas are confirmed (17).
Another treatment approach that seems to be effective in psychological distress, infertility self-efficacy, and also the quality of life of infertile women, is the treatment based on acceptance and commitment (13). Treatment based on acceptance and commitment is one of the treatments of the third wave of the cognitive-behavioral approach, whose primary goal is to increase the quality of life by reducing the effect of ineffective control strategies and supporting behavioral change based on values (22). According to the above material, the researcher is trying to answer the question whether the effectiveness of treatment based on schema therapy has an effect on psychological distress, infertility self-efficacy and the quality of life of infertile women in Tehran.

The current research was semi-experimental with a pre-test-post-test-follow-up design with a control group for this purpose among infertile women who had referred to the infertility treatment centers of districts 1 to 5 of Tehran in 1401. With the coordination of the director of the infertility centers of regions 1 to 5, the health and care officer of the center provided the files of the infertile people to the researcher and while contacting the infertile women, they were given explanations about the working method. Based on this, 30 people were selected as a sample using the available sampling method and were randomly divided into two control and experimental groups.
In the first session and before the beginning of the treatment sessions, a pre-test and at the end of the last session, a post-test was conducted in both groups. A follow-up meeting was held in the same place after three months. The experimental group participated in schema therapy group sessions twice a week for ten 2-hour sessions. This treatment protocol with the opinion of clinical experts and the use of reliable sources (16) is presented by sessions in Table 1.

The results showed that there is a significant difference between the average scores of psychological distress in pre-test, post-test and follow-up. Also, the interaction effect between time and group is significant, which shows that the mean scores of psychological distress of infertile women are different at different times according to the variable levels of the group. That is, there is a significant difference between the two groups (the second experimental group and the control group) in the reduction of the psychological distress scores of infertile women from the pre-test stage to the follow-up. Also, the significance of the group factor on the psychological distress scores of infertile women indicates that regardless of the measurement time, there is a significant difference between the mean psychological distress scores of the experimental and control groups (P=0.001).
Another finding showed that there is a significant difference between the mean infertility self-efficacy scores in pre-test, post-test and follow-up. Also, the interaction effect between time and group is also significant, which shows that the mean infertility self-efficacy scores of infertile women are different at different times according to the variable levels of the group. That is, there is a significant difference between the two groups (the second experimental group and the control group) in the increase in infertility self-efficacy scores of infertile women from the pre-test stage to follow-up. Also, the significance of the group factor on the infertility self-efficacy scores of infertile women indicates that regardless of the measurement time, there is a significant difference between the mean infertility self-efficacy scores of the experimental and control groups (P=0.002). (Table 3).
As can be seen in Table 4, there is a significant difference between the mean scores of the quality of life in the pre-test, post-test and follow-up. It was also found that the quality of life scores of infertile women are different at different times according to the variable levels of the group. That is, there is a significant difference between the two groups (the second experimental group and the control group) in the increase in the quality of life scores of infertile women from the pre-examination stage to the follow-up. Also, the significance of the group factor on the quality of life scores of infertile women indicates that regardless of the measurement time, there is a significant difference between the mean quality of life scores of the experimental and control groups (P=0.002).

Schema therapy by emphasizing the change of maladaptive coping styles and maladaptive schemas formed in childhood and explaining how they are effective in processing and facing life events in therapy instead of ineffective coping styles and strategies provides an opportunity for the patient to stop negative evaluation and avoidance. and instead use normal and adaptive coping strategies (27).
Schema therapy is used to change processes and activities such as negative rumination, threat monitoring, focusing on danger, selling thoughts and behaviors such as behavioral, cognitive, and emotional avoidance that people prone to depression use to deal with the perceived inconsistency and regulate the resulting negative emotions. they give, it pays, and in this way it reduces the feeling of helplessness and inefficiency in a person (30).
This approach is effective by challenging incompatible schemas and ineffective responses and replacing them with inappropriate and healthier thoughts and responses. Schema therapy, with the ability to improve some basic and destructive components such as negative emotions and thoughts, depression, anxiety, personality abnormalities, etc., seems to be able to improve the omponents of the quality of life in people (28).