Middle Eastern Journal of Disability Studies

Background & Objectives: Breast cancer is probably a frightening tumor in women and causes emotional distress and experiential avoidance in these people. One of the problems of people with cancer is psychological and emotional distress that can be seen in different phases of cancer diagnosis and treatment. Distress is a multifactorial unpleasant experience of a psychological nature (cognitive, behavioral, emotional) that interferes with the ability to cope effectively with cancer, its physical symptoms and treatment. It is also a broad term that includes a wide range of emotions and psychiatric symptoms, including depression and anxiety. In addition to emotional distress, receiving a breast cancer diagnosis can upset a person in as much as rejecting the truth of having cancer, a response called experiential avoidance. In this study, we try to compare the effectiveness of transdiagnostic therapy and schema therapy based on mindfulness on improving emotional distress and experiential avoidance in patients with breast cancer.
Methods: The research method was quasi–experimental with a pretest–posttest and a 45–day follow–up design with a control group. The statistical population was all female patients with breast cancer in 2018–2021 who were referred to Omid and Imam Reza (AS) hospitals in Mashhad. A total of 41 subjects were purposefully selected and randomly assigned to the two experimental (mindfulness–based schema therapy with 14 people and transdiagnostic therapy with 13 people) and one control group (14 persons). Data collection tools were Depression Anxiety Stress Scales (DASS–21) (Lovibond and Lovibond, 1995) and Acceptance and Action Questionnaire second version (AAQ–II) (Bond et al., 2011). Schema therapy based on mindfulness was implemented in 8 sessions and two 90–min follow–up sessions and transdiagnostic therapy in ten 90–min sessions only for the experimental groups. To analyze the data, descriptive statistics (frequency, mean and standard deviation) and inferential statistics (1–way analysis of variance, Chi–square test, analysis of variance with repeated measures and Bonferroni's post hoc test) were used in SPSS version 25. The significance level of statistical tests was considered 0.05.
Results: Findings showed that the group effect, time effect, and time × group interaction effect were significant for depression, anxiety, and stress subscales of the emotional distress variable (p<0.05) and the experiential avoidance variable (p<0.05). There was no statistically significant difference between the two groups of transdiagnostic therapy and schema therapy based on mindfulness in terms of changes in the average score of depression (p=0.060), anxiety (p=0.880), and stress (p=0.870) subscales. However, there were significant differences between the two groups of schema therapy based on mindfulness and control in terms of changes in the average score of depression (p<0.001), anxiety (p=0.040), and stress (p<0.001) subscales and also between the transdiagnostic therapy and control groups in terms of changes in the average scores of depression (p=0.020), anxiety (p=0.040) and stress (p=0.002) subscales. Changes in the mean scores of depression, anxiety, and stress subscales in the two intervention groups between the pretest and posttest stages (p=0.001 for all subscales) and the pretest and follow–up stages (p=0.001 for all subscales) were significant and also in the mentioned subscales between the posttest and follow–up stages (p=0.002, p=0.040, p=0.030, respectively) there were significant statistical differences, indicating the persistence of the effectiveness of treatments in the follow–up phase. No significant statistical difference was observed between the two groups of transdiagnostic therapy and schema therapy based on mindfulness in terms of changes in the average score of the experiential avoidance variable (p=0.860). However, there was a statistically significant difference between the schema therapy based on mindfulness and control groups (p=0.029) and between the transdiagnostic therapy and control groups (p=0.038) in terms of changes in the average score of the experiential avoidance variable. The average changes of experiential avoidance scale in the two intervention groups between the pretest and posttest stages (p=0.001) and the pretest and follow–up stages (p=0.001) were significant and also in the mentioned variable between the posttest and follow–up stages (p=0.001) showed a statistically significant difference, indicating the persistence of the effectiveness of the treatments in the follow–up phase.
Conclusion: Based on the study’s findings, transdiagnostic treatment and schema therapy based on mindfulness reduce emotional distress and experiential avoidance in women with breast cancer but no difference was observed between the two interventions.