Abstract
Keywords
Acceptance and Commitment Therapy Hypochondriasis Psychological Adjustment Divorce
Fulltext
Divorce is a serious crisis in women’s psychosocial health. It is considered as important social harm leading to much psychological stress for women (1). The problems associated with divorce vary depending on social, familial, and cultural conditions and even gender. The level of adjustment decreases in divorced women who experience an emotional crisis (2). Women’s mental health plays an important role in building a healthy family that guarantees the health of society. Divorce destroys the family structure and is a major loss in family life. It influences the adjustment of family members in emotional, cognitive, and social dimensions. Divorced women become more involved in interpersonal and social problems. Studies have shown that the social level and acceptance of divorce predict how the psychological well-being of individuals will be shaped (3).
Hypochondriasis can be viewed as a concept that exists along a continuum ranging from mild anxiety concerning health and development of diseases to illness anxiety disorder (IAD). It imposes considerable costs related to healthcare (4), quality of life (5), and occupational capability (6). Hypochondriasis (or IAD) is characterized by the fear of a serious disease that interferes with activities of daily living. Hypochondriasis, especially IAD, is accompanied by extreme anxiety regarding diseases, particularly serious diseases, inability to ignore simple bodily symptoms and selective attention to these symptoms after hearing of or reading about a disease, excessive visits to physicians and healthcare centers, as well as extreme fear of death. There is a strong correlation between hypochondriasis and symptoms of mental disorders, especially anxiety and depression (7, 8).
Divorce and separation have many negative psychological and social effects on women, including a higher risk of mental diseases, increased physical illnesses, and violent and disorderly expression of emotions. In women, divorce disrupts the dimension of psychosocial adjustment. The stresses they experience due to divorce influence the level of their adaptation and adjustment to these stresses (9). Because of numerous social problems caused by it, unfavorable governing opinions in society concerning this issue, and the social stigma that it carries, divorce is a phenomenon that affects women’s adjustment from different aspects. Therefore, divorce makes it difficult for women to attain individual and social adjustment in life. Increased individual and social adjustment in divorced women have positive effects both on their acceptance of occupational and familial roles and responsibilities of daily life and other opportunities and on the expansion of their independence (10).
Third-wave psychotherapies [cognitive-behavioral therapies (CBTs)] emphasize issues such as mindfulness, emotions, acceptance, relationships, values, goals, and metacognition. Acceptance and commitment therapy (ACT) is considered to be a component of third-wave CBTs and includes therapies such as integrated mindfulness-based cognitive therapy and behavioral couple therapy (11). ACT is one of the new cognitive-behavioral interventions that comprise the four approaches of mindfulness, acceptance, commitment, and behavior change. Its general goal is to achieve psychological flexibility so that there is no need to get rid of bad feelings, but rather, despite the presence of these feelings, the individual moves towards behavior that is based on perceived value. ACT is generally a behavioral therapy but still presents human cognition based on a comprehensive empirical analysis (12). In the analysis of clinical behavior, ACT focuses mainly on spirituality, values, and self-as-context (13).
For hypochondriasis, the ACT is based on functional methodology and emphasizes the function of inner experience, i.e., how thoughts on diseases, feelings, and physical feelings are experienced and controlled using the strategy of acceptance and reduction of the tendency to dwell on negative thoughts (14). According to the results of various studies ACT is effective in reducing anxiety disorders, obsessive-compulsive disorder, psychological distress, anxiety, depression, and stress (15-18) and increasing general health (19). In addition, ACT decreases hypochondriasis and stress symptoms by changing psychological flexibility and paying conscious attention to the present (20, 21).
Evaluation and explanation of ACT on hypochondriasis and psychosocial adjustment in divorced women are among the most important innovations of this study. Regarding the above statements and the necessity of investigating divorced women’s mental health, the present study aimed to investigate the effectiveness of ACT on hypochondriasis and psychosocial adjustment in divorced women referring to counseling centers of Tehran.
The participants in this study were 30 women aged 20 - 50 years, of whom 40.2 and 24.4% had finished high school and middle school, respectively, and 35.4% had a university degree. Table 2 shows the mean and standard deviation (SD) of the studied variables in the experimental and control groups in the pretest and posttest. The mean ± SD of the hypochondriasis for ACT and control group in the posttest stage was 35.13 ± 1.92 and 37.33 ± 3.07, respectively. However, the mean ± SD of the psychosocial adjustment for ACT and control group in the posttest stage was 60.66 ± 4.51 and 53.91 ± 4.81, respectively (Table 2).
| Variables | Experimental Group | Control Group | P |
|---|---|---|---|
| Hypochondriasis | |||
| Pretest | 36.17 ± 2.44 | 37.47 ± 3.23 | 0.845 |
| Posttest | 35.13 ± 1.92 | 37.33 ± 3.07 | 0.016 |
| Psychosocial adjustment | |||
| Pretest | 54.13 ± 6.37 | 53.91 ± 4.81 | 0.642 |
| Posttest | 60.66 ± 4.51 | 54.19 ± 4.72 | 0.001 |
The Shapiro-Wilk test was used to test the normality of the distribution of the scores. The null hypothesis of normality of distribution of the two groups’ scores was confirmed (Table 3). In other words, the assumption of the normality of distribution of pretest scores for both experimental and control groups was confirmed. The result of the Levene test was not significant for hypochondriasis and psychosocial adjustment (P > 0.05); hence, the variances of the variables were not significant between the two experimental and control groups. Accordingly, the assumption of homogeneity of variance was confirmed. The results of the Pearson correlation test regarding the variables of hypochondriasis and psychosocial adjustment demonstrated a canonical correlation between them.
| Dependent Variables | Shapiro-Wilk | ||
|---|---|---|---|
| Statistics | df | P | |
| Hypochondriasis | |||
| Experimental | 0.87 | 20 | 0.61 |
| Control | 0.79 | 20 | 0.46 |
| Psychosocial adjustment | |||
| Experimental | 0.91 | 20 | 0.72 |
| Control | 0.93 | 20 | 0.78 |
The results of MANCOVA showed a significant difference between the divorced women in the experimental and control groups in terms of at least one of the dependent variables (hypochondriasis and psychosocial adjustment). Table 4 presents the results of the ANCOVA for hypochondriasis and psychosocial adjustment in the experimental and control groups. According to Table 4, ACT significantly reduced hypochondriasis in divorced women. This difference indicated that decreased symptoms of hypochondriasis were observed in the divorced women after they received ACT compared to those in the control group. In addition, the results revealed that ACT had significant effects on psychosocial adjustment in divorced women. This difference suggested that the symptoms of psychosocial adjustment increased in the divorced women who had received ACT compared to those in the control group.
| Variables | SS | df | MS | F | P | ηp2 |
|---|---|---|---|---|---|---|
| Hypochondriasis | ||||||
| Pretest | 258.03 | 1 | 258.03 | 25.56 | 0.023 | 0.56 |
| Group | 302.53 | 1 | 302.53 | 12.07 | 0.043 | 0.65 |
| Error | 202.50 | 27 | 7.50 | |||
| Psychosocial adjustment | ||||||
| Pretest | 5827.67 | 1 | 1165.53 | 5.13 | 0.001 | 0.39 |
| Group | 8895.64 | 1 | 8895.64 | 39.18 | 0.0001 | 0.29 |
| Error | 74.21 | 27 | 2.74 |
The present study aimed to investigate the effectiveness of ACT on hypochondriasis and psychosocial adjustment in divorced women referring to counseling centers of district one of Tehran in 2018. The results of the present study showed that the ACT approach decreased hypochondriasis. This finding is consistent with the results of Eilenberg et al.’s (27) and Hoffmann et al.’s (28) studies. Divorce is accompanied by social, economic, physical, mental, and psychological problems, as well as emotional changes for the divorced woman (29). In other words, stress and pressures resulting from divorce can decrease the psychological well-being of divorced women, disrupt their occupation and social relationships, and cause other difficulties due to increased anxiety, psychosocial maladjustment, and depression (30). ACT shapes openness and interest in and acceptance of the experience of life by creating universal consciousness and awareness of the here and now (18, 31). In the ACT, mindfulness includes living in the here and now, being active, and avoiding painful thoughts related to the existing problems. In other words, mindfulness enables individuals to transfer their thoughts and feelings to self-consciousness without any specific control so that their acceptance makes it possible to turn threats into opportunities, to consider the most painful events more bearable, and to search for solutions to problems. They, thus, maintain their occupational and social adjustment while reducing their anxiety under difficult conditions and shaping a problem-focused approach instead of an emotion-focused one.
The present study found the ACT intervention to be effective in increasing psychosocial adjustment. This finding is consistent with the results of Beilby et al.’s (32) study. Since a major part of the negative emotions that people experience results from obsessive rumination developed in their mind following negative experiences, it can be said that the mindfulness component decreases the negative emotions (maladjustment) by reducing the divorced women’s obsessive rumination. Consequently, group ACT increases adjustment, happiness, and hopefulness, and decreases depression and the feeling of being lonely in the divorced women in the experimental group compared to the control group. The effectiveness of ACT in reducing symptoms of mood disorders and increasing adjustment probably result from the familiarization of the divorced women with their healthy way of thinking and healthy emotions (32, 33). Divorced women, especially in Iranian society, generally face significant problems and challenges in organizing emotional and social problem-solving activities due to the pressures resulting from the attitude of the society and also the attitude of the people around them on the one hand and the problems caused by the divorce process and disintegration of marriage on the other hand. Therefore, ACT can help people adjust to each other better while providing a more comprehensive viewpoint on problems.
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