Acceptance and commitment: An intervention for improving family function and emotional problems in informal caregivers of people with severe traumatic brain injury: A randomized clinical trial

Document Type : Original Article

Authors

1 Department of Clinical Psychology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran

2 Department of Biostatistics and Epidemiology, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran

3 Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

10.4103/atr.atr_4_22

Abstract

Background and Objectives: Traumatic brain injury (TBI) is one of the main causes of disability. Since individuals with TBI experience many problems in their daily life, they must be highly supported. Regarding the nature of their problems, their caregivers suffer from many psychological problems. The current study aimed to investigate the effect of group acceptance and commitment therapy (ACT) on the family function, experiential avoidance, and anxiety of the TBI patients' caregivers. Methods: The current study was a randomized clinical trial with waiting list and intervention groups. Forty caregivers of TBI patients who referred to Kashan's Shahid Beheshti Hospital, Iran, since 2017 until 2019 were randomly assigned to the experimental (n = 20) and the waiting list control (n = 20) groups. Both the groups completed a demographic information questionnaire, the Family Assessment Device, the Experiential Avoidance in Caregiving Questionnaire, and the anxiety subscale of the Depression, Anxiety, and Stress Scale in pretest, posttest, 3-month follow-up, and 6-month follow-up. Results: The results of repeated measures analysis of variance showed that ACT program can significantly decrease the anxiety, experiential avoidance, and most of the dimensions of the family functions (P < 0.005). Conclusion: ACT could be utilized to improve the family functions and reduce the experiential avoidance and the anxiety of the TBI patients' caregivers. This trial is registered with the Registry of Clinical Trials: “IRCT20190704044100N1.”

Keywords

References

1.
Hampton T. Traumatic brain injury a growing problem among troops serving in today's wars. JAMA 2011;306:477-9.  Back to cited text no. 1
    
2.
Hassan ST, Khaw WF, Rosna AR, Husna J. Traumatic brain injury: Caregivers' problems and needs. JNMA J Nepal Med Assoc 2011;51:53-5.  Back to cited text no. 2
    
3.
Ebrahimi FH, Moshiri E, Zand S. An investigation on quality of emergency care of head injury patients in emergency ward, Vali-e-Asr Hospital, Arak 2005. J Arak University of Med Sci Winter 2017;10:1-11.  Back to cited text no. 3
    
4.
Masel BE, DeWitt DS. Traumatic brain injury: A disease process, not an event. J Neurotrauma 2010;27:1529-40.  Back to cited text no. 4
    
5.
Roick C, Heider D, Toumi M, Angermeyer MC. The impact of caregivers' characteristics, patients' conditions and regional differences on family burden in schizophrenia: A longitudinal analysis. Acta Psychiatr Scand 2006;114:363-74.  Back to cited text no. 5
    
6.
Cole WR, Paulos SK, Cole CA, Tankard C. A review of family intervention guidelines for pediatric acquired brain injuries. Dev Disabil Res Rev 2009;15:159-66.  Back to cited text no. 6
    
7.
Ahmadiye A. Al davoud SA. Family Participation in Treatment and Rehabilitation of Chronic Mental Patients Iran, Tehran. Pardis: ISBN 9789647403306; 2008.  Back to cited text no. 7
    
8.
Semenova V, Stadtlander L. Death anxiety, depression, and coping in family caregivers. J Soc Behav Health Sci 2016;10:5.  Back to cited text no. 8
    
9.
Goldstein TR, Miklowitz DJ, Richards JA. Expressed emotion attitudes and individual psychopathology among the relatives of bipolar patients. Fam Process 2002;41:645-57.  Back to cited text no. 9
    
10.
Kia S, ZarehHarafte Z. The effectiveness of stress management training on cognitive-behavioral disorders and quality of life for female heads of households. Sociol Educ J 2018;8:94-110.  Back to cited text no. 10
    
11.
Sheikholeslami F, Khalatbary J, Ghorbanshiroudi S. Effectiveness of stress coping skills trainingwith psycho-educational approach among caregivers' of schizophrenic patients on family function and psychological wellbeing. J Holist Nurs Midwifery 2015;26:46-54.  Back to cited text no. 11
    
12.
Elvira de la Morena MJ, Cruzado JA. Caregivers of patients with disorders of consciousness: Coping and prolonged grief. Acta Neurol Scand 2013;127:413-8.  Back to cited text no. 12
    
13.
Zimmermann P, Iwanski A. Emotion regulation from early adolescence to emerging adulthood and middle adulthood: Age differences, gender differences, and emotion-specific developmental variations. Int J Behav Dev 2014;38:182-94.  Back to cited text no. 13
    
14.
Sheppes G, Levin Z. Emotion regulation choice: Selecting between cognitive regulation strategies to control emotion. Front Hum Neurosci 2013;7:179.  Back to cited text no. 14
    
15.
Hayes S, Strosahl K, Wilson K. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press; 1999.  Back to cited text no. 15
    
16.
Lee JK, Orsillo SM, Roemer L, Allen LB. Distress and avoidance in generalized anxiety disorder: Exploring the relationships with intolerance of uncertainty and worry. Cogn Behav Ther 2010;39:126-36.  Back to cited text no. 16
    
17.
Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol 1996;64:1152-68.  Back to cited text no. 17
    
18.
Sheppes G, Scheibe S, Suri G, Radu P, Blechert J, Gross JJ. Emotion regulation choice: A conceptual framework and supporting evidence. J Exp Psychol Gen 2014;143:163-81.  Back to cited text no. 18
    
19.
Sousa RM. Traumatic brain injury-Theoretical Foundations of Nursing Interventions. Neuroscience Nursing: Essentials for clinical practice. Atheneu: São Paulo. 2006. p. 209-31.  Back to cited text no. 19
    
20.
Magliano L, Fadden G, Economou M, Held T, Xavier M, Guarneri M, et al. Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 2000;35:109-15.  Back to cited text no. 20
    
21.
Riebschleger J, Scheid J, Luz C, Mickus M, Liszewski C, Eaton M. How are the experiences and needs of families of individuals with mental illness reflected in medical education guidelines? Acad Psychiatry 2008;32:119-26.  Back to cited text no. 21
    
22.
Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy. American Psychological Association Washington: DC; 2009.  Back to cited text no. 22
    
23.
Coyne LW, McHugh L, Martinez ER. Acceptance and commitment therapy (ACT): Advances and applications with children, adolescents, and families. Child Adolesc Psychiatr Clin N Am 2011;20:379-99.  Back to cited text no. 23
    
24.
Hayes SC, Strosahl KD. A Practical Guide to Acceptance and Commitment Therapy. New York: Springer Science+ Business Media; 2005.  Back to cited text no. 24
    
25.
Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy: The Process and Practice of Mindful. New York: Guilford Press; 2011.  Back to cited text no. 25
    
26.
Blackledge JT, Hayes SC. Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child Fam Behav Ther 2006;28:1-18.  Back to cited text no. 26
    
27.
Zettle RD. Acceptance and commitment therapy (ACT) versus. Systematic desensitization in treatment of mathematics anxiety. Psychol Rec 2003;53:197-215.  Back to cited text no. 27
    
28.
Moghbel Esfahani S, Haghayegh SA. The effectiveness of acceptance and commitment therapy on resilience, meaning in life, and family function in family caregivers of patients with schizophrenia. Horiz Med Sci 2019;25:298-311.  Back to cited text no. 28
    
29.
Feeney J. Physical Disability and Psychological Distress in Multiple Sclerosis: The Role of Illness Representations and Experiential Avoidance. Cardiff, Wales: Cardiff University; 2012.  Back to cited text no. 29
    
30.
Michielin P, Cenedese C, Cristofoli M, Zaros N. Usefulness and effectiveness of group cognitive-behavioral psychotherapy and mutual support group therapy for depressed caregivers of psychiatric patients. G Ital Med Lav Ergon 2007;29:B18-25.  Back to cited text no. 30
    
31.
Harris R. ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy. Oakland, California: New Harbinger Publications; 2019.  Back to cited text no. 31
    
32.
Brown TA, Barlow DH, DiNardo PA. Anxiety Disorders Interview Schedule Adult Version: Client Interview Schedule. New York: Graywind Publications Incorporated; 1994.  Back to cited text no. 32
    
33.
Amini H , Sharifi V, Asaadi S.M, Mohammadi M.R, Kaviani H, Semnani, et al. Validity of the Iranian version of the structured clinical interview for DSM-IV [SCID-I. the diagnosis of psychiatric disorders]. Payesh-Health Monitor 2008;7:49-57.  Back to cited text no. 33
    
34.
Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 1995;33:335-43.  Back to cited text no. 34
    
35.
Sahebi A, Asghari MJ, and Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. J of Iranian Psychologists 2005;1.4:36-54.  Back to cited text no. 35
    
36.
Epstein NB, Baldwin LM, Bishop DS. The McMaster family assessment device. J Marital Fam Ther 1983;9:171-80.  Back to cited text no. 36
    
37.
Zarei H, Younesi J. The effectiveness of cognitive techniques on improvement of family function in mal adjusted couples. J Daneshvar Raftar 2009;29:35-52.  Back to cited text no. 37
    
38.
Kabacoff RI, Miller IW, Bishop DS, Epstein NB, Keitner GI. A psychometric study of the McMaster family assessment device in psychiatric, medical, and nonclinical samples. J Fam Psychol 1990;3:431.  Back to cited text no. 38
    
39.
Losada A, Márquez-González M, Romero-Moreno R, López J. Development and validation of the experiential avoidance in caregiving questionnaire (EACQ). Aging Ment Health 2014;18:897-904.  Back to cited text no. 39
    
40.
Jansen JE, Morris EM. Acceptance and commitment therapy for posttraumatic stress disorder in early psychosis: A case series. Cogn Behav Pract 2017;24:187-99.  Back to cited text no. 40
    
41.
Hayes SC, Masuda A, Bissett R, Luoma J, Guerrero LF. DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behav Ther 2004;35:35-54.  Back to cited text no. 41
    
42.
Twohig MP. Acceptance and Commitment Therapy: Introduction. Amsterdam: Elsevier; 2012.  Back to cited text no. 42
    
43.
Harris R. Embracing your demons: An overview of acceptance and commitment therapy. Psychother Aust. 2006;12:70-6.  Back to cited text no. 43
    
44.
Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther 2006;44:1-25.  Back to cited text no. 44
    
45.
Zamani E, Moatamedy A, Bakhtiari M. The effectiveness of acceptance and commitment group therapy on anxiety in multiple sclerosis. Q J Health Psychol 2017;5:152-67.  Back to cited text no. 45
Archives of Trauma Research
Volume 11, Issue 2
June 2022
Pages 90-96

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  • Receive Date: 18 June 2023
  • Accept Date: 18 June 2023

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