The Effectiveness of Acceptance and Commitment Therapy on the Reduction of Perceived Stress in the Elderly Afflicted by Chronic Pain

Document Type : Original Article

Authors

1 Department of Counseling and Psychology, Faculty of Literature and Human Science, Islamic Azad University, Quchan,iran

2 Department of Counseling and Psychology, Faculty of Literature and Human Science, Islamic Azad University, Quchan, iran

Abstract

Chronic pain seems to be one of the chronic diseases associated with the elderly which causes stress in the elderly. Researchers are looking to treat this stress through non-pharmacological methods. Therefore, the present research­ aimed to determine the effectiveness of acceptance and commitment therapy on the reduction of perceived stress in the elderly afflicted with chronic pain. This research was a quasi-experimental study with a pretest-posttest and control group design. The statistical population included all the elderly with chronic pain living in Mashhad during 2017. For this aim, 24 of the elderly were chosen through a convenience sampling method along with inclusion criteria and placed randomly into two groups of experimental and control (with 12 members). Research tools consisted of the Cohen Perceived Stress Scale and the McGill Pain Questionnaire. Acceptance and commitment therapy was administered to the experiment group in eight 90-minute sessions, while the control grope received no intervention at the same time. Research data were analyzed using the univariate analysis of covariance (ANCOVA). Results indicated the reduction of scores of perceived stress in the experimental group in comparison to that of the control group (P<0.05). Thus, acceptance and commitment therapy appears to be effective in the reduction of perceived stress in the elderly afflicted with chronic pain. The findings demonstrate the necessity of using acceptance and commitment therapy to reduce perceived stress in the elderly. Therefore, acceptance and commitment therapy is suggested to be used to provide psychological services for the elderly.

Keywords


استودارد، جی.، آفری، ن. (1396). کتاب بزرگ استعاره‌های اکت (ترجمه ر. حسن­زاده، م. جویباری، گ. مهدی­نژاد، س. محرابی) تهران، ویرایش. (تاریخ انتشار به زبان اصلی، 2014)
سازمان بهداشت جهانی. (1393). بهداشت جهانی و سالمندان (ترجمه ف. اکبری، ک. مهری، م .حسن­زاده). تهران، بعثت. (تاریخ انتشار به زبان اصلی، 2014)
میلر، ر.، استولتینگ، ر. (1390). اصول بیهوشی میلر (ترجمه ا. مرادی مقدم). تهران، اندیشه رفیع. (تاریخ انتشار به زبان اصلی،2010)
معروفی­زاده، س.، زارعیان، آ.، و سیگاری، ن. (1393). خصوصیات روان سنجی نسخه‌های 14، 10 و 4 عبارتی «مقیاس تنش ادراک‌شده» در بیماران مبتلا به آسم. مجله پایش، 13(4)، 465-457.
American Psychological Association. (2017, January 3). Older AdultsHealth and age-related changes. Retrieved from http://www.apa.org/pi/aging/resources/guides/older.aspx
Centers for Disease Control and Prevention. (2005). Morbidity mortality weekly reporthomicides and suicides, national violent death reporting system.
Cohen, S., Tyrrell, D. A., & Smith, A. P. (1993). Negative life events, perceived stress, negative affect, and susceptibility to the common cold. Journal of Personality and Social Psychology, 64(1), 131-140.
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta‐analysis. World Psychiatry, 13(1), 56-67.
Dworkin, R. H., Turk, D. C., Revicki, D. A., Harding, G., Coyne, K. S., Peirce-Sandner, S., Farrar, J. T. (2009). Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2), 144(1-2), 35-42.
Freire de Araújo Patrício, A., Lopes Rodrigues, B., Ferreira, M., Gomes, R., de Brito, T., de Medeiros, A., Félix, I., & Santos, J. (2016). Application of Mental Health Scale and Perceived Stress in Elderly Assisted by Basic Health Units. International Archives of Medicine Section: Epidemiology, 9(44), 1-7.
Gilleard, C. (2018). Suffering: The darker side of ageing. Journal of Aging Studies, 44, 28-33.
Hayes, s. (2017, February 6). About ACT, Association for Contextual Behavioral Science. Retrieved from https://contextualscience.org/act
Hayes, S. C. (2016). Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavioral and Cognitive Therapies–Republished Article. Behavior therapy, 47(6), 869-885.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: an experimental approach to behavior change(pp.151-175), New York: Guilford Press.
Maroufizadeh, S., Zareiyan, A., & Sigari, N. (2014). Psychometric properties of the 14, 10 and 4-item “Perceived Stress Scale” among asthmatic patients in Iran. Payesh Health Manitor journal of Iranian Institude for Health Sciences Reaserches, 13(4), 457- 465. [Persian]
Melzack, R. (1975). The McGill Pain Questionnaire: major properties and scoring methods. Pain, 1(3), 277-299.
Merskey, H., & Bogduk, N. (1994). Classification of chronic pain, IASP Task Force on Taxonomy. Seattle, WA: International Association for the Study of Pain Press (Also available online at www. iasp-painorg).
Miler, R., & Stoleting, R. (2010). Basics of anesthesia (5th ed.). (Translated by A, Moradi Moghadam). Tehran: Rafihe. (Published in the original language, 2010) [Persian]
Murphy, N., Karlin-Zysman, C., & Anandan, S. (2018). Management of Chronic Pain in the Elderly: A Review of Current and Upcoming Novel Therapeutics. American Journal of Therapeutics, 25(1), 36-43.
Orimo, H., Ito, H., Suzuki, T., Araki, A., Hosoi, T., & Sawabe, M. (2006). Reviewing the definition of “elderly”. Geriatrics & gerontology international, 6(3), 149-158.
Osmanovic-Thunström, A., Mossello, E., Åkerstedt, T., Fratiglioni, L., & Wang, H. X. (2015). Do levels of perceived stress increase with increasing age after age 65? A population-based study. Age and ageing, 44(5), 828-834.
Phillips, A. C. (2013). Perceived stress. In Encyclopedia of Behavioral Medicine (pp. 1453-1454). New York: Springer.
Pielech, M., Vowles, K. E., & Wicksell, R. (2017). Acceptance and Commitment Therapy for Pediatric Chronic Pain: Theory and Application. Children (Basel, Switzerland), 4(2), 10.
 Rassu, F., Linsenbardt, H., Hahn, H., & Meagher, M. (2018). Chronic perceived stress heightens laboratory pain in healthy young adults. The Journal of Pain, 19(3), S13.
Roberts, S. L., & Sedley, B. (2016). Acceptance and Commitment Therapy with Older Adults: Rationale and Case Study of an 89-Year-Old with Depression and Generalized Anxiety Disorder. Clinical Case Studies, 15(1), 53-67.
Rochon, P. A. (2013). Drug prescribing for older adults. Sokol. Retrieved from http://www. uptodate. com/contents/drug-prescribing-for-olderadults.
Rodriguez, M. A., Xu, W., Wang, X., & Liu, X. (2015). Self-acceptance mediates the relationship between mindfulness and perceived stress. Psychological reports, 116(2), 513-522.
Rönnlund, M., Åström, E., Adolfsson, R., & Carelli, M. G. (2018). Perceived Stress in Adults Aged 65 to 90: Relations to Facets of Time Perspective and COMT Val158Met Polymorphism. Frontiers in psychology, 9, (378), 1-10. doi:10.3389/fpsyg.2018.00378
Santos, K. A. D. S., Cendoroglo, M. S., & Santos, F. C. (2017). Anxiety disorder in elderly persons with chronic pain: frequency and associations. Revista Brasileira de Geriatria e Gerontologia, 20(1), 91-98.
Scott, W., Daly, A., Yu, L., & McCracken, L. M. (2017). Treatment of chronic pain for adults 65 and over: Analyses of outcomes and changes in psychological flexibility following interdisciplinary acceptance and commitment therapy (ACT). Pain Medicine, 18(2), 252-264.
Simon, L. S. (2012). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Journal of pain & palliative care pharmacotherapy, 26(2), 197-198.
Stoddard, J. A., & Afari, N. (2014). The Big Book of ACT Metaphors: a practitioner's guide to experiential exercises and metaphors in Acceptance and Commitment Therapy. (Translated by H, Hassan zadeh., M, Juybari., G, Mehdinezhad., & S, Mehrabi). Tehran: Virayesh. (Published in the original language, 2017) [Persian]
 US Food and Drug Administration. (2017, January 26). Learning about Side Effects, Unwanted or Unexpected Drug Reactions. Retrieved from https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm196029.htm
Vowles, K. E., & Sorrell, J. T. (2007). Life with chronic pain: An acceptance-based approach (therapist guide and patient workbook). Unpublished manuscript.
Wersebe, H., Lieb, R., Meyer, A. H., Hofer, P., & Gloster, A. T. (2018). The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. International Journal of Clinical and Health Psychology, 18(1), 60-68.
White, R. S., Jiang, J., Hall, C. B., Katz, M. J., Zimmerman, M. E., Sliwinski, M., & Lipton, R. B. (2014). Higher Perceived Stress Scale scores are associated with higher pain intensity and pain interference levels in older adults. Journal of the American Geriatrics Society, 62(12), 2350-2356.
World Health Organization. (2014). Global Health and Aging, Orange Country Master