مقایسه اثر‌بخشی شناخت درمانی مبتنی بر ذهن‌آگاهی و معنویت‌درمانی بر احساس تنهایی سالمندان

 
 Choosing appropriate treatment methods that help to solve the problems of older adults will be a great help for human societies. Feelings of loneliness (FOL) is one of the important problems of older adults that affects the health, well-being and longevity of them, and any effort to solve it seems necessary. Therefore, this study was conducted with the aim of comparing the effectiveness of mindfulness-based cognitive therapy (MBCT) and spirituality therapy on FOL in older adults. This was a quasi-experimental study with pretest-posttest-follow-up design with a control group. The statistical population of the research was made up of older adults who were member of neighborhood community centers in Tehran in 2022. The sample of the research consisted of included 54 older people aged 60-75 years, selected using convenience sampling method and according to inclusion and exclusion criteria, and randomly assigned into two experimental groups with 17 members each (MBCT and spiritual therapy) and a control group with 20 members. The measure was Russell et al.’s Loneliness Questionnaire. One of the experimental groups underwent eight 90-minute sessions of MBCT based on the guidelines of Tizdel et al. and the other experimental group received ten sessions of spiritual therapy based on the instructions of Waziri et al. The data were analyzed using analysis of covariance (ANCOVA) in SPSS-24. The results indicated that both MBCT and spirituality therapy groups significantly reduced FOL compared to the control group in both the post-test and follow-up phases (P<.01). However, there was no significant difference between the two therapeutic methods in both the post-test and follow-up phases in reducing FOL (P>.05). Based on the findings of this research, it is suggested to use MBCT and spiritual therapy as therapeutic methods to help reduce FOL in older adults.
 
 EXTENDED ABSTRACT
   Introduction
 studies have indicated that feelings of loneliness (FOL) exerts undesirable effects on the mental, social and physical health as well as cognitive function of the older adults. Accordingly, any effort aimed at alleviating feelings loneliness in older adults will contribute to enhancing their overall health. To date, the effectiveness of certain therapeutic approaches such as logotherapy and existential therapy on diminishing FOL of older adults has been somewhat limitedly investigated. Familiarity with the concept of FOL and a study of theoretical concepts and research backgrounds related to two therapeutic approaches of mindfulness-based cognitive therapy (MBCT) and spirituality therapy provide prospects suggesting that these two therapeutic methods might also be effective in addressing FOL in older adults. However, although research has been conducted on the effectiveness of these two therapeutic methods on alleviating FOL, most of these studies have been related to age groups other than older people. The number of studies conducted regarding the effectiveness of these therapeutic approaches on addressing FOL in older adults is by no means sufficient. Therefore, considering the existing gaps in the research literature in this field of inquiry, the present study aimed to compare the effectiveness of MBCT and spirituality therapy on reducing FOL in older adults.
 Method
 The current study, in terms of its objective was practical and in terms of its method was quasi-experimental, utilizing a pretest-posttest-follow-up design with a control group. The research population consisted of older adults who were members of neighborhood community centers of Tehran, Iran. The sample comprised 54 participants (17 in the MBCT group, 17 in the spirituality therapy group, and 20 in the control group). Inclusion criteria were (1) age between 60 and 75 years, and (2) a minimum education level of ninth grade. Exclusion criteria were (1) participation in any educational or psychological treatment programs in the last three months, and (2) diagnosis of neurological-cognitive disorders, Alzheimer’s disease, mental disorders, substance abuse, or alcoholism as diagnosed by physician of neighborhood community center. The measure employed in the current study was the Russell’s Loneliness Scale. All participants filled out the loneliness questionnaire, and those scoring higher than other participants were selected and randomly assigned into two experimental groups and one control group. Utilized during group therapy were Tizdel et al.’s MBCT protocol and Vaziri et al.’s spirituality therapy Protocol. The post-test was conducted a week after the intervention, followed by a three-month follow-up. The gathered data were analyzed using analysis of covariance (ANCOVA) and Bonferroni’s post hoc test in SPSS-24 software.
 Results
 The normality of the distribution of FOL and the equality of error variances for FOL were tested and confirmed through Shapiro-Wilk’s and Levene’s tests, respectively. Moreover, the establishment of correlation between pre-test and post-test of the dependent variable, and the homogeneity of regression slopes for FOL were ere tested and confirmed.
The results of the ANCOVA can be observed in Table 1. Results of the covariance analysis revealed significant differences between groups in the post-test and follow-up phases, indicating that there is significance difference between at least two groups. The Bonferroni follow-up test indicated that both MBCT and spirituality therapy groups significantly reduced FOL compared to the control group in both the post-test and follow-up phases at the significance level of P<0.01. Additionally, there was no significant difference between the MBCT and spirituality therapy groups in both the post-test and follow-up phases in reducing FOL (p>.05). Therefore, both interventions effectively reduced FOL among older adults, with no significant difference between their effectiveness.
Conclusion
 MBCT aids in improving interpersonal relationships by reinforcing non-judgmental perspectives, enhancing acceptance, reducing rumination, and fostering cognitive distancing, which in turn, leads to decrease of FOL. Furthermore, by teaching and practicing attention control toward present experiences and reinforcing beginner’s mind, this therapeutic method evokes sense of novelty, attractiveness, and excitement toward all entities, such as objects, plants, animals, or humans in a way as if they are inviting old adults for social interaction, which consequently diminishes FOL.
Spirituality therapy helps individuals perceive themselves as part of a larger whole. A sense of belonging to this larger whole, whether that larger whole is God, nature, the universe, or humanity, can alleviate    feelings     of      loneliness.    The concept of reliance, by strengthening the belief that the gracious God is close and attentive and will not abandon them, prevents FOL in individuals. Besides, spirituality therapy improves interpersonal relationships and ultimately reducing an individual’s FOL through practical training and assistance for forgiving others, strengthening patience and forbearance, continence, and spiritual self-control, encouraging kindness and affectionate behavior toward others, considering others as siblings, distancing from self-centeredness, and promoting participation in collective spiritual ceremonies such as prayers, meditation, and group gratitude sessions.
 Ethical Considerations
 This research was approved under the ethics identification at Islamic Azad University IR.IAU.CTB.REC.1401.148, Tehran Central Branch, and has been registered on the National Ethics System for Biomedical Research.
 Financial Support
  This study had no financial support.
 Authors’ Contributions
 N.H: Methodology, investigation, software, validation, formal analysis, data curation, writing original draft; P.gh: Project administration, writing-review & editing; Z.S.A: Project administration, writing-review & editing
 Conflict of Interest
 The authors of this study declare no conflicts of interest.
 Acknowledgments
 The researchers express their utmost gratitude to the esteemed officials at the Shahara and Satarkhan neighborhood community centers for their collaboration and support in coordinating and executing this project. They also extend their heartfelt thanks to the dear older adults who participated in this project.
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