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Moradi, F., Ghadiri-Anari, A., Dehghani, A., Reza Vaziri, S., & Enjezab, B. (2020). The effectiveness of counseling based on acceptance and commitment therapy on body image and self-esteem in polycystic ovary syndrome: An RCT. International Journal of Reproductive BioMedicine (IJRM), 13(4), 243–252. https://doi.org/10.18502/ijrm.v13i4.6887
https://doi.org/10.18502/ijrm.v13i4.6887
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- Cited by 6 articles
authors
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Fatemeh Moradi
Fatemeh Moradi
Student Research Committee, Faculty of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Akram Ghadiri-Anari
Akram Ghadiri-Anari
Department of Internal Medicine, Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Ali Dehghani
Ali Dehghani
Department of Biostatistics and Epidemiology, Public Health School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Seyed Reza Vaziri
Seyed Reza Vaziri
Clinical Psychologist, Private Counseling Center of Negaresh, Yazd, Iran
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Behnaz Enjezab
Behnaz Enjezab
Department of Midwifery, Research Center for Nursing and Midwifery Care, Faculty of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Published Date
- May 5, 2020
The effectiveness of counseling based on acceptance and commitment therapy on body image and self-esteem in polycystic ovary syndrome: An RCT
Abstract
Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders known with irregular menstruation, hirsutism, alopecia, obesity, infertility, and acne. These symptoms cause a negative effect on the satisfaction of body image, self-esteem, and quality of life in such patients. Recent studies emphasize the need to consider the psychological problems in these women and also the need for appropriate interventions.
Objective: The aim of this study was to determine the effectiveness of group counseling based on acceptance and commitment therapy (ACT) on body image and self-esteem in patients with PCOS.
Materials and Methods: In this randomized controlled trial, 52 women with PCOS were randomly allocated to intervention and control groups (n = 26/each) using the table of random numbers. Group counseling based on the ACT was held in eight sessions of 90 min once a week for the intervention group. The demographic questionnaire, Littleton development of the body image concern inventory and Rosenberg self-esteem scale were completed in both groups before, immediately after, and one month after the intervention.
Results: The mean scores of body image concern (p = 0.001) and self-esteem (p ≤ 0.001) in the intervention group after the intervention and follow-up were significantly different from the control group.
Conclusion: Based on the findings of this study, use of cognitive-behavioral therapies in health care centers is recommended as a complementary method.
Key words: Acceptance and commitment therapy, Body image, Self-esteem, Polycystic ovary syndrome, Cognitive behavior therapies.
References
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[2] Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol 2011; 9: 39.
[3] Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health 2015; 7: 745–763.
[4] Enjezab B, Eftekhar M, Ghadiri-Anari A. Association between severity of depression and clinicobiochemical markers of polycystic ovary syndrome. Electron Physician 2017; 9: 5820–5825.
[5] Ebrahimi F, Enjezab B. Quality of life, general health status and related factors in women of polycystic ovary syndrome in Yazd (Iran) 2014. Int J Med Res Health Sci 2016; 5:91–97.
[6] Mosalanejad L, Khodabakshi Koolaee A, Jamali S. Effect of cognitive behavioral therapy in mental health and hardiness of infertile women receiving assisted reproductive therapy (ART). Iran J Reprod BioMed 2012; 10: 483–488.
[7] Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Faghihzadeh S. Health-related quality of life and its relationship with clinical symptoms among Iranian patients with polycystic ovarian syndrome. Iran J Reprod Med 2013; 11: 371–378.
[8] Izydorczyk B, Sitnik-Warchulska K. Sociocultural appearance standards and risk factors for eating disorders in adolescents and women of various ages. Front Psychol 2018; 9: 429.
[9] Higgins S, Wysong A. Cosmetic surgery and body dysmorphic disorder-an update. Int J Womens Dermatol 2017; 4: 43–48.
[10] Koçan S, Gürsoy A. Body image of women with breast cancer after mastectomy: A qualitative research. J Breast Health 2016; 12: 145–150.
[11] Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome. Iran J Reprod Med 2013; 11: 829–836.
[12] Tracey D, Gray T, Truong S, Ward K. Combining acceptance and commitment therapy with adventure therapy to promote psychological wellbeing for children at-risk. Front Psychol 2018; 9: 1565.
[13] Abbasi M, Porzoor P, Moazedi K, Aslani T. [The effectiveness of acceptance and commitment therapy on improving body image of female students with bulimia nervosa]. Journal of Ardabil University of Medical Sciences 2015; 15: 15–24. (In Persian).
[14] Mortezaie Shemirani Sh, Hadi Najar Z, Pouyanfar A, Ghaedi F, Haji Rasoliha Z. Effectiveness of acceptance and commitment therapy on psychological outcomes and selfesteem of infertile women. Third International Conference on Recent Innovations in Psychology, Counseling and Behavioral Sciences, Iran, Tehran. Available from: https://www.civilica. com/Paper-PSYCHO03-PSYCHO03_227.html. (In Persian)
[15] Givehki R, Afshar H, Goli F, Scheidt CE, Omidi A, Davoudi M. Effect of acceptance and commitment therapy on body image flexibility and body awareness in patients with psychosomatic disorders: a randomized clinical trial. Electron Physician 2018; 10: 7008–7016.
[16] Hill ML, Masuda A, Melcher H, Morgan JR, Towhig MP. Acceptance and commitment therapy for women diagnosed with binge eating disorder: A case-series study. Cognitive and Behavioral Practice 2015; 22: 367–378.
[17] Rasooli Ali Abadi B, Kalantari M. [Based on acceptance and commitment therapy on depression, self-esteem and body image concerns, after the first birth, women in kashan city]. Avicenna J Nurs Midwif Care 2018; 26: 103–112 (In Persian).
[18] Fogelkvist M, Parling T, Kjellin L, Gustafsson SA. A qualitative analysis of participant’s reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy. J Eat Disorders 2016; 4: 29–37.
[19] Hinton MJ, Gaynor ST. Cognitive defusion for psychological distress, dysphoria, and low selfesteem: a randomized technique evaluation trial of vocalizing strategies. Int J Behavl Consult Ther 2010; 6: 164–185.
[20] Dewhurst E, Novakova B, Reuber M. A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy. Epilepsy Behav 2015; 46: 234–241.
[21] Saeidmanesh M, Babaie Z. The effectiveness of acceptance and commitment therapy (ACT) on anxiety and self-esteem in adolescents 14 to 16 years of stuttering. MEJDS 2017; 7: 56–61. (In Persian)
[22] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19–25.
[23] Littleton HL, Axsom D, Pury CL. Development of the body image concern inventory. Behav Res Ther 2005; 43: 229–241.
[24] Ghadakzadeh S, Ghazipour A, Khajeddin N, Karimian N, Borhani M. Body image concern inventory (BICI) for identifying patients with BDD seeking rhinoplasty: using a Persian (Farsi) version. Aesthetic Plast Surg 2011; 35: 989–994.
[25] Rosenberg M. Society and the adolescent selfimage. Princeton, NJ: Princeton University Press, 1965. 326.
[26] Joshanloo M, Ghaedi G. Reinvestigation of the reliability and validity of the Rosenberg self-esteem scale in Iran. CPAP 2008; 1: 49–56. (In Persian)
[27] Stefanaki C, Bacopoulou F, Livadas S, Kandaraki A, Karachalios A, Chrousos GP, et al. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress 2015; 18: 57–66.
[28] Correa JB, Sperry SL, Darkes J. A case report demonstrating the efficacy of a comprehensive cognitive-behavioral therapy approach for treating anxiety, depression, and problematic eating in polycystic ovarian syndrome. Arch Womens Ment Health 2015; 18: 649–654.
[29] Abdollahi L, Mirghafourvand M, Babapour Kheyradin J, Mohammadi M. The effect of cognitive behavioral therapy on depression and obesity in women with polycystic ovarian symptoms: a randomized controlled clinical trial. Iran Red Crescent Med J 2018; 20: e62735.
[30] Jiskoot G, Benneheij SH, Beerthuizen A, de Niet JE, de Klerk C, Timman R, et al. A threecomponent cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): a protocol for a randomized controlled trial. Reprod Health 2017; 14: 34.
[31] Cooney LG, Milman LW, Hantsoo L, Kornfield S, Sammel MD, Allison KC, et al. Cognitive-behavioral therapy improves weight loss and quality of life in women with polycystic ovary syndrome: a pilot randomized clinical trial. Fertil Steril 2018; 110: 161–171.
[2] Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol 2011; 9: 39.
[3] Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health 2015; 7: 745–763.
[4] Enjezab B, Eftekhar M, Ghadiri-Anari A. Association between severity of depression and clinicobiochemical markers of polycystic ovary syndrome. Electron Physician 2017; 9: 5820–5825.
[5] Ebrahimi F, Enjezab B. Quality of life, general health status and related factors in women of polycystic ovary syndrome in Yazd (Iran) 2014. Int J Med Res Health Sci 2016; 5:91–97.
[6] Mosalanejad L, Khodabakshi Koolaee A, Jamali S. Effect of cognitive behavioral therapy in mental health and hardiness of infertile women receiving assisted reproductive therapy (ART). Iran J Reprod BioMed 2012; 10: 483–488.
[7] Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Faghihzadeh S. Health-related quality of life and its relationship with clinical symptoms among Iranian patients with polycystic ovarian syndrome. Iran J Reprod Med 2013; 11: 371–378.
[8] Izydorczyk B, Sitnik-Warchulska K. Sociocultural appearance standards and risk factors for eating disorders in adolescents and women of various ages. Front Psychol 2018; 9: 429.
[9] Higgins S, Wysong A. Cosmetic surgery and body dysmorphic disorder-an update. Int J Womens Dermatol 2017; 4: 43–48.
[10] Koçan S, Gürsoy A. Body image of women with breast cancer after mastectomy: A qualitative research. J Breast Health 2016; 12: 145–150.
[11] Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome. Iran J Reprod Med 2013; 11: 829–836.
[12] Tracey D, Gray T, Truong S, Ward K. Combining acceptance and commitment therapy with adventure therapy to promote psychological wellbeing for children at-risk. Front Psychol 2018; 9: 1565.
[13] Abbasi M, Porzoor P, Moazedi K, Aslani T. [The effectiveness of acceptance and commitment therapy on improving body image of female students with bulimia nervosa]. Journal of Ardabil University of Medical Sciences 2015; 15: 15–24. (In Persian).
[14] Mortezaie Shemirani Sh, Hadi Najar Z, Pouyanfar A, Ghaedi F, Haji Rasoliha Z. Effectiveness of acceptance and commitment therapy on psychological outcomes and selfesteem of infertile women. Third International Conference on Recent Innovations in Psychology, Counseling and Behavioral Sciences, Iran, Tehran. Available from: https://www.civilica. com/Paper-PSYCHO03-PSYCHO03_227.html. (In Persian)
[15] Givehki R, Afshar H, Goli F, Scheidt CE, Omidi A, Davoudi M. Effect of acceptance and commitment therapy on body image flexibility and body awareness in patients with psychosomatic disorders: a randomized clinical trial. Electron Physician 2018; 10: 7008–7016.
[16] Hill ML, Masuda A, Melcher H, Morgan JR, Towhig MP. Acceptance and commitment therapy for women diagnosed with binge eating disorder: A case-series study. Cognitive and Behavioral Practice 2015; 22: 367–378.
[17] Rasooli Ali Abadi B, Kalantari M. [Based on acceptance and commitment therapy on depression, self-esteem and body image concerns, after the first birth, women in kashan city]. Avicenna J Nurs Midwif Care 2018; 26: 103–112 (In Persian).
[18] Fogelkvist M, Parling T, Kjellin L, Gustafsson SA. A qualitative analysis of participant’s reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy. J Eat Disorders 2016; 4: 29–37.
[19] Hinton MJ, Gaynor ST. Cognitive defusion for psychological distress, dysphoria, and low selfesteem: a randomized technique evaluation trial of vocalizing strategies. Int J Behavl Consult Ther 2010; 6: 164–185.
[20] Dewhurst E, Novakova B, Reuber M. A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy. Epilepsy Behav 2015; 46: 234–241.
[21] Saeidmanesh M, Babaie Z. The effectiveness of acceptance and commitment therapy (ACT) on anxiety and self-esteem in adolescents 14 to 16 years of stuttering. MEJDS 2017; 7: 56–61. (In Persian)
[22] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19–25.
[23] Littleton HL, Axsom D, Pury CL. Development of the body image concern inventory. Behav Res Ther 2005; 43: 229–241.
[24] Ghadakzadeh S, Ghazipour A, Khajeddin N, Karimian N, Borhani M. Body image concern inventory (BICI) for identifying patients with BDD seeking rhinoplasty: using a Persian (Farsi) version. Aesthetic Plast Surg 2011; 35: 989–994.
[25] Rosenberg M. Society and the adolescent selfimage. Princeton, NJ: Princeton University Press, 1965. 326.
[26] Joshanloo M, Ghaedi G. Reinvestigation of the reliability and validity of the Rosenberg self-esteem scale in Iran. CPAP 2008; 1: 49–56. (In Persian)
[27] Stefanaki C, Bacopoulou F, Livadas S, Kandaraki A, Karachalios A, Chrousos GP, et al. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress 2015; 18: 57–66.
[28] Correa JB, Sperry SL, Darkes J. A case report demonstrating the efficacy of a comprehensive cognitive-behavioral therapy approach for treating anxiety, depression, and problematic eating in polycystic ovarian syndrome. Arch Womens Ment Health 2015; 18: 649–654.
[29] Abdollahi L, Mirghafourvand M, Babapour Kheyradin J, Mohammadi M. The effect of cognitive behavioral therapy on depression and obesity in women with polycystic ovarian symptoms: a randomized controlled clinical trial. Iran Red Crescent Med J 2018; 20: e62735.
[30] Jiskoot G, Benneheij SH, Beerthuizen A, de Niet JE, de Klerk C, Timman R, et al. A threecomponent cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): a protocol for a randomized controlled trial. Reprod Health 2017; 14: 34.
[31] Cooney LG, Milman LW, Hantsoo L, Kornfield S, Sammel MD, Allison KC, et al. Cognitive-behavioral therapy improves weight loss and quality of life in women with polycystic ovary syndrome: a pilot randomized clinical trial. Fertil Steril 2018; 110: 161–171.