AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2637-8892/245
1 Islamic Azad University, Department of industrial and organizational Psychology, Arsenjan Branch. Shiraz, Iran.
2 Tehran University of Medical Sciences, Department of medicine, Tehran, Iran.
*Corresponding Author: Delaram Dehnashi, Islamic Azad University, Department of industrial and organizational Psychology, Arsenjan Branch. Shiraz, Iran.
Citation: Delaram Dehnashi., Nabi Fatahi, Davoud Keshavarzi. (2024), Mindfulness-based stress reduction (mbsr) training improves some dimensions of the quality of life in patients with multiple sclerosis, Psychology and Mental Health Care, 8(2): DOI:10.31579/2637-8892/245
Copyright: © 2024, Delaram Dehnashi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 23 January 2024 | Accepted: 30 January 2024 | Published: 07 February 2024
Keywords: mbsr; emotion; quality of life; multiple sclerosis
Multiple Sclerosis, an autoimmune disease, can significantly impact a person's daily functioning and overall well-being. Patients often experience emotional disorders and find it challenging to regulate their cognitive-emotional responses during the course of their illness. The objective of this current study was to evaluate the impact of MBSR training on quality of life of patients with Multiple Sclerosis (MS). The study consisted of 40 participants with multiple sclerosis, all of whom were enrolled in the MS Society of Shiraz in Fars Province, Iran. The participants were evenly divided into two groups: an experimental group of 20 individuals and a control group of 20 individuals. The experimental group underwent a series of eight MBSR training sessions, held once a week for 60 minutes over a period of 60 days. The control group did not receive any interventions. The findings of the present study demonstrate a notable disparity between the experimental and control groups in terms of quality of life, specifically in areas such as physical function, pain management, mental well-being, energy levels, health perception, and cognitive function in relation to health changes (P<0.05). However, while these differences were statistically significant, no significant differences were noted among the dimensions of role limitation caused by physical problems, mental challenges, and social functioning (P>0.05).The results of the present study showed that MBSR training improves some dimensions of the quality of life in patients with Multiple Sclerosis and reduced negative emotion regulation strategies.
Cognitive Emotion Regulation Questionnaire (CERQ)
The CERQ is a comprehensive survey designed to assess an individual's use of cognitive emotion regulation strategies, also known as cognitive coping strategies, following a negative experience or situation (Garnefski et al., 2001). In contrast to other coping questionnaires that do not explicitly distinguish between an individual's thoughts and behaviors, various versions of the CERQ have been developed for adults, adolescents, and children. The survey measures nine components: Self-blame, Blaming others, Acceptance, Refocusing on planning, Positive refocusing, Rumination, Positive reappraisal, Putting into perspective, and Catastrophizing. Participants respond using a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always). Based on a prior research, the questionnaire's reliability was established with a Cronbach's alpha coefficient of 0.87. The individual items in the questionnaire exhibited a range of 0.86 to 0.89 in terms of their reliability (Jermann,2006).
MS quality of life - MSQOL-54MSQOL-54 is a multidimensional, widely-used, health-related quality of life (HRQOL) measure that combines both generic and MS-specific items into a single instrument. This 54-item survey produces 12 subscales and two summary scores, as well as two single-item measures. The subscales include physical function, role limitations-physical, role limitations-emotional, pain, emotional well-being, energy, health perceptions, social function, cognitive function, health distress, overall quality of life, and sexual function (Vickrey et al, 1995). The summary scores consist of the physical health composite summary and the mental health composite summary, while the single item measures include satisfaction with sexual function and change in health. Furthermore, the 12 subscales of the MSQOL-54 demonstrate strong internal consistency, with Cronbach's alphas ranging from 0.74 to 0.95 (Vickrey et al, 1995).To conduct an analysis of the research data, the information gathered from the questionnaires was processed in SPSS26 software. This involved dividing the data into descriptive and inferential sections. The descriptive section involved calculating measures such as mean, standard deviation, skewness, and kurtosis for the variables. In addition, to test the hypotheses, the statistical method of analysis of covariance was utilized. The research hypotheses included the following: a) MBSR training has a significant impact on emotion regulation strategies b) MBSR training has a significant impact on life quality of patients.
Prior to testing the research hypotheses, an examination of the normal distribution of research variables was conducted using measures of skewness and kurtosis in order to contextualize the status of the studied groups. The results indicated that all variables fell within an acceptable range of +2 to -2, confirming that the distribution of research variables can be considered normal for this study. Hence, it is reasonable to assume that the lack of normality in the data has been accounted for in conducting covariance analysis. To assess the homogeneity of variances, the Levin test was employed (see Table 1). The data analysis for the variables of cognitive emotion regulation strategies, perceived stress, and dimensions of quality of life in patients with multiple sclerosis revealed a significant F statistic value above 0.05. This suggests that the error variance among the groups was equal and no significant differences were observed between them. Based on our analysis, we confirm that there is no significant difference in the homogeneity of variance among all variables in both the experimental and control groups. Therefore, we can conclude that the assumption of homogeneity of variance is valid. Furthermore, our examination using Box’s M test also indicates that there are equal variances across the groups (Box’s =16.86, P= 0.119).
Table 1: Levin test results to investigate homogeneity of variance.
findings from the covariance analysis on the impact of MBSR treatment on emotion regulation strategies are presented in Table 2. The findings presented in Table 2 indicate a significant contrast between the experimental and control groups in terms of self-blame, other-blame, acceptance, positive reappraisal, and reassess variables. However, there were no notable distinctions observed between the two groups in relation to the variables of mental rumination, adopt a perspective, catastrophic perception, and refocus on planning.
findings from the covariance analysis on the impact of MBSR treatment on emotion regulation strategies are presented in Table 2. The findings presented in Table 2 indicate a significant contrast between the experimental and control groups in terms of self-blame, other-blame, acceptance, positive reappraisal, and reassess variables. However, there were no notable distinctions observed between the two groups in relation to the variables of mental rumination, adopt a perspective, catastrophic perception, and refocus on planning.findings from the covariance analysis on the impact of MBSR treatment on emotion regulation strategies are presented in Table 2. The findings presented in Table 2 indicate a significant contrast between the experimental and control groups in terms of self-blame, other-blame, acceptance, positive reappraisal, and reassess variables. However, there were no notable distinctions observed between the two groups in relation to the variables of mental rumination, adopt a perspective, catastrophic perception, and refocus on planning.
| Eta coefficient | P value | Fstatic | df | Total squares | Variable |
| 0.345 | 0.001 | 21.44 | 1 | 549.22 | Self-blame |
| 0.298 | 0.001 | 18.80 | 1 | 457.43 | Other-blame |
| 0.021 | 0.511 | 1.81 | 1 | 122.17 | Mental rumination |
| 0.035 | 0.653 | 1.09 | 1 | 99.35 | Catastrophic perception |
| 0.35 | 0.005 | 26.65 | 1 | 673.11 | Acceptance |
| 0.06 | 0.463 | 1.90 | 1 | 143.61 | refocus on planning |
| 0.44 | 0.001 | 31.42 | 1 | 873.30 | positive reappraisal |
| 0.37 | 0.001 | 27.24 | 1 | 672.39 | Reassess |
| 0.02 | 0.725 | 1.00 | 1 | 87.61 | Adopt a perspective |
findings from the covariance analysis on the impact of MBSR treatment on emotion regulation strategies are presented in Table 2. The findings presented in Table 2 indicate a significant contrast between the experimental and control groups in terms of self-blame, other-blame, acceptance, positive reappraisal, and reassess variables. However, there were no notable distinctions observed between the two groups in relation to the variables of mental rumination, adopt a perspective, catastrophic perception, and refocus on planning.
| Eta coefficient | P value | Fstatic | df | Total squares | Variable |
| 0.345 | 0.001 | 21.44 | 1 | 549.22 | Self-blame |
| 0.298 | 0.001 | 18.80 | 1 | 457.43 | Other-blame |
| 0.021 | 0.511 | 1.81 | 1 | 122.17 | Mental rumination |
| 0.035 | 0.653 | 1.09 | 1 | 99.35 | Catastrophic perception |
| 0.35 | 0.005 | 26.65 | 1 | 673.11 | Acceptance |
| 0.06 | 0.463 | 1.90 | 1 | 143.61 | refocus on planning |
| 0.44 | 0.001 | 31.42 | 1 | 873.30 | positive reappraisal |
| 0.37 | 0.001 | 27.24 | 1 | 672.39 | Reassess |
| 0.02 | 0.725 | 1.00 | 1 | 87.61 | Adopt a perspective |
Table 2: Results of covariance analysis for the effect of MBSR treatment on emotion regulation strategies
Results of covariance analysis for the effect of MBSR treatment on perceived stress showed in Table 3. The test results in Table 3 show that after adjusting the effects of the pretest, the value of F for the group became significant (F = 32.078), (P <0>
| Eta coefficient | P value | F static | df | Total squares | Variable |
| 0.18 | 0.02 | 6.03 | 1 | 49.62 | Pre-test |
| 0.54 | 0.000 | 32.03 | 1 | 263.70 | Group |
| - | - | - | 27 | 222.97 | Error |
Table 3: Results of covariance analysis for the effect of MBSR treatment on perceived stress.
The findings of the covariance analysis on the impact of MBSR treatment on quality of life dimensions are presented in Table 4. The results demonstrate a significant difference between the experimental and control groups for various variables related to quality of life, including physical function, pain, mental well-being, energy level, health perception, cognitive function related to health changes, and overall quality of life. However, there was not a significant difference observed between the dimensions of role limitation due to physical problems and social function was not revealed. This finding indicates the effectiveness of mindfulness-based stress reduction therapy on increasing the variables of quality of life in patients with multiple sclerosis.
| Eta coefficient | P value | F static |
df | Total squares | Variable |
| 0.26 | 0.005 | 9.520 | 1 | 231.25 | Physical function |
| 0.06 | 0.241 | 1.174 | 1 | 417.69 | Role limitation due to physical problems |
| 0.05 | 0.764 | 1.729 | 1 | 652.87 | Role limitation due to mental problems |
| 0.26 | 0.065 | 9.438 | 1 | 942.14 | Pain |
| 0.29 | 0.005 | 11.651 | 1 | 763.12 | Psychological well-being |
| 0.19 | 0.026 | 6.639 | 1 | 743.65 | Energy |
| 0.24 | 0.017 | 8.420 | 1 | 851.32 | Understanding health |
| 0.07 | 0.006 | 2.240 | 1 | 142.34 | Social Performance |
| 0.44 | 0.123 | 21.611 | 1 | 2098.31 | Cognitive function |
| 0.47 | 0.001 | 23.171 | 1 | 4473.21 | Health changes |
| 0.09 | 0.001 | 2.168 | 1 | 144.62 | Health stress |
| 0.47 | 0.110 | 22.253 | 1 | 2178.29 | Sexual function |
| 0.56 | 0.001 | 24.622 | 1 | 4328.70 | Satisfaction with sexual function |
| 0.36 | 0.001 | 15.352 | 1 | 967.89 | Overall quality of life. |
Table 4: Results of covariance analysis for the effect of MBSR treatment on dimensions of quality of life.
The aim of this study was to evaluate the effectiveness of stress reduction therapy based on MBSR training on emotion regulation strategies, perceived stress and quality of life in patients with MS in Shiraz. The research hypotheses are examined below. Hypothese a) MBSR treatment has a significant impact on emotion regulation strategies
The results of covariance analysis for the effect of MBSR treatment on negative emotion regulation strategies showed that MBSR could have an increasing effect on positive emotion regulation strategies and also a reducing effect on negative emotion regulation strategies in patients with multiple sclerosis. Similar results have been reported in other studies (Malinowski, 2013; Kumar etal,2014). It has been reported that mindfulness training leads to increased metacognitive awareness and reduced rumination, stress, dysfunctional skills and negative thoughts (Wells , 2013; Anvari, 217). According to a previuos study in Iran, the MBSR program has continuous significant effects on emotion regulation (P < 000>
frequency of negative automatic thoughts and an increase in the ability to drive out those thoughts and ultimately psychological well-being. Observing, describing, action with awareness, and nonjudgmental acceptance are components that highly correlated to mindfulness skills (Dekeyser,2008).
Hypothese b) MBSR treatment has a significant impact on perceived stress.
About the effect of MBSR treatment on perceived stress, the results of this study showed that the perceived stress score of the MBSR-experimental group was significantly lower than that of the control group. Therefore, MBSR training has been able to reduce perceived stress in patients with MS. Consistent with the study results, a significant positive association between MBSR training and stress reduction reported (Venkatesan etal, 2021; Chen etal 2021). In MBSR, people learn to develop acceptance and compassion rather than judging their experience; and create momentary awareness instead of automatic guidance. These abilities contribute to increased psychological flexibility and reduced in depressive symptoms and perceived stress (Janusek,2019).
Hypothese c) MBSR treatment has a significant impact on life quality of patients.
About the effect of MBSR treatment on quality of life of patients with multiple sclerosis, our results revealed that increases the overall quality of life in these patients. However, in some subscales, no significant relationship was observed between this treatment and those subscales (role limitation due to physical, mental, and social functioning problems). The results of Ghazagh study showed that MBSR treatment is effective in reducing fatigue and increasing some of the subscales including; physical functioning, role in relation to physical and mental energy, mental well-being, health threats, and satisfaction with sexual function (P<0>
Finally, it can be concluded that MBSR therapy increases positive emotion regulation strategies and quality of life dimensions (physical function, pain, mental well-being, energy, health perception, cognitive function, health changes, health stress, function sexual satisfaction and sexual quality and overall quality of life) and reduces negative emotion regulation strategies and perceived stress.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
