Efficacy of Mindfulness-Based Cognitive Therapy on Cognitive Fusion and Alexithymia in Students with Signs of Psychosomatic Disorders

Aghaei, Maryam; Ebrahimi, Amrollah; Ansari Shahidi, Mojtaba

doi:10.22055/psy.2023.41106.2870

Document Type : Research Article

Authors

¹ PhD Student, Department of Health Psychology, School of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran

² Associate Professor, Behavioral Sciences Research Center, Department of Health Psychology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

³ Assistant Professor, Department of Psychology, School of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran

10.22055/psy.2023.41106.2870

Abstract

Introduction
In the past decades, a group of diseases have been classified under the title of psychosomatic complaints and it has been reported that the diagnostic problems and their differentiation from other diseases have caused an increase in paraclinical and diagnostic costs in the patients of this group of patients. Psychosomatic diseases are a class of diseases in which a person suffers from physical and physical signs and symptoms that are caused by psychological factors or may be intensified under the influence of psychological characteristics and stressors. It seems that in addition to biological mechanisms, psychological and emotional factors are involved in the occurrence of these diseases. In this way, different levels of feelings of hostility, depression, and anxiety can be seen as the predominant basic factors of psychosomatic complaints. According to this, the present study was conducted to investigate the efficacy of mindfulness-based cognitive therapy on cognitive fusion and alexithymia in students with psychosomatic disorders.

Method
The research method was quasi-experimental with pretest, posttest, control group, and two-month follow-up period design. The statistical population included secondary high school students with psychosomatic disorder in Khomeini Shahr in the academic year 2020-21. 37 students with signs of psychosomatic disorder were selected through the purposive sampling method and randomly accommodated into experimental and control groups (18 in the experimental and 19 in the control group). The experimental group received eight seventy-five-minute sessions of mindfulness-based cognitive therapy intervention during two months. The applied questionnaires in this study included a psychosomatic complaints scale (Takata & Sakara, 2004), a Cognitive fusion questionnaire (Gillanders et al., 2014), and an alexithymia (Takata & Sakara, 2004) questionnaire (Bagby et al., 1994). The data from the study were analyzed through mixed ANOVA via SPSS23 software.

Results
The results showed that mindfulness-based cognitive therapy has a significant effect on cognitive fusion and alexithymia in students with psychosomatic disorder (p<0.001). Also, the results showed that this effectiveness remained stable in the two-month follow-up period. Descriptive findings also indicated that cognitive therapy based on mindfulness was able to reduce the average scores of cognitive fusion and alexithymia of students with psychosomatic complaints.

Conclusion
According to the findings of the present study, it can be concluded that mindfulness-based cognitive therapy can be used as an efficient therapy to decrease cognitive fusion and alexithymia in students with psychosomatic disorder through mindful activities and attitudes and addressing feelings and problem-making emotions. In addition, cognitive therapy based on mindfulness by applying practical mechanisms (such as body awareness and cognitive and emotional re-evaluation), can reduce the cognitive and emotional avoidance of students with psychosomatic complaints. On the other hand, by accepting signs and symptoms, students reduce overthinking about symptoms and learn that these are part of the body's defense mechanisms against stress that they have to deal with. This process improves the skill of regulating, managing, and expressing emotions and reduces alexithymia and cognitive fusion.

Keywords

References

Asadi Jozani, R. (2023). The relationship between perfectionism and emotional regulation with psychosomatic simptoms in women with family problems. MA Thesis, Higher Education Institute of sciens and technology. [Persian]

Asli Azad, M., Manshaei, G., & Ghamarani, A. (2019). The effect of mindfulness therapy on tolerance of uncertainty and thought-action fusion in patients with obsessive-compulsive disorder. Quarterly Journal of Child Mental Health, 6(1), 83-94. https://doi.org/10.29252/jcmh.6.1.8

Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale-I: Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23-32. https://doi.org/10.1016/0022-3999(94)90005-1

Barnhofer, T. (2019). Mindfulness training in the treatment of persistent depression: Can it help to reverse maladaptive plasticity? Current Opinion in Psychology, 28, 262-267. https://doi.org/10.1016/j.copsyc.2019.02.007

Besharat, M. A. (2005). The relationship between personality dimensions and mood disorder. Journal of Contemporary Psychology, 2(2), 55-66. [Persian] https://bjcp.ir/article-1-968-en.html

Biglari, F., Asli Azad, M., & Miri Sangtarashani, S. A. (2022). Efficacy of mindfulness-based cognition therapy on Covid-19 Anxiety and distress tolerance in the patients recovered from Corona Virus. Psychological Achievements, 22(2), 69-90. https://doi.org/10.22055/ psy.2022.40247.2807 [Persian]

Blaettler, L. T., Stewart, J. A., Gubler, D. A., Egloff, N., Känel, R., & Holtforth, M. (2020). Corrigendum to “Alexithymia moderates effects of psychotherapeutic treatment expectations on depression outcome in interdisciplinary Chronic pain treatment”. Journal of Psychosomatic Research, 133, 69–72. https://doi.org/10.1016/j.jpsychores.2019.04.010

Bodenlos, J. S., Hawes, E. S., Burstein, S. M., & Arroyo, K. M. (2020). Association of cognitive fusion with domains of health. Journal of Contextual Behavioral Science, 18, 9-15. https://doi.org/10.1016/j.jcbs. 2020.08.001

Capobianco, L., Reeves, D., Morrison, A. P., & Wells, A. (2018). Group metacognitive therapy vs. mindfulness meditation therapy in a transdiagnostic patient sample: A randomized feasibility trial. Psychiatry Research, 259, 554-561. https://doi.org/10.1016/j.psychres.2017.11.045

Chalah, M. A., & Ayache, S. S. (2017). Alexithymia in multiple sclerosis: A systematic review of literature. Neuropsychologia, 104, 31-47. https://doi.org/10.1016/j.neuropsychologia.2017.07.034

Cooper, D., Yap, K., & Batalha, L. (2018). Mindfulness-based interventions and their effects on emotional clarity: Asystematic review and meta-analysis. Journal of Affect Disorders, 235, 265-276. https://doi.org/ 10.1016/j.jad.2018.04.018

Crosswell, A. D., Moreno, P. I., Raposa, E. B., Motivala, S. J., Stanton, A. L., … & Bower, J. E. (2017). Effects of mindfulness training on emotional and physiologic recovery from induced negative affect. Psychoneuroendocrin-ology, 86, 78-86. https://doi.org/ 10.1016/j.psyneuen.2017.08.003

Day, M. A., & Thorn, B. E. (2017). Mindfulness-based cognitive therapy for headache pain: An evaluation of the long-term maintenance of effects. Complementary Therapies in Medicine, 33, 94-98. https://doi.org/ 10.1016/j.ctim.2017.06.009

De Boer, S. F., & Sgoifo, A. (2021). Editorial introduction for the neuroscience & biobehavioral reviews special issue “Social Stress: Psychological and Psychosomatic implications”. Neuroscience & Biobehavioral Reviews, 121, 156-159. https://doi.org/10.1016/j.neubiorev.2020.12.006

Eftekhar Afzali, A., & Izadi, F. (2021). The effectiveness of mindfulness-based cognitive therapy on self-compassion, Alexithymia and cognitive distortion of students experiencing love failure. Journal of Research in Cognitive and Behavioral Sciences, 22(2), 61-72. http://psychologicalscience.ir/article-1-1084-en.html [Persian]

Farahzad Bourojeni, S., Ahmadi, R., Ghazanfari, A., & Sharifi, T. (2021). The effectiveness of mindfulness-based and motivational interviewing group therapy on pain self- efficacy and distress tolerance in patients with multiple sclerosis. Journal of Psychological Sciences, 20(100), 635-651. https://psychologicalscience.ir/browse.php?a_id=1084&sid=1&slc_lang=en [Persian]

Farhadi, T., Asli Azad, M., & Shokrkhodaei, N. (2018). Effectiveness of mindfulness therapy on executive function and cognitive fusion in the adolescents with obsessive-compulsive disorder. Journal of Exceptional Child Empowerment, 9(4), 81-92. https://doi.org/ 10.22034/ceciranj.2018.91194 [Persian]

Fatahi, N., Kazemi, S., Bagholi, H., & Kouroshnia, M. (2021). Comparison of the effectiveness of two classic cognitive-behavioral therapies (CBT) and mindfulness-based stress reduction (MBSR) on the emotion regulation strategies of patients with type 2 diabetes in Shiraz. Journal of Psychological Sciences, 20(101), 813-821. http://psychologicalscience.ir/article-1-758-en.html [Persian]

Feltz-Cornelis, C. (2020). The shared heritage of european psychiatry: Perspectives from psychosomatic psychiatry. The European Journal of Psychiatry, 34(2), 55-58. https://doi.org/10.1016/j.ejpsy.2019.11.002

Flynn, M. K., Hernandez, J. O., Hebert, E. R., James, K. K., & Kusick, M. K. (2018). Cognitive fusion among hispanic college students: Further validation of the cognitive fusion questionnaire. Journal of Contextual Behavioral Science, 7, 29-34. https://doi.org/10.1016/j.jcbs.2017.11.003

Gillanders, D., Ashleigh, K. S., Margaret, M., & Kirsten, J. (2015). Illness cognitions, cognitive fusion, avoidance and self-compassion as predictors of distress and quality of life in a heterogeneous sample of adults, after cancer. Journal of Contextual Behavior Science, 4, 300-311. https://doi.org/ 10.1016/j.jcbs.2015.07.003

Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., … & Remington, B. (2014). The development and initial validation of the cognitive fusion questionnaire. Behavior Therapy, 45(1), 83-101. https://doi.org/10.1016/j.beth.2013.09.001

Goetzmann, L., Siegel, A., & Ruettner, B. (2019). The connectivity/ conversion paradigm-A new approach to the classification of psychosomatic disorders. New Ideas in Psychology, 52, 26-33. https://doi.org/10.1016/j.newideapsych.2018.08.001

Golami, P. (2023). The effectivness of mindfulness on reducing psychosomatic signs and negative emotionals on students with the signs of psychosomatic disorders. Senior thesis, North Khorasan Payam Noor University. ganj.irandoc.ac.ir//#/articles/422463fcfaf69581c71f2a6197339a0f/fulltext [Persian]

Hajlo, N. (2012). Psychometric properties of Takata and Sakata’s psychosomatic complaints scale among Iranian university students. Journal of Research in Behavioural Sciences, 10(3), 204-212. http://rbs.mui.ac.ir/article-1-258-en.html [Persian]

Hatamieh, J., Khorshidi, M. M., Bahrami Ehsan, H., Rahimi, S. A. S., & Hatami, A. J. (2013). The role of processing levels and mood matching in recognizing emotional words in people with Alexitimia. Journal of Applied Psychology, 6(1), 69-83. https://ensani.ir/file/download/article/1569653074-10236-90-66.pdf

Hofmann, S. J., & Gómez, A. G. (2017). Mindfulness-Based interventions for Anxiety and depression. Psychiatric Clinics of North America, 40(4), 739-749. https://doi.org/10.1016/j.psc.2017.08.008

Hopwood, T. L., & Schutte, N. S. (2017). A meta-analytic investigation of the impact of mindfulness-based interventions on post traumatic stress. Clinical Psychology Review, 57, 12-20. https://doi.org/10.1016/j.cpr.2017.08.002

Hosseinpour, H., Akbari, M., Hassani, J., & Zargar, F. (2020). The efficacy of pharmacotherapy combined with short-term mindfulness therapy on the reduction of migraine disability and improvement of sleep quality. Shefaye Khatam, 8(2), 18-28. https://doi.org/10.29252/shefa.8.2.18 [Persian]

Hüfner, K., Ower, C., Kemmler, G., Vill, T., Martini, C., … & Sperner-Unterweger, B. (2020). Viewing an alpine environment positively affects emotional analytics in patients with psychosomatic disorders and healthy controls. Journal of Psychosomatic Research, 133, 110-114. https://doi.org/10.1016/j.jpsychores.2020.110015

Kabat-Zinn, J. (2003). Mindfulness-based interventions in contect: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156. https://doi.org/10.1093/clipsy/bpg016

Kenangil, G., Demir, M., Tur, E., & Domac, F. (2021). Alexithymia, depression, and cognition in patients with Parkinson’s disease. Acta Neurol Belg, 17, 217-221. https://doi.org/10.1016/j.parkreldis.2020.06.089

Khakshour Shandiz, F., Sodagar, S., Annani Sarab, G., Malihi Al-zakerini, S., & Zarban, A. (2021). Effectiveness of mindfulness-based cognitive therapy on cognitive fusion and positive and negative affect in women with Type II Diabetes. J Diabetes Nurse, 9(2), 1419-1430. http://jdn.zbmu.ac.ir/article-1-478-en.html [Persian]

Kliewer, W., Riley, T., Zaharakis, N., Borre, A., Drazdowski, T. K., & Jäggi, L. (2016). Emotion dysregulation, anticipatory cortisol, and substance use in urban adolescents. Personality and Individual Differences, 99, 200–205. https://doi.org/10.1016/j.paid.2016.05.011

Korostiy, B. (2015). Alexithymia, aggressiveness and predictive ability in patients with psychosomatic diseases and emotional (anxiety and Depressive) disorders. European Psychiatry, 30(1), 1251-1255. https://doi.org/10.1016/S0924-9338(15)32006-X

Krafft, J., & Levin, M. E. (2021). Does the cognitive fusion questionnaire measure more than frequency of negative thoughts? Journal of Contextual Behavioral Science, 22, 63-67. https://doi.org/10.1016/j.jcbs.2021.09.002

Kroska, E. B., Miller, M. L., Roche, A. I., Kroska, S. K., & O’Hara, M. W. (2018). Effects of traumatic experiences on obsessive-compulsive and internalizing symptoms: The role of avoidance and mindfulness. Journal of Affective Disorders, 225, 326-336. https://doi.org/ 10.1016/j.jad.2017.08.039

Li, J., Sidibe, A. M., Shen, X., & Hesketh, T. (2019). Incidence, risk factors and psychosomatic symptoms for traditional bullying and cyberbullying in Chinese adolescents. Children and Youth Services Review, 107, 104-110. https://doi.org/10.1016/j.childyouth.2019.104511

Lyvers, M., Mayer, K., Needham, K., & Thorberg, F. A. (2019). Parental bonding, adult attachment, and theory of mind: A developmental model of alexithymia and alcohol-related risk. Journal of Clinical Psychology, 75(7), 1288-1304. https://doi.org/10.1002/jclp.22772

Martin, M., Henrich, J., & Gjelsvik, B. (2019). Mindfulness-based cognitive therapy for irritable bowel syndrome: Reducing symptoms and increasing quality of life. Journal of Psychosomatic Research, 121, 147-152. https://doi.org/10.1016/j.jpsychores.2019.03.142

Martin, M., Henrich, J., & Gjelsvik, B. (2020). Theoretical and therapeutic implications of a randomised clinical trial of mindfulness-based cognitive therapy for women with Irritable Bowel Syndrome. Journal of Psychosomatic Research, 133, 110-114. https://doi.org/10.1016/j.jpsychores.2020.110063

Mathur, S., Sharma, M. P., Balachander, S., Kandavel, T., & Reddy, J. (2021). A randomized controlled trial of mindfulness-based cognitive therapy vs stress management training for obsessive-compulsive disorder. Journal of Affective Disorders, 282, 58-68. https://doi.org/10.1016/j.jad.2020.12.082

Mazaheri, M., Aghaei, A., Abedi, A., & Adibi, P. (2020). Effectiveness of mindfulness-based cognitive therapy on the perceived stress of patients with ulcerative colitis. Journal of Guilan University of Medical Sciences, 29(1), 85-94. http://journal.gums.ac.ir/article-1-2249-en.html [Persian]

Mehrizi, Z., Nasiri, A., Sahranavard, S., & Sebzari, A. R. (2020). The effect of mindfulness-based intervention on perceived stress in family caregivers of patients with cancer. Iranian Nursing Scientific Association, 7(6), 1-10. http://ijpn.ir/article-1-1408-en.html [Persian]

Musa, Z. A., Soh, K. L., Mukhtar, F., Soh, K. Y., Oladele, T. O., & Soh, K. G. (2021). Effectiveness of mindfulness-based cognitive therapy among depressed individuals with disabilities in Nigeria: A randomized controlled trial. Psychiatry Research, 296, 113-117. https://doi.org/10.1016/j.psychres.2020.113680

Obeid, S., Haddad, C., Fares, K., Malaeb, D., Sacre, H., … & Hallit, S. (2021). Correlates of emotional intelligence among Lebanese adults: the role of depression, anxiety, suicidal ideation, alcohol use disorder, alexithymia and work fatigue. BMC Psychology, 9(18), 177-182. https://doi.org/10.1186/s40359-021-00525-6

Oraki, M., & Asadpour, A. (2021). Effectiveness of mindfulness-based stress reduction therapy on psychological well-being and perceived stress in women with gastroesophageal reflux disease. Journal of Health Psychology, 9(4), 151-168. https://doi.org/10.30473/hpj.2021.51273.4708 [Persian]

Peters, E., Tumala, S., & Kruse, J. (2020). Perceived stress and morning serum cortisol drop after psychosomatic inpatient therapy in a German university hospital. Journal of Psychosomatic Research, 133, 110-114. https://doi.org/10.1016/j.jpsychores.2020.110091

Petrenko, T., Retjunskiy, K., Kublanov, V., & Petrenko, A. (2019). Application of non-invasive electrostimulation of the autonomic nervous system in the complex treatment of children with psychosomatic disorders. Brain Stimulation, 12(2), 568-569. https://doi.org/10.1016/j.brs.2018.12.884

Porcelli, P., De Carne, M., & Leandro, G. (2020). Distinct associations of DSM-5 Somatic Symptom Disorder, the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) and symptom severity in patients with irritable bowel syndrome. General Hospital Psychiatry, 64, 56-62. https://doi.org/10.1016/j.genhosppsych.2020.03.004

Sabaghi, S., & Mahdi Zadegan, I. (2020). Compare social desirability and alexithymia among students with internalized behavioral disorder and normal students. Journal of Psychological Sciences, 19(90), 765-772. http://psychologicalscience.ir/article-1-355-en.html

Segal, Z., Dimidjian, S., Vanderkruik, R., & Levy, J. (2019). A maturing mindfulness-based cognitive therapy reflects on two critical issues. Current Opinion in Psychology, 28, 218-222. https://doi.org/10.1016/j.copsyc.2019.01.015

Shahgholian, M., Moradi, A., & Kafee, M. (2007). Relationship of Alexithymia with emotional expression styles and general health among university students. IJPCP, 13(3), 238-248. http://ijpcp.iums.ac.ir/article-1-269-en.html

Shafiabady, A., Hasani., J., & Yari, M. (2023). Comparing effectiveness of emotion-focused cognitive-behavioral therapy and mindfulness based cognitive therapy on body image and cognitive emotion regulation in adolescent girls interested in cosmetic surgery. Psychological Achievements, 30(1), 19-36. https://doi.org/10.22055/psy.2022.34239.2569 [Persian]

Shallcross, A. J., Duberstein, Z. T., Sperber, S. H., Visvanathan, P. D., Lutfeali, S., … & Spruill, T. M. (2021). An open trial of telephone-delivered mindfulness-based cognitive therapy: Feasibility, acceptability, and preliminary efficacy for reducing depressive symptoms. Cognitive and Behavioral Practice, 29(2), 280-291. https://doi.org/ 10.1016/j.cbpra.2020.12.004

Takata, Y., & Sakata, Y. (2004). Development of a psychosomatic complaints scale for adolescents. Psychiatry Clinical Neuroscience, 58(1), 3-7. https://doi.org/10.1046/j.1440-1819.2001.00777.x

Thomas, K. N., & Bardeen, J. R. (2020). The buffering effect of attentional control on the relationship between cognitive fusion and anxiety. Behaviour Research and Therapy, 132, 103-108. https://doi.org/10.1016/j.brat.2020.103653

Visi, M. (2023). Schemaes emotional, Alexitaimia and psychosomatic signs of students with and without planning disability. Master Thesis, Gasvin Payam Noor University. [Persian]

Zacharia, M., Ioannou, M., Theofanous, A., Vasiliou, V. S., & Karekla, M. (2021). Does cognitive fusion show up similarly across two behavioral health samples? Psychometric properties and invariance of the Greek–Cognitive Fusion Questionnaire (G-CFQ). Journal of Contextual Behavioral Science, 21, 212-222. https://doi.org/10.1016/j.jcbs.2021.01.003

Zare, H. (2014). Standardization of the gilanders cognitive fusion social scale based on the Bohrenstat model. Journal of Social Psychology Research, 4(15), 17-28. [Persian]

Efficacy of Mindfulness-Based Cognitive Therapy on Cognitive Fusion and Alexithymia in Students with Signs of Psychosomatic Disorders

References

References

Volume 31, Issue 1 - Serial Number 31May 2024Pages 121-146

Volume 31, Issue 1 - Serial Number 31
May 2024
Pages 121-146