نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری روان‌شناسی عمومی، گروه روان‌شناسی، دانشکده علوم انسانی و اجتماعی، دانشگاه اردکان، اردکان، ایران.

2 دانشیار، گروه مشاوره، دانشکده علوم انسانی و اجتماعی، دانشگاه اردکان، اردکان، ایران.

3 استادیار، گروه فقه و مبانی حقوق اسلامی، دانشکده علوم انسانی و اجتماعی، دانشگاه اردکان، اردکان، ایران.

4 دانشیار، گروه روان‌شناسی، دانشکده علوم انسانی و اجتماعی، دانشگاه اردکان، اردکان، ایران.

10.22055/psy.2023.42498.2937

چکیده

تحمل پریشانی از عوامل تأثیرگذار بر خودمدیریتی بیماران دیابتی است. این پژوهش به منظور تعیین نقش میانجی پذیرش‌خود در ارتباط بین خودشکوفایی، تعالی‌خود و تحمل‌پریشانی در بیماران دیابتی نوع دو انجام شد. پژوهش حاضر از نوع توصیفی- همبستگی بوده و با روش تحلیل مسیر انجام گرفت. به این منظور 207 پرسشنامه به روش در دسترس در بیماران دیابتی نوع دو ساکن استان یزد اجرا شد. ابزارهای پژوهش شامل مقیاس تحمل‌پریشانی Simons & Gaher و مقیاس تکامل وجودی Loonstra بود. داده‌ها با استفاده از تحلیل مسیر در نرم‌افزار AMOS 24 تحلیل شدند. یافته‌ها نشان داد که پذیرش‌خود با تحمل‌پریشانی (001/0 > P و 24/0 r =)، خودشکوفایی با تحمل‌پریشانی (01/0 > P و 22/0 r =) و تعالی‌خود با تحمل‌پریشانی (05/0 > P و 23/0 r =) ارتباط معنی‌دار مثبتی دارند. همچنین پذیرش‌خود نقش میانجی معنی‌داری در رابطه بین خودشکوفایی و تحمل‌پریشانی (01/0>p) و نیز تعالی‌خود و تحمل‌پریشانی (05/0>p) بازی می‌کند. میزان تحمل پریشانی فرد دیابتی تا 22 درصد توسط عوامل خودشکوفایی، تعالی‌خود و پذیرش‌خود قابل پیش‌بینی بود (01/0>p). نتایج نشان داد افراد مبتلا به دیابت نوع دو که پذیرش‌خود، تعالی‌خود و خودشکوفایی بالاتری دارند، تحمل‌پریشانی بالاتری داشته‌اند. بنابراین پیشنهاد می‌شود که مراکز بهداشتی-درمانی به آموزش‌های روان‌شناختی جهت ارتقاء خودشکوفایی، تعالی‌خود و بطور خاص پذیرش‌خود در بیماران دیابتی توجه ویژه‌ای داشته باشند.

کلیدواژه‌ها

عنوان مقاله [English]

Mediating Role of Self-Acceptance in the Relationship between Self-Actualization, Self-Transcendence, and Distress Tolerance in Diabetic Patients

نویسندگان [English]

  • Nadere Afkhami Ardakani 1
  • Yasser Rezapour Mirsaleh 2
  • Hossein Ghafuri Charkhabi 3
  • Azra Mohammadpanah Ardakan 4

1 Ph.D. student, Department of Psychology, Faculty of Humanities and Social Sciences, Ardakan University, Ardakan, Iran.

2 Associate Professor, Department of Counseling, Faculty of Humanities and Social Sciences, Ardakan University, Ardakan, Iran.

3 Assistant Professor, Department of Principles of Islamic Jurisprudence, Faculty of Humanities and Social Sciences, Ardakan University, Ardakan, Iran.

4 Associate Professor, Department of Psychology, Faculty of Humanities and Social Sciences, Ardakan University, Ardakan, Iran.

چکیده [English]

Introduction
Diabetes is a chronic and costly disease that has a high prevalence throughout the world, Iran, and specifically in Yazd province. Considering the heavy psychological and economic costs of diabetes and its complications, it is important to pay attention to all the factors that can increase diabetes self-management. Since self-management is the main key to controlling diabetes and postponing the occurrence of diabetes complications, it is valuable to pay attention to distress tolerance and its affecting factors as one of the significant factors in diabetes self-management. Self-acceptance, self-actualization, and self-transcendence are proposed as three psychological factors that seem to improve people's distress tolerance. But evidence shows that self-acceptance can play a mediating role in the relationship between self-actualization, self-transcendence and distress tolerance in type 2 diabetic patients; however, few studies have investigated the relationship between these variables in diabetic people, which shows the necessity of conducting more studies.
 
Method
This is a descriptive-correlational study, performed using path analysis. A total of 207 questionnaires were administered by the available sampling method to type 2 diabetic patients living in Yazd province. The data was gathered using the Distress Tolerance Scale (Simmons & Gaher, 2005) and the Existential Fulfillment Scale (Loonstra, 2007). The Existential Fulfillment Scale is composed of three subscales: self-acceptance, self-actualization, and self-transcendence. The correlation and structural equation analysis were conducted to analyze the data using SPSS-23 and AMOS-24 software, respectively.
 
Results
The results showed that self-acceptance, self-actualization, and self-transcendence have a significant positive relationship with distress tolerance in diabetic patients. In other words, self-actualization has a positive and direct effect on distress tolerance (r =.22, p<.01), self-transcendence has a direct and significant effect on distress tolerance (r =.23, p<.05), and the direct effect of self-acceptance on distress tolerance is statistically positive and significant (r =.24, p<.001). The data also revealed that self-actualization has a direct and positive effect on self-acceptance (β=.29, p<.001), and the direct effect of self-transcendence on self-acceptance is statistically positive and significant (β=.21, p< 0.01). Also, self-acceptance plays a mediating role in the relationship between self-actualization and distress tolerance (Sobel test = 2.72, p<.01), and self-acceptance has a mediating role in the relationship of self-transcendence with distress tolerance (Sobel test = 2.45, p<.05) in diabetics. The distress tolerance of diabetic patients can be predicted up to 22% by the sum of self-actualization, self-transcendence, and self-acceptance (p<.01).
 
Conclusion
The results showed that individuals with type 2 diabetes who have higher self-acceptance, self-actualization, and self-transcendence show higher distress tolerance. Considering the mediating role of self-acceptance in the proposed model, it is suggested that by trying to promote the self-actualization and self-transcendence of diabetic patients, their self-acceptance of diabetics is improved. Higher self-acceptance, in turn, leads to greater distress tolerance and ultimately better diabetes self-management.

کلیدواژه‌ها [English]

  • Diabetic Patients
  • Distress Tolerance
  • Self-Acceptance
  • Self-Actualization
  • Self-Transcendence
Abdollahi, A., Panahipour, H., Allen, K. A., & Hosseinian, S. (2021). Effects of death anxiety on perceived stress in individuals with multiple sclerosis and the role of self-transcendence. OMEGA-Journal of Death and Dying, 84(1), 91-102. Doi:10.1177/0030222819880714
Afkhami Ardakani, N. (2022). The Relationship Between Existential Fulfilment, Spiritual Well-being, Religious Coping, and Distress Tolerance with Self-Management of Diabetic Patients. Unpublished Master Thesis, Ardakan university. [persian]
Aflakseir, A., Ziaee, M., & Imani, M. (2020). The effectiveness of Self-Acceptance on stress reduction among a group of high school male students expecting university entrance exam in Hamadan, Iran. International Journal of School Health, 7(1), 56-60. Doi:10.30476/intjsh.2020.83562.1010
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), S81-S90. Doi:10.2337/dc14-S081
Andami Khoshk, A. (2013). The mediating role of resilience in the relationship between cognitive emotion regulation and distress tolerance with life satisfaction. Unpublished Master Thesis, Allameh Tabataba’i University. [Persian]
Azizi, A., Mirzaei, A., & Shams, J. (2010). Correlation between Distress Tolerance and Emotional Regulation With Students Smoking Dependence, Hakim Research Journal, 13(1), 11–8. [Persian]
Bahadori, M., Mehrabizadeh Honarmand, M., Asgari, P., Ahadi, H., & Moradi, L. (2022). Comparison of the Effectiveness of Compassion Focused Therapy and Positive Psychology with Well-being Approach on Alexithymia, Adaptive Behavior and Adherence to Treatment of Patients with Diabetes Type 2. Psychological Achievements, 29(1), 161-188. Doi:10.22055/psy.2021.35153.260 [persian]
Baptista, G., Galvão A. M., & Pimentel M. H. (2014). Evaluation of acceptance of chronic disease: A need of health professionals. In 2nd World Congress of Health Research. Atención Primaria, 33-33.
Bernstein, A., Zvolensky, M. J., Vujanovic, A. A., & Moos, R. (2009). Integrating anxiety sensitivity, distress tolerance, and discomfort intolerance: A hierarchical model of affect sensitivity and tolerance. Behavior Therapy, 40(3), 291-301. Doi:10.1016/j.beth.2008.08.001
Carson, S. H., & Langer, E. J. (2006). Mindfulness and self-acceptance. Journal of rational-emotive and cognitive-behavior therapy, 24(1), 29-43. Doi:10.1007/s10942-006-0022-5
Coon, D., & Mitterer, J. (2009). Psychology of Test anxiety. Journal of Cengage Learning, 28(3), 48-53.
Del Castillo, F. A. (2021). Self-actualization towards positive well-being: combating despair during the COVID-19 pandemic. Journal of Public Health, 43(4), e757-e758. Doi:10.1093/pubmed/fdab148
Ellis, A., David, D., & Lynn, S. J. (2010). Rational and irrational beliefs: A historical and conceptual perspective. Rational and irrational beliefs: Research, theory, and clinical practice, New York. Oxford university press. 3-22.
Esmaeilishad, B., Keshavarzi Arshadi, F., & Yaghoubi, A. (2022). The relationship between health literacy and resilience with the mediating role of self-acceptance in the elderly. Navide Noo. 24(80), 56–65. Doi:10.22038/nnj.2022.58561.1298
Frankl, V. E. (1959). The spiritual dimension in existential analysis and logotherapy. Journal of Individual Psychology, 15(2), 157-165.
Harrell, A. (2018). Self-actualization wellness: a developmental approach to predicting and reducing college student stress related to the person and environment variables. Unpublished Dissertation, Drake University.
Health Information Observatory Dashboard (2022). Atlas of Stepwise approach to noncommunicable disease (NCD) risk factor surveillance (STEPs) 2021, National Institute for Health Research Islamic Republic of Iran publication. http://nihr.tums.ac.ir [Persian]
Hooman, H. A. (2005). Structural Equation Modeling with LISREL Application. Tehran, Samt publications. [Persian]
International Diabetes Federation (2019). IDF Diabetes Atlas, 9th edition. Belgium: Brussels, Available at: https://www.diabetesatlas.org
Jameson, J. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Loscalzo, J. (Eds.), (2018). Harrison's principles of internal medicine, 20th edition. New York: McGraw-Hill Press.
Jibeen, T. (2017). Unconditional self-acceptance and self-esteem in relation to frustration intolerance beliefs and psychological distress. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 35(2), 207-221. Doi:10.1007/s10942-16-0251-1
Längle, A., Orgler, C., & Kundi, M. (2003). The Existence Scale: A new approach to assess the ability to find personal meaning in life and to reach existential fulfillment. European Psychotherapy, 4(1), 135-151.
Loonstra, B., Brouwers, A., & Tomic, W. (2007). Conceptualization, construction, and validation of the existential fulfilment scale. European Psychotherapy, 7(1), 5-18.
Loonstra, B., Brouwers, A., & Tomic, W. (2009). Feelings of existential fulfilment and burnout among secondary school teachers. Teaching and teacher education, 25(5), 752-757. Doi:10.1016/j.tate.2009.01.002
Maslow, A. (1968). Some educational implications of the humanistic psychologies. Harvard Educational Review, 38(4), 685-696. Doi:10.17763/haer.38.4.j07288786v86w660
Morris, T., Moore, M., & Morris, F. (2011). Stress and chronic illness: the case of diabetes. Journal of Adult Development, 18(2), 70-80. Doi:10.1007/s10804-010-9118-3
Nakhaii, Sh., Ahi Q, Qanifar, M. H., Shahabizadeh, F., & Tabatabaii T. (2021). The mediating role of self-transcendence in the relationship between perceived stress and Professional quality of life of nurses. Iranian Journal of Nursing Research, 16(1), 64-77. [Persian]
Pavai, P. S., Geetha, K., Vigneshwari, J., & Suganthi, L. M. (2021). Investigation of relation between decision making and self-actualization. Materials Today: Proceedings, 37, 785-788. Doi:10.1016/j.matpr.2020.06.002
Polonsky, W. H., Anderson, B. J., Lohrer, P. A., Welch, G., Jacobson, A. M., Aponte, J. E., & Schwartz, C. E. (1995). Assessment of diabetes-related distress. Diabetes care, 18(6), 754-760. Doi:10.2337/diacare.18.6.754
Reed, P. G. (1991). Self-transcendence and mental health in oldest-old adults. Nursing research. 40(1), 5–11. Doi:10.1097/00006199-199101000-00002
Shrivastava, S. R., Shirvastava, P. S. & Ramasamy, J. (2013). Role of self-care in management of diabetes mellitus. Journal of Diabetes & Metabolic Disorders, 12(1), 1-5. Doi:10.1186/2251-6581-12-14
Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion, 29(2), 83-102. Doi:10.1007/s11031-005-7955-3
Soltanian, N., Rahimian Boogar, I. & Talepasand, S. (2022). Comparison of the Effectiveness of Acceptance and Commitment Therapy with Health-Promoting Lifestyle Intervention on Disease Perception and Adjustment with Type 2 Diabetes. Psychological Achievements, 29(1), 139-160. Doi:10.22055/psy.2021.36614.2669 [Persian]
Tarricone, R., Petracca, F., Svae, L., Cucciniello, M., & Ciani, O. (2024). Which behaviour change techniques work best for diabetes self-management mobile apps? Results from a systematic review and meta-analysis of randomised controlled trials. Ebiomedicine, 103. Doi:10.1016/j.ebiom.2024.105091
Teixera, M. E. (2008). Self-transcendence. A concept analysis for nursing praxis. Holistic Nursing Practice, 22, 25-31. Doi:10.1097/01.HNP.0000306325.49332.ed.
Thomas, J. (2015). Relationships among self-transcendence, illness distress, and health-promoting behaviors in African American women diagnosed with breast cancer. Unpublished Dissertation, University of Arizona.
Tofangchi, M., Raisi, Z., Ghamarani, A., & Rezaei, H. (2022). The Psychometric properties of Distress Tolerance Scale (DTS) in women with tension-type headaches. Journal of Anesthesiology and Pain, 12(4), 34-43. [Persian]
Tomic, M., & Tomic, E. (2010). Existential fulfilment, workload, and work engagement among nurses. Journal of Research in Nursing, 16(5), 468-479. Doi:10.1177/1744987110383353
Zhang, X., Yue, H., Sun, J., Liu, M., Li, C., & Bao, H. (2022). Regulatory emotional self-efficacy and psychological distress among medical students: multiple mediating roles of interpersonal adaptation and self-acceptance. BMC Medical Education, 22(1), 1-9. Doi:10.1186/s12909-022-03338-2
Zhang, Y. Y., Li, W., Sheng, Y., Wang, Q., Zhao, F., & Wei, Y. (2024). Prevalence and Correlators of Diabetes Distress in Adults with Type 2 Diabetes: A Cross-Sectional Study. Patient preference and adherence, 111-130. Doi:10.2147/PPA.S442838