Study of Effectiveness of Narrative Therapy on Life Satisfaction According to Coping Strategies in Patients with Cancer in Tehran
The purpose of this study was to investigate the effectiveness of narrative therapy on the life satisfaction of cancer patients in Tehran in 2014. The statistical population includes patients with cancer in Tehran who were admitted to the hospital for treatment, and the sampling method was available and voluntary. 20 people participated in this research as a statistical sample. This research was semi-experimental with pre-test-post-test with a control group. Diners life satisfaction questionnaire was completed as a pre-test and post-test. Quality of life includes expectations, satisfaction, value system and other important aspects of the patients life and depends on factors such as health status, financial status, job satisfaction and living conditions. Also, Lazarus and Folkmans coping strategies questionnaire was used. The data obtained from the questionnaires were analyzed by multivariate covariance analysis and one-way covariance analysis. Based on the results obtained from the multivariate covariance analysis, the second hypothesis was rejected, that is, the effect of narrative therapy on the life satisfaction of cancer patients was not significant. Based on the results obtained from one-way covariance analysis, the first hypothesis regarding the direct and indirect effect of narrative therapy on the life satisfaction of cancer patients was confirmed. Considering the effectiveness of narrative therapy on increasing the life satisfaction of cancer patients, the permanent presence of a clinical psychologist in the blood department is necessary for the psychotherapy of cancer patients and the patients primary caregiver. Narrative therapy: "A type of therapy for individuals, couples or families that helps the client to have a new perception of the events in his life and rewrite them in the form of narratives or real stories that improve life.
Considering the effectiveness of narrative therapy in increasing the life satisfaction of cancer patients, which is one of the findings of the present study, and considering the physical and mental suffering that the patient and his family suffer, training on how to talk with family members in situations Crisis and education make it necessary for people with cancer and primary caregivers to establish social communication and talk with people around them in times of crisis, including the occurrence of illness. The non-significance of the effect of narrative therapy can mean that the chronic disease of cancer has changed the personality and coping pattern of the person suffering from cancer just as it has changed the routine of a persons life. That is, the person himself has come to the conclusion that the usual and previous coping strategies that he had are not working in this issue. Considering this issue, it is suggested that cancer patients and their primary caregivers should be taught effective ways to deal with stress during long-term periods. In this case, the therapists and clients metaphors can be transferred between each other. This phenomenon can be a type of rapid displacement of the persons emotional situation, which can be used for psychotherapy purposes and displacement of information and skills. That is, when the main focus of the person is on the outside of himself and because of unpleasant emotions, from the outside by presenting a pleasant emotion, one can establish a direct connection with the client without the intermediary of personal defense and convey metaphors to him Transferred.
This research was semi-experimental with pre-test-post-test and control groups. The sampling method was available and voluntary sampling, and the statistical population included cancer patients who were hospitalized for treatment in Tehran in 2014. In this research, there was an experimental group and a control group, so the number of members in each group was 10 people. Dieners life satisfaction questionnaire was used as pre-test and post-test. Dieners Life Satisfaction Scale is a 5-question questionnaire that measures a persons overall satisfaction with life. This test is answered with a 7-point Likert scale. Diener et al validated this test on 186 students. The obtained results are as follows: the average was 0.87 and the standard deviation was 0.82. The retest reliability of this test with an interval of two months is equal to 0.84 and the obtained Cronbachs alpha coefficient is 0.87. This test has content reliability. The reliability of the questionnaire with Cronbachs alpha is equal to 0.71(Diener, 1985) Sheikhi, Homan, Ahadi and Separah Mansour validated Diners Life Satisfaction test on 400 students. The results showed that the internal consistency of this scale is 0.85 and its retest reliability is 0.77. The results of factor analysis showed that this scale is a single factor and has the necessary validity to measure life satisfaction among students (Sheikhi et al., 1390). The coping strategies questionnaire was designed and validated by Lazarus and Folkman. It has 66 questions and measures 8 types of strategies. Lazarus obtained an internal consistency of 0.66 to 0.79 for each of the 8 types of strategies. Cronbachs alpha coefficient was 0.86 for the total coping strategy, 0.72 for emotion-oriented coping, 0.79 for problem-oriented coping, and 0.77 for the initial sample of 148 people. This questionnaire has face validity (Lazarus, Folkman, 1984). The data obtained from the questionnaires were analyzed by multivariate covariance analysis and one-way covariance analysis (Khalatbari F., & Farahani BC., 2024).
Data obtained from Dieners life satisfaction questionnaire Lazarus coping strategies and Folkman was analyzed using descriptive and inferential statistical analysis. The inferential statistics used in this research are: one-way covariance analysis and multivariate covariance analysis
Table 1: Pre-test and post-test descriptive statistical data of the experimental and control groups.
The statistical method used in this section is multivariate covariance analysis and one-way covariance analysis. The assumptions of covariance analysis are: normality of distribution of scores, homogeneity of variance of groups, homogeneity of regression slope, linearity. After performing the Kolmogorov-Smironov test to check the normal distribution of the scores, the significance levels obtained for the pre-test and post-test are 0.687 and 0.222, these values are greater than 0.05. Therefore, the distribution of scores is normal. After performing Levines test to check the homogeneity of variances, the significance level obtained is equal to 0.850 and 0.769. This value is greater than 0.05. It can be said that the variance of the groups has homogeneity.
Table 2: One-way covariance analysis results for the first hypothesis.
After performing Levines test to check the equality of variances, the significance level obtained is equal to 0.443. This value is more than .005. That is, the data did not question the assumption of equality of error and variance. After drawing the pre-test-post-test graph in the experimental and control groups, it was observed that both graphs were linear.
Table 3: Results of multivariate covariance analysis for the second hypothesis.
Therefore, it can be said that the variance of the experimental and control groups is homogeneous. According to the results obtained from the Kolmogorov-Smironov test, the Levin test, and the pre-test-post-test chart of the experimental and control group, the data obtained from the life satisfaction questionnaires for the experimental and control group have all the assumptions of covariance analysis.
Regarding the first hypothesis, the significance level obtained for the group factor is 0.003. This value is less than 0.01. Therefore, the first hypothesis is confirmed, that is, narrative therapy has an effect on the life satisfaction of cancer patients.
Table 4: Results of multivariate covariance analysis for the second hypothesis.
Therefore, the second hypothesis is rejected. The effect of narrative therapy on the life satisfaction of cancer patients was not significant. Regarding the second hypothesis, the significance level obtained for the group factor is equal to 0.285. This value is more than 0.01.
For the group factor, the significance level obtained is equal to 0.120. This value is greater than 0.005. Therefore, the second hypothesis is rejected.
Based on the collected data, the first hypothesis was confirmed and the second hypothesis was rejected. Narrative therapy has a direct effect on the life satisfaction of cancer patients. However, the effectiveness of narrative therapy on the life satisfaction of cancer patients through coping strategies was not significant. Looking at the researches that has been done about the effectiveness of narrative therapy, the dependent variable of the present study was not found. In this context, we can refer to Amini Khos research (Aminikhoo & Masoomeh, 1387) Amini Khoo conducted an experimental intervention of narrative therapy and cognitive behavioral therapy on 30 women with breast cancer and analyzed its effect on their body image and self-esteem. The result obtained by Amini Kho was that narrative therapy and cognitive behavioral therapy were effective in improving the body image and self-esteem of women with breast cancer. Meanwhile, cognitive behavioral therapy has been more effective than narrative therapy on the body image and self-esteem of these women. If we want to compare the achievement of such a result with the second hypothesis of the current research, it can be said that narrative therapy can indirectly affect the level of life satisfaction of women with breast cancer by improving self-esteem and perceived body image. Women are influential. One of the reasons that can be mentioned for the greater effectiveness of cognitive behavioral therapy can be the fact that one of the side effects of breast cancer is organ removal, and this affects a persons perception of their own value as a woman in marital relationships or choosing a spouse. It has a direct and real effect. The perception of women with breast cancer changes completely before and after the disease, and no one can say that this is a perception error and does not have an objective reality, but insisting on this fact fuels the individuals emotional conflict, because the changes caused by The disease can be seen in the persons appearance and the people around him acknowledge it. In such a situation, restoring the clients knowledge about the severity and importance of the perceptions that arise in him can be effective on his self-esteem and his perceived body image. Cancer patients and their family members are exposed to various stressful events. Suffering from a chronic, life-threatening disease constitutes a part of the mental suffering of these patients and their families, while there are other common stressful life events as well. Mehrinejad, Khosravani Shariati, and Hosseini Abad Shapouri [25] have investigated the sources of stress in women with breast cancer. The result of this study was that the level of tension in women with breast cancer is significantly different from healthy women. This difference means that women with breast cancer experience more tension than healthy women and the type of tension experienced by these patients is different from the type of tension experienced by healthy women in the sample group. Events such as unwanted pregnancy, divorce or the death of a family member cause high stress for women with breast cancer. Cancer also affects the patients family members. Family members of cancer patients are exposed to psychological damage such as depression and anxiety. The course of medical treatment for cancer is long. Meanwhile, the mental health of family members and especially the patients primary caregiver is important for the successful and hopeful progress of treatment plans for a person with cancer. Providing psychological interventions to achieve this goal is effective. Eskandari, Bahmani, Hosni, Dadkhah and Naghiyi (Eskandari, 1393) studied the effectiveness of existential cognitive therapy group in reducing the depression of parents of children with cancer. The result obtained is that the level of depression of these parents was significantly reduced at the end of the study. Roozdar (Roozdar & Ebrahim, 1390) investigated the effectiveness of this intervention on the depression of 25 people during 8 narrative therapy sessions. The result was that narrative therapy was effective in reducing the severity of depression symptoms, especially in patients with mild and moderate depression symptoms. Comparing this research with the findings of the current research, it can be said that narrative therapy can indirectly increase a persons life satisfaction by reducing the symptoms of depression. At the same time, reducing the symptoms of depression, such as reducing negative mental rumination, increasing the energy directed to the clients actions, adjusting sleep and waking hours, increasing the clients useful speech and communication with the people around him, etc. It moves towards the dominant metaphorical field, which is interpreted as mental health in the dominant culture.
This is a use in a favorable way and a favorable use of a problem that is called the dominant narrative in narrative therapy. Naziri, Kaderi, and Zare (Naziri et al., 1388) and Rostagari and Moradi (Rastgari & Moradi, 2014) also conducted similar research with the aim of investigating the effectiveness of narrative therapy on reducing womens depression and reached a similar result. In the case of the present study, the explanation that can be given for the second hypothesis is that in the psychotherapy session, if the therapeutic communication is empathic and if there is unconditional acceptance, there is no sense of the existence of a dominant narrative governing the psychotherapy session in clients, and clients experience a sense of connection with security in an atmosphere outside the perception of dominance. This could have been an escape for him to vent his painful emotions. Along with emotional discharge, the amount of communication through conscious cognition decreases and direct communication with the therapist is established.
Another explanation that can be given for this hypothesis is that the referent carries a narrative saturated with problems in the context of his mind. This problem narrative is usually the dominant narrative from which the individual sits outside the center and receives only its unpleasant emotions. It is an internal suffering that comes from the outside. In a therapeutic relationship, if the therapist can gain the clients trust in him and the client trusts the therapists expertise and ability, in such a situation, the client will experience a sense of peace at the same time as telling the story of the problem.
In this case, the therapists and clients metaphors can be transferred between each other. This phenomenon can be a type of rapid displacement of the persons emotional situation, which can be used for psycho-therapy purposes and displacement of information and skills. That is, when the main focus of the person is on the outside of himself and because of unpleasant emotions, from the outside by presenting a pleasant emotion, one can establish a direct connection with the client without the intermediary of personal defense and convey metaphors to him Transferred. Koyama et al. (Koyama et al., 2010) investigated the effectiveness of narrative therapy on family members of cancer patients. Components such as age, gender, social status, relationship with the cancer patient, psychological and physical symptoms, psychiatric diagnosis, duration of recovery and the effect of family members on the patient were analyzed. Depression, anxiety disorders and adjustment disorders were among the most common mental disorders of cancer patients and their family members.
In this research, mental-psychological disorders are mentioned that are associated with cancer. According to this research, the explanation that can be put forward for the second hypothesis is that getting cancer is a problem that seems unusual and is not considered a daily and expected problem, and a person has previous cognitive structures about the effects of cancer which can be associated with cancer and is not affected. This issue is important because big problems require big schemas or, in the language of narrative therapy, big metaphors. When a person with mental powers that are within the scope of everyday affairs is faced with a chronic disease and a weak power such as cancer, this disease enters the persons mental organization without any boundaries and dominates other structures. When this issue is accompanied by the analysis of physical strength the change of role and communication of the person and the financial crisis caused by the cost of treatment, the cancer patient reduces the amount of personal confrontations. The reason for doing this can be that the person wants to temporarily reach a point of balance to feel calm. This is a kind of attempt to communicate with the dominant structure and attempt to restore psychological harmony. Considering the effectiveness of narrative therapy in increasing the life satisfaction of cancer patients, which is one of the findings of the present study, and considering the physical and mental suffering that the patient and his family suffer, training on how to talk with family members in situations Crisis and education make it necessary for people with cancer and primary caregivers to establish social communication and talk with people around them in times of crisis, including the occurrence of illness. The non-significance of the effect of narrative therapy can mean that the chronic disease of cancer has changed the personality and coping pattern of the person suffering from cancer just as it has changed the routine of a persons life. That is, the person himself has come to the conclusion that the usual and previous coping strategies that he had are not working in this issue. Considering this issue, it is suggested that cancer patients and their primary caregivers should be taught effective ways to deal with stress during long-term periods.
M.A.: conceptualization, methodology, writing the manuscript, M.A.: contributed to data analysis. M.A.; and M.A.: finally checked the manuscript and editing, Data Curation, and Formal Analysis. Both authors who are involved in this research read and approved the manuscript for publication.
We are grateful to all the dear professors for providing their information regarding this research.
Authors declare that they have all read the manuscript and have no conflict of interest.
Academic Editor
Dr. Phelipe Magalhães Duarte, Professor, Department of Veterinary, Faculty of Biological and Health Sciences, University of Cuiabá, Mato Grosso, Brazil.
Master of Clinical Psychology, Allameh Tabatabai University, Iran.
Akbarnezhad M., and Akbarnezhad M. (2024). Study of effectiveness of narrative therapy on life satisfaction according to coping strategies in patients with cancer in Tehran. Eur. J. Med. Health Sci., 6(6), 201-207. https://doi.org/10.34104/ejmhs.024.02010207