Volume 31, Issue 3 (10-2022)                   JGUMS 2022, 31(3): 206-217 | Back to browse issues page


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KheirKhah J, Aghel Masjedi M. Investigating the Effectiveness of Emotion-Focused Therapy on Perceived Stress and Alexithymia in Patients With Coronary Heart Disease in Rasht City, Iran. JGUMS 2022; 31 (3) :206-217
URL: http://journal.gums.ac.ir/article-1-2526-en.html
1- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
2- Invited Faculty of Rahman Institute of Higher Education, Ramsar, Iran. , m.masjediosycho@yahoo.com
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1. Introduction
The latest data from the American Heart Association in 2021 show that the prevalence of cardiovascular diseases (including coronary heart disease, heart failure, stroke, and high blood pressure) in adults over the age of 20 is 49.2% (126.9 million cases in 2018). This number increases by age among men and women. The prevalence of non-hypertensive cardiovascular diseases (only coronary artery disease, heart failure, and stroke) is also reported to be 9.3% (26.1 million cases in 2018) [1]. Coronary artery disease is the most common cardiovascular disease [3]. When a person is under constant stress and uses inappropriate defensive mechanisms, such as anger (which can be attributed to alexithymia), in such conditions, high blood pressure becomes chronic and manifests as a disease. In other words, people who have internal conflicts and do not have the power to express and discharge negative emotions are more prone to high blood pressure and cardiovascular diseases [8]. Psychosocial risk factors of coronary heart disease include depression, anxiety, stress, and alexithymia. Considering cognitive and emotional defects, it is assumed that alexithymia can be related to health indicators in general, and physical and medical problems in particular [12]. Emotion-focused therapy (EFT) is an experimental approach that helps patients to acquire new adaptive emotional resources and provide adaptive emotional responses for themselves [22]. This study aims to investigate the effectiveness of EFT on perceived stress and alexithymia in patients with coronary heart disease.
Methods
The statistical population of this study included patients who were referred to Dr. Heshmat Heart Hospital in Rasht City, Iran, from April to June 2019. The inclusion criteria were having the cardiovascular disease at the discretion of a cardiologist, informed consent and willingness to participate in the study, the ability to participate in meetings and cooperate in doing the assigned tasks, minimum high-school education, and age range up to 20 to 55 years. From this population, a sample of 200 cases was selected and after administering the tests related to the measuring variable, the subjects were screened based on the mean and one standard deviation (SD) above and below the cutting point to be separated from others. Of 76 cases, 30 were selected by the simple random sampling method and were assigned into two groups of 15 persons, including an experimental group and a control group. Moreover, after obtaining written and oral consent from the subjects, the questionnaires were distributed at the beginning of the research (pretest stage) and completed. Then, the intervention sessions started according to the treatment protocol.
The experimental group received EFT for eight 90-min sessions, one session per week for two months. However, the control group received no intervention. The data on demographic information included age, marital status, employment status, and education. Perceived stress and alexithymia in patients were measured by the 14-item perceived stress scale (PSS-14).
The 20-item Toronto alexithymia scale (TAS-20) was administered before and after the intervention. Mean and SD was estimated for analyzing the statistical data at the descriptive level and multivariate analysis of covariance (MANCOVA) was used at the inferential statistical level. To describe and analyze the data, we used the IBM SPSS software, v. 25.
Results
The two groups were assessed in terms of demographic variables. The results showed that the subjects of the two groups were not statistically different in terms of age, marital status, employment, and education. Investigating the mean, SD, and adjusted mean showed a significant difference between the mean of the control group and the experimental group in terms of dependent variables in the posttest. The results of the Bonferroni post hoc test for pairwise comparison between the mean values of the experimental and control groups showed a significant difference between the perceived stress variables and alexithymia in the experimental and control groups (P<0.05). MANCOVA of F ratio for the size of the combined variable showed a significant difference between the experimental group that received EFT and the control group that did not receive any treatment (F2, 25=170.5, P < 0.001, η2p=0.932). This difference, according to the adjusted means, indicates the effectiveness of EFT.
Discussion
The present study aimed to investigate the effectiveness of EFT on perceived stress and alexithymia in patients with coronary heart disease. It was found that EFT can reduce perceived stress and alexithymia. After EFT, patients could reduce their anxiety and stress by focusing on their emotions, identifying and describing them, and expressing new experiences in life and the emotions associated with them.

Ethical Considerations
Compliance with ethical guidelines

The present study is approved by the Ethics Committee of Guilan University of Medical Sciences (IR.GUMS.REC.1399.157).

Funding
This study was supported by Guilan University of Medical Sciences.

Authors' contributions
Conceptualization, methodology, validation, analysis, research, sources: Both Author; Drafting, editing, and finalization: Maryam Aghel Masjedi; Data visualization, supervision, and project management: Jalal KheirKhah.

Conflicts of interest
The authors declare that there is no conflict of interest.

Acknowledgements
The authors would like to express their sincere gratitude to the staff of the Heart Research Center of Dr. Heshmat Hospital. Investigating the Effectiveness of Emotion-Focused Therapy on Perceived Stress and Alexithymia in Patients With Coronary Heart Disease in Rasht City, Iran.



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Review Paper: Research | Subject: Special
Received: 2021/06/14 | Accepted: 2022/08/1 | Published: 2022/10/1

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