Effectiveness of Logo Therapy to Reduce Stress and Increase Happiness in Women with Breast Cancer

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Vol-7, Special Issue-Number5, 2016, pp1381-1387 http://www.bipublication.com

Review Article

Effectiveness of Logo Therapy to Reduce Stress and Increase

Happiness in Women with Breast Cancer

Reyhaneh Shadab Jouposhti1and Mohammad Mehdi Pasandideh2

1

Department of Psychology, Islamic Azad University, Rasht branch, Rasht, Iran r.sh_raha@yahoo.com

2

Department of Psychology, Payam Noor University, Rasht, Iran (Corresponding Author: mmpasandideh@gmail.com) ABSTRACT

Current research was performed aiming at determining effect of logotherapy on reducing stress and increasing happiness in women with breast cancer. It is of quasi-experimental type with pre-test and post-test and control group. Statistical population included all women with breast cancer in Rash city. Statistical sample included 30 women with breast cancer (15 in case group and 15 in control group) who were randomly selected using convenient sampling method and were randomly assigned to case and control groups. For casegroup, 10 sessions (90 min) of Logotherapy was provided and control group received no intervention. Subjects in two stages (pretest and posttest) were evaluated using perceived stress scale and Oxford’s happiness survey. Data analysis was done using descriptive statistics methods (mean, SD, frequency and percentage) as well as inferential statistics (ANCOVA and multivariate analysis of covariance). Data analysis showed that Logotherapy in case group led to increased happiness and reduced perceived stress in women in this group. Thus, it can be stated providing Logotherapy training can help patients to accept and adopt to their disease leading to increasing happiness and reducing stress in women with cancer.

Keywords: Logotherapy, happiness, perceived stress, breast cancer

INTRODUCTION

Breast cancer has highest rank among death reasons in USA and Europe so that one out of 14 women in normal life gets caught by this disease (Zaheran et al., 2013). Breast cancer diagnosis as a crisis in the one’s life causes disturbing her living balance. Due to major role of breast in woman’s gender, reaction to the disease may include widespread psychological dimensions such asfear, anxiety and persistent sadness. People with breast cancer often experience intense psychological distress at the time of awareness of cancer and during treatment period. Studies indicate that up to 50 to 85 percent of patients simultaneously suffer from a psychiatric disorder and experience a lot of anxiety and stress associated with the diagnosis of this disease (Sharma et al., 2012). This disease, like other chronic physical diseases, is associated with stress and tension. Stress is a condition that causes

disturbances in normal psychological or

physiological functions for most people. In fact, stress is a response to a negative stimulus which causes excessive pressure on the person ultimately causing stress in the person (Lambert et al., 2015).

Perceived stress refers to assessment of people from the stressful situations of life and it was

developed based on Lazarus concept of

assessment. Tradition of psychological stress emphasizes on perception and assessment of organism from potential damage caused by confrontation with motivating environmental experiences (Lazarus, 2007). In these cases, patients adopt different styles and coping skills. These strategies are specific methods in solving problems related to this disease. Coping process includes specific skills which people utilize against stressful events in the life. One’s ability to cope stressful factors can be investigated from three aspects. Coping strategy for this problem includes stages which one uses in performing constructive and useful events in stressful conditions. They include active coping, planning,

abstaining from engaging in competitive

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feelings, positive reinterpretation, acceptance and humor, and, on the other hand, they shape negative emotions, coping and ineffective strategies, which include lack of effective intervention by the issue and denial, behavioral disengagement with respect to this problem, focusing on emotions and using drugs and alcohol (LotfiKashani et al., 2014). Positive Psychology has opened new horizons for the psychologists and researchers. In this branch of psychology, instead of emphasizing on identification and studying mental and behavioral deficiencies and repairing or treating them, recognition and promotion of positive aspects and strengths of human being is taken into account.one of the basic concepts in positive psychology, which is one branch of novel psychology, is happiness (Safarnejada, Ho-Abdullahb, and Mat Awal, 2014). Happiness is peasantstate of the person which results from positive emotions. Thus, happiness is not product of outside judgment which is imposed on the person, rather it is an internal state (Hillis and Argyle, 2001), and it can protects people against mental pressures. In addition, happiness produces energy, ecstasy and guarantees health of people (Pelechano, Gonzalez-Leandro, Garcia, and Moran, 2013). Also, findings indicate that happiness is associated by positive outcomes such as physical and mental health, optimal performance and production and entrepreneurship (Engnero et al., 2010). Furnham and Cheng (1997) believe that happiness is a personality trait and is considered as one of components of life quality. Thus, lack of happiness and having stress can have negative impacts on the health of people. Cancer is one of the chronic diseases which causes creating stress, mental and physical disorders in the life events. Considering high prevalence of cancer cases as well as high levels of experiencing stress, anxiety and depression in these patients and their families, researchers seek for medical methods affecting

physical and mental aspects beside

pharmacological and merely medicine dependent treatments. Hence, application of treatments other than pharmacological treatments seems necessary for reducing disease symptoms and increasing physical and psychological strength. Group logo therapy is a treatment method which mostly is focused on the future and less focused on the past

attempting to find meaning and purpose in the life (Pavel and Simon, 2007). Logo therapy was

originally developed by Frankl (1967). In

consulting with clients he attempted to direct them toward the purpose which gives meaning to the life (Pavel and Simon, 2007). This approach considers such concepts as seeking meaning in life, personal failure, and neuroticism, free thought, scrambling thought, devoid of life, opposite intention, meaning of love and the meaning of suffering in the course of treatment. For example,Mc AR Dell (2011) studied 272 women with breast cancer. Among them, some patients were randomly selected for receiving supportive psychotherapy program and intensive care. The group receiving psychotherapy program experienced significant reduction in their mental distress. Also, coping with issues and problems is a stable personality trait which is necessary to reach life meaning or its maintenance and achieve goals of development periods (Samadzadeh et al., 2013). Nowadays many studies and attempts have been done on cancer by academic, research and scientific centers. Considering attempts by oncologist, surgeons and practitioners to treat cancer, it seems that efforts on psychotherapy should also be done so that such research works can brings more hopeful future for patients and reduce their pain and suffering and at the same time, if intervention is necessary for them, to be provided. There is no doubt that diagnosis of life-threatening diseases, such as cancer has different effects on a person's quality of life.Given the high prevalence of breast cancer in women and harmful effects of psychological factors such as stress on disease process and reducing happy feeling in the patients and their families, this research aims to examine the effectiveness of logo therapy to reduce perceived stress and increase happiness in women with breast cancer.

METHODOLOGY

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They were selected considering specific physical and mental conditions of patients in this research. Thus, all female patients with breast cancer in Green Gilan Institute of Cancer Support were asked to register in logo therapy intervention sessions if they wanted. Then, among registered people, 30 ones were selected who had inclusion criteria, and were randomly assigned in case and control group. Inclusion criteria included age range as 25 – 65,minimum literacy, being in course of chemotherapy or after that as well as lack of acute psychological disorders or chronic diseases. Simultaneous attendance in other consulting seasons, being absent for one or more

sessions in logo therapy sessions and

unwillingness to participate in the sessions were exclusion criteria of this study. In this study, following questionnaires were used to measure the perceived stress and happiness. Perceived Stress Scale:Perceived Stress Scale was developed by Cohen et al. (1983). This scale includes 14 items and each item is answered based on five-score Likert scale. Reliability coefficient and internal consistency of scale was obtained in a range of 0.84 to0.86 in two groups of students and one

group of smokers in quitting program

usingCronbach's alpha coefficient (Cohen et al., 1983). Oxford’s Happiness Survey: Oxford’s happiness survey includes 29 items and measures personal happiness. Theoretical foundation of this survey is definition of Crossland and Argyle fromhappiness (in order to provide an operational definition of happiness, they consider it as including three main parts: frequency and degree of positive emotional, the average level of satisfaction during a period and not having negative emotions). This test was constructed in 1989 by Michele Argyle based on Beck Depression Survey (BDI, 1976). Highest score which can be gained by the subject is 87 in this scale which denotes highest level of happiness, and lowest score is 0 denoting dissatisfaction of subject with life and one’s depression. Normal score in this test is between 40 and 42.

RESEARCH METHOD:

Following coordination with authorities in Green Gilan Supportive Institute, list of women with breast cancer covered by this institute was prepared and they were called. Following introducing sessions and explaining on regulations

for presence in sessions, patients who wished to attend were registered, and they were asked to refer to the institute in specific day. Then, 30 people were selected who had inclusion criteria, and pre-test was conducted. Then they were assigned randomly in control and case group. For case group, 10 sessions of logo therapy (90min) were provided and control group received no intervention. Following sessions, post-test was conducted ontwo groups and results were examined. Data analysis was done using

descriptive statistics methods (mean, SD,

frequency and percentage) as well as inferential statistics (ANCOVA and multivariate analysis of covariance). Analysis was data was conducted using SPSS software (Ver. 20).

Details of group logo therapy training sessions, which were conducted within 10 sessions during 10 weeks, are given as follows:

- Session 1: organization of sessions and

justification of subjects and familiarization of group members, determination of regulations and time of sessions, familiarization of group member for group coherence, introduction of goals and distribution of questionnaires among group members were actions taken in first session.

- Session 2: Goals of second session included as

follows:

 Familiarization with meaning and resources of

logo in the life

 Increasing participation of members in the

group

- Session 3: goals of this sessions included as

follows:

 Introducing meaningsources

 Finding meaning through having goal in the

life

 Increasingdialogue among members with each

other and understanding solutions to giving meaning to life

follows:

 Meaning finding through love, way of meaning

finding in suffering

follows:

 Assuming responsibility in order to find the

meaning of life

 Increasing accountability towards self and

others

follows:

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follows:

 Increasing and deepening internal

self-awareness and self-awareness related to stressful behaviors and ways to overcome stress for patients

 Presence in the present time

follows:

 Understanding of happiness

 Overcoming despair and acquiring happiness

follows:

 Application of learnt issues in life

 Improving the living conditions of people

using material mentioned in the previous sessions

- Sessions 10: goals of this sessions included as

follows:

 Summarization of materials

 Stating learned materials by members

FINDINGS

In this research, 30 women with breast cancer (15 in case group and 15 in control group) were examined. Results showed that 26.7 percent of case group members were in age groups 25 – 34, 35 – 44, and above 55 years old, and 20 percent were in age group 45 – 54. In control group, 66.7 percent of subjects (n = 10) were in age range 35

– 44. Investigation of marital status showed 86.7 percent of case group and control group were married and others were single. Review of academic status showed 46.7 percent of case group had education below secondary school, 33.3 percent had high school diploma degree and associate degree, and 13.3 percent (n = 2) had PhD and MA and PhD degree. Also, t was found that 40 percent of case group members and 46.7 percent of control group members had history of below one year for this disease. In addition, it was specified that 13.3 percent (n = 2) in case group and 6.7 percent (n = 1) in control group had history of above 8 years for this disease. Review of treatment period shoed 46.7 percent of case group members and 53.3 percent of control group members were under treatment for less than one year, and 13.3 percent of case group members and 6.7 percent of control group members were under treatment for more than 8 years. In this research, for measuring perceived stress, perceived stress survey (PSS-14) was used. It has a total score. Table 1 indicates mean and SD for this component in terms of case and control group and test (post-test and pre-(post-test).

Table 1: Mean and SD for perceived stress in terms of group and test

Component Group Test Mean SD

Perceived stress

Control Pre-test 36.66 2.84 Post-test 36.40 2.52

Case Pre-test 35.73 3.01 Post-test 34.40 2.09

Table 1 indicates mean and SD for perceived stress in terms of case and control test and tests including pre-test and post-test. As observed, mean perceived stress in post-test of case group is reduced compared to control group. Then, happiness level and its aspects including satisfaction with life, self-esteem, subjective well-being, fulfillment and positive mood were assessed in two groups. Results showed there has been increase in five aspects of this scale and its total score in pore-test and post-test of case group. While mean in pre-test and post-test of control group showed no significant change. Results of this analysis are given in Table 2 in details.

Table 2: Mean and SD of happiness aspects and total score in terms of group and test

Component Group Test Mean SD

satisfaction with life

Case Pre-test 12 1.30 Post-test 12.80 1.52

self-esteem

subjective well-being

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fulfillment

Control Pre-test 8 1 Post-test 7.73 0.96

positive mood

Total score of happiness

Case Pre-test 46.06 2.57 Post-test 50.20 3 In order to investigate effectiveness of logo

therapy in reduction of perceived stress in women with breast cancer, Univar ate analysis of variance was used considering Univar ate dependent variable. Thus, firstly assumptions of the test were examined. Levene's test of homogeneity of variance between the two groups was used to evaluate the assumptions and results of this test showed that this assumption is established (F1,28 = 0.043, P = 0.837). Considering establishment of this assumption, it can be stated there is no limitation in using Univar ate analysis of variance. Results of this analysis showed that logo therapy leads to significant difference in post-test in case and control group and comparison of means suggests reduction of this component in test group

(F = 19.728, P = 0.0001, ฀2 = 0.42). Thus, it can

be stated that logo therapy is effective in reduction of perceived stress in women with breast cancer. Results for Chi Eta indicate degree of effectiveness. Also, Univar ate analysis of

covariance was used for investigating

effectiveness of logo therapy on increasing happiness score in women with breast cancer. Thus, firstly assumptions of the test were

examined. Levene's test of homogeneity of variance between the two groups was used to evaluate the assumptions and results of this test showed that this assumption is established (F1,28 = 10.384, P = 0.198). Considering establishment of this assumption, it can be stated there is no limitation in using Univar ate analysis of variance. Results of this analysis showed that logo therapy leads to significant difference in post-test in case and control group and comparison of means suggests increasing total score of happiness in in test group (F = 46.559, P = 0.0001, ฀2 = 0.63). then aspects of happiness were examined. Thus, in order to specify effectiveness of logo therapy on increasing aspects of happiness, multivariate analysis of covariance was used considering multivariate state of dependent variable. Hence, firstly assumptions of the test were examined. M Box test was used to check the assumption of homogeneity of variance - covariance matrix. The results showed that this assumption is established (MBox = 9.910, F15,3156.632= 0.751, P = 9.910). Then Levene’s test was used to evaluate assumption of homogeneity of error variance in two groups.

Table 3:Levene's test results to investigate homogeneity of error variance in happiness aspects

Components F Dfl Df2 Sig. level Satisfaction with life 1.914 1 28 0.177

Self-esteem 0.004 1 28 0.952 subjective well-being 0.022 1 28 0.884 Fulfillment 1.430 1 28 0.242 positive mood 1.844 1 28 0.185

Levene's test results showed this assumption is established for five aspects of happiness including life satisfaction, subjective well-being, fulfillment, positive mood and self-esteem. Considering establishment of these assumptions it can be stated there is no limitation to use multivariate analysis of covariance. Results of multivariate tests showed that logo therapy has had effect on increasing happiness aspects in

women with breast cancer ( 2 = 0.744, value = 0.256, F = 11.017, P = 0.0001).

Table 4: Multivariate analysis of covariance tests for investigating treatment effectiveness in increasing happiness

aspects

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ReyhanehShadab Jouposhti and Mohammad Mehdi Pasandideh ₁₃₈₆

Self-esteem 5..013 1 5.013 15.970 0.001 0.410

subjective well-being 6.850 1 6.850 18.041 0.0001 0440

Fulfillment 4.227 1 4.227 14.873 0.001 0..393

positive mood 5.041 1 5.041 11.963 0.002 0.342

Results of multivariate analysis of covariance showed that logo therapy leads to significant difference in posttest in test and control group and comparison of means suggests increasing happiness aspects in test group. Thus, it can be stated that logo therapy leads to increasing happiness aspects in women with breast cancer. Results for Chi Eta indicate degree of effectiveness.

DISCUSSION AND CONCLUSION

Current research aims at investigating effectives of logo therapy on reduction of perceived stress and increase of happiness in women with breast cancer. Results showed that training logo therapy for case group led to reducingperceivedstress in women with breast cancer. This finding is consistent with previous studies including Lambert et al. (2012), Lazarus et al., (2007), Volkmann (2013) and Schneider et al. (2006). As observed logo therapy as considerable impact on stress reduction. Actually logo therapy by cresting hope and meaning in life leads to creating opportunities for individual success and positive image of oneself and will help to create a positive attitude in the person. In this therapeutic method, participants learn to re-examine their values andcompare to others’ values.Generally, logo therapy increases the awareness to help people to have meaning and purpose in their life. They learn that for realization ofvalues they should try and control their own behavior. With encouraged to express their feelings and feedback in group members they understand the relationship between meaninglessness and his stress problems and in the face of difficulties, they do not condemn themselves. Folkman (2013) also in this regard, believes that hope and psychological stress are characteristics that have some common points including both are field-based, dynamic and meaning-based.Alsoboth difficult circumstances affect the psychological well-being. Folk man believes that hope is one of the variables which has decisive role in dealing with stress is, so there is a direct relationship between hope and

coping and by strengthening internal and external freedom one can stand against unfavorable environmental conditions and destiny. Also, logo

therapy with emphasis on responsibility,

commits the person to take responsibility and do his duty. Thus feeling of responsibility and control are established which are signs of hopeful people and motivation and effort emerges. As a result, training logo therapy in turn can be

effective in improving attitudes towards

problems and the ability of the individual in dealing with situations and emotional control. Thus, the change in attitude and way of thinking and identification of emotions leads to a decrease in perceived stress in women.Schneider et al. (2006) in their study to determine the effectiveness of group hope therapy intervention on stress, depression, self-esteem and life found that intervention reduces stress and depression and increases self-esteem and a sense of meaning in life. The other finding in this research was effectiveness of logo therapy on increasing happiness in women under study. This finding was consistent with findings by other studies (Mc AR Dellm 2011; Abedi and Hevrat, 2011; Saloy et al., 2001).

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look for finding ways to increase hope and maintain the spirit of happiness in these patients. The results showed that the training logo therapy can increase their level of happiness in patients with breast cancer. These findings can be justified in this way that happiness contains ability to solve existing problems and feeling that the situation would not be the same in future. Today there are many people under treatment which hope and self-efficiency would be reduced in them if they are not identified and treated at due time, and it would exceeds from personal control. Extension of such behavior not only threatens personal and social life, but also causes problems which impose cost on all society individuals and finally it would become an obstacle for economic and social development and major problems and obstacle would be faced in life. Thus, by training these people it is

possible to prevent from subsequent

consequences. In this research, training logo therapy could considerably increase happiness and retrieve hope to patients. People learn

cognitive – behavioral techniques using

organized homework and providing required feedbacks, and they apply them in their normal and natural environment. This educational method increases happiness given relationship between event, belief, outcomes, and behavioral

identification indicative of efficacy and

identifying the beliefs and the ability to change them with real analysis, profitability and

logicality analysis. Finallycooperation of

authorities in Green Gilan Institute of Cancer Support as well as all people helping in conducting this research are acknowledged.

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