Vol-7, Special Issue-Number2-April, 2016, pp1037-1043 http://www.bipublication.com
esearch Article R
Investigating the Influence of Group Therapy with Logo Therapy Approach in
Reducing Depression in Patients with Colorectal Cancer
1
Amir Hossein Sharifi, 2Farahnaz Meschi * and 3Mohammad Reza Seirafi
1Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran 2. Assistant Professor, Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran 3. Assistant Professor, Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran *Corresponding Author Email: Fa-meschi@yahoo.com
ABSTRACT
This study was carried out in order to investigate the Influence of group therapy with logo therapy approach in reducing depression in patients with colorectal cancer in Hazrat-e-Rasoul Hospital. The research method was quasi-experimental design with pre-test, post-test, control group and follow-up (2 months). The study population included all patients with colorectal cancer in Tehran and referred samples to Hazrat-e-Rasoul Hospital in the second 6 months of the year 2015. The sample consisted of 30 patients with colorectal cancer (45 to 65 years old) who were selected for sampling and randomly divided into two Control and Experimental groups (15 people). The tool was Beck Depression questionnaire that consists of 21 questions that was conducted in three stages. The intervention included logo therapy package in group method that it was in held in 10 sessions of 2 hours, 2 sessions per a week for experimental group and there was no intervention in the control group. To analyze the data, and inferential findings, descriptive statistic and the one-way ANCOVA, two-way and repeated measures test was used, respectively. The results of investigating data showed that intervention with logo therapy approach was effective on reducing depression in patients with colorectal cancer and the results of follow-up analysis showed effect lasting over time. So, this method can be used to reduce depression in patients with colorectal cancer.
Keywords:group therapy, logo therapy, depression, colorectal cancer
INTRODUCTION
One of the therapeutic strategies to reduce depression in people's lives is logo therapy approach. logo therapy is a method of treatment that provides the philosophical and theoretical background great for teamwork. logo therapy can provide a conceptual framework to help clients for the challenge of finding meaning in their lives. This way stresses on the four major interests that is rooted in human existence. Death, freedom, isolation and meaninglessness (Corey, Marianne,
as having interests in common though, It is a journey of discovery to learn of his true abilities, expand his view of the world around them and clarify what gives meaning life to him, current and future. In this group, people feel that they can be together deeply in meaningful ways of living (Corey, 2005 translated by Seyyed Mohammadi, 2006).Depression is one of the most common mood disorders that is associated with lack of pleasure, lack of motivation, increase or decrease of appetite and weight, sexual disorders, sleep and depression disorders. Depression is one of the most common complications of colorectal cancer, particularly can be seen due to reduced social activities and disability in these patients (Kaplan and Sadok, 2007 Translated by Rafie and Rezai, 1999).Depression is a risk factor in reducing survival in patients with colorectal cancer and an important factor in the treatment rejection by these patients. Regard to the high prevalence of depression in cancer patients, researchers knows embed sessions of psychotherapy and antidepressant medications as one of the main components of treatment of the patients and physicians has recommended to all professionals. On the other hand, from the view of Frankel Logo therapy, frustration, loss of meaning in life and undervalued feeling, condemn the person to choose the depression (Frankel, 1963).Group therapy has high efficiency in the health and medical situations because the group can be used to short therapy. Scot Sleek regard to this issue, studied studies in which the evidence was presented that in total, group therapy is effective as well as individual therapy to reform and change. And fundamental aspects of social skills especially role playing, exercises and feedback occurs strongly in group situations (Curry and Schneider, 2005). Also, logo therapy is a method that its use can help a person to find the meaning of life (Prochaska and Norcross, 2009 Translated by Seyyed Mohammadi, 2012).
The meaning of life is a positive response to life, no matter what we face, either suffering or death. The manner in which a person accepts fate and
find mean for their suffering, that means finding mean, effort and human struggle to achieve a set of ideals or values and finally, the quest for the meaning of life (Frankel, 1963). The group logo therapy provides an opportunity to members to recognize, understand and release of the obstacles that block their freedom to achieve and experience the above process with full participation and consciously (Navabi-nejad, 2004). The question that arises here is whether group therapy with logo therapy approach is effective in reducing depression in patients with colorectal cancer?
METHODOLOGY
The present study was applied and used research method was quasi-experimental with pre-test and post-test with 2 months control and follow-up. The population included all patients with colorectal cancer in Hazrat-e-Rasoul hospital, Tehran in the second 6 months of 2015. The sample consisted of 30 patients with colorectal cancer between the ages of 45 -65 that were selected by convenience sampling method and were randomly replaced assigned to two experimental and control groups. The tool was Beck Depression questionnaire. Beck Depression questionnaire (1972) is a self-report questionnaire that has been prepared for depression in adolescents and adults. This questionnaire is a 21-point scale that subject select one of the four options in each item that reflects the severity of depression. This questionnaire had high reliability and the reliability coefficient of internal consistency (Cronbach's alpha), its reliability with retest in one-week and correlation of its article was 0.92, 0.75 and 0.30-0.76, respectively. Any question is scored on a range of four parts from 0 to 3. Each of the test items describes depressive symptoms (physical and mental).
overall level of depression: 0 to 13: no or minimal depression, 14 to 19: mild depression, 20 to 28 moderate depression, 29 to 63 severe depression, but it should be noted that scores less than four, indicating possible denial of depression, pretend to be good and scores less than usual are even for healthy people. Generally, the implemented method was in a way that at first both groups were tested by the Beck Depression questionnaire.
Then, experimental group received group therapy with logo therapy approach in 10 sessions of 1.5 hours (2 times a week) and control group received no intervention. After the sessions, both groups responded to questions after the test, experimental group answered to questions in order to assess the durability of therapy method after two months. Here is a summary of the treatment protocol of group therapy sessions:
Meetings Goals Activities
First meeting Mutual understanding and awareness
of the Charter Group
The introduction of the general structure, work process and how the process works and Charter Group of work processes
The second
meeting Therapy seekers knowledge from the
treatment basic concepts
concentrated expression of Frankel history and basic beliefs of logo therapy
Third
meeting Knowledge of work practices means
and receiving life meaning Expressing three proposed methods in seeking mean
Fourth
meeting Acceptance of individual freedom and
responsibility
group dialogue on freedom and responsibility linking the concept to reality life of treatment seekers
Fifth meeting Understanding the meaning of love group dialogue in the areas of love and its meaning and
personal experience of treatment-seekers
Sixth
Meeting Understanding the meaning of
suffering
Group dialogue in the areas of co-morbid suffering with the disease S.ch
Seventh
Meeting Understanding the meaning of death Group dialogue in the transient life, reality of concept and
its meaning
Eighth
Meeting Understand transcendent presence of
God in the human unconscious
Speaking about the presence of God in the deepest part of human existence
Ninth
meeting Taking positive meaning of illness group discussion about the meaning that treatment seekers
have received from the difficulty of S.ch disease. Tenth
meeting
Conclusion of told, read and reception of treatment seekers
Conclusion and expression abstract of the findings of previous meetings
RESULTS
To evaluate the hypothesis of research, one-way and two-way ANCOVA test, repeated measures test was used. It should be noted that before the statistical tests, hypothesis test was investigated through Kolmogorov-Smirnov test (to check normality), Levine test (to check the homogeneity of variances) and Mauchly. The analysis of data was presented in the following tables:
Table 1. .Mean and standard deviation of depression scores in three phases of pre, post and follow-up test of subjects
in both experimental and control groups
Variable Group
Pre-test Post-test Follow-up
Mean±SD Mean±SD Mean±SD
Control 24.00±10.70 29.13 ±9.00
As can be seen in the table above, depression scores mean of experimental group at pre-test, post-test and follow-up was, 24.46, 12.66 and 13.60, respectively. Depression scores mean of control group at pre-test and post-test was 24.00 and 29.13, respectively.
Table 2. Covariance analysis to determine the effect of group therapy with logo therapy approach to reduce
depression in patients with colorectal cancer
Source of variations sum of squares df Mean Square F Sig. Eta square
Modified
model 3484.344 2 1742.172 168.988 0.000 0.926
Intercept 73.674 1 73.674 7.146 0.013 0.209
pre-test
1450.711 1 1450.711 140.716 0.000 0.839
Group 2113.194 1 2113.194 204.976 0.000 0.884
Error 278.356 27 10.309
Total 16867.00 30
According to the table above, depression in patients with colorectal cancer after controlling the effect of pre-test experimental was significant in experimental and control groups (p≤0.01). ETA statistic value (0.88) also show that the independent variable (group therapy with logo therapy approach) explained 88% of the observed variance in the dependent variable i.e. the reduction of depression. So, the main theory about the effect of group therapy with logo therapy approach in reducing depression in patients with colorectal cancer was confirmed.
Table 3. One-way Covariance analysis to determine the effect of group therapy with logo therapy approach to reduce
depression among females' patients with colorectal cancer
Source of variations sum of squares df Mean Square F Sig. Eta square
Modified
model 876.745 2 468.372 32.557 0.000 0.855
Intercept 27.798 1 27.798 2.064 0.179 0.158
pre-test
419.602 1 419.602 31.163 0.000 0.739
Group 685.873 1 685.873 50.938 0.000 0.822
Error 148.113 11 13.465
Total 16867.000 14
According to Table 3, there is a significant difference in post-test scores of women between the experimental and control groups with control pre-test effect (p≤0.01). In other words, group therapy with logo therapy approach was effective in reducing depression in female patients with colorectal cancer, thus, this hypothesis was confirmed.
Table 4. One-way Covariance analysis to determine the effect of group therapy with logo therapy approach to reduce
depression among male patients with colorectal cancer
Source of variations sum of squares df Mean Square F Sig. Eta square
Modified
model 2112.964 2 1056.482 208.178 0.000 0.970
Intercept 92.252 1 92.252 18.178 0.001 0.583
pre-test
369.901 1 369.901 72.888 0.000 0.849
Group 1414.947 1 1414.947 278.813 0.000 0.955
Error 65.974 13 13.465
According to Table 4, there is a significant difference in post-test scores of men between the experimental and control groups with control pre-test effect (p≤0.01). In other words, group therapy with logo therapy approach was effective in reducing depression in male patients with colorectal cancer, thus, this hypothesis was confirmed.
Table 5. The results of repeated measures of depression scores in pair wise comparison of testing stages in the
experimental group
Based on Table 5, there was significant difference in depression scores mean in the experimental group between pretest-posttest comparisons (p≤0.01). Also, there was significant difference between depression scores at follow-up-pretest comparison (p≤0.01). This indicates that the intervention was effective to reduce depression in people with cancer. No difference between posttest- follow-up (p>0.05) indicates the sustainable effect of group therapy with logo therapy on depression in patients with colorectal cancer, therefore, this hypothesis was confirmed.
DISCUSSION AND CONCLUSION
The results showed that depression in patients with colorectal cancer was significant after controlling for the effect of pre-test in experimental and control groups (p ≤0.01). Value and ETA (0.88) also show that independent variables (group therapy with logo therapy approach) was 88% of the observed variance in the dependent variable i.e. it explains the reduction of depression. So, the main theory about the effect of treatment with therapeutic approach was confirmed in reducing depression in patients with colorectal cancer. This study was consistent with Khaledian and Sohrab (2014) research, Kang et al. (2009). In explaining the findings, it can be concluded that humans react in the face of suffering unwanted hardships, and no one that except him cannot take this right from him. What brings a man down is not meaningless suffering and their unpleasant fate but is tragic life and meaning is not only in joy and gladness, but it can be found in suffering and death, as well. If we accept suffering bravely until the last minute of life, life will have meaning (Frankel, 1963, translated by Salehian and Milani, 2006).
Another result showed that group therapy with logo therapy approach is effective in reducing depression in women with colorectal cancer. This
study was in line with research of Pirkhaleghi and Salehi (2013) as meaning of the effectiveness of group therapy on mental health promotion for women with breast cancer (Garfami, Shafiabadi and Zaker, 2009). Regard to the effectiveness of group therapy with logo therapy approach in reducing symptoms of mental health problems in women with breast cancer, Blair (2004) used logo therapy to help adolescent patients with depression, and the results were impressive, Kang et al. (2009) performed the study entitled logo therapy efficacy on the meaning and quality of life of young people with breast cancer that was in line with the results of this research. In explaining the findings, it can be mentioned that painful nature of disease and attention to this logo therapy is hidden. It is nature that can lead patient to disease beyond of absurd. The gradual loss of a person's capabilities can face the individual with this crisis that not only its being has no benefit for the family and others, but they will cause damage and concerns. The crisis raised fears that if neglected can cause serious damage. In logo therapy group we realized the mean of suffer. Emotional reactions and emotional outbursts were carried out, many topics that they have experienced deeply.
Stages→ Pretest-posttest Pretest-follow up Posttest -follow up
Variable Mean differences Sig. Mean differences Sig. Mean differences Sig.
Another result of the study showed that group therapy with logo therapy approach has effect in reducing depression among men with colorectal cancer. The results of the study was in line with the findings of Ranjbar and Rasouli and Sanaee (2012), Nagata (2003) on the effect of logo therapy and side treatments in a traumatic stress disorder caused by the war which has an effective role (Ghanbari-Zarandi and Goudarzi, 2008 ). In explaining the theoretical concepts of research findings, can be noted to concepts of logo therapy. In this approach, the essence of the human is knows with his responsibility, starting point is the awareness of individual to his responsibility. Every human is constantly faced with different situations that in each of these situations, there is a meaning. A healthy person is apparently the second time that he has born. He see to every occasion of life and unparalleled as an opportunity gap who must grapple with the challenges of this position and vindicate the meaning. Investigating the durability of the treatment effect showed that there was significant difference in the experimental group, depression score mean in comparison of pretest-posttest between scores (p≤0.01). Also, was a significant difference between depression scores in comparison of follow-up and pretest (p≤0.01). This indicates that the intervention had significant effect to reduce depression in people with colorectal cancer. No difference between pre-test and follow up (p>0.05) indicates a sustained effect of group therapy with logo therapy approach on decreasing depression in patients with colorectal cancer, therefore, this hypothesis was confirmed, as well. The present study was in line with Gholami and Pasha and Sudan research (2009) entitled "the effectiveness of logo therapy to increase the hope and also reduce depression". In explaining the findings of this research, it can be concluded that the study's participants realized that life offers valuable experience to them. Experiences that can be said are life gifts.
For example, sunrise and sunset are beautiful like flowers, trees, etc. All of these are gifts that they
are people without paying the cost of living and then, it is better to continue this way. When they find the meaning of life experiences and life events and with the knowledge, understanding and self emancipation of the obstacles that has blocked their release with the full participation and informed can control their worries and give the meaning to the challenges and suffering the inevitable sense. They realized that with the awareness of the gift of freedom, spirituality and responsibilities can be passed healthy through development and growth to achieve the proper sense, freely, choice his reaction to situations ahead and accept responsibly the results of their actions and choices.
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