Comparison of Effectiveness of Quality of Life Therapy and Treatment Based on Islamic Spirituality on Distress Tolerance, Stress, Anxiety, and Depression in Women with Tension Headaches

Document Type : Original Article


1 استاد، گروه روانشناسی دانشگاه اصفهان، اصفهان، ایران

2 دانشجوی دکتری روانشناسی دانشگاه اصفهان، اصفهان، ایران

3 استادیار، گروه روانشناسی دانشگاه اصفهان، اصفهان، ایران

4 دانشیار، گروه نورلوژی دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران


Introduction: Tension headache is one of the psychosomatic disorders and it is very common in throughout the world. Stress and bad moods are among the aggravating factors of tension headaches. The purpose of the study is to compare effectiveness of quality of life therapy and treatment based on Islamic spiritualty on distress tolerance, stress, anxiety, and depression in women with tension headaches.
Method: This is an experimental study with pre-test, post-test, follow-up and control group. The study population included all the female patients with tension headaches in Kermanshah city in 2014. 39 subjects were selected by random sampling method and inclusion-exclusion criteria, and randomly were divided into two experimental groups and one control group (n=13). The experimental group of quality of life therapy was under treatment within 8 sessions of 90-minute and the experimental group of spiritual therapy was also treated within 8 sessions of 100-minute while the control group received no treatment. The research tools included Distress Tolerance Scale, and Depression Anxiety Stress Scales which were conducted in pre-test, post-test, and follow-up.
Results: Data analysis by using multivariate covariance method and post hoc tests showed that both treatments; the quality of life therapy and treatment based on Islamic spirituality  had significant effects on improving distress, stress, anxiety, and depression tolerance in post-test and follow-up. But the efficiency of spiritual treatment in reducing anxiety and depression in post-test was more significant compared to quality of life therapy. Hence, there was no significant difference between the two groups in the post-test regarding improvement of distress and depression tolerance. In the follow-up stage, the effect of spiritual therapy was more than quality of life therapy in all variables.
Conclusion: According to the findings both treatments, the quality of life therapy and treatment based on Islamic spirituality are effective interventions for patients with tension headaches. But the long-term impacts of treatment based on Islamic spirituality are more significant.


1- Aruna P, Puviarasan N, and P. B., An investigation of neuron-fuzzy systems in psychosomatic disorders. Expert Syst Appl, 2005; 28(4): 673-9.
2- M., V.-G.m., The impact of migraine and other primary headaches on the health system and in social and economic terms. Rev Neurol. 2006; 43: 228-35.
3- Foundation, N.H., Tension-Type Headache Accessed. 2016.
4- Espı´-Lo´pez GV, et al., Lucas Monzani. (2016). Efficacy of manual therapy on anxiety and depression in patients with tension-type headache.A randomized controlled clinical trial. Inter J Oste Med. 2016; 22: 11-20.
5- Kurt S and K. Y., Epidemiological and Clinical Characteristics of Headache in University Students. Clin Neurol Neurosurg. 2008; 110: 46-50.
6- Holroyd KA, et al., Managment of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: A randomized controlled trial. JAMA. 2001; 285(17): 2208-15.
7- Holroyd  KA, Stensland M, and L. G, Psychosocial correlates and impact chronic tension-type headache. Headache. 2000; 40(1): 3-16.
8- Kowacs F, et al., Symptoms of depression and anxiety, and screening for mental disorders in migrainous patients . Cephalalgia. 2003; 23: 79-89.
9- R, K., Psychosomatic disorders:The canalization of mind into matter. J Anal Psy. 2011; 56(1): 37-55.
10- Rains JC, P.D., McCrory GN. 2005; 45:92-109., Behavioral headache treatment: History view of the empirical literate ,and meta dialogical critique. Headache. 2005; 45: 92-109.
11- Kikuchi H, et al., Influence of psychological factors on acute exacerbation of tension-type headache: Investigation by ecological momentary assessment. J Psy Res. 2015; 79: 239-42.
12- Cathcart S, Petkov J, and W. AH, Central mechanisms of stress-induced headache. Cephalalgia. 2010; 30: 285-95.
13- Sadock BJ and S. VA, Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences /clinical psychiatry. 10th ed.Philadelphia, PA: Lippincott Williams & Wilkins. 2007.
14- J, O., Health Psychology: A Textbook, McGraw-Hill Education. 2007.
15- Galego JC, et al., Chronic daily headache: stress and impact on the quality of life. Arq Neur. 2007; 65(4B): 1126-9.
16- Black JM and H. JH, Medical-surgical Nursing: Clinical Management for Positive Outcome. Elsevier Saunders. 2005.
17- S., S. and B. B, Brunner and Suddarth text book of medical-surgical nursing. North America :Lippincott Williams & Wilkins. 2010.
18- Breslav NY, Schulte LR, and S. WF; Headache and major depression. Neurology. 2003; 54(2): 308-13.
19- Marlow  RA, Kegowicz CL, and K.N. Starkey. Prevalence of depression symptoms in outpatients with a complaint of headache. J Am Board Fam Med. 2009; 22(6): 633-7.
20- Heath, et al. 2008.
21- Fennell, Bent-levy, and &watsbrok. 2004.
22- CE., C., The effect of dialectical behavioral therapy on moderately depressed adults: A multiple baseline design.Ph.D.Dissertation.USA:. University of Denver College of psychology. 2006.
23- Simons J and G. R., The Distress Tolerance Scale: development and validation of a self-report measure. Motivation and Emotion. 2005; 29: 83-102.
24- Bendtsen L, et al., EFNS guideline on the treatment of tension-type headache-report of an EFNS task force. Eur J Neurol. 2010; 17: 1318.
25- Lozano Lópeza C, et al., Efficacy of manual therapy in the treatment of tension-type headache.A systematic review from 2000 to 2013. Neurología. 2016; 31(6): 357-69.
26- Frisch, M.B., Quality of life Therapy.New jersey: John Wiley & Sons Press. 2006.
27- S., J. and L. AP, Positive therapy (A meta-theory for Psychological practice). USA: Rutledge Press. 2006.
28- JL, M.-M., herapist’s guide to positive psychological interventions.New York: Academic Press. 2009.
29- Sanjuan P, Ruiz A, and P. A., Life satisfaction and positive adjustment as predicators of emotional distress in men with coronary heart diseases. J Happy Study. 2011; 32: 314-26.
30. R, B.-D., Practicing positive psychology coaching. Hoboken, NJ: Wiley. 2010.
31- MB, F., Evidence-Based Well-Being/ Positive Psychology Assessment and Intervention with Quality of Life Therapy and Coaching and the Quality of Life Inventory (QOLI). Soc Indic Res. 2013. 114: 193-227.
32- Abedi MR and v. P, Evaluation of quality of life therapy for parents of children with obsessive compulsive disorders in Iran. Eur child Adolesc psychiatry. 2010; 19(7): 605-13.
33- Rodrigve JR, Madel brot DA, and p. M.A, psychological intervation to improve quality of life and reduce psychological distress in adults awaiting kidney trans plantation. Nephrol Dial Transplant. 2010; 26(2): 709-15.
34- P., K.W., Spiritual  history  assessment  and occupational therapy:  students using  the   FICA.Washington , University  of Puget  Sound,  Unpublished  Master  Thesis in Occupational Therapy. 2012.
35- Pargament KI, et al., Religion and problem-solving process: Three styles of coping. J for the Sci Study of Rel. 2007; 27: 90-104.
36- Peters M, et al., Migraine and Chronic Daily Headache Management: A Qualitative Study of Patients’ Perceptions. Second J OF Car Sci. 2005; 18(3): 249-303.
37- Muller PS and D. Plevak, Religious involvement ,spiritual and medicine: Implication for clinical practice Mayo Clinical Preceding. 2001; 76: 1225-35.
38- D., B., Does Religious psychotherapy improve anxiety and depression in religious aduits? . Inte J of Psy Nur Res. 2002; 8(1):. 875-90.
39- Hoffman BM, et al., Meta-Analysis of Psychological Interventions for Chronic Low Back Pain. Orignal Res Article Health Psy. 2007; 26(1): 1-9.
40- RE., N. and S. Y, Culture ,change , and perception psychological science, 2001. 12: p. 450-456.
41- D`Souza RF and R. A, Spiritually augmented cognitive behavioral therapy. Australian Psychiatry. 2004; 12(2): 148-152.
42- Props, L., et al., Comparitive Efficacy of Religious and Nonreligious Cognitive-Behavioral Therapy for the Treatment of Clinical Depression. Journal of Consulting and Clinical Psychology. 1992; 60: 94-103.
43- Cole B and p.K.p. 495-407., Re-creating your life: a spritual psychotherapeutic intervention for people  diagnosed with concer psychology. 1999; 5(5): 407-95.
44- Paukert AL, et al., Integration of religion into cognitive-behavioral therapy for geriatric anxiety and depression. J Psychiatr Pract. 2009; 15(2): 103-12.
45- Ellison CG , Burdette AM, and H. TD, Blessed assurance: religion, anxiety, and tranquility among US adults. Soc Sci Res. 2009; 38(3): 656-67.
46- Koszycki D, et al., A multifaith spiritually based intervention for generalized anxiety disorder: a pilot randomized trial. J Clin Psychol. 2010; 66(4): 430-41.
47- Barrera TL, et al., Integrating religion and spirituality into treatment for late-life anxiety: three case studies. Cognitive and Behavioral Practice. 19(2): 346-58.
48- M., J., The study of effectiveness of psychotherapy with and without religious orientations on reducing of anxiety and stress. [Thesis].Tehran: Tarbiat Modares University.           [Persian]. 1999.
49- H., Y., Sohrabi F, and M. A, The comparison of cognitive behavior therapy and Islamic based spiritual religion psychotherapy on reducing of student's overt anxiety. Beh Sci Res. 2013; 10(2): 99-107.
50- M, J., Gray determine the effectiveness of the treatment of anxiety and stress with and without Islamic Orientation. Psy J. 2000; 4. [Persian].
51- Strauss A and J. C, Principles of qualitative research techniques and manufacturing processes underlying theory, translation: Ebrahim Afshar, publishing:  Straw. [Persian]. 2014.
52- N, H., Principles and methods of qualitative research.Thehran: Islamic Azad University. [Persian]. 2007.
53- Simons JS and G. RM, The Distress Tolerance Scale: Development and Validation of a Self-report Measure. . Motivation and Emotion. 2005; 29: 83-102.
54- Lavibond  PF and L. SH, The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behavior Research Therapy, 1995; 33(3): 335-43.
55- H, M., A Practical Guide SPSS  10-13-14, Esfahan: the dynamics of thought. 2008. [Persian].
56- MP, S., Authentic happiness.New York: Free Press. 2002.
57- MA, S., Key  concepts in  Islamic  spirituality: Love,  thankfulness  and  humbleness Z. . Message  of Thaqalayn. 2010; 11.
58- CR, K. and H. PS., Quality of Life from Nursing and Patient Perspective.Jones and Bartlett publishers. Massachusettes. 2003.
59- B., F., How religion helps us to health and well-being ?,. Journal of Psychology and Reli. 2009; 3: 127-40.[ Persian].
60- A, H., Relationship between religious orientation with mental disorders and academic achievement,. Psychology and Religion. 2009; 3: 107-79.                [Persian].
61- MH, S., Psychotherapy integration patterns.Qom: Institute of Science. 2014. [Persian].
62- V., W., Psychotherapy and spirituality. Translation Shahidi, Shirafkan Tehran: Roshd Publication. 2009. [Persian]. .
63- Lysne CJ and W. AB, Pain, spirituality, and meaning making, what can we learn from the literature? J Religions. 2011; 2(1): 1-16.
64- A, V., Spirituality and mental health. Indian J Psychiatry. 2008; 50(4): 233-7.
65- F, S., Effectiveness wait on anxiety and happiness. . Islamic Studies and Psychology. 2: 79-94.[Persian].
66- AS, P., The role of prayer in peace ,. Psychology  Dealing Reli. 2009; 1(1): 21-53.[Persian].
67- MB, Y., Effects  of spiritual  Capital  on Muslim  econmy:  The  case  of  Malaysia. Research  on  Humanities  and Social  Science. 2011; 1.
68- LR., P., Psychotherapy in a religious frame work. Man Sciences Pries. 2008.
69- B, T., Person-centered counseling and Christian spirituality: the secular and the holy.London: Whirr. 2008.
70- MH, T., Al-Mizan (Volume XI), Qom: . Islamic Publication. 1998. [Persian].