اثربخشی درمان مبتنی بر پذیرش و تعهد بر معنای زندگی، تحمل پریشانی هیجانی و خودکارآمدی درد در بیماران مبتلا به مولتیپل اسکلروزیس

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشیار ،گروه علوم تربیتی دانشگاه حکیم سبزواری ، سبزوار، ایران

2 کارشناسی ارشد روانشناسی بالینی، گروه روانشناسی دانشگاه آزاد اسلامی واحد علوم و تحقیقات خراسان رضوی ،نیشابور، ،ایران

3 کارشناسی ارشد روان شناسی بالینی،گروه روان شناسی دانشگاه فردوسی مشهد ،مشهد ،ایران

10.22075/jcp.2019.16347.1557

چکیده

مقدمه: مولتیپل اسکلروزیس یک بیماری التهابی است که عوارض جسمانی و روانشناختی متعددی را به همراه دارد. این پژوهش با هدف بررسی اثربخشی درمان مبتنی برپذیرش و تعهد بر معنای زندگی، تحمل پریشانی هیجانی و خودکارآمدی درد در بیماران مبتلا به مولتیپل اسکلروزیس انجام گرفت.
روش: پژوهش حاضر با استفاده از طرح پیش آزمون پس آزمون با گروه کنترل انجام شد. از بین اعضای انجمن مولتیپل اسکلروزیس شهرستان قوچان در سال 1397، 20 نفر به روش نمونه‌گیری در دسترس انتخاب و به طور تصادفی در دو گروه آزمایش و کنترل قرار داده شدند. گروه آزمایش طی 8 جلسه تحت درمان گروهی مبتنی بر پذیرش و تعهد قرار گرفتند، در حالی که گروه کنترل روند عادی جلسه های انجمن MS را می گذراندند. پرسشنامه های معنای زندگی، تحمل پریشانی و خود کارآمدی درد در پیش آزمون و پس آزمون مورد استفاده قرار گرفت. داده ها با استفاده از تحلیل کواریانس چند متغیره تجزیه و تحلیل شد.
یافته ها: نتایج نشان داد که آزمودنی های گروه آزمایش در مقایسه با گروه کنترل در متغیرهای معنای زندگی و مولفه های آن (وجود معنای زندگی و جست و جوی معنای زندگی )، تحمل پریشانی هیجانی و خرده مقیاس هایش (تحمل ،جذب ،ارزیابی وتنظیم) و خودکارآمدی درد (0/05>p) بهبود معنادار داشتند.
بحث و نتیجه گیری: درمان مبتنی برپذیرش و تعهد منجر به بهبود معنی دار معنای زندگی، تحمل پریشانی هیجانی و خودکارآمدی درد در بیماران مبتلا به مولتیپل اسکلروزیس می شود.

کلیدواژه‌ها


عنوان مقاله [English]

Effectiveness of Acceptance and Commitment Therapy in the Meaning in Life, Emotional Distress Tolerance and Pain Self-Efficacy in Patients with Multiple Sclerosis

نویسندگان [English]

  • Hossein Shareh 1
  • Faezeh Dalalmoqaddam 2
  • ٍElham Haghi 3
1 Associate Professor , Department of Literature and Humanities, Hakim Sabzevari University, Hakim Sabzevari Iran
2 MA in Clinical Psychology, Department of Psychology, Islamic Azad University, Science and Research Branch, Khorasan Razavi (Neyshabour), Iran
3 Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
چکیده [English]

Introduction: Multiple Sclerosis is an inflammatory disease that is associated with several physical and psychological complications. This study was conducted with the aim of investigating the effectiveness of acceptance and commitment therapy (ACT) in the meaning of life, emotional distress tolerance and pain self-efficacy among patients with multiple sclerosis.
Method: The present research was carried out using a pretest-posttest control ‎group design. Out of Multiple Sclerosis ‎Association‎ members in Quchan County in 2019, 20 subjects were chosen through available sampling method and were randomly assigned into two experimental and control groups. The experimental group received 8 sessions of acceptance and commitment group therapy whereas the control group attended the regular meetings held by the MS Society. Meaning in Life Questionnaire ‎‎(MLQ), Distress Tolerance Scale and Pain Self-Efficacy Questionnaire were applied in the pretest and posttest. The data were analyzed using multivariate analysis of covariance.
Findings: The results demonstrated that the experimental group subjects compared to the control group participants significantly improved in the variables of the meaning in life and its components (P

کلیدواژه‌ها [English]

  • acceptance and commitment therapy
  • meaning in life
  • distress tolerance
  • self-efficacy
  • Multiple sclerosis
منابع
1. Cohen JA, Rae-Grant, Alexander In: 2012, editor. Handbook of multiple sclerosis.
2. Marrie R, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated. Multiple Sclerosis Journal. 2009;15(3):385-92.
3. Raskind MA. Diagnosis and treatment of depression comorbid with neurologic disorders. The American journal of medicine. 2008; 121(11): S28-S37.
4. Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. Journal of the neurological sciences. 2002; 205(1): 51-8.
5. Baradaran M, Zare H, Alipuor A, Farzad V. Comparison of Effectiveness of Acceptance and Commitment Therapy and Motivational Interviewing on Decreasing Anxiety, Depression, Stress and Increasing Hope in Essential Hypertensive Patients. Clinical Psychology. 2016; 8(4): 95-105.
6. Solaro C, Brichetto G, Amato M, Cocco E, Colombo B, D’aleo G, et al. The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology. 2004; 63(5): 919-21.
7. Denison E, Åsenlöf P, Sandborgh M, Lindberg P. Musculoskeletal pain in primary health care: subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables. The Journal of Pain. 2007; 8(1): 67-74.
8. Zeldin AL, Britner SL, Pajares F. A comparative study of the self‐efficacy beliefs of successful men and women in mathematics, science, and technology careers. Journal of Research in Science Teaching: The Official Journal of the National Association for Research in Science Teaching. 2008; 45(9): 1036-58.
9. Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs—a moderator of treatment efficacy in patients with low back pain: a systematic review. The Spine Journal. 2014; 14(11): 2658-78.
10. Wells-Federman C, Arnstein P, Caudill M. Nurse-led pain management program: effect on self-efficacy, pain intensity, pain-related disability, and depressive symptoms in chronic pain patients. Pain Management Nursing. 2002; 3(4): 131-40.
11. Keough ME, Riccardi CJ, Timpano KR, Mitchell MA, Schmidt NB. Anxiety symptomatology: The association with distress tolerance and anxiety sensitivity. Behavior therapy. 2010; 41(4): 567-74.
12. Potter CM, Vujanovic AA, Marshall-Berenz EC, Bernstein A, Bonn-Miller MO. Posttraumatic stress and marijuana use coping motives: The mediating role of distress tolerance. Journal of anxiety disorders. 2011; 25(3): 437-43.
13. Simons JS, Gaher RM. The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion. 2005; 29(2): 83-102.
14. Dennison L, Moss-Morris R, Silber E, Galea I, Chalder T. Cognitive and behavioural correlates of different domains of psychological adjustment in early-stage multiple sclerosis. Journal of psychosomatic research. 2010; 69(4): 353-61.
15. Smith S, Young C. The role of affect on the perception of disability in multiple sclerosis. Clinical rehabilitation. 2000; 14(1): 50-4.
16. Rutherford HJ, Goldberg B, Luyten P, Bridgett DJ, Mayes LC. Parental reflective functioning is associated with tolerance of infant distress but not general distress: Evidence for a specific relationship using a simulated baby paradigm. Infant Behavior and Development. 2013; 36(4): 635-41.
17. Feldman DB, Snyder CR. Hope and the meaningful life: Theoretical and empirical associations between goal–directed thinking and life meaning. Journal of social and clinical psychology. 2005; 24(3): 401-21.
18. Halama P, Dedova M. Meaning in life and hope as predictors of positive mental health: Do they explain residual variance not predicted by personality traits? Studia psychologica. 2007; 49(3): 191.
19. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy. 2004; 35(4): 639-65.
20. Pakenham KI, Scott T, Uccelli MM. Evaluation of Acceptance and Commitment Therapy Training for Psychologists Working with People with Multiple Sclerosis. International journal of MS care. 2018; 20(1): 44-8.
21. Bayati A, Abbasi P, Bashiri H, Dehghan F, Yazdanbakhsh K. The Effectiveness of Acceptance and Commitment Therapy on Psychological Well-Being in Women with Ms. Iioab Journal. 2017; 8(1): 82-6.
22. Eifert GH, Heffner M. The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry. 2003; 34(3-4): 293-312.
23. Hayes SC, Pistorello J, Levin ME. Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist. 2012; 40(7): 976-1002.
24. Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior therapy. 2013; 44(2): 180-98.
25. Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of counseling psychology. 2006; 53(1): 80.
26. Mesrabadi J, Jafariyan S, Ostovar N. Discriminative and construct validity of meaning in life questionnaire for Iranian students. International Journal of Behavioral Sciences. 2013; 7(1): 83-90.
27. Shams J, Azizi A, Mirzaei A. Correlation between distress tolerance and emotional regulation with students smoking dependence. Hakim Research Journal. 2010; 13(1): 11-8.
28. Nicholas MK. The pain self‐efficacy questionnaire: Taking pain into account. European journal of pain. 2007; 11(2): 153-63.
29. Mesgarian F, ASGHARI MM, Shairi M. The role of self-efficacy in predicting catastrophic depression in patients with chronic pain. JOURNAL OF CLINICAL PSYCHOLOGY. 2013; 4(16): 73-82.
30. Nicholas M, editor Self-efficacy and chronic pain. St Andrews: Annual Conference of British Psychological Society, 1989; 1989.
31. Asghari Moghaddam MA JS. Investigating the role ofanger and the perception of error in adaptation to chronic pain. Journal of Psychology and Cognition. 2008; 12(3): 314-31.
32. Yazdanbakhsh K, Kaboudi M, Roghanchi M, Dehghan F, Nooripour R. The effectiveness of acceptance and commitment therapy on psychological adaptation in women with MS. Journal of Fundamental and Applied Sciences. 2016; 8: 2767-77.
33. Feeney J. Physical Disability and Psychological Distress in Multiple Sclerosis: The Role of Illness Representations and Experiential Avoidance: Cardiff University. 2012.
34. Sheppard SC, Forsyth JP, Hickling EJ, Bianchi J. A novel application of acceptance and commitment therapy for psychosocial problems associated with multiple sclerosis: Results from a half-day workshop intervention. International Journal of MS Care. 2010; 12(4): 200-6.
35. Gillanders S, Gillanders D. An acceptance and commitment therapy intervention for a woman with secondary progressive multiple sclerosis and a history of childhood trauma. Neuro-Disability and Psychotherapy. 2014; 2(1-2): 19-40.
36. Sheydayi Aghdam S, Shamseddini Lory S, Abassi S, Yosefi S, Abdollahi S, Moradi Joo M. The effectiveness of treatment based on acceptance and commitment in reducing distress and inefficient attitudes in patients with MS. J Consult Clin Psychol. 2014; 9(34): 57-66.
37. Seyfollahi M, Monfaredi A, Mohtashami J, Mohammadi H. Effectiveness of acceptance and commitment therapy (ACT) on reducing anxiety, depression and increasing the quality of life and self-efficacy in patients with multiple sclerosis (MS). Journal of Fundamentals of Mental Health. 2016; 18: 596-605.
38. Nordin L, Rorsman I. Cognitive behavioural therapy in multiple sclerosis: a randomized controlled pilot study of acceptance and commitment therapy. Journal of rehabilitation medicine. 2012; 44(1): 87-90.
39. Pourfaraj OM. The effectiveness of acceptance and commitment group therapy in social phobia of students. KNOWLEDGE AND HEALTH. 2011; 6(2): 1-5.
40. Veehof MM, Oskam M-J, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. PAIN®. 2011; 152(3): 533-42.
41. Godfrey E, Holmes MG, Wileman V, McCracken L, Norton S, Moss-Morris R, et al. Physiotherapy informed by Acceptance and Commitment Therapy (PACT): protocol for a randomised controlled trial of PACT versus usual physiotherapy care for adults with chronic low back pain. BMJ open. 2016; 6(6): e011548.
42. Hoffmann D, Halsboe L, Eilenberg T, Jensen JS, Frostholm L. A pilot study of processes of change in group-based acceptance and commitment therapy for health anxiety. Journal of Contextual Behavioral Science. 2014; 3(3): 189-95.
43. Hayes SC, Villatte M, Levin M, Hildebrandt M. Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual review of clinical psychology. 2011; 7(1): 141-68.
44. Alonso-Fernández M, López-López A, Losada A, González JL, Wetherell JL. Acceptance and commitment therapy and selective optimization with compensation for institutionalized older people with chronic pain. Pain medicine. 2016; 17(2): 264-77.
45. Dewhurst E, Novakova B, Reuber M. A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy. Epilepsy & Behavior. 2015; 46: 234-41.
46. Forman EM, Herbert JD. New directions in cognitive behavior therapy: Acceptance-based therapies. General principles and empirically supported techniques of cognitive behavior therapy. 52009. p. 77-101.
47. Weinstein N, Brown KW, Ryan RM. A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality. 2009; 43(3): 374-85.
48. Pull CB. Current empirical status of acceptance and commitment therapy. Current Opinion in Psychiatry. 2009; 22(1): 55-60.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
منابع
1. Cohen JA, Rae-Grant, Alexander In: 2012, editor. Handbook of multiple sclerosis.
2. Marrie R, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated. Multiple Sclerosis Journal. 2009;15(3):385-92.
3. Raskind MA. Diagnosis and treatment of depression comorbid with neurologic disorders. The American journal of medicine. 2008; 121(11): S28-S37.
4. Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. Journal of the neurological sciences. 2002; 205(1): 51-8.
5. Baradaran M, Zare H, Alipuor A, Farzad V. Comparison of Effectiveness of Acceptance and Commitment Therapy and Motivational Interviewing on Decreasing Anxiety, Depression, Stress and Increasing Hope in Essential Hypertensive Patients. Clinical Psychology. 2016; 8(4): 95-105.
6. Solaro C, Brichetto G, Amato M, Cocco E, Colombo B, D’aleo G, et al. The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology. 2004; 63(5): 919-21.
7. Denison E, Åsenlöf P, Sandborgh M, Lindberg P. Musculoskeletal pain in primary health care: subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables. The Journal of Pain. 2007; 8(1): 67-74.
8. Zeldin AL, Britner SL, Pajares F. A comparative study of the self‐efficacy beliefs of successful men and women in mathematics, science, and technology careers. Journal of Research in Science Teaching: The Official Journal of the National Association for Research in Science Teaching. 2008; 45(9): 1036-58.
9. Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs—a moderator of treatment efficacy in patients with low back pain: a systematic review. The Spine Journal. 2014; 14(11): 2658-78.
10. Wells-Federman C, Arnstein P, Caudill M. Nurse-led pain management program: effect on self-efficacy, pain intensity, pain-related disability, and depressive symptoms in chronic pain patients. Pain Management Nursing. 2002; 3(4): 131-40.
11. Keough ME, Riccardi CJ, Timpano KR, Mitchell MA, Schmidt NB. Anxiety symptomatology: The association with distress tolerance and anxiety sensitivity. Behavior therapy. 2010; 41(4): 567-74.
12. Potter CM, Vujanovic AA, Marshall-Berenz EC, Bernstein A, Bonn-Miller MO. Posttraumatic stress and marijuana use coping motives: The mediating role of distress tolerance. Journal of anxiety disorders. 2011; 25(3): 437-43.
13. Simons JS, Gaher RM. The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion. 2005; 29(2): 83-102.
14. Dennison L, Moss-Morris R, Silber E, Galea I, Chalder T. Cognitive and behavioural correlates of different domains of psychological adjustment in early-stage multiple sclerosis. Journal of psychosomatic research. 2010; 69(4): 353-61.
15. Smith S, Young C. The role of affect on the perception of disability in multiple sclerosis. Clinical rehabilitation. 2000; 14(1): 50-4.
16. Rutherford HJ, Goldberg B, Luyten P, Bridgett DJ, Mayes LC. Parental reflective functioning is associated with tolerance of infant distress but not general distress: Evidence for a specific relationship using a simulated baby paradigm. Infant Behavior and Development. 2013; 36(4): 635-41.
17. Feldman DB, Snyder CR. Hope and the meaningful life: Theoretical and empirical associations between goal–directed thinking and life meaning. Journal of social and clinical psychology. 2005; 24(3): 401-21.
18. Halama P, Dedova M. Meaning in life and hope as predictors of positive mental health: Do they explain residual variance not predicted by personality traits? Studia psychologica. 2007; 49(3): 191.
19. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy. 2004; 35(4): 639-65.
20. Pakenham KI, Scott T, Uccelli MM. Evaluation of Acceptance and Commitment Therapy Training for Psychologists Working with People with Multiple Sclerosis. International journal of MS care. 2018; 20(1): 44-8.
21. Bayati A, Abbasi P, Bashiri H, Dehghan F, Yazdanbakhsh K. The Effectiveness of Acceptance and Commitment Therapy on Psychological Well-Being in Women with Ms. Iioab Journal. 2017; 8(1): 82-6.
22. Eifert GH, Heffner M. The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry. 2003; 34(3-4): 293-312.
23. Hayes SC, Pistorello J, Levin ME. Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist. 2012; 40(7): 976-1002.
24. Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior therapy. 2013; 44(2): 180-98.
25. Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of counseling psychology. 2006; 53(1): 80.
26. Mesrabadi J, Jafariyan S, Ostovar N. Discriminative and construct validity of meaning in life questionnaire for Iranian students. International Journal of Behavioral Sciences. 2013; 7(1): 83-90.
27. Shams J, Azizi A, Mirzaei A. Correlation between distress tolerance and emotional regulation with students smoking dependence. Hakim Research Journal. 2010; 13(1): 11-8.
28. Nicholas MK. The pain self‐efficacy questionnaire: Taking pain into account. European journal of pain. 2007; 11(2): 153-63.
29. Mesgarian F, ASGHARI MM, Shairi M. The role of self-efficacy in predicting catastrophic depression in patients with chronic pain. JOURNAL OF CLINICAL PSYCHOLOGY. 2013; 4(16): 73-82.
30. Nicholas M, editor Self-efficacy and chronic pain. St Andrews: Annual Conference of British Psychological Society, 1989; 1989.
31. Asghari Moghaddam MA JS. Investigating the role ofanger and the perception of error in adaptation to chronic pain. Journal of Psychology and Cognition. 2008; 12(3): 314-31.
32. Yazdanbakhsh K, Kaboudi M, Roghanchi M, Dehghan F, Nooripour R. The effectiveness of acceptance and commitment therapy on psychological adaptation in women with MS. Journal of Fundamental and Applied Sciences. 2016; 8: 2767-77.
33. Feeney J. Physical Disability and Psychological Distress in Multiple Sclerosis: The Role of Illness Representations and Experiential Avoidance: Cardiff University. 2012.
34. Sheppard SC, Forsyth JP, Hickling EJ, Bianchi J. A novel application of acceptance and commitment therapy for psychosocial problems associated with multiple sclerosis: Results from a half-day workshop intervention. International Journal of MS Care. 2010; 12(4): 200-6.
35. Gillanders S, Gillanders D. An acceptance and commitment therapy intervention for a woman with secondary progressive multiple sclerosis and a history of childhood trauma. Neuro-Disability and Psychotherapy. 2014; 2(1-2): 19-40.
36. Sheydayi Aghdam S, Shamseddini Lory S, Abassi S, Yosefi S, Abdollahi S, Moradi Joo M. The effectiveness of treatment based on acceptance and commitment in reducing distress and inefficient attitudes in patients with MS. J Consult Clin Psychol. 2014; 9(34): 57-66.
37. Seyfollahi M, Monfaredi A, Mohtashami J, Mohammadi H. Effectiveness of acceptance and commitment therapy (ACT) on reducing anxiety, depression and increasing the quality of life and self-efficacy in patients with multiple sclerosis (MS). Journal of Fundamentals of Mental Health. 2016; 18: 596-605.
38. Nordin L, Rorsman I. Cognitive behavioural therapy in multiple sclerosis: a randomized controlled pilot study of acceptance and commitment therapy. Journal of rehabilitation medicine. 2012; 44(1): 87-90.
39. Pourfaraj OM. The effectiveness of acceptance and commitment group therapy in social phobia of students. KNOWLEDGE AND HEALTH. 2011; 6(2): 1-5.
40. Veehof MM, Oskam M-J, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. PAIN®. 2011; 152(3): 533-42.
41. Godfrey E, Holmes MG, Wileman V, McCracken L, Norton S, Moss-Morris R, et al. Physiotherapy informed by Acceptance and Commitment Therapy (PACT): protocol for a randomised controlled trial of PACT versus usual physiotherapy care for adults with chronic low back pain. BMJ open. 2016; 6(6): e011548.
42. Hoffmann D, Halsboe L, Eilenberg T, Jensen JS, Frostholm L. A pilot study of processes of change in group-based acceptance and commitment therapy for health anxiety. Journal of Contextual Behavioral Science. 2014; 3(3): 189-95.
43. Hayes SC, Villatte M, Levin M, Hildebrandt M. Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual review of clinical psychology. 2011; 7(1): 141-68.
44. Alonso-Fernández M, López-López A, Losada A, González JL, Wetherell JL. Acceptance and commitment therapy and selective optimization with compensation for institutionalized older people with chronic pain. Pain medicine. 2016; 17(2): 264-77.
45. Dewhurst E, Novakova B, Reuber M. A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy. Epilepsy & Behavior. 2015; 46: 234-41.
46. Forman EM, Herbert JD. New directions in cognitive behavior therapy: Acceptance-based therapies. General principles and empirically supported techniques of cognitive behavior therapy. 52009. p. 77-101.
47. Weinstein N, Brown KW, Ryan RM. A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality. 2009; 43(3): 374-85.
48. Pull CB. Current empirical status of acceptance and commitment therapy. Current Opinion in Psychiatry. 2009; 22(1): 55-60.