The effect of metacognitive-analytical therapy on the ego strength of nurses suffering from anxiety and depression in covid-19 wards

Document Type : Original Article

Authors

1 Ph.D. student of clinical psychology, Tehran University of Science and Culture

2 Assistant Professor and member of the Faculty of Psychology, Faculty of Human Sciences, University of Science and Culture, Tehran-Iran.

3 Assistant Professor of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran

Abstract

Introduction: The aim of this study was to investigate the effect of metacognitive analytical therapy on the ego strength of nurses suffering from anxiety and depression in COVID-19 wards.
Method: This study is applied in terms of its objective, In terms of method the single subject was semi-experimental (quantitative) of type A-B. The statistical population consisted of nurses with anxiety and depression disorders referred to psychological centers in Zahedan. Three participants were purposefully selected and underwent 10 sessions of intervention. Data were collected using the Ego Strength Questionnaire. Intra-situational and inter-situational visual analysis was used for data analysis.
Results: The results showed that the data of the two stages of the baseline and the intervention have a good non-overlap.Tau-U for the three participants )0.93, 0.82, 0.82(, respectively. Hedge's- g ) 1.73, 1.50, 0.84(, respectively, and the Reliable Change Index scores were 117.6, 21.96, 55.9(, respectively, indicating an increase in scores with a high effect size and significant reliable change.
Conclusion: Analytical metacognitive therapy has an effect on the ego strength of nurses. It is recommended to managers of health-therapeutic centers and psychologists to consider analytical metacognitive therapy in the prevention and treatment programs of psychological problems of people, especially nurses.

Keywords

Main Subjects


  1. منابع

    1. Karimi L, Sirti Nair M, Khalili R. stress comparison; Anxiety and depression of nursing and non-nursing staff in the face of covid-19. Journal of Nursing Research. 2022; 17(2): 49-50. (in Persian).
    2. Sun N, Shi S, Jiao D, Song R, & Wang H. A qualitative study on the psychological experience of caregivers of covid‐19 patients. American Journal of Infection Control.2020; 48(6): 592–598.
    3. Kaveh, M., Davari-tanha, F., Varaei, S., Shirali, E., Shokouhi, N., Nazemi, P., et al. Anxiety levels among Iranian health care workers during the COVID-19 surge: A cross-sectional study. medRxiv, JOGCR. 2022; 7(2): 69-76.
    4. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in china. International Journal of Environmental Research and Public Health.2020; 17 (5): 17-29.
    5. Yang L, Wu D, Hou Y, Wang X, Dai N, Wang G, et al. Analysis of psychological state and clinical psychological intervention model of patients with COVID-19. MedRxiv.2020; DOI:10.1101/2020.03.22.20040899
    6. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open. 2020; 2;3(3): 1-12.
    7. Eva Morawa LG, Adler w, Schug C, Borho A, Geiser F, Beschoner P, Jerg-Bretzke L, Albus C, Weidner K, Mogwitz S. Depression and anxiety among nurses during the COVID-19 pandemic: Longitudinal results over 2 years from the multicentre VOICE–EgePan study. Journal of Clinical Nursing. 2024; 33(6): 1-12.
    8. Sabokzaie A, Nastiezaie N. The Relationship of Meaning in Life, Spiritual Well-Being and Ego Strength with The Anxiety Related to COVID19. Positive psychology research paper. 2023; 9(33):107-124. (in Persian).
    9. Besharat MA, Asadi MM, Gholamali Lavasani M. The mediating role of ego strength in the relationship between dimensions of perfectionism and depressive symptoms. Rushdie psychology (Iranian psychologists magazine). 2017;13(51):229-243. (in Persian).
    10. Goryczka A D˛ebski P, Gogola AM, Gorczyca P, Piegza M. Depressive and Anxiety Symptoms and Their Relationships with Ego-Resiliency and Life Satisfaction amongWell-Educated, Young Polish Citizens during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health.2022; 19(16): 1-9.
    11. Sadri Damirchi E, Zakibakhsh Mohammadi N, Amir SMB. The Role of Thwarted Belongingness, Perceived Burden­someness, Self-Efficacy and Ego Strength in Predicting Suicidal Ideation of Nurses. Health in Emergencies and Disasters Quarterly. 2019; 4(2):85-92.
    12. Singh,N.,Anand,A. Ego-Strength and Self-Concept among Adolescents: A Study on Gender Differences. The International Journal of Indian Psychology. 2015; 3(1): 50-58.
    13. Kocheki Ravandi M, Munirpur N, Araj A. The role of attachment styles, the quality of subjective relationships and ego strength in predicting irritable syndrome; Faiz Journal of Medical Sciences. 2014; 19 (3): 231-241. (in Persian).
    14. Cui Y, Yang T, Gao H, Ren L, Liu N, Liu X, Zhang Y. The relationship between ego depletion and work alienation in Chinese nurses: A network analysis. Front Psychol. 2022; doi: 10.3389/fpsyg.2022.915959.
    15. Al-Harbi,B; Ibrahim, Kh; Al-Rababaah, J; Al- mehsin,S. The Ego Depletion and Its Relationship with the Future Anxiety among the University Female Students. International Journal of Higher Education.2021; 10(2): 128-139.
    16. Wegener JR, Ludlow CE, Olsen AJ, Tortosa M, Wintch PH. Ego Depletion: A contributing factor of hopelessness depression," Intuition: The BYU Undergraduate Journal of Psychology. 2007; 3(1). https://scholarsarchive.byu.edu/intuition/vol3/iss1/4.
    17. Summers F. Object relations theories and psychopathology: a comprehensive text.Published by Psychology Press, New York.2014.
    18. Eagle MN. Toward a Unified Psychoanalytic Theory, Foundation in a Revised and Expanded Ego Psychology, New York, NY; Routledge.2022.

    19.Janbozuri M, Gharvi SM. New theories of psychotherapy and counseling. Samt Publications, 2015. (in Persian).

    1. Corbridge c, Brummer L, Coid P. Cognitive Analytic Therapy: Distinctive Features (Psychotherapy and Counselling Distinctive Features) Published Routledge,2018.
    2. Ryle A, Kerr, IB. Introducing cognitive analytic therapy: principles and practice of a relational approach to mental health. Second edition. Hoboken, NJ, Wiley. 2020.
    3. Wakefield S, Delgadillo J, Kellett S, White S, Hepple J. The effectiveness of brief cognitive analytic therapy for anxiety and depression: A quasi-experimental case-control study. Br J Clin Psychol. 2021; 60(2):194-211.
    4. Hini S, Nirimani M, Atadokht A, Basharpour S, Sadeghi Movahed F. The effectiveness of cognitive-analytical therapy on ego strength and object relations of people with borderline personality disorder. Urmia Medical Journal, 2016; 29(1): 1-11. (in Persian).
    5. Wells A. Metacognitive Therapy for Anxiety and Depression. Publisher ‏The Guilford Press; Reprint edition. 2009.
    6. Wells A. Cognition about cognition: metacognitive therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice. 2007; 14(1)18-25.
    7. Flavell, J.H. Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry. American Psychologist.1979; 34(10): 906-911.
    8. Wells A, Matthews G. Modeling cognition in emotional disorder: The S-REF model. Behav ResTher 1996; 34(11): 881-888.
    9. Besharat MA, Ramesh S. Worry, anger rumination, ego-strength and adjustment to heart diseaseInquiétude, rumination de la colère, force de l’ego et adaptation aux maladies cardiaques.2023;181(8):726-730.
    10. Hagen R, Kennair LEO. Metacognitive therapy for depression. Cogent Mental Health. 2024., 3(1), 1–19.
    11. Rafezi Z, Pirabbasi G, Eskandari H. Efficasy of group metacognitive therapy on emotional self-regulation and ego strength of anxious students. Monthly Journal of Psychological Science. 2022; 20(108): 2239-2254
    12. Cyranka k, Rutkowski k, Mielimąka m, Sobański j, Klasa K, Müldner-Nieckowski l, et al. Changes in ego strength in patients with neurotic and personality disorders treated with a short-term comprehensive psychodynamic psychotherapy. Psychiatr.2018; 52 (1): 115–127.
    13. Neal D. Metacognitive Changes in Individuals with Severe Mental Illness in Response to Psychoanalytic Therapy, Thesis Ph.D. of Clinical Psychology George Fox University. 2020.
    14. Parviz K, Agha Mohammadian Shearbaf HR, Ghanbari Hashimabadi BA, Dehghani M. The relationship between ego strength and metacognition in male and female students. Journal of Education Strategies in Medical Sciences. 2015; 9 (2): 126-118. (in Persian).
    15. Parviz K, Agha Mohammadian Shearbaf HR, Dehghani M, Ghanbari Hashimabadi BA. Investigating the relationship between superego and metacognition among male and female students at Ferdowsi University of Mashhad. Journal of Principles of Mental Health. 2015, 19(2)70-76. (in Persian).
    16. Parviz K. Development of a comprehensive model of superego and metacognitive functioning (CMSMO) in obsessive-compulsive disorder and antisocial personality disorder. Construction and validation of metaself-metacognition conflict test (SMCQ) based on CMSMO. PhD thesis, Ferdowsi University of Mashhad. 2015. (in Persian).
    17. Freud, S. An outline of psycho-analysis. The International Journal of Psychoanalysis.1940., 21, 27–84.
    18. Hosseini-Ramaghani NA, Rezaei F, Sepahvandi MA, Gholamrezaei S, Mirderikvand F. The mediating role of the metacognition, time perspectives and experiential avoidance on the relationship between childhood trauma and post-traumatic stress disorder symptoms European Journal of Psychotraumatology.2019; 10 (1):10.1080/20008198.2019.1648173
    19. Demirdogen ES, Algedik P, Warikoo N, Bahadır E, AkbiyikM, et al. The associations between metacognition problems, childhood trauma and internalizing symptoms in healthcare workers working directly with patients infected with COVID-19. Psychology, Health & Medicine.2022; 27(9): 1937-1950.
    20. Martin S, Strodl E. The relationship between childhood trauma, eating behaviours, and the mediating role of metacognitive beliefs. Appetite. 2023;188(1). doi: 10.1016/j.appet.2023.106975.
    21. Shahbakhsh R, Soleimani A, Kachooei M, Farahani HU. Developing and feasibility of metacognitive-analytic treatment protocol to increase ego strength and reduce anxiety and depression of nurses in covid-19 wards.Scientific Journal of Clinical Psychology and Personality of Shahed University(In press).
    22. Freud A. The ego and the mechanisms of defense (revised edition). Connecticut: International Universities Press. 1966.