Document Type : Research Article (s)

Authors

Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran

Abstract

Background: Adolescents with leukemia experience a variety of physical and psychological stresses that affect their quality of life. Given the association of resilience and existential anxiety with cancer, one of the methods to help adolescents with leukemia is through dialectical behavior therapy (DBT). The present study aimed to determine the effectiveness of DBT on psychological resilience and existential anxiety in adolescents with leukemia.
Methods: This quasi-experimental study included a pretest / posttest design and a control group. The study sample consisted of 38 adolescents with leukemia living in Rasht City, Guilan Province, Iran (2019); the participants were selected by a simple random sampling and were randomized into an experimental and a control group. Connor-Davidson Resilience Scale (CD-RISC) and Existential Anxiety Inventory (EAI) were used for data collection before and after the intervention. A 12-session DBT was performed for the experimental group, but the control group received no treatment. The analysis of covariance (ANCOVA) was used for data analysis.
Results: The mean ± standard deviation (SD) of the post-test scores for personal competence, strengthening effect of stress, positive acceptance of change, perceptions of control, spiritual influences, and existential anxiety were respectively 29.83 ± 2.28, 24.47 ± 2.51, 17.58 ± 2.19, 10.82 ± 2.47, 6.96 ± 2.14, and 11.75 ± 2.65 in the experimental group and 13.81 ± 2.31, 12.61 ± 2.84, 9.97 ± 2.45, 4.28 ± 1.66, 3.74 ± 1.19, and 22.31 ± 2.23 in the control group. The results indicated that the DBT improved the psychological resilience and existential anxiety in adolescents with leukemia (p <0.001).
Conclusions: DBT can be an appropriate therapy for reducing the anxiety in adolescents with leukemia and increasing the resilience in people with chronic diseases; it can also result in life satisfaction among adolescents. This research confirms the fundamental importance of the above facts for education and mental health of adolescents.

Keywords

1. Vora A. Childhood acute lymphoblastic leukemia. Switzerland: Springer; 2017. ## 2. Abel GA, Klepin HD. Frailty and the management of hematologic malignancies. Blood. 2018;131:515-24. doi: 10.1182/blood-2017-09-746420. PubMed PMID: 29141942. ## 3. Abla O, Coco FL, Sanz MA. Acute promyelocytic leukemia: A clinical guide. Switzerland: Springer; 2018. ## 4. Belson M, Kingsley B, Holmes A. Risk factors for acute leukemia in children: A review. Environ Health Perspect. 2007;115:138-45. doi: 10.1289/ehp.9023. PubMed PMID: 17366834; PubMed Central PMCID: PMCPMC1817663. ## 5. Almeida A, De Azevedo I, Pinto D, Vitor A, Santos V, Ferreira JM. Clinical and epidemiological aspects of leukemias. Revista Cubana de Hematología, Inmunología y Hemoterapia. 2017;33:1-14. ## 6. Koohi F, Ghoncheh M, H S. Epidemiology and trend of incidence of the Leukemia in Iran. Journal of Isfahan Medical School. 2016;33:2055-61. ## 7. Rodin G, Deckert A, Tong E, Le LW, Rydall A, Schimmer A, et al. Traumatic stress in patients with acute leukemia: A prospective cohort study. Psychooncology. 2018;27:515-23. doi: 10.1002/pon.4488. PubMed PMID: 28665521. ## 8. Udensi UK, Tchounwou PB. Dual effect of oxidative stress on leukemia cancer induction and treatment. J Exp Clin Cancer Res. 2014;33:1-15. doi: 10.1186/s13046-014-0106-5. PubMed PMID: 25519934; PubMed Central PMCID: PMCPMC4320640. ## 9. Goyal NG, Maddocks KJ, Johnson AJ, Byrd JC, Westbrook TD, Andersen BL. Cancer-specific stress and trajectories of psychological and physical functioning in patients with relapsed/refractory chronic lymphocytic leukemia. Ann Behav Med. 2018;52:287-98. doi: 10.1093/abm/kax004. PubMed PMID: 30084895; PubMed Central PMCID: PMCPMC6408323. ## 10. Poole JC, Dobson KS, Pusch D. Childhood adversity and adult depression: The protective role of psychological resilience. Child Abuse Negl. 2017;64:89-100. doi: 10.1016/j.chiabu.2016.12.012. PubMed PMID: 28056359. ## 11. Dooley LN, Slavich GM, Moreno PI, Bower JE. Strength through adversity: Moderate lifetime stress exposure is associated with psychological resilience in breast cancer survivors. Stress Health. 2017;33:549-57. doi: 10.1002/smi.2739. PubMed PMID: 28052491; PubMed Central PMCID: PMCPMC5496804. ## 12. Gloria CT, Steinhardt MA. Relationships among positive emotions, coping, resilience and mental health. Stress Health. 2016;32:145-56. doi: 10.1002/smi.2589. PubMed PMID: 24962138. ## 13. Sharpe L, Curran L, Butow P, Thewes B. Fear of cancer recurrence and death anxiety. Psychooncology. 2018;27:2559-65. doi: 10.1002/pon.4783. PubMed PMID: 29843188. ## 14. Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. Bmj. 2018;361:k1415. doi: 10.1136/bmj.k1415. PubMed PMID: 29695476. ## 15. Hu T, Zhang D, Wang J. A meta-analysis of the trait resilience and mental health. Pers Individ Dif. 2015;76:18-27. doi: 10.1016/j.paid.2014.11.039. ## 16. Vartolomei L, Ferro M, Mirone V, Shariat SF, Vartolomei MD. Systematic review: Depression and anxiety prevalence in bladder cancer patients. Bladder Cancer. 2018;4:319-26. doi: 10.3233/blc-180181. PubMed PMID: 30112443; PubMed Central PMCID: PMCPMC6087432. ## 17. Hong K, Liu G, Chen W, Hong S. Classification of the emotional stress and physical stress using signal magnification and canonical correlation analysis. Pattern Recogn. 2018;77:140–9. doi: 10.1016/j.patcog.2017.12.013. ## 18. Rahbar Karbasdehi E, Abolghasemi A, Rahbar Karbasdehi F. The effectiveness of schema therapy integrated with rehabilitation on cognitive emotion regulation and existential anxiety in patients with congestive heart failure. J Contemp Psychother. 2018;48:233-9. doi: 10.1007/s10879-018-9390-2. ## 19. An E, Lo C, Hales S, Zimmermann C, Rodin G. Demoralization and death anxiety in advanced cancer. Psychooncology. 2018;27:2566-72. doi: 10.1002/pon.4843. PubMed PMID: 30053317. ## 20. De Siqueira S. Existential meaning of patients with chronic facial pain. J Relig Health. 2018;57:1125-32. doi: 10.1007/s10943-018-0583-5. PubMed PMID: 29455430. ## 21. Kunin-Batson AS, Lu X, Balsamo L, Graber K, Devidas M, Hunger SP, et al. Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study. Cancer. 2016;122:1608-17. doi: 10.1002/cncr.29946. PubMed PMID: 27028090; PubMed Central PMCID: PMCPMC4860039. ## 22. Grossman CH, Brooker J, Michael N, Kissane D. Death anxiety interventions in patients with advanced cancer: A systematic review. Palliat Med. 2018;32:172-84. doi: 10.1177/0269216317722123. PubMed PMID: 28786328. ## 23. Dobson K, Dozois D. Handbook of cognitive-behavioral therapies. 4th ed. New York: Guilford Publications; 2019. ## 24. Prochaska J, Norcross J. Systems of psychotherapy: A transtheoretical analysis. 9th ed. New York: Oxford University Press; 2018. ## 25. Linehan MM. DBT skills training manual. 2nd ed. New York: Guilford Press; 2015. ## 26. De Silva P. The psychology of emotions and humour in buddhism. Palgrave Pivot, Cham: Springer; 2018. ## 27. Haghayegh S, Neshatdoost H, Adibi P, Shafii F. Efficacy of dialectical behavior therapy on stress, resilience and coping strategies in irritable bowel syndrome patients. Zahedan Journal of Research in Medical Sciences. 2017;19:e5809. doi: 10.17795/zjrms-5809. ## 28. Navarro-Haro MV, Modrego-Alarcón M, Hoffman HG, López-Montoyo A, Navarro-Gil M, Montero-Marin J, et al. Evaluation of a mindfulness-based intervention with and without virtual reality dialectical behavior therapy mindfulness skills training for the treatment of generalized anxiety disorder in primary care: A pilot study. Front Psychol. 2019;10:1-14. doi: 10.3389/fpsyg.2019.00055. PubMed PMID: 30745888; PubMed Central PMCID: PMCPMC6360930. ## 29. Lee S, Mason M. Effectiveness of brief DBT-informed group therapy on psychological resilience: A preliminary naturalistic study. J College Stud Psychother. 2019;33:25-37. doi: 10.1080/87568225.2018.1425646. ## 30. Lothes J, Mochrie K, Wilson M, Hakan R. The effect of DBT-informed mindfulness skills (what and how skills) and mindfulness-based stress reduction practices on test anxiety in college students: A mixed design study. Curr Psychol. 2021;40:2764-77. doi: 10.1007/s12144-019-00207-y. ## 31. Rosner B. Fundamentals of biostatistics. 8th ed. Boston: Cengage learning; 2015. ## 32. Clark MP, Westerberg BD. Holiday review. How random is the toss of a coin? Cmaj. 2009;181:E306-8. doi: 10.1503/cmaj.091733. PubMed PMID: 19969575; PubMed Central PMCID: PMCPMC2789164. ## 33. Connor KM, Davidson JR. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:76-82. doi: 10.1002/da.10113. PubMed PMID: 12964174. ## 34. Good LR, Good KC. A preliminary measure of existential anxiety. Psychol Rep. 1974;34:72-4. doi: 10.2466/pr0.1974.34.1.72. PubMed PMID: 4813985. ## 35. Hashim BL, Vadnais M, Miller AL. Improving adherence in adolescent chronic kidney disease: A dialectical behavior therapy (DBT) feasibility trial. Clin Pract Pediatr Psychol. 2013;1:369-79. doi: 10.1037/cpp0000024. ## 36. Lois BH, Miller AL. Stopping the nonadherence cycle: The clinical and theoretical basis for dialectical behavior therapy adapted for adolescents with chronic medical illness (DBT-CMI). Cogn Behav Pract. 2018;25:32-43. doi: 10.1016/j.cbpra.2017.01.006. ## 37. Gravette FJ, Wallnau LB. Statistics for the behavioural sciences. 10th ed. Boston: Cengage Learning; 2017. ##