International Research Journal of Applied and Basic Sciences

© 2016 Available online at www.irjabs.com

ISSN 2251-838X / Vol, 10 (8): 1017-1021
Science Explorer Publications

Comparative study of the effectiveness of mixed

method (Rational-Emotive-Behavioral Therapy and
Reality Therapy) and Reality Therapy on the Hope of
Breast cancer Patients
Pegah Ebadi1, Maryam Javaherian2 , Parastoo Hajian3, Hamidreza Mirzaei4*
1. Midwifery counselor ;MA.BSc. Address:Counseling clinic,IVF Division,Bahman Hospital,Iran zamin Street,
Tehran,Iran
2. Phd student in health psychology. Young Researchers and Elite club, Central Tehran Branch, Islamic Azad
University, Tehran, Iran.
3. MD,Radiation Oncologist ,Cancer Research Center ,Shohadae Tajrish Hospital ,Department of Radiation
Oncology ,Shahid Beheshti University of Medical Sciences.
*4. MD,Associate Professor ,Cancer Research Center ,Shohadae Tajrish Hospital ,Department of Radiation
Oncology ,Shahid Beheshti University of Medical Sciences .

*Corresponding Author email: mirzaei65@yahoo.com

ABSTRACT: Back ground: Today Cancer is among the most important global health problems. As
Cancer has awful effects on Psychological aspects of patients surviving him on one hand and returning
her to healthy life style on the other hand is paramount goal. The aim of this study is to assess the
effectiveness of Rational-Emotive-Behavioral therapy on the Hope of Patients with Second Stage
/Invasive ductal breast carcinoma in Tehran. Material and method:This survey was quasi-experimental
thereby 60 Breast cancer patients referring to cancer research center of Shohadaye Tajrish hospital were
selected based on their score (≤24 Snyder Adult Hope Scale as pre test) . They were divided randomly in
2 experimental and a control group. (20 patients per each).Mixed method of Rational – Emotive- Behavior
Therapy and Reality Therapy (mixed) and reality therapy were applied individually as counseling method.
Each session lasted between 30 to 45 minutes for 8 sessions. After interventions, Snyder AHS as post
test were applied for each group. Results:The meaningful differences of scores before and after
intervention revealed us that these techniques have been efficient and effective in increasing hope among
breast cancer patients.(P<0.001 ,Eta=0.38) however No meaningful differences were demonstrated
between these two approaches. Conclusion: It is suggested to apply mixed method and also RT to
increase Hope in breast cancer patients and also to preserve fertility before cancer treatment.
Keywords: Breast Cancer, Rational Emotive Behavior Therapy and Reality Therapy, Mixed Therapy,
Hope

INTRODUCTION

Cancer is one of the most important health problems around the world and patient suffer from stress and
mental problems after diagnosis and treatment process. Cancer patients have high levels of psychological
problems which the scope of these disorders are different from depression, anxiety, lack of coping with the disease
and self-esteem reduction, body image to emotional disorders, fear of recurrence and death and become hopeless
[1]. Breast cancer is the most common cancer among women worldwide. Incidence rates increased rapidly
predominantly in women 50 and older [2]. in the 1980s due to the increased detection of smaller, earlier-stage
cancers with the widespread adoption of the screening of mammography among asymptomatic women [3]. Breast
cancer affects Iranian women at least one decade younger than their counterparts in developed countries [4].
Advances in diagnostic and treatment could result in increased survival. Therefore, coping with breast as a chronic
disease has become a common phenomenon [5]. Previous evidence has indicated that breast cancer patients may
not show obvious evidence of disease, but they do suffer from a number of problems which persist long after initial
Intl. Res. J. Appl. Basic. Sci. Vol., 10 (8), 1017-1021, 2016

treatment[6-7] such as physical problems (pain and fatigue), psychological problems (fear of recurrence and
inability to cope with the disease), and psychosocial problems(family worries and sexual problems)[8]. Therefore,
there is a great need to provide education, information and support over time [9]. Most of women because of these
problems become: hopeless, agency thinking is weak in them, and don’t have motivation for targeting and
recognizing pathways to gain goals. During the treatment of breast cancer, patients suffer psychological morbidity,
and hope is one important factor in maintaining psychological health [10]. Psychological interventions may improve
the quality of life in cancer patients through affecting the bio-psycho-social dimensions [11]. Hope Therapy is
essentially a time -based and future-oriented and donors to look at what is going on now and examine future goals.
Glasser's Reality Therapy approach as a combination intervention on the part of this research can be applied to the
treatment of the disease the patient is responsible exacerbation of anxiety , followed by the minimize maladaptive
reactions [12]. Rational Emotive Behavior Therapy is a comprehensive and integrated approach that developed
based on the judge's thinking, deciding and acting stresses [13]. Treatment starts with problematic behaviors and
emotions and thoughts that they create the challenges directly [14].
This study is aimed to Comparative study of the effectiveness of mixed method (Rational-Emotive-
Behavioral Therapy and Reality Therapy) and Reality Therapy on the Hope of Breast cancer Patients

MATERIAL AND METHOD

In the present study, quasi-experimental design of pre- post-test was used. The study population included
85 patients with breast cancer under certain conditions who referred to Shohada cancer researches center of
Tajrish. The population with secondary breast cancer were based on Schneider Hope Scale score were lower than
24. Schneider Hope Scale was administered to all the population and eventually 60 of them stayed on as the
sample into three groups:
The combined group counseling or rational approach - emotional counseling with reality therapy approach
Consultations with reality therapy approach
: The control group with the same volume of 20 randomly (draw) were replaced.
The used Instrument is hope 12-items scale questionnaire of Schneider which is planned for 15 years old
and more and includes two subscales bus and motivation [15].
To answer any questions, Ranging from 1 (completely wrong) to 4 (completely true) is considered. In
Golzari research (2007) was conducted on 660 female students in Tehran, Schneider Hope Scale reliability was
evaluated with using internal consistency and Cronbach's alpha coefficient was 0.89. Hope scale has high
correlation with the scales which measure similar psychological processes. Schneider hope scale reliability of this
study was obtained 0.79 with using Cronbach's alpha. Concurrent validity in this structure has highly correlated
with the given responses to some measure scale of the same psychological processes. Hope scale in research and
clinical fields have been implemented on more than 20,000 people. These tools help people to determine their
hope level in different situations. In the study was conducted by Kermani, Khodapanahi and Heidari (2000) to
determine the psychometric properties of Schneider hope in the University of Shahid Beheshti on Bachelor
students, constructer validity survey with using confirmatory factor analysis showed that scale includes two-factor
structure of factor thinking and the paths. Concurrent validity survey of this scale correlation measuring with
Suicidal Ideation Scale, perceived and meaning social support suggests a negative relationship between hope
scale scores with suicidal ideation scale scores and positive relationship with perceived and meaning social
support scales scores in the life. In the research which was to determine Schneider Hope Psychometric Properties
by Kermani and Khodapanahi, reliability of this scale was obtained 0.86 with using Cronbach's alpha formula and
was obtained 0.81 with retest and resulted into that Schneider hope scale for Iranian population has good reliability
and validity and can be used in Iran psychological measurement and it can be used as a valid and appropriate tool
in clinical and educational settings in order to assess patients and provide treatment and preventive programs[16].
The present study sessions run every 45 minutes in three groups of 20 patients randomized to the combination of
Rational Emotive Behavioral Consultation and reality Therapy and reality therapy method.

Findings
To evaluate the effectiveness of reality therapy approach on the hopes of a second breast cancer patients
was used these processes.

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Table 1. Statistical indicators related to the scores reality therapy in breast cancer patients of experimental group and control
group in the pretest and posttest Hope Scale. (n=40).
Criteria variable group average Standard min max
deviation
pretest experimental 22/06 2/58 0.16 0.24
Witness 20.33 2.74 0.16 0.24
posttest experimental 24/31 3/08 18/0 28/0
Hope Witness 19.46 3.15 0.14 0.24

The data in Table 1 shows the experimental group scores that their treatment is based on reality therapy
approach, in the test has remarkable increase. To measure the effects of reality therapy on the treatment of
patients with breast cancer hope, the analysis of covariance was used the results of which are shown in the table
2.

Table 2
Criteria Eta coefficient Significance F value Squares’ Degree of Total
variable level average freedom squares
pretest 0.49 0.001 27.26 103.63 1 103.63
group 0.38 0.001 16.89 65.42 1 65.42
error 3.94 27 106.49
total 30 0.14679
General 29 378.16
modified

So it can be concluded that the approach reality therapy caused a significant change in the performance of
the test groups in the hope of breast cancer patients. And this is the effect of practically 38 %.
To test this hypothesis which rational - emotional - behavioral approach is effective on breast cancer patient hope,
according to Table 3 surveys were carried out.

Table 3
Criteria variable group average Standard min max
deviation
pretest experimental 20/80 2/62 16/0 0.24
Witness 20.33 2.74 0.16 0.24
posttest experimental 22/08 2/75 16/0 26/0
Hope Witness 19.46 3.15 0.14 0.24

The data in Table 1 shows the experimental group scores that their treatment is based on rational -
emotional - behavioural approach, in the test has remarkable increase. To measure the effects of rational -
emotional - behavioural approach on the treatment of patients with breast cancer hope, the analysis of covariance
was used the results of which are shown in the table 4.

Table 4
Criteria Eta coefficient Significance F value Squares’ Degree of Total
variable level average freedom squares
pretest 0.58 0.001 37.66 143.37 1 143.37
group 0.38 0.001 16.89 64.30 1 64.30
error 3.80 27 102.76
total 30 0.13728
General 29 329.46
modified

So it can be concluded that the approach rational - emotional - behavioural caused a significant change in
the performance of the test groups in the hope of breast cancer patients. And this is the effect of practically 38%.
About the effectiveness of reality therapy, and combined the two approaches and Rational Emotive
Behavioral Therapy reality check expectancy following breast cancer patients was conducted
Table 5, One-way analysis of variance to compare the effectiveness of two therapeutic approach
(approach reality therapy, and combination of these two approaches) are the hope for breast cancer patients
(n=20).

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Table 5
Criteria Eta coefficient Significance F value Squares’ Degree of Total Ability
variable level average freedom squares test
Among 0/02 0/33 1/12 8/28 1 143.37 0/11
group
Intergroup 7/37 42 64.30
total 44 326/31

Can concluded that the mean efficacy of treatment (approach reality therapy, and combination of Rational
Emotive Behavioral Therapy approach) there is no significant difference on the level of hope in patients with breast
cancer.

DISCUSSION AND CONCLUSION

Based on the above findings, rational-emotive behavioral therapy and combination approach and the
approach of reality therapy) were effected on patients with breast cancer. The findings of this study is consistent
with previous research on the effectiveness of the therapy on cancer patients [17-21].
Also the results of other researchers, indicated the effectiveness of psychosocial interventions such as
reality therapy and Rational-Emotive-Behavioral in depression, on anxiety and hope and quality of life patients with
cancer [22]. The quality of life of cancer patients in all three dimensions (physical, psychological and social) has
limitations and the use of psychological interventions with medical therapy can be effective in improving quality of
life [23].
In order to explain the results it seems that cancer patients, encountered more challenges in the combined
treatment approach rational emotive behavior and attitude fact. Because they challenged the reasonableness of
opinion and responsibility According to Glasser 's disease in some patients.
While the fear of death, believed to continue treatment with high costs and inability to pay for treatment
costs Leave a spouse or close relatives such as spouse and children in the hardest lack of understanding
psychiatric conditions following the incurable disease detection and disease burden of challenging ideas and
responsibilities , including Among other issues, are the psychological pressure are sobered the patient's logic.
The limitations of this study are as following:
Due to changes in the condition of patients increasing of chemotherapy and skin inflammation caused by the side
effects of radiation therapy, the treatment seemed to take on the post-test questionnaire response affects patients.
Different economic levels, causing some confusion in the cost of treatment in patients who were treated together.
Due to the sampling of the sample was available for this research.
Since the method is based on the patient's life expectancy is suggested that this method may also be used to
other types of cancer and other chronic diseases.
On the other hand need more researches the method of sedation and relaxation, for art therapy and its impact on
patients.

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