Comparison of the Effectiveness of Short-Term Psychodynamic Therapy and Integrated Acceptance and Commitment Therapy with Schema Therapy on Sleep Quality and Disability Caused by Tension-Type Headache in Insecurely Attached Nurses with Anxiety Symptoms

Abstract

Nurses working in intensive, emergency, and oncology settings are exposed to persistent emotional, cognitive, and physical demands. In nurses with insecure attachment and anxiety symptoms, these demands may be expressed through sleep disturbance and disabling tension-type headache. This study compared the effectiveness of short-term psychodynamic therapy and an integrated acceptance and commitment therapy with schema therapy intervention on sleep quality and tension-type headache-related disability in insecurely attached nurses with anxiety symptoms. A quasi-experimental pre-test-post-test design with a wait-list control group and one-month follow-up was used. The population consisted of nurses employed in ICU, CCU, emergency, and oncology wards of Imam Reza Hospital, Mashhad, Iran, during the second half of 1403 SH. From 420 eligible nurses, 180 volunteered for screening; 70 had anxiety scores above the cut-off on DASS-21, 40 also showed predominant insecure attachment, and 30 met all inclusion criteria. Participants were randomly assigned to short-term psychodynamic therapy (n = 10), integrated acceptance and commitment therapy with schema therapy (n = 10), or wait-list control (n = 10). Both active interventions were delivered in eight 70-minute sessions. Outcome measures were the Pittsburgh Sleep Quality Index and the Headache Disability Inventory. Data were analyzed using multivariate and univariate analysis of covariance and Bonferroni post hoc tests. Results: After controlling for pre-test scores, the overall multivariate group effect was significant for sleep quality, Wilks' Lambda = .49, F(4, 50) = 5.43, p = .001, partial eta squared = .30, and for headache disability, Wilks' Lambda = .30, F(8, 44) = 4.50, p = .001, partial eta squared = .45. Group effects were significant for sleep quality at post-test and follow-up and for both emotional and functional dimensions of headache disability at post-test and follow-up. Adjusted Bonferroni comparisons indicated significant advantages of the psychodynamic group over the control group for sleep quality at post-test and follow-up, and significant advantages of both active interventions over control for headache disability. For headache disability, the adjusted pairwise comparisons indicated larger reductions in the psychodynamic condition than in the integrated treatment condition across post-test and follow-up. Both active interventions were associated with improvements in sleep quality and tension-type headache-related disability; however, the adjusted inferential results suggested a stronger effect of short-term psychodynamic therapy on headache-related disability in this sample. The findings support the clinical relevance of emotion-focused and schema/acceptance-based interventions for anxious, insecurely attached nurses, while emphasizing the need for replication with larger samples and longer follow-up.