Investigating the Effectiveness of the Integrated Intervention Model Based on Acceptance, Compassion, and Mindfulness on Psychological Distress and Intolerance of Uncertainty in Nurses with Anxiety in the Emergency Department
Keywords:
integrated intervention model based on acceptance, compassion, mindfulness, psychological distress, intolerance of uncertainty, anxietyAbstract
Objective: This study aimed to examine the effectiveness of an integrated intervention model based on acceptance, compassion, and mindfulness in reducing psychological distress and intolerance of uncertainty in nurses with anxiety working in emergency departments.
Methods and Materials: The study employed a quasi-experimental design with pre-test and post-test assessments and included an experimental and control group. A total of 40 nurses with anxiety working in emergency departments were selected using purposive sampling. Participants were randomly assigned to either the experimental (n=20) or control group (n=20). The experimental group underwent 12 sessions (60 minutes each) of the integrated intervention, while the control group received no intervention. Data were collected using the Kessler Psychological Distress Scale (Kessler et al., 2003) and the Intolerance of Uncertainty Scale (Freeston et al., 1994). The results were analyzed using analysis of covariance (ANCOVA).
Findings: The results showed a significant reduction in psychological distress in the experimental group compared to the control group (F(1, 37) = 256.42, p < .001). Similarly, there was a significant reduction in intolerance of uncertainty in the experimental group compared to the control group (F(1, 37) = 63.73, p < .001). These findings indicate that the intervention effectively reduced both psychological distress and intolerance of uncertainty in the experimental group.
Conclusion: The integrated intervention model based on acceptance, compassion, and mindfulness was effective in reducing psychological distress and intolerance of uncertainty in nurses with anxiety. This intervention provides a practical approach for addressing emotional difficulties faced by nurses, helping them cope with the stress of their profession, improve their psychological flexibility, and align their actions with their life values. These findings suggest that such interventions can improve the mental well-being of healthcare workers, particularly those in high-stress environments like emergency departments.
Downloads
References
Abadi, Y., Abolghasemi, S., & Khalehtabari, J. (2021). The Effectiveness of Acceptance-Based Commitment Therapy on Life Hope and Distress Tolerance in Mothers of Children with Physical-Motor Disabilities. Journal of the Faculty of Medicine, Mashhad University of Medical Sciences, 64(2), 2706-2719. https://mjms.mums.ac.ir/article_18502.html
Abdulmohdi, N. (2024). The relationships between nurses' resilience, burnout, perceived organisational support and social support during the second wave of the COVID‐19 pandemic: A quantitative cross‐sectional survey. Nursing Open, 11(1), e2036.
Abyar, Z., Makvandi, B., Bakhtyarpour, S., Naderi, F., & Hafezi, F. (2019). Comparing the Effectiveness of Acceptance and Commitment Therapy, Mindfulness Training, and Combined Method (Mindfulness-Based and Acceptance and Commitment) on Depression. childmh, 5(4), 27-38. http://childmentalhealth.ir/article-1-399-en.html
Afarin Sadeghi, O., Zahra Bagherzadeh, G., Mehdi, A., & Ahmad, M. (2021). Comparison of cognitive- behavioral therapy with transdiagnostic treatment on the clinical syndrome and distress tolerance of students. Razi Journal of Medical Sciences, 27(10), 1-13. https://www.magiran.com/paper/2249965
Aghili, M., & Kashiri, S. (2022). The Effectiveness of Acceptance and Commitment-Based Therapy on Uncertainty Intolerance, Turmoil Tolerance, and Sexual Function in Betrayed Women [Research --- Open Access, CC-BY-NC]. The Neuroscience Journal of Shefaye Khatam, 10(3), 57-67. https://doi.org/10.52547/shefa.10.3.57
Ahmadi, A., & Raeisi, Z. (2018). The Effect of Acceptance and Commitment Therapy on Distress Tolerance in Mothers of Children with Autism [Research]. Quarterly Journal of Child Mental Health, 5(3), 69-79. http://childmentalhealth.ir/article-1-349-en.html
Aliyari Khanshan Vatan, F., Ahadi, H., Kalhornia Golkar, M., & Sedaghat, M. (2022). The Effectiveness of Cognitive-Behavioral Therapy in Anxiety and Distress Tolerance in Patients with Coronary Heart Diseases [Research]. Iranian Journal of Rehabilitation Research in Nursing, 8(3), 54-65. https://doi.org/10.22034/IJRN.8.3.54
Aloufi, M. A., Jarden, R. J., Gerdtz, M. F., & Kapp, S. (2021). Reducing stress, anxiety and depression in undergraduate nursing students: Systematic review. Nurse Education Today, 102, 104877. https://doi.org/10.1016/j.nedt.2021.104877
Asli azad, M., Manshaee, G. r., & Ghamarani, A. (2020). Effectiveness of Acceptance and Commitment Therapy on Cognitive Emotion Regulation and Intolerance of uncertainty of The Students with Obsessive-Compulsive Disorder. Psychology of Exceptional Individuals, 9(36), 33-53. https://doi.org/10.22054/jpe.2019.44480.2027
Babaee, Z., Mansoobifar, M., Sabet, M., Borjali, M., & Mashayekh, M. (2022). Comparison of the effectiveness of cognitive-behavioral therapy and mindfulness treatment on distress tolerance and suicidal ideation in adolescents with suicidal thoughts. Journal of Clinical Psychology, 13(4), 41-52. https://doi.org/10.22075/jcp.2021.23039.2123
Babapoor, J., Zeianli, S., Azimi, F., & Chavoshi, S. (2019). Efficacy of Cognitive Behavior Therapy on Quality of life, Anxiety and Fatigue of cancer section’s nurses: A Clinical Trail study [Quantitative-Research]. 2 Journal of Nursing Education, 8(4), 26-32. http://jne.ir/article-1-1042-en.html
Bakhshandeh Larimi, N., Zebardast, A., & Rezaei, S. (2021). The effectiveness of acceptance and commitment therapy on cognitive flexibility, rumination, and distress tolerance in persons with Migraine headache [Research]. Shenakht Journal of Psychology and Psychiatry, 8(2), 74-87. https://doi.org/10.32598/shenakht.8.2.74
Bazgouneh, A., & Zarbakhsh, M. (2021). The Relationship between Sleeping Disorders and Posttraumatic Stress Disorder Syndrome with Corona Anxiety: the Intermediary Role of Health Anxiety. Applied Family Therapy Journal (AFTJ), 2(5), 287-308. https://journals.kmanpub.com/index.php/aftj/article/view/860
Bernstein, A., Zvolensky, M. J., Vujanovic, A. A., & Moos, R. (2009). Integrating Anxiety Sensitivity, Distress Tolerance, and Discomfort Intolerance: A Hierarchical Model of Affect Sensitivity and Tolerance. Behavior therapy, 40(3), 291-301. https://doi.org/10.1016/j.beth.2008.08.001
Carleton, R. N. (2012). The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives. Expert Rev Neurother, 12(8), 937-947. https://doi.org/10.1586/ern.12.82
Chen, S., Yao, N., & Qian, M. (2018). The influence of uncertainty and intolerance of uncertainty on anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 61, 60-65. https://doi.org/10.1016/j.jbtep.2018.06.005
Delgado, C., Roche, M., Fethney, J., & Foster, K. (2021). Mental Health Nurses’ Psychological Well‐being, Mental Distress, and Workplace Resilience: A Cross‐sectional Survey. International journal of mental health nursing, 30(5), 1234-1247. https://doi.org/10.1111/inm.12874
Drapeau, A., Marchand, A., & Beaulieu-Prévost, D. (2017). Epidemiology of psychological distress. In Mental illnesses: Understanding, prediction and control (pp. 105-134). InTech. https://www.intechopen.com/chapters/25512
Dugas, M. J., schewartz, A., & Francis, K. (2004). Intolerance of uncertainty, Worry, and depression. Cogn Ther Res, 28, 835-842. https://doi.org/10.1007/s10608-004-0669-0
Dugas, M. J., Sexton, K. A., Hebert, E. A., Bouchard, S., Gouin, J.-P., & Shafran, R. (2022). Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder. Behavior therapy, 53(6), 1147-1160. https://doi.org/10.1016/j.beth.2022.05.003
Ebrahimi, M., Shahhabizadeh, f., Esmaeili, A. A., & Ahi, G. (2021). The Effectiveness of Trans diagnostic based Emotion Efficiency Therapy on Emotional Distress, Nursing Stress, and Health Anxiety of Anxious Nurses; Simultaneous Follow-Up with COVID-19 Pandemic. IJNR, 16(5), 19-31. http://ijnr.ir/article-1-2502-en.html
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509-528. https://doi.org/10.1016/S0005-7967(02)00088-8
Falavarjani, M. F., & Yeh, C. J. (2019). Optimism and distress tolerance in the social adjustment of nurses: examining resilience as a mediator and gender as a moderator. Journal of Research in Nursing, 24(7), 500-512. https://doi.org/10.1177/1744987119839102
Fang, P., Tan, L., Cui, J., & Yu, L. (2023). Effectiveness of Acceptance and Commitment Therapy for people with advanced cancer: A systematic review and meta-analysis of randomized controlled trials. Journal of Advanced Nursing, 79(2), 519-538. https://doi.org/10.1111/jan.15543
Forman, E. M., & Herbert, J. D. (2008). New directions in cognitive behavior therapy: acceptance based therapies. In J. E. Fisher (Ed.), Cognitive behavior therapy: Applying empirically supported treatments in your practice, 2nd ed. (pp. 263-265). Wiley. https://www.researchgate.net/publication/230745913_New_directions_in_cognitive_behavior_therapy_Acceptance-based_therapies
Forouzanfar, A., Lavasani, G., & Shuae Kazemi, M. (2017). The Effectiveness of Group Counseling Based on Acceptance and Commitment on Distress Tolerance and Anxiety Sensitivity in Women Dependent on Substance Abuse. Addiction Research Quarterly, 11, 135-154. https://etiadpajohi.ir/browse.php?a_id=1290&slc_lang=en&sid=1&printcase=1&hbnr=1&hmb=1
Ghawadra, S. F., Abdullah, K. L., Choo, W. Y., Phang, C. K. (2019). Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. Journal of clinical nursing, 28(21-22), 3747-3758. https://doi.org/10.1111/jocn.14987
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal ofClinical Psychology, 53, 6-41. https://doi.org/10.1111/bjc.12043
Gillett, C. B., Bilek, E. L., Hanna, G. L., & Fitzgerald, K. D. (2018). Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment. Clin Psychol Rev. https://doi.org/10.1016/j.cpr.2018.01.007
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2009). Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006
Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The counseling psychologist, 40(7), 976-1002. https://doi.org/10.1177/0011000012460836
Hebert, E. A., & Dugas, M. J. (2018). Behavioral Experiments for Intolerance of Uncertainty: Challenging the Unknown in the Treatment of Generalized Anxiety Disorder. Cogn Behav Pract, 14, 24-38. https://www.researchgate.net/publication/327380984_Behavioral_Experiments_for_Intolerance_of_Uncertainty_Challenging_the_Unknown_in_the_Treatment_of_Generalized_Anxiety_Disorder
Karami, P. (2024). Comparing the Effectiveness of Cognitive Behavioral Therapy and Compassion-Focused Therapy in Improving Distress Tolerance and Self-Compassion in Women With Experiences of Marital Infidelity. Jarac, 6(2), 27-35. https://doi.org/10.61838/kman.jarac.6.2.4
Kim, J. S., & Choi, J. S. (2016). Factors Influencing Emergency Nurses' Burnout During an Outbreak of Middle East Respiratory Syndrome Coronavirus in Korea. Asian Nursing Research, 10(4), 295-299. https://doi.org/10.1016/j.anr.2016.10.002
Koerner, N., & Dugas, M. J. (2008). An investigation of appraisals in individuals vulnerable to excessive worry: The role of intolerance of uncertainty. Cognit Ther Res, 32(5), 619-638. https://doi.org/10.1007/s10608-007-9125-2
Koerner, N., Mejia, T., & Kusec, A. (2017). What’s in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder*. Cognitive behaviour therapy, 46(2), 141-161. https://doi.org/10.1080/16506073.2016.1211172
Maarefvand, A., & Shafiabady, A. (2024). Effectiveness of Shafie-Abadi's Multidimensional Model Training on Enhancing Occupational Well-being and Quality of Work Life among Teachers in Qom City. International Journal of Education and Cognitive Sciences, 4(4), 21-30. https://doi.org/10.61838/kman.ijecs.4.4.3
Mahvash, M., Yamini, M., & Mahdian, H. (2024). Comparing the Effectiveness of Instructional Mental Imagery and Tolerance of Ambiguity Training on Students' Academic Procrastination [Research Article]. Iranian Journal of Educational Sociology, 7(1), 10-20. https://doi.org/10.61838/kman.ijes.7.1.2
Markey, K., Tilki, M., & Taylor, G. (2020). Practicalities in doctorate research of using grounded theory methodology in understanding nurses’ behaviours when caring for culturally diverse patients. Nurse Education in Practice, 44, 102751. https://doi.org/10.1016/j.nepr.2020.102751
Moradi, S. (2022). The effectiveness of realistic acceptance and commitment therapy (RACT) on distress tolerance and resilience of divorced women. Applied Family Therapy Journal (AFTJ), 3(5), 581-596. https://doi.org/10.61838/kman.aftj.3.5.34
Norouzi, A., Hosseini, H., Sharif-Nia, H., & Rezapour, M. (2023). The Effect of Logotherapy Based on Rumi's Thoughts on Anxiety, Depression, and Distress in Frontline Nurses During the COVID-19 Pandemic. https://brieflands.com/articles/jnms-137898
Pa, R. A. S. G. E. (2016). Concurrent and prospective associations of intolerance of uncertainty with symptoms of prolonged grief, posttraumatic stress, and depression after bereavement. J Anxiety Disord, 41, 65-72. https://doi.org/10.1016/j.janxdis.2016.03.004
Pangngay, J. J. (2024). The Relationship Between Resilience, Wellbeing, and Psychological Distress as Mediated by Mindfulness and Coping. Philippine Social Science Journal, 6(3), 36-45. https://doi.org/10.52006/main.v6i3.754
Ream, E., Hughes, A. E., Cox, A., Skarparis, K., Richardson, A., Pedersen, V. H., Wiseman, T., Forbes, A., & Bryant, A. (2020). Telephone interventions for symptom management in adults with cancer. Cochrane Database of Systematic Reviews(6). https://doi.org/10.1002/14651858.CD007568.pub2
Rezaeian, A., Agha Akbari, L., Amirzadeh, F., & MalekMohammadi, N. (2021). The Effectiveness of Acceptance and Commitment Therapy on Distress Tolerance and Depression in Students. childmh, 8(4), 94-107. https://doi.org/10.52547/jcmh.8.4.8
Sarabadani, A., Hasanzadeh, R., & Ghanadzadegan, H. (2023). The effectiveness of acceptance and commitment therapy on distress tolerance and cognitive emotion regulation in women with generalized anxiety disorder. Applied Family Therapy Journal (AFTJ), 4(2), 96-114. https://doi.org/10.61838/kman.aftj.4.2.6
Talebi, M. (2021). The Effectiveness of Mindfulness-Based Cognitive Therapy on Anxiety, Happiness and Mindfulness in Nurses [Original Research]. Avicenna Journal of Nursing and Midwifery Care, 29(2), 126-136. https://doi.org/10.30699/ajnmc.29.2.126
Tyrer, H., Tyrer, P., Lisseman-Stones, Y., McAllister, S., Cooper, S., Salkovskis, P., Crawford, M. J., Dupont, S., Green, J., Murphy, D., & Wang, D. (2015). Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients. International journal of nursing studies, 52(3), 686-694. https://doi.org/10.1016/j.ijnurstu.2014.11.013
Yıldırım, D., & Çiriş Yıldız, C. (2022). The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses' Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 Pandemic: A Randomized Controlled Trial. Holistic Nursing Practice, 36(3), 156-165. https://doi.org/10.1097/hnp.0000000000000511

Downloads
Additional Files
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2024 Elnaz Abdolahi (Author); Maryam Nasri (Corresponding Author); Fatemeh Shahabizadeh (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.