Comparing the effect of supportive-expressive and cognitive-behavioral psychotherapies on depression and adherence to treatment in hemodialysis patients focusing on improving physician-patient relationship

Document Type : Research Paper

Authors

1 Ph.D. student in health psychology, Torbat Jam Branch, Islamic Azad University, Torbat Jam, Iran.

2 Assistant professor of health psychology, Kashmar Branch, Islamic Azad University, Kashmar, Iran

3 Associate professor of Chinese medicine and complementary medicine, Faculty of Iranian and Complementary Medicine, Mashhad University of Medical Science, Mashhad, Iran

Abstract

Introduction: The purpose of this study was to compare the effect of supportive-expressive and cognitive-behavioral psychotherapies on depression and adherence to treatment in hemodialysis patients with a focus on improving the physician-patient relationship.
Materials and Methods: This clinical trial was performed as pretest and posttest with randomized sampling control group. Participants were 45 hemodialysis patients, aged 20-50 years, in Imam Reza hospital of Mashhad and Taleghani hospital of Torbat Jam in 2018-2019 who completed these 3 questionnaires: Beck Depression II, Karami and Keyvanara Physician-Patient Relation Patterns and End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ). The patients with moderate to severe depression divided into 2 experimental groups and one control group (n=15). Data were analyzed using SPSS-23 software and repeated measures analysis of variance (ANOVA) and Bonferroni post hoc tests.
Results: Findings in multivariable indicators showed a short-term effect (pretest-posttest) equal to 0.81 and a long-term effect (pretest-4 month follow-up) equal to 0.83 in supportive-expressive therapy group compared to the control group. In the cognitive-behavioral therapy with the same significance level, the short-term and long-term effects were 0.70 and 0.14. Finally, by using Bonferroni test and average comparison profiles, the short-term and long-term effects of supportive-expressive therapy were more than cognitive-behavioral therapy.
Conclusion: It seems that supportive-expressive therapy with focusing on improving the relationship has more significant effects to reduce depression and increase adherence to treatment than the other therapy.

Keywords


1. Bronze D. [Why depression? Cognitive therapy]. Hariri N. (translator). 1st ed. Tabriz:   Vanguard of Science Publications; 1994: 42. (Persian)
2. Barzin A. [Comparison of mental image of body in kidney donors and recipients before and after transplantation in Isfahan and Tehran hospitals in 1996-97]. Journal of Kerman University of Medical Sciences 1998; 1(6): 25-17. (Persian)
3. Brock M. Uncertainly, information needs and coping effectiveness of renal families. ANNA J 1990; 17(3): 242-5.
4. Watnick K. Depression in patients undergoing hemodialysis. Available from: www.Depression and ESRD.com.2000-2001.Pdf research.1-3.
5. Mahmoudabadi A. [Chronic kidney failure and dialysis]. Mashhad: Kordegari Publications; 2017: 53. (Persian)
6. Saffari M, Shojaeizadeh D. [Principles of health education and health promotion]. Tehran: Samat publication; 2014: 115. (Persian)
7. Cukor D. Use of CBT to treat depression among patients on hemodialysis. Am Psychiatr Assoc 2007; 58(5): 711-2.
8. Aganwa HS, Morakinyo O. Psychiatric complication of hemodialysis at a kidney center in Nigeria. J Psychosom Res 1997; 42(5): 445-51.
9. Kimmel PL, Thamer M, Richard C. Psychiatric illness in patients with end stage renal disease. Am J Med 1998; 105(3): 214-21.
10. Zali M. [New principles of patient-physician relationship]. Tehran: Legal publications; 2007: 245. (Persian)
11. Zamani A, Shams B, Siadat ZD, Adibi P, Salehi H, Saneii H. [The effect of communication skill training on clinical skill of internal medicine and infectious disease]. Journal of Isfahan University of Medical Sciences 2006; 2(8): 98. (Persian)
12. Taylor Sh. [Health psychology]. Badiee Aval M, Rafiei Shafiq M, Seyyed Zadeh Z. (translators). 1st ed. Mashhad: Faraangizesh Publications; 2017: 351-4. (Persian)
13. Ghadiri Lashkajani M, Zolfaghari M. [Patient-physician relationship]. Tehran: Iran University of Medical Sciences; 2000: 35. (Persian)
14. Soltani Arabshahi K, Ajami A, Siyabani S. [Investigation of doctor-patient communication skills teaching: Medical learners’ perception (stager-intern) and staffs of Iran University of  Medical Sciences and Kermanshah University of Medical Sciences]. Journal of Iran University of Medical Science 2004; 11(41): 423-32. (Persian)
15. Sanderson K. [Health psychology]. Jomhuri F, Maschi F, Sodagar Sh, Samari AA, Hejir F, Sobhi A, et al. 2nd ed. Tehran: Sarafraz publications; 2013: 148-50. (Persian)
16. Rafiee Verdanjani L, Parvin N, Mahmoodi Shen Gh, Mollai E, Shariati A, Hashemi Nia A. [Adherence to hemodialysis therapy and its relationship with some factors in hemodialysis patients referred to Hajar Training Center of Shahrekord]. Journal of clinical nursing and midwifery 2013; 4(2): 18. (Persian)
17. Aeedmanesh M; Masoodi Z, Yadegari S, Shams M. [The effect of stress management training on reducing anxiety and depression of patients undergoing dialysis in Shahid Sadoughi Hospital in Yazd]. Proceeding of the 3rd International Conference on Modern Research in Education and Psychology and Social Studies in Iran. Tehran. Soroush Hekmat Mortazavi Center for Islamic Studies and Research, 2018: 52. (Persian)
18. Sookhk F, Zolfaghari M, Asadinoghabi A, Haghani H. [The effect of cognitive-behavioral interventions on adherence to the medication regime of hemodialysis patients. Hayat 2014; 3(20):    85-94. (Persian)
19. Azimian S. [The effectiveness of mindfulness-based cognitive therapy on depression and anxiety in hemodialysis patients]. MA. Dissertation. Tehran: School of Social Welfare and Rehabilitation Sciences, 2016: 93-112. (Persian)
20. Beck AT, Brown G, Steer R.A. Manual for the Beck Depression Inventory-II. San Antonio, TX: The Psychological Corporation; 1996.
21. Fathi Ashtiani A, Dastani M. [Psychological examinations]. Tehran: Besat publications; 2010: 336-    9. (Persian)
22. Mohammadian Y, Shahidi Sh, Mohammadi A, Mahaki B. [Effect of poetry therapy on signs of depression students]. Scientific journal of ILam University of Medical Sciences 2009; 18(2): 9-16. (Persian)
23. Karami Z, Keyvan Ara M. [Investigating patterns of physician-patient relationship among patients referred to Shahid Beheshti Hospital Clinic in Isfahan in 2007]. Journal of Medical Education Development and Research Center 2007; 2(6): 149-56. (Persian)
24. Kim Y, Evangelista LS. Relationship between illness perceptions, treatment adherence, and clinical outcomes in patients on maintenance hemodialysis. Nephrol Nurs J 2010; 37(3): 271-80.
25. Kim Y, Evangelista LS, Phillips LR, Pavlish C, Kopple JD. The End-Stage Renal Disease  Adherence Questionnaire (ESRD-AQ): testing the psychometric properties in patients receiving in- center hemodialysis. Nephrol Nurs J 2010; 37(4): 377-93.
26. Khalili F, Eslami AA, Farajzadeghan Z, Hasan Zadeh A. [The association between social- psychological factors and treatment adherence behaviors among maintenance hemodialysis patients in Isfahan, Iran: A conceptual framework based on social cognitive theory]. Health system research 2011; 7(3): 278-90. (Persian)
27. Winston A, Rosenthal R, Robert L. Learning supportive psychotherapy: An illustrated guide. 2nd ed. New York: American Psychiatric Association Publishing; 2019: 192-8.
28. Khodayari Farad M, Abedini Y. [Cognitive-behavioral therapy]. Tehran: Tehran University Press; 2015: 48-49. (Persian)
29. Amiri Jabbarz B, Gorganinejad Moshizi M. [The effectiveness of cognitive-behavioral therapy     in reducing emotional maladaptation in hemodialysis patients in Kerman]. Studies in psychology and education 2016; 4: 43-9. (Persian)
30. Badiee Aval M. [Comparison of the effectiveness of two supportive-expressive and cognitive- behavioral psychotherapy on depression in hemodialysis patients]. MA. Dissertation. Torbat-e-Jam:  Islamic Azad University, Torbat-e-Jam branch, 2015: 48-54. (Persian)
31. Hadian Z, Rafiee Vardanjani L, Barimnejad L. [The most important causes of non-adherence in patients on dialysis]. Clinical excellence 2017; 2(5): 84-97. (Persian)
32. Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, et al. Comparative efficacy of therapies for treatment of depression for patients undergoing maintenance hemodialysis: A randomized clinical trial. Ann Intern Med 2019. (In press)