Fundamentals of Mental Health

Fundamentals of Mental Health

Comparing the effectiveness of positive thinking skills training and behavioral activation therapy on differentiation of self and health anxiety in diabetic patients

Document Type : Research Paper

Authors
Sedigheh Rostami 1
Hamzeh Akbari 2
Hassan Abdollahzadeh 3
1 Ph.D. student, Department of Psychology, Gorgan Branch, Islamic Azad University, Gorgan, Iran.
2 Assistant professor, Department of Psychology, Gorgan branch, Islamic Azad University, Gorgan, Iran.
3 Assistant professor, Department of Psychology, Payame Noor University, Behshahr, Iran.
10.22038/JFMH.2025.85782.3211
Abstract
Introduction: Differentiation of self and health anxiety are factors that play a significant role in diabetic patients. Therefore, the present study aims to compare the effectiveness of positive thinking skills training and behavioral activation therapy on differentiation of self and health anxiety in diabetic patients.
 
Materials and Methods: The statistical population of this clinical trial included all patients with diabetes who were referred to the Vanoshe Diabetes Clinic in Qaemshahr city, Iran, in 2020-2021. Forty-five patients with diabetes were selected using accessible sampling and randomly assigned to 3 equal groups. The first and second experimental groups received therapy interventions in 6 and 8 sessions, and the control group was on the waiting list. The research instruments included the differentiation of self-questionnaire and health anxiety inventory. The obtained data were analyzed using a repeated measure of variance analysis and Bonferroni post hoc test with  SPSS 22.
 
Results: The findings showed that both therapy interventions reduced differentiation of self and health anxiety in patients with diabetes, and the effect of these therapeutic interventions in the follow-up phase has been stable (P< 0.05). Also, the Bonferroni post hoc test results showed that the effectiveness of positive thinking skills training intervention on research variables was higher (P< 0.05).
 
Conclusion: Based on the findings, positive thinking skills training and behavioral activation therapy interventions can effectively improve the differentiation and health anxiety of patients with diabetes.
Keywords
Behavioral activation therapy
Diabetes
Differentiation
Health anxiety
Positive thinking
  1. Ezazi Bojnourdi E, Ghadampour S, Moradi Shakib A, Ghazbanzadeh R. [Predicting corona anxiety based on cognitive emotion regulation strategies, health hardiness and death anxiety in diabetic patients]. Iranian journal of psychiatric nursing 2020; 8(2): 34-44. (Persian)
  2. Shahbeik S, Taghavi Jourachi F, Abroshan F, Naseri M. [Effectiveness of group-based cognitive therapy based on mindfulness on family function and marital adaptation of couples with type II diabetes]. Iranian journal of nursing research 2019; 13(6): 68-75. (Persian)
  3. Singh AK, Singh A, Shaikh A, Singh R, Misra A. Chloroquine and hydroxychloroquine in the treatment of COVID-19 with or without diabetes: A systematic search and a narrative review with a special reference to India and other developing countries. Diabetes Metab Syndr 2020; 14(3): 241-6.
  4. Abdi A, Jalilian M, Sarbarzeh PA, Vlaisavljevic Z. [Diabetes and COVID-19: A systematic review on the current evidences]. Diabetes research and clinical practice 2020; 166: 108347. (Persian)
  5. Kazemi M, Sadeghi AR. [The relationship between differentiation of self and anxiety of COVID-19 disease in adolescents mediated by parent-child conflict]. Journal of applied family therapy 2020; 1(2): 48-67. (Persian)
  6. Hung FN, Chan RCH. , proximal minority stress, and life satisfaction among sexual minorities: Intrapersonal and interpersonal pathways to life satisfaction. Am J Orthopsychiatry 2022; 122: 201-20.
  7. Mayer A. The development of our sense of self as a defense against invading thoughts: From Buddhist psychology to psychoanalysis. New Ideas Psychol 2020; 58: 100775.
  8. Kazemi N, Nemati L, Yadegari SL, Abdous F. [Predicting social cognition based on differentiation of self and cognitive flexibility in students]. Social psychology research 2022; 48(4): 103-16. (Persian)
  9. Nichols MP, Davis S. Family therapy: Concepts and methods. 11th ed. Australia: Pearson Pty Ltd; 2016.
  10. Mohammadi MT, Shahyad Sh. [Health anxiety during viral contagious diseases and COVID-19 qutbreak: Narrative review]. Journal of military medicine 2020; 22(6): 623-31. (Persian)
  11. Bailer J, Kerstner T, Witthöft M, Diener C, Mier D, Rist F. Health anxiety and hypochondriasis in the light of DSM-5. Anxiety Stress Coping 2016; 29(2): 219-39.
  12. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed. Washington, D.C.: American Psychiatric Association; 2013.
  13. LeBouthillier DM, Thibodeau MA, Alberts NM, Hadjistavropoulos HD, Asmundson GJG. Do  people  with  and  without  medical  conditions  respond similarly   to   the   Short   Health   Anxiety   Inventory? An   assessment   of   differential   item functioning using item response theory. J Psychosom Res 2015; 78(4): 384-90.
  14. Witthöft M, Hiller W. Psychological approaches to origins and treatments of somatoform disorders. Annu Rev Clin Psychol 2010; 6: 257-83.
  15. Homayooni A, Hosseini Z. [Investigating the relationship between perceived stress and health anxiety and the quality of life (QoL) during the COVID-19 pandemic]. Journal of preventive medicine 2022; 9(1): 38-49. (Persian)
  16. Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety and perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr 2020; 51: 102083.
  17. Wang C, Pan R, Wan XIA, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020; 17(5): 1729.
  18. Nikmanesh Z, Zandvakili M. [The effect of positive thinking training on quality of life, depression, stress and anxiety in delinquent juveniles]. Positive psychology research 2015; 1(2): 53-64. (Persian)
  19. Yekanizad A, Gol Mohammadnejhad Bahrami G, Soleimannezhad A. [The effectiveness of positive thinking skills training on psychological capital and happiness of students]. Quarterly journal of child mental health 2019; 5(4): 135-48. (Persian)
  20. MahmodiTabar M, Safarzadeh S. Comparison of the effectiveness of integrated meta-diagnostic treatment and positive thinking skills training on adherence to treatment and coronary anxiety in patients with type 2 diabetes. Iranian journal of psychiatric nursing 2021; 9(5): 87-98. (Persian)
  21. Najarasl S, Askari P, Naderi F, Esmaeelkhani F. [Comparison of the effectiveness of positive thinking training and communication imaging treatment on communication attributions, attitudes to crossover relationships, and differentiation of self among those referring to psychological centers]. Positive psychology research 2021; 6(4): 62-79. (Persian)
  22. Waters L, Algoe SB, Dutton J, Emmons R, Fredrickson BL, Heaphy E, et al. Positive psychology in a pandemic: Buffering, bolstering, and building mental health. J Posit Psychol 2022; 17(3): 303-23.
  23. Russo GB, Tirrell E, Busch A, Carpenter LL. Behavioral activation therapy during transcranial magnetic stimulation for major depressive disorder. J Affect Disord 2018; 236: 101-104.
  24. Balan IC, Lejuez CW, Hoffer M, Blanco C. Integrating motivational interviewing and brief behavioral activation therapy: Theoretical and practical considerations. Cogn Behav Pract 2016; 23(2): 205-20.
  25. Walsh EC, Eisenlohr-Moul TA, Minkel J, Bizzell J, Petty C, Crowther A, et al. Pretreatment brain connectivity during positive emotion upregulation predicts decreased anhedonia following behavioral activation therapy for depression. J Affect Disord 2019; 243: 188-92.
  26. Amiri S, Ehtesham Zadeh P, Hafezi F, Borna MR. [Comparison of the effectiveness behavioral activation treatment therapy and acceptance and commitment therapy on executive functions of learning the rules, inhibiting impulsivity, and flexibility in patients with depression]. The neuroscience journal of Shefaye Khatam 2020; 9(2): 68-78. (Persian)
  27. Ataie Moghanloo V, Ataie Moghanloo R. [The effect of behavioral activation therapy based on changing lifestyle on depression, psychological well-being and feeling of guilt in children between 7-15 years old with diabetes]. Journal of Rafsanjan University of Medical Sciences 2015; 14(4): 325-38. (Persian)
  28. Karimi Rahjerdi M, Sodani M, Gholamzadeh Jefre M, Asgari P. [Effectiveness of behavioral activation therapy on depression and sexual satisfaction in patients with type 2 diabetes]. Journal of consulting excellence and psychotherapy 2022; 41: 1-10. (Persian)
  29. Tajipoor A, Abbasi Motlagh F. [The effect of behavioral activation therapy on coping strategies in students with generalized anxiety disorder]. Rooyesh-e-Ravanshenasi 2020; 8(10): 181-8. (Persian)
  30. Shams M, Hashemi S. [Prediction of decision-making styles based on behavioral brain systems; the mediating role of differentiation of self]. Journal of adolescent and youth psychological studies 2020; 1(1): 152-60. (Persian)
  31. Sayehmiri K. [Applied biostatistics and research method]. 2nd ed. Ilam, Iran: Nowruzi ; 2021. (Persian)
  32. Skowron EA, Schmitt TA. Assessing interpersonal fusion: Reliability and validity of a new DSI fusion with others subscale. J Marital Fam Ther 2003; 29 (2): 209-22.
  33. Shariati S, Abbasi Gh, Mirzaian B. [The effectiveness of eating-based mindfulness training on alexythymia and differentiation of self of overweight women]. Journal of adolescent and youth psychological studies 2023; 4(7): 70-83. (Persian)
  34. Salkovskis PM, Warwick H. The health anxiety inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med 2002; 32: 843-53.
  35. Davoudi I, Nargesi F, Mehrabizadeh Honarmand M. [The comparison of dysfunctional beliefs and personality traits between teachers with and without health anxiety]. Quarterly journal of health psychology 2013; 1(3): 30-38. (Persian)
  36. Rashid T, Seligman MEP. Positive psychotherapy in current psychotherapies. 10th ed. Corsini RJ, Wedding D. (editors). Belmont, CA: Cengage; 2013.
Fundamentals of Mental Health
Volume 27, Issue 4
July and August 2025
Pages 277-285