Journal of Health And Care
Volume 27, Issue 3 (Autumn 2025)
JHC 2025, 27(3): 320-334 |
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Ethics code: IR.IAU.K.REC.1403.091
Clinical trials code: IR.IAU.K.REC.1403.091
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Esmaeili R, Firoozi M, Beiranvand M. Comparing the Effectiveness of Transdiagnostic and Inoculation Treatments on Reducing Perceived Stress, Cognitive Emotion Regulation, and Quality of Life in Patients with Cardiovascular Disorders. JHC 2025; 27 (3) :320-334
URL: http://hcjournal.arums.ac.ir/article-1-1614-en.html
URL: http://hcjournal.arums.ac.ir/article-1-1614-en.html
Department of Psychology, University of Tehran, Tehran, Iran
Abstract: (173 Views)
Background: Cardiovascular diseases are the most common non-communicable diseases and the leading cause of death worldwide. Therefore, investigating and selecting the most effective psychological interventions for managing stress and improving the quality of life of these patients is essential. This study aimed to compare the effectiveness of two methods, transdiagnostic therapy and stress inoculation training, in reducing perceived stress, improving cognitive emotion regulation, and enhancing the quality of life of cardiac patients.
Methods: The present study was a quasi-experimental research with a pretest-posttest design and follow-up, including a control group. The statistical population consisted of cardiovascular patients referred to Shahid Madani Hospital in Khorramabad, Lorestan. Using a convenience sampling method, 90 patients were selected and randomly assigned to one of three groups: control, experimental group 1 (stress inoculation training), and experimental group 2 (unified transdiagnostic therapy). The interventions were conducted based on Meichenbaum's stress inoculation training protocol and Barlow's unified transdiagnostic therapy protocol. Data were collected using the Garnefski Cognitive Emotion Regulation Questionnaire, Cohen's Perceived Stress Scale, and the WHO Quality of Life Questionnaire. Data were analyzed using repeated measures ANOVA.
Results: The results indicated that in the group receiving stress inoculation training, the mean score of perceived stress decreased in the posttest and follow-up stages (p<0.05). In the unified transdiagnostic therapy group, the total score of cognitive emotion regulation increased in the posttest and follow-up stages (p<0.001). Regarding quality of life, the transdiagnostic intervention demonstrated greater effectiveness compared to the stress inoculation training group (p<0.01).
Conclusion: According to the findings, healthcare professionals can purposefully utilize these interventions in the treatment process of cardiac patients, depending on each patient's specific needs (immediate stress reduction or sustained improvement in emotions and quality of life).
Methods: The present study was a quasi-experimental research with a pretest-posttest design and follow-up, including a control group. The statistical population consisted of cardiovascular patients referred to Shahid Madani Hospital in Khorramabad, Lorestan. Using a convenience sampling method, 90 patients were selected and randomly assigned to one of three groups: control, experimental group 1 (stress inoculation training), and experimental group 2 (unified transdiagnostic therapy). The interventions were conducted based on Meichenbaum's stress inoculation training protocol and Barlow's unified transdiagnostic therapy protocol. Data were collected using the Garnefski Cognitive Emotion Regulation Questionnaire, Cohen's Perceived Stress Scale, and the WHO Quality of Life Questionnaire. Data were analyzed using repeated measures ANOVA.
Results: The results indicated that in the group receiving stress inoculation training, the mean score of perceived stress decreased in the posttest and follow-up stages (p<0.05). In the unified transdiagnostic therapy group, the total score of cognitive emotion regulation increased in the posttest and follow-up stages (p<0.001). Regarding quality of life, the transdiagnostic intervention demonstrated greater effectiveness compared to the stress inoculation training group (p<0.01).
Conclusion: According to the findings, healthcare professionals can purposefully utilize these interventions in the treatment process of cardiac patients, depending on each patient's specific needs (immediate stress reduction or sustained improvement in emotions and quality of life).
Keywords: Integrated Transdiagnostic Treatment, Immunization Treatment Against stress, Perceived Stress, Cognitive Regulation of Emotion, Quality of Life, Cardiovascular Patients
Type of Study: Applicable |
Subject:
Psychiatric Nursing
References
1. Khachfe HH, Refaat MM. Bibliometric analysis of cardiovascular disease research activity in the Arab world. Global Cardiology. 2024;2(2):25-29. [DOI:10.4081/cardio.2024.34]
2. Khaltaev N, Axelrod S. Cardiovascular disease mortality and air pollution in countries with different socioeconomic status. Chronic Diseases and Translational Medicine. 2024;10(03):247-55. [DOI:10.1002/cdt3.116] [PMID] []
3. Samuel PO, Edo GI, Emakpor OL, Oloni GO, Ezekiel GO, Essaghah AEA, et al. Lifestyle modifications for preventing and managing cardiovascular diseases. Sport Sciences for Health. 2024;20(1):23-36. [DOI:10.1007/s11332-023-01118-z]
4. Lu W-l, Yuan J-h, Liu Z-y, Su Z-H, Shen Y-C, Li S-j, et al. Worldwide trends in mortality for hypertensive heart disease from 1990 to 2019 with projection to 2034: data from the Global Burden of Disease 2019 study. European Journal of Preventive Cardiology. 2024;31(1):23-37. [DOI:10.1093/eurjpc/zwad262] [PMID]
5. Danpanichkul P, Wattanachayakul P, Duangsonk K, Ongsupankul S, Sripusanapan A, Uawithya E, et al. The burden of alcohol-related cardiovascular complications in young and middle-aged adults: rising burden of atrial fibrillation and hypertensive heart disease. Acta Cardiologica. 2024;79(5):549-56. [DOI:10.1080/00015385.2024.2346872] [PMID]
6. Hussain MM, Rafi U, Imran A, Rehman MU, Abbas SK. Risk factors associated with cardiovascular disorders. Pakistan BioMedical Journal. 2024:7(2):03-10. [DOI:10.54393/pbmj.v7i02.1034]
7. Picano E, Pierard L, Peteiro J, Djordjevic-Dikic A, Sade LE, Cortigiani L, et al. The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC. European Heart Journal-Cardiovascular Imaging. 2024;25(2):e65-e90. [DOI:10.1093/ehjci/jead250] [PMID]
8. Xing A, Hengudomsub P, Ponpinij P. Factors predicting preoperative anxiety among adult patients undergoing cardiac surgery in China: a cross-sectional study. Belitung Nursing Journal. 2025;11(2):163-71. [DOI:10.33546/bnj.3695] [PMID] []
9. Gatie BK, Al-Hadrawi HH. Effectiveness of emotional-focused coping on heart-focused anxiety in patients prior to cardiac catheterization. Current Problems in Cardiology. 2025;50(7):102917. [DOI:10.1016/j.cpcardiol.2024.102917] [PMID]
10. Yang J, Luo J, Tian X, Zhao Y, Li Y, Wu X. Progress in understanding oxidative stress, aging, and aging-related diseases. Antioxidants. 2024;13(4):394. [DOI:10.3390/antiox13040394] [PMID] []
11. Satkar SG, Kumar A, Bhusare S, Sahu A, Gautam R. Impact of pollution and toxic stress on fish health: mechanisms, consequences, and mitigation strategies. Uttar Pradesh Journal of Zoology. 2024;45(6):29-45. [DOI:10.56557/upjoz/2024/v45i63949]
12. Boemo T, Martín-Garcia O, Pacheco-Romero AM, Blanco I, Lafit G, Myin-Germeys I, et al. Not just emotion regulation, but cognition: an experience sampling study testing the relations of ecological interpretation biases and use of emotion regulation strategies with momentary affective states during daily life functioning. Behaviour Research and Therapy. 2024;177:104550. [DOI:10.1016/j.brat.2024.104550] [PMID]
13. Duru E, Balkıs M. COVID-19 related negative life events and psychological distress: the role of emotion and cognitive emotion regulation strategies. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2024;42(1):69-91. [DOI:10.1007/s10942-022-00488-6] [PMID] []
14. Pruessner L, Timm C, Kalmar J, Bents H, Barnow S, Mander J. Emotion regulation as a mechanism of mindfulness in individual cognitive‐behavioral therapy for depression and anxiety disorders. Depression and Anxiety. 2024;2024:9081139. [DOI:10.1155/2024/9081139] [PMID] []
15. Opotowsky AR, Khairy P, Diller G, Kasparian NA, Brophy J, Jenkins K, et al. Clinical risk assessment and prediction in congenital heart disease across the lifespan: JACC scientific statement. Journal of the American College of Cardiology. 2024;83(21):2092-111. [DOI:10.1016/j.jacc.2024.02.055] [PMID]
16. Rojas M. Valuations of Life/Injury. Encyclopedia of Quality of Life and Well-Being Research. Springer; 2024. [DOI:10.1007/978-3-031-17299-1_3141] [PMID]
17. Lewandowska A, Lewandowski T, Rudzki G, Próchnicki M, Stryjkowska-Góra A, Laskowska B, et al. Anxiety levels among healthcare workers during the COVID-19 pandemic and attitudes towards COVID-19 vaccines. Vaccines. 2024;12(4):366. [DOI:10.3390/vaccines12040366] [PMID] []
18. Liu J, Xu J, Jia L, Zhou Y, Fu Q, Wang Y, et al. Pterostilbene nanoemulsion promotes Nrf2 signaling pathway to downregulate oxidative stress for treating Alzheimer's disease. International Journal of Pharmaceutics. 2024;655:124002. [DOI:10.1016/j.ijpharm.2024.124002] [PMID]
19. Gkintoni E, Antonopoulou H, Kazantzi E, editors. Cognitive behavioral therapy for enhancing emotional regulation and resilience in online learning environments. a clinical psychology perspective. In: ICERI2024 Proceedings. 17th International Conference of Education, Research and Innovation; Nov 11-13; Seville, Spain. IATED; 2024.
20. Norton PJ, Provencher MD, Roberge P. Transdiagnostic approaches to cognitive behavioural therapy for negative emotional disorders in adults. Canadian Psychology/Psychologie canadienne. 2024;66(3):158-70. [DOI:10.1037/cap0000405]
21. Farchione TJ, Long LJ, Spencer-Laitt D, Moreno J, Barlow DH. State of the science: the unified protocol for transdiagnostic treatment of emotional disorders. Behavior Therapy. 2024;55(6):1189-1204. [DOI:10.1016/j.beth.2024.04.007] [PMID]
22. Eslami M, Khoshakhlagh H, Rezaei Dehnavi S, Zareh Neyestanak M. Comparing the effectiveness of unified transdiagnostic treatment of Barlow and acceptance and commitment therapy on rumination and intolerance of uncertainty in Corona victims' wives. Research in Cognitive and Behavioral Sciences. 2024;13(2):137-62.
23. Wiederhold B. The stress vaccine? how technology can increase resilience. Cyberpsychology, Behavior and Social Networking. 2024;27(4):235-37. [DOI:10.1089/cyber.2024.92202.editorial] [PMID]
24. Meichenbaum D. Stress inoculation training: a preventative and treatment approach. In: Lehrer PM, Woolfolk RL, Sime WE, editors. Principles and practice of stress management. 3rd ed. New York: Guilford Press; 2005.
25. Barlow DH, Farchione TJ, Sauer-Zavala S, Latin HM, Ellard KK, Bullis JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. 2nd ed. New York: Oxford University Press; 2017. [DOI:10.1093/med-psych/9780190685973.001.0001]
26. Jones MV, Turner MJ. Stress Inoculation Training (SIT). Applying Cognitive Behavioural Therapeutic Approaches in Sport: Routledge; 2023. [DOI:10.4324/9781003162513-8]
27. Garnefski N, Van Den Kommer T, Kraaij V, Teerds J, Legerstee J, Onstein E. The relationship between cognitive emotion regulation strategies and emotional problems: comparison between a clinical and a non‐clinical sample. European Journal of Personality. 2002;16(5):403-20. [DOI:10.1002/per.458]
28. Pazoki L, Entezar RK, Panah AG. Psychometric characteristics of the cognitive emotion regulation questionnaire. Psychometry. 2015;4(14):1-11.
29. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of Health and Social Behavior. 1983:24(4):385-96. [DOI:10.2307/2136404] [PMID]
30. Lee E-H. Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research. 2012;6(4):121-27. [DOI:10.1016/j.anr.2012.08.004] [PMID]
31. Meri F, Sharifi Shahrivar S, Kuhi V, Etemadi M, Kalaee Rad M, Mousavi S. The effectiveness of cognitive-behavioral intervention based on stress-induced immunization training on improving sleep quality and mental health of adults during COVID-19 pandemic. Journal of Research in Psychopathology. 2021;2(6):10-16. [DOI:10.5058/stresskagakukenkyu.2021004]
32. Ware JE, Sherbourne CD. The MOS 36-Item Short form Health Survey (SF-36): I. Conceptual Framework and Item Selection. Medical Care. 1992;30:473-83. [DOI:10.1097/00005650-199206000-00002] [PMID]
33. Montazeri A, Goshtasebi A, Vahdaninia M. Educational inequalities in self-reported health in a general Iranian population. BMC Research Notes. 2008;1:1-6. [DOI:10.1186/1756-0500-1-50] [PMID] []
34. Chen B, Wen J, You D, Zhang Y. Implication of cognitive-behavioral stress management on anxiety, depression, and quality of life in acute myocardial infarction patients after percutaneous coronary intervention: a multicenter, randomized, controlled study. Irish Journal of Medical Science. 2024;193(1):101-109. [DOI:10.1007/s11845-023-03422-6] [PMID] []
35. Sadeghlou E, Pashang S, Sabet M. Effectiveness of stress immunization on resilience, anger rumination, and perceived stress among women with hypertension. Razavi International Journal of Medicine. 2022;10(2):7-11.
36. Bigonah Roodmajani M, Nayyeri M, Ramezani J. Comparison of mindfulness-based cognitive therapy and integrated transdiagnostic psychotherapy for emotion regulation and distress tolerance. Elderly Health Journal. 2024;10(1):52-61. [DOI:10.18502/ehj.v10i1.15966]
37. Ordoubadi AS, Golmakani ZB, Amiri M, Mansouri A. The effectiveness of transdiagnostic treatment in clinical symptoms, cognitive emotion regulation, and distress tolerance of university students. Journal of Fundamentals of Mental Health. 2021;23(1):49-56.
38. Iwakabe S, Nakamura K, Thoma NC. Enhancing emotion regulation. Psychotherapy Research. 2023;33(7):918-45. [DOI:10.1080/10503307.2023.2183155] [PMID]
39. Nordahl H, Anyan F, Hjemdal O, Wells A. Metacognition, cognition and social anxiety: a test of temporal and reciprocal relationships. Journal of Anxiety Disorders. 2022;86:102516. [DOI:10.1016/j.janxdis.2021.102516] [PMID]
40. Alimehdi M, Mohammdinia Z. The effectiveness of emotion regulation therapy on cognitive disturbance, function, and difficulty in emotion regulation among adolescents. International Journal of Applied Behavioral Sciences. 2022;9(4):9-16.
41. Harris KM, Jacoby DL, Lampert R, Soucier RJ, Burg MM. Psychological stress in heart failure: a potentially actionable disease modifier. Heart Failure Reviews. 2021;26(3):561-75. [DOI:10.1007/s10741-020-10056-8] [PMID] []
42. Verdejo-García A, Rossi G, Albein-Urios N, Lozano OM, Diaz-Batanero C. Identifying internalizing transdiagnostic profiles through motivational and cognitive control systems: relations with symptoms, functionality, and quality of life. Comprehensive Psychiatry. 2024;133:152498. [DOI:10.1016/j.comppsych.2024.152498] [PMID]
43. Flores-Mendoza JB, Robles García R, García-Méndez M, Rodríguez-Argüelles NL. Psychological barriers to adherence to pharmacological treatment of cardiovascular risk conditions in healthcare workers. Frontiers in Public Health. 2024;12:1462281. [DOI:10.3389/fpubh.2024.1462281] [PMID] []
44. Mufassery MR, Asadnia S, Arabi Divrazmi S, Rahimi F, Shahini S, Shahini P. The comparison of illness anxiety disorder with panic disorder based on meta-diagnostic cognitive structures: pain catastrophizing and anxiety sensitivity. Journal of Research in Psychopathology. 2023;4(14):29-36.
45. Taheri Kondar R, Hassani L, Ghanbarnejad A. The effect of educational intervention based on social support theory on the perceived stress caused by the COVID-19 pandemic in patients with diabetes in hormozgan (2020-2021). BMC Public Health. 2024;24(1):691. [DOI:10.1186/s12889-024-18180-y] [PMID] []
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