Journal List > J Korean Acad Nurs > v.48(4) > 1108856

Lee and Ha: The Effects of an Acceptance-Commitment Therapy Based Stress Management Program on Hospitalization Stress, Self-Efficacy and Psychological Well-Being of Inpatients with Schizophrenia

Abstract

Purpose

The purpose of this study was to construct an acceptance-commitment therapy (ACT)-based stress management program for inpatients with schizophrenia and to examine its effects on hospitalization stress, self-efficacy, and psychological well-being.

Methods

A non-equivalent control group pretest-posttest design was used. Participants were 44 inpatients with a diagnosis of schizophrenia. The experimental group (n=22) received the ACT-based stress management program twice a week for a total of four weeks. The control group (n=22) received the usual care from their primary health care providers. The study was carried out from August 7 to September 1, 2017, and data were analyzed using IBM SPSS/WIN 22.0 with a Chi-square test, Fisher's exact test, and an independent t-test.

Results

The experimental group showed a significant decrease in hospitalization stress (t=5.09, p<.001) and an increase in self-efficacy (t=2.44, p=.019). However, there was no significant difference in psychological well-being between the two groups (t=0.13, p=.894).

Conclusion

The results of this study suggest that the ACT-based stress management program can be used as an effective mental health nursing intervention for hospitalization stress and self-efficacy for inpatients with schizophrenia.

References

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Figure 1.
Flow chart of the study.
jkan-48-443f1.tif
Table 1.
Acceptance-Commitment Therapy Based Stress Management Program
Session Themes Contents of program Time (minutes)
1 Orientation Introduce the program and therapist 10
My stress check Introduce self and present a nickname 30
Discuss individual stress and coping style
Wrap up Breathing meditation 10
Homework: stress event experience diary
2 Getting started Share the conent of the previous session 10
Acceptance Typical usual method of dealing with auditory hallucinations 30
Activities using metaphors
Wrap up Breathing meditation 10
Homework: event experience diary
3 Getting started Share the content of the previous session 10
Cognitive defusion Choosing actions regardless of language 30
Milk·milk·milk game
Black and white game
Wrap up Breathing meditation 10
Homework: event experience diary
4~5 Getting started Share the conent of the previous session 10
Self as context Fear of relapse and future: lecture (PPT) 30
Understanding schizophrenia and using drugs
Improve self-efficacy: watching the video
Raisins eating meditation
Wrap up Breathing meditation 10
Homework: event experience diary
6 Getting started Share the content of the previous session 10
Stay in the present A letter from the future 30
A soap-blowing game
Wrap up Breathing meditation 10
7 Getting started Find my value: watching video 10
Find value Commitment to resemble my hero 30
Wrap up Breathing meditation 10
8 Getting started Activities using metaphor 10
Commitment to my values Complete program review and finalization 40
Share thoughts on participating in the program
Table 2.
Homogeneity of General Characteristics between Experimental and Control Groups (N=44)
Characteristics Categories Exp.(n=22) n (%) or M±SD Cont.(n=22) n (%) or M±SD χ2 p
Sex Male 13 (59.1) 12 (54.5) 0.09 >.999
Female 9 (40.9) 10 (45.5)
Age (yr) ≤30 2 (9.0) 2 (9.0) 0.75 .457
31~40 4 (18.2) 5 (22.8)
41~50 5 (22.8) 8 (36.4)
≥51 11 (50.0) 7 (31.8)
47.14±10.23 44.68±8.94 0.84 .402
Marital status Married 6 (27.3) 4 (18.2) 0.52 .721
Single 16 (72.7) 18 (81.8)
Education level ≤High school 17 (77.3) 18 (81.8) 0.14 >.999
≥College 5 (22.7) 4 (18.2)
Types of admission Voluntary 11 (50.0) 13 (59.1) 0.37 .763
Involuntary 11 (50.0) 9 (40.9)
Hospitalization period (month) <3 9 (40.9) 9 (40.9) -0.32 .746
3~<6 5 (22.7) 3 (13.6)
≥6 8 (36.4) 10 (45.5)

Exp.=Experimental group; Cont.=Control group; M=Mean; SD=Standard deviation.

Fisher’s exact probability test.

Table 3.
Homogeneity of Dependent Variables in Pretest (N=44)
Variables Exp.(n=22) M±SD Cont.(n=22) M±SD t p
Hospitalization stress 59.72±8.47 57.05±10.35 0.94 .352
Self-efficacy 60.63±10.84 63.64±11.01 -0.91 .368
Psychological well-being 119.50±11.34 123.77±12.52 -1.19 .242

Exp.=Experimental group; Cont.=Control group; M=Mean; SD=Standard deviation.

Table 4.
Comparisons of Dependent Variables between the two Group (N=44)
Variables Group Pre test Post test Difference t p
M±SD M±SD M±SD
Hospitalization stress Exp.(n=22) 59.72±8.47 41.91±7.02 -17.82±6.64 -5.09 <.001
Cont.(n=22) 57.05±10.35 54.50±9.26 -2.55±5.25
Self-efficacy Exp.(n=22) 60.63±10.84 71.72±8.40 11.09±5.33 2.44 .019
Cont.(n=22) 63.64±11.01 63.91±12.46 0.27±7.16
Psychological well-being Exp.(n=22) 119.50±11.34 133.09±8.25 13.59±6.85 0.13 .894
Cont.(n=22) 123.77±12.52 132.73±9.64 8.95±7.78

Exp.=Experimental group; Cont.=Control group; M=Mean; SD=Standard deviation.

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