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

Jae Woon Lee; Jae Hyun Ha

doi:10.4040/jkan.2018.48.4.443

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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

Original Article

J Korean Acad Nurs 2018;48(4):443-453.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.4.443

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

Jae Woon Lee¹, Jae Hyun Ha^2,

¹Nursing Department, Bugok National Hospital, Changnyeong

²Department of Nursing, Masan University, Changwon, Korea

Address reprint requests to : Ha, Jae Hyun Department of Nursing, Masan University, 2640 Hamma-daero, Naeseo-eup, Masanhoewon-gu, Changwon 51217, Korea Tel: +82-55-230-1143 Fax: +82-55-230-1441 E-mail: malern@hanmail.net

Received 12 March 2018 Revised 29 July 2018 Accepted 31 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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.

Keywords: Acceptance and Commitment Therapy, Hospitalization, Schizophrenia, Self Efficacy, Stress, Psychological

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Figure 1.

Flow chart of the study.

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
Variables	Group	M±SD	M±SD	M±SD	t	p
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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