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 Table of Contents  
Year : 2017  |  Volume : 3  |  Issue : 4  |  Page : 240-244

The effectiveness of ACT on psychological, social and spiritual health of the patients with angina pectoris

1 Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
2 Department of Psychiatry, University of Medical Sciences, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication9-Feb-2018

Correspondence Address:
Dr. Mohsen Maroufi
Department of Psychiatry, University of Medical Sciences, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-2296.225099

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AIM: The aim of this study was to evaluate the effectiveness of acceptance and commitment therapy (ACT) on psychological, social, and spiritual health of the patients with angina pectoris.
METHODOLOGY: Research method was semi-experiment, and research design was two groups with pre- and post-test. The statistical population comprised all cardiovascular patients who referred to the Seddygheh Tahereh Cardiovascular Research Center. Among them, 30 patients were selected voluntarily and then randomly assigned to experiment and control groups. The study instruments comprised the Lifestyle (Lali et al.,) and Demographic Questionnaires. The data were analyzed using analysis of covariance.
RESULT: The findings indicated that there was no significant difference between experimental group and control group in psychological, social, and spiritual health (P < 0.05).
CONCLUSION: ACT can be effective in promoting psychological, social, and spiritual health of the patients with angina pectoris.

Keywords: Acceptance and commitment, angina pectoris, therapy

How to cite this article:
Amiri M, Maroufi M, Sadeghi M. The effectiveness of ACT on psychological, social and spiritual health of the patients with angina pectoris. Int J Educ Psychol Res 2017;3:240-4

How to cite this URL:
Amiri M, Maroufi M, Sadeghi M. The effectiveness of ACT on psychological, social and spiritual health of the patients with angina pectoris. Int J Educ Psychol Res [serial online] 2017 [cited 2023 Jun 5];3:240-4. Available from: https://www.ijeprjournal.org/text.asp?2017/3/4/240/225099

  Introduction Top

One of the most common causes of morbidity and mortality from heart disease, especially ischemic heart disease, which is caused by insufficient blood supply to the coronary arteries. The most obvious manifestation of ischemic heart disease is angina. Angina happened from an imbalance between demand and supply of oxygen to the myocardium. The main reason for this imbalance is coronary heart disease (CHD), in which a reduction in oxygen supply caused by atherosclerotic narrowing occurs in one or more coronary arteries. Men almost make up 70% of all angina patients and a large part of the population is below 50 years of age.[1]

CHD is very common in Iran. In the last two decades, studies conducted by the Center for Cardiovascular Research shows a high prevalence of cardiovascular disease and mortality caused by them in society. So that now the disease is known as thefirst cause of death in our society (45.75). The frequency of significant risk factors for the disease such as diabetes, hypertension, dyslipidemia, weight gain, and obesity have been reported in different studies.[2]

Cardiovascular diseases are including chronic diseases who not only account to a high number of deaths but also causes a limitation in quality of life.[3]

Limitations created as well as job tasks the patient's family and social life cause difficult and result social isolation and depression. Quality of life is in the fields of health, labor, economic, social, psychological, person's social development, and independence degree.[4] Also, studies have shown that the severity and frequency of symptoms in these patients have nature threat this sense that death is the imminent causes mood disorders result. Anxiety, fear, ultimately anxiety, and mood disorders benefit due to lack of proper sleep. Physical symptoms due to disease and intolerance activities led to social isolation and sexual dysfunction in patients and thus changed the role of the patient's family and social life, and decreases their satisfaction of life.[5]

Zambroski et al. found that poor physical performance and depression are caused that quality of life undesirable in these patients.[6]

Also Juenger et al. in a study of demonstrated patients with heart failure compared to patients with other chronic diseases such as chronic obstructive pulmonary disease, arthritis, unstable angina and patients with a history of heart attack benefit a lower quality of life. Juenger et al. in their investigated the quality of life of patients with heart failure were indicated inappropriate and that the majority of heart failure patients have described the poor quality of life. As a result, They cannot function well in their social health and mental health and as well as in their spiritual health show weakness.[7]

Sirius studied at the University of Florida showed that socio_psychological factors have an important role in the frequency of angina pectoris.[8]

In recent years, many studies have been made on the effects of depression and anxiety, which is the main component of mental health, on the start, along the course and prognosis of CHD. Recent studies have shown that depression in both healthy subjects and in patients with CHD increases the risk of cardiac events in the 40–65% of patients clinically after myocardial infarction (MI) becomes observed significant depressive symptoms. While in other patients with major depressive disorders is 20–25%.[9]

Depression increases the risk of MI and death following cardiovascular events. Also, patients with depression after MI are developed more likely to complications such as cardiac arrhythmias. The depression in patients with CHD, resulting in deterioration of cardiac function (increased frequency or severity of chest pain) increasing physical limitations is reduced satisfaction of treatment and quality of life.[9]

Studies on the general population and patients continually show that more than 90% of people believe a supreme being (higher being). Some studies indicate that 94% of the patient are equally important the physical and spiritual health. Most patients are seeking care and their religious needs. Most patients want to handling and fulfilling their religious needs. A study of family physicians showed that 96% of respondents believe that spiritual health is an important factor in health. Despite these findings often are neglected the spiritual needs of patients. Some studies suggest that without spiritual health other aspects of biological, psychological and social factors cannot function correctly or is reached the maximum capacity thus the highest level of quality of life will not be available.[10] Many researchers suggest that psychological interventions should be part of the treatment plan heart patients and typically done. However the results of various tests, in order to determine the effectiveness of psychological interventions on physical and mental health of these patients, are not fully aligned.[11]

Lillis et al. in research to improve the lives of people with obesity showed that after 3 months of training mindfulness and acceptance and commitment is resulted in a significant increase in quality of life, reduce the psychological concerns, body mass index, tolerability concerns and psychological resilience against obesity.[12]

Acceptance and commitment therapy (ACT) a treatment that has formed the development of cognitive behavior therapy. ACT has deep roots in the philosophical theory called functional areas oriented and theoretically based on the Rational Frame Theory (RFT) is about mental. According to this theory, people on the basis have been not responding to interactions that already driven to them but his response to stimuli depends on the interaction with driving other events.[13] A man can say or assume that a new stimulus “like” or “different” from what previous interact with it and this new drive on the network relational mind will performance that these symptoms cause.[14] The RFT clearly seen only in humans as well as a man grows and RFT grows.[14] Avoiding pain and stress are the main problem for patients who take disability and decreased life satisfaction. According to this theory avoidance happens when that negative thoughts and excitement does effect of excessively and inappropriate on the from. The main method of ACT is the exposure of patients to situations that they have been avoided them previously.[15]

Considering the above, this study was to evaluate the efficacy of commitment and acceptance therapy on psychological, social, and spiritual of heart patients will open a new chapter in the research literature. In fact, a way to answer the question of whether on the commitment and acceptance therapy is effective to change psychological, social, and spiritual health patients with angina pectoris?

  Methodology Top

The research method is quasi-experimental using pre- and post-test that was performed with both the control and experimental groups [Table 1].
Table 1: Research project

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The objective of this study was to determine the effect of commitment and acceptance therapy of psychological, social, and spiritual health patients compared to the control group. The experimental research method was appropriate for this purpose.

In this type of research can examine influence one or more independent variables on one or more variables. This kind of research is possible of manipulating those variables there is significant knowledge of causal relationships between variables lose.

The population of this study are heart patients who admitted to coronary care units in August 2014 in Isfahan city. That with CHD and angina and heart disease diagnose by a physician and their disease have been confirmed with laboratory findings.

Statistic population studied in this research include heart disease in 2014 were admitted to coronary care units in Isfahan. Then, all cardiology centers in Isfahan will be selected statistical Seddygheh Tahereh Cardiovascular Research Center availability. The sample in this study due to the nature of the sampling study with intervention was voluntary. In case referred of heart patients from July to October 2014 the center. Then, 30 number were registered of them to participate in the study volunteers and after to complete the number of samples with volunteers to participate in project call phone received and then collect from the center to demographic information and a description of the subject. A meeting was held briefing. After obtaining the consent of the individual Member States to participate in the project, groups were randomly assigned to experimental and control groups (15 people).

Inclusion criteria for the study were

  • No acute or chronic mental disorders
  • No other psychological program
  • The ability to participate in therapy sessions.

Exclusion criteria

  • Medical condition lay deteriorating
  • The absence of more than two sessions
  • Hospitalization was in the hospital.

Research instrument

  • Demographic questionnaire researcher
  • Life Style Questionnaire:

To assess patients' psychological health, social health and spiritual health Lifestyle Questionnaire (LSQ) is used by Lali et al. made and validate.

To evaluate the reliability of internal consistency and test-retest were used two methods. The internal consistency between the components and the whole LSQ Cronbach's alpha coefficients range is located between 76/0 and 89/0. The test-retest reliability coefficients range from 84/0 to 94/0 in there. The reliability of the questionnaire in this study was obtained through Cronbach's alpha equal to 81/0.

Implementation and scoring

The questionnaire has 70 questions that are always Likert spectrum grading is: Always - 3, often - 2, sometimes - 1, never - 0. The questionnaire method using principal component analysis of 10 factors with a value >1 were extracted on a 46/22% of the total variance is determined their psychological, social, and spiritual health of lifestyle. Varimax rotation 10 factors were identified and confirmed that the variance in equity are as follows:

  • Physical health
  • Sports and fitness
  • Weight management and nutrition
  • Preventable diseases
  • Psychological health
  • Spiritual health
  • Social health
  • Avoid drugs, drug, and alcohol
  • Prevent accidents
  • Environmental health.

Construct validity and reliability of multi-dimensional LSQ have been approved as a tool for evaluation and measurement of lifestyle.[16] The results of the factor structure and multi-dimensional lifestyle are consistent with the findings of several studies that have suggested that lifestyle is a multi-dimensional structure.[16],[17]

Of course, we are paid in the process of this research that only three variables to measure the psychological health and social health and spiritual health.

If earn high scores on each component represents good health variables.

The study method

After the selection according to criteria stated the subjects were randomly divided into two experiment and control groups and pretest was administered to both groups. Independent variable for experiment ACT interventions as a set of empirical exercises that combined to behavioral interventions standard was used to accepting without judgment and experience to develop an individual treatment. Treatment 8 sessions a month and a half hours during two sessions as a week. Treatment done during 8 sessions of and a half hours the two sessions as a week during a month.

Data analysis

To investigate this hypothesis, the obtained data were analyzed using analysis of covariance (ANCOVA).

The analysis of data research was conducted on pre- and post-test variables. For Data analysis was used descriptive statistics and ANCOVA. Statistical findings from research to achieve the objectives of the intervention were analyzed using Statistical Package for Social Science 20 version. In terms of demographic variables age range 45–70 participants and of sexually had formed 30% of women and 70% of men. Descriptive data are shown in [Table 2].
Table 2: Compares descriptive findings of the study variables in two separate groups

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[Table 2] shows mean variables psychology, social, and spiritual health in the pre- and post-test. The mean is a significant difference in psychology, social, and spiritual health in the pre- to post-test. After approval of the assumptions of normality equal variance and also because of equal sample size in the tests was used to parametric ANCOVA analyze the data.

The results of ANCOVA are provided in [Table 3].
Table 3: Comparing the results of the research groups

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Based on the findings obtained in [Table 3], there were significant differences in mean scores of marital satisfaction at posttest in control and experimental groups. The difference variables psychology, social and is significant between experimental and control groups in the pre- and post-test (P < 0.05). Namely ACT on these three variables could be effective.

  Discussion and Conclusion Top

As previously was expressed three variables psychology, social and spiritual health was observed a significant difference between control and experimental groups which shows the effectiveness of the ACT to these three variables.

The results of research are consistent with Hor et al., Heidari, as well as with research Endalib (2012).[18],[19],[20]

Thoughts imposed cognitive structure can create the human mind different effects. When a permanent think rush to the scene of his conscious mind people even if it is not based on reality and emanate maimed and sick of the beliefs of can lead to impaired cognitive beliefs and become a reality for the individual. One can imagine that when a heart patient experience than his disease thought forced. No doubt, from his hope, motivation, effort, and commitment will decrease to control and treat the disease likely based on extensive studies that have been conducted so far. In heart patients to a mental rumination than disease and there are micro and macro implications. Such rumination has taken on the nature of the threat slowly for cardiovascular patients while cannot be deleted the other simply the mind despite serious efforts cannot be deleted the mind easily. In the process of ACT in such patients is taught in addition to his acceptance and physical conditions, as well as accept to commitment, trying and responsibility to the goals and values of life.

Also note that one permanent own life in the present moment. Despite there are disease and problems need to efforts that behavioral objectives and values rather than focus on the imposed and disturbing thoughts.

ACT will provide the opportunity for the client to feel inner unpleasant experiences without trying to control their and doing so makes them seem less threatening and reduced their impact on one's life.

As for the presence of the patients were required full satisfaction to training sessions, so patients randomly selected likely to affect both groups, and thus be to generalize the results of caution.

Therefore, are affected the probability of randomly selecting two groups, and so is required more careful to be made order to generalizing the results.

There are acute problems in some patients lead to raises observe some of the preventive measures by them and this may increase bias in the response of patients to fill out the questionnaire.

It is suggested that in future research is recommended to check effectiveness other postmodern method on another health variables of psychosomatic of patients. Additional be performed researches on the larger community and to with more meetings.

Since the approach of ACT is a postmodern approach is recommended Cardiologists and heart disease treatment centers, dedicated education provider in this field. It is suggested that rehabilitation centers for heart disease consider mental rehabilitation programs as part of strategies treatment standard.


From officials honorable Cardiovascular Research Center Sedighe Tahereh (as) particularly part cardiac rehabilitation center be sincerely appreciated for had ultimately collaboration to the conduct and progress of research.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Lily L. Pathophysiology of Heart Disease: Translation, Mousavi AF. Tehran: University Nashr Publication; 2005.  Back to cited text no. 1
Sarrafzadegan N, Paydar N. Isfahan Healthy Heart Program: Prevention and Control of Cardiovascular Diseases in Iran Pilot in Isfahan, Najafabad and Arak; 2006.  Back to cited text no. 2
Hasanpour-Dehkordi A, Nazari AA, Heidar-Nejad MS, Asadi-Noghabi AA, Forouzandeh N, Kasiri KA, et al. Factors influencing quality of life in patients with myocardial infraction. Iran J Nurs 2009;22:43-52.  Back to cited text no. 3
Cockerham WC. Health lifestyle theory and the convergence of agency and structure. J Health Soc Behav 2005;46:51-67.  Back to cited text no. 4
Khoshdel M. Relationship Between Social Support and Self Respect in Students of Tabriz University. Ms Thesis. Tabriz: Social Sciences Collage, Tabriz University 2000. p. 2-45.  Back to cited text no. 5
Zambroski CH, Moser DK, Bhat G, Ziegler C. Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure. Eur J Cardiovasc Nurs 2005;4:198-206.  Back to cited text no. 6
Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, et al. Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart 2002;87:235-41.  Back to cited text no. 7
Talai A, Asnaashari A, Moharreri F, Aradani AR, Myrshjayyan. Case-control study of depression in patients with unstable angina. J Ment Health 2010;4:299-306.  Back to cited text no. 8
Ghaleiha A, Imami F, Hassani RA, Tabrizi BN. Prevalence of anxiety and depression in patients with acute coronary syndrome admitted to hospital in the city of Hamedan Ekbatan. Fac Med Sci 2010;4:43-9.  Back to cited text no. 9
Omidvary S. Spirituality, concepts and challenges. Q J Interdiscip Res Quran 2008;1:6-16.  Back to cited text no. 10
Hofmann SG, Asmundson GJ. Acceptance and mindfulness-based therapy: New wave or old hat? Clin Psychol Rev 2008;28:1-16.  Back to cited text no. 11
Lillis J, Hayes SC, Bunting K, Masuda A. Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Ann Behav Med 2009;37:58-69.  Back to cited text no. 12
Hayes SC, Barnes-Holmes D, Roche B. Relational Frame Theory: A Post. Skinnerian Account of Human Language and Cognition. New York: Kluwer Academic; 2001.  Back to cited text no. 13
Izadi R, Abedi MR. Acceptance and commitment Therapy. Isfahan: Publication of Jangal; 2012.  Back to cited text no. 14
Izadi R, Asgari K, Neshatdoost HT, Abedi MR. Case reports of treatment efficacy based on acceptance and commitment therapy on the frequency and severity of symptoms of obsessive-compulsive disorder. J Med Sci 2012;14:107-12.  Back to cited text no. 15
Lali M, Abedi A, Kajbaf M. Construction and validation questionor of life style Psychol Res 2008;15:43-55.  Back to cited text no. 16
Colquhoun D, Bunker SJ, Clarke DM, Glozier N, Hare DL, Hickie IB, et al. Screening, referral and treatment for depression in patients with coronary heart disease. A consensus statement from the National Heart Foundation of Australia. Med J Aust 2013;198:483-4.  Back to cited text no. 17
Hor M. The Effectiveness of Acceptance and Commitment Therapy on Depression and Mental Health in Type II Diabetic Patients: MA Thesis in General Psychology, University of Isfahan; 2012.  Back to cited text no. 18
Heidari P. The Effectivenesst of Acceptance and Commitment Group Therapy Vitality and Resiliency of Female Patients with Psoriasis Isfhan. MA Thesis, of Psychology, University of Isfahan; 2013.  Back to cited text no. 19
Endalib S. The Effectiveness of Acceptance and Commitment Therapy on Mindfulness Skills, Repression of Thought, Mind Control, Rigidity and Valuable Life in Patients with Cardiovascular Disease, MA Thesis in General Psychology, Free University of Isfahan (Khorasgan); 2012.  Back to cited text no. 20


  [Table 1], [Table 2], [Table 3]


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