Developing a Feasibility Study of a Metacognitive-Analytic Treatment Protocol to Enhance Ego Strength and Alleviate Anxiety and Depression Among Nurses in COVID-19 Wards

Document Type : Original Article

Authors

1 Ph.D. student of Clinical Psychology, Science and Culture University, Tehran, Iran.

2 Assistant professor and member of the academic board of the Department of Psychology, Faculty of Human Sciences, University of Science and Culture, Tehran, Iran.

3 Assistant professor and member of the academic faculty of the Department of Psychology, Faculty of Educational Sciences-Psychology, Tarbiat Modares University, Tehran, Iran.

Abstract

Introduction: Researchers have found the combination of metacognitive and psychodynamic therapy to be beneficial. In this context, the present study aimed to design and conduct a feasibility investigation of metacognitive analytic therapy to enhance ego strength and reduce anxiety and depression among nurses working in COVID-19 wards.
Method: This research employed an exploratory qualitative approach. The statistical population consisted of psychology specialists, from which 36 individuals were purposefully selected as the research sample. Following a review of the literature to identify risk and treatment factors, 10 additional individuals were interviewed to gather further insights. The content validity ratio and content validity index for both risk factors and treatment factors were assessed with the input of 14 participants. Additionally, the content validity ratio and content validity index for treatment sessions, as well as the feasibility of the treatment protocol, were evaluated with 12 participants.
Results: The results indicated that the risk components, treatment components, and therapy sessions demonstrated a strong content validity ratio and content validity index. Additionally, the feasibility results revealed that metacognitive analytic therapy had exhibited acceptability, applicability applicability, integrity, adaptability, resources resource availability, and generalizability.
Discussion and conclusion: The metacognitive analytic treatment protocol can be assessed for its suitability in clinical interventions, as it demonstrates strong validity in its risk components, treatment components, and metacognitive analytic therapy. Additionally, this therapy have exhibits acceptability, and applicability, adaptability, resources and resource availability, generalizability. Therefore, researchers are recommended to encouraged the investigate and effectiveness of this protocol, while protocol. Psychologists are also advised to use metacognitive implement therapy to strengthen ego and enhance clients' ego strength and alleviate of clients, depression, particularly among nurses.

Keywords

References

  • Sun, N., Shi, S., Jiao, D., Song, R., Wang, H. A. qualitative study on the psychological experience of caregivers of covid-19 patients. American Journal of Infection Control, 2020; 48(6): 592-598. https://doi.org/1016/j.ajic.2020.03.018
  • Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, Z., Xiang, B., Hu, S., Zhang, K., Wang, G., Ma, C., Liu, Z.Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun, 2020; 87(5): 11-

https://doi.org/10.1016/j.bbi.2020.03.028

  • Smith, G. D., Ng, F., Ho Cheung Li, W. COVID-19: Emerging compassion, courage and resilience in the face of misinformation and adversity. J Clin Nurs. 2020;29(9-10):1425-1428.

https://doi.org/10.1111/jocn.15231

  • Douplat, M., Subtil, F., Termoz, A., Jacquin, L., Verbois, F., Potinet, V., Hernu, R., Landel, V., Mazza, S., Berthiller, J., Haesebaert, J., Tazarourte, K. Changes over time in anxiety, depression, and stress symptoms among healthcare workers in French emergency departments during the first COVID-19 outbreak. Journal of Affective Disorders. 2022 ;316: 194-200. https://doi.org/ 10.1016/j.jad.2022.08.028.
  • Ding, C., Wang, L., Guo, Z., Chen, Y., Jin, J. Psychological care needs for frontline nurses during the COVID-19 pandemic: A qualitative study. Front Public Health. 2022.

https://doi.org/10.3389/fpubh.2022.1043515.

  • Conejero, I., Petrier, M., Fabbro Peray, P., Voisin, C., Courtet, P., Potier, H., Elotmani, L., Lafont, B., Lefrant, J. Y., Lopez Castroman, J., Arbus, C., Blain, H. Post-traumatic stress disorder, anxiety, depression and burnout in nursing home staff in South France during the COVID-19 pandemic. Transl Psychiatry. 2023; 13(1): 205-215.

https://doi.org/10.1038/s41398-023-02488-1

  • Morawa, E., Adler, W., Schug, C., Borho, A., Geiser, F., Beschoner, P., Jerg-Bretzke, L., Albus, C., Weidner, K., Mogwitz, S. Depression and anxiety among nurses during the COVID-19 pandemic: Longitudinal results over 2 years from the multicentre VOICE–EgePan study. Journal of Clinical Nursing. 2024; 33(6): 1-12.

https://doi.org/10.1111/jocn.17079

[In Persian].

  • Chen, H. Y., Ahmad, C. A., Abdullah, K. L.The impact of serving in disaster relief among volunteers in Malaysia. Chin J Traumatol. 2021;24(4):237-248. https://doi.org/10.1016/j.cjtee.2021.04.002
  • Rajkumar, R. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020; 52:102066.

https://doi.org/ 10.1016/j.ajp.2020.102066.

  • de Girolamo, G., Cerveri, G., Clerici, M., Monzani, E., Spinogatti, F., Starace, F., et al. Mental health in the coronavirus disease 2019 emergency-the Italian response. JAMA Psychiatry. 2020; 77(9): 974-976.

https://doi.org/10.1001/jamapsychiatry.2020.1276

  • Varghese, A., George, G., Kondaguli, S. V., Naser, A. Y., Khakha, D. C., Chatterji, R. Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis. Journal of Global Health, 2021; 11, 05009.

https://doi.org/10.7189%2Fjogh.11.05009

  • Sadri Damirchi, E., Zakibakhsh Mohammadi, N., Amir, S. M. B. The Role of Thwarted Belongingness, Perceived Burden someness, Self-Efficacy and Ego Strength in Predicting Suicidal Ideation of Nurses. Health in Emergencies and Disasters Quarterly. 2019; 4(2): 85-92. http://hdq.uswr.ac.ir/article-1-228-en.html
  • Fallah, M., Moshtagh, N., Dolatshahi, B., Mirabzadeh, A. Correlation between Different Dimensions of Anger and Depression in Women by Mediating Objectives and Capabilities of Igo.  Journal of Health Promotion Management (JHPM), 2019; 8(3): 59-67.‌https://sid.ir/paper/363768/fa

[In Persian].

https://doi.org/10.22108/PPLS.2017.2171[In Persian].

  • Goryczka, A., Dębinski, P., Gogola, A. M., Gorczyca, P., Piegza, M. Depressive and Anxiety Symptoms and Their Relationships with Ego-Resiliency and Life Satisfaction amongWell-Educated, Young Polish Citizens during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health.2022; 19(16): 1-9.

https://doi.org/10.3390/ijerph191610364

  • Eagle, M.N. Toward a Unified Psychoanalytic Theory, Foundation in a Revised and Expanded Ego Psychology, New York, NY; Routledge.2022. https://psycnet.apa.org/record/2021-65199-000
  • Koochaki-Ravandi, M., Monirpour, N., Arj, A. The role of attachment styles, quality of object relations and ego strength in predicting irritable bowel syndrome. Journal of Kashan University of Medical Sciences, August 2015; 19(3); 231-241.

http://feyz.kaums.ac.ir/article-1-2718-fa.html

[In Persian].

  • Cui, Y., Yang, T., Gao, H., Ren, L., Liu, N., Liu, X., Zhang, Y. The relationship between ego depletion and work alienation in Chinese nurses: A network analysis. Front Psychol. 2022 Jul 22;13:915959. PMID: 35936327; PMCID: PMC9355549. https://doi.org/3389/fpsyg.2022.915959
  • AAl-Harbi,B; Ibrahim, Kh; Al-Rababaah, J; Al- mehsin,S. The Ego Depletion and Its Relationship with the Future Anxiety among the University Female Students. International Journal of Higher Education. 2021; 10(2): 128-139.

https://files.eric.ed.gov/fulltext/EJ1285601

  • Wegener, J. R., Ludlow, C. E., Olsen, A. J., Tortosa, M., Wintch, P. H. Ego Depletion: A contributing factor of hopelessness depression," Intuition: The BYU Undergraduate Journal of Psychology. 2007; 3(1).

https://scholarsarchive.byu.edu/intuition/vol3/iss1/4

  • Summers, F. Object relations theories and psychopathology‌: a comprehensive text.Published by Psychology Press, New York.2014. https://doi.org/10.4324/9781003485452
  • Clair, S. T. M., Wigren, J. Object Relations and Self Psychology: An Introduction 3th Edition. Publisher, Cengage Learning, 2000.

https://www.amazon.com/Object-Relations-Self-Psychology-Introduction/dp/053436280X

https://sid.ir/paper/16893/fa [In Persian].

  • Janbozorghi, M., Gharavi, M. New Theories of Psychotherapy and Counseling. Tehran: Samat Publications, 2016.

      https://samta.samt.ac.ir/product/14236/

      [In Persian].

  • Corbridge, C., Brummer, L., Coid, P. Cognitive Analytic Therapy: Distinctive Features (Psychotherapy and Counselling Distinctive Features) Published Routledge, 2018.

https://www.routledge.com/Cognitive-Analytic-Therapy

  • Ryle, A., Kerr, I. B. Introducing cognitive analytic therapy : principles and practice of a relational approach to mental health. Second edition. Hoboken, NJ, Wiley. 2020.

https://www.wiley.com/en-us/Introducing+Cognitive+Analytic+Therapy

  • Wakefield, S., Delgadillo, J., Kellett, S., White, S., Hepple, J. The effectiveness of brief cognitive analytic therapy for anxiety and depression: A quasi-experimental case-control study. Br J Clin Psychol. 2021; 60(2): 194-211.

https://doi.org/10.1111/bjc.12278

  • Einy, S., Narimani, M., Atadokht, A., Basharpoor, S., Sadeghi Movahhed, F. EFFECTIVENESS OF COGNITIVE-ANALYTICAL THERAPY ON EGO-STRENGTH AND OBJECT RELATIONS OF PERSONS WITH BORDERLINE PERSONALITY Studies in Medical Sciences, Monthly_Apr 2018; 29 (1): 1-11.

http://umj.umsu.ac.ir/article-1-4286-fa.html

[In Persian].

  • Wells, A. Metacognitive Therapy for Anxiety and Depression. Publisher The Guilford Press; Reprint edition. 2009.

https://www.guilford.com/books/Metacognitive-Therapy

  • Wells, A., Fisher, P. L. Metacognitive therapy for obsessive– compulsive disorder: A case series. Journal of Behavior Therapy and Experimental Psychiatry, 2008; 39 (2): 117-132.

https://doi.org/10.1016/j.jbtep.2006.12.001

  • Flavell, J. H. Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry. American Psychologist,1979; 34(10): 906–911.

https://doi.org/10.1037/0003-066X.34.10.906

  • Aydın, O., Balıkçı, K., Arslan, Y., Ünal-Aydın, P., Muezzin, E., Spada, M. M. The Combined Contribution of Fear and Perceived Danger of COVID-19 and Metacognitions to Anxiety Levels during the COVID-19 Pandemic. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2022; 40: 603–617.

https://doi.org/10.1007/s10942-021-00429-9

  • Spada, M. M., Georgiou, G. A., Wells, A. The relationship among metacognitions, attentional control, and state anxiety. Cognitive Behaviour Therapy, 2010; 39 (1): 64-71.

https://doi.org/10.1080/16506070902991791

  • Gutierrez, R., Hirani, T., Curtis, L., Ludlow, A. K. Metacognitive beliefs mediate the relationship between anxiety sensitivity and traits of obsessive-compulsive symptoms.BMC Psychology volume. 2020; 8 (40): 1-7.

https://doi.org/10.1186/s40359-020-00412-6

  • Mostafazadeh, Sh., Davoodi, A. Prediction of depression based on metacognitive beliefs and negative affect in individuals with social anxiety symptoms. Afagh Human Sciences Monthly, 2019; 4(41): 17-35.

https://civilica.com/doc/1556222 [In Persian].

  • Hajati, A. R., Mirzaeyan, B., Donyavi, R. Modeling structural relationships of uncertainty intolerance with worry mediated referral thinking, metacognitive beliefs and perfectionism in patients with generalized anxiety disorder. Journal of Psychology New Ideas, 2022; 13(17): 1-17.   http://jnip.ir/article-1-737-fa.html

[In Persian].

  • Huntley, C. D., Young, B., Smith, C. T., Jha, V., Fisher, P. L. Assessing metacognitive beliefs in test anxiety: Psychometric properties of the metacognitions questionnaire, 30 (MCQ-30) among university students. Current Psychology. 2022; 41 (3): 1425–1433.

https://doi.org/10.1007/s12144-020-00662-y

  • Wells, A. Cognition about cognition: metacognitive therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice. 2007; 14(1): 18-25.

https://doi.org/10.1016/j.cbpra.2006.01.005

  • Fonagy, P. Attachment and borderline personality disorder. Journal of the American Psychoanalytic Association. 2000; 48(4): 1129–1146.

https://doi.org/10.1177/00030651000480040701

  • Aydin, O., Balikci, K., Tas, C., Aydin, P. U., Danaci, A. E., Brüne, M., et al. The developmental origins of metacognitive deficits in schizophrenia. Psychiatry Res, 2016; 30(‌245): 15–21. https://doi.org/1016/j.psychres.2016.08.012
  • Weijers, J., ten Kate, C., Eurelings-Bontekoe, E., Viechtbauer, W., Rampaart, R., Bateman, A., et al. Mentalization-based treatment for psychotic disorder: protocol of a randomized controlled trial. BMC Psychiatry, 2016; 16:191.

https://doi.org/ 10.1186/s12888-016-0902-x

  • Hosseini Ramaghani, N. A., Rezaei, F., Sepahvandi, M. A., Gholamrezaei, S., Mirderikvand, F. The mediating role of the metacognition, time perspectives and experiential avoidance on the relationship between childhood trauma and post-traumatic stress disorder symptoms. European Journal of Psychotraumatology, 2019; 10(1): Article 1648173. 10(1), Article 1648173. 

https://doi.org/10.1080/20008198.2019.1648173

  • Demirdogen, E. S., Algedik, P., Warikoo, N., Bahadır, E., Akbiyik, M., et al. The associations between metacognition problems, childhood trauma and internalizing symptoms in healthcare workers working directly with patients infected with COVID-19. Psychology, Health & Medicine, 2022; 27(9): 1937-1950.

https://doi.org/10.1080/13548506.2021.1985147

  • Martin, S., Strodl, E. The relationship between childhood trauma, eating behaviours, and the mediating role of metacognitive beliefs. Appetite. 2023; 188(1).

https://doi.org/ 10.1016/j.appet.2023.106975.

  • Lysaker, P. H., Kukla, M., Vohs, J. L., Schnakenberg Martin, A. M., Buck, K. D., Hasson Ohayon, I. Metacognition and recovery in schizophrenia: from research to the development of metacognitive reflection and insight therapy.J. Exp. Psychopathol. 2019; 10(1).

https://doi.org/10.1177/2043808718814992

  • Lysaker, P. H., Gagen, E., Klion, R., Zalzala, A., Vohs, J., Faith, L. A., Leonhardt, B., Hamm, J., Hasson-Ohayon, I. Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis. Psychol Res Behav Manag, 2020; 13(1): 331-341.

https://doi.org/10.2147/PRBM.S198628

  • Besharat, M. A., Ramesh, S. Worry, anger rumination, ego-strength and adjustment to heart diseaseInquiétude, rumination de la colère, force de l’ego et adaptation aux maladies cardiaques. 2023; 181(8): 726-730.

https://doi.org/10.1016/j.amp.2022.05.003

  • Abbasi, L., Akhlaghi-fard, M. The effectiveness of mindfulness training on ego-strength and meta-cognitive beliefs of students. Journal Of Social science and Humanities Research. 2021; 9(1): 12-26.

https://doi.org/10.24200/jsshr.vol9iss01pp12-26

  • Rafezi, Z., Pirabbasi, G., Eskandari, H. Efficasy of group metacognitive therapy on emotional self-regulation and ego strength of anxious students. Monthly Journal of Psychological Science. 2022; 20(108): 2239-2254.

https://doi/org/10.52547/JPS.20.108.2239

  • Cyranka, K., Rutkowski, K., Mielimąka, M., Sobański, J., Klasa, K., Müldner-Nieckowski, L., et al. Changes in ego strength in patients with neurotic and personality disorders treated with a short-term comprehensive psychodynamic psychotherapy. Psychiatr.2018; 52 (1): 115–127. https;//doi.org/12740/PP/OnlineFirst/40020
  • Neal, D. Metacognitive Changes in Individuals with Severe Mental Illness in Response to Psychoanalytic Therapy, Thesis Ph.D. of Clinical Psychology George Fox University. 2020.

https://digitalcommons.georgefox.edu/psyd/256

  • Parviz, K., Aghammohamadian Sherbaf,1 H. R.‌, Ghnbari Hashemabadi, B. A., Dehghani, M. The relationship between ego strength and metacognition among male and female students. Education Strategies in Medical, 2019; 9(2);118-126.

http://edcbmj.ir/article-1-968-fa.html [In Persian].

  • Parviz, K., Aghamohamadian, H. R. sh., Dehghani, M., Ghanbari-Hashemabadi, B. A. Study of the relationship between superego and metacognition of male and female students. Journal of Fundamentals of Mental Health, Mar-Apr 2017; 19(2): 70-76.

https://doi.org/10.22038/JFMH.2017.8291

[In Persian].

  • Parviz, K. Development of a comprehensive model of superego and metacognition functioning (CMSMO) in obsessive-compulsive disorder and antisocial personality disorder. Construction and validation of the CMSMO-based superego-metacognition conflict test (SMCQ). PhD thesis, Ferdowsi University of Mashhad. 2016.‌https://elmnet.ir/doc/10932034-22381 [In Persian].
  • Freud, S. An outline of psycho-analysis. The International Journal of Psychoanalysis, 1940; 21: 27-84. https://ia802907.us.archive.org
  • Kaae, S., Søndergaard, B., Haugbølle, L. S., and Traulsen, J. M. Development of a qualitative exploratory case study research method to explore sustained delivery of cognitive services. Pharmacy World & Science. 2010; 32(1): 36-42. https://1007/s11096-009-9337-5
  • Hunter, D., McCallum, J., Howes, D. Defining Exploratory-Descriptive Qualitative (EDQ) research and considering its application to healthcare. Journal of Nursing and Health Care. 2019; 4(1).

http://dl6.globalstf.org/index.php/jnhc/article/view/1975

  • Busetto, L., Wick, W., Gumbinger, C. How to use and assess qualitative research methods. Neurol. Res. Pract. 2020; 2(14). https://doi.org/ 10.1186/s42466-020-00059-z.
  • Shalani, B., Azadfallah, P., Farahani, H. Developing a Scale for Assessing Feasibility of Psychoeducational and Psychotherapy Protocols: A Guide for Researchers. Applied Psychology, 2023; 17 (‌4): 17-37.

https://doi.org/10.48308/APSY.2021.224241.119 [In Persian].

  • Hauser, S. T., Borman, E. H., Powers, S. I., Jacobson, A. M., Noam, G. G. Paths of adolescent ego development: links with family life and individual adjustment. Psychiatr Clin North Am. 1990‌; 13(3): 489-510.

https://doi.org/10.1016/S0193-953X(18)30356-3

  • Kuzminskaite, E., Penninx, B. W. J. H., van Harmelen, A. L., Elzinga, B. M., Hovens, J. G. F. M., Vinkers, C. H. Childhood Trauma in Adult Depressive and Anxiety Disorders: An Integrated Review on Psychological and Biological Mechanisms in the NESDA Cohort. J Affect Disord. 2021;15(283):179-191.

https://doi.org/10.1016/j.jad.2021.01.054

Files

Share

How to cite

Statistics