Abstract
Background & Objectives: Breast cancer is a type of cancer that originates from the breast. Expressing emotions plays a key role in the release of negative emotions caused by chronic diseases, including cancer, and helps a person manage the experience of negative emotions. Also, anger rumination is a strong predictor of decreased mental health in people with breast cancer. Accordingly, it is important to use psychological interventions that help women with breast cancer to release their emotions. Breast cancer is also associated with decreased psychological flexibility in women. Psychological flexibility, while helping people to manage unexpected situations better, helps them learn new things, easily replace old information in their minds with new learning, and discard old learning. Appropriate and timely intervention will prevent and treat many future injuries and will allow women with breast cancer to return to their normal individual and family lives. Narrative therapy helps the individual to vent an overwhelming and difficult problem. So, the present study was conducted to investigate the effectiveness of narrative therapy on anger rumination and psychological flexibility in women with breast cancer.
Methods: The present study was quasi–experimental with a pretest–posttest and a three–month follow–up design with a control group. The statistical population comprised all women with breast cancer referring to Arad Hospital in Tehran city, Iran, who had received a diagnosis of breast cancer from a specialist in 2023 to 2024. Among them, 32 eligible women with breast cancer were included in the study through voluntary sampling and were randomly assigned to two experimental and control groups (16 people in each group). The inclusion criteria for patients entering the study were as follows: personal consent to participate; a breast cancer diagnosis by a specialist; and aged 20 to 45 years. Exclusion criteria for patients leaving the study were failure to attend more than 2 sessions during the training period and recurrence of the disease during the training period. To comply with ethical principles, after explaining the research and the intervention in question, possible participant questions were addressed, and, in addition to obtaining informed consent from the volunteers to participate in the study, an effective intervention was also implemented for the control group at the end of the study. The study's results were made available to the participants. The experimental group underwent group narrative therapy in 8 sessions, and the control group did not receive any intervention. Data were collected using the Anger Rumination Scale (Sukhodolsky et al., 2001) and the Psychological Flexibility Inventory (Dennis and Vander Wal, 2010) at three time points: before the treatment, immediately after the treatment, and 3 months after the treatment. The research data were analyzed in SPSS statistical software, version 26, using a repeated–measures analysis of variance and a Bonferroni post hoc test. The significance level of the tests was set at 0.05.
Results: A significant difference was observed between the experimental (narrative therapy) and control groups for anger rumination (p<0.001) and psychological flexibility (p<0.001). Also, in the experimental group, anger rumination and psychological flexibility showed significant differences between pretest and posttest, and between posttest and follow–up (p<0.05).
Conclusion: According to the results of the study, the use of non–pharmacological narrative therapy intervention is effective in reducing anger rumination and increasing psychological flexibility in women with breast cancer, and improves their psychological problems; therefore, the use of narrative therapy programs in treatment and counseling centers for women with breast cancer is recommended.