The Effects of the Educational Package to Overcome Learned Helplessness in Women with Helplessness and Breast Cancer

Breast cancer is the second most prevalent cancer and the fifth cause of cancer deaths worldwide. In women with breast cancer, the prevalence of depression varies from 1.5% to 50% depending on the sample, especially the definition of depression and assessment method. Patients with breast cancer feel helpless due to the nature of the illness and treatment process, and present severe mental health impairments. A significant reason for not responding to treatment by these patients is feeling helpless and frustrated. Therefore, Learned Helplessness (LH) could be a major obstacle to improving their mental health and life expectancy. Considering the lack of studies in this area, designing research to build a protocol for minimizing helplessness seems necessary. The current research aimed to evaluate the effect of implementing the training package to overcome LH in women with helplessness and breast cancer. We explored whether this training package could reduce feelings of helplessness, stress, depression, and suffering in this group or not.

Investigating the effect of applying the educational package to overcome LH in helplessness women with breast cancer was conducted in two stages. To adjust in the first phase, we employed a qualitative research method based on content analysis. Furthermore, in the second stage, a quantitative research method in the form of a quasi–experimental study with a pretest–posttest and a control group design (one group received the educational program & the other one was the control group) was performed. In the qualitative part of this study, the statistical population included experienced by university experts, directors, and positive psychology intervention experts. In this study, the number of selected samples equaled 12. To evaluate the validity of the final protocol, a content validity approach was used. In the qualitative study of the content, experts were requested to submit their comments following a qualitative review of the tool; according to which the issues were corrected. The content validity correlation coefficient was quantitatively employed to evaluate the Content Validity Ratio (CVR). The calculated CVR equaled 0.88, which indicated the desirable content validity of the protocol. The study samples of the quantitative part of the research were women with breast cancer referring to the health department of the Cancer Research Center and Vali–e–Asr clinic in Imam Khomeini Hospital, in 2018. In this regard, 30 individuals were selected by the targeted sampling method and according to the inclusion and exclusion criteria of the study. After initial sampling, 30 subjects were randomly assigned to the experimental and control groups; each group included 15 subjects. Then, for the experimental group, the protocol was performed in 12 one–hour sessions twice a week. After collecting the completed questionnaires, the pretest and posttest data were analyzed using Multivariate Analysis of Covariance (MANCOVA). To collect the required data, the Attributional Style Questionnaire (ASQ) (Peterson & Seligman, 1984) was used.

The results of the first phase indicated that there were 5 main themes, including documentary retraining, cognitive reconstruction, goal management, immunity against stress, and acceptance. Furthermore, there were 13 conceptual categories, including positive thinking skills, adaptive attribution styles, catastrophic, extreme generalization, mind–reading, meaning in life, attitude toward the future, determining and following targeted behaviors, coping strategies, resilience, mindfulness, cognitive flexibility, acceptance and commitment for determining the effective characteristics and factors to overcome LH according to which the intervention package was developed. Surveying the quantitative part signified that training to overcome LH included the following results. While the study revealed a reduction in the negative internal/external styles (F=23.829, p<0.001), negative stability/instability (F=14.131, p<0.010), and negative general/specific style (F=19.081, p=0<0.001), it indicated an increase in positive styles, i.e., positive internal/external style (F=7.868, p=0.010), positive stability/instability (F=7.110, p=0.014), and positive general/specific style (F=10.943, p=0.003).

In an intensive intervention to overcome LH, a patient with breast cancer, by applying effective problem–oriented coping styles in addition to adaptive attributional styles, used her cognitive skills to explain the stress caused by illness. The study subjects could find appropriate solutions to reduce anxiety. Thus, reducing stress increased self–confidence and improved the patient’s health status.