Comparing the Effects of Cognitive-Behavioral Therapy and Optimism Training on Psychological Wellbeing in Patients With Hypothyroidism

Hormones of the thyroid critically impact the body's metabolism. Thyroid disease can decrease or increase the metabolic rate. The thyroid gland crucially affects human health; when this gland is disturbed, it presents various symptoms in the human body that cannot be ignored. A disorder of the thyroid gland is hypothyroidism. Hypothyroidism can affect various aspects of an individual's life, including biopsychological dimensions. Psychological symptoms, anxiety, and physical symptoms impair the quality of life and psychological wellbeing of these patients. Furthermore, the structures of positive psychology and optimism, by changing the attitudes and beliefs of individuals, play an essential role in increasing the capacity of individuals to improve their psychological wellbeing. Similar studies highlighted the effect of Cognitive–Behavioral Therapy (CBT) and Optimism Training (OT) on psychological wellbeing. This study aimed to compare CBT and OT's effects on psychological wellbeing in patients with hypothyroidism.

This was a quasi–experimental study with a pretest,–posttest–follow–up, and a control group design. The statistical population of this study included all hypothyroid patients referring to a private endocrinologist in Bandar Abbas City, Iran, in 2020. The minimum sample size for a quasi–experimental study equals 7–15 subjects; thus, the study included 45 eligible patients and volunteers from the population mentioned above. Accordingly, 45 patients with hypothyroidism were randomly assigned to two experimental groups (CBT & OT) and a control group. The study inclusion criteria were patients with severe hypothyroidism, aged 20 to 60 years, no diagnosis of bipolar disorder, borderline personality disorder, and history of substance use disorders, no concomitant use of psychological therapy, no chronic illnesses, including thyroid, diabetes, and cancer, and biopsychological defects with a higher education level than a diploma. The exclusion criteria included absence from >2 intervention sessions, exacerbated hypothyroidism preventing the subject from participating in the study, requiring psychiatric medications and other medications to treat other illnesses during the study, and refusing to continue cooperation. In pretest, posttest, and follow–up, all study participants completed the Ryff Psychological Well–Being Scale–Revised Form (Ryff & Keyes, 1995). The first group received a 90–minute CBT in 8 sessions presented by Houghton and associates (2010). The second group received eight 90–minute OT sessions presented by Mohammadi and colleagues (2018). The control group received no intervention. Descriptive statistics (frequency, percentage, mean, & standard deviation) and inferential statistics, including repeated–measures Analysis of Variance (ANOVA), Bonferroni post hoc test, and one–way ANOVA, were used to analyze the obtained data in SPSS at the significance level of 0.05.

The obtained results suggested that CBT and OT affected psychological wellbeing (p<0.001). The effect of time increased psychological wellbeing, compared to the pretest stage (p<0.001). The interaction effect of the time*group increased psychological wellbeing, compared to the control group (p<0.001). There was also a significant difference between the mean scores of psychological wellbeing variables in the pretest, posttest, and follow–up stages (p=0.001), suggesting the continuity of the effect of CBT and OT (p=1.000). There was no significant difference between the provided interventions concerning psychological wellbeing (p=1.000).

According to the collected results, CBT and OT demonstrated a similar effect on improving psychological wellbeing in patients with hypothyroidism. Therefore, both methods can be used effectively to improve psychological wellbeing in patients with hypothyroidism.