Comparison of the Effectiveness of Acceptance and Commitment Therapy and Intensive Short-Term Dynamic Psychotherapy on Attention and Executive Function of Patients with Lupus Erythematosus: A quasi-Experimental Single-Subject Study

Autoimmune and chronic diseases cause many psychological problems by directly and indirectly affecting the nervous system. Lupus is one of the autoimmune diseases that, in addition to the problems caused by the nature of the disease itself, the side effects of its drugs also cause emotional and mental disturbances. The prevalence of lupus in women is about 9 times higher than in men, and the patients are usually between 15 and 45 years old. In Iran, according to a study conducted by the Rheumatology Research Center of Tehran University of Medical Sciences, lupus has a prevalence of 40 in 100,000, that is, 1 person per 2,500 Iranians is diagnosed with lupus. People with lupus Erythematosus experience many skin ulcers, joint pains, periodicity of the disease, side effects of medications, and stressful events. In the framework of psychological interventions for people with lupus, in recent years acceptance-based therapy (ACT) and commitment is a non-pharmacological strategy and among the effective treatment lines for patients with physical diseases. This therapeutic approach is part of the third wave of behavioral therapies, which aims to help clients achieve a more valuable and satisfying life by increasing psychological flexibility and not focusing solely on cognitive reconstructions. Research has emphasized the effectiveness of cognitive functions and attention management and executive function by ACT in patients with chronic diseases. For example, Menshi et al showed in their research in 2015 that ACT can improve people's executive function by adjusting incompatible schemas, however, no research was found regarding the effectiveness of this treatment method in people with lupus. In addition to ACT, another psychological approach and non-pharmacological strategies that have been proposed to improve psychological and functional variables such as attention and executive function in people with lupus is short-term intensive dynamic psychotherapy (ISTDP). The goal of ISTDP or psychoanalysis is to help clients achieve a full experience of repressed emotions and the fantasies and memories that are repressed by these emotions. By clarifying defenses and challenging them, ISTDP focuses on experiencing unconscious feelings and emotions to increase awareness. It is a psychological process that can help you change how you react to life's inevitable hardships. The review of the literature showed that even though several studies on the effectiveness of ACT and also the ISTDP approach have been conducted separately on different populations, no study compares these two treatment approaches in patients with lupus Erythematosus. The present study was conducted to compare the effectiveness of ACT and ISTDP on attention and executive function in lupus Erythematosus patients.

The current research was a semi-experimental single-subject type with multiple baseline designs. The participants of this study were 6 people with lupus, members of the Lupus Patients Support Association in Tehran, who were selected as available and randomly assigned to two groups of three. The tools used in the research included the Wisconsin Card Sorting Test and the Stroop Test. The subjects of the first group received ACT and the subjects of the second group (ISTDP) individually in 8 sessions of 90 minutes. To analyze the data, the effect size was used.

Regarding effect size calculations in Stroop dimensions between treatment groups, the results generally showed that the ACT method had a more significant effect than ISTDP in the extent of reaction time. In terms of reducing the number of errors in the error of the first stage, the effect size in the ACT group is medium and in the ISTDP group, slightly too high, in the second and third stages, both are high, but the magnitude of the effect is higher in the second stage in the ISTDP and in the third stage in the ACT group. Regarding the calculation of effect size and index of stable change in Wisconsin dimensions between treatment groups, the results of the study also showed that the average effect size in the residual error of the first and second stages of the Wisconsin test in the ACT group is higher than the average effect of the ISTDP group. In terms of increasing the number of correct answers in the first and second stages, the effect size in the ACT group is lower than in the ISTDP group.

The results of the study showed that despite the effectiveness of ISTDP on the attention and executive function of patients with lupus Erythematosus, ACT had more effectiveness than ISTDP on the attention and executive function of patients with lupus Erythematosus, hence this approach along with other approaches The existing treatment is recommended as a suitable option to improve attention and executive function in people with lupus Erythematosus. It is also suggested that health therapists pay attention to the findings of this research and the discussion of executive functions to enrich their diagnostic formulation, and if they find a symptom in executive functions, they should use cognitive interventions in this direction. Due to the problems in collecting samples from patients with lupus Erythematosus, the available sampling method was used in this research. Therefore, the selected sample group is less representative of the entire society and the results cannot be generalized. Also, this research was considered without a control group and follow-up stage. The same researcher and therapist in ACT may also increase the possibility of bias in the results. Also, in this research, the effect of moderating variables such as gender was not investigated, which may have distorted the results.