Comparing the Effectiveness of Schema Therapy and Mindfulness-Based Cognitive Therapy on the Tolerance of Ambiguity and Rumination in Infertile Women

Infertility is one of the most important crises in life, which leads to psychological problems and serious stressful experiences for people (1). The consequences of infertility are multiple and can bring social consequences and personal pain and suffering and expose affected people to various psychological pressures (4). In this connection, researchers have so far reported the occurrence of impulsive behaviors and scattered pressures, depression and feelings of worthlessness in the case of infertile people, and the presence of these conditions causes low happiness in the lives of these people (6). One of the factors that have a negative effect on infertile women is tolerance of uncertainty. Dugas et al. (2007) define ambiguity tolerance as beliefs about worry, negative problem orientation, and avoidant coping style (7). Tolerating ambiguity is one of the important factors in coping with difficulties. Ambiguity tolerance, which means the capacity to experience and tolerate a negative mental state, can be the result of cognitive or physical processes and can be experienced as an emotional state, which is often characterized by action tendencies to relieve the emotional experience (9).In recent years, the investigation of cognitive and thinking patterns in infertile women has shown that rumination and depression have a mutual relationship with each other (10). Rumination is defined as resistant and recurring thoughts. These thoughts involuntarily enter the consciousness and divert the attention from the subjects and goals of the person (11, 12). One of the effective methods of the third wave of psychotherapy in reducing the problems of infertile women is schema therapy (14). The goal of treatment is for patients to use more compatible coping styles instead of maladaptive coping styles so that they can satisfy their basic emotional needs (15). Also, in recent years, one of the therapeutic approaches that many researchers have investigated its effectiveness in different fields is cognitive therapy based on mindfulness (16). Cognitive therapy based on mindfulness as one of the approaches of the third wave of cognitive behavioral therapies has been effective on a wide range of psychological problems and disorders (16).Less research has compared the effectiveness of schema therapy with cognitive therapy based on mindfulness on the tolerance of ambiguity and rumination of infertile women, and this research is devoted to investigating this research gap. The results ofTozandehjani et al.'s research (2020) showed that schema therapy was effective on ambiguity tolerance (19). The results of the research of Zemestani et al. (2018) showed that cognitive therapy based on mindfulness had an effect on rumination (20). The research results of Shahmoradi et al. (2017) showed that therapeutic schema and cognitive therapy based on mindfulness as two effective therapeutic methods are effective in reducing incompatible schemas and improving the health of patients (21). Also, the results ofLouis et al.'s research (2018) showed that schema therapy improves psychological well-being in people (22).Due to the increasing of infertility in developing countries, including Iran, it is felt necessary to pay attention to the mental health of infertile people, especially infertile women who are more exposed than men to physical, psychological and social stressorscaused by infertility and its treatment. According to the mentioned cases, the main issue of this research is to compare the effectiveness of schema therapy and cognitive therapy based on mindfulness on the tolerance of ambiguity and rumination of infertile women, and the present study tries to answer this question: Is the effectiveness of schema therapy and cognitive therapy based on mindfulness on tolerance Ambiguity and rumination of infertile women are different?

The method of this research is semi-experimental with a pre-test-post-test design. The statistical population included all infertile women aged 18 to 45 from the infertility centers of Sari city, 45 of whom were selected by purposeful sampling and divided into three groups (group 1: schema therapy (15 people), group 2: cognitive therapy based on mindfulness (15 people) and group 3 were selected as the control group (15 people). Data collection was based on McLain's ambiguity tolerance scale (1993) and Nolen Hoeksema et al.'s (1991) rumination scale, and the experimental group received Yang et al.'s (2003) schema therapy and Williams et al.'s (2002) cognitive therapy based on mindfulness. Data were analyzed through mixed ANOVA with SPSS version 22 software.

The results showed that the effectiveness of schema therapy and cognitive therapy based on mindfulness on the tolerance of ambiguity and rumination of infertile women is different (P=0.001), which is more in the experimental group. Also, there is no significant difference between the two experimental groups in terms of change in ambiguity tolerance and rumination (P<0.05).

The findings showed that the difference between the schema therapy group and the control group was statistically confirmed in terms of ambiguity tolerance and rumination. Also, the results showed that the difference between cognitive therapy based on mindfulness and control group was confirmed statistically. The results of this research are in agreement with the researches of Najafi et al. (2018) (26), Zemestani et al. (2018) (20), Shahmoradi et al. (2017) (21), Toozandehjani et al. (2020) (19), Goldberg et al., Mak et al. (2018) (28), Louis et al. (2018) (22) were aligned. In explanation, it can be said that schema therapy helps infertile women to comment on what is going on in their inner world as well as what they experience, including various physical feelings, thoughts, beliefs and values. When a person becomes aware of the origin of his dysfunctional patterns, life and relationship find a new meaning for him, and the person can put aside his negative interactions and inappropriate personality patterns and turn to a healthy mentality; Also, find a way to get rid of the traps of life and fulfill your main emotional needs. This strategy emphasizes a deeper level of cognition and seeks to correct the core of the problem; This practice has a high rate of success in treating disorders such as anxiety, depression, improving happiness, mental health and psychological well-being (25). On the other hand, mindfulness and mindfulness techniques are considered as a general desire to be aware of experiences, that a person has a non-judgmental and open look at these emotions and feelings and his inner psychological experiences, becomes aware of his bodily feelings and experiences and experiences them. Also, mindfulness encourages curiosity and open attention to inner experiences and communication and familiarity with thoughts and feelings related to the body (29). In general, interventions based on mindfulness through the mechanism of increasing the neural processing related to the identification of bodily states and feelings can have an effect on the tolerance of uncertainty and rumination of infertile women. In another explanation of the results, it can be said that schema therapy is effective in reducing rumination symptoms, but more sessions are needed for better efficiency. In addition to therapeutic techniques focused on attention training, schema therapy includes a wide range of specific therapeutic strategies designed to facilitate cognitive and emotional change (31). The main limitation of this research is related to external validity, because the statistical population of the research is a special group of society, that is, infertile women aged 18 to 45 in the infertility centers of Sari city, who were in the second half of 1401, so the possibility of generalizing the results to the whole society is limited. Based on the results of schema therapy and cognitive therapy based on mindfulness, it can play an important role in improving the tolerance of ambiguity and rumination of infertile women. Therefore, it is suggested to use these methods along with other treatment methods to improve these variables in infertile women.