The Effects of Emotion Efficiency Therapy on Intolerance of Uncertainty, Experiential Avoidance, and Distress Tolerance in Anxious Nurses

Nursing is associated with numerous stressors. Furthermore, inefficient cognitive processes, intolerance of uncertainty, and experiential avoidance affect the onset, exacerbation, and persistence of psychological symptoms. Intolerance of uncertainty leads to high experiential avoidance; consequently, it reinforces avoidance behavior by reducing short–term relaxation, leading to decreased distress tolerance levels. These stages are closely linked with various anxiety disorders and emotion dysregulation. Therefore, Emotion Efficacy Therapy (EET) can be a useful therapy that integrates the components of acceptance and commitment therapy, dialectical behavior therapy, and cognitive–behavioral therapy. Numerous studies reported the effectiveness of these therapies on distress tolerance and intolerance of uncertainty. Thus, this study aimed to determine the effects of EET on the components of a defective cognitive system (i.e., intolerance of uncertainty & experiential avoidance) and distress tolerance in anxious nurses.

This was a quasi–experimental study with pretest–posttest, a two–month follow–up, and a control group design. The statistical population included all nurses working in Chamran and Hazrat Rasool Hospitals in Ferdows City, Iran, in December 2019. In total, 50 individuals was estimated by considering a test power of 80%, a mean effect size of 0.5, and an error probability of 0.05 as the study sample. Initially, based on the inclusion and exclusion criteria, 140 nurses were enrolled, who completed Beck Anxiety Inventory (BDI; Beck & Steer, 1991). The obtained results signified that 48(34.3%) nurses had no anxiety, 36(25.7%) subjects reported mild anxiety, 42(30%) nurses manifested moderate anxiety, and 10 (7.1%) subjects presented severe anxiety. Fifty nurses with moderate to severe anxiety were recruited and randomly assigned to the experimental and control groups. The experimental group received eight 90–minute EET sessions in two months; however, the control group received no intervention. Data collection tools included BDI, Acceptance and Action Questionnaire–II (Bond et al., 2011), Intolerance of Uncertainty Scale (Freeston et al., 1994), and Distress Tolerance Scale (Simmons and Gaher, 2005). The obtained data were analyzed using descriptive statistics (including mean & standard deviation) and inferential statistics, including Chi–squared test, Fisher's Exact test, Independent Samples t–test, repeated–measures Analysis of Variance (ANOVA), and Bonferroni post hoc test in SPSS. The significance level of the tests was considered 0.05.

The present study results revealed that the group effect was significant for experimental avoidance (p=0.047) and distress tolerance (p<0.001); however, it was not significant for uncertainty intolerance (p=0.100). Moreover, time effect was significant for experimental avoidance, distress tolerance, and uncertainty intolerance (p<0.001); group*time interaction was significant for experimental avoidance, distress tolerance, and uncertainty intolerance (p<0.001). In addition, in the experimental group, for all 3 variables, a significant difference was observed between pretest and posttest scores (p<0.001) as well as pretest and follow–up steps (p<0.001). However, there was no significant difference between the posttest and follow–up stages in experimental avoidance (p=0.100), distress tolerance (p=0.370), and uncertainty intolerance (p=0.610).

Based on the current research findings, EET can be effective as a timely intervention to reduce experiential avoidance and uncertainty intolerance, and increase distress tolerance among anxious nurses; therefore, this intervention can be used in medical centers.