Effect of cognitive therapy based on positive thinking on depression, stress, and anxiety of mothers after recovering from COVID-19

In December 2019, the World Health Organization (WHO) announced the outbreak of a new viral infectious disease that originated in Wuhan, China (1). COVID-19 is highly contagious, causing acute respiratory syndrome (2). This disease has led to the death of more than six million people in the world (3). In 2022, the WHO identified this disease as a significant threat to both physical and mental health due to its impact on lifestyle changes. Adapting to pregnancy, childbirth, and taking care of babies is one of the most critical and stressful events in a woman's life, increasing the likelihood of psychological disorders in women (4, 5). During the COVID-19 pandemic, with the increase in mortality rate and social isolation, the prevalence of many psychological disorders increased (6). It is necessary to identify people prone to these disorders in order to improve the mental health of society with appropriate psychological methods and techniques (7). All of the people, specifically healthcare staff, are at the highest risk of mental disorders (8). Depression, stress, fear, and frustration can make people susceptible to diseases such as Coronavirus (9). Anxiety seems to be primarily due to the lack of information about unknown diseases among people (10). During the pandemic of this disease, stress and fear of the disease and death cause people to be involved with the anxiety of the disease (11). The anxiety of this disease, being quarantined at home, and the closing of many recreational and educational centers has threatened all members of society, exclusively mothers, and have made them susceptible to anxiety disorders, depression, and fear (13). Fear and anxiety among people due to the unknown nature of this disease cause irreparable damage to people's health. Among these injuries, we can mention significant mental disorders, such as post-traumatic stress disorder, depression, anxiety, panic disorders, and behavioral disorders. Factors that cause these disorders include being away from family, loneliness, receiving false information from social media, financial insecurity, and loss of loved ones. Furthermore, the obligation to observe quarantine and stay away from others can cause people to suffer from depression (14). The importance of the physical and mental health of mothers in society is evident; considering the increasing growth of mental disorders, it is necessary to identify and provide medical services for them (15). Positive psychology emphasizes the increase of mental health and scientific study on the role of personal strengths and positive social systems in promoting optimal health. The goal of this approach is to improve people's living standards. Positive psychology deals with the positive issues of life, such as emotional regulation, well-being, positive thinking, and the like. Besides, it has an effect on improving compliance with treatment and reducing the anxiety of corona in patients (16, 17). Positive thinking refers to the process of focusing on positive emotions and positive behavioral habits. One study on positive thinking shows that it helps in coping with stress, anxiety, and other psychological disorders as well (18). Therefore, in this research, the effectiveness of cognitive therapy based on positive thinking on depression, stress, and anxiety of mothers with a history of COVID-19 has been studied.

This study was semi-experimental with pre-test and post-test design. The population of the research was all mothers with a history of being infected with COVID-19 in Hamedan city, Iran, in 2021-2022. First, two healthcare centers were randomly selected. Forty mothers, aged 20-55 years, with at least a primary school education and who attended the training sessions, were chosen based on specific criteria. Those with a history of positive thinking courses, psychological disorders, or incomplete questionnaires were excluded. The selected participants were then randomly divided into two groups: An intervention group and a control group. The experimental group participated in the sessions. Over the course of four weeks, participants engaged in cognitive therapy focused on positive thinking, attending two 1.5-hour sessions each week for a total of eight sessions. These sessions introduced participants to key concepts and techniques of cognitive behavioral therapy centered on positive thinking. Additionally, participants were instructed to practice exercises related to these concepts on the same day they were introduced. The educational material was based on Susan Quilliam's book "Positive Thinking and Applied Positivism" (18).In this research, socio-demographics, Beck's anxiety and depression questionnaire, and perceived stress scale were used. Beck's anxiety questionnaire: The internal consistency (alpha coefficient) is 0.92, its reliability is 0.75 with the retest method after one week, and the correlation of its items varies from 0.30 to 0.76 (20).Beck's depression questionnaire: The internal consistency of this questionnaire is reported as 0.72-0.92 with an average of 0.86. Correspondingly, the alpha coefficient is 0.86 for psychiatric populations and 0.81 for non-psychiatric populations. The reliability of Beck's test with the test-retest method is reported as 0.48 to 0.86 according to the distance between the two tests and the studied population (21).Perceived Stress Scale: Cohen et al. reported that the retest reliability of the PSS was 0.85, and the internal consistency of this test was calculated from 0.84 to 0.86 (32). The construct validity of this questionnaire was acceptable P<0.5 (24). SPSS-24 software was used in order to analyze the data.

Based on the obtained results, 42.5% were between 30 and 40 years old, and 65% had a diploma. The mean of depression, stress, and anxiety in the pre-test and post-test stages is 29.42, 36.07, and 38.72, respectively, with a standard deviation of 6.05, 6.88 and 7.72. The post-test average is 26.42, 34.9, and 33.5, respectively, with a standard deviation of 11.56, 8.54, and 7.35. There was a significant relationship between stress (P=0.000) and anxiety (P=0.024) with mothers' age. The difference between depression before and after positive thinking cognitive therapy was not significant (P=0.310, F=1.244), but this treatment was effective on stress (P=0.038, F=2.486), and mothers' anxiety (P=0.000, F=11.96), with a history of COVID-19, had an effect.The results of checking the assumptions of one-way covariance analysis test are as follows:The groups are independent of each other, the distribution of the dependent variables (depression, stress, and anxiety) is normal, and Levene's test was run to check the homogeneity of the variances of the dependent variables. The test results showed that the variance of the groups is homogenous, and between the pre-test of depression, stress, and anxiety, and the independent variable is a linear correlation. The assumption of correlation between the associated variable and the independent variable has been met (P<0.05)

Positive thinking intervention reduces the psychological problems of the patients, including depression, stress, and anxiety, which ultimately results in increased life expectancy, adaptation to the conditions of the disease, and better relationships with relatives. In addition, the reduction of problems related to psychological disorders, generally, led to an increase in better mental conditions concerning the Coronavirus disease. According to the results of the present study, it is recommended to use cognitive therapy based on positive thinking psychological clinics and enter as an effective intervention method.