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ISSN: 1935-1232 (P)

ISSN: 1941-2010 (E)

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Research Article - Clinical Schizophrenia & Related Psychoses ( 2022) Volume 0, Issue 0

Effectiveness of Positive Cognitive-Behavioral Therapy on Sexual Dysfunctional Beliefs and Quality of Life in People with a Substance Abuse Tendency
Marziyeh Hajati Pirabbas1 and Nila Elmy Manesh2*
 
1Department of General Psychology, Semnan Branch, Islamic Azad University, Semnan, Iran
2Department of Psychology, Payame Noor University, Tehran, Iran
 
*Corresponding Author:
Nila Elmy Manesh, Department of Psychology, Payame Noor University, Tehran, Iran, Email: [email protected]

Received: 12-Apr-2022, Manuscript No. CSRP-22-60217; Editor assigned: 16-Apr-2022, Pre QC No. CSRP-22-60217 (PQ); Reviewed: 30-Apr-2022, QC No. CSRP-22-60217; Revised: 06-May-2022, Manuscript No. CSRP-22-60217 (R); Published: 13-May-2022, DOI: 10.3371/CSRP. PMNM.051322

Abstract

Introduction and Objective: In recent years, drug addiction has to turn into a novel human problem and a threat to human societies. This study aimed to determine the effectiveness of positive cognitive-behavioral therapy on sexual dysfunctional beliefs and quality of life in people with a substance abuse tendency.

Methods: The present study was a quasi-experimental study with a pretest-posttest control-group design. The statistical population of the study included people at risk of addiction in the charity and public groups, the Rayehe’ye Fatemeh (PBUH) Charity Foundation, and the Association of Children at Risk. A total of 30 people were randomly selected using the cluster sampling method and divided into two groups of 15 people, including the experimental and control groups. The 26-item quality of life questionnaire (WHOQOL-BREF) and the Sexual Dysfunctional Beliefs Questionnaire (SDBQ) were used as data collection tools. The data were analyzed after scoring the received answers. Data analysis was performed using multivariate analysis of covariance in SPSS24 software.

Results: The control group included 14 females and 1 male, but in the experimental group, all participants were female. Of the 15 participants in the control group, 8 were single and 7 were married, while In the experimental group, 10 were single and 5 were married. The results of the present study showed that positive cognitive-behavioral therapy had a significant effect on sexual dysfunctional beliefs.

Conclusion: Positive cognitive-behavioral therapy had a significant effect on sexual dysfunctional beliefs and the quality of life of people with a substance abuse tendency.

Keywords

Behavioral therapy • Sexual dysfunctional beliefs • Quality of life • Addiction

Introduction

Addiction is a disorder with clinical, behavioral, and cognitive symptoms that are affected by social, psychological, biological, and pharmacological factors [1]. Addiction is a condition in which a person becomes physically and mentally dependent on a substance, feels a strong and forced need to continue using that substance, is unable to quit it voluntarily, and gradually losses his/her tolerance against using the substance [2]. Factors affecting people's tendency to addiction can be summarized in the forms of individual factors [3], social and cultural factors [4], and economic factors. Long-term drug use causes addiction, which not only adversely affects the socio-economic status of the drug user or addicted person, but also has a devastating and detrimental effect on the psychological burden of the family. Substance abuse is a global problem so that every society suffers from in some way based on specific characteristics of its individuals [5]. In general, addiction is the cause of various social harms and family and individual disorders. Addiction and especially the increasing dependence on new substances is a phenomenon with psychological, moral, and social effects and a threat to the family and society. It can negatively affect the quality of life and, especially in cases of women's addiction, sexual perversion. Therefore, this phenomenon can be considered as one of the most important social issues in the world today and one of the most complex human phenomena that weakens the foundation of human societies [6].

Quality of life, as an indicator of the health status of individuals [7], is a multidimensional concept that that mentally assesses various aspects of life, including cognitive function and well-being [8]. Quality of life is people's perception of their position in life in the context of culture, the value system in which they live, their goals, expectations, standards, and priorities. Researchers in the United States first evaluated the quality of life in different parts of the country in the 1930s. Afterward, the concept attracted the attention of interdisciplinary scientists so that the first research on the quality of life was conducted in the northwest of England in 1985. The main focus of these studies was limited to chronic mental illness and they used this concept as an indicator to assess mental health. Today, this concept is used to measure the effectiveness of treatments, drugs, surgeries, and health indicators [9]. Various studies conducted on the lifestyle of addicted people have shown that drug addiction affects and is affected by different aspects of a person's lifestyle. Drug addiction also affects the psychological dimension of the individuals and increases the incidence of depression, anxiety, anger, lack of enjoyment, and other abnormal psychological states. Thus, quality of life has different physical, psychological, and social dimensions, covering a broad spectrum of life aspects [10].

As mentioned, addiction is a serious personal and social damage and, in addition to its effects on the life of an addicted person, causes a crisis in marital relationships such as marital boredom and emotional and legal divorce [11]. Insecurity in intimate relationships, personality traits affecting intimate relationships, and the encompassing and profound crisis of addiction can be a source of burnout and gradual deterioration of life and marital relationships [12]. Previous research on the devastating consequences of addiction has indicated that addiction causes multiple marital disputes and conflicts in the lives of addicts. In this regard, some researchers showed that addicted people have more physical and marital problems than normal non-addicted people [13]. Sexual dissatisfaction is one of the main causes of marital problems in addicts. Sexual dysfunction is always one of the serious problems facing substance abusers.

Positive cognitive-behavioral therapy is a new therapeutic intervention that combines cognitive behavioral therapy and positive psychology. Positive cognitive-behavioral therapy is a changing approach that calls for discussion about the individual's goals and the factors influencing the achievement of those goals. Positive cognitive-behavioral therapy focuses on developing or reorganizing positive and affective aspects, rather than focusing on issues and problems. The purpose of this intervention is not limited to pathology, the main problems and issues, and the improvement of the worst conditions, but also to achieve and bring success. It first deals with the positive aspects, strengths, and correct actions and creating the best things and does not simply emphasize the reduction of discomfort [14]. Geschwind, et al. showed that explicit focus on positive emotions efficiently diminishes depressive symptoms [15]. Jalali, et al. also reported that cognitive-behavioral group therapy reduced methamphetamine use among abusers with AIDS [16]. Gao, et al. also showed that smartphone addiction and depression were both affected neuroticism and quality of life [17]. Various studies have examined each of the components of quality of life, positive cognitive-behavioral therapy, and sexual dysfunction separately. Based on the literature review above, there is a gap in evaluating the effectiveness of positive cognitive-behavioral therapy on sexual dysfunctional beliefs and quality of life in people with a substance abuse tendency. Accordingly, this study aimed to evaluate the effectiveness of positive cognitive-behavioral therapy on sexual dysfunctional beliefs and quality of life in people with a substance abuse tendency.

Materials and Methods

Participants

The present study was a quasi-experimental study with a pretestposttest control-group design. The statistical population of the study included people at risk of addiction in the charity and public groups, the Rayehe’ye Fatemeh (PBUH) Charity Foundation, and the Association of Children at Risk. Inclusion criteria of the study included having at least 20 years of age, awareness, complete consent to participate in the study, no physical defects such as blindness, deafness, and disability, no use of antidepressants, and no history of hospitalization in a mental hospital. Exclusion criteria were dissatisfaction during the research. A total of 30 people with addiction tendencies were randomly selected using the cluster sampling method and divided into two groups of 15 people, including the experimental and control groups.

Intervention method

The experimental group received positive cognitive-behavioral therapy for sexual dysfunctional beliefs and quality of life based on the titles and objectives of the training sessions. This treatment course was conducted in 10 sessions, two 50-minute sessions per week. The control group received no training or treatment. Briefly, the contents of the training sessions were the following: communication, introduction, acquaintance, taking pretests and increasing sexual awareness, Getting familiar with negative thoughts and beliefs that lead to negative feelings about sexual issues, explaining the effect of psychological factors on sexual function, cognitive reconstruction, educating sexual disorders, training of correct sexual intercourse, and conducting post-test.

Data collection method

Data collection tools in the present study included a standard 26-item quality of life questionnaire (WHOQOL-BREF) and a Sexual Dysfunctional Beliefs Questionnaire (SDBQ). After conducting all the sessions, the questionnaires were distributed once again between the control and experimental groups, and the differences were examined between the two groups to evaluate the effectiveness of positive cognitive-behavioral therapy on sexual dysfunctional beliefs and quality of life in people with addictive tendencies.

Sexual Dysfunction Beliefs Questionnaire (SDBQ)

This questionnaire includes 40 items to assess sexual beliefs and perceptions that are considered in the clinical literature as predisposing factors for sexual dysfunction in men and women. Individuals were asked to rank their agreement based on a five-point scale from completely disagree to agree [18]. The subscale of the form includes six types of beliefs: beliefs about female chastity, beliefs of sexual desire and pleasure as a sin, beliefs about body image, beliefs about the primacy of affection over sexual pleasure, and beliefs about the primacy of motherhood duties over sex. Test-retest reliability for men and women version with a four-week interval showed a significant and satisfactory correlation.

26-item Quality of Life Questionnaire (WHOQOL-BREF)

This tool has been used by several centers around the world to measure the quality of life and has therefore been extensively tested and examined. It includes 26 items that are taken from the 100-item version of this questionnaire. This questionnaire measures 4 broad domains of physical health, psychological health, social relationships, and the environment. This questionnaire can also be used to assess general health. Questionnaire items are evaluated on a 5-point scale, in which a higher score indicates a better quality of life. Examination of the WHOQOLBREF questionnaire showed that the scores of the four domains are very similar to those obtained for the full version questionnaire [19]. Research on psychometric properties of the WHOQOL-BREF questionnaire showed differential validity, content validity, internal reliability (a Cronbach's alpha of 80% for physical health, 76% for psychological health, 66% for social relations, and 83% for environment), and appropriate test-retest reliability. In Iran, Nasiri et al. have translated this scale into Persian and reported its validity and reliability. A Cronbach's alpha coefficient of 84% indicates the favorable internal consistency of this questionnaire [20].

Statistical analysis

In the present study, data analysis was performed using multivariate analysis of covariance in SPSS24 software.

Results

A total of 30 people with addiction tendencies were randomly assigned into two groups of 15 people, including experimental and control groups. The control group included 14 females and 1 male, but in the experimental group, all participants were female. Table 1 shows the frequency distribution of participants by age, education, and marital status.

Table 1: Frequency and percent distribution of participants’ age, education, and marital status.
Variable Control Experiment
Frequency Percent Frequency Percent
Age 25-30 4 26.7 5 33.3
31-35 3 20 1 6.7
36-40 3 20 4 26.7
>40 5 33.3 5 33.3
Education Under diploma 1 6.7 4 26.7
Diploma 5 33.3 3 20
Associate degree 1 6.6 1 6.6
BSC 4 26.7 3 20
MSC 4 26.7 4 26.7
Marital status Single 8 53.3 10 66.7
Married 7 46.7 5 33.3
Total 15 100 15 100

To provide a better understanding of the research variables, a description of the variables is presented in Table 2. Smirnov-Kolmogorov test was used to evaluate the normality of the variables. According to the results of the Smirnov-Kolmogorov test, it can be inferred that the expected distribution was not significantly different from the observed distribution for all variables (P>0.05) and, therefore, the variables had a normal distribution. In addition, the results of Levene's test using SPSS software showed that the variance of the groups was homogeneous (significance level greater than 0.05).

Table 2: Description of research variables.
Variable Group Pretest Posttest
Mean SD Mean SD
Beliefs about female chastity Control 10.27 2.46 9.27 1.79
Experiment 10 2.51 11.87 3.81
Beliefs of sexual desire and pleasure as a sin Control 10.53 2.20 10.67 2.16
Experiment 11.67 3.44 13.40 5.58
Beliefs about body image Control 10.33 1.11 10.33 1.11
Experiment 11 2.33 13.80 4.51
Beliefs about the primacy of affection over sexual pleasure Control 9.73 1.62 12.27 2.25
Experiment 10 1.46 17 5.01
Beliefs about the primacy of motherhood duties over sex Control 11.07 2.15 9.53 0.83
Experiment 11.40 2.35 12.27 2.25
Physical health Control 6.47 0.92 6.53 0.83
Experiment 7.80 3.10 12.80 2.91
Psychological health Control 15.67 2.74 15.93 2.96
Experiment 18.13 7.39 34.73 5.80
Social relationships Control 4.40 1.30 4.33 1.35
Experiment 5.13 2.39 9.73 2.55
Environmental health Control 14.60 2.03 13.93 2.15
Experiment 17.07 6.61 21 4.29

Moreover, the evaluation of relationship linearity and regression slope homogeneity of the scores obtained for the studied variables (beliefs about female chastity, beliefs of sexual desire and pleasure as a sin, beliefs about body image, beliefs about the primacy of affection over sexual pleasure, and beliefs about the primacy of motherhood duties over sex, physical health, psychological health, social relationships, and the environmental health) using the F-test showed that the assumption of homogeneity of regression lines is also valid. According to the competency tests above, the analysis of covariance was performed. Table 3 shows the results of the analysis of covariance.

Table 3: Analysis of covariance of the dependent variable.
Variable   Type III sums of squares Degrees of freedom Mean square F Significance level
Beliefs about female chastity Pretest 43.701 1 43.701 5.524 0.024
Group 55.890 1 55.890 7.362 0.011
Error 204.965 27 7.591    
Total 299.367 29      
Beliefs of sexual desire and pleasure as a sin Pretest 116.341 1 116.341 8.168 0.007
Group 710.556 1 710.556 49.884 0.008
Error 381.593 27 14.244    
Total 1364.967 29      
Beliefs about body image Pretest 107.858 1 107.858 9.204 0.005
Group 679.002 1 679.002 57.941 0.001
Error 316.408 27 11.719    
Total 1235.467 29      
Beliefs about the primacy of affection over sexual pleasure Pretest 79.326 1 79.326 6.474 0.017
Group 829.265 1 829.265 67.683 0.001
Error 330.807 27 12.252    
Total 1200.667 29      
Beliefs about the primacy of motherhood duties over sex Pretest 61.641 1 61.641 4.607 0.041
Group 1570.765 1 1570.765 117.386 0.001
Error 361.292 27 13.381    
Total 2050.967 29      
Physical health Pretest 26.023 1 26.023 6.881 0.014
Group 223.615 1 223.615 59.128 0.001
Error 102.111 27 3.782    
Total 422.667 29      
Psychological health Pretest 206.081 1 206.081 14.349 0.001
Group 2207.006 1 2207.006 153.665 0.001
Error 387.786 27 14.362    
Total 3244.667 29      
Social relationships Pretest 26.707 1 26.707 8.052 0.009
Group 182.424 1 182.424 54.996 0.001
Error 89.559 27 3.317    
Total 334.967 29      
Environmental health Pretest 163.487 1 163.487 27.684 0.001
Group 240.011 1 240.011 40.642 0.001
Error 159.447 27 5.905    
Total 697.467 29      

According to the results of Table 3, the F ratio is statistically significant for the dependent variables. The results of Table 3 for the experimental and control groups show that there is a significant difference in the mean values between the two groups after the intervention. It can therefore be said that positive cognitive-behavioral therapy has a significant effect on beliefs about female chastity, beliefs of sexual desire and pleasure as a sin, beliefs about body image, beliefs about the primacy of affection over sexual pleasure, beliefs about the primacy of motherhood duties over sex, physical health, psychological health, social relationships, and the environmental health. The results of Levene's test showed that the box’s test related to variance homogeneity is not significant due to significant levels of less than 0.05, so the assumption of variance homogeneity is confirmed. The results also showed that there is a significant difference between the studied variables. Moreover, the results of the analysis of covariance (significance level less than 0.05) showed that positive cognitive-behavioral therapy had a significant effect on sexual dysfunctional beliefs and quality of life in people with addiction tendencies (Table 4).

Table 4: Results of analysis of covariance.
Source Dependent variable Type III sums of squares Degrees of freedom Mean square F Significance level
Corrected model Quality of life 18793.461a 3 6264.487 38.110 0.000
Sexual dysfunctional beliefs 16565.286b 3 5521.762 93.821 0.000
Interception  Quality of life 1007.630 1 1007.630 6.130 0.020
Sexual dysfunctional beliefs 549.772 1 549.772 9.341 0.005
Quality of life Quality of life 668.918 1 668.918 0.636 0.012
Sexual dysfunctional beliefs 615.838 1 615.838 10.464 0.003
Sexual dysfunctional beliefs Quality of life 635.209 1 635.209 0.214 0.021
Sexual dysfunctional beliefs 634.976 1 634.976 10.789 0.003
Group Quality of life 14788.296 1 14788.296 89.964 0.000
Sexual dysfunctional beliefs 8125.426 1 8125.426 138.060 0.000
Error Quality of life 4273.906 26 164.381    
Sexual dysfunctional beliefs 1530.214 26 58.854    
Total Quality of life 202945.000 30      
Sexual dysfunctional beliefs 397783.000 30      
Corrected model Quality of life 23067.367 29      
Sexual dysfunctional beliefs 18095.500 29      

Discussion

The results of the present study indicated that positive cognitivebehavioral therapy had a significant effect on sexual dysfunctional beliefs and quality of life in people with a tendency to addiction. Since people with a tendency to addiction have different sexual dysfunctional beliefs and quality of life from the general population, and because their quality of life may be affected by their tendencies towards addiction, It can be said that positive cognitive-behavioral therapy is an effective factor with a significant impact on sexual dysfunctional beliefs and quality of life of people with a substance abuse tendency. In line with the results of the present study, Jalali, et al. evaluated the effectiveness of cognitive-behavioral group therapy in reducing cravings among methamphetamine abusers living with HIV/AIDS. Their results showed that methamphetamine cravings decreased among HIV/AIDS abusers [16]. Moreover, Bennebroek, et al. showed in their study that cognitive-behavioral therapy has a significant effect on the quality of life, anxiety, and depressive symptoms in patients with inflammatory bowel disease [21]. The results of this study showed that positive cognitive- behavioral therapy had a significant effect on beliefs about women chastity in addicted individuals because such beliefs could be low in addicted individuals and positive cognitive-behavioral therapy can reinforce such beliefs in individuals with a tendency to addiction. Our findings on the effect of positive cognitive-behavioral therapy on beliefs about sexual desire and pleasure as a sin are consistent with the results of Keshtkar, et al. who showed that the effectiveness of cognitive-behavioral self-management group therapy in reducing pain-related anxiety was significantly different between experimental group and control [22]. Abadi, et al. also stated that positive cognitive-behavioral therapy had a significant effect on beliefs about sexual desire and pleasure as a sin in people with a tendency to addiction [23]. People with a tendency to addiction have different beliefs about sexual desire and pleasure as a sin than general people due to their special circumstances. Thus, it can be said that positive cognitive- behavioral therapy is a proper tool to treat beliefs about sexual desire and pleasure as a sin in people with a tendency to addiction.

Positive cognitive-behavioral therapy had a significant effect on body image beliefs in people with an addiction tendency. The results of Jalai, et al. and Bahram Abadi, et al. studies are consistent with the findings of the present study [16,23]. Based on the results of the current study, it can be concluded that positive cognitive-behavioral therapy had a significant effect on beliefs about the primacy of affection over sexual pleasure in people with a tendency to addiction. The results of other studies and researches also confirm these findings [24,25]. Positive cognitive-behavioral therapy can be used as a tool for changing sexual pleasure in people with addictions, through which these people become aware of the problems caused by their tendencies and attempt to treat them. It can also be said that beliefs about the primacy of emotion and sexual pleasure in people with a tendency to addiction are different from that in general people. Due to the special circumstances of this individual, they always resort to addiction when facing hardships and difficulties, so it can be argued that positive cognitive-behavioral therapy has a significant effect on beliefs about the primacy of emotion over sexual pleasure in people with addiction. These results are consistent with those reported by Ghaderi Mehr and Ahmadi [26] and Bennebroek, et al. [21]. Moreover, the physical health of people with addiction tendencies is always endangered due to their tendencies towards drugs, so it can be argued that positive cognitive-behavioral therapy is an effective and influential factor on the physical health of individuals with addiction tendencies. Similar results were also reported by Gao, et al. and Abdolmanafi, et al. [17,27].

The results of the present study showed that positive cognitivebehavioral therapy had a significant effect on psychological health in people with a tendency to addiction. The results of other similar studies and researches confirm these findings [16,24]. This issue can be explained as the special atmosphere and environment that exists among these people can increase their tendencies towards addiction and endanger their psychological health. Hence, it can be stated that positive cognitivebehavioral therapy has a significant effect on psychological health in people with addictive tendencies. Irandoost, et al. showed in their study that sexual dysfunction beliefs had a significant positive effect on psychological distress and a significant negative effect on marital intimacy and sexual function [28]. Alipour, et al. reported different rates of improvement in vital signs and psychological well-being between the control and experimental groups [29]. According to the results of the present study, positive cognitive-behavioral therapy had a significant effect on social relations in people with addictive tendencies. This is in agreement with the results obtained by Irandoost, et al. and Alipour, et al. [28,29]. Finally, the results of the present study indicated a significant effect of positive cognitive-behavioral therapy on the environmental health of people with a tendency to addiction. Similar results have also been reported by Rahimi Siahgoli, et al. and Amanallahi, et al. [30,31].

Conclusion

Drug addiction also affects the psychological dimension of the individuals and increases the incidence of depression, anxiety, anger, lack of enjoyment, and other abnormal psychological states .Sexual dysfunction is always one of the serious problems facing substance abusers. Positive cognitive-behavioral therapy is a new therapeutic intervention that combines cognitive behavioral therapy and positive psychology. Positive cognitive- behavioral therapy is an effective factor with a significant impact on sexual dysfunctional beliefs and the quality of life of people with a substance abuse tendency.

Acknowledgments

We like to thank and appreciate all the participants in this study.

Conflict of Interest

The authors declare that there is no conflict of interest in publishing this article.

References

Citation: Pirabbas, Marziyeh Hajati and Nila Elmy Manesh. “Effectiveness of Positive Cognitive-Behavioral Therapy on Sexual Dysfunctional Beliefs and Quality of Life in People with a Substance Abuse Tendency.” Clin Schizophr Relat Psychoses 16S (2022). Doi: 10.3371/CSRP. PMNM.051322.

Copyright: © 2022 Pirabbas MH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.