Effectiveness of Cognitive Behavioral Therapy on Anxiety, Lifestyle, and Experiential Avoidance in Patients with Meniere's

Rahmani, Mahdi; Jalali, Mohsen; Pourahmadi, Elnaz; Nikan, Abdolsamad

doi:10.30473/ijohp.2025.74264.1398

Document Type : research

Authors

¹ Department of Health Psychology, Go.C., Islamic Azad University, Gorgan, Iran.

² Assistant Prof of clinical psychology, Faculty of Humanities and Social sciences, Golestan University, Gorgan, Iran

³ Department of Psychology, BG.C., Islamic Azad University, Bandar Gaz, Iran.

10.30473/ijohp.2025.74264.1398

Abstract

Objective: Patients with Ménière's often experience multiple psychological problems and are not satisfied with the results of medication therapy. This study aimed to evaluate the effectiveness of cognitive-behavioral therapy (CBT) on anxiety, lifestyle, and experiential avoidance in patients with Ménière's disease.
Method: The study employed a quasi-experimental design with a pre-test, post-test, and one-month follow-up approach. The statistical population comprised all patients diagnosed with Ménière's disease who sought treatment at the specialized ear clinic affiliated with Mashhad Medical Sciences Hospital between January and March 2023. From this population, 30 patients meeting the inclusion criteria were selected using an oriented sampling method. Participants were randomly assigned to a CBT intervention group (n = 15) and a control group (n = 15). Data collected at three time points—pre-intervention, post-intervention, and 30 days after the intervention—using the Smith Lifestyle Questionnaire, Bond Experiential Avoidance Questionnaire, and the Anxiety subscale of the DASS-21. The data were analyzed using repeated measures analysis of variance.
Results: The results indicated a significant reduction in anxiety levels in the CBT group compared to the control group in both the post-test and follow-up assessments (P < 0.05). Additionally, a significant improvement was observed in lifestyle scores in the CBT group relative to the control group (P < 0.05). The difference in experiential avoidance between the two groups was also statistically significant (P < 0.05).
Conclusion: The findings suggest that cognitive-behavioral therapy is effective in reducing anxiety and experiential avoidance while improving lifestyle in patients with Ménière's disease. These results underscore the potential of CBT as an adjunctive treatment in managing the psychological and lifestyle-related challenges associated with Ménière's disease.

Keywords

Main Subjects

Psychological and social aspects of disease prevention

Article Title [Persian]

بررسی اثربخشی درمان شناختی رفتاری بر اضطراب، سبک زندگی و اجتناب تجربه ای در بیماران مبتلا به منییر

Authors [Persian]

مهدی رحمانی ¹
محسن جلالی ²
الناز پوراحمدی ³
عبدالصمد نیکان ³

¹ Department of Health Psychology, Go.C., Islamic Azad University, Gorgan, Iran.

² Assistant Prof of clinical psychology, Faculty of Humanities and Social sciences, Golestan University, Gorgan, Iran

³ Department of Psychology, BG.C., Islamic Azad University, Bandar Gaz, Iran.

Abstract [Persian]

هدف: بیماران مبتلا به منیر اغلب مشکلات روانشناختی متعددی را تجربه می‌کنند و از نتایج دارودرمانی راضی نیستند. این مطالعه با هدف ارزیابی اثربخشی درمان شناختی-رفتاری بر اضطراب، سبک زندگی و اجتناب تجربی در بیماران مبتلا به بیماری منیر انجام شد.

روش: این مطالعه از یک طرح نیمه تجربی با رویکرد پیش‌آزمون، پس‌آزمون و پیگیری یک ماهه استفاده کرد. جامعه آماری شامل کلیه بیماران مبتلا به بیماری منیر بود که بین ژانویه تا مارس 2023 به کلینیک تخصصی گوش وابسته به بیمارستان علوم پزشکی مشهد مراجعه کرده بودند. از این جمعیت، 30 بیمار که معیارهای ورود به مطالعه را داشتند با استفاده از روش نمونه‌گیری هدفمند انتخاب شدند. شرکت‌کنندگان به طور تصادفی به یک گروه مداخله (15 نفر) و یک گروه کنترل (15 نفر) اختصاص داده شدند. داده‌ها در سه مقطع زمانی - قبل از مداخله، بعد از مداخله و 30 روز پس از مداخله - با استفاده از پرسشنامه سبک زندگی اسمیت (1988)، پرسشنامه اجتناب تجربی باند (2007) و خرده مقیاس اضطراب DASS-21 (1995) جمع‌آوری شدند. داده‌ها از طریق تحلیل واریانس با اندازه‌گیری مکرر تجزیه و تحلیل شدند.

نتایج: نتایج نشان‌دهنده کاهش معنادار سطح اضطراب در گروه مداخله در مقایسه با گروه کنترل در هر دو ارزیابی پس‌آزمون و پیگیری بود (P < 0.05). علاوه بر این، بهبود معناداری در نمرات سبک زندگی و اجتناب تجربی مشاهده شد (P < 0.05).

نتیجه‌گیری: این نتایج، پتانسیل درمان شناختی رفتاری را به عنوان یک درمان کمکی در مدیریت چالش‌های روانشناختی و سبک زندگی مرتبط با بیماری منییر برجسته می‌کند.

Keywords [Persian]

اضطراب
درمان شناختی رفتاری
سلامت
اجتناب تجربه ای
سبک زندگی

References

Aazh, H. (2025). Cognitive Behavioural Therapy (CBT) for Managing Tinnitus, Hyperacusis, and Misophonia: The 2025 Tonndorf Lecture. Brain Sciences, 15(5), 526. ; https://doi.org/10.3390/brainsci15050526

Abedpour, S., Zare, H., et al. (2024). The Effectiveness of Mindfulness-Based Cognitive Therapy in Resilience, Rumination, and Dysfunctional Attitudes of Infertile Couples. Iranian Journal of Health Psychology; 7, 11-23. https://doi.org/10.30473/ijohp.2024.63277.1241

Akbari, M., shokhmgar, Z., et al. (2021). Comparison of the Effectiveness of Schema Therapy and Cognitive Behavioral Therapy on CommunicationSkills and Problem Solving and Mental Health in Couples with Extra-Marital Experience. Journal of Nursing Education, 9(1), 1-10. URL: http://ijpn.ir/article-1-1476-en.html

Amiri Arjmand, S. A., Mirzaiean, B., et al. (2021). Comparison of the effectiveness of drug therapy and cognitive-behavioral stress management on cognitive avoidance and alexithymia in patients with tension headaches. Psychological Methods and Models, 12(45), 121-136. 10.30495/JPMM.2021.27939.3389

Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., ... & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior therapy, 42(4), 676-688. doi: 10.1016/j.beth.2011.03.007. Epub 2011 May 25.

Carpinelli, L., Cosci, F., Guidi, J., & Fava, G. A. (2023). Cognitive behavioral therapy for anxiety disorders in chronic medical conditions: A meta-analytic review. Journal of Psychosomatic Research, 170, 111158. https://doi.org/10.1016/j.jpsychores.2023.111158

Demirhan, M. A., & Celebisoy, N. (2023). Cognitive functions in episodic vestibular disorders: Meniere’s disease and vestibular migraine. Journal of Vestibular Research, 33(1), 63-70 doi: 10.3233/VES-220025

Eraslan Boz, H., Kırkım, G., et al. (2023). Cognitive function in Meniere’s disease. Psychology, health & medicine, 28(4), 1076-1086. doi: 10.1080/13548506.2022.2144637

Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2009).Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160.https://doi.org/10.3758/BRM.41.4.114

Fazel, A., Haghshenas, H., et al. (2011). Ability to predict personality traits and lifestyle on women's satisfaction nurse city couple. Quarterly Journal of Woman and Society, 2(7), 139-163.20.1001,1,20088566,1390,2,7,8,1.

Garcia-Toro, M., Aguilar-Latorre, A., et al. (2023). Mindfulness skills and experiential avoidance as therapeutic mechanisms for treatment-resistant depression through mindfulness-based cognitive therapy and lifestyle modification. Frontiers in psychology, 14, 1008891. 10.3389/fpsyg.2023.1008891. eCollection 2023.

Grajdan, M. M., Etel, E., Farrell, L. J., & Donovan, C. L. (2025). A systematic review of parental involvement in digital cognitive behavioural therapy interventions for child anxiety. Clinical Child and Family Psychology Review, 28(1), 22-70. doi: 10.1007/s10567-024-00505-3.

Hokmabadi, M., Zeraatkar, M., et al. (2022). The Effectiveness of Cognitive-Behavioral Therapy Based on Healthy Lifestyle on Self-Care Improvement in Patients With Heart Failure. Middle Eastern Journal of Disability Studies, 13:83. 10.29252/mejds.0.0.5

Hu, C., Yang, W., et al. (2022). Risk factors for Meniere disease: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology, 279(12), 5485-5496. doi: 10.1007/s00405-022-07505-5. Epub 2022 Jul 6.

Iwasaki, S., Shojaku, H., et al. (2021). Diagnostic and therapeutic strategies for Meniere's disease of the Japan Society for Equilibrium Research. Auris Nasus Larynx, 48(1), 15-22. doi: 10.1016/j.anl.2020.10.009.

Lahiji, M. R., Akbarpour, M., et al. (2022). Prevalence of anxiety and depression in Meniere's disease; a comparative analytical study. American Journal of Otolaryngology, 43(5), 103565. doi: 10.1016/j.amjoto.2022.103565.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy, 33(3), 335-343. doi: 10.1016/0005-7967(94)00075-u.

Maleki Kambakhsh, S., Masoudi, R., et al. (2021). Correlation of Depression, Anxiety and stress with indices of dental caries and periodontal disease among 15-year-old adolescents in Bandar Abbas during 2017-18. Journal of Mashhad Dental School, 45(4), 405-415. 10.22038/JMDS.2021.54726.2010

Meine, L. E., Müller-Bardorff, M., Recher, D., Paersch, C., Schulz, A., Spiller, T., ... & Kleim, B. (2024). Network analyses of ecological momentary emotion and avoidance assessments before and after cognitive behavioral therapy for anxiety disorders. Journal of anxiety disorders, 106, 102914. https://doi.org/10.1016/j.janxdis.2024.102914

Meulders, A., Traxler, J., Vandael, K., & Scheepers, S. (2024). High-anxious people generalize costly pain-related avoidance behavior more to novel safe contexts compared to low-anxious people. The Journal of Pain, 25(3), 702-714. https://doi.org/10.1016/j.jpain.2023.09.023

Moghaddam, A., Saed, F., Dibajnia, P., & Zangeneh, J. (2008). A preliminary validation of the depression, anxiety and stress scales (DASS) in non-clinical sample. Clinical psychology and personality, 6(2), 23-38. 20.1001.1.23452188.1387.6.2.3.6

Mohammed Hashem, E., Antar Saleh, A., et al. (2024). Effect of Lifestyle and Dietary Intervention on Quality of Life and Self-care among Patients with Meniere's Disease. Egyptian Journal of Health Care, 15(3), 692-707. 10.21608/EJHC.2024.379367

Oraki, M. (2021). Comparison of Effectiveness Mindfulness and Cognitive-behavioral Therapies on Experiential Avoidance of Women with Insomnia. Psychological Studies, 17,310.22051/PSY.2021.36386.2463

Rizk, H. G., Mehta, N. K., et al. (2022). Pathogenesis and etiology of Ménière disease: a scoping review of a century of evidence. JAMA Otolaryngology–Head & Neck Surgery, 148(4), 360-368. doi: 10.1001/jamaoto.2021.4282.

Sanchez-Cuadrado, I., Calvino, M., et al. (2021). Quality of life following cochlear implantation in patients with Menière's disease. Frontiers in Neurology, 12, 670137. https://doi.org/10.3389/fneur.2021.670137

Swain, S. K. (2023). Current treatment of Meniere's disease. Matrix Science Medica, 7(1), 1-6.

Tavakolian, E., Farahani, H., et al. (2024). Clustering somatic symptoms based on psychological risk factors. Iranian Journal of Health Psychology, 7(2), 9-20https://doi.org/10.30473/ijohp.2024.68495.1317

Teggi, R., Finocchiaro, C. Y., et al. (2021). Alexithymia in patients with ménière disease: A possible role on anxiety and depression. Audiology Research, 11(1), 63-72. doi: 10.3390/audiolres11010008.

Vlachou, E., Ntikoudi, A., et al. (2022). Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: an update review of randomized controlled trials. Journal of Diabetes and its Complications, 36(5), 108185. https://doi.org/10.1016/j.jdiacomp.2022.108185

Webster, K. E., George, B., et al. (2023). Lifestyle and dietary interventions for Ménière’s disease. Cochrane Database of Systematic Reviews,2,44 doi: 10.1002/14651858.CD015244.pub2.

Yang, J., Lo, W. L. A., et al. (2022). Evaluation of cognitive behavioral therapy on improving pain, fear avoidance, and self‐efficacy in patients with chronic low back pain: A systematic review and meta‐analysis. Pain Research and Management, 2022(1), 4276175 doi: 10.1155/2022/4276175.

Zandipour, T. (2009). MS patients\'attitude toward the quality of their life and counseling and psychology services. Journal of Psychological Studies, 5(2), 89-116. 10.22051/PSY.2009.1600

Zhou, Y., Sun, W., & Liu, F. (2023). Effectiveness of cognitive-behavioral therapy in vestibular disorders: A randomized controlled trial. Behavior Therapy, 54(1), 56–68. https://doi.org/10.1016/j.beth.2022.11.004

Effectiveness of Cognitive Behavioral Therapy on Anxiety, Lifestyle, and Experiential Avoidance in Patients with Meniere's

References

References

Volume 8, Issue 2 - Serial Number 24June 2025

Volume 8, Issue 2 - Serial Number 24
June 2025