Document Type : Original Article
Authors
1 Department of Mental Health, Jahrom University of Medical Sciences, Jahrom, Iran
2 Department of Family Counseling, University of Social Welfare and Rehabilitation Science, Tehran, Iran
Abstract
Keywords
Approximately 10 to 15% of child bearing age
couples experience infertility. Infertility is a stressful
event that can give rise to psychological difficulties.
This problem affects multiple areas of
life, including physical, emotional, financial, social,
and psychological (
Wischmann explained that women who have
experienced infertility face psychological disturbances,
including low self-esteem and other mental health problems. For this reason counseling
and psychological intervention could help them
achieve a healthy, high quality of life (
Evidence suggests that the anxiety and depression
associated with infertility are similar to those associated
with other serious medical conditions such as
cancers and infection with human immunodeficiency
virus (
Currently, the number of clients who seek infertility
treatments is increasing because of women’s
interests in delaying pregnancy and their increased
awareness about infertility treatment. Couples who
are aware of the effects of psychosocial treatment
on increasing the chances of pregnancy are quite
motivated to participate in counseling and psychotherapy
sessions (
Psychosocial interventions are known to not only
prevent and lessen various mental problems such as
anxiety, depression, and phobias, but also to play a
positive role in physical health and achieving pregnancy
(
Humans are more susceptible to a variety of illnesses
when they suffer from feelings of meaninglessness
or existential frustration. ‘‘It has been considered
that some form of the meaning of life does
exist for individuals, although it has to be discovered,
and that the meaning of life for an individual
can neither be given nor created, it has to be found
or discovered’’ (
Logotherapy is an existential psychotherapy that
can be used with patients who have psychological
and mental disorders. The center of logotherapy is
self-transcendence, a pathway that increases the
sense of purpose, which in turn enhances the sense
of well-being and the ability to cope with suffering
and stress. This approach is based on the assumption
that fulfillment in life is the best protection
people from emotional instability (
Logotherapy assists those who suffer from mental
disorders, neuroticism, or psychopathic problems
and enables individuals to break through their
high expectations and disappointments (
Frankl created logotherapy, which came from his
life experiences. He has stated that human beings
search for the meaning of life and they are motivated
to discover and elaborate on that meaning.
According to Frankl human existence has three
components: soma, psychological, and spiritual.
These aspects comprise the “self” and they are related
to each other. Frankl suggested that" the most
difficult psychological issue facing modern people
is existential emptiness due to a lack of meaning in
life, and developed logotherapy to overcome this
most challenging hurdle" (
Meaning in life is described as an important goal
that adds purpose to life. It is a powerful forcein
humans and is taken into consideration in logotherapy
treatments. Logotherapy includes the following
techniques of paradoxical intention: dereflection,
hyper-reflection, attitude modification,
Socrates talks, and self-transcendence (
According to Farankel the process of analyzing
the meaning of life follows a few fundamental philosophical
elements that include: i. life has meaning,
ii. We derive motivation from this meaning, iii. we
have freedom to search for our own meaning and iv.
the components of human being self are-consists of
soma(physical), psyche, and truth (
A human being does not consist of just somatic
health and environmental forces, but is free to take
a stand toward inner conditions and outer circumstances
(
This study was a randomized clinical trial that included all infertile couples who attended the Maternity and Gynecological Clinic at Jahrom University of Medical Sciences, Jahrom, Iran. Infertility was defined as at least one year of unprotected coitus without conception. Among 800 women or couples, 80 met the following inclusion criteria: history of primary infertility, no somatic or psychiatric problems, residents of Jahrom, between 20-40 years of age, had a personal mobile phone, were literate, and expressed interest in participating in regular group meetings. At the onset of the study, we enrolled the 80 females who met the inclusion criteria.
Study participants were randomly divided into two groups (experimental and control) according to their file numbers. During the first two sessions, 15 people were absent or did not complete the questionnaire in its entirety and therefore they were excluded. The duration of the study was conducted with 65 participants, 33 in the experimental group and 32 in the control group who regularly attended the meetings after the end of study. Participants in the experimental group received group logo therapy for 12 weekly sessions. All participants elaborated on their own positive meaningful messages in the sessions, and a brief summary of each session was sent to each person at the end of every two sessions in order to achieve maximum performance. The control group did not receive any intervention, but due to ethical considerations, we gave a presentation (one session) about infertility treatment for this group after the research process was completed. Participant consent was acquired and the research project was approved by the Ethics Committee at Jahrom University of Medical Sciences.
The logotherapy educational program is an intervention
program. The executive package has
been used by various researchers in both chronic
and severe diseases (
The objectives of the sessions are as follows:
Identify the goals and rules of the meeting, the familiarity of members with each other, and the expression of the meaning of life, which are steps that aim to create trust within the group and promote group dynamics (1 session).
Gather information from patients' characteristics and capabilities as the center of self-consciousness and reflection into anxiety-related factors and determining all strategies to expose anxiety (2 sessions).
Necessity of maintaining one's personal identity and how to interact with others as a way to find the meaning of love (1 session).
How to establish good relations with families and use different approaches to counseling date families so that they can search for the meaning of life through strengthening family ties (1 session).
The meaning of suffering, finding the hidden meaning of the infertility problem by emphasizing the philosophy of life and marriage (2 sessions).
Identifying assisted reproductive therapies and providing information about all treatment options as a way to creating hope (2 sessions).
Recognizing the value of creating the kind of work and service to others who can give meaning to life (i.e., helping charities, organ donation, etc.) (1 session).
Understanding the empirical values of the meaning of life and its value in addressing nature, the deepening of life through interaction with nature, and pursuing art. (Seeing the beauty that exists in nature and art to coping with -the - challenges) (1 session).
In one session, we have included trend values that discuss situations where people are powerless to deal with and are forced to accept that situation (i.e., living without a child).
Data were gathered from two questionnaires, the
PSWQ and the PSS. The PSWQ investigates clinical
and non-clinical groups of adults and consists of
16Likert items. This questionnaire has excellent internal
consistency, test-retest reliability, and concurrent
and discriminative validities. In a clinical group
study by Brown et al. (
The PSS is a 14 item self-report questionnaire
that measures a person's evaluation of the stressfulness
of situations during the past month of their
lives. This questionnaire is the most widely used
psychological tool for measuring the perception of
stress.‘‘It is a measure of the degree to which situations
in one’s life are appraised as stressful. Items
were designed to tap how unpredictable, uncontrollable,
and overloaded respondents find their lives.
The scale also includes a number of direct queries
about current levels of experienced stress’’. Subjects
responses are measured on a five-point scale,
0 (never), 1 (almost never), 2 (sometimes), 3 (fairly
often), and 4 (very often). This self-report test
is from Cohen et al. (
The current study included 33 infertile women in the treatment group and 32 infertile women in the control group. The demographic characteristics of the two groups did not significantly differ in terms of age (p=0.43), education (p=0.13), duration of infertility, and etiology of infertility (p=0.26).
In the two groups, 44.6% of the women were between the ages of 20-30 years and 49.2% were between the ages of 31-40 years. Education level was similar in the treatment and control groups (p=0.13).There were 59.5% of participants in the treatment group and 59.5% of control group participants who had high school educations. Infertility duration in the treatment group was 12 (36.5%) years and in the control group, it was 16(51.6%) years. There were no significant differences between the two groups (p=1).
Female factor infertility was observed in
18 (56.2%) of participants in the treatment group
and 16 (51.6%) in the control group. Male factor
infertility was observed in 3 (9.4%) participants in
the treatment group and 7 (22.6%) in the control
group. The cause of infertility was similar in both
groups (p=0.26;
Demographic characteristics of the treatment and control groups
Variable | Experimental group (n%) | Control group (n%) | P value |
---|---|---|---|
15 (23) | 14 (21.6) | 1.71 (0.43) | |
15 (23) | 17 (26.2) | ||
2 (3.1) | 2 (3.1) | ||
6 (15.5) | 11 (32.3) | -1.52 (0.13) | |
19 (59.5) | 18 (58.1) | ||
7 (21.7) | 1 (3.2) | ||
1 (3.3) | 2 (6.5) | ||
12 (37.5) | 9 (29) | -1.11 (0.26) | |
5 (15.6) | 6 (19.4) | ||
11 (34.4) | 16 (51.6) | ||
4 (12.5) | 0 (0) | ||
18 (56.2) | 16 (51.6) | -1.11 (0.26) | |
3 (9.4) | 7 (22.6) | ||
11 (34.4) | 8 (25.8) | ||
Psychological intervention in the treatment group
caused a significant decrease in the PSWQ score
from 33.25 ± 12.24 to 27.31 ± 13.50 (p=0.004).
The stress score in the control group was 34.19 ±8.80 before and 34.45 ± 8.23 after the study, which
was not significant (p=0.65;
Differences between mean score of Penn State Worry Questionnaire between groups, pre and post-test
Group | Pre-test Mean (SD) | Post-tes Mean (SD) | t-student | P value |
---|---|---|---|---|
33.25 (12.24) | 27.31 (13.50) | 3.06 | 0.004* | |
34.19 (8.80) | 34.45 (8.23) | -0.45 | 0.65 | |
*; P<0.05 is significant.
Differences between mean score of Penn State Worry Questionnaire (PSWQ) in the two groups with ANCOVA
Group | Mean (SD) | F-test | P value |
---|---|---|---|
5.21 | 0.27 | ||
33.25(12.24) | |||
34.19(8.80) | |||
11.37* | 7.28* | ||
27.31(13.50) | |||
34.45(8.23) | |||
*; P≤0.001 is significant.
Other results showed no significant differences between
the mean PSWQ scores. Rather, differences
in the mean scores of the PSWQ in the two groups
were significant after intervention (p=0.01), as confirmed
by ANCOVA (p=0.009;
Differences in mean score of the Perceived Stress Scale (PSS) between the two groups, pre and post-test with ANCOVA
Group | Pre-test Mean (SD) | Post-test Mean (SD) | F-test | P value |
---|---|---|---|---|
29.25(4.75) | 28.18(4.94) | 1.11 | 0.27 | |
29.09(4.79) | 28.29(4.62) | 1.12 | 0.27 | |
Results of the PSS are presented in table 4. Psychological
intervention in the treatment group decreased
the level of stress (29.25 ± 4.75 vs. 28.18 ±
4.94; p=0.27). In the control group there was also a
decreased level of stress (29.09 ± 4.79 vs. 28.29 ±
4.62; p=0.27), however neither of the scores were
significant (
There were significant differences between mean
scores of the PSS after intervention in mean stress in
the two groups by ANCOVA, as a level of total perceived
stress (F=7.05, p=0.01) in the treatment group
decreased more than in the control group (
Differences between mean scores of the PSS between groups according to ANCOVA
Experimental Mean (SD) | Control Mean (SD) | F-test | P value | |
---|---|---|---|---|
29.25 (4.75) | 29.09 (4.79) | 0.31 | 0.18 | |
17.93 (3.5) | 16.48 (3.27) | 0.40 | 0.24 | |
14.43 (3.50) | 15.51 (5.07) | 2.82 | 2.39 | |
28.18 (4.94) | 28.29 (4.62) | 0.33 | 7.05* | |
17.37 (4.64) | 15.58 (2.99) | 5.1 | 3.65* | |
14.90 (3.68) | 15.22 (4.31) | 0.46 | 1.30 | |
*; P≤0.05 is significant.
According to our results the experimental
group reported decreased worry and stress perception.
The relationship between logotherapy
and medicine has been the focus of considerable
interest in recent years. Studies have suggested
that many patients believe spirituality
plays an important role in their lives, that there
is a positive correlation between one's spirituality
and health outcomes, and that patients would
like physicians to consider these factors in their
medical care (
Logotherapy is an educational program to activate
comprehensive human critical power. This
process stimulates and activates human brain
function (
Recent results have also shown that this approach
decreases worry from infertility symptoms. Others
have studied the impact of this approach on treatment
of serious diseases. Logotherapy, according
to one study, was an effective approach that supported
adolescent cancer patients to find meaning
in their lives and successfully reduced their suffering.
As spiritual intervention in a medical center,
logotherapy has demonstrated effective promotion
of the quality of life and prevented hopelessness
caused by illness for patients under somatic
stressful events (
It has been argued by Koenig et al. that meaning
of life is purely a measure of emotional well-being
(
‘‘Spirituality intervention plays in the patient’s
ability to cope with the illness. Although the spirituality
may be a source of support but in some
cases may be a source of emotional turmoil and
stress’’(
One study of group logotherapy on life expectation
in cancer patients has shown that this therapy
increased life expectation (
As with our results, evidence has confirmed the
positive impact of other approaches, specific stress
management intervention, and group therapy on
the mental health of infertile couples and other important
effects of these approaches on pregnancy
rates (
Some studies have stated that group therapy and
other approaches did not improve pregnancy rates,
but rather they noted decreased rates of depression
and anxiety (
Psychological interventions can be used as appropriate
methods for infertile women who are
not undergoing medical treatment (
Logotherapy can be a sufficient method to reduce stress, worries, and other symptoms. This approach may of benefit for infertile couples' mental health. Thus, it can be concluded that logotherapy and attention to the spiritual aspect of patients who suffer from infertility may be a sufficient intervention during all stages of the infertility treatment. Further research is needed to understand whether other psychological approaches have the same consequences on infertility.