Journal of Police Medicine

fa مقایسه اثر بخشی درمان شناختی ـ رفتاری و درمان پذیرش و تعهد بر خود کارآمدی درد و کیفیت زندگی بیماران مبتلا به کمردرد مزمن Comparison of the Effectiveness between Cognitive-Behavioral and Acceptance and Commitment Therapies on Pain Self-Efficacy and Quality of life in Chronic Back Pain Patients روان‌شناسی انتظامی Police Related Psychology پژوهشی اصيل Original Research <div style="text-align: justify;">اهداف: در میان دردهای مزمن، کمر درد مزمن یکی از فراگیرترین انواع درد است. در این تحقیق هدف مقایسه اثربخشی درمان شناختی-رفتاری و درمان مبتنی بر پذیرش و تعهد در بیماران مبتلا به کمر درد مزمن بر خودکارآمدی درد و کیفیت زندگی بود. مواد و روش‌ها: تحقیق حاضر آزمایشی از نوع پیش آزمون، پس آزمون و پیگیری همراه با گروه شاهد است که از بهمن‌ماه سال 1398 تا اسفند سال 1399 انجام شد. جامعه آماری این پژوهش، تمامی بیماران مراجعه‌کننده دارای کمردرد مزمن به بخش تخصصی کلینیک الزهرا حکیمیه در شهر تهران بود. جمعیت نمونه تحقیق شامل ۴۵ نفر بود که به روش هدفمند و در دسترس انتخاب و به صورت تصادفی در سه گروه‌ 15 نفره قرار داده شدند. مداخله درمانی برای گروه اول، درمان شناختی-رفتاری و برای گروه دوم درمان مبتنی بر پذیرش و تعهد بود و برای گروه کنترل هیچ آموزشی درنظر گرفته نشد. ابزار مورد استفاده، پرسش‌نامه‌های اطلاعات جمعیت‌شناختی، خودکارآمدی درد و کیفیت زندگی سازمان بهداشت جهانی بود. فرضیه‌های پژوهش به صورت جداگانه با استفاده از تحلیل کوواریانس تک‌متغیری بررسی شدند. یافته‌ها: در این پژوهش 45 بیمار (33 مرد و 12 زن) با میانگین سنی 14/09±41/18 سال شرکت کرده بودند. نسبت F تحلیل کوواریانس تک‌متغیره برای تفاوت تمامی متغیرهای وابسته بین گروه‌های آزمایش و گروه کنترل معنا‌دار بود (0/001>p). در ادامه به منظور مقایسه اثربخشی دو روش درمانی بر خودکارآمدی درد و کیفیت زندگی از نتایج آزمون تعقیبی بنفرونی استفاده شد. تفاوت بین میانگین گروه درمان شناختی-رفتاری و درمان مبتنی بر پذیرش و تعهد بر خودکفایتی درد و کیفیت زندگی در هر دو مرحله پس‌آزمون و پیگیری معنادار نبود (0/05<p). بنابراین اثربخشی دو روش درمانی بر خودکفایتی درد و کیفیت زندگی این بیماران یکسان بود. نتیجه‌گیری: اثربخشی هر دو روش درمانی شناختی-رفتاری و درمان مبتنی بر پذیرش و تعهد در افزایش خودکارآمدی درد و کیفیت زندگی در بین بیماران کمردرد مزمن اثربخش است اما بین دو روش درمانی مذکور تفاوت معناداری وجود ندارد.</div> <div style="text-align: justify;"> Introduction ... [1]. Chronic pain is used to describe non-cancerous and resistant to treatment that has lasted longer than the period expected to improve [2]. A significant population with chronic pain suffers from depression and social maladaptation and poor quality of life [3]. Low back pain is one of the most common types of chronic pain [4]. ... [5, 6]. Studies on the effects of chronic low back pain on the mental status of patients indicate a higher prevalence of mental disorders among them than the general population [7]. Compare to the general population, the disease is more prevalent among the military [8]. ... [9, 10]. Because psychological disorders may be associated with low back pain and even cause it, will lead to the adoption of appropriate treatment methods and more serious follow-up [11]. ... [12, 13]. In the research of Kiani et al., it has been found that acceptance and commitment therapy and positive cognitive-behavioral therapy are effective on pain self-efficacy in patients with chronic pain [14]. Razavi et al. have also shown that acceptance and commitment therapy leads to increased feelings of hope and pain management in women with chronic pain [15]. Emotion-focused cognitive-behavioral therapy and acceptance and commitment therapy have reduced the symptoms of pain and depression and have increased life satisfaction among patients with chronic low back pain [16]. The role of acceptance and commitment therapy in reducing catastrophizing and disabling pain in women with low back pain has been proven and has been stable during the two-month follow-up period [17]. Aim (s) This study aimed to compare the two methods of cognitive-behavioral therapy and acceptance and commitment therapy in patients with chronic low back pain to determine the effectiveness of these two methods in increasing pain self-efficacy and quality of life. Research Type The present study is a pre-test, post-test, and follow-up experiment with a control group. Research Society, Place and Time All patients with chronic low back pain referred to the specialty ward of Al-Zahra Hakimieh Clinic in Tehran, Iran from February 2020 to March 2021 was the statistical population of this study. Sampling Method and Number 45 subjects were selected by purposive and available sampling method and were randomly divided into two experimental groups and one control group. Used Devices & Materials The Demographic Information Questionnaire was used to identify patients with chronic pain. Other tools used in this study were the Pain Self-Efficacy Questionnaire [18] and the WHO Quality of Life Questionnaire. Experimental group A (CBT) and experimental group B (ACT) received weekly group training (Tables 1 and 2) and no training was provided for the control group. Finally, after two months, a follow-up period was performed. Ethical Permissions The necessary license has been obtained from the ethics committee of Ahvaz Azad University, Medical Sciences Branch, number IR.IAU.AHVAZ.REC.1399.012. Statistical Analysis In this study, data were analyzed using univariate analysis of variance and Bonferroni's post hoc test. Finding by Text In this study, 45 patients with chronic low back pain, including 33 men and 12 women participated with a mean age of 14.81±14.09 years. All variables were examined in three groups (two experimental groups and one control group) and three stages of pre-test, post-test, and follow-up (Table 3). The hypothesis of normal distribution of scores in the pretest was confirmed in both experimental and control groups (p>0.05). The results of the Levin test also showed the homogeneity of variances in experimental and control groups before the experimental intervention (in the pre-test stage) (p>0.05). Therefore, the possibility of using analysis of covariance was confirmed. In this study, the pre-tests of pain self-efficacy and quality of life variables were considered as co-variates and their post-test were considered as dependent variables. Since the dependent variables of the study did not form a common focus, univariate or ANOVA analysis of covariance was used. The results showed that the F-ratio of univariate analysis of covariance was significant for the difference of all dependent variables between the experimental groups and the control group (p <0.001). This means that both treatments were effective on the dependent variables of the research separately (Table 4). Therefore, to compare the effectiveness of the two methods of cognitive-behavioral therapy and acceptance and commitment therapy on pain self-efficacy and quality of life, the results of the Bonferroni post hoc test were used (Table 5). In addition, the difference between the mean of cognitive-behavioral therapy group and acceptance and commitment therapy on pain self-sufficiency and quality of life in both post-test and follow-up stages was not significant at the level of 0.05 (p>0.05). Therefore, the effectiveness of the two treatments on pain self-sufficiency and quality of life in these patients was the same. Main Comparison to the Similar Studies The findings of this study are consistent with a study aimed at managing pain in inflammatory bowel disease [14]. In this study, it was shown that after the intervention of cognitive-behavioral therapy, the scores of quality of life and self-efficacy of pain improved and depression, anxiety, and catastrophic pain decreased. In the study of Anvari et al., it has been shown that acceptance and commitment therapy has a significant effect on the severity of pain and anxiety and quality of life of patients with chronic low back pain, which is consistent with the results of the present study [19]. Also, according to the findings of Rahimian Booger, cognitive-behavioral therapy is effective in reducing multifaceted pain symptoms among patients with chronic low back pain [9]. By reviewing research related to pain treatment, including the present study, it can be concluded that the best outcome of pain treatment occurs when the various factors involved in pain processing are also considered. ... [20]. Thus, the findings of the present study showed that both cognitive-behavioral therapy and acceptance and commitment therapy were able to change the inefficiency of patients with chronic low back pain to better efficiency and self-efficacy in coping with pain and also improving the quality of life of this group of patients via influencing cognitions, emotions, behaviors and non-adaptive coping skills, as well as by increasing flexibility, the ability to go back to the present, being aware and observing thoughts and emotions [21]. ... [22, 23]. Considering the role of psychological factors on the sense of self-efficacy and quality of life facing chronic low back pain, it can be said that the factors and variables in pain have an interactive and reciprocal role [24]. ... [25]. Limitations The sampling of this study lasted from February 2020 to March 2021due to the Corona pandemic and related limitations. Suggestions Due to the importance of psychological factors and structures in the phenomenon of pain, especially chronic pain, more research is emphasized in this category. It is also recommended to conduct research related to chronic pain with an emphasis on gender segregation in different groups. It is suggested that the effectiveness of these two treatments on other variables affecting the statistical population be compared and evaluated. Conclusions The effectiveness of both cognitive-behavioral therapy and acceptance and commitment therapy is effective in increasing pain self-efficacy and quality of life among patients with chronic low back pain, but there is no significant difference between the two therapies. Clinical & Practical Tips in Police Medicine According to the results of this study based on the effectiveness of two approaches of cognitive-behavioral therapy and acceptance and commitment therapy, such interventions can be used in medical centers of the police and other armed forces for patients with chronic low back pain. Acknowledgments This article is taken from the Ph.D. dissertation on health psychology at the Islamic Azad University, Khorramshahr branch and thanks all the participants in the research, as well as the professors, advisors and consultants, the neurologist and the management of Al-Zahra Hakimiyeh Clinic in Tehran, Iran. Conflict of Interest The authors state that there is no conflict of interest in the present study. Funding Sources The present study had no financial support Table 1) Description of cognitive-behavioral therapy sessions <table align="center" class="MsoTableGrid" style="border-collapse:collapse;border:none;width:1000px;"> <tbody> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Meeting </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Aim </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Content </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Duties </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 1 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Establishing a therapeutic relationship, acquainting people with the subject of the research, conducting a pre-test </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Introduction and acquaintance, expression of research objectives and how the research process, number of sessions and rules and regulations of the department, conducting pre-test </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Determining your goals of participating in a research project by clients </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 2 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Self-awareness </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Discuss the clients' goals of participating in the sessions, empowering the members in the field of self-awareness and recognizing their characteristics, needs, wants, goals, values and identity. </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Identify and note the positive and negative characteristics of needs, wants and values </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 3 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Identify and modify cognitive distortions </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Discuss the problems of clients in the path of self-awareness and examine the needs and desires, familiarize members with the relationship between thought, behavior and familiarity with spontaneous thoughts, cognitive distortions and challenging cognitive distortions </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Daily diary of events, thoughts and feelings that follow and identify cognitive distortions </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 4 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Familiarity with the concept of documents </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Discuss the identified cognitive distortions and their effect on the thoughts, feelings and behaviors of clients, familiarize themselves with the concept of documents and investigate the causes of misunderstandings and teach how to change documents. </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Identify documents about difficult life events (back pain) and try to change incorrect documents </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 5 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Familiarity with problem solving skills </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Discuss the impact of attributions on clients' feelings, thoughts, and behaviors, and problem-solving skills training, including problem definition, alternative solutions, evaluation of solutions, selection and implementation of selected solutions, and evaluation of implemented selected solutions. </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Investigate one of the problems that the client is facing and implement problem-solving skills </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 6 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Familiarity with communication and negotiation skills </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Discuss the effect of applying problem solving skills in personal and social life, defining communication and its elements, familiarizing members with effective communication skills and their characteristics, and teaching effective methods of problem control (pain). </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Practice effective communication during the week and examine its consequences </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 7 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Familiarity with bold behavior </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Discuss the effect of using effective communication methods in personal and social life, familiarizing clients with assertive behavior and performing practical activities and playing a role in teaching this skill </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Practice the skill of bold behavior during the week and examine its consequences </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 8 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Investigate constructive changes and consolidate and consolidate them </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Discuss the impact of using assertive behavior on clients 'personal and social lives, examine the constructive changes that have taken place during treatment. </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Note the positive and negative points of the taught programs, note the strengths and weaknesses of the teaching methods </td> </tr> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 9 </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Summarize sessions and perform post-test </td> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> Provide a summary of treatment sessions and an overview of the skills taught, discuss the pros and cons of the treatment plan and plan, and receive feedback from clients, conduct post-tests, and complete treatment sessions. </td> </tr> </tbody> </table> <div style="text-align: center;"></div> <table align="center" class="MsoTableGrid" style="border-collapse:collapse; border:none"> <tbody> <tr> <td style="border-bottom:1px solid black; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> </td> </tr> </tbody> </table> Table 2) Description of treatment sessions based on acceptance and commitment <table align="center" class="MsoTableGrid" style="border-collapse: collapse; border: none; width: 1000px;" width="786"> <tbody> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Meeting </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:1px solid black; border-right:none; border-left:none"> Target </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:1px solid black; border-right:none; border-left:none"> Content </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:1px solid black; border-right:none; border-left:none"> Duties </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 1 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Establishing a therapeutic relationship, acquainting people with the subject of the research, conducting a pre-test </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Introduction and acquaintance, expression of research objectives and how the research process, number of sessions and rules and regulations of the department, conducting pre-test </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Determining the goals of the participants in participating in the research project </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 2 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Familiarity of members with chronic pain </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Discuss clients' goals, provide explanations about chronic pain and its cases and consequences </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Determining the effects of low back pain on their personal and social lives by therapists </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 3 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Investigating inefficient control strategies and creating helplessness </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Discuss the effects of low back pain on patients' lives, examine the control strategies that patients have used to deal with low back pain, and the ineffectiveness of these strategies, help clinicians to realize the futility of control strategies using the metaphor of the person in the well. </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Identify control strategies and their impact on personal and social life </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 4 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Mindfulness training and acceptance </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Discuss the futility of past strategies, avoid painful experiences and their consequences, introduce mindfulness and acceptance, teach acceptance steps and practice acceptance of thoughts and feelings </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Perform mindfulness exercises during the week and examine their impact on personal and social life </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 5 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Cognitive fault training </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Explain cognitive fusion and express the common relationship of emotions, cognitive functions and observable behavior Cognitive fault and distance from thoughts without judgment and action independent of mental experiences using train metaphor </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Exercise faulting during the week and study its impact on personal and social life </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 6 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Familiarity with yourself as a background </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Examining the practice of faulting in the lives of therapists, explaining the concepts of their role, context and types and moving towards a valuable life with a receptive and observant self by using the metaphor of chess </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Practice awareness of different sensory perceptions and separation from the senses that are part of the mental content and study its impact on personal and social life </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 7 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Specify values </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Discuss the effect of observation of thoughts on the lives of clients, explain the concept of values, motivate change and empower clients for a better life </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Identify values and prioritize them in the ten areas of family, marriage, occupation and profession, education and personal growth, leisure and entertainment, spirituality, social life, environment and nature and health </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 8 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Creating a commitment to act in line with values </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Discuss values and barriers to action according to them, create different behavioral patterns in accordance with the values and create a commitment to action in line with the goals and values and overcome obstacles using the metaphor of passengers on the bus </td> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Identify and implement behavioral plans in accordance with values and examine them in personal and social life </td> </tr> <tr> <td style="border-bottom:1px solid black; width:72px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> 9 </td> <td style="border-bottom:1px solid black; width:158px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Summarizing sessions and conducting post-test </td> <td style="border-bottom:1px solid black; width:310px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Discuss the consequences of practice based on values, examine constructive changes during the treatment period and how to consolidate and consolidate them, provide a summary of treatment sessions and receive feedback from clients, conduct post-test and completion of treatment sessions </td> </tr> </tbody> </table> <div style="text-align: center;"></div> <table align="center" class="MsoTableGrid" style="width:786px; border-collapse:collapse; border:none" width="786"> <tbody> <tr> <td style="border-bottom:1px solid black; width:246px; padding:5px 5px 5px 5px; border-top:none; border-right:none; border-left:none"> Table 3) Mean of self-efficiency of pain and quality of life in experimental and control groups  in pre-test, post-test and follow-up levels </td> </tr> </tbody> </table> <table align="center" class="MsoTableGrid" style="width:424px; border-collapse:collapse; border:none" width="424"> <tbody> <tr> <td rowspan="2" style="border-bottom:1px solid black; width:63px; padding:2px 5px 2px 5px; height:25px; border-top:1px solid black; border-right:none; border-left:none"> Variable </td> <td rowspan="2" style="border-bottom:1px solid black; width:49px; padding:2px 5px 2px 5px; height:25px; border-top:1px solid black; border-right:none; border-left:none"> Group </td> <td colspan="2" style="border-bottom:1px solid black; width:105px; padding:2px 5px 2px 5px; height:25px; border-top:1px solid black; border-right:none; border-left:none"> Pre-test </td> <td colspan="2" style="border-bottom:1px solid black; width:104px; padding:2px 5px 2px 5px; height:25px; border-top:1px solid black; border-right:none; border-left:none"> Post-test </td> <td colspan="2" style="border-bottom:1px solid black; width:104px; padding:2px 5px 2px 5px; height:25px; border-top:1px solid black; border-right:none; border-left:none"> Follow up </td> </tr> <tr> <td style="border-bottom:1px solid black; width:36px; padding:2px 5px 2px 5px; height:11px; border-top:none; border-right:none; border-left:none"> Mean </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:11px; border-top:none; border-right:none; border-left:none"> Standard deviation </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:11px; border-top:none; border-right:none; border-left:none"> Mean </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:11px; border-top:none; border-right:none; border-left:none"> Standard deviation </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:11px; border-top:none; border-right:none; border-left:none"> Mean </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:11px; border-top:none; border-right:none; border-left:none"> Standard deviation </td> </tr> <tr> <td rowspan="3" style="border-bottom:1px solid black; width:63px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> Pain self-efficiency </td> <td style="border-bottom:1px solid black; width:49px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> CBT </td> <td style="border-bottom:1px solid black; width:36px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> 20.53 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:8px; border-top:none; border-right:none; border-left:none"> 3.75 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> 29.66 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:8px; border-top:none; border-right:none; border-left:none"> 3.49 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> 28.73 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:8px; border-top:none; border-right:none; border-left:none"> 3.34 </td> </tr> <tr> <td style="border-bottom:1px solid black; width:49px; padding:2px 5px 2px 5px; height:6px; border-top:none; border-right:none; border-left:none"> ACT </td> <td style="border-bottom:1px solid black; width:36px; padding:2px 5px 2px 5px; height:6px; border-top:none; border-right:none; border-left:none"> 21.13 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:6px; border-top:none; border-right:none; border-left:none"> 3.97 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:6px; border-top:none; border-right:none; border-left:none"> 29.06 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:6px; border-top:none; border-right:none; border-left:none"> 3.55 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:6px; border-top:none; border-right:none; border-left:none"> 28.80 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:6px; border-top:none; border-right:none; border-left:none"> 2.93 </td> </tr> <tr> <td style="border-bottom:1px solid black; width:49px; padding:2px 5px 2px 5px; height:14px; border-top:none; border-right:none; border-left:none"> Control group </td> <td style="border-bottom:1px solid black; width:36px; padding:2px 5px 2px 5px; height:14px; border-top:none; border-right:none; border-left:none"> 21.06 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:14px; border-top:none; border-right:none; border-left:none"> 6.25 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:14px; border-top:none; border-right:none; border-left:none"> 22.06 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:14px; border-top:none; border-right:none; border-left:none"> 5.49 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:14px; border-top:none; border-right:none; border-left:none"> 22.40 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:14px; border-top:none; border-right:none; border-left:none"> 5.67 </td> </tr> <tr> <td rowspan="3" style="border-bottom:1px solid black; width:63px; padding:2px 5px 2px 5px; height:11px; border-top:none; border-right:none; border-left:none"> Quality of Life </td> <td style="border-bottom:1px solid black; width:49px; padding:2px 5px 2px 5px; height:11px; border-top:none; border-right:none; border-left:none"> CBT </td> <td style="border-bottom:1px solid black; width:36px; padding:2px 5px 2px 5px; height:11px; border-top:none; border-right:none; border-left:none"> 20.53 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:11px; border-top:none; border-right:none; border-left:none"> 6.94 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:11px; border-top:none; border-right:none; border-left:none"> 43.56 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:11px; border-top:none; border-right:none; border-left:none"> 7.46 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:11px; border-top:none; border-right:none; border-left:none"> 42.86 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:11px; border-top:none; border-right:none; border-left:none"> 6.64 </td> </tr> <tr> <td style="border-bottom:1px solid black; width:49px; padding:2px 5px 2px 5px; height:12px; border-top:none; border-right:none; border-left:none"> ACT </td> <td style="border-bottom:1px solid black; width:36px; padding:2px 5px 2px 5px; height:12px; border-top:none; border-right:none; border-left:none"> 21.13 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:12px; border-top:none; border-right:none; border-left:none"> 7.17 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:12px; border-top:none; border-right:none; border-left:none"> 43.53 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:12px; border-top:none; border-right:none; border-left:none"> 7.41 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:12px; border-top:none; border-right:none; border-left:none"> 42.60 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:12px; border-top:none; border-right:none; border-left:none"> 7.61 </td> </tr> <tr> <td style="border-bottom:1px solid black; width:49px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> Control group </td> <td style="border-bottom:1px solid black; width:36px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> 21.06 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:8px; border-top:none; border-right:none; border-left:none"> 7.09 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> 36.26 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:8px; border-top:none; border-right:none; border-left:none"> 6.69 </td> <td style="border-bottom:1px solid black; width:35px; padding:2px 5px 2px 5px; height:8px; border-top:none; border-right:none; border-left:none"> 36.66 </td> <td style="border-bottom:1px solid black; width:69px; padding:0cm 5px 0cm 5px; height:8px; border-top:none; border-right:none; border-left:none"> 6.07 </td> </tr> </tbody> </table> Table 4) Results of univariate analysis of covariance on each of the dependent variables <table align="center" class="MsoTableGrid" style="border-collapse:collapse; border:none"> <tbody> <tr> <td style="border-bottom:1px solid black; width:54px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> level </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> The dependent variable </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Total squares </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> df </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Average squares </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> F </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Impact factor </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Power of test </td> </tr> <tr> <td rowspan="2" style="border-bottom:1px solid black; width:54px; padding:0cm 5px 0cm 5px; height:21px; border-top:none; border-right:none; border-left:none"> Post-test </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:21px; border-top:none; border-right:none; border-left:none"> Self-efficiency of pain </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:21px; border-top:none; border-right:none; border-left:none"> 501.50 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:21px; border-top:none; border-right:none; border-left:none"> 2 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:21px; border-top:none; border-right:none; border-left:none"> 250.75 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:21px; border-top:none; border-right:none; border-left:none"> 37.82 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:21px; border-top:none; border-right:none; border-left:none"> 0.66 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:21px; border-top:none; border-right:none; border-left:none"> 1 </td> </tr> <tr> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:15px; border-top:none; border-right:none; border-left:none"> Quality of Life </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:15px; border-top:none; border-right:none; border-left:none"> 693.85 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:15px; border-top:none; border-right:none; border-left:none"> 2 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:15px; border-top:none; border-right:none; border-left:none"> 346.92 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:15px; border-top:none; border-right:none; border-left:none"> 42.83 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:15px; border-top:none; border-right:none; border-left:none"> 0.69 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:15px; border-top:none; border-right:none; border-left:none"> 1 </td> </tr> <tr> <td rowspan="2" style="border-bottom:1px solid black; width:54px; padding:0cm 5px 0cm 5px; height:17px; border-top:none; border-right:none; border-left:none"> Follow up </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:17px; border-top:none; border-right:none; border-left:none"> Self-efficiency of pain </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:17px; border-top:none; border-right:none; border-left:none"> 377.48 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:17px; border-top:none; border-right:none; border-left:none"> 2 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:17px; border-top:none; border-right:none; border-left:none"> 188.74 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:17px; border-top:none; border-right:none; border-left:none"> 26.60 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:17px; border-top:none; border-right:none; border-left:none"> 0.58 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:17px; border-top:none; border-right:none; border-left:none"> 1 </td> </tr> <tr> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:19px; border-top:none; border-right:none; border-left:none"> Quality of Life </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:19px; border-top:none; border-right:none; border-left:none"> 500.22 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:19px; border-top:none; border-right:none; border-left:none"> 2 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:19px; border-top:none; border-right:none; border-left:none"> 250.11 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:19px; border-top:none; border-right:none; border-left:none"> 33.41 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:19px; border-top:none; border-right:none; border-left:none"> 0.64 </td> <td style="border-bottom:1px solid black; width:45px; padding:0cm 5px 0cm 5px; height:19px; border-top:none; border-right:none; border-left:none"> 11 </td> </tr> </tbody> </table> P=0.0001 Table 5) Results of Bonferroni post hoc test to compare the difference between the means of pain self-efficiency in the two stages of post-test and follow-up <table align="center" class="MsoTableGrid" style="border-collapse:collapse; border:none"> <tbody> <tr> <td style="border-bottom:1px solid black; width:68px; padding:2px 5px 2px 5px; border-top:1px solid black; border-right:none; border-left:none"> Index </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; border-top:1px solid black; border-right:none; border-left:none"> Variables </td> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; border-top:1px solid black; border-right:none; border-left:none"> Compared groups </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; border-top:1px solid black; border-right:none; border-left:none"> Mean difference </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; border-top:1px solid black; border-right:none; border-left:none"> Standard  error </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; border-top:1px solid black; border-right:none; border-left:none"> P </td> <td style="border-bottom:none; border-top:none; border-right:none; border-left:none; width:0px">   </td> </tr> <tr> <td rowspan="7" style="border-bottom:1px solid black; width:68px; padding:2px 5px 2px 5px; border-top:none; border-right:none; border-left:none"> Pain self-efficacy </td> <td rowspan="4" style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; border-top:none; border-right:none; border-left:none"> Post -test </td> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; border-top:none; border-right:none; border-left:none"> CBT-control group </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; border-top:none; border-right:none; border-left:none"> 7.71 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; border-top:none; border-right:none; border-left:none"> 1.11 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; border-top:none; border-right:none; border-left:none"> 0.001 </td> <td style="border-bottom:none; border-top:none; border-right:none; border-left:none; width:0px">   </td> </tr> <tr> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:9px; border-top:none; border-right:none; border-left:none"> ACT- control group </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:9px; border-top:none; border-right:none; border-left:none"> 5.57 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:9px; border-top:none; border-right:none; border-left:none"> 1.09 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:9px; border-top:none; border-right:none; border-left:none"> 0.001 </td> <td style="border-bottom:none; height:9px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:29px; border-top:none; border-right:none; border-left:none"> CBT - ACT </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:29px; border-top:none; border-right:none; border-left:none"> 2.14 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:29px; border-top:none; border-right:none; border-left:none"> 1.10 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:29px; border-top:none; border-right:none; border-left:none"> 0.17 </td> <td style="border-bottom:none; height:29px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td rowspan="2" style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:23px; border-top:none; border-right:none; border-left:none"> CBT-control group </td> <td rowspan="2" style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:23px; border-top:none; border-right:none; border-left:none"> 6.44 </td> <td rowspan="2" style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:23px; border-top:none; border-right:none; border-left:none"> 1.09 </td> <td rowspan="2" style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:23px; border-top:none; border-right:none; border-left:none"> 0.001 </td> <td style="border-bottom:none; height:23px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td rowspan="3" style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:23px; border-top:none; border-right:none; border-left:none"> Follow up </td> <td style="border-bottom:none; height:23px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:9px; border-top:none; border-right:none; border-left:none"> ACT- control group </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:9px; border-top:none; border-right:none; border-left:none"> 5.01 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:9px; border-top:none; border-right:none; border-left:none"> 1.07 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:9px; border-top:none; border-right:none; border-left:none"> 0.001 </td> <td style="border-bottom:none; height:9px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:10px; border-top:none; border-right:none; border-left:none"> CBT-ACT </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.42 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.08 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 0.58 </td> <td style="border-bottom:none; height:10px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td rowspan="6" style="border-bottom:1px solid black; width:68px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> Quality of Life </td> <td rowspan="2" style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> Post-test </td> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:10px; border-top:none; border-right:none; border-left:none"> CBT- control group </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 9.21 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.07 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 0.001 </td> <td style="border-bottom:none; height:10px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:10px; border-top:none; border-right:none; border-left:none"> ACT- control group </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 7.57 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.04 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 0.001 </td> <td style="border-bottom:none; height:10px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td rowspan="4" style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> Follow up </td> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:10px; border-top:none; border-right:none; border-left:none"> CBT-ACT </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.64 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.05 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 0.38 </td> <td style="border-bottom:none; height:10px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:10px; border-top:none; border-right:none; border-left:none"> CBT- control group </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 7.90 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.03 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 0.001 </td> <td style="border-bottom:none; height:10px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:10px; border-top:none; border-right:none; border-left:none"> ACT- control group </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 6.27 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.01 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 0.001 </td> <td style="border-bottom:none; height:10px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> <tr> <td style="border-bottom:1px solid black; width:82px; padding:0cm 5px 0cm 5px; height:10px; border-top:none; border-right:none; border-left:none"> ACT-CBT </td> <td style="border-bottom:1px solid black; width:82px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.63 </td> <td style="border-bottom:1px solid black; width:58px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 1.01 </td> <td style="border-bottom:1px solid black; width:52px; padding:2px 5px 2px 5px; height:10px; border-top:none; border-right:none; border-left:none"> 0.35 </td> <td style="border-bottom:none; height:10px; border-top:none; border-right:none; border-left:none; width:0px"></td> </tr> </tbody> </table> </div> درمان شناختی-رفتاری,درمان مبتنی بر پذیرش و تعهد,خودکارآمدی,کیفیت زندگی,کمردرد مزمن, Cognitive-Behavioral Therapy,Acceptance and,Self-Efficacy,Quality of Life,Chronic Back Pain, 1 13 http://jpmed.ir/browse.php?a_code=A-10-1161-1&slc_lang=fa&sid=1 Nasser Amini Sadr ناصر امینی صدر 100319475328460014050 100319475328460014050 Yes Department of Health Psychology, Khorramshahr International Branch, Islamic Azad University, Khozestan, Iran گروه روان‌شناسی سلامت، واحد بین المللی خرمشهر، دانشگاه آزاد اسلامی، خوزستان، ایران Behnam Makvandi بهنام مکوندی makvandi@iauahvaz.ac.ir 100319475328460014051 100319475328460014051 No Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran گروه روان‌شناسی واحد اهواز، دانشگاه آزاد اسلامی، اهواز، ایران Parviz Askari پرویز عسکری askari47@iauahvaz.ac.ir 100319475328460014052 100319475328460014052 No Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran گروه روان‌شناسی واحد اهواز، دانشگاه آزاد اسلامی، اهواز، ایران Nasser Seraj Khorami ناصر سراج خرمی serajkhorrami@iauahvaz.ac.ir 100319475328460014053 100319475328460014053 No Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran گروه روان‌شناسی واحد اهواز، دانشگاه آزاد اسلامی، اهواز، ایران