IMPACT OF POSITIVE THERAPY UPON STRESS

LEVELS IN INFERTILE WOMEN

DR.A.JAYASUDHA

ASSOC. PROFESSOR

King Khalid University

Female College of Applied Medical Sciences, Bisha

INTRODUCTION Parenting is viewed by most of the couples as

their central role in life, and the thought of not

achieving it can be very upsetting. When

fertility fails, the couples become

psychologically depressed; some may feel

frustrated and feel guilty; whereas some get

angry to their fate and blame each other for

the failure. Instead couples can begin to view

themselves constructively rather than viewing

their fertility as failure.

CONTD…. Infertility is not an absolute condition. The

ability to conceive varies with each cycle,

environmental circumstances and treatment

options. Women may find themselves

increasingly despairing at the thought of never

becoming pregnant. Social events loom as

infertile women begin to dread social

occasions. They may also get isolated from

family members and work colleagues.

NEED FOR THE STUDY A person with negative perception will also

have negative thoughts. Negative thoughts

lead to negative beliefs, which are more

often irrational. These negative beliefs in the

long run affect a person’s mental health as

well as physical health. Positive therapy

aims at modifying negative thoughts,

belief’s, emotions and behavior by using a

number of techniques like Relaxation

therapy, counseling and exercises.

In positive therapy the individual is made to understand that worrying about the past or future is unnecessary and unwanted. The individuals are trained to live in the present and enjoy the present. Positive therapy helps to replace debilitating negative thoughts with positive self-enhancing thoughts. It helps in the development of positive personality traits such as courage, confidence, cheerfulness, optimism etc… and making them to face their problems with a smile. The positive therapy was developed by Natesan (2000) a psychologist and is widely used to reduce stress in hospitalized patients with various diagnoses

It is assumed that when negative

thoughts are replaced by positive

thoughts, the infertile women can

become more realistic and reasonable in

their perception. Thus the

understanding of stress of infertile

women can help nurses to design

successful interventions to reduce

stress, promote healthy adaptation and

prevent them moving towards

avoidance and denial.

STATEMENT OF PROBLEM

An experimental study to determine the

impact of positive therapy upon the

stress levels in infertile women

attending the selected Centre for

reproductive medicine at selected

hospitals, Coimbatore.

OBJECTIVES OF THE STUDY

To determine the levels of stress in

infertile women in terms of their stress

reactions and general well being.

To determine the impact of positive

therapy upon the levels of stress in

infertile women.

NULL HYPOTHESES Ho1 There will be no significant

difference between the stress reactions of infertile women in the pre and post test among infertile women of experimental and control group.

Ho2 There will be no significant correlation between stress reactions and general well being of infertile women in the pre test and post test among experimental and control group.

LITERATURE REVIEW Both research and non research related

research literature were reviewed from published articles and MEDLINE search to broaden the understanding and gain insight into the selected problem under study. The review of literature related to topic of study is grouped under the following headings:

 Incidence of infertility Biological dimensions of infertility Stress in Infertile women Impact of stress reduction strategies in infertile

women Positive therapy and stress reduction

RESEARCH METHODOLOGY

The experimental research approach was selected for the present study as the study involved a new intervention for infertile women

 The controlled experiment is considered to be the gold standard for yielding reliable evidence about the cause and effect. Hence the randomized clinical trial (RCT) a full experimental design to test a new treatment involving random assignment to treatment group and control group was selected for the present study as the study has to determine the impact of positive therapy upon stress levels.

The data were collected from 120 infertile

women who were randomly assigned into

control and experimental group. The pretest

stress was assessed on day 2 of the menstrual

cycle and the post test stress was assessed on

day 14 of the menstrual cycle of all the infertile

women. The positive therapy was implemented

only for the experimental group of women for 5

times from day 3 to Day7and they were asked

to continue to practice by listening to the audio

cassette given to them on positive therapy.

POSITIVE THERAPY

It is the therapy which facilitates sound mental health, leading to better adjustments through relaxation therapy, counseling and exercises.

Relaxation therapy: It involves deep breathing practice, relaxation training.

Counseling: It involves the techniques of rational emotive therapy, thought stopping, and cognitive restructuring.

Exercises: Positive therapy involves tension releasing exercises, smile therapy and laughing therapy to help clients to get rid of their tension and develop a happy state of mind.

 

The instruments used for data collection were

demographic variable proforma, biological variable

proforma, and stress reactions to infertility inventory

and WHO’s general well being index. Validity and

reliability were established for the tools developed

by the researcher and the standardized tools were

translated into Tamil and their reliability was

established. Pilot study was conducted on 10

infertile women. The analysis of data was done

through an integrated system of computer program

known as statistical package for social sciences

(SPSS)

MAJOR FINDING OF THE STUDY The control group infertile women reported a

stress score of 246.13± 21.82 in the pretest

and in post test 247.06 ± 21.89 Whereas the

experimental group women had their stress

mean score of 247.51± 23.14 in the pre test

and after undergoing positive therapy it was

found to be 164.30± 19.03 in the post test

which was statistically significant at p<

0.0001 level.

FREQUENCY AND PERCENTAGE DISTRIBUTION OF PRE TEST LEVEL OF STRESS REACTIONS IN CONTROL AND EXPERIMENTAL GROUP OF

INFERTILE WOMEN.

Stress levelControl Group

(N=60)Experimental Group (N=60)

N % N %

Low stress (< 220) 7 11.7 10 16.7

Average stress (221 –

237)

8 13.3 9 15.0

Moderate high stress

(238 – 249)

23 38.3 21 35.0

High stress (> 250) 22 36.7 19 31.7

FREQUENCY AND PERCENTAGE DISTRIBUTION OF POST TEST LEVEL OF STRESS REACTIONS IN CONTROL AND EXPERIMENTAL GROUP OF INFERTILE WOMEN.

 

StressControl Group (N=60) Exp. Group

(N=60)

N % N %

Low stress (< 220) 6 10.0 60 100.0%

Average stress (221 – 237)

16 26.7 - -

Moderate high stress (238 – 249)

19 31.7 - -

High stress (> 250) 19 31.7 - -

COMPARISON OF PRE AND POST TEST STRESS REACTIONS OF CONTROL AND EXPERIMENTAL

GROUP OF INFERTILE WOMEN. Group N Pre test Post test ‘t’ Value

Mean SD Mean SD

Control 60 246.65 22.18 247.06 21.89 0.937

Experimental 60 247.51 23.14 164.30 19.03 33.93***

*** P< .0001

246.13 247.06 247.51

164.3

0

50

100

150

200

250

Mea

n +/

- SD

Control Group Experimental Group

Fig.6.Comparison of pre and post test stress reactions in control and experimental group of infertile women.

Pre test

Post test

COMPARISON OF PRE AND POST TEST STRESS REACTION SCORES IN VARIOUS DIMENSIONS IN CONTROL GROUP OF INFERTILE WOMEN. (N=60)

Dimensions of stress

Pre test Post test ‘t’ Value

Mean SD Mean SD

Physical 24.15 2.99 25.91 4.10 - 7.692xxx

Emotional 27.76 2.93 27.95 2.88 - .773

Social 39.08 6.36 38.00 6.36 2.226x

Sexual 25.83 4.98 25.18 4.07 4.163xxx

Relationship concern

40.01 5.46 39.53 5.46 2.682xx

Rejection of child free life style

38.25 3.63 37.88 3.63 1.831

Need for parenthood

51.55 4.62 52.60 4.06 - 4.751xxx

COMPARISON OF PRE AND POST TEST STRESS REACTIONS IN VARIOUS DIMENSIONS IN

EXPERIMENTAL GROUP OF INFERTILE WOMEN. (N=60)

Dimensions of stress

Pre test Post test ‘t’ Value

Mean SD Mean SD

Physical 25.46 4.10 13.83 2.63 27.534***

Emotional 28.18 2.93 14.80 3.29 28.124***

Social 37.81 6.36 23.23 4.79 23.827***

Sexual 25.41 4.98 17.00 5.94 10.844***

Relationship concern

39.95 5.46 25.86 3.96 22.834***

Rejection of child

free life style

37.60 3.63 27.46 4.26 20.087***

Need for

parenthood

52.16 4.62 42.10 3.72 16.848***

*** P < .0001

GENERAL WELLBEING IN INFERTILE WOMEN

The control group infertile women reported a general well being score of 14.65± 2.11in the pretest and in post test 15.56± 1.38 (‘t’3.013). Whereas the experimental group women had their general wellbeing mean score of 14.81±2.31 in the pre test and after undergoing positive therapy it was found to be 20.93±2.17 in the post test (‘t’38.32)which was statistically significant at p< 0.001 level.

 

COMPARISON OF PRE AND POST TEST GENERAL WELL BEING OF INFERTILE WOMEN IN CONTROL

AND EXPERIMENTAL GROUP Group N Pre test Post test ‘t’ Value

Mean SD Mean SD

Control 60 14.65 2.11 15.11 1.38 3.013

Experimental 60 14.81 2.31 20.93 2.17 38.32***

*** P < .0001

FREQUENCY, PERCENTAGE DISTRIBUTION AND CHI SQUARE VALUE OF THE TREATMENT OUTCOME OF

CONTROL AND EXPERIMENTAL GROUP OF INFERTILE WOMEN

Treatment outcome

Control group (n=60) Experimental group (n=60) 2 value

PregnantNon pregnant

N % N %2.000

(df =1)

25

35

41.67

58.33

40

20

66.67

33.33

The data presented in the above table shows that 40 (66.67%)

women in the experimental group got conceived as against 25

(41.67%) women from the control group. The results can be

attributed to the significance of positive therapy, though it

was not statistically significant.

CONCLUSION A majority of the women in control and

experimental group were experiencing moderate to high level of stress and decreased level of general wellbeing in the pretest. Whereas after undergoing positive therapy the experimental group of women had low stress and increased level of general well being in the post test. The control group infertile women did not have any significant reduction in the stress or improvement in their general wellbeing. There was a significant negative correlation between stress and general wellbeing in the pre and post test of both control and experimental groups.

IMPLICATIONS Nursing practice : The infertile women

need to be motivated to seek treatment at the early age, as the fertility potential declines with advancement of age. The women living in nuclear families can be explained the need to have supportive people at home in helping them to avoid strenuous domestic work during the luteal phase of implantation of the conceptus. The nurses will be able to render culturally sensitive care if they develop an understanding about how infertility is viewed in the context of various religions and cultural groups

The family counselling can be conducted in which even the husbands and other significant family members can be taught to learn and use positive therapy.

 The positive therapy can be taught to community health nurses to implement for the infertile women at home as well as follow them up and encourage them to practice it regularly.

Nursing education :As the infertile women

face much of the psycho social problems and

they are very sensitive, the students must

be taught to show a compassionate and

empathetic attitude while caring for infertile

women. The counselling skills education and

stress reduction strategies is also required to

be incorporated in the curriculum to enable

the students to implement it effectively for

their patients in distress.

Nursing research with regard to care of infertile women is not yet well developed. Further research in the area of bio-psycho-social dimension of infertile women are required to identify specific interventions that would be useful in helping the infertile couples to achieve their ultimate goal of becoming a parent. The interventions which would increase marital adjustment, family support and decrease stress of infertile women are to be developed, tested through research and recommended for practice.

RECOMMENDATIONS The same study can be done on a larger

population for a more valid generalization. The study can be replicated in different settings. A comparative study can be conducted to

evaluate the effectiveness of different strategies available to reduce stress in infertile women.

The knowledge, attitude and practice of reproductive health nurses in stress reduction strategies of infertile women can be studied.

The effectiveness of positive therapy in reducing stress in patients suffering from any other illness can be studied

REFERENCES Abbey,A. Halman,L.J., Andrews, F.M (1992).

Psychosocial, treatment, and demographic predictors of the stress associated with infertility. Fertility and sterility. 57(1), 122-128.

Brucker, P.S.,Mckenry,P.C.(2004).Support from health care providers and the psychological adjustment of individuals experiencing infertility. J obstet gynec neonatal nursing.33(5).597-603.

 Burns, N., Grove, S.(1999). Understanding Nursing Research. Philadelphia: W.B. saunders.

De klerk, C. et al. (2005). Effectiveness of a psycho social counselling intervention for first time IVF couples. Human Reproduction. 20(5), 1333 – 8.

Latha and Rohini, N.S. (2006). Management of stress in wives of alcoholics through Positive Therapy. Unpublished manuscript. Department of Psychology, Avinashilingam University for Women. Coimbatore.

Polit,D.F., & Hungler, B.P. (1998).Nursing research: principles and methods. Philadelphia. J.B.Lippincott &co.

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