In addition, after removing the effect of the pretest, mindfulness-based cognitive therapy had a significant impact on conflict resolution (test coefficient [0, 24]: 5.69; P=0.025). Regarding the amount of confounding variable effect (i.e., mindfulness-based cognitive therapy), it can be said that (eta coefficient: 0.192) mindfulness-based cognitive therapy training was effective in the promotion of conflict resolution in the intervention group.
A repeated-measures ANOVA with a Greenhouse-Geisser correction determined that mean depression differed significantly between pretest, posttest, and follow-up phases (F=23.07; P<0.0005). Post hoc tests using the Bonferroni correction revealed that mindfulness-based cognitive therapy elicited a slight reduction in depression since pretraining to 3 months after training, which was statistically significant (P<0.001). However, posttraining marital satisfaction increased to 26.60±3.60, which was significantly different from that reported for the pretest (P<0.0005) and 3 months after the training therapy (P<0.001). Therefore, it can be concluded that a long-term mindfulness-based cognitive therapy program (i.e., 6 months) elicits a statistically significant increase in marital satisfaction.
The follow-up test showed that in mindfulness-based cognitive therapy, the mean of marital satisfaction at follow-up was not different from that of the posttest. Furthermore, the results of the follow-up test revealed that in the group receiving mindfulness-based cognitive therapy, the mean of sexual self-efficacy in the follow-up stage was not different from that of the posttest; nevertheless, the mean of sexual self-efficacy in the posttest stage was significantly higher than that reported for the pretest. In addition, the mean of sexual self-efficacy in the follow-up stage was significantly higher than that of the pretest (P<0.05). In the control group, there was no significant difference in different stages of the test (P<0.05).
Discussion
Mindfulness-based cognitive therapy affects the sexual self-efficacy of couples with marital conflicts. The findings of the present study showed that mindfulness-based cognitive therapy training has led to increased sexual self-efficacy in the intervention group. This result is in line with the findings of studies carried out by Burpee and Langer
[21], Newcombe and Weaver
[22], and Kanter et al.
[23]. In explaining such a finding, it should be noted that mindfulness-based cognitive therapy helps to increase an individual’s ability to cope with difficult emotions, especially those associated with low sexual perception and self-concept.
In mindfulness-based cognitive therapy, the therapist wants the patient to postpone his/her judgment regarding his/her sexual experiences. Secondly, awareness is seriously concentrated on the events for some time. However, by the application of this technique, the patient experiences higher empowerment in his/her sexual relationships and will have higher self-efficacy
[24]. In the confrontation technique of mindfulness-based cognitive therapy, the psychotherapist requires the patient to pay close attention to his or her sexual relationship and on the other hand impartially focus on his or her experiences, feelings, and perceptions. This attention leads to an increase in the perception of the positive aspects of sexual life and subsequently enhances sexual self-efficacy.
On the other hand, the therapist with cognitive change is trying to replace the pattern of maladaptive thinking about sexual incapability with sexual efficacy and empowerment. One of the critical points of mindfulness-based cognitive therapy is to emphasize that sexual self-efficacy is purely a subjective issue, and the interpretation that an individual considers him/herself weak regarding sexual relationship is truth or reality. On the other hand, during this course of treatment, the patient learns not to emotionally judge his/her sexual performance, stay calm, and thoroughly and impartially promote sexual self-efficacy by accepting and experiencing the sexual act
[25].
In explaining such a finding, it should be noted that the mindfulness-based cognitive therapy training course empowers individuals to focus their attention on the experiences of emotions and events happening within themselves or around them at the moment. Through the introduction of metacognitive learning and new behavioral strategies, the therapist encourages the patient to pay more attention to his/her life issues and tries to reduce the rumination and inclination to worrying responses in the individual’s marital life. During the treatment, the patient is reminded that marital problems and differences are common in life, and the patient should respond to events with thought and reflection rather than responding involuntarily. In addition, the therapist teaches the patient to view the circumstances of his/her marital life and better know his/her emotions and accept them
[25].
On the other hand, after undergoing mindfulness-based cognitive therapy, the patient can understand and digest physical phenomena and marital life events more easily and tries to use logical, rational, and consistent strategies in different situations of marital life; such a process leads to a coherent and sensible attitude toward the experiences of patient marital life and promotes marital satisfaction
[26].
The mindfulness-based cognitive therapy course helps individuals modify negative behavioral patterns and automatic thoughts and adjust positive couple-friendly behaviors. In other words, mindfulness-based cognitive therapy through the combination of happiness and vivid view of marital life experiences can make positive changes in the patient’s mental states and increase the levels of marital satisfaction.
Undergoing mindfulness-based cognitive therapy allows the patient to use metacognitive and innovative behavioral strategies to focus on attention and prevent rumination and tendency to worry about responses. This ability in marital life enables the patient to spread his/her thoughts and effectively dispel unpleasant emotions from marital life. As a result, a patient with higher mindfulness due to having dominance at the right time and not fearing from life changes can create a consistently dynamic and flexible environment in his/her life
[27, 28].
One of the limitations of the present study was a lack of the investigation of age, gender, and social groups (i.e., individuals of different ages, both genders, and different educational levels). Using a limited sample size of 15 individuals per group was another limitation of the current study. The short interval between the three stages of pretest, posttest, and follow-up was also another limitation of the current study. In addition, this study focused only on women with marital conflicts in Rasht, Iran, and the results should be cautiously generalized.
It is recommended to perform this therapy technique in future studies on other age groups, genders, psychological domains, and study groups by increasing the number of interventions and control groups to enhance the external validity and compare to other therapeutic outcomes. Using a higher number of participants in treatment courses can add to the validity of the research findings. The enrollment of different participants from other cities enhances the generalizability of the results.
Treatment courses with intervals can improve the effectiveness and durability of the results with greater validity. It is suggested to benefit from long-term efficacy courses in future studies. Given the impact of mindfulness-based cognitive therapy on sexual self-efficacy, it is recommended to offer such educational methods to therapists to use as therapeutic protocols in the domain of sexual problems.
Regarding the effect of mindfulness-based cognitive therapy on marital satisfaction, it is suggested to use the findings of the present study to design treatment courses and make decisions on family consolidation in counseling and family therapy centers. Considering the impact of mindfulness-based cognitive therapy on early maladaptive schemas, it is recommended to provide the proposed therapeutic model to welfare centers to empower the maladaptive unattended dysfunctional families.
Concerning the impact of mindfulness-based cognitive therapy on sexual self-efficacy, it is recommended to hold workshops for spouses to clarify the importance of this therapy and solve problems related to self-efficacy and sexual function. Considering the effect of mindfulness-based cognitive therapy on marital satisfaction, it is proposed to design possible implementation plans by health education centers and welfare organizations to provide the possibility of developing this program in family environments.
With regard to the effect of mindfulness-based cognitive therapy on early maladaptive schemas, it is suggested to increase the importance of this methodological approach in marital relationships by holding scientific conferences and seminars in this regard. In general, training and treatment programs can be run in counseling centers for married people or by performing specific workshops on mindfulness-based cognitive therapy and early maladaptive schemas to positively change the individual performance of couples.
Conclusions
Based on the obtained results, it can be concluded that mindfulness-based cognitive therapy can improve sexual self-efficacy and marital satisfaction in couples with marital conflicts.
Compliance with ethical guidelines
All the ethical principles were considered in the present study. The participants were informed about the purpose of the study and implementation of the stages. Furthermore, informed consent was obtained from all the study subjects. They were also assured of the confidentiality of their information. Moreover, the participants were allowed to withdraw from the study at any time, and the results of the study would be available to them if desired. The present study was extracted from a student’s doctoral thesis of health psychology approved by the Ethics Committee of Islamic Azad University of Rasht with the ethics code of IR.IAURASHT.REC.1397.012.
Acknowledgments
The authors would like to express their gratitude to the participants, who greatly cooperated with this study.
Funding/Support
The current study did not receive any specific grant from funding agencies in public, commercial, or not-for-profit sectors.
Conflicts of Interest
The authors declare that there is no conflict of interest
.
References