Document Type : Original Article

Authors

1 MSc of Health Education, Iran University of Medical Sciences, Tehran, Iran

2 Professor of cardiothoracic surgery Tehran heart center Tehran university of medical science, Tehran, Iran

3 MD, PhD, Epidemiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

4 Master of Animation, Tarbiat Modares University, Tehran, Iran

5 Master of Nanophysics, Al-Zahra University, Tehran, Iran

6 Associate Professor, Health Promotion Research Centre, Iran University of Medical Sciences, Tehran, Iran

Abstract

BACKGROUND AND PURPOSE: Most patients experience anxiety before heart surgery. On the 
other hand, spiritual health can improve the candidate patient’s adaptation to surgery. Therefore, 
this study aimed to investigate the effect of group logotherapy on spirituality and anxiety of patients 
undergoing cardiac surgery.
MATERIALS AND METHODS: In this quasi‑experimental study, 60 hospitalized candidates for 
cardiac surgery were randomly assigned to two groups (30 in the experimental group, 30 in the 
control group). To measure anxiety and relationship with God, Beck Anxiety Questionnaire and the 
researcher‑made scale about relationship with God (reconstruction of Lawrence’s scale of perception 
of God) were used, respectively. In the intervention group, in addition to drug therapy, individuals 
received two sessions of group discussion and spiritual skills training using the behavioral‑cognitive 
method with emphasis on spiritual thoughts and problem‑solving methods, but the control group 
received only drug therapy. Data were analyzed using SPSS software.
RESULTS: In the experimental group, the anxiety scores mean in the posttest and follow‑up were 
significantly lower than the pretest (P < 0.05), while the mean anxiety in the control group in the 
posttest stage was not significantly different, but at the follow‑up stage, it was significantly lower 
than the pretest, but the decrease in mean anxiety in the experimental group was greater (P < 0.05). 
The mean subscales of relationship with god (influence, divine providence, acceptance, presence, 
challenge, benevolence) were significantly higher in the experimental and control groups in the 
follow‑up stage than the pretest, but the increase in the mean of these variables was more in the 
experimental group in the follow‑up stage (P < 0.05).
CONCLUSION: Findings showed that the components of relationship with God are a good predictor 
of pre‑surgery anxiety, so by focusing on spiritual training of patients who are candidates for surgery, 
the incidence or severity of anxiety can be reduced.

Keywords

  1. Hu Y. Survival analysis of cardiovascular diseases [Dissertations]. 
    Saint Louis, US: Washington University; 2013. p. 1.
    2. Lin A, Zhang G, Liu Z, Gu J, Chen W, Luo F. Community-based 
    lifestyle intervention for reducing blood pressure and glucose 
    among middle-aged and older adults in China: A pilot study. Int 
    J Environ Res Public Health 2014;11:11645-63.
    3. Rezaei M, Adib-Hajbaghery M, Seyedfatemi N, Hoseini F. 
    Prayer in Iranian cancer patients undergoing chemotherapy. 
    Complement Ther Clin Pract 2008;14:90-7.
    4. Akhbarzadeh M. Role of spiritual beliefs and prayer in health 
    promotion of chronic patients: A qualitative study. Quran Med 
    2011;1:5-9.
    5. Naghi JJ, Philip KJ, Phan A, Cleenewerck L, Schwarz ER. The 
    effects of spirituality and religion on outcomes in patients with 
    chronic heart failure. J Relig Health 2012;51:1124-36.
    6. Kazemi SH, Saadati M. The study of effective logo therapy training 
    on reduction hopelessness in breast cancer Women’s in Tehran 
    city. Iran J Breast Dis 2010;3:40-8.
    7. Shoushi F, Jannati Y, Mousavinasab NA, Shafipour V. The impact 
    of family centered care on depression, anxiety and stress of family 
    caregivers of patients undergoing open heart surgery. Iran J 
    Rehabil Res 2017;3:53-60.
    8. Ghaem-magham Farahani Z, Rahimian Boogar I, Najafi M, 
    Forooeddin Adl AS. The comparison of group behavioral 
    activation with and without familial support effectiveness on 
    anxiety reduction in coronary heart disease. Behav Sci Res 
    2012;10:79-89.
    9. Ghaleiha A, Emami F, Naghsh Tabrizi B. A Survey on the 
    frequency of Depression and anxiety in the patients with acute 
    coronary syndrome, Ekbatan Hospital of Hamadan City. Sci J 
    Hamadan Univ Med Sci 2011;17:43-9.
    10. Niinikoski H, Jula A, Viikari J, Rönnemaa T, Heino P, Lagström H,
    et al. Blood pressure is lower in children and adolescents with a 
    low-saturated-fat diet since infancy: The special Turku coronary 
    risk factor intervention project. Hypertension 2009;53:918-24.
    11. Babaei M, Kermanshahi SM, Alhani F. Influence of discharge 
    planning on anxiety levels in patients with myocardial infarction. 
    Koomesh. 2011;12(3).
    12. Souri A, Azadmard S, Zahedi O, Ashoori J. The effect of metacognitive therapy and educating the components of spiritual 
    intelligence on generalized anxiety disorder of students. Iran J 
    Health Educ Health Promot 2016;3:349-59.
    13. Kaur G, Tee GH, Ariaratnam S, Krishnapillai AS, China K. 
    Depression, anxiety and stress symptoms among diabetics in 
    Malaysia: a cross sectional study in an urban primary care setting. 
    BMC family practice. 2013 Dec;14(1):1-3.
    14. Harari J. The relationship between religiosity/spirituality and 
    mental health in gay Orthodox Jews. [Dissertations]. Newyork, 
    US: Fordham University; 2012. p. 4.
    15. Yonker JE, Schnabelrauch CA, Dehaan LG. The relationship 
    between spirituality and religiosity on psychological outcomes 
    in adolescents and emerging adults: A meta-analytic review. 
    J Adolesc 2012;35:299-314.
    16. Walborn F. Religion in Personality Theory. London: Academic 
    Press; 2014. p. 21.
    17. Ebadi A, Afzal SH, Rafiee AA, Saeed Y. The comparison of quality 
    of life of men with hypertension and normal men. J Midwifery 
    2011;20:5-13.
    18. Pargament K. The Psychology of Religion and Coping: Theory, 
    Research and Practice. New York: The Guilford Press; 1997.
    19. Maiello C. Degrees of belief in God: A measure of belief for use 
    in cross culture. Ment Health Religion Culture 2005;8:87-95.
    20. Javadzadeh Shahshahani A, Monadi M, Kiamanesh A. Examine 
    the Relationship Between Religious Identity and Critical Thinking 
    in Students, 22-20 Years. [MS Dissertation]. Iran Tehran: Azzahra 
    University; 2004.
    21. Behdani S, Dastjerdi R, Sharifzadeh GH. Relationship between 
    trust in God and self- efficacy With mental health in type II 
    diabetics. J Birjand Univ Med Sci 2012;19:302-11.
    22. Vance DL. Nurses, attitudes towards spirituality and spiritual 
    care. Medsurg Nurs 2001;10:264-70.
    23. Frankl VE. Man’s search for meaning. Lahooti A, translator. 
    Tehran: Jami; 2015. [Persian].
    24. MacKinlay E, Burns R. Spirituality promotes better health 
    outcomes and lowers anxiety about aging: The importance 
    of spiritual dimensions for baby boomers as they enter older 
    adulthood. Journal of Religion, Spirituality & Aging. 2017 Oct 
    2;29(4):248-65.
    25. Ramesh C, Nayak BS, Pai VB, George A, George LS, Devi ES. 
    Pre-operative anxiety in patients undergoing coronary artery 
    bypass graft surgery – A cross-sectional study. Int J Afr Nurs Sci 
    2017;7:31-6.
    26. Lawrence RT. Measuring the image of god: The god 
    image inventory and the god image scales. J Psychol Theol 
    1997;25:214-26.
    27. Hall TW, SorenceRL. God image inventory. In: Hill PC, HoodRW, 
    editors. Measures of Religiosity (399-406). Birmingham, Alabama: 
    Religious Education Press; 1999.
    28. Manock DI. The relationship of adult attachment styles and image 
    of God in individuals. Fuller Theological Seminary, School of 
    Psychology; 2003.
    29. Lawshe CH. A quantitative approach to content validity. Pers 
    Psychol 1975;28:563-75.
    30. Polit DF, Beck CT. Nursing Research: Principles and Methods. 
    7th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
    31. McHugh ML. Interrater reliability: The kappa statistic. Biochem 
    Med (Zagreb) 2012;22:276-82.
    32. Beck AT, Epstein N, Brown G, Steer RA. An inventory for 
    measuring clinical anxiety: Psychometric properties. J Consult 
    Clin Psychol 1988;56:893-7.
    33. Momeni Ghale-Ghasemi T, Musarezaie A, Moeini M, Naji 
    Esfahani H. The effect of spiritual care program on ischemic heart 
    disease patients’ anxiety, hospitalized in CCU: A clinical trial. 
    Journal of research in behavioural sciences. 2013; 10(6).
    34. Moghimian M, Salmani F. The Study of Correlation between 
    Spiritual well-being and Hope in Cancer Patients Referring to 
    Seyyedo Shohada Training Therapy Center of Isfahan University 
    of Medical Sciences, 2010, Isfahan, Iran. Qom Univ Med Sci J 
    2012;6:40-5.
    35. Golmohammadian M, Nazari H, Parvaneh A. Effectiveness of 
    group logo therapy on death anxiety and social adjustment of 
    elderly men. Aging Psychol 2017;2:175-67.
  2. 36. Tang PL, Chen WL, Cheng SF. Using logotherapy to relieve death 
    anxiety in a patient with recurrent cancer: A nursing experience. 
    Hu Li Za Zhi 2013;60:105-10.
    37. Jo KH, Song BS. Effect of family cohesion, subjective happiness 
    and other factors on death anxiety in Korean elders. J Korean 
    Acad Nurs 2012;42:680-8.
    38. Khoshhal-Dastjerdi T, Kazami M. The analysis of position of 
    mentioning in Quran and its reflection on Islamic mysticism. 
    Didactic Lit Rev 2010;2:15-40.
    39. Hojjati H, Taheri N, Akhondzade G, Heidari B, Sharif Nia SH. 
    Resorting to pray rate in hemodialysis patients of Golestan 
    province. Iran J Crit Care Nurs 2010;3:75-9.
    40. Moeini M, Sharifi S, Zandiyeh Z. Does Islamic spiritual program 
    lead to successful aging? A randomized clinical trial. Journal of 
    education and health promotion. 2016;5.
    41. Dadashi Haji M. Medical Efficiency of Pray Regarding General 
    Health of the Cadets of Imam Ali(puh) Military University. 
    Journal of Military Management. 2011;40: 11- 38 [Persian].
    42. Anderson JW, Nunnelley PA. Private prayer associations with 
    depression, anxiety and other health conditions: an analytical 
    review of clinical studies. Postgraduate medicine. 2016 Oct 
    2;128(7):635-41.
    43. Sharif SP, Nia HS, Lehto RH, Moradbeigi M, Naghavi N, 
    Goudarzian AH, Yaghoobzadeh A, Nazari R. The Relationship 
    Between Spirituality Dimensions and Death Anxiety among 
    Iranian Veterans: Partial Least Squares Structural Equation 
    Modeling Approach. Journal of religion and health. 2019 Oct 
    23:1-6.
    44. Faraji Emafti M, Hedayatizadeh-Omran A, Noroozi A, Janbabai 
    G, Tatari M, Modanloo M. The Effect of Group Logotherapy on 
    Spirituality and Death Anxiety of Patients with Cancer: An OpenLabel Randomized Clinical Trial. Iranian Journal of Psychiatry 
    and Behavioral Sciences. 2019 Sep 30;13(3).
    45. Hedayatizadeh-Omran A, Janbabaei G, FarajiEmafti M, Noroozi 
    A, Kolagari S, Modanloo M. Relationship between spirituality and 
    death anxiety in patients with cancer undergoing chemotherapy. 
    Journal of Mazandaran University of Medical Sciences. 
    2018;27(156):98-108.
    46. Kasmo MA, Usman AH, Mohamad Z, Yunos N, Hassan WZ. 
    Perception about God and religion within the Malaysian society. 
    Mediterranean Journal of Social Sciences. 2015 Jan 8;6(1 S1):246-.
    47. Musarezaie A, Moeini M, Taleghani F, Mehrabi T. Does spiritual 
    care program affect levels of depression in patients with 
    Leukemia? A randomized clinical trial. J Educ Health Promot. 
    2014 Aug 28;3:96. doi: 10.4103/2277-9531.139678. PMID: 25250362; 
    PMCID: PMC4165101.
    48. Rahmanian M, Hojat M, Jahromi MZ, Nabiolahi A. The 
    relationship between spiritual intelligence with self-efficacy in 
    adolescents suffering type 1 diabetes. J Educ Health Promot. 
    2018 Aug 2;7:100. doi: 10.4103/jehp.jehp_21_18. PMID: 30159346; 
    PMCID: PMC6088821.
    49. Sussman JC, Liu WM. Perceptions of two therapeutic approaches 
    for palliative care patients experiencing death anxiety. Palliative 
    & supportive care. 2014; 12(4):251-260. https://doi. org/10.1017/
    S1478951513000199
    50. Rahnama M, Fallahi Khoshkenab M, Maddah B, AHMADI F. 
    Designing a model for spiritual care in rehabilitation of cancer 
    patients. Medical and Surgical Nursing Journal. 2014; 3(2):61-70.
    51. Bamdad M, Fallahi Khoshknab M, Dalvandi A, Khodayi Ardakani 
    MR. Impact of spiritual care on spiritual health of hospitalized 
    amphetamin dependents. Iranian Journal of Psychiatric Nursing. 
    2013 Dec 10;1(3):10-8.
    52. Shirahama K, Inoue EM. Spirituality in nursing from a Japanese 
    perspective. Holistic Nursing Practice. 2001 Apr 1;15(3):63-72.
    53. Momennasab M, Moattari M, Abbaszade A, Shamshiri B. Spiritual 
    experience of heart attack patients: A qualitative study. Journal of 
    qualitative research in health sciences. 2020 Aug 24;1(4):284-97.
    54. Jeihooni, A.K., Askari, A., Kashfi, S.M., Rastegarimehr, B, 
    Mansourian, M. Application of health belief model in prevention 
    of osteoporosis among primary school girl students International 
    Journal of Pediatrics, 2017, 5(11), pp. 6017–6029
    55. Mirkarimi, K., Mansourian, M., Kabir, M.J., ...Charkazi, A., 
    Shahnazi, H. Fast food consumption behaviors in high-school 
    students based on the Theory of Planned Behavior (TPB). 
    International Journal of Pediatrics, 2016, 4(7), pp. 2131–2142