The Effect of Online Meaning-Centered Therapy alongside Death Awareness on Death Anxiety, Meaning in Life, and Demoralization among Nurses during the COVID-19 Pandemic

Document Type : Original Article

Authors

1 Department of Psychology, Islamic Azad University, North Tehran Branch, Tehran, Iran

2 Department of Psychology, Islamic Azad University, East Tehran Branch, Tehran, Iran

Abstract

Background: The widespread psychological challenges resulting from the secondary effects of the COVID-19 pandemic significantly affect nurses' mental health. This study aimed to develop and evaluate the effectiveness of an Online Meaning-Centered Therapy (OMCT) protocol and Awareness of Death (AD) in helping nurses cope with death anxiety, find meaning in life, and deal with feelings of demoralization during the pandemic. 
Methods: The study used a quasi-experimental design with pre-test and post-test evaluations, a control group, and a three-month follow-up period. The target population was male and female nurses in Corona care departments in Tehran, Iran, from February to May 2021. Thirty nurses were purposefully selected. Fifteen participants were randomly assigned to the intervention group and 15 to the control group. The intervention group received 15 sessions of OMCT and AD, each lasting 54 minutes. The control group did not receive any intervention. Measurement tools included the Persian version of Tampler’s Death Anxiety Scale (DAS), The Meaning in Life Questionnaire (MLQ), and the Demoralization Scale (DS). Statistical analysis was done using a t-test and repeated measures ANOVA in SPSS-26. 
Results: Findings showed no significant differences between the intervention and control groups at the pre-test stage for death anxiety (47.13±6.61 vs 47.60±5.60, p=0.835), meaning in life (50.66±6.45 vs 49.93±8.72, p=0.796), and demoralization (60.26±9.26 vs 61.00±7.65, p=0.813) indicating the positive impact of the intervention in reducing death anxiety, improving meaning in life, and decreasing demoralization in the intervention group.
Conclusion: These results indicate that OMCT and AD together have the potential to decrease death anxiety, enhance nurses' sense of Meaning in Life, and relieve feelings of demoralization. Amidst technological progress, the significance of utilizing meaning-centered therapy to address death awareness during times of crisis and suffering and discover ways to find meaning becomes evident.

Highlights

Nasim Amini (Google Scholar)

Keywords

References

  1. Neto IG. A reflection on: Breitbart W (2020). Life and death in the age of COVID-19. Palliative and Supportive Care 18, 252-253. Palliat Support Care. 2021;19(2):265-266. doi: 10.1017/S1478951520001376. PubMed PMID: 33461635.
  2. Mesbahian H. A phenomenological encounter with the COVID-19 crisis focused on boundary situations. Journal of Philosophical Investigations. 2020;14(31):305-31. doi:10.22034/jpiut.2020.40685.2611.
  3. Nowicki GJ, Ślusarska B, Tucholska K, Naylor K, Chrzan-Rodak A, Niedorys B. The Severity of Traumatic Stress Associated with COVID-19 Pandemic, Perception of Support, Sense of Security, and Sense of Meaning in Life among Nurses: Research Protocol and Preliminary Results from Poland. Int J Environ Res Public Health. 2020;17(18):6491. doi: 10.3390/ijerph17186491. PubMed PMID: 32906590; PubMed Central PMCID: PMC7559728.
  4. DuBose T. When COVID-19 meets pandemic hope: Existential care of, and in, the impossible. J Humanist Psychol. 2020;60(5):564-70. doi:10.1177/0022167820944645.
  5. WHO COVID-19 Dashboard [Internet]. World Health Organization (WHO); July 21, 2024. Available from: https://data.who.int/dashboards/covid19/cases.
  6. Worldmeter COVID-19 Dashboard [Internet]. American Library Association (ALA); July 21, 2024. Available from: https://www.worldometers.info/coronavirus/country/Iran.
  7. Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry. 2024;23(1):58-90. doi: 10.1002/wps.21160. PubMed PMID: 38214615; PubMed Central PMCID: PMC10786006.
  8. Cénat JM, Farahi SMMM, Dalexis RD, Darius WP, Bekarkhanechi FM, Poisson H, Broussard C, Ukwu G, Auguste E, Nguyen DD, Sehabi G, Furyk SE, Gedeon AP, Onesi O, El Aouame AM, Khodabocus SN, Shah MS, Labelle PR. The global evolution of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis of longitudinal studies. J Affect Disord. 2022;315:70-95. doi: 10.1016/j.jad.2022.07.011. PubMed PMID: 35842064; PubMed Central PMCID: PMC9278995.
  9. Riedel B, Horen SR, Reynolds A, Hamidian Jahromi A. Mental Health Disorders in Nurses During the COVID-19 Pandemic: Implications and Coping Strategies. Front Public Health. 2021;9:707358. doi: 10.3389/fpubh.2021.707358. PubMed PMID: 34765579; PubMed Central PMCID: PMC8575697.
  10. Busch IM, Moretti F, Mazzi M, Wu AW, Rimondini M. What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers. Psychother Psychosom. 2021;90(3):178-190. doi: 10.1159/000513733. Epub 2021 Feb 1. PubMed PMID: 33524983; PubMed Central PMCID: PMC8018214.
  11. Galehdar N, Kamran A, Toulabi T, Heydari H. Exploring nurses' experiences of psychological distress during care of patients with COVID-19: a qualitative study. BMC Psychiatry. 2020;20(1):489. doi: 10.1186/s12888-020-02898-1. PubMed PMID: 33023535; PubMed Central PMCID: PMC7538040.
  12. Yiğit D, Açıkgöz A. Anxiety and Death Anxiety Levels of Nurses in the COVID-19 Pandemic and Affecting Factors. J Educ Res Nurs. 2021;18(1):85-92. doi: 10.5152/jern.2021.35683.
  13. Nowicki GJ, Ślusarska B, Tucholska K, Naylor K, Chrzan-Rodak A, Niedorys B. The Severity of Traumatic Stress Associated with COVID-19 Pandemic, Perception of Support, Sense of Security, and Sense of Meaning in Life among Nurses: Research Protocol and Preliminary Results from Poland. Int J Environ Res Public Health. 2020 Sep 7;17(18):6491. doi: 10.3390/ijerph17186491. PubMed PMID: 32906590; PubMed Central PMCID: PMC7559728.
  14. Or G, Levi-Belz Y, Aisenberg D. Death anxiety and intrusive thinking during the COVID-19 pandemic. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry. 2021;34(4):201–212. doi: 10.1024/1662-9647/a000268.
  15. May R, Yalom I. Existential psychotherapy. San Francisco, CA: Thomson Brooks/Cole Publishing Co; 2005.
  16. Menzies RE, Neimeyer RA, Menzies RG. Death anxiety, loss, and grief in the time of COVID-19. Behaviour Change. 2020;37(3):111-5. doi.org/10.1017/bec.2020.10.
  17. Wong PTP. Meaning Management Theory and Death Acceptance. In: Adrian Tomer, Grafton T Eliason, Paul TP, editors. Existential and Spiritual Issues in Death Attitudes. Mahwah, New Jersey: Erlbaum; 2007. P. 91-114.
  18. Yang Z, Ji LJ, Yang Y, Wang Y, Zhu L, Cai H. Meaning making helps cope with COVID-19: A longitudinal study. Pers Individ Dif. 2021;174:110670. doi: 10.1016/j.paid.2021.110670. PubMed PMID: 33518865; PubMed Central PMCID: PMC7825907.
  19. Botto R, Galante M, Miniotti M, Leombruni P. Demoralization during the Italian quarantine due to 2019 coronavirus disease pandemic: prevalence and association with psychological well-being and coping strategies. Psychol Health Med. 2023;28(2):517-528. doi: 10.1080/13548506.2022.2113104. PubMed PMID: 35979591.
  20. Tang M, Ann-Yi S, Zhukovsky DS, Fellman B, Bruera E. Distress, demoralization, and fulfillment among palliative care providers during the COVID-19 pandemic. Palliat Support Care. 2024;22(3):482-486. doi: 10.1017/S1478951523001803. PubMed PMID: 38037463.
  21. Wong PTP. Existential positive psychology and integrative meaning therapy. Int Rev Psychiatry. 2020;32(7-8):565-578. doi: 10.1080/09540261.2020.1814703. PubMed PMID: 33016788.
  22. Laengle S, Wurm C, editors. Living your own life: Existential analysis in action. UK: Routledge; 2016.
  23. Eisenbeck N, Carreno DF, Pérez-Escobar JA. Meaning-Centered Coping in the Era of COVID-19: Direct and Moderating Effects on Depression, Anxiety, and Stress. Front Psychol. 2021;12:648383. doi: 10.3389/fpsyg.2021.648383. Erratum in: Front Psychol. 2021 May 05;12:682447. doi: 10.3389/fpsyg.2021.682447. PubMed PMID: 33815231; PubMed Central PMCID: PMC8010126.
  24. Yalom ID. Death, Freedom, Isolation and Meaninglessness, and the Existential Psychotherapy. [Master of Health Science Dissertation]. New Zealand: Auckland University of Technology; 2012. Available from: https://hdl.handle.net/10292/4611.
  25. Liu X, Jiang J, Zhang Y. Effects of Logotherapy-Based Mindfulness Intervention on Internet Addiction among Adolescents during the COVID-19 Pandemic. Iran J Public Health. 2021;50(4):789-797. doi: 10.18502/ijph.v50i4.6005. PubMed PMID: 34183929; PubMed Central PMCID: PMC8219621.
  26. Foli KJ, Forster A, Cheng C, Zhang L, Chiu YC. Voices from the COVID-19 frontline: Nurses' trauma and coping. J Adv Nurs. 2021;77(9):3853-3866. doi: 10.1111/jan.14988. PubMed PMID: 34314068; PubMed Central PMCID: PMC8447369.
  27. Harris ML, McLeod A, Titler MG. Health Experiences of Nurses during the COVID-19 Pandemic: A Mixed Methods Study. West J Nurs Res. 2023;45(5):443-454. doi: 10.1177/01939459221148825. PubMed PMID: 36625341; PubMed Central PMCID: PMC9834626.
  28. Templer DI, Ruff CF. Death anxiety scale means, standard deviations, and embedding. Psychological reports. 1971;29(1):173-4. doi: 10.2466/pr0.1971.29.1.173.
  29. Soleimani MA, Bahrami N, Yaghoobzadeh A, Banihashemi H, Nia HS, Haghdoost AA. Validity and reliability of the Persian version of templer death anxiety scale in family caregivers of cancer patients. Iran J Nurs Midwifery Res. 2016;21(3):284-90. doi: 10.4103/1735-9066.180390. PubMed PMID: 27186206; PubMed Central PMCID: PMC4857663.
  30. Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: assessing the presence of and search for meaning in life. J Couns Psychol. 2006;53(1):80. doi: 10.1037/0022-0167.53.1.80.
  31. Majdabadi Z. The Meaning in Life Questionnaire (MLQ). Journal of Developmental Psychology Iranian Psychologists. 2017;13(51):331-33. Available from: https://sanad.iau.ir/en/Article/1054980?FullText=FullText. [In Persian]
  32. Steger MF, Kashdan TB. Stability and specificity of meaning in life and life satisfaction over one year. Journal of Happiness Studies. 2007; 8:161-179. doi: 10.1007/s10902-006-9011-8.
  33. Steger MF, Kawabata Y, Shimai S, Otake K. The meaningful life in Japan and the United States: Levels and correlates of meaning in life. Journal of Research in Personality. 2008;42(3):660–78. doi: 10.1016/j.jrp.2007.09.003.
  34. Steger MF, Kashdan TB, Sullivan BA, Lorentz D. Understanding the search for meaning in life: personality, cognitive style, and the dynamic between seeking and experiencing meaning. J Pers. 2008;76(2):199-228. doi: 10.1111/j.1467-6494.2007.00484.x. PubMed PMID: 18331281.
  35. Steger M.F, Shin JY. The relevance of the Meaning in Life Questionnaire to therapeutic practice: A look at the initial evidence. International Forum for Logotherapy. 2010;33(2):95-104. Available from: https://psycnet.apa.org/record/2010-23577-005.
  36. Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM. The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care. 2004;20(4):269-76. doi:10.1177/082585970402000402. PubMed PMID: 15690829.
  37. Bahmani B, Shahreza SF, Esmaeili MA, Naghiay M, Ghaedniay-Jahromi A. Demoralization Syndrome in Patients with Human Immunodeficiency Virus. Journal of Neyshabur University of Medical Sciences. 2015;3(6):19-27. [In Persian]
  38. Naghiay M, Bahmani B, Alimohammadi F, Dehkhoda A. Demoralization in women with breast cancer: A comparative study. Proceedings of the Third National Congress on Psychology. Marvdasht. 2013. [In Persian]
  39. Kukli M, Amini N, Samiei A, Nazari Z, HameedNabee H. Predicting role of the Meaning in Life-Based on Death Anxiety, Spiritual Health, and Demoralization Syndrome in COVID-19 Mourners. Razi J Med Sci. 2023;29(11):79-88. Available from: http://rjms.iums.ac.ir/article-1-7398-en.html. [In Persian]
  40. Esmaeilpour Dilmaghani R, Panahali A, Aghdasi AN, Khademi A. The comparison of the effectiveness of group-based meaning-centered therapy and solution-oriented therapy on death anxiety and feeling of loneliness in elderly women with fear of coronavirus. Aging Psychology. 2022;8(3):249-35. doi: 10.22126/jap.2022.8172.1645. [In Persian]
  41. Sheykhi M, naderifar M, Firouzkohi M, Abdollahimohammad A, Akbarizadeh MR. The Effect of Group Logotherapy on Burnout of Nurses in Special Wards. IJPN. 2020;8(2):57-65. http://ijpn.ir/article-1-1314-en.html. [In Persian]
  42. Ahmadian H, Pirmoradi F, Karami J, Yarahmadi Y. The Effectiveness of Training Program Based on the Meaning of Life on Nurses’ Subjective Well-being. Jmciri. 2019;36(1):41-47. http://jmciri.ir/article-1-2822-fa.html. [In Persian]
  43. Alizadeh S, Taklavi S, Mahmoud Alilou M, Feizipour H. The Effectiveness of Existential Therapy on Death Anxiety and Meaning of Life in Recovered Patients of Covid-19. Studies in Medical Sciences. 2021; 32 (5):388-398. Available from: http://umj.umsu.ac.ir/article-1-5557-fa.html. [In Persian]
  44. Alipour F, Norouzi A, Hosseini SH, Sharif-Nia H, Rezapour M. The effect of meaning-centered therapy based on Rumi’s thoughts on anxiety, depression, and distress in frontline nurses during the COVID-19 pandemic. JNMS. 2023;10(2). doi:10.5812/jnms-137898.
  45. Vos J, Craig M, Cooper M. Existential therapies: a meta-analysis of their effects on psychological outcomes. J Consult Clin Psychol. 2015;83(1):115-28. doi: 10.1037/a0037167. PubMed PMID: 25045907.
  46. Wong PTP, Mayer CH, Arslan G. Editorial: COVID-19 and Existential Positive Psychology (PP2.0): The New Science of Self-Transcendence. Front Psychol. 2021;12:800308. doi: 10.3389/fpsyg.2021.800308. PubMed PMID: 34956025; PubMed Central PMCID: PMC8699172.

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History

  • Receive Date: 15 October 2024
  • Revise Date: 10 November 2024
  • Accept Date: 12 November 2024
  • Publish Date: 01 March 2025

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