Vai trò của yếu tố chấp nhận đối với kiểu ứng phó ở bệnh nhân ung thư

VAI TRO CUA YEU TO CHAP NHAN
DOI VOI KIEU Q N G PHO
6 BENH NHAN UNG THU
PGS.TS. Nguyen Thi Minh Hang
Ngo Thi Thuy Linh
Tran Thj Nhung

•

Ti-irdiig Dai hgc Khoa hoc Ki hgi vli Nhan mn. Dgi hgc Qudc giu Ha Ngi.

TOM
A T dung ndng luc chdp nhdn trgng tdm ly tr
Nghien cuu nay dua tren md
hinhTung
lieu cua S.C. Hayes vdi ten ggi la Tri lieu chdp nhdn vd cam ket (acceptance and
commitment therapy - ACT), dugc tiin hanh tren 120 benh nhdn ung thu. Nghien ciru
nhim xdc dinh mdi lien he gida ndng luc chdp nhdn vd kiiu ung phd vdt benh a benh
nhdn ung thu. Cde cong cu nghien cim la. 1) Thang do Chip nhdn (the acceptance
subscale of the Philadelphia mindfulness scale - PHLMS) cua Cardaclotto, Herber
Forman, Moitra vd Farrow (2008); 2) Thang do Ifng phd (COPE scale) eia (Carve
Scheier vd Weintraub (1989). Kit qud nghien ciru cho thdy, benh nhdn nam chip nhdn
cao han benh nhdn na, tuii ddi lan han thi chap nhdn eag han. Khdng cd moi tuang
quan giUa chip nhan vd irng phd tap trung vdo vdn de, ngugc lai, ed tucmg quan
nghich giUa chip nhdn vd ung phd tap trung vdo edm xuc vd img phd ne trdnh. ling
pho ne trdnh ciing la yeu td cd khd ndng du bdo manh nhdt ndng luc chdp nhdn cua
benh nhdn ung thu. Tren ca sd cua ket qud nghien cuu ndy, cdc khuyen nghi ve viee d
dung yeu td chdp nhdn trong chdm sdc gidm nhe vd trong tdm ly tri Heu cho benh nhd
ung thu cung nhu nhirng ggi md cho cdc nghien cuu trong tuang lai da dugc thdo ludn
Tir khoa: Chdp nhdn; Ling pho; Ung phd vdi benh; Benh nhdn ung thu.
Ngdy nhdn bdi: 7/3/2019; Ngdy duyet ddng bdi: 25/3/2019.

1. Dat van de
Ung thu la nguyen nhan hang dau gay tu vong tren toan thi gidi, ude
tinh khoang 9,6 trieu ca tit vong vao nam 2018 (WHO, 2018). Nhttng nghien
ciru ve benh nhan ung thu ngay nay da chu trgng den nhung vin di lien ouan
den nhimg thay ddi sinh ly, xa hdi va dac biet la tiim Iy. Ngoai nhung thav ddi
sinh ly nhanh ehdng va cd the la dot ngpt thi cac vin di xa hdi ciins oSv ra
nhieu kho khan va bat Igi, cd the lam giam su tuan thii diiu tri, tu dd ' h
46

TAP CHi TAM LY HOC, S6 4 (241), 4 . 2019


hudng Idn din sue khde eua bpnh nhan. Cae vin di xa hdi ma benh nhan ung
thu phai ddi mat bag gdm: thilu thdng tin hoac ky nang ein thilt di ung phd
vdi benh tat; gian doan edng viee, hpc tap, eude sdng gia dinh dao Idn; eang
thing tai chinh (Adler, Page, 2008). Dae biet, eac vin dl tam ly cua benh nhan
ung thu rit da dang, phttt; tap va thudng biiu Men d mtte do trim trpng. Cae
nghien ettu tam ly eho thay, hau het benh nhan ung thu diu roi vao trang thai
dau khd (distress) (Sehlen va cdng sy, 2003). Trong dd, 23,4% sd benh nhan
ung thu tidu hda va 40,9% sd benh nhan ung thu vu d trong trang thai rit dau
kho (Hersehbach va edng sy, 2004). Cd 28% sd benh nhan ung thu duge chin
doan mac rdi loan tam than, trong dd cd 26% sd benh nhan ed dilm sd eao vl
trim eain va lo au (Keller va cdng su, 2004). Trong nhilu nghien euu khae, lo
au va tram cam ciing la hai loai rdi loan tam than pho biin nhit d benh nhan
ung thu (Nikbakhsb va edng sy, 2014; Kbalil va cdng sy, 2016).
Nhu vay, khdng chi chju dyng dau ddn tbi ehit ma nhttng benh nhan
ung thu edn phai chiu dyng ndi dau tam Iy, tinh than rat Idn. Thye trang nay
dat ra nhieu thaeh thuc eho y hge va ea tam ly hoc trong viee hd trp benh nhan
ung thu vugt qua benh tat va rdi loan tam ly do benh tat gay ra. Trong nhttng
nam gan day, bien phap eham sde giam nhe da phd bien tren the gidi va dan

din duge biet den d Viet Nam. Cham sde giam nhe (palliative care) tap trang
vao lam giam trieu ehiing va eae bien ehung do dieu tri gay ra, tang cudng chat
lugng sdng va hd trg eho benh nhan eung nhu gia dinh cda hg, bao gdm ca hd
trg tam ly. Mdt trong nhung ngi dung cham sdc giam nhe cho benh nhan ung
thu la giup benh nhan tang cudng tinh linh boat tam ly (psychological
flexibility) va chanh niem (mindfulness) di chap nhan eae trai nghiem tieu cue
rapt each nhe nhang hon. Nhieu nghien euu cho thay, yeu td chap nhan da lam
giam stress, lo au, tram cam va eae rdi loan tam ly khae (Carver va edng su,
1993; Campbell-Sillsa va edng sy, 2006). Trong thdi gian theo ddi tu 3 din 9
thang sau dieu tri, ed din 78% sd benh nhan rdi loan lo au da khdng edn dap
img eae tieu ehuin chin doan sau khi duge diiu tri bang lieu phap dya tren sy
chip nhan va 77% sd benh nhan dat dugc eae chuc nang sdng d mtte cao
(Roemer va cdng sy, 2008). Ruiz (2010) da phan tieh ban 30 nghien ettu va di
din nhan djnh ring, ed mdi lien be giua sy chip nhan vdi eac trieu ehung benh
ly va eae eiu true tam ly khae. Chip nhan noi dau ed the giai thich duge sy
thoai mai, di chiu vl tbi ehit va tam thin (Wicksell, Renofalt, Olsson, Bond,
Melin, 2008), lam giam dau, giam sg van ddng, giam trim cam, tang mtte do
hai long vdi eude sdng va tinh linh boat tam ly d nhttng benh nhan dau man
tinh (Wicksell, Ahlqvist, Bring, Melin, Olsson, 2008). Cae nghien ettu cung eho
thiy, su chip nhan la biin sd ed the dy bao duge hieu qua dng phd vdi benh tat
va rdi loan ehue nang tdt ban so vdi eae chiin luge ung phd khae (MeCracken
va Eecleston, 2006; Campbell-Sillsa va cdng su, 2006). Ddi vdi benh nhan, dae

TAPCHiTAM LY HOC, Sd4 (241), 4-2019

47


biet la benh nhan ung thu, chip nhan tinh trang benh va nhung cam xue
euc phat sinh cd anh hudng tich euc din dilu tri (Kratz, Davis va ^aui ,

2007). Chip nhan eung la biln sd giai thich dugc tinh trang boat Wng en
nang va sy phyc bdi chttc nang eua benh nhan (Esteve va cdng su, im ,
MeCracken va Vowles, 2007; MeCracken va Zhao-O'Brien, 2011.).
Ttt nhiiu bing Chung nghien euu, tri lieu chip nhan va cam ket
(aceptance and commitment therapy - ACT) dugc thiet ke tap trang vao vige
hudng din benh nhan din din chip nhan cac cam JiiSe va cam xiic tieu eye eua
ban than eung nhu tao ra sy cam kit trong diiu trj. Tri lieu chap iihan va earn
kit duge danh gia la tiip can tri lieu rit cd hieu qua ddi vdi nhieu rdi loan ehue
nang eung nhu roi loan tam ly va thudng xuyen dugc ap dung cho benh nhan,
trong dd cd benh nhan ung thu dang trong giai doan dieu tri (Branstetter va
edng sy, 2004; Ruiz, 2010; Feros va cdng su, 2013) va ca trong giai doan tai
boa nhap (din theo Landy, Schneider, Arch, 2015).
Nhu vay, nhiiu bing chung nghien euu eho thiy, chip nhan cd vai trd
quan trgng trong viec giiip mgi ngudi ndi chung va benh nhan ung thu ndi
rieng duong diu vdi nhung khd khan, eang thing trong cupc sdng. Tidp can tri
lieu dya tren ly thuyit chip nhan cung dugc ehung minh la cd hieu qua ddi vdi
eac rdi loan tam ly ndi chung va nhttng van de tam ly d benh nhan tmg thu ndi
rieng. Tuy vay, g Viet Nam, viec dng dung yeu td chap nhan ndi chung va tri
lieu chap nhan va cam ket ndi rieng cdn rat mdi me va hau nhu chua duge
nghien euu. Vdi mue di'ch tim ra nhiing bang chung cu the ve mdi lien he gitta
chap nhan va ung phd vdi benh cung nhu stress do benh giiy ra di eung cip eg
sd khoa hpc eho cham sdc giam nhe cung nhu trj lieu chap nhan va earn kit ddi
vdi nhttng ngudi cd vin lie tam ly ndi ehung va benh nhan ung thu ndi rieng d
Viet Nam, chung tdi da tien hanh nghien ciiu nay.
2. Cau hoi nghien cu'u
Cac cau hdi nghien cim ma chiing tdi k^ vpng sg tim ra eau tra loi bao gdm:
Benh nhan ung thu chap nhan hay khdng chip nhan tinh trang benh tat
cila hp? Neu cd, hg chip nhan d mue dp nao?
Su chap nhan hay khdng chip nhan cd anh hudng nhu thi nao din each
ttng phd vdi benh tat d benh nhan ung thu?

3. Khai niem
3.1. Chap nhan
Cac tiep can tri Heu nhan thtte va banh vi trayin thdng thudng duoc van
hanh theo nguyen tic ehung la "ehdng lai hoae ne tranh" ("fight or flight'"!
nghia la than chu dugc hudng din each thue kiim soat cac y nghi va cam '
48

TAP CHi TAM LY HOC, SS 4 (241), 4-2019


tieu eye eua ban than. Khae vdi nguyen tie dd, vao nhung nam 80 eila tbi ky
XX, S.C. Hayes da di xuit mgt each tilp can tri lieu mdi ma triit ly nln tang la
su chip nhan va earn kit hanh dgng di thay ddi. Theg dd, khai niem chdp nhdn
(acceptance) dugc hieu la su col ma vd sdn sdng trdi nghiem tdt ed cde hien
tugng tdm ly ben trong, bao gim y nghi, cdm xic vd cdm gide md khong thay
sii, ne trdnh hay kiim soat chung (Hayes, 1987; Hayes, Wilson, Gifford,
FoUette va Strosahl, 1996). Chip nhan ehinh la each ling phd edi md va ty do,
thuan theo ty nhien nhit, eho phep ehung ta ddi xu tdt vdi ehinh minh, Kr bi vdi
ban than trong sy hien dien eua sy khd chju hay noi dau di chung di qua. Nguge
lai, neu ehiing ta ne tranh hay ed kiem soat ehung tbi sy khd cMu va ndi dau chi
hi hi hoan va tieh tu lai ma thdi, trong khi dd, sy kiim soat ed thi lam eho ehung
ta kiet sue va den mdt luc nao dd ehiing ta se bi "danh gue" bdi sy khd chiu
nhieu hem va ndi dau Idn hon. Trong tri lieu chap nhan va cam kit, sy chip nhan
duge bpc hdi thdng qua viee tang cucmg tinh linh boat tam ly vdn la "nang lyc
tiip xuc vdi giay phut hien tai mdt each trpn ven va cd y thirc di thay ddi hay
duy tri hanh vi nham dat den mpt mue dich cd gia tri (Hayes, Luoma, Bond,
Masuda va Lillis, 2006, trang 7).
De biet each chap nhan, chap nhan benh tat ndi rieng va chap nhan
nhttng trai nghiem tieu eye ndi ehung, de chap nhan khdng ddng nghTa vdi
buong bd hay budng xudi, ea nhan phai cd sy bilu biet va thich ttng linh boat.

Ddi vdi benh nhan ung thu, viee hilu vi tien trinh benh, kha nang khach quan
cila viee ehua tri cung nhu qua trinh lao hda tat yeu cua co the de ed sy thich
ling phu hgp la vd edng quan trpng. Thich irng d day la khdng trdn tranh ma
ddi mat dl giai quylt vin di. Yiu td chip nhan giup benh nhan ung phd tot vdi
cac y nghl phi ehue nang, cam xue tieu eye va cam giac khd chju de quyet tam
thue Men nghiem tue phae dd diiu tri cung nhu tuong tac tdt vdi bae si dieu tri,
nhan vien y te va ngudi than cua minh.
Nhu vay, trong nghien cim nay, khai niem chap nhan khdng ddng nghTa la
su bit luc budng xudi ma la nang lyc nhan dien van de, cdi md va linh boat vdi
cacfrainghiem tieu cue, thieh iing tdt vdi tinh ttang benh va qua ttinh digu tti.
3.2. Ung pho
Trong Tam ly hpc, ed mdt sd each tiip can nghien cira irng phd cua ea
nhan, tuy nhien each tilp can phd biln nhit eoi ttng phd la sy nang ddng cua
chu thi ddi vdi hoan eanh thugc vl Lazarus va Folkman (1984). Thei) hai tac
gia nay, itng pho Id su thay ddt nhdn thuc vd nd luc eia ed nhdn nhdm phdn
img Igl vdt hodn ednh co nhirng thdeh thiic md cd nhdn ddnh gid Id vuat qud
ngudn lue eia hg (Lazarus va Folkman, 1984). Theo dd, cd hai each ung phd
CO ban la: I) ung phd tap trang vao vin di, 2) ung phd tap trang vao cam xue.
Sau dd khdng lau, mdt sd tac gia khae di xuit them ung phd ne tranh, ed nghia
TAP CHi TAM LY HOC, Sd 4 (241), 4 - 2019

49


la lang tranh vin dl, lam sao nhang su ehu y cua ban than (_Ro"i
, ;.„
1986; Anshel, 1996). Tilp nhan quan diem cua cae tac S'^,**"' '™ S-j nhan
cuu nay, chung tdi hiiu ttng phd eua benh nhan ung thu la sy may
.^^
thiic, cam xuc va banh vi eua ca nhan nham ung phd lai vgi tinh trang oe

.
va nhttng cang thing do benh tat gay ra.
4. Phu-ong phap nghien ciiu
4.1. Mdu nghien cdu vd edeh thde thu thgp so lieu
^
Nghien euu duoc tiln hanh vdi cho phep ciia Benh " ? " »?'[j^f ^
Ndi va Benh vien K Ha Ndi, ngudi nha benh nhan va benh nhan. Ph>euJchao
sat duoc phat cho benh nhan ngay tai cae khoa ma benh nhan dang dieu tti. Da
sd benh nhan tu tra Idi philu, sd it benh nhan dugc ngudi khao sat dpe, gm
thieh, sau dd benh nhan W diln vao phuong an tra Idi ma hg lya ehgn^So
lugng benh nhan tham gia vao nghien ciiu la 120 ngudi. Dudi day la cae bien
sd nhan kbiu va biin sd vi benh cua miu nghien ettu.
Bdng 1: Cde dde diim nhdn khdu xd hpi vd dgc diem benh
eia benh nhdn (N = 120)
Bien so

(%)

(%)

Nam

35,0

Co kho khan

71,7

NQ'

65,0

Khong kho khan

28,3

So dat dieu tri hoa chdt

Tudi (DTB = 47,63. DLC = 11.21)
TCr 18-38 tuoi

21,7

1 dot

12,5

Tir 39 - 59 tu6i

62,5

2 - 3 dot

19,2

Tir 60 luoi tro len

15,8

4 - 5 dot

12,5

Hon 5 dgt

55,8

Que qudn
Nong thon

59,2

Loai benh

Thiinli thi

29,2

Vu

31,6

Mien niii

11,7

Da day

17,5

Phoi

17,5

Thdi gian mac benh

50

Tyle

Kho khdn ve kinh le

Gidi linh

1

Bien so

Tyle

Dirai 6 thann

35,8

Dai true trang

10,0

6-12 Ihang

32,5

Buong triing

8,3

TAP CHi TAM LY HOC, So' 4 (241), 4 - 2019


1 - 2 nam

12,5

Hach

Hem 2 nam

19,2

Co tir cung

4

Thirc quan

2,5
1,7

Thdi gian dieu tri

4,2

Dir6i 6 thang

48,3

Luai

6- 12 thang

28,3

Xir ong

1.7

1 - 2 nam

8,3

Tuyen tuy

0,8

Hon 2 nam

15,1

* Bgo dire nghien ciru: Nha nghien cuu gidi thieu vdi benh nhan va
nguoi nha eua hg ve mye di'eh nghien cuu, ndi dung ea ban eua phieu dieu tra,

quyen tu ehdi tra Idi phieu dieu tra. Viec dieu tra bang phieu khao sat eung nhu
phdng van sau ehi duge thye hien khi benh nhan hoan loan ty nguyen va hoan
loan thoai mai, khde manh di dam bao khdng anh budng den sue khde cua hg
cung nhu do xac thye eua thdng tin thu duge. Trong qua trinh thu thap sd lieu,
can bd khao sat da hd trg tam ly cho mgt sd benh nhiin bang each hdi tham, trd
chuyen di hg cam thay vui ve, de chiu hem. Mdt sd benh nhan (theo nhu eau
ciia hg) dugc gidi thieu eae dia ehi tham kham tam ly ed uy tin d Ha Ndi de hg
CO the tilp can khi can.
4.2. Cong eu do lu&ng
4.2.1. Thang do Chdp nhdn
Nghien ciia da su dyng tiiu thang do Chap nhdn (the acceptance
subscale of the Philadelphia mindfulness scale - PHLMS) do Cardaclotto,
Herbert, Forman, Moitra va Farrow dl xuit nam 2008. Thang do gdc PHLMS
dugc thilt kl gdm 20 eau ehia lam 2 tilu thang do la tilu thang do Chap nhan
(10 eau) va tiiu thang do Nhan thue (10 eau). Cdng eu nay duge thiet ke theo
thang Likert 5 mue dp. Tilu thang do Nhan thue va tilu thang do Chap nhan la
hai nhan td dde lap nen ed thi nghien cuu tiSch rieng (Cardaclotto va edng sy,
2008). Do vay, trong nghien euu nay, ehung tdi khdng su dung tieu thang Nhan
thuc (awareness) ma ehi su dung 10 cau trong tiiu thang do Chap nhan de do
mue dp chip nhan cua benh nhan. Vi du vi mdt so cau trong thang do Chap
nhan la: 2- Cd nhirng diiu vi bdn thdn minh md tot khong muon nghi den; 7- To/
tif nhi rdng tot khong nen cdm thdy budn; 10- Khi^ cd mpt ky ire xdu, tdi ed
gdng ldm sao nhang bdn thdn di quen nd di Diim sd eua thang duge tinh bang
ting diem eac eau ma khach thi lua ehpn (cd 10 eau tit ca, mdi cau 5 b?ic).
Tiiu thang do Chip nhan nguyen goe duge quy diim ngupe, nghia la diem
cang cap thi mue dp chip nhan eang thip, vi vay, khi nhap sd lieu chung tdi da
TAP CHi TAM LY HOC, Sd 4 (241), 4 - 2019

51

dao diim lai. Do vay, dilm trang binh eang Idn tbi mue dp chip nhan b?nh eua
benh nhan ung thu cang cao. Kiem dinh dp tin cay bang be so Alpha
Cronbaeh a = 0,87 cho thay thang do cd dp tin eay eao.
4.2.2 Thang do ifng phd
Dl do ludng each thuc ung phd cua benh nhan ung thu, ehiing tdi da xay
dmig thang do tren eo sd tham khao thang do l/ng phd (COPE scale) eua
Carver Scheier va Weintraub (1989). Thang do gde COPE ed 14 tieu thang (5
tiiu thang thudc ung phd tap trung vao giai quyet van de; 5 tieu thang ung plio
tap ttung vao cam xuc va 4 tilu thang ung phd ne tranh). Mdi tieu thang co 4 cau
vdi 5 mue do: 1- khdng bao gid, 2- hiim khi, 3- thinh thoang, 4- thudng xuyen
va 5- ludn ludn. Chung tdi da bd tilu thang Chap nhan (thudc kieu ung pho tap
trang vao cam xue), ebon 2 cau d mdi tilu thang edn lai va sua ddi eho phu hgp
vdi nghien eim ttng phd cua benh nhan ung thu. Nhit vay, thang do mdi gdm 26
cau. Vi du vi mdt so cau: 1- Tot nd lue tudn thi diiu tri; 14- Toi chu dpng tim
kiim thong tin vi benh vd cdeh diiu tri; 20- Toi tiii ring benh tdt la thir thach de
tot mgnh me, truang thdnh han; 21- Tot cau khan vd ldm nhirng viec tam linh
md toi tin tuang. Do tin cay cua tiiu thang do LTng phd tap trung vao van de la
0,698; tieu thang do LTng phd tap trang vao cam xue ed a = 0,650; tieu thang do
iTng phd ne tranh cd a = 0,603.
Bang hdi cac biin sd nhan khiu - xa hdi va bien sd ve benh bao gdm:
gidi tinh, tudi, dia ban sinh song trude khi mac benh, khd khan ve tai ehinh,
thdi gian mac benh, thai gian dieu tri, sd dgt dieu tri hda ehat, loai benh.
5. Ket qua nghien ciru
5.7. Mire dp chdp nhgn & benh nhdn ung thu
Ket quii phan tich du lieu cho thay, loan bd nhdm benh nhan dupe
nghien cuu cd diem trung binh chap nhan la 3,14 (DLC = 0,83), gia tri nhd
nhat la 18 va gia tri Idn nhat la 49. Nhu vay, mtte dp chap nhan eua nhdm bdnh
nhan ung thu nay d khoang trang binh.
So sanh cac nhdm benh nhan khae nhau theo biin sd nhan khiu va

bien sd benh cho thay, khdng cd su khae biet giua cae nhdm benh nhan xet
theo dia ban sinh sdng trudc khi mic benh, thdi gian mic benh, thdi gian dilu
tri, sd dgt dieu tri hda chat ya khd khan tai chinh (p > 0,05) (bang 2) Dg cd
loai ung thu chi cd mdt ho^c hai benh nhan mic phai nen chiing tdi khdna so
sanh chap nhan theo bien sd nay.

52

TAP CHiTAM LY HOC, sa 4 (241).4-2019


Bang 2: So sdnh mirc dp chap nhdn a cde nhom benh nhdn
theo bien so nhdn khdu vd biin sd benh (N = 120)
Cac bien so nhSn khau

N

BTB

DLC

Nam

42

3,35

0,81

Nii

78

3,03

0,82

Tirl8-38tu8i

26

2,55

6,01

Tir 39 - 59 tu6i

75

3,28

8,10

Tir 60 tuoi trd len

19

3,42

8,29

Nong thon

71

3,21

0,84

Thanh thi

35

3,16

0,84

Giii tinh

Tuoi

Dia ban
sinh song

Th6i gian
mac benh

Th6i gian
dieu tri

Kho khan
t^i chinh

Mien nui

14

2,77

0,65

Dual 6 thang

43

3,20

0,79

6 - 1 2 thang

39

3,02

0,79

1-2 nam

15

3,22

0,91

Hon 2 nam

23

3,18

0,92

Dudi 6 thang

58

3,14

0,79

6 - 12 thang

34

3,07

0,80

1-2 nam

10

3,01

0,94

Hem 2 nam

18

3,36

0,94

Co

86

3,09

0,79

Khong

34

3,28

0,91

t/F
37,737

< 0,001

10,011

0,001

1,691

0,189

0,397

0,755

0,566

0,639

-1,145

0,255

Trong khi dd, ed sy khae biet giua nam va ntt ve rnuc dp chap nhan
(t = 37,737; p < 0,001), eu thi, benh nhan nam ed mue dp chip nhan cao hon so
vdi benh nhan nu. Tuong tu, ed sy khae biet gitta eae nhdm mdi theo xu hudng
ngudi eang Idn mdi tM miic do chip nhan benh cang cao F(2,117) = 10,011; p < 0,001.

5.2. ifng phd cda benh nhan ung thu
Dilm trang binh ung phd tap trung vko vin di eao nhat (DTB = 3,48;
DLC = 0,52), tilp din la ttng phd tap trung vao e t o xue (DTB = 3,38; DLC = 0,60)
va thip nhit la ttng phd ne tranli (DTB = 2,02; DLC = 0,47). Nhu vay, benh
nhan ung thu thudng ed xu hudng tim ra eae giai phap eho vin de dang gap

TAPCHiTAM LYHOC, Sd'4 (241), 4 - 2019

53


phai hon la chi tap trang vao cam xuc ciia ban than. Hg eung It khi ne tranh van
de hay khd khan eua ban than.
Bdng 3: Ifng phd tap trung vdo idn di a benh nhdn ung thu (N - 120)
Tan suat (%)

iTng pho tap trung vao van de
No luc tuan thii dieu tri

BTB

DLC

56,7

4,52

0,59

13,3

2,79

1,47

TT

TX

LL

0,0

5,0

28,3

KBG

HK

0,0

Dal thu- tir uu lien cho timg viec phai lam

31,7

11,7

15,8 27.5

Tap n-ung, khong de viec nao khae anh

0,0

3,3

15,0 42,5

39,2

4,17

0,86

Kilm che ban than dl khong lam bSt cu
dieu gi thieu kiem soat

6,7

7.5

31,6

42,5

11,7

3,45

1,02

Xin loi khuyen til' chuyen gia, bac sT, y ta

6,7

15,8

31,7 37,5

8,3

3,25

1,03

Chil dong liin kiem tliong tin ve benh va
each dieu tri

11,7

9.2

28,3

48,3

2,5

3,21

1,05

Len ke hoaeh hanh dpng ciia rieng minh
trong thoi gian dieu iri

31,7

25,8

23,4

18,3

0,8

2,31

1,12

De ban than khong bi phan tam boi suy
nghT va hanh dgng khae trong khi dieu tri

17

4,1

24,2

50,0

20,0

3,83

0,85

Khong de cho vin dl toi le hon do hanh
dong qua voi vang

2,5

3,3

26,7

43,3

24,2

3,83

0,92

Hoi kinh nghiem 6 cac benh nhan khae

5,0

6,7

31,7

44,1

12,5

3,53

0,97

Ghi chii: KBG: khong bao gia; HK: hiim khi, TT: thinh thoang. TX- thu&ng xuyen; LL: luon
luon.

Tieu thang LTng phd tap trung vao vin di bilu bien d viee ehu dpng ung
phd, len ke hoaeh giai quyit vin di, tap ttung giai quylt vin dl, kiim ehi phan
ung, flm kiem hd trg xa hdi vi vat ehit. Trong eac each dd, benh nhan ung thu
sir dung nhieu nhat la tap trung giai quyit vin dl va kiim ehi phan ung Cu
the, eac each dugc benh nhan thudng xuyen va ludn ludn sit dung la- nd lue
tuan thu dieu tri (85%), tap trung vao diiu tri va khdng di viec gi khae anh
hudng den dieu tri (81,7%), giu cho ban than khdng bi phan tam bdi eac suv
nghl va hanh ddng khae trong khi dieu tti (70%), khdng dl cho vin di tdi td
hon do hanh dgng qua vdi vang (67,5%). Tuy nhien, chu ddng itng phd ieh'
dgng len ke hoaeh, tim kiem thdng tin vl benh, trao ddi/xin Idi khuye t"

54

TAP CHITAM LY HOC, Sd 4 (241), 4•2019


chuyen gia, bac si, y ta) la eaeh ung phd rit hieu qua trong dieu tri benh ndi

chung va dac biSt quan trong trong dilu tti ung thu thi chua duge benh nhan
thuc hien nhieu (bang 3).
Bdng 4: (fngpho tap trung vdo cdm xie a benh nhdn ung thu (N = 120)
iTiig pho tap trung
vao cam xuc

Tan suat t"io)

DTB

DLC

10,8

3,55

0,96

49,2

15

3,67

0,91

11,7

37,5

43,3

4,15

0,95

28,3

28,3

7,5

2,86

1,25

19,2

25

12,5

2,80

1,40

22,5

38,3

7,5

3,04

1,23

50

15,8

3,61

1,02

KBG

HK

TT

TX

LL

Chia se cam xuc ciia minh vai
nguoi khae

1,7

12,5

25,8

49,2

Tim su h6 trg tinh thiin tir
nguai than va ban be

2,5

7,5

25,8

L?c quan rang minh se duac
chiia khoi benh

1,7

5,8

21,7

14,2

Tim su an ui trong ton giao

26,6

16,7

CSu khan va lam nhflng viec
tam linh

17,5

14,2

Hanh dong nhu the benh tat
khong anh hudng gi toi minh

3,3

14,2

16,7

Tin rang benh tat la thir thach
de minh manh me han, truang
thanh han

Ghi chu KBG: khong bao gid; HK: hiim khi; TT thinh thoang; TX: thucmg xuyen; LL: luon
luon.

LTng phd tap trang vao cam xuc ed 3 nhdm eo ban, do la tim kiem hd tro
xa hgi ve tinh cam, diln giai tieh eye, tim den tdn giao. Bang 4 cho thay, ung
phd tap trang vao cam xue d benh nhan ung thu the hien nhieu nhat d su dien
giai tich eye va tim kiim sy hd trg xa hdi. Diln hinh nhit la benh nhan thudng
xuyen va ludn ludn lae quan ring minh se duge ehua khdi benh (80,8%). Nhung
each ttng phd bing cam xue khae cung dupe sii dung nhieu, do la chia se cam

xic eua minh vdi ngudi khae (60%), tim sy hd trg tinh thin tu ngudi than va ban
be (64,2%), hanh ddng nhu thi benh tat khdng anh hudng gi tdi minh (65,8%).
Tiiu thang do LTng phd ne tranh gdm 3 nhdm hanh vi: trut bd cam xue,
budng xudi hanh vi va budng xudi tinh thin. Trong ba nhdm treii, benh nhan
ung thu su dung nhiiu nhit la budng xudi tinh thin, diin hinh nhat la "Khi cd
nhung cam xue, suy nghl tieu eye thi tim viee khae de lam" (67,5% sd benh
nhan thudng xuyen va ludn ludn lam nhu vay, DTB = 3,64; DLC = 0,90) hay

TAPCHiTAM LYHOC, Sd'4 (241), 4 - 2019

55


"Mo mong vi nhttng thu khae" (36,7%; DTB = 2,96; DLC = 1,20). ^^f^^^
ttng phd ne tranh khae mang tinh tieu eye ban nhu budng xuoi hanh vi (m
dung viec diiu tti bay su dung thudc la, rugu, bia) thi benh nhan ung tnu
.
ehpn su dung.
Bdng 5: Ung phd ne trdnh a benh nhdn ung thu (N - 120)
ran suat (%1

DTB

BLC

4,2

2,55

1,25

7,5

0,0

1,94

0,98

10,8

2,5

0,0

1,41

0,78

13,3

21,7

5,0

0,0

1,72

0,97

4,2

5,8

22,5

56,7

10,8

3,64

0,90

Mo mong ve nhieu thir khao

18,3

14,2

30,8

30,0

6,7

2,93

1,20

Sir dung thuoc la hoac ruon, bia

95,8

2,5

1,7

0,0

0,0

1,06

0,29

Sir dung thuoc an than

84,1

7,5

6,7

1,7

0,0

1,26

0,65

65,9

9,2

13,3

8,3

3,3

1,74

1,17

iTng pho ne tranh
KBG

HK

TT

TX

LL

Thi hien nhirng cam xuc bu6n
khi rat nhilu

25,8

24,2

23,3

22,5

Thi hien cam xiic tieu cue ra

43,3

26,7

22,5

Muln dung viec dieu tri benh

75,0

11,7

Thira nhan minh khong the doi

60,0

Khi CO cam xiic, suy nghT tieu
cue thi tim viec khae de lam

Tu noi rang "Day khong phai la
1 sir that"

Ghi chit: KBG: khong bao gid: HK: hiem khi; TT: thinh thoang; TX: thudng xuyen; LL: luon
luon.

Ket qua kiem dinh T-test cho thiy, khdng cd sy khae biet ed y nghia ttong
ttng phd tap trang vao van de gitta nam benh nhan va ntt benh nhan (p > 0,05),
nhung ed sy khae biet cd y nghia trong ung phd tap trung vao cam xue
(1(118) = -3,968; p < 0,01) va ung phd ne tranh (t(I18) = -2,421; p < 0,05).
Theo dd, benh nhan ntt cd mue dp ung phd tap trang vao cam xue (DTB = 3 32DLC = 0,57) cao hon benh nhan nam (DTB = 2,89; DLC = 0,56) va miie' dd
ung phd ne tranh d ntt (DTB = 2,13; DLC = 0,42) eung cao hon so vdi nam
gidi (DTB = 1,92; DLC = 0,52).
Tdm lai, benh nhan ung thu trong nghien ettu nay thudng ttng phd vdi
benh bing each tap trang vao diiu tri, kilm chi phan ttng di nhttng khd khan
cua minh khdng phuc tap them, nhin nhan benh tat mgt each tich cue va f
56

TAP CHiTAM LY HOC, Sd 4 (241), 4 .
2019


kilm sy hd trg xa hdi. Ben canh dd, benh nhan eung kha thudng xuyen su dung
each ling phd ne tranh nhu tap trung vao mgt ddi tugng khae di tam thdi quen
di benh tat va nhttng khd khan eua minh. Hg eung it su dung cae each ung phd
tieu cue nhu sd dung chit kich thieh. Tuy nhien, nhttng each ttng phd tieh eye
hon nhu chu ddng tim kilm thdng tin hay trao dc^i, xin Idi khuyen eua bae si va
nhan vien y te ehua duge benh nhan thye hien nhilu.
Phan tieh tuong quan Pearson eho thiy, ttng phd tap trung vao vin dl ed
tuong quan thuan vdi ling phd tap trung vao cam xuc (r = 0,296; p < 0,01) va

tuong quan nghich vdi ung phd ne tranh (r = -0,184; p < 0,05), trong khi dd,
ling phd tap trang vao earn xuc khdng cd mdi tuong quan vdi ung phd ne ttanh
(r = -0,133; p > 0,05). Dieu nay ehung td ring, eang ung phd tap trung vao vin
di thi benh nhan ung thu eang ed xu hudng ung phd tap trung vao cam xuc
hoac ngugc lai. Ben canh dd, eQng ed thi nhan dinh ring, eang ttng phd tap
trung vao vin de va tap trang vao cam xiie tbi benh nhan eang it ung phd ne
ttanh bang nhttng each thue tieu eye.
6. Anh htrdug ciia sir chap nhan den trng pho vdi benh tat d benh
nhan ung thtr
Bdng 6: Khd ndng du bdo da yeu to chdp nhgn doi vol kieu irng phd
a benh nhdn ung thu

Bien so

R=

R'A

He so chua
ehuan hoa

He so
ehuan hoa

B

SE

P

t

P

ling pho tap trung
vao van de

0,034

0,026

0,116

0,057

0,184

2,037

0,044

Ung pho tap trung
vao cam xuc

0,115

0,108

-0,247

0,063

-0,340

-3,921

< 0,001

Ung pho ne tranh

0,285

0,279

-0,305

0,044

-0,534

-6,860

< 0,001

Phan tieh dtt lieu bing ttrcmg quan Pearson cho thay, chap nhan benh va
ling phd tap ttung vao vin dl ed tuong quan thuan vdi nhau (r = 0,184; p < 0,05),
chap nhan tuong quan nghich vdi ung phd tap trung vao earn xue (r = -0,340;
p < 0,01) va ling phd ne ttanh (r = -0,534; p < 0,01). Dilu nay cd nghia la eang
chip nhan benh tat bao nhieu thi benh nhan ung thu cang tim each giai quyet van
di cua minh biy nhieu va eang it tim kiim su hd trg vl cam xue, it trut bd cam

TAP CHi TAM LY HOC, Sd 4 (241), 4 - 2019

57


xuc, it tim din sy hd trg cda tam linh va it budng xudi ve tinh than cung nhu
hanh vi hoac ngugc lai.
Kit qua phan tich hdi quy tuyin tinh dan biin vdi biln sd dgc lap la
chip nhan va tung biin sd phu thupe la ung phd tap trung vao vin de, ttng pho
tap trung vao cam xdc va ung phd ne tranh duge the hien d bang 6.
Sy chip nhan benh cd thi dy bao dugc 3,44% ttng phd tap unng vag
vin di theo hudng tang kha nang ung phd nay (R^ = 0,034; p = 0,184; p < 0,05).
Ngugc lai, chip nhan cd thi dy bao duge 11,5% iing phd tap trung^vao cam
xuc (R^ = 0,115; p = -0,340; p < 0,001) va 28,5% ttng phd ne tranh (R = 0,285;
P = -0,534; p < 0,001) d benh nhan ung thu theo hudng giam hai kilu ung phd nay.
7. Ban luan
Kit qua nghien ettu cho thiy, nam gidi ed mue do chap nhan cao hgn so
vdi ntt gidi. Cac bing cbttng da ehi ra ring, khi ddi mat vdi can benh de dga
din tinh mang benh nhan ung thu thudng xem xet lai each song cua bg va
nhilu ngudi chgn mdt sd mue tieu uu tien va tap trung vao eae van de hien sinh
nhu suy nghiem ve y nghia euge sdng, tang trucmg tam linh ca nhan va sdng ed
chanh niem (Brennan, 2001), tuy nhien, sy khae liiet ve gidi trong chanh niem
khdng duge tim thay (Brown va Ryan, 2003; Catak, 2012; De Petrillo va edng
su, 2009; Feldman va edng sy, 2007; MaeKillop va Anderson, 2007; Malcoun,
2008). Mac du vay, xet ve tung yeu td eua chanh niem, nghien ettu eua Sabina
Alispabie, Enedina Hasanbegovic-Anie (2017) eho thay, cd su khae biet gidi d
tung yeu td thanh phan theo Bang bdi 5 yeu td chanh niem (Five factor
mindfulness questionnaire): Nu gidi cd diim sd cao d tilu thang Quan sat
(observing), trong khi dd, nam gidi cd diim sd eao d tiiu thang Hanh ddng tinh

thuc (acting with awareness). Diiu nay phu hgp vdi kit qua nghien euu vi sy
khae biet gidi tinh trong cudng do cam xuc va each thue ttng phd. Theo dd,
phu ntt dugc cho la cd cudng do phan ung cam xue eao hon va chu y vao cae
trai nghiem cam xiic (ca cam xuc tieu eye va cam xuc tieh eye) eung nhu tap
trung nhiiu vao sy kiim soat cam xuc (Diener, Sandvik va Larsen, 1985),
trong khi dd, nam gidi lai thudng sit dung chiin luge ttng phd tap ttung vac)
nhan thtte va hanh ddng ttng phd nhilu ban la cac trai nghiem cam xue tieu
eye. Ket qua phan tich T-test vi sy khae biet trong ba kiiu ung phd giua benh
nhan nam va benh nhan nQ cung hoan loan phu hop vdi cac nhan dinh nay (nu
ed diem sd ung phd tap trung vao cam xuc va img phd ne ttanh eao hon nam)
Ket qua nghien cuu cua chiing tdi eung eho thiy, nhdm ngudi ed mdi ddi
eao hon cd diem sd chap nhan cao hon nhdm it tudi. Xet vi dp ttidi ed 62 5»/
benh nhan tii 39 - 59 tudi va 15,8% benh nhan tu 60 tuoi trd len nghia la d~ t ^°

58

TAP CHI TAM LYHOC, Sfi4 (241), 4-2019


cua benh nhan tuang ddi eao (tudi trung binh la 47,63). Mdt sd nghien ettu khae
cung tim thiy mdi lien he giua dp mdi vdi mtte do chip nhan, chanh niem va sy
tap trang vao thdi diem hien tai (Sabina Alispabie, Enedina Hasanbegovic-Anie,
2017; Mogilner, Kamvar va Aaker, 2011; Smrgess, 2012). Mat khae, thdi giati
mic benh ciing la yiu td giai thieh eho sy khae biet vi dp tudi trong chip nhan.
Khoang hai phin ba (64,2%) benh nhan da biit minh mic benh ttt 6 thang ttd
len, do dd, hp da ed mpt khpang thdi gian hrong ddi dai dl thich ung vdi benh
cua minh. Cae nghien cira khae da chi ra rang, eac biin so nhu thdi gian ki ttt
khi chin doan (Velikova va edng su, 2001) va eac trieu cbttng lien quan din ung
thu (Nordin, Berglund, Glimelius va Sjoden, 2001) ed tbi tae ddng din ttang
thai tam ly cua ngudi benh. Elisabeth Kubler-Ross (1969, 2011) da dua ra nam

giai doan ddi mat vdi eai chet ma sau nay duge nhiiu tac gia khae danh gia la
phu hpp vdi ea phan irng ve dau budn va benh tat. Giai doan diu tien dac trang
bdi phan iing sde (shock) vi nhSn duge chin dgan, benh nhan thutmg phu nhan
(denial) hien thue ("Dieu nay khdng tbi xay ra vdi tdi") hoac nghi ngd ("Cd thi
day la mdt ehan doan sai"). Giai doan thtt hai la Gian dtt (Anger), benh nhan
thudng dat eau hdi: "Tai sao lai la tdi?", "Dieu nay that khdng edng bUngi", "Tdi
da lam gi sai?" Ngudi benh ed the dd Idi cho ban than hoac do Idi cho ngudi
khae. Giai doan thtt ba la Mae ea (Bargaining), d day ngudi benh tim each ne
ttanh benh tat bang each mac ca vdi ban than va vdi ngudi khae, tham ehi vdi ea
nhttng nang lyc sieu binh ("Neu khdi benh tdi se..."). i) giai doan nay eiing
thudng nay sinh mac cam tgi 16i ("Gia ma tdi..."). Giai doan tiep theo la Trim
cam (Depression) sy xuat hien thudng xuyen eua cac y nghl va cam xuc tieu
cue. Ngudi benh ed the bd thude hoae bd diiu tri. Giai doan eudi eiing la Chap
nhan (Acceptance), benh nhan bit diu hilu ring ed the khdng ed each nao lam
mit ngay can benh eiia minh nhung minh ed tbi thieh nghi vdi nd. Cam giac lo
ling va khd chju cd thi thinh tbgang vin quiy riy benh nhan nhung hp da biet
each ttng phd vdi chung.
Nghien euu eua ehung tdi da xae dinh sy anh hudng cua chap nhan den
ba kiiu ttng phd cy thi. Kit qua nghien euu cho thay, chip nhan it cd kha nang
dy bao ttng phd tap trang vao vin di nhttng lai ed kha nang du bao tuong ddi
tit ddi vdi ttng phd tap trung vao cam xuc va dac biet, cd kha nang dy bao rat
lit ung phd ne tranh. iTng phd ne tranh dupe eoi la kilu ung phd khdng hieii
qua bdi chung ta khdng thi ne tranh hoan loan viee giai quyet nhung vin de
vdn la nguon gde gay eang thing. Da ed khdng it nghien euu dua ra bang
chung vi viee anh hudng tieu cue eua ne tranh a benh nhan ndi ehung, trong
do cd benh nhan ung thu. LTng phd ne tranh cd mdi tuong quan thuan vdi stress
va tuong quan nghjeh vdi tinh thin lac quan d benh nhan ung thu (Friedman va
cong sy, 1992). LTng phd ne ttanh la ylu td trung gian gitta hanh vi khdng hd
trg etia ngudi than va stress cd hai d benh nhan ung thu vu (Manne va cdng
TAP CHi TAM LY HOC, Sd 4 (241), 4 - 2019

59


sy, 2005). Mdt nghien ettu khae theo ddi va danh gia mdi lien he giua ung
phd ne tranh va eae ttieu chung trim cam tren 1.211 ngudi d dp tudi trung
nien trong vdng 10 nam cho thiy, cd mdi lien quan chat ehe gitta cac sy kien
gay eang thing, each ttng phd ne tranh va trieu chung tram cam (Holahan va
edng su, 2005).
Niu nhu utig phd tap trang vao su loai bd hay kiem soat y nghl va cam
xuc thi chip nhan lai dtm gian la nhan biet rd su bien dien eua cam xue tieu
eye va di cho chung qua di ma khdng can de nen, kiem soat hay ed loai bd
cbttng. Chap nhan eung ddng nghia vdi sy khdng ne tranh ma la bao dung va ttt
bi vdi cam giac khd chju va nhttng trang thai cam xuc tieu eye cua ban than.
Do dd, chap nhan khdng lam cho benh nhan eang thang, met mdi vi tieii bag
nhieu nang lugng tinh than. Nhttng bang chung da trinh bay d phan dat van de
eho thay, chap nhan cd tac dung giam dau, giam stress, lo au va tram earn, day
nhanh su phue hdi chttc nang. Nhung dieu nay ggi y chg viec bd trg tam ly eho
benh nhan ung thu bang each danh gia mtte dp chap nhan d benh nhan, hudng
dan benh nhan loai bd dan thdi quen "chien dau" ehdng lai cae cam xue tieu
cue. Thay vao dd, hudng dan benh nhan cac ky thuat theo ddi va nhan biet cam
xiie tieu cue, tang mtte dp chanh niem de giam sy ne tranh, khoan dung va tu
bi ban vdi cac cam xue tieu eye de chung qua di mot each ty nhien.
Nhu vay, tong hgp ket qua eua eae nghien ettu tren the gidi da trinh bay
d phan dau vdi kit qua nghien cuu eua ehiing tdi cd thi dua ra hai nhan djnh
nhu sau: I) Chap nhan la yeu td ed thi lam giam trieu cbttng benh eung nhu
giam cac cam xiic tieu cue do benh tat gay ra, tang sy thoai mai va ed tac dgng
tich cue din su pbiic hdi chttc nang thdng qua eo chi giam ttng phd ne tranh;
2) Ung phd ne ttanh lam giam hieu qua diiu ttj d benh nhan. Tir hai nhan dinh
tten cd the dua ra gia dinh quan trgng, do la: chip nhan ed thi la yiu to lam

tang hieu qua dieu ttj d benh nhan, trong dd ed benh nhan ung thu. Day eiing
chinh la ggi y eho cac nghien cuu trong tugng iai tap trung vao viee kiim
cbttng mdi quan he gitta chap nhan benh va cae cam xuc tieu cue di kem vdi
hieu qua dieu trj d benh nhan.
Cac nghien euu ttong tuong lai cung cin kham pha ra eac biln sd cd vai
trd dieu net mdi quan he giua chap nhan va ung phd vdi benh d benh nhan una
thu. Lieu cac yeu td dd cd phai la dac diem tam ly ea nhan etia benh nhan ftinh
hudng ndi/hudng ngoai, tinh lae quan/bi quan,...) hay eac ylu td tam Iv xS hdi
(sy ho trp xa bdi, giao tiep gitta bac si va benh nhan, su cung cip diy du thd '
tin vee benh
dieu trj benh,...) hay
L o r.,?
. va each
, ,--^.-;'-••••••:;)
hay su
sy kit
kit ban
bop eiOa
giua cac
cae vl„
ylu ,A
tddd?
Davit
nhunj buong eo the nghien euu tiep tue ve anh hudng cua chip nhan din t~ t
nhung
nhan ung
thu
nhan
nno thir
^^ Oenn

60

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-2019


8. Kit luan vk ap dung
Nghien ciiti tten 120 benh nhan ung thu da eho thiy mdi lien he rd rang
gitta nang lye chip nhan va ung phd tap trang vao cam xtte va ttng phd ne
ttanh. Kit qua nghien eu:u nay la ea sd khoa hge bude diu dl ed tbi ap dung
yiu td chap nhin vao ndi dung eua cham sde giam nhe cho benh nhan ung thu
d Viet Nam nhim giam iiguy ea mie them eae rdi loan tam ly trong qua trinh
dilu tti benh thye the. Ddi vdi nhttng benh nhan ung thu ed kem theo rdi loan
lo au va tram cam can duge ap dung tiep e|in tri lieu chip nhan va cam kit
trong can thiep tam ly song song vdi eae can thiep y khoa, giup benh nhan ttng
phd tdt vdi benh tat di ed ehat lugng sdng tdt hem. Tuy nhien, cin thye hien
them nhiiu nghien ettu khae nua de thu thap them eae bing ehttng khga hpe vi
CO che anh hudng eua nang lyc chip nhan den ttng phd, nang lue chip nhan va
anh hudng eiia nd len hieu qua dieu tti benh d eac giai doan benh khae nhau
tten nhieu nhdm benh nhan khae nhau vdi nhieu the benh da dang hon.
Tai lieu tham khao
1. Adler N.E., Page A.E. (2008). Cancer care for the whole patient- Meeting
psychosocial health needs. Washington (DC). National Academies Press (US).

2. Anshel M.H. (1996). Coping styles among adolescent competitive athletes. The Journal
of Social Psychology. 136. 311 - 323.
3. Blalock J.A., Joiner Jr T.E. (2000). Interaction of Cognitive Avoidance Coping and
Stress in Predicting Depression/Anxiety. Cognitive Therapy and Research. Vol. 24. Issue 1.

47-65.
4. Branstetter A.D., Wilson K.G., tfildebrandt M. and Mutch D. (2004). Improving
psychological adjustment among cancer patients: ACT and CBT. The Meeting of the
Association for Advancement of Behavior Therapy. New Orleans. Google Scholar.
5. Brennan J. (2001). Adjustment to cancer: Coping or personal transition. PsychoOncology. Vol. 10. P. 1 - 18.
6. Brown K.W. & Ryan R.M. (2003). The benefits of being present- Mindfulness and
its role in psychological well-being. Joumal of Personality and Social Psychology. 84
(4). 822 - 848. Doi: 10.1037/0022-3514.84.4.822.
7. Campbell-Sillsa L., Barlowb D.H., Brownb T.A., Hofmann S.T. (2006). Effects of
suppression and acceptance on emotional responses of individuals with anxiety and
mood disorders. Behaviour Research and Therapy. 44 (2006). 1.251 - 1.263.

8. Cardaclotto L.A., Herbert J.D., Forman E.M., Moitta E. & Farrow V. (2008). The
assessment of present-moment awareness and acceptance. The Philadelphia Mindfuln
Scale. Assessment Vol. 15. No. 2. P. 204-223. Doi: 10.1177/1073191107311467.

TAPCHiTAM LYHOC, Sd4 (241), 4 - 2019

61


9. Carver C.S.. Pozo C , Harris S.D., Noriega V., Scheier M.F., Robinson D.S.,
Ketcham A.S., Moffat F.L. & Clark K.C. (1993). How coping mediates the effect oj
optimism on distress: A study of women with early stage breast cancer. Journal o
Personality and Social Psychology. Vol. 65. P. 375 - 390.
10. Carver C.S., Scheier M.F. & Weintraub J. K. (1989). Assessing coping strategies,
A theoretically based approach. Joumal of Personality and Social Psychology. Vol. 56.
P. 2 6 7 - 2 8 3 .
11. Catak P.D. (2012). The Turkish version of the cognitive and affective mindfulness
scale-revised Europe's Journal of Psychology. 8 (4). 603 - 619. Doi: 10.5964/ejop.v8i4.436.

12. De Petrillo L.A., Kau&nan K.A., Glass C.R. & AmkoffD.B. (2009). Mindfulness for
long-distance runners- An open trial using mindful sport performance enhancement
(MSPE). Joumal of Clinical Sport Psychology. 3 (4). 357 - 376. Doi: 10.1123/jcsp.3.4.357.
13. Diener E., Sandvik E. & Larsen R.J. (1985). Age and sex effects for emotional
(n/e<isi/y. Developmental Psychology. 21 (3). 542 - 546. />14. Eisenberg S.A., Shen B.J., Sehwarz E.R., Mallon S. (2012). Avoidant coping
moderates the association between anxiety and patient-rated physical functioning in
heart failure patients. Journal of Behavioral Medicine. Vol. 35. Issue 3. P. 253 - 261.
15. Endler N.S. & Parker J.D.A. (2000). Coping with health injuries and
(CHIP). New York. MHS.

problems

16. Esteve R., Ramirez-Maestre C , Lopez-Martinez A.E. (2007). Adjustment to chronic
pain: The role of pain acceptance, coping strategies, and pain-related cognitions. Armual
of Behavioral Medecine. 33 (2). 179 -188. Doi:10.1007/BF02879899.
17. Feldman G., Hayes A., Kumar S., Greeson J. & Laurenceau J.P. (2007). Mindfulness
and emotion regulation: The development and initial validation of the cognitive and
affective mindfulness scale-revised (CAMS-R). Joumal of Psychopathology and Behavioral
Assessmem. Vol. 29. P. 177 -190. Doi: 10.1007/sl0862-006-9035-8.
18. Feros D., Lane L., Ciarrochi J., Blackledgc J.T. (2013). Acceptance and commitment
therapy (ACT) for improving Ihe lives of cancer patients: A preliminary study Psycho Oncology. Joumal of the Psychological. Social and Behavioral Dimensions of Cancer
Vol. 22. Issue 2. P. 459 - 464. Doi.org/10.1002/pon.2083.
19. Friedman L . C , Nelson D.V., Baer P.E., Lane M., Smith F.E., Dworkin R J
(1992). The relationship of dispositional optimism, daily life stress and domestic
environment lo coping methods used by cancer patients. Journal of Rphavi„r=.l
Medicine. Vol. 15. Issue 2. P. 127 - 141.
oenavioral
20. Hayes S.C. (1987). A contextual approach to therapeutic change In N Jac b
(Ed.). Psychotherapists in clinical practice: Cognitive and behavioural nprc„,«
P. 327 - 387. New York. Guilford.

Perspectives.

62

TAP CHi TAM LY HOC, Sd 4 (241), 4 . 2019


21. Hayes S.C, Luoma J.B., Bond F.W., Masuda A. & Lillis J. (2006). Acceptance
and commitment therapy: Model, processes and outcome. Behaviour Research and
Therapy. 44. 1 - 25. Doi: 10.1016/j.brat.2005.06.006.
22. Hayes S.C, Wilson K.G., Gilfford E.V., FoUette V.M., Strosahl K. (1996).
Experiential avoidance and behavioral disorders; Afunctional dimensional approach
to diagnosis and treatment. Joumal of Counsulting and Clinical Psychology Vol 64
No. 6. P. 1.152-1.168.

23. Hersehbach P., Keller M., Knight L., Brandl T., Huber B., Henrich G., MartenMittag B. (2004). Psychological problems of cancer patients- A cancer distress
screening-with a cancer .specific questionnaire. British Joumal of Cancer. 91 (3), 504 - 511
Doi: 10.1038/sj.bjc.6601986; PMID: 15238979.
24. Holahan C.J., Moos R.H., Holahan C.K., Brennan P.L., Schutte K.K. (2005).
Stress generation, avoidance coping, and depressive symptoms: A 10 - year model.
Journal of Consulting and Clinical Psychology. Vol. 73. No. 4. P. 658 - 666.
25. Keller M., Sommerfeldt S., Fischer C, Knight L., Riesbeck M., Lowe B., Herfarth C,
Lehnert T (2004). Recognition of distress and psychiatric morbidity in cancer palienls;
A multi-method approach. Annals of Oncology. Vol. 15. Issue 8. P. 1.243 - 1.249.
Doi.crg/10.1093/annonc/mdh318.
26. Khalil A., Faheem M., Fahim A., Innocent H., Mansoor Z., Rizvi S., Farmkh H.
(2016). Prevalence of depression and anxiety amongst cancer patients in a hospital
setting: A cross-sectional study. Psychiatry Joumal. Vol. 3964806. Doi: 10.1155/2016/
3964806. PMID: 27752508.
27. Kohlmann C.W., Weidner G., Messina C.R. (1996). Avoidant coping style and

verbal-cardiovascular response dissociation. Psychology and Health. Vol. 11. Issue
3. 371 - 384. Doi.org/10.1080/08870449608400265. Kubler-Ross E. (2011). On Death
and Dying. New York: Scribner. Reprint edition.
28. Kratz A.L., Davis M.C. & Zautta A.J. (2007). Pain acceptance moderates Ihe
relation between pain and negative affect in female osleoarthrUis and fibromyalgia
patients. Annals of Behavioral Medicine. Vol. 33. P. 291 - 301.
29. Landy L.N., Schneider R.L., Arch J.J. (2015). Acceptance and commitment therapy
for the treatment of anxiety disorders: A concise review. Current opinion in Psychology.
Vol. 2. P. 70 - 74.'
30. Lazaras R , Folkman S. (1984). Stre.is, appraisal and coping. New York: Springer
31. MaeKillop J. & Anderson E.J. (2007), Further psychometric validation of the
mindful attention awareness scale (MAAS). Joumal of Psychopathology and Behavioral
Assessment. 29 (4). 289 - 293. Doi: 10.1007/sl0862-007-9045-l.

32. Malcoun E. (2008). Unpacking mindfulness: Psychological processes underlying
the health benefits of a mindfulness- ba.'ied stress reduction program (Doctoral thesis,

TAP CHiTAM LY HOC, Sd4 (241), 4-2019

63


Bryn Mawr College, PA, USA). Available from bttp://search.proquest.com/docview/
288102215.
33. Manne S.L., Ostroff J., Winkel G , Grana G. (2005). Partner unsupporttve
response, avoidant coping, and distress among women with early stage breast cancer.
Patient and partner perspective. Health Psychology. Vol. 24. No. 6. P. 635 - 641.
34. McCracke L.M., Eecleston C. (2006). A comparison of the relative utility of
coping and acceptance-based measures in a sample of chronic pain sufferers.
European Joumal of Pain Vol. 10. P. 23 - 29.

35. MeCracken L.M. & Vowles K.E. (2007). Psychological flexibility and traditional
pain management strategies in relation to patient functioning with chronic pain: An
examination of a revised instrument. Joumal of Pain. Vol. 8, P. 339 - 349.
36. MeCracken L.M. & Velleman S. (2010). Psychological flexibility in adults with
chronic pain: a study of acceptance, mindfulness, and values-based action in primary
care. Pain. Vol. 148. P. 141 - 147.
37. MeCracken L.M. & Zhao-O'Brien J. (2011). General psychological
acceptance
and chronic pain; There is more to accept that pain itself. European Joumal of Pain.
14(2). 170-175.
38. Mogilner C , Kamvar S.D, & Aaker J. (2011). The shifting meaning of happiness. Social
Psychological & Personality Science. 2 (4). 395 - 402. Doi:10.1177/1948550610393987.
39. Nikbakhsh N., Moudi S., Abbasian S., Khafri S. (2014). Prevalence of depression
and anxiety among cancer patients. Caspian Joumal of Intemal Medicine. 5 (3). 167- 170
PMID: 25202445.
40. Nordin K., Berglund G., Glimelius B. & Sjoden P.O. (2001). Predicting anxiety
and depression among cancer patients: A clinical model. European Joumal of Cancer
37.376-384.
41. Roemer L., OrsiUo S.M. & Salters-Pedneault K. (2008). Efficacy of an acceptancebased behavior therapy for generalized anxiety disorder Evaluation in a randomized
controlled trial. Joumal of Consulting and Clinical Psycholoev 76 (6) 1 083 - 1 089
Doi.org/10.1037/a0012720.
'
'
42. Roth S. & Cohen L.J. (1986). Approach, avoidance, and coping with stress American
Psychologist. Vol. 41. P. 813 - 819.
43. Ruiz F.J. (2010). A review of acceptance and commitment therapy (ACT) emDirical
evidence: correlational experimental psychopathology, component and outcome
studies international. Journal of Psychology and Psychological Therapy 10 (1). 125-162
44. Sabina Alispabie, Enedina Hasanbegovic-Anie (2017). Mindfulness- A
rf

gender differences on a bosnian sample. Psychological Thought Vol l o r n i < f f i l
Doi:10.S964/psyct.vlOil.224.
'
' ' " HT 155 - 166.

64

TAP CHiTAM LY HOC, Sd 4 (241), 4 . 2019


45. Sehlen S., Fahmuller H., Hersehbach P., Aydemir U., Lenk M., Diihmke E..
(2003). Psychometric properties of the stress index radio oncology (SIRO) - a new
questionnaire measuring quality of life of cancer patients during radiotherapy.
Sttahlentherapie Onkologie. 179 (4). P. 261 - 269.
46. Stargess M.A. (2012). Psychometric validation and demographic differences in
two recently developed trait mindfulness measures. Master's Thesis. Victoria University
of Wellington.
47. Velikova G., Wright P., Smith A.B., Stark D., Perren T., Brown J. & Selby P.
(2001). Self-reported quality of life of individual cancer patients- Concordance of
results with disease course and medical records. Joumal of Clinical Oncology. Voi.
19. P. 2.064-2.073.
48. WHO (2018). fVorld Cancer Report.
49. Wicksell R.K., Ahlqvist J., Bring A., Melin L., Olsson G.L. (2008). Can exposure and
acceptance strategies Improve functioning and life satisfaction in people with chronic pain
and whiplash-associated disorders (WAD)? A randomized conUolled Ukd. Cognitive Behavior
Therapy. 37 (3). 169 - 182. Doi: 10.1080/16506070802078970.
50. Wicksell R.K., Renofalt J., Olsson G.L., Bond F.W. & Melm L. (2008). Avoidance
and cognitive fusion - central components in pain related disability? Development
and preliminary validation of the Psychological Inflexibility in Pain Scale (PIPS). European
Joumal of Pain. Vol. 12. P. 491 - 500.

TAP CHi TAM LY HOC, Sd 4 (241), 4 - 2019

65