The effectiveness of existential psychotherapy on attitude to life and self-flourishing of educated women homemakers.

INTRODUCTION: Women make up half of the world's population and play a critical role in the health and well-being of the family and society. The purpose of this study is to determine the effectiveness of existential psychotherapy on attitude to life and self-flourishing of educated women homemakers.
METHODS: A quasiexperimental study with the pretest-posttest design is used in this work. The research population included 68 homemakers with university education who live in Neyshabur, Iran. Sampling method was available. The women were randomly assigned into two groups: intervention and control groups. The women in the intervention group participated in 10 sessions of existential therapy group. The data collection tool was a questionnaire of Life Regard Index (LRI) and Human Flourishing Questionnaire (HFQ). The data were analyzed by the SPSS software version 21 using Chi-square, independent t-test, and paired t-test while P < 0.05 considered as a significant level.
RESULTS: Scores of attitude to life and self-flourishing in educated homemakers before intervention were not significantly different in the two groups. Independent t-test showed that self-flourishing was significantly increased in the intervention group (90.88 ± 15.27) compared to the control group (79.64 ± 15.87) (P = 0.004). The attitude to life was significantly increased in the intervention group (35.79 ± 14.21) compared to the control group (27.50 ± 8.77) (P = 0.005).
CONCLUSIONS: The results of this study emphasize that existential group therapy is effective in attitude to life, and self-flourishing of educated homemakers. This therapy can also be used to enhance individual and social abilities the importance and impact of existential psychotherapy on enhancing capabilities such as a positive attitude to life and self-flourishing. Copyright:

RCT Entities:   Population Interventions Outcomes

Introduction

Women make up half of the world's population and play a critical role in the health and well-being of the family and society.[1] In general, the housework can be defined merely for its accomplishment, and it has no law, principle, and backing, and is regarded as repetitive and inconclusive.[23] This conflict and dichotomy can provide grounds for despair, depression, and frustration.[45] In contrast, studies show that education and employment lead women to growth, productivity, and self-flourishing in different fields.[6] According to the results of some studies, the quality of life of employed women is better than nonemployed women.[78]

Moreover, significantly improves vitality and mental health.[9] Furthermore, as a result, homemakers have less mental health and dissatisfaction than employed women. These individuals can change their attitudes to life, and by improving self-flourishing, they will improve their life satisfaction and enjoy their day-to-day activities.

Self-flourishing is a growing force and is part of the genetic nature of human.[10] Self-flourishing is the robust and intrinsic ability of each person, the desire to be better and better than what it is and what the individual is capable of, and the prosperity of his real talents.[11] The fundamental need of the organism is its fundamental inherent desire for realization, preservation, and excellence. Under the influence of this fundamental desire, the organism moves toward self-fulfillment, self-actualization, survival and self-esteem, self-control, autonomy, independence, responsibility, and self-control.[1213] A positive attitude to life is a change related to self-flourishing. The content of the attitude of life includes the goal of life, existential vacuum, life control, acceptance of death, meaningfulness, purpose search, and the realization of meaning for the future. A positive attitude toward life, self-development, and the development of the individual's unique talents and abilities, and everything that a person deserves is facilitated.[14] Therefore, the attitude of life affects the selection of activities and goals and leads to the individual having a purposeful life, accompanied by a feeling of strength and sense of development.[1516] Several therapeutic methods, including spiritual interventions (either individually or in combination), have been used to create a positive attitude to life and self-flourishing.[17] Based on the existential approach, happiness in life is realized if everyone accepts that there is no permanent safety and happiness in life. In this regard, they are encouraged to encounter the dimensions of their life that they have always escaped, and boldly recognize and accept these unfortunate events in their lives.[18] Existential therapy deals with the last issues of human being's existence and shows how people think about death, the balance of freedom and responsibility, the method of connecting loneliness and communication, and how to modify meaning and meaninglessness.[1920] Existential psychotherapy, based on his view of human life, addresses the importance of his life. The core and mainstay of existential therapy are to bring references to the point that can have a free choice,[21] and more than other perspectives, it examines human consciousness of oneself and its ability to look beyond its problems and existential issues,[2223242526] Therefore, it can be useful in creating a positive attitude toward life and Self-flourishing. Various studies have examined the effectiveness of this approach and because more than 85% of Iranian women[27] are homemakers, and most of them are educated and given that homemaking sometimes causes self-defeating. This phenomenon is considered a common problem in Iran. Accordingly, the present study seeks to answer the question of whether the existential group therapy is effective in self-flourishing and improving the attitude to life in educated women homemakers.

Materials and Methods

This study is a quasiexperimental study with two pretest and posttest groups. The research populations were selected from educated and the homemaker women of Neyshabur, Iran, in 2018. In this study, the sample size was 68 and sampling method was available. Samples were randomly allocated to two groups, 34 intervention groups and 34 control group using random numbers. One person from the intervention group was excluded from the study due to lack of participation in the sessions and one person from the control group due to lack of completion of the questionnaires. Based on a pilot study and mean comparison formula, with 95% confidence level and 80% test power and the given sample loss, the sample size was estimated to be 68 (34 controls and 34 intervention groups).

The criteria for entering the study were: having a bachelor's degree or above, being homemakers, and written consent for participation in the study and exclusion criteria was having acute psychological disorders (a psychologist monitored it) and participating in other counseling and psychotherapy programs. The pretest was conducted within both the intervention and control groups by completing the attitude of life and self-flourishing questionnaires. After the completion of the intervention, the posttest was conducted same as a pretest. Participants were assured that all information is confidential and would be only used for research purposes. Furthermore, at the end of the study, group therapy sessions were held for the control group.

The research tool was a questionnaire of Life Regard Index (LRI) and a questionnaire of Human Flourishing Questionnaire (HFQ). The attitude to life was measured by LRI questionnaire in 28 item, designed by Battista and Almond (1973). It has two subscales: (1) Framework scale) individual belief in having a vision or concept in life and choosing goals, intentions or points of view for life (and (2) supplemental scale (measuring the extent to which a person has perfected himself/herself or is in the process of realizing his/her life's framework or aspirations).

The test is composed of 28 items with a 5-point scale and is divided into two subscales, framework, and fulfillment. Each scale is composed of 14 items, half phrased positively, half negatively, to control the response set. The sum of these two scales comprises the life regard (LR) scale and was included to evaluate its use as an overall indicator of positive LR.

The range of scores in this test varies between 14 and 42. The high score of the individual expresses a high personal meaning, and a low score indicates a low personal meaning of life.

Battista and Almond (1973) reported a retest reliability of this index r = 0.94. The reliability of this test in 5 weeks is r = 0.80 for the index, r = 0.73 for the framework scale, and r = 0.79 for the supplemental scale. In another study, Cronbach's alpha for the index was 0.75, for the framework scale was 0.64, and for the supplemental scale was 0.75.[28] The validity of the content was confirmed by five faculty members of Mashhad Psychology Faculty and reliability of this index r = 0.88 in our study.

Self-flourishing was measured by HFQ questionnaire in 28 items. The questionnaire was developed by Soleimani, Rezaei, Kian Eersi, Hazhbariyan and Khalili (2014) based on the five-factor seligman model (positive excitement, relationships, meaning, progress, and fascination). The Cronbach's alpha coefficients in the questionnaire were 0.91, 0.83, 0.88, 0.87, and 0.95, respectively, for positive excitement, relationships, meaning, progress and total questionnaire. The validity of the questionnaire was calculated by determining the correlation coefficient of this scale with the questionnaires of “Ahvaz Self-flourishing,” “Diner” and “Beck Depression” and confirmed (P < 0.01).[29] In the questionnaire, questions 1, 5, 9, 13, 17, 21, 25 are defined to measure positive emotions. Questions 2, 6, 10, 14, 18, 22, and 26 are used to measure relationships. Questions 3, 7, 11, 15, 19, 23, and 27 are designed to measure meaning. Questions 4, 8, 12, 16, 20, 24, and 28 are considered for measuring progress. To some of the questions in a Likert spectrum, “I agree,” “I agree,” “slightly disagree,” “somewhat disagree,” and “totally disagree” to the values 1, 2, 3, 4, 5, and six are scored. The total score of the flourish comes from the sum of the total questionnaire. In this way, the overall score of self-flourishing is between 28 and 168, and the score of each factor is between 7 and 42.

The candidates were asked to participate in group therapy sessions for 10 weeks, once a week, the duration of each 120 min.

Group therapy sessions were held according to the concepts of existential psychology. Emmy van Deurzen, a leading existential philosopher and therapist, presents a practical method of working, using systematic observation, clarification, and reflection to help clients rediscover their inner strengths. She shows how personal assumptions, values, and talents, once acknowledged, can be turned to constructive use.[20] The program (group therapy with an existential approach) included Session 1: Referral and familiarity with the group and the expression of the rules. Session 2: Explaining the concepts of responsibility, choice, and freedom. Session 3: Talking about decision and will. Session Four: Explaining concepts of decision, will, and love. Session 5: Talking about the meaning of life and find meaning in suffering. Session 6: Discussion of the meaning and concept of loneliness. Session 7: Explaining the concepts of loneliness. Sessions 8 and 9: Talking about death and knowledge of finality. Session 10: Summing up and ending. The control group did not receive any intervention during this period.

Data were analyzed by SPSS software version 21 (SPSS Inc. Released 2007 SPSS for Windows, Version 21. Chicago, SPSS Inc.) using Chi-square, independent t-test andpaired t-test and P < 0.05 considered as a significant level. Independent t-test used for comparison of the mean score of self-flourishing and the mean score of attitude to life in both intervention and control groups before and after the study. Paired t-test used for intra-group comparison in the mean score of attitude to life and the mean score of self-flourishing in the control group before and after the intervention. Chi-square test used for the educational level of two groups.

All participants were informed that at each stage of the research, if they did not want to continue to cooperate can be excluded and the results of the research are confidential and are published only in general.

Results

The mean age of the participants in the intervention group was 35.55 ± 5.47 years and in the control group was 31.88 ± 4.88 years. Independent t-test showed that there was no significant difference between the ages of two groups (P = 0.591). In the intervention group, there were 24 undergraduate and ten masters, and in the control group, there were 27 undergraduate and ten masters. Chi-square test showed that there was no significant difference between the educational level of two groups (P = 0.401).

According to the results of Table 1, in the pretest, the mean score of self-flourishing in the intervention group was 78.52 ± 17.52 and in the control group was 78.64 ± 19.08, which according to the independent t-test, were not significantly different (P = 0.979). However, in the posttest, the mean score of self-flourishing in the intervention group was 90.88 ± 15.27 and in the control group was 79.64 ± 15.87, which was significantly higher in the intervention group than the control group (P = 0.004).

Table 1

Comparison of the mean score of self-flourishing in both intervention and control groups before and after the study

Groups	Intervention	Control	Between two groups independent t-test (t, df, P)
Before intervention	78.52±17.52	78.64±19.08	0.026, 66, 0.979
After intervention	90.88±15.27	79.64±15.87	2.974, 66, 0.004
The difference before and after	12.23±11.72	1.11±4.85	−3.559, 66, 0.001
Intergroups test (t, df, P)	−6.086, 33, <0.001	−1.343, 33, 0.189

The results of paired t-test for intra-group comparison showed that there was no significant difference in the mean score of self-flourishing in the control group before and after the intervention (P = 0.189). However, in the intervention group, the mean score of self-flourishing in the postintervention phase was significantly higher than before the intervention (P = 0.001). Mean difference of self-flourishing score in both intervention and control groups was significantly different before and after the intervention (P < 0.001).

According to the results of Table 2, in the pretest, the mean score of attitude to life in the intervention group was not significantly different with control group (P = 0.377). However, in the posttest, the mean score of attitude to life was significantly higher in the intervention group than the control group (P = 0.005).

Table 2

Comparison of the mean score of attitude to life in both intervention and control groups before and after the study

Groups	Intervention	Control	Between two groups independent t-test (t, df, P)
Before intervention	31.88±0.92	30.08±8.55	−0.889, 66, 0.377
After intervention	35.79±14.21	27.50±8.71	−2.090, 66, 0.005
The difference before and after	−2.58±3.83	3.91±9.93	5.110, 66, <0.001
Intergroups test (t, df, P)	3.932, 33, <0.001	−2.296, 33, 0.028

The results of paired t-test for intra-group comparison showed that there was a significant difference in the mean score of attitude to life in the control group before and after the intervention (P = 0.028). However, in the intervention group, the mean score of attitude to life in the postintervention phase was significantly higher than before the intervention (P < 0.001). Mean difference of attitude to life score in both intervention and control groups was significantly different before and after the intervention (P < 0.001).

Discussion

The study aimed to determine the effectiveness of existential psychotherapy on attitude to life and self-flourishing of educated homemakers. The results showed that the existential therapy group could have a significant positive effect on attitude to life and self-flourishing of educated women homemakers. The findings of this study are consistent with studies.[192223262829303132]

Homemakers, especially those with a university education, due to comparing themselves with working women, changing their standards and expectations, and the conflict between housekeeping and employment, as well as housekeeping problems such as house invisibility, uniformity, unproductive, and self-alienation, may become frustrated and depressed.[5] In the unpleasant situations, people have different responses. When people are faced with threatening situations of interests, desires, and being, they are provoked by their existence and therefore tend to talk about it.[19] In these cases, existential therapy is helpful. Different worldviews are the answer to these existential worries and unpleasant situations. The worldview is the essential attitude of life and is defined as a profound individual pattern of sense of hope, happiness, certainty, pessimism, or hopelessness.[33] The core of the existential approach is the attitude that individuals are capable of being healthy and capable of proper functioning, and this ability can move them toward self-awareness and self-actualization.[34] In the existential approach, it is believed that man can create meaning for his life in any situation (even in moments of life where nothing is in accordance with his will, and the conditions are unpleasant and unpredictable).[35] Existential therapy emphasizes that while accepting some facts about human beings, we are free to make what we want to do about the conditions.[33] Existential psychotherapy tells people that they are free in their lives, and if they deal with avoidable conditions, they can freely alter their thoughts about the limitations and suffering of the present,[29] and it facilitates a change in attitude to life. In fact, the benefits of existential psychotherapy to other approaches are focusing on choices and paths to personal growth and emphasis on accepting personal responsibilities, expanding awareness of the current situation and accepting the situation with all its shortcomings and its shortcomings[30] self-flourishing individuals have characteristics such as self-awareness, experiencing every moment, self-confidence, freedom in decision making and creativity, and the nature of existential therapy, expanding self-awareness and increasing the ability to make choices.[30] The therapist will help the authorities throughout treatment to take steps to discover its uniqueness and increase awareness of its dimensions.[31]

The existential therapist explains the existence of man to raise his self-awareness and helps him to identify and act on his capabilities in the realization of himself. The existential approach emphasizes that mortality and transience are not only the main features of life but also a critical factor in its significance and individual realizes that although the real conditions of life cannot be changed, the methods of coping with it can be changed.[3132] When an individual is uncertain in his decisions, the existential therapist's approach to healing with his self-awareness and his ability to look beyond his problems and to plan for existential issues helps to better reconcile the crisis. In this approach, human suffering is not being consumed because human life is suffering in nature and instead helps people to find meaning for pain in life, in which case pain will be enjoyable.[3637] In fact, existential psychotherapy leads to an increase in the adaptability of individuals with high-stress and intolerable situations and with the promotion of hope, can better deal with severe conditions.[3738]

In Bahmani et al. study, cognitive-existential group therapy was effectiveness on increasing hope and decreasing depression in women;[39] it is similar to our results.

Limitation

One of the most important limitations of this study was the small sample size and lack of attention to various groups of individuals and the lack of follow-up. This research was carried out on educated homemakers in the city of Neyshabur, Iran, so that it is not possible to generalize the results to all women in society, so it is suggested that research on men and women with different occupations and different social levels be implemented so that the results can be generalized to different groups.

Offers

It is suggested that mental health professionals in the field of working with homemakers, mainly educated homemakers, emphasize on existential issues to help these people changing their attitudes to life and self-flourishing and as a result, solving their problems.

Conclusions

The results of this study emphasize that existential group therapy is effective in attitude to Life, and self-flourishing of educated homemakers. This therapy can also be used to enhance individual and social abilities the importance and impact of existential psychotherapy on enhancing capabilities such as a positive attitude to life and self-flourishing. By applying the suggested therapeutic approach on people who are involved with different issues, they can be helped to show better performance in life problems and reach a higher level of mental health. Psychotherapists and counselors can used this approach to increase the spirituality among educated homemakers.

Financial support and sponsorship

This study was financially supported by Neyshabur Azad University, Iran.

Conflicts of interest

There are no conflicts of interest.