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| From
the Editor |
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Editorial
A. Abyad (Chief Editor) |
|
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........................................................
In Memoriam
Professor
Orhan Ekrem Müftüoglu
|
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Original
Contribution / Clinical Investigation
|
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Cholelithiasis
and cholecystectomy may lower the low density
lipoprotein cholesterol in plasma
DOI: 10.5742/MEWFM.2017.93010
[pdf
version]
Mehmet Rami Helvaci, Mursel Davarci, Orhan Veli
Ozkan, Ersan Semerci, Abdulrazak Abyad, Lesley
Pocock
Serum
and follicular fluid vitamin D and follicular
response among infertile women undergoing ICSI
DOI: 10.5742/MEWFM.2017.93011
[pdf
version]
Sedighe Esmaeilzadeh, Maryam Aliasgharpour,
Parvaneh Mirabi, Azita Ghanbarpour
Maede Fasihian
Studying
the relation of quality of work life with socio-economic
status and general health among the employees
working in Students Welfare Fund of Ministry
of Health and Medical Education in 2016
DOI: 10.5742/MEWFM.2017.93012
[pdf
version]
Saeed Reza Azami, Nasrin Shaarbafchizadeh, Soheil
Mokhtari, Ali Maher
On the Effect
of Cognitive Behavioural Counseling on Sexual
Satisfaction of Mothers with Autistic Children:
A Randomized Clinical Trial
DOI:
[pdf version]
Leila Arbil, Mitra Kolivand, Farzaneh Golboni,
Effat MerghatiKhoei, Mansour Rezaei
Pre-operative
sublingual misoprostol and intra-operative blood
loss during total abdominal hysterectomy: a
randomized single-blinded controlled clinical
trial
DOI: 10.5742/MEWFM.2017.93013
[pdf
version]
Taravat Fakheri, Tayebe Noori
Investigating
the Effect of Endotracheal Tube Cuff Pressure
on Sore Throat, Hoarseness and Cough in Patients
with Coronary Artery Bypass Surgery
DOI: 10.5742/MEWFM.2017.93014
[pdf
version]
Ali Akbar Vaezi, Mohammad Hassan Mondegari Bamakan
Comparing
the Self-Esteem and Resiliency between Blind
and Sighted Children and Adolescents in Kermanshah
City
DOI: 10.5742/MEWFM.2017.93015
[pdf
version]
Saeedeh Bakhshi, Nafiseh Montazeri , Babak Nazari,
Arash Ziapour, Hashem Barahooyi,
Fatemeh Dehghan
|
........................................................
Population
and Community Studies
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|
Frequency
of Uric Acid Levels, Symptomatic and Asymptomatic
Hyperuricemia among the Pakistani Population
DOI: 10.5742/MEWFM.2017.93016
[pdf
version]
Waris Qidwai, Masood Jawaid
Determinants
of Tooth Brushing among Primary School Students
DOI: 10.5742/MEWFM.2017.93017
[pdf
version]
Mohammad Mahboubi, Mohammad Ismail Motlagh,
Mehdi Mirzaei-Alavijeh, Farzad Jalilian, Hassan
Gharibnavaz,
Mohammad Fattahi
Depression
in patients suffering from gender dysphoria:
The hospitalized patients of Legal Medicine
Center in Southwest of Iran
DOI: 10.5742/MEWFM.2017.93018
[pdf
version]
Zahra Gorjian, Mohammad Zarenezhad, Mohhamad
Mahboubi, Saeid Gholamzadeh,
Nahid Mahmoodi
An epidemiological
study of suicide attempts and to determine the
correlation between attempted suicide causes
and demographic characteristics of people in
Kermanshah Province during a year
DOI: 10.5742/MEWFM.2017.93019
[pdf
version]
Hamid Reza Shetabi, Samira Rostami, Mohsen Mohammadi,
Mahsa Cheleii, Lida Saedi, Saba Amiri Nasab,
Shirin Zardui GolAnbari
The
effectiveness of life skills training on happiness,
mental health, and marital satisfaction in wives
of Iran-Iraq war veterans
DOI: 10.5742/MEWFM.2017.93038
[pdf
version]
Kamal Solati
The
Role of Self-Compassion Factors in Predicting
the Marital Satisfaction of Staff at Kermanshah
University of Medical Sciences
DOI:10.5742/MEWFM.2017.93020
[pdf
version]
Parisa Janjani, Lida Haghnazari, Farahnaz Keshavarzi,
Alireza Rai
Mediating
role of irrational beliefs in the relationship
between the quality of family communication
and marital satisfaction
DOI:10.5742/MEWFM.2017.93021
[pdf
version]
Parisa Janjani, Khodamorad Momeni, Alireza Rai,
Mohammad Reza Saidi
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........................................................
Review Article
........................................................
International Health
Affairs
........................................................
Education
and Training
........................................................
Clinical
Research and Methods
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Adaptive
LASSO Logistic Regression applied on gene expression
of prostate cancer
DOI: 10.5742/MEWFM.2017.93028
[pdf version]
Amir Hossein Hashemian, Maryam Ghobadi Asl,
Soodeh Shahsavari, Mansour Rezaei,
Hadi Raeisi Shahraki
The
prevalence of brain and neck injuries in patients
with maxillofacial fractures in teaching hospitals
of Rasht in 2016
DOI: 10.5742/MEWFM.2017.93029
[pdf
version]
Seyed Mohammad Talebzadeh, Ali Khalighi Sigaroudi,
Babak Alijani, Safa Motevasseli,
Saied Dashtyari, Mahsa Shariati, Zeinab Davoudmanesh
Cultural
competency: a concept analysis in TUMS (Tehran
University of Medical Science) DOI:
10.5742/MEWFM.2017.93030
[pdf version]
Foruzan Khatamidoost, Mandana Shirazy, Hamid
Khankeh, Nemat Allah Musapour
Majid Sadeghi, Kamran Soltani Arabshahi
The
Effect of Proprioceptive Neuromuscular Facilitation
(PNF) on Activities of Daily Living of client
with Cerebrovascular accident
DOI: 10.5742/MEWFM.2017.93031
[pdf
version]
Najafi Doulatabad Shahla, Afrasiabifar Ardashir,
Parandvar Yaghoub
Evaluation
of the ratio of T helper 17 and T regulatory
cells in patients with chronic idiopathic urticaria
DOI: 10.5742/MEWFM.2017.93032
[pdf
version]
Hossein Shahriari, Farahzad Jabbari, Seyyed
Abdolrahim Rezaee, Houshang Rafatpanah
Majid Jafari, Reza Farid Hosseini, Majid Asadi-Samani
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Model
and System of Primary Care
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Case
Series and Case Reports
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Chief
Editor -
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Abyad
MD, MPH, MBA, AGSF, AFCHSE
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|
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| September 2017
- Volume 15, Issue 7 |
|
|
On the Effect of Cognitive
Behavioural Counseling on Sexual Satisfaction
of Mothers with Autistic Children: A Randomized
Clinical Trial
Leila
Arbil (1)
Mitra Kolivand
(2)
Farzaneh Golboni
(2)
Effat MerghatiKhoei
(3)
Mansour Rezaei
(4)
(1) Nursing
and Midwifery Faculty, Kermanshah University
of Medical Sciences, Kermanshah, Iran
(2) Department of Midwifery, Nursing and Midwifery
Faculty, Kermanshah University of Medical Sciences,
Kermanshah, Iran
(3) Iranian National Center for Addiction Studies
(INCAS), Tehran University of Medical Sciences,
Tehran Iran
(4) Fertility and Infertility Research Center,
Kermanshah University of Medical Sciences, Kermanshah,
Iran
Correspondence:
Farzaneh Golboni, Msc,
Department of Midwifery, Nursing and Midwifery
Faculty,
Kermanshah University of Medical Sciences,
Kermanshah Iran
Email: Farzanehgolboni@kums.ac.ir
|
Abstract
Introduction: Sexual
satisfaction is one of the important factors
affecting the quality of marital life
which seems to be significantly decreasing
among parents with autistic children.
Goal: the
present study aimed to determine the effect
of cognitive-behavioral counseling on
sexual satisfaction of mothers with children
with autism in Qom province in 2016-2017.
Methods:
It was a randomized, single-blinded clinical
trial. Samples of the study included all
mothers with autistic children who were
referred to the autism center of Qom province,
Iran. According to the criteria of entry
and exit, 30 mothers were selected and
the research was explained to them and
they signed written consents. Samples
were randomly divided to intervention
and control groups (n=15). The samples
in both groups completed the Linda Berg
and Karst sexual satisfaction questionnaire
before the intervention, and answered
demographic questionnaire. The intervention
took place at the Autistic center in Qom,
Iran for 8 sessions of 90 minutes. At
the end of the third step of evaluation,
the control group received a training
program. At the end of counseling sessions,
both groups received post tests immediately
after finishing the program and four weekslater.
Gathered data were analyzed using SPSS
19. Wilcox on test, paired t-test and
Mann-Whitney test were also used for further
analysis of data.
Results:
Results from the analysis showed meaningful
changes in sexual satisfaction mean scores
of mothers with autistic children in the
intervention group after receiving cognitive-behavioral
counseling sessions compared to the control
group. It was suggested that cognitive-behavioral
counseling improved samples sexual satisfaction
(P<0.001).
Conclusion:
Results showed that cognitive behavioral
counseling increased the sexual satisfaction
of women with autistic children. Consequently,
paying special attention to these women,
especially in the area of sexual satisfaction,
could increase their satisfaction of marital
relationships, their longevity and their
attempts to care for such children.
Key words:
cognitive-behavioral counseling, sexual
satisfaction, autism, mothers
|
Sexual satisfaction is the emotional response
that results from a person’s subjective
assessment of positive and negative dimensions
of intercourse [1]. Sexual satisfaction is one
of the important factors in satisfying marital
life, and usually those who have more sexual
satisfaction report a better quality of life
than those who report no sexual satisfaction[2].
One of the factors influencing women’s
sexual satisfaction is chronic diseases and
conditions of children, including autism, causing
major confusion in marital life. Autism is one
of the most common psychiatric disorders in
children affecting one in every 50 live births;
it is defined as a disorder characterized by
a variety of developmental disorders, usually
associated with delays or problems in cognitive,
social, emotional, verbal, sensory and motor
skills [4]. Due to many physical and psychological
problems of autistic children, including communication
disorders, restlessness, behavioral stereotypes,
etc., having these children in the family is
a very big and stressful experience for parents
that can lead to anxiety, distress, and persecution
between the couple. Although the autistic child’s
parents experience these crises, since in most
societies mother has the responsibility of the
child’s physical and mental care, mothers
with autistic children face more complex challenges
and problems after giving birth to a child with
autism; they may even be partially socially
excluded [5-7]. Several reasons could justify
such stress and dissatisfaction among mothers
with autistic children, such as reducing the
stimulus and pleasure of interpersonal interactions,
the emergence of interpersonal problems especially
between mother and father, reducing the total
pleasure and satisfaction of women from life
or shifting the pleasure to child care, which
may lead to mothers’ self-neglect [6-8].
Singan et al. (2010) reported divorce rates
of 13.8 % and 23.5% among parents without and
with autistic children, respectively [9]. Therefore,
it seems that mothers with autistic children
require counseling in a variety of contexts
as well as sexual satisfaction in order to survive
and improve their quality of life.
Shorfen Gaue et al. (2010) showed that parents
with children with autism suffer from a higher
mental burden than normal children’s parents
[10]. Mothers of these children showed less
marital satisfaction, love, coherence and family
cohesion than their fathers. Tavakolizadeh et
al. (2013), Hesam Khageh et al. (2013), Nemati
et al. (2012) and Hoyer et al (2009) investigated
the effect of cognitive-behavior counseling
on satisfaction, marital quality and sexual
dysfunction and reported that a significant
number of clients had improved after counseling,
indicating a significant difference and effect
on subjects’ disorder [11-14].
Different approaches and methods have been
used while counseling on sexual satisfaction.
Cognitive-behavioral counseling is known as
an effective approach in treatment of sexual
dysfunction [15]. As a result, cognitive-behavioral
counseling can be helpful to increase sexual
satisfaction and improve the quality of life
of mothers with autistic children.
A significant increase in the prevalence of
autism disorder in the last three decades has
motivated many studies in the field to acquire
a better understanding of biological and genetic
symptoms associated with the causality and incidence
of autism. However, limited research has been
conducted on the relationship between the symptoms
of this disease and family functioning. Regarding
the role of sexual satisfaction in couples’
pleasure and increasing their physical and mental
potentials to deal with the problems of autistic
children on one hand and considering the human
rights of women for having a pleasant sexual
relationship, the researcher conducted a study
on the effectiveness of cognitive-behavior counseling
on sexual satisfaction of mothers with autistic
children in 2016 and 2017.
It was a randomized, single-blinded clinical
trial. Being approved by the Ethics Committee
number IR.KUMS.REC.1395.538 in Kermanshah University
of Medical Sciences research center, and submitted
in clinical trial center number IRCT2016111130830N1,
the present study investigated mothers with
autistic children referring to autism centers
in Qom, Iran. 30 mothers were randomly selected
and divided into intervention and control groups
(n=15). Using the formula for estimating sample
size for comparing two ratios in two groups
and considering parameters such as confidence
interval %95 (1-), test power of 90% (1-) and
other parameters of this formula, sample size
was defined based on the results from a similar
study by Nemati et al. [13]. Participants in
the control and intervention groups were selected
using random assignment method in different
autism centers since mothers with autistic children
attending a same center showed a strong relationship
for their common problems. It was hypothesized
that if the participants in the two groups attended
the same center, there would be a possibility
to transfer information. Easy and random sampling
was used to choose participants as mothers attending
the centers on even days were set in the counseling
group and those referring on odd days were set
in the control group. Randomized placement with
cards A and B was used to select intervention
and control groups. In order to hide the randomization
process, a research collaborator (a staff member
at the Autism Centers) was requested to run
sampling and do group assignments without knowing
the nature of the cards A and B to select participants
in intervention or control groups. In this study,
the research fellow was in charge of the randomization
and concealment of allocation and implementation
was carried out by the researcher. Blinding
the study was performed by data analyzer so
that the subjects of intervention and control
groups were identified by the codes (for example,
1 and 2) while the analyzer was not aware of
the subject matter of the codes. Recalling in
the autism centers of Qom, 30 qualified mothers
interested in participating in this research
were selected, and were informed about the goals
of the plan. They signed consent to their participation
in the study. The criteria for entering the
study included: age range of 25-45, non-pregnancy,
non-use of psychotropic drugs, non-use of psychosocial
drugs, non-addiction, education at least at
guidance school, fluent in Persian, living with
a spouse, no history of psychiatry and depression
requiring treatment, no history of psychosis
or suicide, having no suicidal thoughts or severe
neuropsychiatric disorders, not attending relaxation
courses, yoga, etc., having a 5-year-old child
with severe autism (certified by a psychiatrist
or certified therapist of autism center or accredited
university centers), lack of sexual dissatisfaction
before giving birth to an autistic child. Exit
criteria included: mothers who had complete
sexual satisfaction according to the results
from Linda Leaf sexual satisfaction questionnaire,
being absent in two or more sessions of counseling
sessions, lack of consent of the individual
to continue participating in the study. Participants
of both groups completed the Linda Berg and
Krast Sexual Satisfaction Questionnaire and
the demographics form before and after the intervention.
The intervention group received 8 sessions of
personal cognitive-behavioral consulting each
lasting for 90 minutes in Qom autism centers
in Winter and Spring 2016 (Table 1).
Click here for Table
1: Cognitive-behavioral consulting sessions
The major goals of consulting sessions included
cognitive restructuring, reforming distorted
cognitive thoughts and training exercises and
techniques. After the end of the third step
of the assessment, the control group also received
an educational program. The post test was offered
to both groups immediately at the end of program
and four weeks after the intervention. LindaBerg
and Karst questionnaire included 17 items and
responses were in form of a Likert scale (totally
agree=5 to totally disagree=1). Maximum and
minimum scores in the test were 17 and 85, respectively.
The questionnaire was developed by Linda Berg
and Karst in 1997, and its validity and reliability
was confirmed by Salehifadri in Iran [16]. Hosseini
(2002) confirmed the reliability of sexual satisfaction
questionnaire using Cronbach’s alpha coefficients
(r=0.83); also, Noorani et al. (2008) made use
of test-retest process to confirm its reliability
(r=0.89) [17, 18]. SPSS 19 was used to analyze
the data. Descriptive statistics (mean and standard
deviation) and inferential statistics were used
to test the hypotheses. Wilcoxon test, paired
t-test and Mann-Whitney test were used to compare
the mean scores of groups before and after the
intervention.
There
were
15
participants
in
intervention
and
control
groups
and
the
total
number
of
participants
equaled
30.
The
mean
and
standard
deviation
of
mothers’
age
in
the
intervention
group
and
in
the
control
group
were
31.33
±
0.6
and
31.07
±
0.62,
respectively.
The
mean
and
standard
deviation
of
the
age
of
the
child
with
autism
in
the
intervention
and
control
groups
were
1.85
±
8.2
and
0.33
±
5.8
years,
respectively.
The
mean
and
standard
deviation
of
the
children
in
the
intervention
group
were
0.131
±
1.6
and
in
the
control
group
0.131
±
1.6.
There
were
no
significant
differences
between
the
intervention
and
control
groups
which
suggested
similar
demographic
data
among
both
groups
(Tables
2
and
3
-
next
page).
There
was
no
significant
difference
between
the
mean
of
sexual
satisfaction
before
the
cognitive
behavioral
counseling
in
intervention
and
control
groups.
However,
there
was
a
significant
difference
reported
between
the
mean
score
of
sexual
satisfaction
after
one
month
of
cognitive-behavioral
counseling
in
both
interventional
and
control
groups
(Table
4).
Click
here
for
Table
2:
Absolute
and
relative
frequency
of
demographic
variables
of
research
units
Table
3.
Qualitative
comparison
of
intervention
and
control
groups
Table
4.
Comparison
of
sexual
satisfaction
before,
after
and
one
month
after
intervention
in
intervention
and
control
groups
*
Mann-Whitney
test
The
results
of
the
present
study
showed
a
significant
difference
in
the
level
of
sexual
satisfaction
of
mothers
with
autistic
children
in
the
intervention
group
before,
immediately
after
and
one
month
after
counseling,
which
could
indicate
the
influence
of
cognitive-behavioral
counseling
on
increasing
sexual
satisfaction;
however,
sexual
satisfaction
was
not
significantly
different
in
the
control
group
before,
immediately
after
counseling
and
follow
up
one
month
later.
While
reviewing
the
related
literature,
no
specific
study
was
conducted
on
the
sexual
satisfaction
of
women
with
autistic
children
and
advice
to
improve
their
condition.
Several
studies
made
use
of
cognitive-behavioral
counseling
to
investigate
sexual
satisfaction
of
women
without
autistic
child,
including
Nemati
et
al.
(2012)
and
Mofid
and
colleagues
(2014)
that
suggested
increased
sexual
satisfaction
in
the
intervention
group
using
cognitive-behavioral
counseling
(P<0.05,
p<0.05)
[15,
19].
Also,
Hoyer
et
al.
(2009)
showed
that
sexual
dysfunction
in
most
patients
decreased
by
63.2%
after
attending
cognitive-behavioral
counseling.
Tavakolizadeh
et
al.
(2012)
reported
that
cognitive
behavioral
education
was
effective
in
increasing
the
marital
satisfaction
scores
from
intervention
group
compared
to
control
group
(p
=
0.038)
(p
=
0.038)
[11],
and
Hesam
Khageh
et
al.
(2013)
suggested
that
the
counseling
was
influential
on
quality
of
marital
life
and
subscales
of
sexual
satisfaction,
sexual
excitement,
marital
satisfaction
and
love
(p
<0.05)
[12];
the
results
of
these
studies
indicated
that
cognitive-behavioral
counseling
techniques,
including
participatory
education
on
cognitive-behavioral
approach
with
emphasis
on
sexual
behaviors,
knowing
about
the
negative
thoughts
and
beliefs
on
sexual
behaviors
and
belief
in
these
thoughts,
getting
to
know
about
self-help
thoughts
on
sexual
behaviors,
study
the
verifiable
evidence
and
rejecting
negative
beliefs
on
sexual
behaviors,
training
first-type
sensory
concentration,
second-type
sensory
concentration
training,
relaxation
techniques
and
muscle
relaxation,
may
have
improved
women’s
sexual
satisfaction
and
had
positive
effects
on
spouses,
especially
in
relation
to
sexual
relations,
and
marital
satisfaction.
Considering
the
results
of
previous
studies
and
this
study,
it
can
be
concluded
that
cognitive-behavioral
approach
was
effective
on
knowledge,
attitude,
self-confidence,
sexual
self-expression,
etc.
In
this
approach,
behavioral
exercises
for
individuals
are
not
merely
physical
and
mechanical
factors,
but
they
can
influence
the
emotions
and
thoughts
of
individuals.
For
example,
sensory
concentration
exercises
in
sessions
enhances
responsive
responses,
prevents
unwanted
tensions
and
anxiety,
affects
the
relationship
with
the
spouse,
and
couples
improve
their
emotional
relationships.
This
approach
helps
people
express
their
sexual
excitement
freely
about
the
wishes,
interests,
sexual
needs
and
preferences
of
physical
contact.
In
the
cognitive-behavioral
approach,
attention
is
paid
to
the
negative,
maladaptive
and
irrational
beliefs,
thoughts,
and
cognitive
understandings
of
the
individuals,
and
it
is
favorable
to
replace
these
maladaptive
notions,
guilt
feelings,
or
unconscious
fears
with
proper
cognitions
[11-14,
19].
Most
mothers
with
autistic
children
lack
the
ability
to
focus
on
pleasures
and
sexually
pleasing
thoughts
due
to
their
child’s
problems.
Having
thoughts,
beliefs,
attitudes,
and,
in
general,
disturbing
sexual
incompatibility
and
irrational
knowledge,
having
thoughts
that
are
not
related
to
sexual
issues
(such
as
worry
about
the
child)
could
prevent
sexual
satisfaction
[6,
8].
Therefore,
it
is
clear
that
parents
with
autistic
children
need
to
pay
attention
to
cognitive
factors
to
treat
their
sexual
problems,
and
the
lack
of
attention
to
it
reduces
therapeutic
goals.
Results
suggested
that
cognitive-behavioral
counseling
increased
sexual
satisfaction
of
women
with
autistic
children.
Careful
attention
to
these
women,
especially
in
terms
of
sexual
satisfaction,
could
lead
to
increased
satisfaction
with
marital
relationships,
life
expectancy
and
better
care
for
such
children.
The
limitation
of
this
study
included
studying
women
with
autistic
children
since
it
was
not
possible
to
conduct
the
study
on
men
by
female
researcher
due
to
the
religious
nature
of
Qom
and
the
importance
of
gender
homogeneity
and
the
specific
nature
of
the
topic.
We
hope
that
the
present
study
provides
the
basis
for
full
interventions
on
couples.
A
strength
to
the
present
study
was
that
it
was
one
of
the
few
studies
that
addressed
one
of
the
basic
needs
of
families
and
couples,
namely,
sexual
satisfaction.
Acknowledgment
The
present
study
was
driven
from
master’s
thesis
in
midwifery
counseling.
Hereby,
the
researcher
appreciates
all
who
collaborated
in
the
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