Effectiveness of Cognitive-Behavioral Therapy and Mental Imagery on Hope and Self-Efficacy of Patients with Leukemia and Lymphoma





Cognitive behavioral therapy, Imagery, Hope, Self-efficacy, Cancer


Background: Cancer treatment accompanies several psychological pressures some of which reduce the quality of life and cause anxiety and depression. The present study aimed to investigate the effectiveness of cognitive-behavioral therapy and mental imagery on the hope and self-efficacy of patients with leukemia and lymphoma.

Methods: The research method was quasi-experimental with a pretest-posttest design and a control group. The statistical population of this study consisted of all male and female patients with leukemia and lymphoma visiting the hematology department of Ayatollah Rouhani Hospital of Babol in 2019. Of them, 45 patients (15 per group) were selected using convenience sampling and randomly assigned to two experimental groups and a control group. The first experimental group received eight 90-minute sessions of individual cognitive behavioral therapy and the second experimental group received ten 90-minute sessions of mental imagery. The control group received no intervention. The research instruments included the Miller Hope Scale (MHS) and Cancer Behavior Inventory (CBI). Data were analyzed using the analysis of covariance.

Results: Findings suggested that cognitive-behavioral therapy and mental imagery have a significant effect on patients’ self-efficacy and hope (Pvalue<0.001). There was no significant difference between the effectiveness of the two therapies.

Conclusions: Considering the effectiveness of the therapies, they are suggested to be utilized extensively along with medical and clinical interventions to improve the psychological well-being of cancer patients.

Keywords: Cognitive behavioral therapy, Imagery, Hope, Self-efficacy, Cancer


1. Mendoza ME, Capafons A, Gralow JR, Syrjala KL, Suárez-Rodríguez JM, Fann JR, et al. Randomized controlled trial of the Valencia model of waking hypnosis plus CBT for pain, fatigue, and sleep management in patients with cancer and cancer survivors. Psychooncology. 2017;26(11):1832-8.
2. Khojaste Kashani A, Kooshki S, Kazemi AS,Khajevand Khoshli A. Structural equation modeling of relationshipsbetween social support, self-efficacy, and quality of life in patients withheart failure. Int J Health Stud 2020;6(3):29-34.
3. Periyakaruppan M, Kumar S, Kandasamy S, Sangaralingam T, Srinivasan S, Thiagarajan A, et al. COVID Abdomen: SARS-CoV-2 Infection Presenting as 'Acute Abdomen' in a Child. Indian J Pediatr. 2021;88(3):299-300.
4. Conway MF, Pantaleao A, Popp JM. Parents’ Experience of Hope When Their Child Has Cancer: Perceived Meaning and the Influence of Health Care Professionals. Journal of Pediatric Oncology Nursing. 2017;34(6):427-34.
5. Hashemzadeh S, Borjali M, Hasani Abharian P. Biological Stress Indicators based on Perceived Stress mediated by Emotional Regulation among Patients with Gastrointestinal Cancer: A Structural Equation Modeling. Razavi International Journal of Medicine. 2021;9(2):9-15.
6. Merluzzi TV, Pustejovsky JE, Philip EJ, Sohl SJ, Berendsen M, Salsman JM. Interventions to enhance self-efficacy in cancer patients: A meta-analysis of randomized controlled trials. Psychooncology. 2019;28(9):1781-1790.
7. Baik SH, Oswald LB, Buitrago D, Buscemi J, Iacobelli F, Perez-Tamayo A, et al. Cancer-Relevant Self-Efficacy Is Related to Better Health-Related Quality of Life and Lower Cancer-Specific Distress and Symptom Burden Among Latina Breast Cancer Survivors. International journal of behavioral medicine. 2020;27(4):357-65.
8. Huguet A, Rao S, McGrath PJ, Wozney L, Wheaton M, Conrod J, et al. A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression. PLoS One. 2016;11(5):e0154248.
9. Hyland KA, Nelson AM, Eisel SL, Hoogland AI, Ibarz-Pinilla J, Sweet K, et al. Fatigue Perpetuating Factors as Mediators of Change in a Cognitive Behavioral Intervention for Targeted Therapy-Related Fatigue in Chronic Myeloid Leukemia: A Pilot Study. Ann Behav Med. 2021.
10. Teo I, Tan YP, Finkelstein EA, Yang GM, Pan FT, Lew HYF, et al. The Feasibility and Acceptability of a Cognitive Behavioral Therapy-Based Intervention for Patients with Advanced Colorectal Cancer. J Pain Symptom Manage. 2020;60(6):1200-7.
11. Lang H, France EF, Williams B, Humphris G, Wells M. The existence and importance of patients' mental images of their head and neck cancer: A qualitative study. PLoS One. 2018;13(12):e0209215.
12. Sinha MK, Barman A, Goyal M, Patra S. Progressive Muscle Relaxation and Guided Imagery in Breast Cancer: A Systematic Review and Meta-analysis of Randomised Controlled Trials. Indian J Palliat Care. 2021;27(2):336-344.
13. Whitaker KL, Brewin CR, Watson M. Imagery rescripting for psychological disorder following cancer: a case study. Br J Health Psychol. 2010;15(Pt 1):41-50.
14. Charalambous A, Giannakopoulou M, Bozas E, Marcou Y, Kitsios P, Paikousis L. Guided Imagery and Progressive Muscle Relaxation as a Cluster of Symptoms Management Intervention in Patients Receiving Chemotherapy: A Randomized Control Trial. PLoS One. 2016;11(6):e0156911.
15. Miller JF, Powers MJ. Development of an instrument to measure hope. Nursing Research, 1988; 37: 6–10.
16. Abdi N, Asadi-Lari M. Standardization of Three Hope Scales, as Possible Measures at the End of Life, in Iranian Population, Int J Cancer Manag. 2011; 4(2):e80732.
17. Merluzzi TV, Philip EJ, Heitzmann Ruhf CA, Liu H, Yang M, Conley CC. Self-efficacy for coping with cancer: Revision of the Cancer Behavior Inventory (Version 3.0). Psychol Assess. 2018;30(4):486-499.
18. Karamoozian M, Kalantari Khandani B, Bagheri M, Dehghanifar F, Darekordi A. Assessing Self-efficacy for Coping with Cancer: Psychometric Analysis of the Cancer Behavior Inventory (CBI). Iranian Journal of Breast Diseases. 2019;12(4):8-20
19. Zhang P, Mo L, Torres J, Huang X. Effects of cognitive behavioral therapy on psychological adjustment in Chinese pediatric cancer patients receiving chemotherapy: A randomized trial. Medicine (Baltimore). 2019;98(27):e16319.
20. Sheikhzadeh M, Zanjani Z, Baari A. Efficacy of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy for Anxiety, Depression, and Fatigue in Cancer Patients: A Randomized Clinical Trial. Iran J Psychiatry. 2021;16(3):271-280.
21. Daniels S. Cognitive Behavior Therapy for Patients with Cancer. J Adv Pract Oncol. 2015;6(1):54-56.
22. Sun H, Huang H, Ji S, Chen X, Xu Y, Zhu F, et al. The Efficacy of Cognitive Behavioral Therapy to Treat Depression and Anxiety and Improve Quality of Life Among Early-Stage Breast Cancer Patients. Integr Cancer Ther. 2019;18:1534735419829573-.
23. Shahlapour S, Sedaghat M, Pashang S. Comparison of the Effect of Lazarus Multimodal Approach and Cognitive-Behavioral Therapy on Psychological Distress, Working Memory, and Anxiety in Patients with Multiple Sclerosis. Razavi International Journal of Medicine. 2021;9(3):5-12.
24. Kucherer S, Ferguson RJ. Cognitive behavioral therapy for cancer-related cognitive dysfunction. Curr Opin Support Palliat Care. 2017;11(1):46-51.
25. Pop CA, Tiba AI. Mental imagery, optimism, and self-efficacy: The role of imagery perspective and imagery modality in positive cognition. Romanian Journal of Applied Psychology. 2019;21(2):35-43.
26. Pearson J. The human imagination: the cognitive neuroscience of visual mental imagery. Nat Rev Neurosci. 2019;20(10):624-634.
27. Conway MF, Pantaleao A, Popp JM. Parents’ Experience of Hope When Their Child Has Cancer: Perceived Meaning and the Influence of Health Care Professionals. Journal of Pediatric Oncology Nursing. 2017;34(6):427-34.







How to Cite

Effectiveness of Cognitive-Behavioral Therapy and Mental Imagery on Hope and Self-Efficacy of Patients with Leukemia and Lymphoma. (2022). International Journal of Health Studies, 9(1), 7-11. https://doi.org/10.22100/ijhs.v9i1.940