823765

research-article2019
JAO0010.1177/0391398818823765The International Journal of Artificial OrgansBargiel-Matusiewicz et al.

IJAO The International

Journal of Artificial
Organs
Original research article

The International Journal of Artificial

The positive influence of psychological

Organs
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© The Author(s) 2019
intervention on the level of anxiety Article reuse guidelines:
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and depression in dialysis patients: https://doi.org/10.1177/0391398818823765

DOI: 10.1177/0391398818823765
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A pilot study

Kamilla Bargiel-Matusiewicz, Agnieszka Łyś

and Paulina Stelmachowska

Abstract
Medical progress in dialysis therapy made it possible to treat patients with the end-stage renal disease for many years. But
at the other side it may lead to profound changes in everyday life and may induce depression and anxiety. The research
presented in this article explores the influence of psychological interventions on anxiety and depression levels in patients
undergoing dialysis therapy. The experimental design included two experimental groups: cognitive intervention and
cognitive/narrative intervention and one control group (standard treatment). In total, 139 participants aged 22–75,
including 67 women and 72 men diagnosed with end-stage renal disease and treated with dialysis, were divided into a
control group and two experimental groups. Two well-known tools were used in the study: Beck Depression Inventory
and State-Trait Anxiety Inventory. It was indicated that cognitive intervention may decrease the level of anxiety as a
state, whereas cognitive/narrative intervention may decrease the level of anxiety as a state and the level of depression
in dialysis patients. The stronger effect in the case of using narrative therapy may be the consequence of the fact that
narrative therapy stimulates deeper analysis of the discussed issues (involving emotional level).

Keywords
Anxiety, depression, dialysis, psychological intervention, experimental procedure

Date received: 6 October 2018; accepted: 17 December 2018

Introduction deprived of a considerable external or internal value. In the

This article presents the issues of psychological aspects of
chronic somatic disease. Such a situation is a multidimen-
sional experience that is why the analysis of coping with its
consequences also requires a multidimensional approach.
Apart from following medical orders, it is very important
that individuals suffering from the disease suitably manage
their personal resources, for example, self-esteem, opti-
mism, and self-efficacy, to facilitate functioning on the
optimum level in the long term.1–4 Psychological care in
this regard is an important element of the interdisciplinary
approach. The psychological and social problems accom-
panying a treatment with the use of dialyses have many
aspects that are worth mentioning.
Dialyzed patients experience often a sense of loss. Loss
may be understood as a trauma connected with being
case of patients treated with repeated dialyses, there are a
lot of such elements. Losses refer to professional and social
position. A large percentage of dialyzed patients demon-
strate their anxiety and worry about the future. The reduced
financial status is a very significant problem which often
leads to further losses: the necessity to change the lifestyle
or habits, or resignation from hobbies. Losses concerning
people’s concept of self as well as changes in their concept
of self and self-confidence may be equally important.5–7
University of Warsaw, Warsaw, Poland
Corresponding author:
Kamilla Bargiel-Matusiewicz, University of Warsaw, Krakowskie
Przedmieście 26/28, Warsaw 00-927, Poland.
Email: kmatusiewicz@psych.uw.edu.pl
2 The International Journal of Artificial Organs 00(0)
The next issue is mood reduction and resignation atti-
tude. The symptoms that usually occur in depression gain
special significance in the case of patients treated with
dialyses. The loss of appetite in the case of these patients
may lead to quick occurrence of metabolic disorders.8,9
Determinants of mortality in patients treated using
hemodialysis include, for example, older age and nutri-
tional status.10,11 Psychosocial factors, such as depression
and anxiety, are also associated with mortality in dialysis
patients.11,12
Mood reduction may result in willingness to give up
treatment. McDade-Montez et al.13 found out that in the
period up to 4 years from the occurrence of depression
symptoms 18% of patients resigned from dialyses. There­
fore, depression symptoms are a significant early indica-
tion of bad prognosis as to survival of patients treated with
dialyses.
The prevalence of depression in patients undergoing
hemodialysis ranges from 5% to 30%, while in general
population the prevalence ranges from 3% to 5% in Poland.
Depressive/anxiety symptoms are found in up to 54%. The
occurrence of depressive symptoms frequently begins with
the onset of dialysis or ever earlier in with chronic kidney
disease of greater severity.11,14,15
Although elevated depressive and anxiety symptoms
are common in individuals with chronic kidney disease,
the use of treatment focusing on it is low.14
The study conducted by Kusztal et al.11 underscored the
fact that depression is an important psychosocial factor
affecting quality of life and survival in hemodialysis patients.
The article discusses two authorial psychological inter-
ventions: cognitive and cognitive/narrative. The interven-
tions are set in the cognitive theory of psychological stress,
contemporary research on narrative construction of reality,
and Erickson’s approach.
It is worth referring to the postulate formulated by
Diener and Lucas,16 Folkman and Moskowitz,17,18
Fordyce,19 Seligman et al.,20,21 and Folkman22 encouraging
to transfer more and more results of scientific research set
in the paradigm of psychological stress to practical influ-
ence on the groups of people experiencing the problem.
The authors highlight that the issue should be studied in
the context of specific situations and the findings and con-
clusions should be referred thereto.
This study has concerned patients undergoing dialysis
who experience the chronic stress, which is proved by
many studies taking into account psychological variables.
The modification of the level of anxiety and depression
was the aim of the psychological interventions presented
in this article. Many studies have shown that elevated lev-
els of depression and anxiety are the variables that often
negatively affect the quality of life of patients undergoing
dialysis.8,13,23
So far, only few studies on attempts to improve the
mental state of dialysis patients have been conducted. The
conclusions of these few attempts encourage further
research into this issue though.24,25 Indications on the ben-
eficial influence of psychological interventions are also
derived from the studies of other clinical groups.1,26 We
have had a hypothesis that the effect of the combined ther-
apy may be stronger than in the case of using only cognitive
therapy separately because narrative therapy may stimulate
deeper analysis of the discussed issues (involving emo-
tional level).
Material and methods
Participants
In total, 139 participants aged 22–75, including 67 women
and 72 men diagnosed with end-stage renal disease (ESRD)
and treated by dialysis, were randomly chosen from a wait-
ing list and divided into a control group and two experi-
mental groups.
Participation was voluntary and anonymous. The partici-
pants were not remunerated. Informed consent was obtained
from all individual participants included in the study.
The specific diagnoses of these ESRD patients were as
follows: diabetic nephropathy, hypertensive nephrosclero-
sis, and chronic glomerulonephritis. Patients meeting the
following criteria were eligible for inclusion: more than
6 months on dialysis, standard hemodialysis three times a
week, and no physical impairments that would prevent the
completion of the questionnaires. Exclusion criteria were
additional medical problems and antidepressive treatment.
The research project was accepted by the local Research
Ethics Committee at the Faculty of Psychology, University
of Warsaw.
The experimental procedure
Participation in the study was voluntary. The study
included people who responded to the advertisement
(describing the study) placed in the dialysis stations. These
people were entered on the waiting list. Then they were
randomly chosen from a waiting list and divided into a
control group and two experimental groups. Only one per-
son from the control group and two persons from experi-
mental group 1 have dropped out. The experimental design
included two experimental groups: cognitive intervention
and cognitive/narrative intervention and one control group
(standard treatment). All three groups at the same time
(pre–post design) completed the same research tools (Beck
Depression Inventory (BDI) and State-Trait Anxiety
Inventory (STAI)) twice.
The baseline testing before the start of the intervention
was carried out 10–14 days before. Measurement at the
end of the intervention was carried out 9–13 days after it.
Experimental group 1 was subjected to cognitive interven-
tion. Patients listened to a psychological intervention
Bargiel-Matusiewicz et al. 3
recorded on a CD twice a day for 4 weeks. The recording
was 20 min long. It included background music and thera-
peutic metaphors based on the principles of cognitive27,28
and Ericksonian29 therapy. Many authors confirm that
therapeutic metaphors can stimulate cognitive reconstruc-
tion of a difficult situation and thus reduce the emotional
burden.30,31 Therapeutic metaphors can provide an incen-
tive to divert attention to positive areas of personal experi-
ence. The reversal of unconstructive thoughts may be
effective in treating anxiety and depressive disorders.26
Three therapeutic metaphors were used. The first meta-
phor (birds hiding from rain) was used to raise among the
participants the awareness of values like freedom, ease,
and comfort, which they used to have in the periods
between dialyses. The analogy of rain and birds hiding
from it may, by reference to natural phenomena, also make
the situation of dialysis more neutral in perception. The
second metaphor (finding a mysterious letter that contains
advice on how to enjoy life) was used to illustrate to
patients the value of small, everyday pleasures and thus
increase the intensity of positive emotions. The third meta-
phor (walking among friendly people) aimed at raising the
awareness of the sources of social support.
Experimental group 2 was subjected to cognitive/narra-
tive intervention. Patients (like group 1) listened to a CD
with a recorded intervention twice a day for 4 weeks. In
addition, the second experimental group met a psycholo-
gist twice a week within those 4 weeks. Meetings lasted
approximately an hour, and each of them was dedicated to
a different subject. The following issues were discussed
during the meetings (in that order): analysis of the most
important areas in life; building their hierarchy; assess-
ment of the impact of disease and treatment on those areas;
analysis of one’s advantages and achievements; assess-
ment of the availability of social support; development of
small pleasures lists that can improve mood; and summary
of conclusions from each meeting. Analysis of these issues
has been implemented on the basis of assumptions con-
cerning the building of self-narration. Cognitive activity in
this area is considered an important factor in adapting to
difficult situations.
Narrative therapy may stimulate deeper analysis of the
discussed issues (involving emotional level) than in the
case of using only classical cognitive therapy.32,33
The control group did not participate in the psychologi-
cal intervention. These people were subject to standard
medical procedures during the experiment. They were
offered to participate in one of the psychological interven-
tion procedures after finishing the study procedure.
Assessment
Two well-known tools were used in this study: BDI34,35
and STAI developed by Spielberger et al.36,37 The question-
naires have good psychometric parameters. The following
values of Cronbach’s α: BDI—0.75, STAI Trait Anxiety—
0.84, and STAI State Anxiety—0.79 were recorded for the
research sample. The questionnaires were administered
both at baseline and post intervention.
Results
In order to conduct statistical analysis, IBM SPSS 24 sta-
tistical package was used (SPSS Inc., 2016). First, descrip-
tive statistics for the variables were analyzed. The main
analysis was performed with the use of analysis of vari-
ance (ANOVA).
Descriptive data
A total of 139 persons (67 women and 72 men aged 22–75,
M = 48.05, standard deviation (SD) = 8.74) that underwent
dialysis were examined, with experimental group 1 includ-
ing 46 people (22 women and 24 men aged 22–64,
M = 46.09, SD = 9.69), experimental group 2 including 45
people (23 women and 22 men aged 36–59, M = 48.44;
SD = 5.60) and the control group including 48 patients (22
women and 26 men aged 24–75, M = 49.56, SD = 9.94).
People from experimental group 1 were dialyzed for the
period ranging from 6  months to 22  years (M  = 
5.21,
SD = 5.13). Patients from experimental group 2 were dia-
lyzed from 7 months to 22 years (M = 5.46, SD = 5.58).
Patients from the control group were dialyzed from
7 months to 18 years (M = 3.81, SD = 3.91). The demo-
graphic characteristics were similar between the three
groups. Table 1 shows the frequency distribution for the
place of residence, the level of education, and the marital
status of the respondents. Most participants lived in a city
with the number of inhabitants larger than 1000, had sec-
ondary education, and remained in a stable relationship.
Table 2 shows the average values of depression and
anxiety in both stages of the measurement.
ANOVA models
In order to verify the effectiveness of the interventions, an
ANOVA with repeated measures and Bonferroni’s multiple
comparison tests were conducted. Measurements obtained
in the two stages were analyzed as a within-subject factor.
The belonging to one of the three compared groups was
analyzed as a between-subject factor. There were not base-
line differences in depression and anxiety between the
three groups. The effect of the interaction between belong-
ing to one of the compared groups and the difference
between the pre-test and the post-test was expected to be
statistically significant. The performed analyses were
related to the severity of depression and anxiety. It was
supplemented with the results of statistical significance
test of the interactive ANOVA with repeated measures
(Table 3).
4 The International Journal of Artificial Organs 00(0)

Table 1.  Frequency distribution—place of residence, educational level, and marital status in each of the three groups.

Experimental group 1 (%) Experimental group 2 (%) Control group (%)

Place of residence Village 32.6 37.8 31.3
City with less than 100 inhabitants 28.3 28.9 33.3
City with more than 100 inhabitants 39.1 33.3 35.4
Level of education Primary 4.3 2.2 2.1
Vocational 30.4 33.3 33.3
Secondary 39.1 42.4 39.6
Higher (incomplete) 8.7 8.9 4.2
Higher 17.4 13.3 20.8
Marital status Single 10.9 6.7 8.3
Divorced 4.3 4.4 8.3
Separated 6.5 11.1 6.3
In a stable relationship 65.2 66.7 68.8
Widowed 13 11.1 8.3

The chi-square test (2.353) demonstrates that the differences between the treatment groups in terms of place of residence, level of education, and
marital status are not statistically significant (p = 0.968).

Table 2.  Frequency distribution—place of residence,

p > 0.28). There was no significant correlation between
educational level, and marital status in the whole sample.
age and difference between the pre-test and post-test nei-
N % ther in the control group (r = –0.01, p = 0.95) nor in experi-
mental group 1 (r = –0.15, p = 0.36) and experimental group
Place of residence
 City with the number of inhabitants over 32 31.1
2 (r = –0.14, p = 0.36). The time of being dialyzed turned
100,000 out to be uncorrelated with the difference between the pre-
 City with the number of inhabitants from 30 29.1 test and post-test in the control group (r = 0.15, p = 0.32)
1000 to 100,000 and experimental group 1 (r = –0.18, p = 0.25). In experi-
 Small town with the number of inhabitants 41 39.8 mental group 2, the negative correlation has a tendency
less than 1000 toward statistical significance (r = –0.28, p = 0.07).
Level of education The average value of depression obtained in the post-
  Higher completed 15 14.6 test was lower than the average value obtained in the post-
  Higher professional  5 4.9 test, only in experimental group 2 (F(1, 42)  = 
45.20,
 Post-secondary 11 10.7 p < 0.05, η2  = 
0.52). Differences between pre-test and
 Secondary 46 44.7 post-test obtained in the control group (F(1, 40) = 0.109,
 Occupational 26 25.1 p > 0.05) and in experimental group 1 (F(1, 37) = 0.336,
Marital status p > 0.05) were not statistically significant. In the post-test,
 Stable relationship (marriage or informal 74 71.8
level of depression in experimental group 2 was lower in
relationship)
comparison to the control group (t(89) = 2.36, p < 0.03,
 Single 29 28.2
d = 0.05), as well as in comparison to experimental group 1
(t(84) = 2.51, p < 0.02, d = 0.05). The difference between
There were some changes in the level of anxiety as a the control group and experimental group 1 was not sig-
state and depression. In the control group, the average val- nificant (t(85) = –0.11, p > 0.99). In experimental group 2,
ues of anxiety as a state during the pre-test and post-test of we found also a significant, negative correlation between
measurement were similar (F(1, 45)  = 
1.33, p  > 0.05), age and level of anxiety as a state, both before and after
whereas in experimental group 1 (F(1, 41) = 7.82, p < 0.02, intervention (Tables 4 and 5).
η2 = 0.16) and experimental group 2 (F(1, 44) = 38.00,
p < 0.001, η2 = 0.46), the average value of anxiety as a
state was lower during the post-test than the pre-test. In the
Discussion
second stage of measurement, anxiety as a state in experi- The analysis showed that based on the obtained results it
mental group 2 was lower in comparison to the control can be concluded that both applied psychological interven-
group (t(91) = 4.93, p < 0.001, d = 0.10), as well as in com- tions had a positive impact on the patients’ mental state,
parison to experimental group 1 (t(87) = 5.32, p < 0.001, although cognitive/narrative intervention resulted in more
d = 0.11). The difference between the control group and pronounced effects. No statistically significant changes
experimental group 1 was not significant (t(90) = 1.07, were observed in the case of the control group.
Bargiel-Matusiewicz et al. 5

Table 3.  Interactive analysis of variance with repeated measures.

Variables Group Stage 1 Stage 2 F df p

M SD M SD
Depression Control 12.61 8.41 12.39 8.51 14.95 2; 119 <0.001
Experimental group 1 12.87 6.74 12.45 7.29
Experimental group 2 12.40 7.70 8.72 5.82
Anxiety as a Control 41.41 13.72 39.83 12.71 34.2 2; 130 <0.001
state Experimental group 1 41.69 11.38 37.38 7.64
Experimental group 2 38.38 12.46 29.69 6.63

SD: standard deviation.

Table 4.  Descriptive statistics for interval scales.

Experimental group 1 Experimental group 2 Control group

  M SD M SD M SD
Depression Pre-test 13.68 (7.16) 12.40 (7.70) 12.52 (8.33)
Post-test 12.17 (7.14) 8.69 (5.69) 12.15 (8.10)
Anxiety (state) Pre-test 41.25 (11.30) 38.38 (12.46) 41.41 (13.72)
Post-test 37.77 (7.68) 29.69 (6.63) 40.15 (12.59)

SD: standard deviation.

We managed to reduce the level of anxiety state. The
average values of the level of anxiety state in the first and
second measurements of the control group were similar to
each other, whereas in the first and second experimental
groups the mean severity of anxiety as a state was lower in
the second stage of measurement than in the first one.
However, the level of trait anxiety has not changed. The
fact of statistically significant changes in relation to the
anxiety state, in the absence of changes in trait anxiety, is
consistent with the assumptions of Spielberger’s37 con-
cept. This concept is based on the fundamental distinction
between anxiety understood as a relatively stable personal-
ity trait and anxiety understood as a transitional and situa-
tionally determined state of an individual. A major feature
of the definition of trait anxiety is its high stability over
time. There are no doubts that some forms of psychother-
apy may influence personality, for example, the level of
trait anxiety; however, we have used only a short form of
intervention.
In terms of the level of depression, its reduction was
observed as the effect of the cognitive/narrative intervention.
Among patients undergoing cognitive intervention and
patients in the control group, no change in the level of
depression was observed. We can say that only the use of
the expanded version of intervention (cognitive/narrative)
can change the level of depression. The level was lower at
the second stage than at the first one only in the second
experimental group. Differences between the first and sec-
ond measurements obtained in the control group and in the
first experimental group were not statistically significant.
Accordingly to these findings, we can say that only the
use of the expanded version of the psychological interven-
tion (cognitive/narrative) resulted in a decrease in the level
of depression. Beck’s27,28,38 depression questionnaire, used
in this study, is based on the concept of the designer.
According to its assumptions, the emotional component of
depression is a part of the clinical picture and, to a large
extent, is the result of the specificity of beliefs about one-
self and the world. Three main levels of cognition, within
which there is a distortion, are negative beliefs about one-
self, negative beliefs about the world around them and oth-
ers, as well as the negative expectations for the future.
Cognitive distortions occurring in the process of interpret-
ing the reality may contribute to a reduction in mood.39
The obtained results in this study suggest that constructive
changes occurred in the belief system of patients undergo-
ing the extended version of psychological intervention.
These studies, however, did not test directly the beliefs
associated with depression. Therefore, it can only indi-
rectly infer that some destructive beliefs of the patients
have been weakened as a result of the extended version of
psychological intervention. This conclusion results from
the assumptions of the cognitive concept of depression in
some way.27,38,40 Similar conclusions can be drawn from
the studies of coping with stress. The change of negative
beliefs about a given situation involves the reduction of
emotional tension.17,18,26,41–45
To sum up, it can be concluded that the cognitive/narra-
tive intervention affected the patients in a broader range
than the simpler option of intervention, the cognitive
6 The International Journal of Artificial Organs 00(0)

Table 5.  Correlations: age, time of being dialyzed (in months), anxiety, and depression.

Age Dialysis (in Before intervention After intervention

months)
  Anxiety Depression Anxiety Depression
Control group Age 1  
Time of being dialyzed 0.1 1  
Before intervention Anxiety –0.27* –0.05 1  
Depression –0.13 –0.04 0.53** 1  
After intervention Anxiety –0.2 –0.04 0.72** 0.57** 1  
Depression –0.01 –0.27 0.55** 0.78** 0.60** 1
Experimental Age 1  
group 1 Time of being dialyzed 0.07 1  
Before intervention Anxiety –0.07 –0.39** 1  
Depression 0.1 –0.17 0.64** 1  
After intervention Anxiety –0.06 –0.44** 0.58** 0.47** 1  
Depression 0.15 –0.17 0.64** 0.79** 0.61** 1
Experimental Age 1  
group 2 Time of being dialyzed 0.15 1  
Before intervention Anxiety –0.40** –0.11 1  
Depression 0.06 –0.09 0.59** 1  
After intervention Anxiety –0.44** 0.12 0.71** 0.44** 1  
Depression 0.08 –0.05 0.63** 0.91** 0.49** 1

*p < 0.05, **p < 0.01.

intervention. As mentioned before, cognitive/narrative
intervention, in addition to the effects associated with ther-
apeutic metaphors, refers to one’s ability to build
self-narration.
The topics that were discussed during the meetings with
patients in the second intervention are, for example, analy-
sis of the most important areas in life, building their hier-
archy, assessment of the impact of disease and treatment
on various areas, and analysis of one’s strengths and
achievements.
Analysis of these topics may promote the reconstruc-
tion of one’s own assessments of the situation. Many
authors also indicate that narrative structuring of impor-
tant experiences for the individual is a very important fac-
tor in the context of coping and adaptation to difficult
situations.32,33 We cannot conclude that the narrative ther-
apy component has contributed to the reduction in depres-
sion or anxiety. Probably, the interaction of cognitive
element and narrative element of intervention is the most
important factor.
Anyway, the conclusion of this research concerns the
possibility of improving the emotional state of patients
undergoing dialysis using psychological interventions.
The reduction of negative emotions and beliefs gives
the opportunity for meaningful activities that foster adap-
tation to chronic disease.42,46,47 Therefore, it can be con-
cluded that the forms of psychological help presented in
this article are worth recommending.
Our study has several limitations: the number of
respondents and lack of control group for the narrative
therapy. Our study can be treated as a pilot study (we have
changed the title of the article).
Further research is needed to clarify these preliminary
findings. Studies with more participants and with addi-
tional control group (participation in social interactions
which are not connected with described interventions, e.g.
educational program concerning neutral topics) are recom-
mended. A prospective longitudinal study would also pro-
vide better insights into time effects in the long-term
consequences of the described interventions.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Ethical approval
This study was carried out in accordance with the recommenda-
tions of the local Research Ethics Committee at the Faculty of
Psychology, University of Warsaw. The protocol was approved
by the above-mentioned committee. All procedures performed
in this study were in accordance with the ethical standards of
the institutional research committee and with the Helsinki
declaration.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article:
This study was supported through Grant BW: 180632/08 from
the Faculty of Psychology, University of Warsaw and the
Ministry of Science and Higher Education Grant NN106 069935.
Bargiel-Matusiewicz et al. 7
References
1. Rigby SA, Thornton EW and Young CA. A randomized
group intervention trial to enhance mood and self efficacy
in people with multiple sclerosis. Br J Health Psychol 2008;
13: 619–631.
2. Gillanders DT, Ferreira NB, Bose S, et al. The relationship
between acceptance, catastrophizing and illness representa-
tion in chronic pain. Eur J Pain 2013; 17: 893–902.
3. Beacham AO, Linfield K, Kinman CR, et al. The chronic ill-
ness acceptance questionnaire: confirmatory factor analysis
and prediction of perceived disability in an online chronic
illness support group sample. J Context Behav Sci 2015; 4:
96–102.
4. Obieglo M, Uchmanowicz I, Wleklik M, et al. The effect
of acceptance of illness on the quality of life in patients
with chronic heart failure. Eur J Cardiovasc Nurs 2016; 15:
241–247.
5. Nesse RM. Is depression an adaptation? Arch Gen
Psychiatry 2000; 57(1): 14–20.
6. Davison SN and Jhangri GS. The impact of chronic pain on
depression, sleep, and the desire to withdraw from dialysis
in hemodialysis patients. J Pain Symptom Manage 2005;
30(5): 465–473.
7. Bargiel-Matusiewicz K, Sobota A and Wilczynska A.
Self-evaluation in dialysis patients. Eur J Med Res 2010;
15: 7–9.
8. Bargiel-Matusiewicz K. Psychological influence on the psy-
chical state of hemodialysis patients. J Physiol Pharmacol
2006; 57(Suppl. 4): 33–38.
9. Steele TE, Baltimore D, Finkelstein SH, et al. Quality of
life in peritoneal dialysis patients. J Nerv Ment Dis 1996;
184(6): 368–374.
10. Cooper B, Penne E, Bartlett L, et al. Protein malnutrition
and hypoalbuminemia as predictors of vascular events and
mortality in ESRD. Am J Kidney Dis 2004; 43(1): 61–66.
11. Kusztal M, Trafidło E, Madziarska K, et al. Depressive
symptoms but not chronic pain have an impact on the sur-
vival of patients undergoing maintenance hemodialysis.
Arch Med Sci 2018; 14(2): 265–275.
12. Kimmel P, Peterson R, Weihs K, et al. Multiple measure-
ments of depression predict mortality in a longitudinal study
of chronic hemodialysis outpatients. Kidney Int 2000; 57(5):
2093–2098.
13. McDade-Montez EA, Christensen AJ and Cvengros JA. The
role of depression symptoms in dialysis withdrawal. Health
Psychol 2006; 25(2): 198–204.
14. Fischer M, Xie D, Jordan N, et al.; CRIC Study Group
Investigators. Factors associated with depressive symp-
toms and use of antidepressant medications among par-
ticipants in the Chronic Renal Insufficiency Cohort (CRIC)
and Hispanic-CRIC studies. Am J Kidney Dis 2012; 60(1):
27–38.
15. Tsai YC, Chiu YW, Hung CC, et al. Association of symp-
toms of depression with progression of CKD. Am J Kidney
Dis 2012; 60(1): 54–61.
16. Diener E and Lucas RE. Personality and subjective well-
being. In: Kahneman D, Diener E and Schwarz N (eds)
Well-being: the foundations of hedonic psychology. New
York: Russell Sage Foundation, 1999, pp. 213–229.
17. Folkman S and Moskowitz JT. Coping: pitfalls and promise.
Annu Rev Psychol 2004; 55: 745–774.
18. Folkman S and Moskowitz JT. Positive affect and meaning-
focused coping during significant psychological stress. In:
Hewstone M, Schut H, de Wit J, et al. (eds) The scope of
social psychology: theory and application. Hove: Psychology
Press, 2006, pp. 193–208.
19. Fordyce MW. A program to increase happiness. J Couns
Psychol 1983; 30(4): 483–498.
20. Seligman MEP, Reivich K, Jaycox L, et al. The optimistic
child. New York: Harper Parennial, 1995.
21. Seligman MEP, Rashid T and Parks AC. Positive psycho-
therapy. Am Psychol 2006; 61(8): 774–788.
22. Folkman S. Commentary on the special section “Theory-
based approaches to stress and coping”: questions, answers,
issues, and next steps in stress and coping research. Eur
Psychol 2009; 14: 72–77.
23. Garcia-Llana H, Remor E and Selgas R. Adherence to treat-
ment, emotional state and quality of life in patients with end-
stage renal disease undergoing dialysis. Psicothema 2013;
25(1): 79–86.
24. Tsay SL, Lee YC and Lee YC. Effects of an adaptation train-
ing programme for patients with end-stage renal disease.
J Adv Nurs 2005; 50(1): 39–46.
25. Bargiel-Matusiewicz K, Trzcieniecka-Green A and
Kozłowska A. The influence of psychological intervention on
cognitive appraisal and level of anxiety in dialysis patients: a
pilot study. Open Nutraceuticals J 2011; 4: 61–64.
26. Knowles MM, Foden P, El-Deredy W, et al. A systematic
review of efficacy of the attention training technique in clin-
ical and nonclinical samples. J Clin Psychol 2016; 72(10):
999–1025.
27. Beck AT. Cognitive therapy and the emotional disorders.
New York: New American Library, 1976.
28. Beck AT. Cognitive therapy: past, present, and future. J
Consult Clin Psychol 1993; 61(2): 194–198.
29. Erickson BA. Ericksonian therapy demystified: a straight-
forward approach. In: Zeig JK (ed.) Ericksonian methods:
the essence of the story. Philadelphia, PA: Brunner/Mazel,
1994, pp. 147–162.
30. Barker P. Using metaphors in psychotherapy. New York:
Brunner/Mazel, 1985.
31. Kopp RR and Craw MJ. Metaphoric language, metaphoric
cognition and cognitive therapy. Psychother Theor Res
Pract Train 1998: 35(3): 306–311.
32. McAdams DP. Personal narratives and the life story. In: John
OP, Robins RW and Pervin LA (eds) Handbook of person-
ality: theory and research. New York: Guilford Press, 2008,
pp. 242–262.
33. Michenbaum D and Fitzpatrick D. A constructivist narrative
perspective on stress and coping: stress inoculation appli-
cations. In: Goldberger L and Breznitz S (eds) Handbook
of stress: theoretical and clinical aspects. New York: Free
Press, 1993, pp. 706–723.
34. Beck AT, Ward CH, Mendelson M, et al. An inventory for
measuring depression. Arch Gen Psychiatry 1961; 4(6):
561–571.
35. Beck AT, Steer RA and Garbin MG. Psychometric proper-
ties of the Beck Depression Inventory: twenty-five years of
evaluation. Clin Psychol Rev 1988; 8: 77–100.
8 The International Journal of Artificial Organs 00(0)
36. Spielberger CD, Gorsuch R, Lushene RE, et al. Manual for
the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting
Psychologists Press, 1983.
37. Spielberger CD. Assessment of state and trait anxiety: con-
ceptual and methodological issues. South Psychol 1985;
4(2): 6–16.
38. Beck AT. Depression: clinical, experimental, and theoreti-
cal aspects. New York: Harper and Row, 1967.
39. Beck AT, Freeman A and Davis DD. Cognitive therapy of
personality disorder. 2nd ed. New York: Guilford Press, 2004.
40. Padesky CA and Greenberger D. Clinician’s guide to mind
over mind. New York: Guilford Press, 1995.
41. Lazarus RS and Folkman S. Stress, appraisal, and coping.
New York: Springer, 1984.
42. Nakamura YM and Orth U. Acceptance as a coping reac-
tion: adaptive or not? Swiss J Psychol 2005; 64: 281–292.
43. Parkerson GR Jr and Gutman RA. Perceived mental health
and disablement of primary care and end-stage renal disease
patients. Int J Psychiatry Med 1997; 27(1): 33–45.
44. Schwarzer R. Stress, resources, and proactive coping.
Applied Psychology 2001; 50: 400–407.
45. Kroemeke A, Bargiel-Matusiewicz K and Kalamarz M.
Mixed psychological changes following mastectomy: unique
predictors and heterogeneity of post-traumatic growth
and post-traumatic depreciation. Front Psychol 2017; 8:
1245.
46. Revenson TA and Felton BJ. Disability and coping as pre-
dictors of psychological adjustment to rheumatoid arthritis.
J Consult Clin Psychol 1989; 57(3): 344–348.
47. Telford K, Kralik D and Koch T. Acceptance and denial:
implications for people adapting to chronic illness: literature
review. J Adv Nurs 2006; 55(4): 457–464.