Breast cancer targets a symbolic organ in women; thus, it is psychologically, emotionally, socially, and sexually more important than other cancers. Accordingly, it can disrupt the regular, daily living activities, making the patient feel that she has lost control of the disease as well as life in general. Therefore, a subject with low cognitive flexibility cannot accept the changes caused by the disease and overcome its challenges [8]. Low cognitive flexibility could lead to rumination, stress, and ineffective coping strategies when encountering chronic physical pain [9].
Furthermore, experiencing positive psychological changes, known as posttraumatic growth, refers to positive personal and psychological changes that occur after a trauma or traumatic event (being diagnosed with cancer) and results from an individual’s struggle against such stressful events [11]. Posttraumatic growth manifests in various forms, including realizing the value of life, making meaningful interpersonal relationships, generating stronger feelings, changing life priorities, and enriching spiritual life [10]. When posttraumatic growth occurs, it can facilitate the process of recognizing and accepting a stressful event in individuals [12].
A method that can be used as a complementary therapy without adverse effects along with medical interventions to reduce cancer-induced psychosocial problems is holographic reprocessing therapy; it is cognitive-experimental psychotherapy, i.e., based on Epstein’s cognitive experiential self-theory of personality. In holographic reprocessing therapy, due to applying various techniques that affect cognition, behavior, and emotion, one learns to adopt a better and more effective perception of events [14].
Certainly, considering psychological factors in patients with breast cancer, especially after mastectomy, is among the research priorities. Moreover, the effects of holographic reprocessing therapy remain unexplored on cognitive flexibility and posttraumatic growth in women with breast cancer in Iran. Thus, the present study aimed to determine the effects of holographic reprocessing therapy on cognitive flexibility and posttraumatic growth in women with breast cancer. Accordingly, by paying more attention to cognitive processing in patients and finding manners to correct them, we can develop an effective measure to reduce the secondary problems caused by the disease.

This was a quasi-experimental study with pretest-posttest and a control group design. The statistical population included all patients with breast cancer who underwent mastectomy and who were being treated in the chemotherapy ward of Imam Khomeini Hospital in Ardabil City, Iran, in 2020. Through the convenience sampling method, 30 women with breast cancer were selected and randomly divided into the experimental and control groups (n=15/group). The inclusion criteria of this study included being diagnosed with breast cancer by an endocrinologist; undergoing mastectomy; being involved with the disease for at least one year; having consent to participate in the study; not consuming any psychiatric medications; being in the age range of 25-55 years, and having a minimum literacy for reading and writing. Exclusion criteria included withdrawal from the study, achieving complete recovery, and presenting acute mental health illnesses.
The experimental group, while receiving pharmacotherapy, collectively underwent holographic reprocessing therapy in 9 one-hour sessions (two sessions per week) for 5 weeks; however, the control group received only pharmacotherapy. Both research groups were assessed in pretest and posttest phases by the Cognitive Flexibility Inventory [23] and the Posttraumatic Growth Inventory [25]. Finally, the collected data were analyzed using Multivariate Analysis of Covariance (MANCOVA) in SPSS.

The present research results revealed that holographic reprocessing therapy was effective on cognitive flexibility (F=42.319, P<0.01) and posttraumatic growth (F=18.300, P<0.01) in women with breast cancer; this approach also increased their cognitive flexibility and posttraumatic growth.

The current study determined the effects of holographic reprocessing therapy on cognitive flexibility and posttraumatic growth in women with breast cancer. Notably, holographic reprocessing therapy improves’ clients adjustability by modifying cognitive processing and the reassessment of their beliefs. In this method, the therapist teaches the clients various coping strategies; subsequently, they can replace these coping skills with previous ineffective methods in stressful situations. This measure requires improved cognitive flexibility. Additionally, by drawing an experimental hologram, the therapist recreates the experience of managing the emotions caused by trauma and disease; clients face the emotions instead of avoiding them and find more logical and meaningful justifications for them while expressing emotions [27]. This is an exercise in cognitive flexibility. Finally, this method emphasizes the establishment of new communication patterns and the formation of new goals for the future; they can be achieved by the reinforcement of cognitive flexibility.
Spontaneous and disturbing thoughts are often uncontrolled and indicate a stress response to the traumatic event. Moreover, they stand against controlled, more positive, and purposeful thoughts. Consequently, clients, during therapy sessions, learn to adopt further control over their thoughts. This is because the deliberate and purposeful reprocessing of trauma might reduce the level of anxiety. Such conditions could also increase the acceptance of emotions, and the potential for posttraumatic growth. This ultimately increases the degree of control of dysfunctional negative thoughts and leads to habituation instead of avoiding the thoughts and subsequent emotions [28]. The present study data can have implications for mental health professionals. By providing educational programs on mental health and paying more attention to information processing procedures in patients, one can reduce the pathogenicity of this disease and prevent its subsequent consequences.

All study subjects signed the written informed consent form. The Research Ethics Committee of Ardabil University of Medical Sciences approved this study (Code: IR.ARUMS.REC.1399.393).

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

All authors met the standard criteria of writing based on the recommendations of the International Committee of Medical Journal Publishers (ICMJE).

The authors declared no conflicts of interest.
 

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