Journal of Biology and Today's World

The Effect of Mindfulness-Based Stress Reduction Program on Metacognitive Awareness, Rumination, and Self-Compassion in Menopausal Women

Mona Hassannejad^1*, Mehrnaz Azad Yekta², Sajad Naderi Sevini³, Abbas Khani⁴ and Seyedeh Fatemeh Razavi^{5 *}Correspondence: Mona Hassannejad, Department of Psychology, Rudehen Branch, Islamic Azad University, Rudehen, Iran, Email:

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Introduction

Menopause is caused by a cessation of follicle-stimulating hormone secretion and is defined as a 12-month interruption of menstruation for no other specific reason [1]. One of the challenges for menopausal women is identifying their symptoms. In epidemiological studies, menopause means the cessation of menstruation (loss of ovarian follicles) for 12 months without a specific cause and finally the end of the reproductive period, and usually occurs between the ages of 45 and 52 years. During it, women undergo endocrine, somatic, and psychological changes that are associated with the aging of follicles and estrogen deficiency.

Changes in body shape and size, skin and hair status, and sexual function are culturally indicative of menopause, and women's attitudes toward experiencing these symptoms affect how they transition and their effects. Leaves several psychological [2]. One of the studied variables in postmenopausal women is metacognitive awareness. Metacognitive awareness shows how individuals use metacognitive knowledge and supervisory expertise to control their cognition [3].

Metacognition is the knowledge of thought processes and the ability to manage cognitive processes and self-knowledge, such as knowledge of the framework of their knowledge, organization, and planning, use of problem-solving strategies, and the ability of self-assessment and self- improvement [4]. In the late 1970s, Flavell coined the term metacognition to mean "cognition of cognitive phenomena" or simply "thinking about one's thinking" [3]. Metacognitive awareness is part of our knowledge of the world that deals with cognitive issues. The knowledge and beliefs that we gain through experience and store in long-term memory. This knowledge does not depend on specific content. Instead, it is related to the mental activity [5].

Based on previous research findings, there is a relationship between metacognitive awareness and rumination [6]. Rumination is a cognitive process that significantly increases the risk of developing pathological symptoms and is associated with maintaining emotional disorders such as anxiety and depression. Rumination is a repetitive thought process that is often uncontrollable and has a specific (but not necessarily) specific intellectual content, and often takes the form of a depressing ruminant. Negative and repetitive thoughts are usually about past events or current stressors [7]. In other words, rumination as a maladaptive cognitive strategy is effective in various disorders such as depression [8-10]. Ruminants can also be the basis of patients 'cognition and include endlessly reviewed thoughts, fueling frustration about the future and negative self-assessments and affecting mood and patients' motivation [11]. Rumination is associated with psychological dysfunction and increased negative emotions such as anger and stress [12]. In some studies, findings have shown that self-compassion-based therapies can effectively reduce the symptoms of rumination [13,14], defines self- love as a three-component structure: kindness to self-judgment, human sharing versus isolation, and mindfulness versus duplication.

Neff [13], considers kindness about being and accepting one's sufferings in life, not denying or belittling them, and considers kindness to oneself and others due to this awareness and acceptance. Neff, et al. [14], believe that affection protects a person against anxiety and depression by controlling self-criticism and negative emotions. Gilbert [15], also believes that much evidence that being kind to oneself affects mental health, well- being, and social relationships. Empathy and compassion with oneself lead to better results and efficiency than self-centeredness.

Therapists with different theoretical approaches use different methods to control and treat feelings of loneliness and rumination in different populations. One of the psychological therapies that have been considered in the treatment of mood disorders in recent years is mindfulness-based stress reduction therapy, which has shown great efficiency in terms of adaptability [16], for primary prevention in health. And has achieved the best results in patients with symptoms of stress, anxiety, depression and negative emotions [17,18]. In mindfulness-based cognitive education, clients learn how to relate to their irrational thoughts and feelings and focus on changing and changing the content of their thoughts [19].

Therefore, this study aimed to evaluate the effect of mindfulness-based stress reduction programs on metacognitive awareness, rumination, and self-compassion in postmenopausal women. The following hypothesis has been tested.

Does a mindfulness-based stress reduction program increase metacognitive awareness and self-esteem in postmenopausal women as well as reduce their rumination?

Research method

This study was applied for purpose and was semi-experimental in terms of implementation method with pre-test and post-test design with a control group. Its statistical population included all Menopausal women referred to the Valiasr Hospital Health Center (we received research ethics committee) in Tehran in 2021, who met the criteria for inclusion in the study, including natural menopause, no severe physical or mental illness. The number of 30 people who had a lower score in the initial test of metacognitive awareness, rumination, and affection were selected in an accessible way and based on the possibility and consent to attend meetings as a research sample and were replaced randomly in two groups of 15 Experimental and control groups [20]. The tools used in this study were as follows;

• Schraw and Dennison Metacognitive Awareness Questionnaire (1994): This study measured the subjects’ metacognitive awareness by Schraw and Dennison’s Metacognitive Awareness Questionnaire. This questionnaire contains 52 questions, of which 17 are components of metacognitive knowledge and 35 of metacognitive regulations. The answers are rated on a 5-point scale, from strongly agree (5) to strongly disagree (1). The total score of this questionnaire range is between 52 and 175. The cognitive component’s score range is between 17 and 85, and that of the metacognitive setting is between 35 and 175. The questionnaire’s validity and reliability in domestic and foreign studies, including the study of Schraw [21], was calculated and confirmed Mousavi [22].

• Nolen-Hoeksema [23], Ruminant Questionnaire: This questionnaire was developed by [23,24], in Iran. It evaluates adverse posterior reactions and consists of two subscales of ruminant responses and distracting responses, each containing 11 expressions. The questionnaire consists of 22 statements graded from 1 (never) to 4 (often) according to the Likert scale. In the study by Bagherinezhad et al. [24], the reliability coefficient of the questionnaire by Cronbach’s alpha method was 0.90, and for its dimensions was 0.92 and 0.89. The questionnaire’s validity by correlating it with the Metacognitive Beliefs Questionnaire was 0.65 at the level of 0.001.

• Neff [13], Self-compassion questionnaire: This questionnaire contains 26 items and 6 components of self-kindness, self-judgment, human commonalities, isolation, vigilance or extreme awareness, and imitation in a 5-point Likert scale from strongly disagree=1 to strongly agree=5. Differential validity, internal consistency, and retest reliability of this scale are appropriate, and Cronbach's alpha coefficient of the original version has been obtained 0.92 [13].

Results

The results of Table 2 show that in both groups it is the most abundant for employed people. And for age in the experimental group, the age group 55 to 57 has the lowest frequency but in the control group, the lowest frequency is in the age group of 52 to 54 years. For education, in both groups, people with university education have the highest frequency.

Table 2. Describes the frequency of demographic data.

Table 3 shows the mean and standard deviation of mental rumination, awareness, and affection variables in the control and experimental groups. Also, the mean of awareness and affection variables increased in the experimental group after the test, which is not observed in the control group.

Table 3. Mean and standard deviation of research variables by group and pre-test-post-test.

In the present study, a single sample Kolmogorov-Smirnov test was used to evaluate the normality of the variables. The results show that for the four modes of pre-test-post-test by groups (experimental and control) the variables of mental rumination, awareness and affection, with respect to significance levels higher than 0.05; Hypothesis zero that the data is normal is accepted and it is concluded that the data follow a normal distribution.

Table 4 illustrates the mean and standard deviation of the variables of rumination, awareness and affection by pre-test-post-test in two groups of control and experiment. The results show that the mean post-test of the experimental group decreased in the rumination variable but did not change significantly in the control group. Also, the mean of awareness and affection variables increased in the post-test of the experimental group, which is not observed in the control group.

Table 4. The mean and standard deviation of the variables of mental rumination, awareness and affection by pre-test-post-test in two groups of control and experimental.

The results of Table 5 of the multivariate effects test with respect to the level of significance show that there is a significant difference between the groups with the effect size of 0.296.

Table 5. Multivariate effects test.

In Table 6, the results of Levin test to examine the similarity of variances of mental rumination, awareness and affection variables show that significance levels higher than 0.05 for all three variables indicate the acceptance of the null hypothesis that the variance is similar in groups.

Table 6. Levin test (test of homogeneity of variances).

As shown in Table 7, the results show that with pre-test control, there is a significant difference between menopausal women in the experimental group and the control group in rumination, metacognitive awareness and self-compassion. (P=0.01 and F=17.663; p=0.024 and F=5.350; p=0.01 and F=15.695 respectively); Therefore, the main hypothesis is confirmed. In other words, mindfulness-based stress reduction programs are effective on mental rumination, metacognitive awareness, and self-love for menopause women. Since the mean post-test of the experimental group decreased in the mental rumination variable but did not change significantly in the control group, it can be concluded that the mindfulness-based stress reduction program reduced the mental rumination of postmenopausal women. Also, since the mean post-test of the experimental group increased in metacognitive consciousness but did not change significantly in the control group, it can be concluded that the mindfulness-based stress reduction program increased metacognitive awareness of postmenopausal women. It has increased but has not changed significantly in the control group. It can be concluded that mindfulness-based stress reduction program has increased affection for postmenopausal women.

Table 7. Results of multivariate analysis of covariance to compare post-test of stress reduction program based on mindfulness on mental rumination, metacognitive awareness and self-compassion of women in all three experimental and control groups awaiting treatment with pre-test control.

Discussion

The findings of this study are consistent with the results of Shi, et al. [25-28]. As Shi, et al. [25], in a study have found that mindfulness training positively effects on pregnant women's mental health and rumination. The study of Hassannejad [8], indicated that mindfulness-based stress reduction treatment programmers have been influential in tolerance of ambiguity, rumination, and metacognitive awareness of infertile women under treatment.

Shulman et al. [26], also found in a study that mindfulness-based cognitive intervention has a positive effect as adjunctive therapy for postpartum depression and rumination. Also, Mortezaee, et al. [27], in a study entitled Comparison of metacognitive therapy and treatment of stress reduction program based on mindfulness on depression, self- assessment and emotion regulation have achieved the results that both types of treatment on depressive symptoms, self-assessment and regulation Emotions have a positive effect.

It is also consistent with the findings of Kabat-Zinn, et al. [29], who stated that in mindfulness-based cognitive education, clients learn how to relate to their irrational thoughts and feelings and to change the content of thoughts. Focus and change them. Also, the findings of Ahmadi et al. [30], Soleimanifar, et al. [31], showed that the mindfulness program affects metacognitive beliefs.

In explaining the effectiveness of mindfulness training on metacognitive awareness, rumination and affection, it can be said that mindfulness creates its effects through four mechanisms of attention regulation, body awareness, emotion regulation, and changes in the individual's view of himself. It is thought that engaging in conscious attention and developing a more receptive relationship with the experience of the moment is helpful because postmenopausal women can enable people to let go of habits and useless reactions to the recent experience and instead choose the path. More beneficial to answer, and this process puts these women on the path to promoting metacognitive awareness and self-love and reducing and controlling rumination.

This judgment-free observation can reduce emotional responses that reduce metacognitive awareness and self-esteem and increase rumination in the long run. Based on this, it can be argued that mindfulness exercises increase the ability of postmenopausal women to tolerate emotional states and equip them to deal effectively. Therefore, it can be said that the primary mechanism in the effectiveness of mindfulness treatment is to promote metacognitive awareness and self-compassion and control and reduce rumination in learning their effective coping strategies during therapy sessions to deal with negative emotions and feelings. Regular mindfulness exercises increase people's attention to their body, emotions, and thoughts. Attention to the body and breathing is practiced in mind, and the people being treated become aware of the different sensations they experience in the body and even while breathing. They also learn that when the body heats in a state of anger or fear, the heart rate increases and the rhythm of breathing changes slows down and slows down, resulting in increased attention to the body by practicing mindfulness. Moreover, this awareness paves the way for the following control.

In this regard, the results of this study indicate the effectiveness of these exercises on metacognitive awareness, rumination, and self- compassion in postmenopausal women. In general, according to the study results, it can be said that the reason for the effectiveness of mindfulness- based cognitive therapy in this study is that mindfulness therapy leads to cognitive change in the way of thinking and behavior of postmenopausal women.

Also, it can be said that mindfulness modulates emotions without judgment and increases awareness of psychological emotions. Furthermore, it helps to see and accept emotions and physical phenomena clearly and recognize thoughts as they occur to play a role in metacognitive awareness, rumination, and self-love in postmenopausal women. Mindfulness treatment by modifying negative behaviors and negative thoughts leads to positive health-related behaviors. One of the essential aspects of mindfulness therapy is that people learn to deal with negative emotions and thoughts and deal with mental events. Experience a cheerful face. In this sense, this process promotes metacognition, reduces rumination, and promotes self-compassion.

Mindfulness-based stress reduction program is a new intervention- treatment-psychology field that requires extensive research in all areas. Therefore, it is suggested that this intervention be performed on different age groups and other disorders with different stages of the disorder and compare the results. It is suggested that in addition to the self-assessment questionnaire, other methods such as clinical interview, observation, projection tests, Etc., be used to measure cognitive emotion regulation strategies. A follow-up study should accompany future research to evaluate the durability of the effect of this treatment method. A follow-up study has not been performed in this study to evaluate the durability and effectiveness of this method over time [32].

It is worth mentioning that to promote metacognitive awareness, reduce rumination, and increase self-esteem in counseling and psychological centers; it is recommended to use this treatment method for postmenopausal women and benefit from this educational method in meetings and workshops. Hold training for them. According to the findings of this study, it can be said that since the educational protocol used in this study is implemented in a group and with a specific period, counselors and psychologists can treat with sessions with a specific time limit.

Conclusion

The primary purpose of this study was the effect of mindfulness- based stress reduction program on metacognitive awareness, rumination, and self-compassion in postmenopausal women. Based on the findings of this study, mindfulness-based stress reduction programs are effective on mental rumination, metacognitive awareness, and self-compassion for postmenopausal women.

Mindfulness-based stress reduction programs have also reduced the mental rumination of postmenopausal women. However, on the other hand, mindfulness-based stress reduction program has increased the metacognitive awareness of postmenopausal women, and finally, mindfulness-based stress reduction program has increased affection for postmenopausal women.

Limitations and Recommendations for Future Research

One of the main limitations of this study is the statistical sample and sampling method. Considering that the participants of this study participated voluntarily, caution should be exercised in generalizing the findings to other statistical populations. In addition, the lack of a follow- up phase to assess the sustainability of the impact of the intervention has limited the generalization of these findings. Therefore, it is suggested that in future research, random sampling methods should be used to select the samples, and the follow-up phase should be included in the research project.

Declarations

Acknowledgments

Special thanks and appreciation to the officials and staff of the health centers in Tehran, members of the medical team, and all the individuals who helped with this study.

Author contributions

M.H. developed the study concept and all authors contributed to the study design. Testing and data collection were performed by A.K. and M.H. and then performed the data analysis and interpretation under the supervision of Dr. M.A.Y. M.H. and S.N.S. aided in interpreting the results and worked on the manuscript. All authors discussed the results and commented on the manuscript. Dr M.A.Y. and M. H. provided critical revisions. All authors approved the final version of the manuscript for submission.

Funding

This study was supported through a grant from Valiasr Hospital Health Center, The Foundation for Health center Research with support from Dr. Aazd Yekta is the (Assistant Professor). The health centers in Tehran had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Availability of data and materials

The datasets used for this manuscript are available from the corresponding author on reasonable request. Investigators interested in obtaining the SPSS can contact the corresponding author.

Declarations

Ethics approval and consent to participate The Valiasr Hospital Health Center was approved. All study participants provided written informed assent before participation.

Competing interests

The authors declare that they have no competing interests.

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