Introduction

Cancer is a group of diseases characterized by uncontrolled growth and spread of unnatural cells (American Cancer Society, 2015). Breast cancer is the most common cancers in women all around the world which has the highest mortality rate among female patients affected by cancer. The outbreak rate of breast cancer differs from one place to another place of the world (Jemal, bray, Center, Ferlay, Ward and Foman, 2011; Costanza, Chen, 2011; Yankaskas, 2005) and about one-fifth of all mortality in women is in the age of 40-50 (Yen, Ko, Yen, Yang et al, 2006). Also in Iran, breast cancer includes 22.26 percent of women^’s cancer and it is the most common cancer among Iranian women (Esmaili, Abed Saeedi and AlaviMajd, 2010). The researches have already known potential risk factors like inheritance, Hormonal and fertility factors, environmental factors like life style and especially mental factors interfering on outbreak of breast cancer (America Cancer Society, 2015; Bamett, Shah, Redman, Easton, Ponder, Pharoah, 2008; Demark- Wahnefried, Aziz, Rouland, Pinto, 2005).

Women with breast cancer are cured by therapies like surgery, radiotherapy, chemotherapy, hormonotherapy, immunotherapy and target therapy ( the drugs which are especially known interfering in growth of cancerous cells, America Cancer Society, 2015). The results of researches indicate the prominent consequences of breast cancer; like physical problems (pain and fatigue), psychological problems (anxiety and depression) and other psychological-social problems in affected persons; this leads to decrease the  quality of life especially with regard to younger women (Spiegel and Riba, 2015; So, Marsh, Ling, Leung et al, 2009).

According to the definition of World Health Organization, the quality of life is the persons perception of their condition in terms of culture, value system in which we live, targets, expectations, standards and their priorities; this concept is completely subjective, it is not observable by others and it is based on persons perception from different aspects of life (World Health Organization, 1996).

The studies have shown that the quality of women^’s life with breast cancer is significantly lower than non-patient young women (Avis, Crawford and Manuel, 2005; Reich, Lesur, Perdizet-Chevallier, 2008; Reyes-Gibby, Anderson, Morrow, Shete and hassan, 2012).

Also many underlying and side factors are able to influence on condition of mental health and life of these patients (Lehto, ojanen, Dyba, Aromaa, and Kellokumpu-Lehtinen, 2006).

According to the report of World Health Organization, mental health includes subjective well-being, perceived self -efficiency, independency, intergenerational dependence and self-actualization of person^, s intellectual and emotional potential among others (World Health organization, 2001).

Patients with breast cancer show high rate of anxiety (Drageset and Lindstrom, 2003) and higher outbreak of depression from slight to middle with low quality of life (Reich, Lesur, Perdizet, Chevallier, 2008), although these findings are in contrast to the results of t-test in Colby and Shifren research (2013) that have shown women with breast cancer have had less score in pessimism, more positive mental health and they have presented good report in life quality domain. The studies show that acceptance and Commitment therapy is an effective method in decreasing anxiety and depression in women with breast cancer (Mohabbatbahar, MalekiRizi, Akbari and Moradijou, 2015; Mojtabaee, Gholamhosseini, 2014). Also acceptance and commitment therapy anticipates the changes in psychological flexibility, changes in  quality of life, distress, moods (Feros, Lane, Ciarrochi and Blackdege, 2013).

Acceptance and commitment Therapy is a process-oriented approach which is known as one of the third-wave Psychotherapy (hayes, Luom, Bond, Masuda and Lillis, 2006). Acceptance and commitment therapy is a form of analysis of clinical behavior which is used in psychotherapy (Plumb, Stewart, Dahl and Lundgren, 2009) and it is a therapeutic method that teaches mindfulness (concentrating on a especial method: target, present moment, unfair judgement) and acceptance (openness, willingness to maintain the contact) and skills for responding to uncontrolled experiences and consequently commitment to personal values. It is a therapy for decreasing the worries with eliminating unwanted thoughts, emotions and sensations and much worries with psychological flexibility (ability for changing the behavior depending on this issue that how can this behavior be suitable and perceived for patient^, s life in long-term?) (Aayes, Strosahl and Wilson, 2012). Acceptance and commitment Therapy struggles for reaching to increase the mental health of patients with breast cancer through acceptance, concentrating on present moments and commitment to value of life (Angiola and Bowen, 2013). According to this, the researcher is looking for this issue that whether Acceptance and Commitment Therapy is effective on increasing the mental health and  quality of patient^, life with breast cancer or not?

Methodology

Current research is a semi-trial kind according to pre-test and post-test design with control group. The population of this research included the women with breast cancer of Omid hospital in Urmia city in autumn 2014-2015. 30 persons were selected from this population by available sampling method and they were randomly divided into two trial (15 persons)and control (15 persons) groups. Having motivation for taking part in the program and persons^, satisfaction and necessary cooperation with researcher at the time of primary interview were taken. The standards of entering to the test stage consist of: having the age of 30 to 50 , all persons should experience chemotherapy and shouldn’t have any other physical disease and the standards of exiting from group psychotherapy sessions consisted of having absence more than 2 sessions and lack of physical ability due to growing process of disease. Before interference and after the end of it, those subjects were tested by questionnaire of Quality Of Life for patients with breast cancer (QOL_BR23) and Goldberg mental Health Questionnaire.

The data collection tools in this research consisted of:

A-questionnaire of Quality Of Life for patients with breast cancer (QOL_BR23):

This questionnaire is used to evaluate the quality of person^, s life in two recent weeks. This questionnaire includes 26 questions in five-degree Likret scale in the frame of 4 domains of physical health, psychological health, social and environmental health. In reported results by manufacturer group of life quality scale of World Health Organization which have been done in 15 international centers of this organization, Koroonbakh Alfa Coefficient has been reported between %73 to %89 for quadruple subscales and whole scale (Skevington, Lotfy, and O^,Connel, 2004). This questionnaire has been translated and standardized in Iran by Nejat, Montazeri, Holakouie, Naeeni et al (2006).

B-Goldberg mental Health Questionnaire GHQ

General Health Questionnaire was manufactured in 1972 by Goldberg. This questionnaire includes 28 questions in four-degree Likert scale in four scales of physical symptoms, anxiety, disorder in social function and depression. Psychometric studies related to this questionnaire with 28 questions indicate significant validity and reliability. Goldberg and Blackwell (1970) by using of a check list of clinical interview on patients of surgery sector have mentioned the validity coefficient of this questionnaire, 0.80 (Hooman, 1998).

After data collection, the scores were analyzed after studying the assumptions related to covariance analysis method. Data were analyzed by spss-16 software.

Methodology

The sessions^, protocol of acceptance and commitment therapy was held in 8 sessions (each session 90 minutes) in 4 successive weeks and the summary of each session^’s content has been presented in table 1.

Table 1: The summary of therapy sessions

Findings

Table 2 shows the descriptive components of research variables by separating the control and test groups.

Table 2: descriptive components of “mental health and quality of life” scores in pre-test and post-test

For detecting the meaningfulness of difference between the above variables, covariance analysis was used.

Table 3: The results of one-way variance analysis in Manva text on variables

According to the contents of table 3, it is observed that the measure of F related to mental health is equal to: F=42.887, (P<0.001) and the components of mental health namely: depression   F=7.137, (P<0.015), social function   F=14.223, Anxiety  F=18.690, physical function  F=14.219, (P<0.001) and they are meaningful. Also as it is observed in table 3, the measure of F related to the variable of quality of life is equal to F=16.788, social health F=8.130, Physical health F=19.965, (P<0.001) and they are meaningful, but the measures of F related to Psychological health, F=1.455 (P<0.242) and environmental health F=0.095 (P<0.761) are not meaningful. According to this, it can be said that interference has been able to influence on quality of life and mental health of test groyup.

Discussion and conclusion

In this study after that the subjects of test group were interfered, the general results indicate the effectiveness of group psychotherapy based on acceptance and commitment on mental health and quality of women^, s life with breast cancer of Urmia city. The obtained results of this study showed that group psychotherapy based on acceptance and commitment has been able to influence on all aspects of mental health in test group that the measure of independent variable in anxiety was more than three subscales of depression, social function, physical function.

Also, in this study psychotherapy based on acceptance and commitment was effective on two components of social and physical health and quality of life but interference hasn’t been able to influence on two other components of quality of life namely psychological health and environmental health.

In a research that Mojtabaee and Gholamhosseini (2014) did on women with breast cancer and depression symptoms, concluded that Acceptance and Commitment Therapy is effective on decreasing depression symptoms in patients with breast cancer. The obtained findings of Acceptance and Commitment Therapy in the study of Mohabbat-Bahar, Malek-Rizi, Akbari and Moradi-Jou (2015) indicate meaningful decreasing in anxiety and depression symptoms of women with breast cancer.

The results of many studies of researchers prove that Acceptance and Commitment Therapy is effective in curing the anxiety and promotion of mental health (Veehof, Oskam, Schreus and Bohlmijer, 2011; Arch, Eifert, Davies, Vilardaga, Rose and Craske, 2012; Schoendorff, Parcell-Lalonde O^, Connor, 2012; Fledderus, Bohlmeijer, Smit, Westerhof, 2010; Pull, 2009). Feros, Lane, Ciarrochi and Blackledge (2013) who have applied the method of Acceptance and Commitment Therapy, concluded that Acceptance and Commitment Therapy can create changes in psychological flexibility, quality of life, distress and moods of participants in this test.

Various studies have concluded that Acceptance and Commitment Therapy is effective on improvement of depression from low to middle (Gaudiano, Nowlan, Brown, Epstein-Lubow and Miller, 2013), obsessive-compulsive disorder (Towhig, Hayes, Plumb, Pruitt et al, 2010), psychosis (Shawyer, Farhall, Mackinnon, Trawer et al, 2012), smoking (Gifford, Kohlenberg, Hayes, Pierson et al, 2011), tinnitus (Westin, Schulin, Hesser, Karlsson et al, 2011), epilepsy and emotional eating after gastric banding surgery (Weineland, Aryidsson, Kakoulidis, Dahl, 2012). Also this therapeutic method has been effective on non-clinical disorders like stress of work environment (Flaxman and Bond, 2010), mental health (Masuda, Hayes, Fletcher, Seignourel et al, 2007) and weight loss (Lillis, Hayes, Bounting, Masuda).

The target of Acceptance and Commitment Therapy is to create the psychological flexibility namely creating the ability of selecting the action among different choices that is more proportionate, not an action which is done just for avoiding from thoughts, sensations, memories or distressful willingness or in fact it is imposed on the person and by using of such techniques and metaphors they struggle to help the persons by applying the method of without avoidance from annoying thoughts and sensations instead of reasoning (Hayes, Luma, Bond, Masuda, Lillis, 2006),therefore it can be expressed that the method of Acceptance and Commitment therapy can decrease the symptoms of anxiety, depression, disordered physical and social function and help them in order to improve the quality of life. Among the research limitations, cultural and ethnic differences of participants in this research can be mentioned, also with regard to the statistical population and limitation of sample that includes just the patients of Omid hospital in Urmia, therefore the selective sample can’t be the representative of all patients of the country and its results can be generalized to other cities with caution.

Because one of the multiplier factors of life quality of patient with cancer is social support (Lehto, Ojanen, Kellokumpu-Lehtinen, 2005), therefore it is suggested the necessary trainings for accepting the patient to be performed for the relatives and family members.

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