Acceptance and Commitment Therapy on Depression of Pulmonary Tuberculosis Patient: An Intervention Based on the Health Belief Model

Gevi Melliya Sari, Muhammad Amin, Laily Hidayati

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Introduction: Depression is a psychological disorder often experienced by patients undergoing tuberculosis treatment. The purpose of this study was to determine the effect of acceptance and commitment therapy based on the health belief model on the depression of pulmonary tuberculosis patients. Methods: This research used a quantitative quasi-experiment design with pre-posttest control group design. There were 56 respondents in this study selected using consecutive sampling   among the Primary Healthcare Center in Sidoarjo district. The independent variables were acceptance and commitment therapy based on the health belief model. The dependent variable was depression. Measurement of depression used the Beck Depression inventory II questionnaire. Analysis of the data in this study used the Wilcoxon Signed Rank Test and Mann-Whitney U Test. Results: The results showed that the treatment group p=0.000 (p<0.05) and control group p=0.000 (p<0.05), but the delta of the treatment group higher than the control group (delta: -9.79). There were differences in depression values obtained between the treatment group and the control group p=0.001 (p<0.05). Conclusion: Acceptance and commitment therapy based on the health belief model given four sessions for 30-45 minutes each session can lower depression level in pulmonary tuberculosis patients rather than a single intervention of health education. This intervention can be used by nurses to help pulmonary tuberculosis patients overcome psychological problems during treatment.


acceptance and commitment therapy; depression; health belief model; pulmonary tuberculosis

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A-Tjak, J. G. L., Morina, N., Topper, M., & Emmelkamp, P. M. G. (2018). A Randomized Controlled Trial in Routine Clinical Practice Comparing Acceptance and Commitment Therapy with Cognitive Behavioral Therapy for the Treatment of Major Depressive Disorder. Psychotherapy and Psychosomatics, 87(3), 154–163.

Ambaw, F., Mayston, R., Hanlon, C., & Alem, A. (2015). Depression Among Patients with Tuberculosis: Determinants, Course and Impact on Pathways to Care and Treatment Outcomes in a Primary Care Setting in Southern Ethiopia - A study Protocol. BMJ Open, 5(7), 1–10.

Amreen and Rizvi Nadeem. (2016). Frequency of Depression and Anxiety among Tuberculosis Patients. Journal of Tuberculosis Research, 4, 183–190.

Dasa, T. T., Roba, A. A., Weldegebreal, F., Mesfin, F., Asfaw, A., Mitiku, H., … Tesfaye, E. (2019). Prevalence and Associated Factors of Depression Among Tuberculosis Patients in Eastern Ethiopia. BMC Psychiatry, 19(1), 1–8.

Gul E, & et al. (2017). Frequency of Depression in Patients Suffering from Pulmonary Tuberculosis. Pakistan Journal of Chest Medicine, 23(1), 03–07. Retrieved from

Hayes, S. C. (2008). Acceptance and Commitment: Implication for Prevention Science. National Instituties of Health, 23(1), 1–7.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25.

Kehbila, J., Ekabe, C. J., Aminde, L. N., Noubiap, J. J. N., Fon, P. N., & Monekosso, G. L. (2016). Prevalence and Correlates of Depressive Symptoms in Adult Patients with Pulmonary Tuberculosis in the Southwest Region of Cameroon. Infectious Diseases of Poverty, 5(1), 1–8.

Kepmenkes. (2009). Pedoman Penganggulangan Tuberkulosis. Keputusan Menteri Kesehatan Republik Indonesia (Vol. 19). Retrieved from

Lee, L. Y., Tung, H. H., Chen, S. C., & Fu, C. H. (2017). Perceived Stigma and Depression in Initially Diagnosed Pulmonary Tuberculosis Patients. Journal of Clinical Nursing.

Madva, E. N., Gomez-bernal, F., Millstein, R. A., Celano, C. M., Park, E. R., Ph, D., … Huffman, J. C. (2019). Magnitude and Sources of Distress in Mid-Life Adults With Chronic Medical Illness: An Exploratory Mixed-Methods Analysis. Psychol Health Med, 23(5), 555–566.

McCracken, L. M., & Vowles, K. E. (2014). Acceptance and Commitment Therapy and Mindfulness for Chronic Pain: Model, Process, and Progress. American Psychologist, 69(2), 178–187.

Mirza, I., & Jenkins, R. (2004). Risk Factors, Prevalence, and Treatment of Anxiety and Depressive Disorders in Pakistan: Systematic Review. British Medical Journal, 328(7443), 794–797.

Molla, A., Mekuriaw, B., & Kerebih, H. (2019). Depression and Associated Factors Among Patients With Tuberculosis in Ethiopia: A Cross-Sectional Study. Neuropsychiatric Disease and Treatment, 15, 1887–1893.

National Institute of Mental Health. (2016). Depression Basics. National Institutes of Health.

Nurhidayati, I., Sulistyowati, A. D., & Dewi, A. Y. K. S. (2019). Health Belief Penderita Tuberkulosis Paru Relaps di Balai Kesehatan Masyarakat (BALKESMAS) Wilayah Klaten:Studi Fenomenologi. Jurnal Keperawatan Dan Kesehatan Masyarakat Cendekia Utama, 8(1), 17.

Pots, W. T. M., Fledderus, M., Meulenbeek, P. A. M., Ten Klooster, P. M., Schreurs, K. M. G., & Bohlmeijer, E. T. (2016). Acceptance and Commitment Therapy as a Web-Based Intervention for Depressive Symptoms: Randomised Controlled Trial. British Journal of Psychiatry, 208(1), 69–77.

Priyoto. (2014). Teori Sikap dan Perilaku Kesehatan. Yogyakarta: Nuha Medika.

Roelofs, J., Van Breukelen, G., De Graaf, L. E., Beck, A. T., Arntz, A., & Huibers, M. J. H. (2013). Norms for the Beck Depression Inventory (BDI-II) in a Large Dutch Community Sample. Journal of Psychopathology and Behavioral Assessment, 35(1), 93–98.

Saedy, M., Kooshki, S., Firouzabadi, M. J., Emamipour, S., & Rezaei Ardani, A. (2015). Effectiveness of Acceptance-Commitment Therapy on Anxiety and Depression among Patients on Methadone Treatment: A Pilot Study. Iranian Journal of Psychiatry and Behavioral Sciences, 9(1), 1–7.

Segal, D. L. (2010). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). In The Corsini Encyclopedia of Psychology.

Suryani, S., Widianti, E., Widianti, E., Hernawati, T., Hernawati, T., Sriati, A., & Sriati, A. (2016). The Effectiveness of Psycho Education Towards Depression, Anxiety and Stress Level of Patients with Pulmonary Tuberculosis. Jurnal NERS, 11(1), 128.

Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgewaya, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.

Tilahun, H., Awoke, N., Geda, B., & Mesfin, F. (2018). Depression and Associated Factors among Adult Inpatients at Public Hospitals of Harari Regional State, Eastern Ethiopia. Psychiatry Journal, 2018, 1–6.

Tola, H. H., Shojaeizadeh, D., Garmaroudi, G., Tol, A., Yekaninejad, M. S., Ejeta, L. T., … Kassa, D. (2015). Psychological Distress and its Effect on Tuberculosis Treatment Outcomes in Ethiopia. Global Health Action, 8(1).

Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2015). Effectiveness of Acceptance and Commitment Therapy in Treating Depression and Suicidal Ideation in Veterans. Behaviour Research and Therapy, 74, 25–31.

Wang, X. B., Li, X. L., Zhang, Q., Zhang, J., Chen, H. Y., Xu, W. Y., … Hou, G. (2018). A Survey of Anxiety and Depressive Symptoms in Pulmonary Tuberculosis Patients with and Without TracheobronchialTuberculosis. Frontiers in Psychiatry, 9(JUL), 1–10.

World Health Organization. (2019). Global Tuberculosis Report. World Health Organization. Retrieved from


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