Comparative effectiveness of cognitive behavioral therapy versus group-based optimism training on psychological outcomes in hemodialysis patients: a randomized controlled trial

Abstract

Patients undergoing hemodialysis (HD) face significant psychological challenges that affect their well-being. Nevertheless, no comparative investigation has yet examined the efficacy of cognitive-behavioral therapy (CBT) versus group-based optimism training on psychological outcomes in this population. Hence, this study aimed to compare the effectiveness of CBT versus group-based optimism training on psychological outcomes in HD patients. This three-arm, parallel-group, randomized controlled trial was conducted from September 2024 to May 2025 with a sample of 135 HD patients. Participants were selected through simple random sampling and were randomly allocated to two experimental groups and one active control group. Prior to the intervention, all three groups completed the relevant questionnaires. The CBT and group-based optimism training programs were then implemented for the first and second experimental groups, respectively, each consisting of eight 90-minute sessions delivered once per week for eight consecutive weeks. The control group received standard educational interventions. Following the completion of the training sessions, the questionnaires were completed again immediately and again two and four-months later. The data were analyzed using SPSS software version 21. All procedures performed on human participants complied with the ethical guidelines of the relevant institutional and national research committees, as well as the Helsinki Declaration and its subsequent revisions, or equivalent ethical frameworks. Repeated-measures ANOVA revealed significant time × group interactions for anxiety (η² p = 0.068), depression (η² p = 0.085), optimism (η² p = 0.101), and hope (η² p = 0.073), all p < 0.001. Both CBT and optimism training significantly improved all outcomes versus control ( p < 0.001). However, optimism training showed superior long-term effects over CBT for depression (d = 0.45, p = 0.032) and optimism (d = 0.36, p = 0.041), while both interventions were equally effective for anxiety and hope ( p > 0.05). The findings indicated that both CBT and group-based optimism training were effective in reducing anxiety and enhancing hope. Nevertheless, a distinction emerged at long-term follow-up, as optimism training yielded more sustained reductions in depression and greater improvements in optimism. This suggests that, although CBT is effective for acute symptom reduction, optimism training may offer additional advantages for sustained psychological well-being. IRCT20240609062065N4, 2025-12-01, ‘retrospectively registered’.