Psychosomatic symptoms are psychological problems that emerged from the bodies but are rooted in acute stress and psychological dynamics. Type 2 diabetes mellitus is one of the most prevalent of these problems (1). Type 2 diabetes mellitus considered a psychosomatic illness and is the third leading cause of death in the world and is one of the most common illnesses that emerge as the form of physical symptoms (2, 3). This illness is significantly correlated with psychological stress and mental disorders. It as well as mental disorders are common and may occur with one another and/or one may worsen the other (4) Insofar as exact screening for psychological problem comorbidities is necessary for type 2 diabetes mellitus patients (5). Studies at the end of the twentieth century showed that the mortality rated for women with type 2 diabetes mellitus were still higher than the normal population. To the extent that the all-cause mortality rates difference between women with type 2 diabetes mellitus and non-diabetic women more than doubled (6) . Psychological interventions can have beneficial effects on diabetic patient's mental health (7). So, the comparison of the effectiveness of existential, cognitive-existential, and humanistic-existential group psychotherapy on psychosomatic complaints in women with type 2 diabetes mellitus is important for their improving physical, mental, and social life.
Existential group psychotherapy
Unlike other methods of counseling and psychotherapy that have a psychological root, existential methods have derived directly from philosophy. Existential psychotherapy derives from the existential philosophical thoughts that founded by Søren Kierkegaard (1813 –1855) and propagate by Jean-Paul Sartre (1905 –1980) (8, 9). Existential issues in group psychotherapy derive from existential thought both as a philosophy and as a value system. Its origins derive from the weakening of traditional values and the growing alienation of humans from himself (10). Existential psychotherapy is a dynamic method of therapy that focuses on the concerns caused by human existence. The principles of existential psychotherapy include addressing specific themes such as self-awareness, free will, existential anxiety, responsibility, loneliness, death anxiety, existential vacuum, meaning search, meaning in life and death (11, 12). Existential psychotherapy involves a kind of philosophical perspective instead of a set of techniques (13). The unique themes of existentialism such as aloneness, responsibility, and freedom are universal to humankind. In including existential concerns as part of group psychotherapy, therapist and patients move more closely to bilateral relationships and subjective interactions (10). One of the main tasks of an existential therapist is to make the patient aware that he or she is not going to act like a passive being whose events determine his or her life and his or her goals. Instead, he or she can consciously shape his or her plan (13, 14).
Cognitive-existential group psychotherapy
Cognitive-existential group psychotherapy is an integrated method created by a logical combination of theoretical and strategic principles of existential psychotherapy and cognitive techniques and strategies of cognitive psychotherapy (15). Integrated psychotherapy methods derived from the combination principles, concepts, and methods of two or more main theories and methods are more effective than the one-dimensional methods that use their structures, concepts, and assumptions to explanation a wide range of human phenomena. Different populations provide psychological support to help alleviate the problem (16). It seems significant that, within the move towards therapeutic integration, little has been a study on a potential relationship between existential-phenomenological and cognitive-behavior therapies and the effect of them. Given that both these approaches emphasize the concept of meaning in working towards psychological growth and change, this omission seems important to researching (17). In Cognitive-existential group psychotherapy, the patients have the opportunity to express his or her existential concerns and current anxieties when applying cognitive strategies, such as identifying, changing, and correcting the various cognitive distortion that leads to undesirable behaviors. This is a combination of cognitive reassessment and coping skills that integrated with existential and group supportive strategic factors. Patients, however, also benefit from the support of participating in group intervention used in the context of group therapy(15).
Humanistic-existential group psychotherapy
Humanistic-existential psychotherapy that developed when the humanistic psychology movement emerged in the 1950s is also derived from existential philosophy (18). It emphasizes existential certainties concerns and subjective experience(18).The humanistic-existential group psychotherapy method is a combination of concepts and applications based on existential values such as self-inquiry, struggle, and responsibility, and popular values such as spontaneity, optimism, and practicality. It is a kind of psychotherapy that, by emphasizing the current reality and by analyzing and replacing specific patterns of response, is an encouragement to help people actuality their potential. This process facilitated in a group environment, because in the humanistic-existential group psychotherapy through interaction with others, more aspects of patients existential certainties concerns are revealed (19) humanistic-existential group psychotherapy involves situations in which people can sincerely recognize themselves and realize their ideas as much as possible (20) .
Logic of research
Helping women with type 2 diabetes mellitus through psychological intervention is very important. Because, it is clear psycho-somatic problems, which women more experience it symptoms than men (21), associated with a higher prevalence of psychological problems (22). The main features of psychological factors influencing on diabetes, presence of one or more clinically significant psychological or behavioral factors that are a harmful way with an increased risk of suffering death or disability affects the medical condition(23) . Simple existential interventions and integrated with other interventions, in addition to addressing existential concerns that can increase acceptance of reality and thus reduce stress, also address various aspects of existence such as the physical, mental, and social worlds that can effective in reducing the negative psychological effects on the body. In these interventions, patients learn to set up a good relationship with themselves, their bodies, and others (13).
In review the evidence of the effectiveness types of existential therapies, the result shows that some of them appear beneficial to some populations. There is significant support for interventions incorporating psycho-education, exercises, and discussing meaning in life directly and positively with physically ill patients (24).
Investigation of the effectiveness of group psychotherapy for problem reduction in patients with type 2 diabetes mellitus shows that limited experience of group psychotherapy among these patients has given encouraging results. The issue remains, however, as to which groups of patients might benefit most(25). Research by Nazari, Yarahmadi, and Zahrakar (26) showed that group psychotherapy increased the marital satisfaction of women with type 2 diabetes mellitus. The findings of the investigation of the effectiveness of existential group psychotherapy have shown that this intervention has been more effective in reducing the problem of the mastectomy in women compared to group reality therapy(27) . Existential-cognitive group therapy could be a selective therapy to improve the psychological stress of depressed women suffering from breast cancer (15), (28) Also, humanistic-existential group therapy could be a selective therapy for borderline personality disorder treatment (29).
Given the very significant limitations of the research on the comparison of the effectiveness of existential, cognitive-existential, and humanistic-existential group psychotherapy on psychosomatic complaints in women with type 2 diabetes mellitus, comparing the effect of these interventions can enrich of psychotherapy try for women with type 2 diabetes mellitus and benefits from reducing this gap. Therefore, this study was conducted to answer the following questions.
- be effective any existential, cognitive-existential, and humanist-existential group psychotherapies compared to the
- Which group of existential, cognitive-existential, and humanist-existential psychotherapy has the greatest impact on women's psychosomatic complaints with women with type 2 diabetes mellitus?