**3.2 Psychoeducation**

Psychoeducation educates patients about the nature of their illness and how to manage the problems associated with illness [58]. These education-based

psychological interventions for ESRD patients receiving HD are aimed to surge their capability of goal setting and health literacy [32]. ESRD patients receiving HD were when psycho-educated, it changed their understanding and some beliefs about their survival treatment; hence, improves adherence behavior toward treatment [59]. In the case of HD, psychoeducation is beneficial at any stage of HD, but when used either before starting HD or in the initial stage exhibits significant advantages [60]. Psychoeducation can be used to address anxiety and depression among hemodialysis [61]. Al saraireh, Aloush [62] preferred psychoeducation over CBT for depression among patients receiving HD. Family-based psychoeducation program is beneficial for HD patients and their families [63]. In most studies [61, 62, 64, 65], ESRD patients undergoing HD were educated about normal kidney function and renal failure, demonstration of the dialysis procedure, diet and fluid, hygiene, essential needed care, and renal replacement options. However, only a few studies included information about potential problem-solving skills, individual stress management, adaptive responses, such as muscle relaxation [61, 62] and emotion-focused coping strategies [64].

#### **3.3 Relaxation techniques**

Patients with ESRD who receive HD can benefit from relaxation techniques. Psychological interventions based on relaxation promote self-regulation, emotional, cognitive, and behavioral flexibility among ESRD patients receiving HD [32]. Moreover, literature illustrates that relaxation technique can improve sleep quality [66–68], activity level [69], adherence to HD and other biomedical markers [70] and reduces pain [71, 72], fatigue [73], depression [74], and anxiety [75] among patients' receiving HD.

Relaxation techniques, including Benson's relaxation technique [66, 67, 69, 70, 72, 74], progressive muscle relaxation [71, 75, 76], and music relaxation therapy [77], can help ESRD patients undergoing HD. These techniques can be used in combination with other relaxation techniques, for instance, Benson relaxation with progressive muscle relaxation [78] and music therapy [79]. Aerobic exercise with relaxation techniques can improve the psychological health of ESRD patients undergoing HD [80]. However, relaxation techniques were suggested to use consistently for longer time, for example, one month among hemodialysis patients [81]. Relaxation techniques can effectively reduce psychological symptoms and improve the quality of life among elderly ESRD patients receiving HD. Hence, it is recommended to use these relaxation techniques in hospitals or HD centers [67].

#### **3.4 Peer support**

Peer-to-peer support improves the quality of life [82], self-management [83], hope [84], and mental health [85, 86] of the HD patients undergoing. Moreover, physical outcomes among HD patients receiving were also reported due to peer support [87]. Patient's "real knowledge" can be more beneficial to other patients undergoing hemodialysis if they share it with other fellow patients [83].

Peer to support benefits both; mentors and mentees in terms of knowledge, self-efficacy, and social support [88]. However, mentors should be trained prior to peer-to-peer mentoring about kidney disease, active listening, communication skills, privacy, and confidentiality [88]. Peer support sessions can also be moderators with the help of facilitators [84]. Generally, patients' can be benefited from informational, *Psychological Interventions for End-Stage Renal Disease Patients' Receiving Hemodialysis DOI: http://dx.doi.org/10.5772/intechopen.112793*

spiritual, instrumental, and emotional support from their fellow patients undergoing maintenance hemodialysis [84]. Moreover, peer support groups promoting selftranscendence were found to improve physical health status and quality of life among HD patients [37].

Peer support for ESRD patients undergoing HD can be done face-to-face or remote. However, HD patients prefer face-to-face peer support instead of remote telephonic peer support [89]. Online peer support was found effective for adolescents [90] and pediatric HD patients [91]. In a study [83], peer support programs were suggested to introduced in the early phase of HD to ESRD patients. Early support from their peers can help them manage their problems and themselves. Although peer support is found effective in improving physical health and psychological well-being, it is not taken advantage of this psychological intervention [92].

#### **3.5 Spiritual practices**

ESRD undergoing HD who use their religious beliefs and practices to cope with their lifelong survival treatment are less likely to experience psychological problems [23, 93, 94]. Spiritual therapy was effectively used with patients' receiving HD to improve their well-being [95], lifestyle [96], hope [97], resilience [98], and reducing their stress, anxiety, depression [99, 100].

In cases of HD, spiritual therapy proved especially effective since HD patients' lifestyle changes have affected their quality of life and researchers found that spirituality improves quality of life [101, 102]. In this context, spiritual interventions became increasingly important for HD patients [103]. Through religious practices, reading religious books, listening to spiritual music, and changing perspectives, spiritual therapy promotes optimism, hope, gratitude, contemplation, patience, raising awareness, and addressing problems through religious beliefs [91, 95, 99, 104, 105]. Further, Hosseini, Naseri-Salahshour [106] found that HD-related fear of death can be addressed through religious counseling. Therefore, spiritual therapy should be utilized as a complement to health care to increase treatment effectiveness [99].

#### **3.6 Tech-based psychological intervention**

Digital technologies (e.g., websites, applications, VR, and telephone) have been increasingly incorporated to optimize HD patients' quality of life. The use of technology-based psychological interventions is accepted, feasible, and needs minimum additional resources to address the mental health of patients on maintenance HD [107]. With the help of technology, it is possible to manage depression, anxiety, fatigue, self-efficacy, and self-management among patients receiving HD [108].

Psychological interventions with the help of digital technologies were tested in various forms with ESRD patients undergoing HD. The use of internet-based positive psychological interventions is an effective therapeutic option for HD patients with depression [109]. Internet-delivered CBT can reduce depression and anxiety among HD patients [110]. Further, therapist-guided Internet-based cognitive-behavioral therapy interventions address the problems associated with HD patients' experience [111]. Video-based ACT can also help HD patients to cope with the challenges associated with HD [112]. App-based self-management intervention can potentially improve the self-efficacy and basic psychological needs of elderly HD patients [113]. Additionally, immersed virtual reality during HD proved to be an active detraction and has the potential to address dialysis-related problems [114].

On the other hand, in tablet-based educational and motivational interviewing interventions when used with patients during HD, certain problems were reported in the user interface [115]. Similarly, HD patients with depression seem not to benefit from guided internet-based self-help problem-solving therapy [116]. In a systematic review, Marin and Redolat [108], the majority of the tech-based psychological intervention studies focused on psychological symptoms associated with HD, and there is a scarcity of literature aiming to target the cognitive functioning of patients' receiving HD. Hence, there is a need to carefully design the content and approachability of the psychological intervention of HD patients.
