**3. Psychological interventions for ESRD patients receiving HD**

Psychological interventions can be effectively improving the mental health of ESRD patients receiving HD. These interventions are delivered either individually [35], in groups [36, 37], or by guided self-help [38, 39]. Cognitive-behavioral therapy (CBT), psychoeducation/educational interventions, relaxation techniques, peer support groups, spiritual therapy, technology-based psychological interventions, and other psychotherapeutic techniques are effective in improving the mental health of ESRD patients receiving HD (**Figure 1**) [40, 41].

#### **3.1 Cognitive-behavioral therapy (CBT)**

CBT is the widely used psychological intervention for HD patients [32]. It aims to develop a positive attitude toward hemodialysis by countering negative thoughts and *Psychological Interventions for End-Stage Renal Disease Patients' Receiving Hemodialysis DOI: http://dx.doi.org/10.5772/intechopen.112793*

**Figure 1.** *Psychological interventions for ESRD patients receiving HD.*

improving the patients' acceptance and understanding of their disease and HD [42]. Moreover, CBT helps to internalize HD patients' locus of control [43]. Therefore, reduce depression [44, 45] and anxiety and improves quality of life of the patients undergoing HD [46, 47]. CBT is effective in increasing hope among ESRD patients receiving HD and dealing with their death anxiety [48].

The benefits of CBT extend into physical health as well. For instance, HD patients can benefit from CBT techniques, including sleep hygiene, to reduce their sleep disturbances [49, 50]. Furthermore, fluid control, which is integral to HD [51], can be achieved by using techniques such as reinforcement, self-monitoring, self-contracting, and other CBT techniques [52, 53]. Moreover, mindfulness meditation improves the biological markers of ESRD patients receiving HD [54]. BReF is specially designed CBT to reduce fatigue among ESRD patients receiving HD by creating consistent activity and rest routines throughout the day [55].

In a systematic review [56], it was concluded that the most promising psychological interventions were thought to be those that have cognitive and behavioral components. These findings highlight the importance of CBT for ESRD patients receiving HD. However, despite the evidence from the literature for the effectiveness of CBT in improving the quality of life and self-management among patients receiving HD patients, it is not being incorporated into practice [57].
