اثربخشی درمان چندبعدی معنوی بر اضطراب بیماران پس از جراحی بای پس (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
هدف این پژوهش، بررسی اثربخشی درمان چندبعدی معنوی بر اضطراب بیماران پس از جراحی بای پس قلبی بود. روش مطالعه شبه آزمایشی با طرح پیش آزمون - پس آزمون و پیگیری همراه با گروه کنترل بود. جامعه آماری این پژوهش شامل بیمارانی بودند که جراحی بای پس عروق کرونر داشتند و در سال 1397 به مرکز بازتوانی بیمارستان قلب تهران مراجعه کردند. 30 نفر از بیمارانی که نمره اضطراب بالایی را در پرسشنامه DASS-21 کسب کردند، به روش دردسترس، انتخاب و به صورت تصادفی در دو گروه آزمایش و کنترل قرار گرفتند. ابزار این پژوهش مقیاس افسردگی، اضطراب و استرس بود. گروه آزمایش طی 10 جلسه 90 دقیقه ای در مرکز بازتوانی بیمارستان در معرض متغیر مستقل (مداخله چندبعدی معنوی) قرار گرفت. برای تحلیل داده ها از آزمون اندازه گیری مکرر استفاده شد. نتایج نشان دادند در نمرات اضطراب بین دو گروه آزمایش و کنترل در مرحله پیش آزمون، پس آزمون و پیگیری 1 ماهه و 3 ماهه تفاوت معناداری وجود دارد. درواقع، کاهش هیجانات منفی به دنبال درمان چندبعدی معنوی، نقش مهمی در پیشگیری از عوارض وخیم تر بیماری قلبی دارند و انجام مداخلات مبتنی بر نتایج این پژوهش برای بیماران قلبی توصیه می شود.Investigating the Effects of Spiritually Multidimensional Psychotherapy on the Patients' Anxiety after Bypass Surgery
This study aimed to investigate the effectiveness of multidimensional spiritual therapy for reducing patients' anxiety after cardiac bypass surgery. The study utilized a quasi-experimental with a pretest-posttest design and follow-up with a control group. The statistical population of this study included patients who had coronary artery bypass surgery and were referred to the Rehabilitation Center of Tehran Heart Hospital in 2018. Thirty patients who scored high for anxiety on the Depression, Anxiety, and Stress Scale (DAS-21) questionnaire were selected by convenience sampling and were randomly assigned to experimental and control groups. The experimental group was exposed to an independent variable (multidimensional spiritual intervention) for ten 90-minute sessions in the hospital rehabilitation center. The results of repeated measurement test showed that there was a significant difference in the anxiety scores for the experimental and control groups in the pre-test, post-test, and one-month and three-month follow-up stages. In addition, there was a significant difference in the pretest-posttest in the spiritual group. There was no significant difference in post-test scores between one-month and three-month follow-ups. Reducing negative emotions by multidimensional spiritual therapy plays an important role in preventing the more severe complications of heart disease, therefore, interventions based on the results of this study are recommended for heart patients. Introduction Cardiovascular diseases, with 11 million deaths per year, are the most important cause of disability and death in the world (Alrawi & Alrawi, 2017). A large number of coronary artery disease (CHD) patients who do not respond to drug treatments undergo coronary artery bypass graft surgery (CABG) (Amjadian et al., 2018). This surgery is accompanied by psychological reactions such as stress, anxiety, and depression. As disturbing factors in treating patients, it affects patients' quality of life, recovery after surgery, the efficiency of surgery, and the rate of death after surgery (Turk-Adawi et al., 2018). The fear of death, disability, and reduced range of motion fuel this anxiety following the continuation of symptoms (Allen et al., 2018). Moreover, anxiety can cause various physical and psychological symptoms such as heart palpitations, increased blood pressure, inability to concentrate, insomnia, and fear of consequences. It seems that the intervention that helps to moderate patients' emotions is multidimensional spiritual treatment psychotherapy. In the form of Lazarus therapy, and in addition to the external dimension of personality, multidimensional spiritual treatment psychotherapy focuses on the spiritual dimension (Richards & Bergin, 2004). Activating the spiritual dimension can take all of them under the and give them unity (Khayatan Mostafavi et al., 2019). Therefore, this study aimed to investigate the effectiveness of multidimensional spiritual therapy on the anxiety of patients after heart bypass surgery. Method The study employed a quasi-experimental with a pre-test-post-test and follow-up design with a control group. The research population included cardiac patients with coronary artery bypass surgery (CABG) at Tehran Cardiac Rehabilitation Center, Iran in 2018. The sample included 30 patients who scored a high anxiety score on the DAS scale. They were selected via convenient sampling and were randomly assigned to two experimental and control groups. The experimental group received the multidimensional spiritual intervention, and the control group was placed on the waiting list. Finally, the repeated measurement test conducted by SPSS-20 software were used to analyze the data. Results Thirty patients were studied to examine the effectiveness of multidimensional spiritual treatment for reducing their anxiety. From the sample, 66.81% were men and 33.19% were women. The highest frequency was related to the age group of 60-69 (45.7), and the lowest frequency was 49-40 (15.8). There was no significant difference between the experimental and control groups in demographic variables and clinical data at baseline. In the experimental group, there was a significant difference between the mean and standard deviation of anxiety in the pre-test and post-test stages. However, no significant difference was seen in the pre-test and post-test scores of the control group. Repeated measure variance analysis showed a significant difference in the anxiety scores between the experimental and control groups in the pre-test, post-test, and one-month and three-month follow-up. The results of the mean difference test comparing the spiritual group and the control group in four stages showed that there was a difference in anxiety scores in the pre-test and post-test scores of the experimental group ( F =11.067, p <0.05). Post-test scores for the one-month and three-month follow-up stages were not statistically significant ( p <0.05). Furthermore, in the control group, the differences in the anxiety scores in the post-test with one-month follow-up and three-month follow-up were not statistically significant ( p < 0.05). Conclusion In this study, the researchers examined the effect of multidimensional spiritual therapy on the patients' anxiety after bypass surgery and the results bear witness to the effectiveness of the intervention. The findings showed that after a 10-session intervention, there was a significant difference between the experimental and control groups in regards to the patients' anxiety. This significant difference persisted between the two groups continued at one-month and three-month follow-ups. The results of this research are in accordance with previous findings regarding the effect of spiritual therapy on reducing emotional disorders such as anxiety (Amjadian et al., 2017; Hadadi Kohsar et al., 2018; Zamarra et al.,1996). The reason for this reduction in the experimental group is the coherence that the patient has gained about herself, her origin, existence, and others during the treatment period. It frees him from an action that is of ambiguous origin or contradicts other actions. Anxiety results from the perception of a vague internal threat and the conflict that reduces the coherence of human action and one’s mastery over her problems. While activating the spiritual path leads to relaxation, it increases a person's mental health and creates emotional stability. The results of the study of Ai AL et al. (2007) on 309 cardiac patients at the University of Michigan Medical Center showed that people who used spiritual confrontations in their daily life had less depression and anxiety and recover fast. However, these results are in contrast with Delaney et al. (2011) who reported that heart patients had a significant average increase in the overall quality of life score in a one-month spiritual intervention. However, there were no significant changes in anxiety and depression scores. Of course, the lack of effectiveness of this treatment in this group can be related to the lack of real experience of spirituality and not internalizing it. Because when one has not experienced spirituality in his/her being, one will not benefit from its real benefits. On the other hand, if these beliefs are from significant others, the disharmony that it creates cannot improve anxiety and depression because incoherence creates tension and anxiety instead of treatment. Furthermore, if the acquisition of these beliefs is made without personal experience and by compulsion, it will have no result other than disgust, anger, and a lot of bad feelings for the person. As a consequence, it causes tension, anxiety, depression, and physical disorders. Therefore, if spirituality leads to the reduction of anxiety, it is internalized and coherent. Ethical Consideration Compliance with Ethical Guidelines All ethical issues like informed consent and confidentiality of participants’ identifications were compiled based on the ethical committee of payamenoor University. Authors’ Contributions Only the authors of the article do all steps of the article Conflict of Interest There is no conflict of interest in this study Funding This study was conducted with no financial support. Acknowledgment The authors thank all the participants in this research. *
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