اثربخشی رفتاردرمانی دیالکتیک بر تنظیم هیجان و اضطراب سلامت بیماران مبتلا به آسم (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
باتوجه به شیوع هم زمان اختلالات روانی در بیماران مبتلا به آسم، درمان های روان شناختی می تواند سهم بسزایی در بهبود علائم روان شناختی این افراد داشته باشد؛ بنابراین، هدف پژوهش، بررسی اثربخشی رفتاردرمانی دیالکتیک بر تنظیم هیجان و اضطراب سلامت بیماران مبتلا به آسم شهر اصفهان بود. طرح پژوهش شبه آزمایشی با گروه آزمایش و کنترل بود و جامعه آماری شامل کلیه بیماران مراجعه کننده به بیمارستان خورشید با تشخیص بیماری آسم بودند. در این جامعه، ۲۲ بیمار مبتلا به آسم با روش نمونه گیری دردَسترس انتخاب و به صورت تصادفی در دو گروه آزمایش و کنترل گمارده شدند. روش مداخله رفتاردرمانی دیالکتیک برای گروه آزمایش در طی هشت جلسه درمانی انجام شد و گروه کنترل و آزمایش در مراحل پیش آزمون و پس آزمون با استفاده از پرسشنامه تنظیم هیجان و اضطراب سلامت ارزیابی شدند. داده های پژوهش با استفاده از روش تحلیل کوواریانس تحلیل شد. مطابق نتایج پژوهش در متغیر تنظیم هیجان در زیرمقیاس ارزیابی مجدد بین دو گروه آزمایش و کنترل تفاوت معنادار وجود داشت؛ اما در زیرمقیاس سرکوبی، تفاوت معناداری وجود نداشت. در متغیر اضطراب سلامت نیز تفاوت معناداری بین دو گروه آزمایش و کنترل وجود داشت. براساس یافته های پژوهش، می توان گفت که رفتاردرمانی دیالکتیک می تواند به بهبود تنظیم هیجان و اضطراب سلامت در بیماران مبتلا به آسم منجر شود؛ بنابراین، این مداخله به عنوان درمانی مؤثر در بهبود این نشانه ها کاربرد دارد و می توان با اجرای آن به بهبود وضعیت روانی مبتلایان به آسم کمک کرد.Effectiveness of Dialectical Behavior Therapy on Emotion Regulation and Health Anxiety in Asthma Patients
The aim of this study was to investigate effectiveness of dialectical behavior therapy on emotion regulation and health anxiety in patients with asthma in Isfahan. Research design was quasi-experimental with experimental and control groups and statistical population included all patients who referred to Khorshid Hospital. In this community, 22 patients with asthma were selected by convenient sampling. They were randomly assigned into the experimental and the control groups. The intervention method of dialectical behavior therapy was performed for experimental group during eight treatment sessions. Both groups were evaluated in pre-test and post-test phases using the emotion regulation and the health anxiety questionnaire. The data was analyzed using covariance analysis method. The results showed that there was a significant difference in emotion regulation variables in reappraisal subscale between experimental and control groups, but there was no significant difference in the suppression subscale. Regarding health anxiety, there was also a significant difference between two groups. Based on research findings, dialectical behavior therapy can lead to improvement of emotion regulation and health anxiety in patients with asthma. Therefore, this intervention is used as an effective treatment in improving these symptoms.IntroductionAsthma is a chronic respiratory disease (Maierean et al., 2019). The overlap of psychiatric symptoms has a negative impact on quality of life of patients with asthma (Normansell et al., 2018).Emotion regulation is a psychological component that plays a significant role in psychological vulnerability of patients with asthma (Hughes et al., 2011). Negative emotional states and emotion regulation problems can lead to the exacerbation and increase of asthma symptoms (Leupoldt et al., 2013).Another component related to psychological vulnerability of asthmatics is the health anxiety (Ten Thoren & Petermann, 2000). Health anxiety is common in people with asthma and has a significant impact on their disease management and symptom perception (Burrows & Mason, 2004).Considering that asthma is a disease consisting of several physical, psychological and social factors; it seems that psychological treatments along with drug treatments can be effective in reducing disease symptoms (Baiardini et al., 2015). Among treatment methods, dialectical behavior therapy seems to be effective in improving symptoms of asthma patients (Linehan, 2020). This treatment is an integrative treatment method in which patient is taught to identify contradictions within or between himself and the environment and achieve an efficient result through their combination and integration (Long & Witterholt, 2013). In recent years, dialectical behavior therapy has been used in a relatively diverse range of disorders (Lin et al., 2019).Finally, since patients with asthma show higher levels of negative emotions, anxiety, stress and excessive attention to symptoms, it is important to search for more novel and different psychological treatments for patients (González-Freire et al., 2020)). Therefore, the present study was conducted with the aim of the effectiveness of dialectical behavior therapy on emotion regulation and health anxiety in patients with asthma. MethodThe research design was quasi-experimental with a pre-test, post-test and two experimental and control groups. The statistical population of the present study was all patients with asthma who referred to Khorshid Hospital, Isfahan. Twenty-two people were selected through convenience sampling. They were randomly assigned to experimental and control groups. The research tools were the emotion regulation questionnaire (Gross & John, 2003) and the health anxiety questionnaire (Salkovskis et al., 2002). Individuals in experimental group underwent dialectical behavior therapy for eight sessions based on protocol of McKay et al. (2007/2011). Finally, SPSS software was used to analyze covariance method. ResultsMultivariate analysis of covariance (MANCOVA) was used to investigate effectiveness of dialectical behavior therapy on emotion regulation. In order to investigate the difference between the groups in each of components of emotion regulation, a between-subjects test was used. Results of the test are presented in Table 1. Table 1: Test of inter-subject effects to compare emotional regulation components of experimental and control groups in post-testVariableLevelSum of squaresdfMean of squaresFpEffect sizesuppressionPre-test0/17910/1790/1700/6850/009 Between subject0/27710/2770/2630/6140/014 error20/014191/053 reappraisalPre-test0/01110/0110/0120/9120/001 Between subject6/52716/5277/2080/0150/275 error17/204190/905 As can be seen in Table 1, pre-test variable is not significant for any of the components of emotion regulation variable (p>0.05). Also, after removing pre-test effect, there was no significant difference between the control and the experimental groups in suppression variable, but in reappraisal component, the difference between control and experimental groups was significant at the level of 0.05 (p<0.05).In order to investigate effectiveness of dialectical behavior therapy on health anxiety, univariate analysis of covariance (ANCOVA) was used. Based on results of covariance analysis (Table 2) to compare health anxiety in experimental and control groups (Table 2), the F value obtained is equal to 8.209 and is significant at level of 0.01 (P < 0.01). Therefore, the null hypothesis is rejected and the research hypothesis that there is a difference between average scores of health anxiety in experimental and control groups is confirmed. Table 2: Results of covariance analysis to compare health anxiety in experimental group and control grouplevelSum of squaresdfMean of squaresFsigEffect sizePre-test0/06810/0680/2320/6350/012Between subject2/41412/4148/2090/010/302error5/586190/294 DiscussionThe present study was conducted with the aim of investigating the effect of dialectical behavior therapy on emotion regulation and health anxiety in patients with asthma. The results of the study regarding variables of emotion regulation showed that dialectical behavior therapy had an effect on reappraisal component, but it did not have any effects on the suppression variable. The findings of the present study are in line with the results of Rodríguez (2012), Zhukava & Shot (2013) and Plourde et al. (2017).In explaining the results, it can be said that during the dialectical behavior therapy, patients were able to identify their emotions in stressful situations and become aware of them. In this situation, a person can re-evaluate the situation that caused him stress and anxiety and examine it in a more positive way. In suppression component, no significant difference was observed between two groups, because during the treatment, the person is taught to observe emotions instead of ignoring them, and to regulate their emotions. In this way, the conditions of dialectical behavior therapy are different from what is seen in suppression.Based on the obtained results, dialectical behavior therapy is effective on health anxiety of asthmatic patients. The findings of present study are in line with results of Feldman et al. (2014) and Boudreau et al. (2015) research.In people with asthma, because anxiety sensitivity increases attention to physical symptoms, one skill that was used in this stage for people with asthma was the ability to tolerate disturbance. By training to tolerate disturbance and identifying harmful coping thoughts, this group of patients were taught to deal with their pain in healthier ways which brought about anxiety sensitivity and consequently catastrophic interpretation of symptoms. Also, by doing mindfulness exercises, patients learn to recognize their physical states, especially their breathing states, and to control their states if they feel difficulty in breathing instead of misinterpreting these symptoms.In line with limitations of the study, including the sample size and limitation of the sample members, it is suggested that study be repeated in a larger sample and in other communities. Also, considering effectiveness of dialectical behavior therapy on emotional regulation and health anxiety in asthmatic patients, it is suggested to use intervention as a complementary treatment in medical centers and hospitals.
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