اثربخشی توان بخشی شناختی همراه با تحریک الکتریکی مستقیم فراجمجمه ای بر بهبود سوگیری توجه و علائم وسواسی جبری در نوجوانان مبتلا به اختلال وسواسی – جبری (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
پژوهش حاضر با هدف بررسی اثربخشی توان بخشی شناختی همراه با تحریک الکتریکی مستقیم فراجمجمه ای بر بهبود سوگیری توجه و علائم وسواسی جبری در نوجوانان مبتلا به اختلال وسواسی - جبری انجام شد. روش پژوهش حاضر نیمه آزمایشی و از نوع پیش آزمون-پس آزمون و پیگیری با گروه کنترل و تخصیص تصادفی آزمودنی ها بود. جامعه آماری پژوهش عبارت بود از نوجوانان دختر و پسر (14 تا 18 سال) مبتلا به اختلال وسواسی - جبری شهر اهواز در سال 1401-1400 که از این میان، 30 نفر انتخاب و در 2 گروه آزمایش و کنترل (هر گروه 15 نفر) به صورت تصادفی تخصیص داده شدند. شرکت کنندگان از طریق آزمون استروپ هیجانی و مقیاس وسواس - بی اختیاری ییل براون ارزیابی شدند. پس از ارزیابی، افراد گروه آزمایش 12 جلسه و هر جلسه 45 دقیقه تحت درمان توان بخشی شناختی قرار گرفتند که در طول این 45 دقیقه، هم زمان با انجام تکالیف توان بخشی شناختی به مدت 20 دقیقه تحریک الکتریکی مستقیم فراجمجمه ای نیز انجام می شد. افراد گروه کنترل مداخله ای دریافت نکردند. پس از اتمام مداخلات و همچنین، پس از 3 ماه، شرکت کنندگان دوباره ارزیابی شدند. برای تحلیل داده ها و پاسخ به فرضیه های پژوهش از روش تحلیل کوواریانس چندمتغیره و همچنین تحلیل کوواریانس تک متغیره استفاده شد. نتایج نشان داد درمان توان بخشی شناختی همراه با تحریک الکتریکی مستقیم فراجمجمه ای می تواند به طرزی معنادار به بهبود سوگیری توجه و کاهش شدت علائم وسواسی - جبری منجر شود (05/0>P). توان بخشی شناختی همراه با تحریک الکتریکی مستقیم فراجمجمه ای می تواند به عنوان یکی از درمان ها در اختلال وسواسی - جبری استفاده شود.The Efficacy of Cognitive Rehabilitation Therapy with Transcranial Direct Current Stimulation in Attention Bias and Obsessive-Compulsive Symptoms of Adolescents with Obsessive-Compulsive Disorder
This study aimed to investigate the efficacy of cognitive rehabilitation therapy with transcranial direct current stimulation in attention bias and obsessive-compulsive symptoms of adolescents with obsessive-compulsive disorder. The current study is Quasi-experimental research using a pre-test-post-test design and a three-month follow-up with a control group. The study's statistical population comprised male and female individuals aged 14 to 18 who were diagnosed with obsessive-compulsive disorder and seeking treatment at counseling and psychological centers in Ahwaz City, Iran. Thirty individuals who met the inclusion criteria for the study were selected using an available sampling method and randomly assigned to the experimental or control group. Those who met the exclusion criteria were excluded from the study. Before commencing the intervention, the participants underwent an evaluation using the appropriate tools, namely the Emotional Stroop Test and Yale-Brown Obsessive-Compulsive Scale. After the evaluation, the participants in the experimental group underwent cognitive rehabilitation therapy for 12 sessions. Each session lasted 45 minutes, during which 20 minutes of transcranial direct current stimulation was performed concurrently with cognitive rehabilitation tasks. The participants in the control group did not receive any intervention. After completing the interventions, the participants were re-evaluated three months later. MANCOVA and ANCOVA were utilized to analyze the data and answer the research question. The results showed that cognitive rehabilitation with transcranial direct current stimulation could improve attention bias and reduce obsessive-compulsive symptoms (p < 0.05). Based on the results, cognitive rehabilitation with transcranial direct current stimulation can be used as a treatment for obsessive-compulsive disorder. IntroductionObsessive-compulsive disorder (OCD) is characterized by two primary symptoms: obsessive thoughts and compulsive behaviors (Skriner et al., 2016). This chronic condition can affect individuals from early childhood through adulthood. Due to its debilitating nature, OCD can significantly impact various aspects of an adolescent's life, including personal, academic, and social functioning, as well as the well-being of their families (American Psychiatric Association, 2022).Several underlying factors contribute to the development of obsessive-compulsive disorder (OCD) in individuals of different ages. Notably, abnormalities in the dorsolateral prefrontal cortex and the orbitofrontal cortex, along with cognitive impairments such as attention bias, play significant roles (American Psychiatric Association, 2022; Cisler & Olatunji, 2010). It is anticipated that enhancing these physiological and cognitive deficiencies will significantly reduce the symptoms of obsessive-compulsive disorder. Among the interventions utilized in this field are cognitive rehabilitation and transcranial direct current stimulation (Kashyap et al., 2019; Thamby et al., 2021).Therefore, this study aimed to investigate the efficacy of cognitive rehabilitation therapy combined with transcranial direct current stimulation in attention bias and obsessive-compulsive symptoms of adolescents with obsessive-compulsive disorder. MethodThe current study is Quasi-experimental research using a pre-test-post-test design and a 3-month follow-up with a control group. The study's statistical population comprised male and female individuals aged 14 to 18 years old who were diagnosed with obsessive-compulsive disorder and seeking treatment at counseling and psychological centers in Ahwaz City, Iran. Thirty individuals who met the inclusion criteria for the study were selected using an available sampling method and randomly assigned to either the experimental or control group. Those who met the exclusion criteria were excluded from the study. Before commencing the intervention, the participants underwent an evaluation using the appropriate tools, namely the Emotional Stroop Test and Yale-Brown Obsessive-Compulsive Scale. After the evaluation, the participants in the experimental group underwent cognitive rehabilitation therapy for 12 sessions. Each session lasted 45 minutes, during which 20 minutes of transcranial direct current stimulation was performed concurrently with cognitive rehabilitation tasks. The participants in the control group did not receive any intervention. After completing the interventions, the participants were re-evaluated three months later. MANCOVA and ANCOVA were utilized to analyze the data and answer the research question FindingsAfter meeting the assumptions of MANCOVA, this method was employed to address the research questions. The results of Wilks's Lambda test are presented in Table 1. Table 1: Results of Multivariate Analysis of Covariance (MANCOVA)StageIndexValueFHypothesis dfError dfSig.Partial Eta SquaredObserved PowerPost-TestWilks' Lambda0.29128.0042230.00010.701Follow-UpWilks' Lambda0.33522.7812230.00010.661 According to the contents of Table 1, Wilks's lambda test results from the multivariate analysis indicated that cognitive rehabilitation therapy combined with transcranial direct current stimulation significantly affected at least one of the dependent variables related to attention bias and obsessive-compulsive symptoms, both during the post-test phase and the follow-up phase (p < 0.05).Based on the results of multivariate covariance analysis, it was determined that there is a significant difference between the control and experimental groups in terms of at least one of the dependent variables. However, the pattern of this difference is not clear. Therefore, univariate covariance analysis was used to examine the different patterns, and the results are presented in Table 2. Table 2: Results of ANCOVA Analysis Comparison of Differences between Experimental and Control Groups in Attention Bias and Obsessive-compulsive SymptomsStageVariableSourceSum of SquaresdfMean squareFSig.Partial Eta SquaredObserved PowerPost-TestAttention biasGroup2.34212.34214.8680.0010.380.050OCD SymptomsGroup127.261127.2642.6080.00010.641Follow-UpAttention biasGroup2.13912.13912.6810.0020.340.927OCD SymptomsGroup74.220174.22034.9550.00010.591According to the contents of Table 2, the results of univariate covariance analysis to determine the effectiveness of cognitive rehabilitation therapy combined with transcranial direct current stimulation on the total score of attention bias and obsessive-compulsive symptoms show the positive effect of this method on attention bias and obsessive-compulsive symptoms in adolescents with obsessive-compulsive disorder, both during the post-test phase and the follow-up phase (p < 0.05). DiscussionThe results of the current study indicate that cognitive rehabilitation therapy combined with transcranial direct current stimulation significantly reduces attention bias in adolescents diagnosed with obsessive-compulsive disorder. When a person engages in cognitive tasks that require selective attention, there is an increase in the activity of brain regions associated with this cognitive function, including the left dorsolateral prefrontal cortex (Li et al., 2016). On the other hand, transcranial direct electrical stimulation (with the anode placed on the F3 area and the cathode on the Fp2 area) enhances neuronal readiness for activity or depolarization by lowering the threshold for neuronal stimulation (Nitsche & Paulus, 2011). a reduction in attention bias will be observed.The results of the current study also indicate that cognitive rehabilitation therapy combined with transcranial direct current stimulation significantly reduces obsessive-compulsive symptoms in adolescents diagnosed with obsessive-compulsive disorder. We know that deficits in cognitive functions, such as inhibitory control, cognitive flexibility, working memory, and attention bias, are observed in many patients with obsessive-compulsive disorder. These deficits can contribute to the development or exacerbation of obsessive-compulsive symptoms (Derbyshire, 2020; Jalal et al., 2023). Cognitive rehabilitation therapy can alleviate the symptoms associated with these deficits through various functions. Therefore, the reduction of obsessive-compulsive symptoms can be attributed to the enhancement of cognitive functions or the improvement of cognitive deficits in these individuals. On the other hand, research has shown an increase in the activity of the OFC and a decrease in the activity of the DLPFC in many individuals with obsessive-compulsive disorder (American Psychiatric Association, 2022; Cisler & Olatunji, 2010). According to the therapy protocol used in this study, transcranial direct current stimulation (TDCS) was administered by placing the anode electrode on the F3 (LDLPFC) and the cathode on FP2 (OFC). This method raised the stimulation threshold of OFC neurons while reducing activity in the LDLPFC region, ultimately leading to a decrease in the severity of OCD symptoms.Based on the findings of the present study, it can be concluded that cognitive rehabilitation therapy combined with transcranial direct current stimulation can reduce attention bias and obsessive-compulsive symptoms of adolescents with obsessive-compulsive disorder. Therefore, this combined treatment can be utilized by mental health professionals for adolescents diagnosed with obsessive-compulsive disorder. [1] Ph.D. in Psychology, Department of Psychology, Faculty of Educational Science and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.[2] Assistant Professor, Department of Psychology, Faculty of Educational Science and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran. Corresponding Author, Email: Davirp38@yahoo.com[3] Professor, Department of Psychology, Faculty of Educational Science and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
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