مقایسه اثربخشی درمان شناختی رفتاری با درمان مبتنی بر پذیرش و تعهد بر نشخوارفکری، انعطاف پذیری شناختی، تاب آوری و استرس ادراک شده در زنان مبتلا به اختلال افسردگی (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
افسردگی، یکی از اختلالات شایع ناتوان ساز و عود کننده روانی است، که تغییرات آشکاری را در انواع عملکردهای زیستی، شناختی، عصبی و عاطفی افراد مبتلا برجای می گذارد. هدف پژوهش مقایسه اثربخشی درمان شناختی رفتاری با درمان مبتنی بر پذیرش و تعهد بر نشخوار فکری، انعطاف پذیری شناختی، تاب آوری و استرس ادراک شده در زنان مبتلا به اختلال افسردگی شهرستان اندیمشک بود. جامعه آماری، شامل کلیه زنان مراجعه کننده به کلینیک های روان پزشکی در بازه زمانی ۱۴۰۰-۱۴۰۱ بودند. 45 نفر از بیماران به صورت تصادفی در سه گروه (دو گروه آزمایش و یک گروه کنترل) ثبت شد. سنجش متغیرهای پژوهش به کمک پرسشنامه نشخوار فکری (Nolen-Hoeksema & Morrow)، انعطاف پذیری شناختی (Dennis & Vander)، تاب آوری (Connor-Davidson) و پرسشنامه استرس ادراک شده (Cohen et al.)، صورت گرفت. در تجزیه و تحلیل از آزمون تحلیل کوواریانس، واریانس دوطرفه، اندازه گیری مکرر و آزمون بن فرونی استفاده شد. نتایج نشان داد بین اثربخشی پذیرش و تعهد با روش شناختی رفتاری بر نشخوار فکری، تفاوت معنی دار وجود دارد (P<0.05). در اثربخشی دو روش بر انعطاف پذیری شناختی و استرس ادارک شده تفاوتی دیده نشد. هیچ کدام از درمان ها بر تاب آوری مؤثر نبود. هر دو رویکرد شناختی رفتاری و پذیرش و تعهد می توانند به عنوان روش های کارآمدی جهت کاهش علائم و نشانه های افسردگی به کار گرفته شوند اما لازم است تفاوت اثربخشی هر دو روش در متغیرهای مربوط به افسردگی در گروه های مختلف نیز مقایسه و ارزیابی گردد.Comparing the Effectiveness of Cognitive Behavioral therapy and Acceptance and Commitment Therapy for Rumination, Psychological Flexibility, Resilience, and Perceived Stress among the Women Suffering from Depression
IntroductionDepression is one of the common disabling and recurring psychological disorders that causes obvious changes in the individual’s different biological, cognitive, nervous, and emotional functions. Depression is also considered as the second most common cognitive disorder, and therefore it has attracted the attention of many researchers around the world. Among the existing physical and mental diseases, depression is considered one of the most important global issues and problems, which according to the definition of the World Health Organization is the most important mood disorders. Some common symptoms of depression include: feelings of sadness, emptiness, hopelessness, worthlessness or guilt, loss of interest in activities that one used to enjoy, having trouble thinking, concentrating or making decisions, difficulty falling and staying asleep or sleeping too much, fatigue and lack of energy, changes in appetite, unexplained physical problems, thoughts of not wanting to live or hurting oneself. Depression is also a common, costly, and debilitating disease that imposes a heavy burden on global societies and can affect people of any age, gender, race, culture, social class or education level. However, people with a family history of depression, chronic pain or those who have experienced major life changes, trauma or stress may be at a higher risk of developing depression. The aim of the present study was to compare effectiveness of cognitive behavioral therapy and acceptance and commitment therapy for rumination, cognitive flexibility, resilience, and perceived stress among the women suffering from depression in Andimeshk city. MethodThe statistical population included all women referred to psychiatric clinics. 45 patients were randomly assigned into three groups (two experimental groups and one control group). Measuring research variables with the help of Nolen-Hoeksema and Morrow’s rumination questionnaire (1991), Dennis and Vanderwaal's (2010) cognitive flexibility, Connor, and Davidson's (2003) resilience, and Cohen et al.'s (1983) perceived stress questionnaire were used. At first, after obtaining the necessary permits and coordination with the psychiatric clinics of the city, all women referred to the psychiatric clinics who were suspected of symptoms of depression were screened by a psychiatrist. The initial diagnosis was made by a psychiatrist, and then, to make the diagnosis more certain, the clinical interview of SKID 5 was conducted by the researcher. According to the criteria for entering the research, 30 patients who were willing to cooperate in the research were randomly assigned into two groups (an experimental group of 15 people each and a control group of 15 people). ResultsAnalysis was done using analysis of covariance, two-way variance analysis and repeated measures and Ben Ferroni’s follow-up test. The results indicated that there was a significant difference between effectiveness of acceptance and commitment therapy compared to cognitive behavioral therapy for rumination; No difference was observed in the effectiveness of the two approaches for cognitive flexibility and perceived stress. The results of the present study indicated that there was no significant difference in the effectiveness of both treatment methods on the three variables of cognitive flexibility, resilience, and perceived stress. There was a difference between the two treatments only in the variable of rumination, so that the effectiveness of the treatment based on acceptance and commitment was confirmed. Regarding cognitive behavioral therapy, no evidence was found to confirm its effectiveness. DiscussionBoth approaches can be considered as effective methods for reduction of the symptoms of depression; cognitive behavioral therapy helps the individual identify the negative mental patterns such as self-criticism, hopelessness and feelings of worthlessness; and by identifying and challenging these distressing cognitive patterns, CBT exercises help the individual change their negative thinking patterns and improve their emotional well-being. Acceptance and commitment therapy, on the other hand, empowers the individual to accept their emotions without judgement and commit to actions aligned with their values as opposed to their symptoms of depression; and this is how ACT reduces the impact of depressive thoughts and feelings. Moreover, ACT was shown to be effective for rumination. In explaining the effectiveness of ACT for rumination it can be said that teaching different methods of challenging irrational thoughts and choosing a correct approach to the problem through mechanisms such as acceptance, increasing awareness, desensitizing, being at the moment, observing without judgement, confronting, and letting go can reduce rumination symptoms in individuals. In other words, ACT helps people to experience their disturbing thoughts only as a thought at first and do what is important to themselves in life and in line with their values, and accept their thoughts and manage unwanted thoughts and feelings. Finally, it is necessary to evaluate and compare effectiveness of the two methods for depression related variables in different groups as well.
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