مقایسه اثربخشی درمان مبتنی بر پذیرش و تعهد همراه با مواجهه، با طرح واره درمانی همراه با مواجهه، بر افسردگی، اضطراب و استرس بیماران مبتلا به اختلال وسواس-جبری (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
هدف: افراد مبتلا به اختلال وسواس-جبری به مرورزمان درگیر اضطراب، استرس و افسردگی می شوند که خود می تواند مانع از پیشرفت درمان باشد. بر این مبنا پژوهش حاضر با هدف مقایسه اثربخشی درمان مبتنی بر پذیرش و تعهد همراه با مواجهه با طرح واره درمانی همراه با مواجهه بر اضطراب، استرس و افسردگی بیماران مبتلا به اختلال وسواس-جبری به انجام رسید. روش: روش پژوهش به صورت نیمه آزمایشی از نوع پیش آزمون و پس آزمون همراه با گروه گواه بود. جامعه آماری پژوهش حاضر شامل کلیه بیماران مبتلا به اختلال وسواس-جبری در سال 1402 در اصفهان بود. شصت نفر با روش نمونه گیری در دسترس انتخاب شدند و در دو گروه آزمایشی و یک گروه گواه (در هر گروه 20 نفر) گمارش تصادفی شدند. گروه های آزمایش هشت جلسه 60 دقیقه ای درمان مبتنی بر پذیرش همراه با مواجهه و طرح واره درمانی همراه با مواجهه دریافت کردند. در این پژوهش از پرسشنامه اضطراب، استرس و افسردگی لاوبوند (1995) استفاده شد. فرضیه ها از طریق تحلیل کوواریانس چند متغیره ارزیابی شدند. یافته ها: یافته های حاصل از پژوهش نشان داد که اثربخشی هر دو درمان بر اضطراب، استرس و افسردگی به طور جداگانه، در مقایسه با گروه کنترل معنا دار است (001/0>p). بر اساس یافته های پژوهش طرح واره درمانی همراه با مواجهه تأثیر بیشتر بر کاهش اضطراب و درمان مبتنی بر پذیرش و تعهد همراه با مواجهه تأثیر بیشتر بر کاهش استرس شرکت کنندگان داشته است؛ و تأثیر هر دو درمان بر افسردگی یکسان است. این نتایج بر اهمیت انتخاب درمان بیماران مبتلا به اختلال وسواس-جبری تأکید دارد و به بهبود راهبردهای درمانی کمک می کند.Comparing the Effectiveness of Acceptance and Commitment Therapy with Exposure and Schema Therapy with Exposure on Depression, Anxiety and Stress in Patients with Obsessive-Compulsive Disorder
Introduction Obsessive-Compulsive Disorder (OCD) is characterized by the presence of obsessions and compulsions. The majority of patients diagnosed with this disorder have been observed to demonstrate a higher degree of self-control over their compulsions (Stein et al., 2019). Depression frequently co-occurs with this disorder, leading to the intensification of obsessive-compulsive thoughts (Jones et al., 2018). Conversely, obsessive-compulsive disorder (OCD) frequently co-occurs with anxiety symptoms. Intolerance of ambiguity in these individuals has been shown to cause anxiety, prompting the person to engage in compulsions to reduce ambiguity (Sharma et al., 2021). In this regard, stress in this disorder is significantly related to the severity of obsessive symptoms but not to the severity of compulsions. In fact, while obsessions are stressful, compulsions act as a stress-reducing mechanism (Sousa-Lima et al., 2019). For this purpose, acceptance and commitment therapy with exposure utilizes three primary processes: acceptance, thought defusion, and values, for the treatment of this disorder (Twohig et al., 2015). Conversely, schemas cause psychological distress through cognitive distortions, destructive life patterns, and maladaptive coping styles. Schema therapy involves the substitution of healthy coping responses with the modification of schemas (Thiel et al., 2014). Consequently, the examination and comparison of these two integrated approaches can yield novel evidence in an efficient field and contribute to a more profound understanding of the factors that influence the persistence of OCD symptoms by focusing on variables such as anxiety, stress, and depression. The objective of this study is to compare the effectiveness of acceptance and commitment therapy with exposure and schema therapy with exposure on depression, anxiety, and stress in patients with OCD. Method This study employed a quasi-experimental pretest-posttest design with both experimental and control groups. Participants were selected through convenience sampling. Using GPower software, we determined a required sample size of 54 participants (18 per group). To account for potential attrition, we initially enrolled 20 participants in each group, resulting in a total sample of 60 individuals. The inclusion criteria for the groups encompassed the following: a diagnosis of obsessive-compulsive disorder, a minimum age of 18 years, and a minimum education level equivalent to middle school. The exclusion criteria encompassed the presence of psychotic disorders, other comorbid disorders, concurrent psychiatric treatments, and absence of more than three sessions. In this study, the Lovibond Depression Anxiety and Stress Scale (DASS-21) (1995) was utilized to assess three scales of depression, anxiety, and stress. The first experimental group engaged in acceptance and commitment therapy with exposure sessions, as outlined by Lee et al. (2018). The second experimental group participated in schema therapy with exposure sessions, as described by Thiel et al. (2016). The control group did not receive any therapeutic interventions. These treatments were administered on a weekly basis, with each session lasting for a duration of 60 minutes. Findings The findings of multivariate covariance analysis demonstrated that there was a significant discrepancy between the groups with respect to the components of depression, anxiety, and stress (F=30.133 and P =0.001), anxiety (F=37.557 and P =0.001), and stress (F=25.044 and P =0.001) in the two experimental and control groups. The post hoc test results indicated that both treatments had a significant and equal effect on depression in patients with obsessive-compulsive disorder (p > 0.05). A significant body of research has demonstrated that schema therapy with exposure has a greater effect on reducing anxiety (p < 0.05). Similarly, acceptance and commitment therapy with exposure has been shown to have a greater effect on reducing stress in participants (p < 0.05). Discussion & Conclusion The objective of this study was to compare the effectiveness of acceptance and commitment therapy with exposure therapy in reducing depression, anxiety, and stress in patients diagnosed with OCD. The findings of the study demonstrate the efficacy of acceptance and commitment therapy with exposure in addressing depression, anxiety, and stress in patients diagnosed with OCD. This finding aligns with the observations reported by Han and Kim (2022), and previous studies have demonstrated the efficacy of this therapeutic approach in enhancing psychological flexibility and alleviating symptoms of stress (Brinkborg et al., 2011) and depression (Twohig & Levin, 2017). This therapeutic modality aims to mitigate negative emotions by modifying the patient's relationship with their thoughts, cognitive processes, and their perception of suffering and harm in life. It assists patients in acknowledging the harm caused by their suffering while facilitating the adoption of steps towards their life values. The study's findings indicate that schema therapy with exposure is effective in addressing depression, anxiety, and stress in patients diagnosed with OCD. This hypothesis aligns with the findings reported by Priemer et al. (2015) and Ansari et al. (2020). Schema therapy demonstrates efficacy in alleviating depression, anxiety, and stress symptoms by targeting and modifying maladaptive schemas. This therapeutic approach proves particularly relevant for individuals with OCD, as their characteristic schemas often maintain depressive cognitions, anxiety patterns, and stress responses. Through schema restructuring, patients develop more adaptive cognitive frameworks that reduce pathological symptoms. A potential pivotal mechanism for the alteration of symptoms within the framework of schemas is the modification in distinctive negative core beliefs. That is to say, when symptoms demonstrate improvement, core beliefs concomitantly exhibit enhancement. The present study was subject to several limitations, including use of a convenience sampling method and the absence of subsequent follow-up. It is recommended that a random sampling method be employed in subsequent research to generalize the results. Additionally, a six-month follow-up period should be incorporated to ascertain the stability of the results over time.
تبلیغات
