اثربخشی مداخله گروهی روابط ابژه کوتاه مدت بر خودآگاهی، اضطراب اجتماعی و آلکسی تایمیا در بیماران مبتلا به آسم (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
هدف: آسم یک بیماری مزمن با ابعاد جسمی و روان شناختی است که بر کیفیت زندگی بیماران تأثیر می گذارد . این پژوهش با هدف بررسی اثربخشی مداخله گروهی روابط ابژه کوتاه مدت بر خودآگاهی، اضطراب اجتماعی و آلکسی تایمیا در بیماران مبتلا به آسم انجام شد. روش : روش پژوهش حاضر از نوع نیمه آزمایشی با طرح پیش آزمون- پس آزمون همراه با گروه کنترل و پیگیری بود. جامعه آماری، شامل کلیه بیماران مبتلا به آسم، بستری در بیمارستان های شهر تهران در سال 1402 بوند. تعداد 40 بیمار به روش نمونه گیری هدفمند انتخاب و به صورت تصادفی در دو گروه آزمایش (20 نفر) و کنترل (20 نفر) گمارده شدند. در طول مطالعه، چهار نفر (دو نفر از گروه آزمایش و دو نفر از گروه کنترل) از ادامه همکاری انصراف دادند. ابزارهای پژوهش شامل مقیاس خودآگاهی فنیگستین (1975)، پرسشنامه اضطراب اجتماعی کانور و مقیاس آلکسی تایمیا تورنتو بود. گروه آزمایش مداخله گروه درمانی روابط ابژه کوتاه مدت را طی 16 جلسه 45 دقیقه ای در مدت چهار ماه دریافت کرد. داده ها با استفاده از آزمون تحلیل واریانس با اندازه گیری مکرر و نرم افزار SPSS تحلیل شدند . یافته ها: نتایج تحلیل واریانس با اندازه گیری مکرر نشان داد، درمان گروهی روابط ابژه موجب افزایش معنادار خودآگاهی (P<0.001) ، و کاهش آلکسی تایمیا (P<0.001) و اضطراب اجتماعی (P<0.05) تا مرحله پیگیری شد . نتیجه: با توجه به یافته های به دست آمده می توان نتیجه گرفت که درمان گروهی روابط ابژه کوتاه مدت روشی مؤثر برای بهبود مشکلات روان شناختی در بیماران مبتلا به آسم بوده و به طور غیرمستقیم در بهبود مشکلات جسمانی این بیماران نیز نقش دارد.Effectiveness of Short-Term Object Relations Group Intervention on Self-Awareness, Social Anxiety and Alexithymia in Patients with Asthma
Introduction: Asthma, a prevalent chronic respiratory condition, has been associated with psychological consequences such as social anxiety (Habibi et al., 2021), emotional dysregulation (e.g., alexithymia), and diminished self-awareness. These psychological factors can intensify the severity of asthma symptoms and diminish the quality of life for individuals affected by the condition (Javaheri Mohamadi et al., 2022). In recent years, object relations-based group intervention has been proposed as an effective approach for patients with asthma. The rationale behind this proposal is that, by focusing on analyzing internal relationships and promoting emotional insight, it can lead to improved psychological and social functioning and, as a result, a reduction in physical symptoms (Cohen & Hulsey, 2022). The objective of the present study was to investigate the effectiveness of short-term object relations group intervention on enhancing self-awareness and reducing social anxiety and alexithymia in patients with asthma. Method: The present study employs a quasi-experimental design, incorporating a pretest, posttest, control group, and follow-up design. The statistical population of this study included all hospitalized patients with asthma in Tehran hospitals in 2023, from which 40 people were selected using purposive sampling. Subsequently, the participants were randomly assigned to experimental and control groups (20 individuals for each group). During the implementation process, four individuals (two from each group) withdrew from further cooperation for various reasons, and the final analysis was conducted on the data of 36 participants. The instruments to collect data consisted of the Fenigstein Self-Consciousness Scale (FSCS) (1975), the Connor et al. Social Anxiety Questionnaire (2000), and the Toronto Alexithymia Scale (TAS-20) (Begby et al., 1994). The experimental group underwent a brief, 12-session object relations-based group therapy intervention, administered over a four-month period. In contrast, the control group did not receive any psychotherapy intervention. For the purpose of data analysis, a repeated-measures analysis of variance was employed in SPSS software, thereby enabling the examination of intragroup and intergroup changes across three phases: pretest, posttest, and follow-up. Findings: The findings of the repeated measures analysis of variance (with respect to statistical assumptions, including the normality of score distribution, homogeneity of variances, the covariance matrix, and sphericity) demonstrated that the therapeutic intervention resulted in a substantial enhancement in self-awareness at the post-test and follow-up stages (F (1.468, 49.915) = 36.599, P < 0.001, η² = 0.518). The results of the analysis indicate a significant decrease in alexithymia (F (1.426, 48.49) = 45.183, P < 0.001, η² = 0.618), and in social anxiety (F (1.320, 44.885) = 61.869, P< 0.001, η² = 0.702). A substantial discrepancy was identified among the intergroup levels of the intervention and control groups. The variable of self-awareness exhibited a significant result (F (1, 34) = 5.204, P= 0.029)). Similarly, a significant result was obtained for alexithymia (F (1, 34) = 5.674, P= 0.023), and a significant result was also obtained for social anxiety (F (1, 34) =8.163, P = 0.007). Due to the violation of the assumption of sphericity in some variables, such as self-awareness (Mauchly's W = 0.638, P = 0.001), the Greenhouse-Geisser correction was employed. The normality of the data distribution was confirmed based on the Shapiro-Wilk test and the homogeneity of variances according to the Levine test in all stages. The analysis of the subscales demonstrated that the object relations intervention led to a significant reduction in the components of fear, avoidance, and physiological discomfort (in cases of social anxiety) as well as a reduction in difficulty in identifying emotions, expressing feelings, and thinking with an external orientation (in Alexithymia). Conclusion: The findings of present study indicated that short-term object relations group therapy resulted in a substantial enhancement in the level of self-awareness among patients diagnosed with asthma. This result aligns with the findings of (Blum, 2010) study, which confirmed the efficacy of analytical approaches in fostering self-awareness. The therapeutic approach, which emphasizes the identification of unconscious relationships and the reconstruction of internalized objects, appears to result in an enhancement of patients' emotional and internal awareness. Consequently, it is proposed that enhancing self-awareness be regarded as a primary treatment objective in psychotherapy programs for patients afflicted with chronic diseases, such as asthma. The findings of this study indicated that the therapeutic intervention resulted in a substantial decrease in social anxiety among the patient population. This finding aligns with the research of (Devlag, 2014), which substantiated the efficacy of object relations-based therapies in mitigating social anxiety. It has been demonstrated that the provision of a secure and empathetic environment within group therapy settings is conducive to the identification of ineffectual defense mechanisms employed by patients in interpersonal relationships. This identification process facilitates the development of more adaptive communication skills among patients, thereby enhancing their ability to navigate and engage in effective interactions with others. Consequently, the utilization of object relations group therapy in interventions concerning anxiety disorders, particularly in patients with psychosomatic diseases, is strongly advised. The third finding of the study demonstrated that object relations group therapy significantly reduced alexithymia in these patients. This finding aligns with the findings of (Haji alizadeh, 2021), which demonstrated the efficacy of object relations therapy in enhancing emotion processing. The mechanism of action of this therapeutic modality can be considered to be an emphasis on increasing the capacity for emotional symbolization and analyzing unconscious defenses, which, in sum, improves the ability to process emotions in patients. Consequently, this therapeutic modality can be regarded as a promising strategy for enhancing the emotional and emotional-physical health of patients afflicted with psychosomatic ailments, such as asthma. Consequently, the implementation of this intervention in conjunction with conventional medical treatments has the potential to enhance the mental well-being and overall quality of life of individuals suffering from chronic conditions.
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