مقایسۀ اثربخشی درمان مبتنی بر پذیرش و تعهد و داروی کلومی‌پیرامین در درمان اختلال وسواسی‌جبری در زنان و مردان شهرستان شیراز
محورهای موضوعی : سایر موضوعات مرتبطعلی درختکار 1 * , فاطمه ناجیان تبریز 2 , حانیه مردادی 3 , آرامه صفی خانی 4
1 - دانشجوی دکتری روانشناسی، گروه روانشناسی، دانشگاه شهید بهشتی
2 - کارشناسی ارشد، روانشناسی بالینی، دانشگاه شهید بهشتی
3 - کارشناسی روانشناسی، دانشگاه شهید بهشتی
4 - کارشناسی ارشد، روانشناسی بالینی، دانشگاه شهید چمران اهواز
کلید واژه: اختلال وسواسی‌جبری, درمان مبتنی بر پذیرش و تعهد, کلومی‌پیرامین,
چکیده مقاله :
هدف مطالعه مقایسۀ اثربخشی درمان‌های مبتنی بر پذیرش و تعهد و داروی کلومی‌پیرامین در درمان اختلال وسواسی جبری و تعیین کارآمدترین نوع درمان از درمان‌های مورد مطالعه در این پژوهش در کاهش علائم مبتلایان به این اختلال بود. این تحقیق از نوع کاربردی و طرح پژوهشی آن هم از نوع شبه آزمایشی با پیش‌آزمون و پس‌آزمون و پیگیری با گروه کنترل بود. جامعۀ پژوهش، شامل مبتلایان به اختلال وسواسی‌جبری مراجعه‌کننده به ده مرکز از مراکز درمانی شهر شیراز در تابستان سال ۹۷ بودند که تشخیص قطعی اختلال وسواسی‌جبری را از روان‌پزشک دریافت کرده بودند. نمونه‌گیری در این پژوهش به روش نمونه‌گیری در دسترس و شرکت‌کنندگان در سه گروه پانزده نفری به صورت تصادفی قرار گرفتند. آزمودنی‌ها قبل و بعد از اجرای مداخله با پرسشنامۀ ییل براون مورد سنجش قرار گرفتند. به‌منظور تجزیه‌وتحلیل داده‌های آماری از روش آزمون تحلیل واریانس اندازه گیری مکرر با استفاده از نسخۀ 21 نرم‌افزار SPSS استفاده گردید. یافته‌های پژوهش حاضر نشان داد که هر دو نوع درمان در پس‌آزمون بر روی بهبود علائم اختلال وسواسی‌جبری مؤثرند (P˂0/01)؛ اما در پیگیری، درمان مبتنی بر پذیرش و تعهد (ACT) اثر درمانی خود را حفظ کرد. لازم به ذکر است که در این پژوهش تفاوت بین زنان و مردان از نظر آماری معنادار نبود. یافته های این پژوهش حاکی از کارایی ماندگارتر درمان مبتنی بر پذیرش و تعهد دارد و این مهم به نظر می رسد به علت تلفیق تکنیک های شرقی و روان شناسی غربی هست که درمان را برای مبتلایان ایرانی کارامدتر می کند.
Introduction: The aim of this study was to compare the efficacy of ACT and Clomipramine was used to treat OCD and to determine the most effective type of treatment in reducing the symptoms of patients with OCD. Methods: This research was an applied and research project. It was a quasi-experimental study with pre-test, post-test, follow-up, and control groups. The research population was obsessive-compulsive disorder referring to counseling centers in the summer of 2018 and received a definitive diagnosis of obsessive-compulsive disorder. Sampling was done by the access method. Participants were randomly assigned to 3 groups of 15. Subjects were evaluated before and after the intervention by the Yale Brown questionnaire. To analyze the statistical data, analysis of variance (repeated measure) was used by SPSS software version 21. Findings: The findings of this study showed that both types of treatment in the short-term affects the improvement of symptoms of OCD (P<0/01), but in follow-up, ACT treatments maintained their therapeutic effect. Moreover, there was no significant difference between men and women statistically in this study. Conclusion: The findings of this study indicate a more lasting effect of treatment based on acceptance and commitment, and this seems to be important due to the combination of Eastern techniques and Western psychology that makes treatment more effective for Iranian patients.
1- Alilo M, Mohamad V, Bayanzadeh A. (2004). Experimental survey of memory problems in type of investigation in one case with obsessive compulsive disorder. Andishe va Rafter, 11(1): 62-70. [Persain]
2- A-tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36.
3- Bajaj, B., & Pande, N. (2016). Mediating role of resilience in the impact of mindfulness on life satisfaction and affect as indices of subjective well-being. Personality and Individual Differences, 93, 63-67.
4- Bazarko, D., Cate, R. A., Azocar, F., & Kreitzer, M. J. (2013). The impact of an innovative mindfulness-based stress reduction program on the health and well-being of nurses employed in a corporate setting. Journal of workplace behavioral health, 28(2), 107-133.
5- Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of anxiety disorders, 28(6), 612-624.
6- Bouvard, M., Fournet, N., Denis, A., Sixdenier, A., & Clark, D. (2017). Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: a comparison using the International Intrusive Thought Interview Schedule. Cognitive behaviour therapy, 46(4), 287-299.
7- Carmody, J., Reed, G., Kristeller, J., & Merriam, P. (2008). Mindfulness, spirituality, and health-related symptoms. Journal of psychosomatic research, 64(4), 393-403.
8- de la Cruz, L. F., Llorens, M., Jassi, A., Krebs, G., Vidal-Ribas, P., Radua, J., ... & Mataix-Cols, D. (2015). Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder. The British Journal of Psychiatry, 207(6), 530-535.
9- Dold, M., Aigner, M., & Kasper, S. (2017, October). Augmentation of serotonin reuptake inhibitors with antipsychotic drugs in treatment-resistant obsessive-compulsive disorder: a meta-analysis. In European Neuropsychopharmacology (Vol. 27, pp. S1004-S1005). PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS: ELSEVIER SCIENCE BV.
10- Greast, J. H., & Jeffersion, J. W. (1998). Pharmaco Thearpy for OCD. British J Psychiatry Aug, 173(suppl 35), 64-70.
11- Goodman, W. K., Rasmussen, S., Price, L., Mazure, L., Heninger, G., & Charney, D. (1991). Yale-brown obsessive compulsive scale (Y-BOCS). Verhaltenstherapie, 1(3), 226-33.
12- Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy, 35(4), 639-665.(A)
13- Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies?. Behavior Therapy, 35(1), 35-54.
14- Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25.
15- Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., ... & McCurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a working model. The psychological record, 54(4), 553-578.(B)
16- Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of consulting and clinical psychology, 64(6), 1152.
17- Iniesta-Sepúlveda, M., Rosa-Alcázar, A. I., Sánchez-Meca, J., Parada-Navas, J. L., & Rosa-Alcázar, Á. (2017). Cognitive-behavioral high parental involvement treatments for pediatric obsessive-compulsive disorder: A meta-analysis. Journal of Anxiety Disorders, 49, 53-64.
18- Izadi R, Abedi M. (2013). Reducing obsessive-compulsive symptoms in patients with obsessive compulsive disorder and treatment-resistant to cure through Acceptance and commitment therapy. Feyz KUMS, 17(3): 275-286. [Persian]
19- Kaplan, H. I., & Sadock, B. J. (1988). Synopsis of psychiatry: Behavioral sciences clinical psychiatry. Williams & Wilkins Co.
20- Kring, A. M., & Johnson, S. L. (2018). Abnormal psychology: The science and treatment of psychological disorders. John Wiley & Sons.
21- Landy, L. N., Schneider, R. L., & Arch, J. J. (2015). Acceptance and commitment therapy for the treatment of anxiety disorders: a concise review. Current Opinion in Psychology, 2, 70-74.
22- Mataix-Cols, D., De La Cruz, L. F., Monzani, B., Rosenfield, D., Andersson, E., Pérez-Vigil, A., ... & Thuras, P. (2017). D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data. JAMA psychiatry, 74(5), 501-510.
23- McCracken, J. T., & Hanna, G. L. (2005). Elevated thyroid indices in children and adolescents with obsessive-compulsive disorder: effects of clomipramine treatment. Journal of Child & Adolescent Psychopharmacology, 15(4), 581-587.
24- McKay D, Sookman D, Neziroglu F, Wilhelm S, Stein DJ, Kyrios M, et al. (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res, 225(3): 236-46.
25- Mikailibarzili N, Ahadi B, Hasanabadi H. (2002). The comparison of effectiveness of Islamic therapy and cognitive behavioral therapy in people with obsessive compulsive disorder. J of psychological achievements, 4(2): 61-86. [Persian]
26- Murray, G. K., Knolle, F., Ersche, K. D., Craig, K. J., Abbott, S., Shabbir, S. S., ... & Robbins, T. W. (2019). Dopaminergic drug treatment remediates exaggerated cingulate prediction error responses in obsessive-compulsive disorder. Psychopharmacology, 236(8), 2325-2336.
27- Rohani, F., Rasouli-Azad, M., Twohig, M. P., Ghoreishi, F. S., Lee, E. B., & Akbari, H. (2018). Preliminary test of group acceptance and commitment therapy on obsessive-compulsive disorder for patients on optimal dose of selective serotonin reuptake inhibitors. Journal of Obsessive-Compulsive and Related Disorders, 16, 8-13.
28- Sajatovic, M., & Ramirez, L. F. (2012). Rating scales in mental health. JHU Press.
29- Smith, B. M., Bluett, E. J., Lee, E. B., & Twohig, M. P. (2017). Acceptance and Commitment Therapy for OCD. The Wiley Handbook of Obsessive Compulsive Disorders, 1, 596-613.
30- Tolin, D. F., Gilliam, C., Wootton, B. M., Bowe, W., Bragdon, L. B., Davis, E., ... & Hallion, L. S. (2018). Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders. Assessment, 25(1), 3-13
31- Twohig, M. P., Vilardaga, J. C. P., Levin, M. E., & Hayes, S. C. (2015). Changes in psychological flexibility during acceptance and commitment therapy for obsessive compulsive disorder. Journal of Contextual Behavioral Science, 4(3), 196-202.
32- Vakili, Y., & Gharraee, B. (2014). The effectiveness of acceptance and commitment therapy in treating a case of obsessive compulsive disorder. Iranian journal of psychiatry, 9(2), 115.