مقایسه اثربخشی درمان هیجان مدار و شناخت درمانگری مبتنی بر ذهن آگاهی بر کیفیت خواب در بیماران مبتلا به اختلال اضطراب فراگیر
محورهای موضوعی : روانشناسی زوجین
مسعود شریف زاده
1
*
,
نرگس رازقی
2
,
حکیمه آقایی
3
,
سید موسی طباطبایی
4
1 - دانشجوی دکترای تخصصی، گروه روانشناسی، واحد شاهرود، دانشگاه آزاد اسلامی، شاهرود، ایران
2 - استادیار گروه روان شناسی، دانشگاه آزاد اسلامی واحد پروفسور حسابی، تفرش، ایران
3 - نویسنده مسئول، استادیار، گروه روانشناسی، واحد شاهرود، دانشگاه آزاد اسلامی، شاهرود، ایران
4 - استادیار دانشگاه سمنان
کلید واژه: اختلال اضطراب فراگیر, کیفیت خواب, درمان هیجان مدار, شناخت درمانگری مبتنی بر ذهن آگاهی. ,
چکیده مقاله :
مقدمه: هدف از پژوهش حاضر مقایسه اثربخشی درمان هیجان مدار و شناخت درمانگری مبتنی بر ذهنآگاهی بر کیفیت خواب در بیماران مبتلا به اختلال اضطراب فراگیر بود.
روش پژوهش: روش پژوهش نیمهآزمایشی با طرح پیشآزمون، پسآزمون با گروه کنترل همراه با مرحله پیگیری 2 ماهه بود. جامعه آماری پژوهش حاضر کلیه بیماران مبتلا به اختلال اضطراب فراگیر شهر تهران در سال 1402 بود. در مرحله اول تعداد 45 نفر با نمره 10 و بالاتر در مقیاس اختلال اضطراب فراگیر انتخاب و سپس به شیوه تصادفی ساده در 2 گروه آزمایش (هر گروه 15 نفر) و یک گروه کنترل (15 نفر) جایگزین شدند. سپس بیماران گروه‌های آزمایش تحت درمان هیجانمدار و شناخت درمانگری مبتنی بر ذهنآگاهی قرار گرفتند؛ اما گروه کنترل هیچ‌گونه مداخلهای دریافت نکرد و در لیست انتظار باقی ماند. از مقیاس اختلال اضطراب فراگیر (GAD-7) اسپیتزر و همکاران (2006) و پرسشنامه کیفیت خواب پیتزبورگ(PSQI) بویس و همکاران1989 به منظور گردآوری اطلاعات استفاده شد. تحلیل دادهها از طریق نرمافزار SPSS نسخه 28 با استفاده از تحلیل واریانس با اندازهگیری مکرر انجام شد.
نتایج: نتایج نشان داد هر دو مداخله مذکور تاثیر معناداری بر بهبود کیفیت خواب داشتهاند (05/0>P). نتایج آزمون تعقیبی بنفرونی نشان داد که درمان هیجان مدار تاثیر بیشتری دارد (05/0>P).
نتیجهگیری: میتوان نتیجهگیری کرد که علاوه بر اثربخش بودن هر دو درمان، تقدم استفاده در درمان مشکلات خواب بیماران مبتلا به اختلال اضطراب فراگیر با درمان هیجانمدار است.
Introduction: The purpose of this study was to comparing effectiveness of emotion-focused therapy and mindfulness-based cognitive therapy on sleep quality in patients with generalized anxiety disorder.
Methods: This semi-experimental study was conducted with a pretest-posttest design with control group and follow-up 2 month. The statistical population of the present study was all patients with generalized anxiety disorder in Tehran in 2023. In the first stage, the number of 45 patients with a score of 10 and above on the generalized anxiety disorder scale was selected and then randomly divided into 2 experimental groups (each group 15 patients) and one control group (15 patients) were replaced and experimental groups underwent emotion-focused therapy and mindfulness-based cognitive therapy, but the control group received no training and remained in the waiting list. To collect data generalized anxiety disorder scale (GAD-7) of Spitzer and et al (2006) and Pittsburgh sleep quality Index (PSQI) of Buysse and et al 1989. Data analysis was performed using SPSS-28 software with analysis of variance with repeated measures and Bonferroni.
Results: The results of the study showed that of both interventions had a significant effect on sleep quality (P<0.05). In addition, the results of Bonferroni post hoc test showed that emotion-focused therapy is more effective (P<0.05).
Conclusion: It can be concluded that, in addition effectiveness of both treatments, the priority of use in the treatment of sleep problems patients with generalized anxiety disorder is with the emotion-focused therapy.
1. Casares MÁ, Díez-Gómez A, Pérez-Albéniz A, Lucas-Molina B, Fonseca-Pedrero E. Screening for anxiety in adolescents: Validation of the Generalized Anxiety Disorder Assessment-7 in a representative sample of adolescents. Journal of Affective Disorders, 2024; 1(1): 1-10. https://doi.org/10.1017/S2045796021000275
2. Yang X, Fang Y, Chen H, Zhang T, Yin X, Man J, Yang L, Lu M. Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiology and psychiatric sciences, 2021; 30(1): 36-47. https://doi.org/10.1016/j.jad.2024.03.047
3. Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, Il Shin J, Kirkbride JB, Jones P, Kim JH, Kim JY. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular psychiatry, 2022; 27(1): 281-295. https://doi.org/10.1038/s41380-021-01161-7
4. Mangione CM, Barry MJ, Nicholson WK, Cabana M, Coker TR, Davidson KW, US Preventive Services Task Force. 2022. Screening for anxiety in children and adolescents: US Preventive Services Task Force recommendation statement. Jama, 2022; 328(14): 1438-1444. https://doi.org/10.1001/jama.2022.16936
5. Verdonk C, Teed AR, White EJ, Ren X, Stewart JL, Paulus MP, Khalsa SS. Heartbeat-evoked neural response abnormalities in generalized anxiety disorder during peripheral adrenergic stimulation. Neuropsychopharmacology, 2024; 1(1): 1-9. https://doi.org/10.1038/s41386-024-01806-5
6. Peng J, Yuan S, Wei Z, Liu C, Li K, Wei X, Ren L. Temporal network of experience sampling methodology identifies sleep disturbance as a central symptom in generalized anxiety disorder. BMC Psychiatry, 2024; 24(1): 1-11.
7. LaFreniere LS, Newman M. Exposing worry’s deceit: Percentage of untrue worries in generalized anxiety disorder treatment. Behavior Therapy, 2020; 51 (3): 413-423. https://doi.org/10.1016/j.beth.2019.07.003
8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5thed.). Washington, DC. American Psychiatric Press 2013. https://www.psychiatry.org/psychiatrists/practice/dsm
9. Gorostiaga A, Balluerka N, Aliri J, Echeveste U, Lameirinhas J. Psychometric properties and factorial invariance of the Educational-Clinical Questionnaire: Anxiety and Depression (CECAD) in Basque population. Psicothema, 2024; 36(1): 80-90. https://doi.org/10.7334/psicothema2023.37
10. Moreno E, Muñoz-Navarro R, Medrano LA, González-Blanch C, Ruiz-Rodríguez P, Limonero JT, Moriana JA. Factorial invariance of a computerized version of the GAD-7 across various demographic groups and over time in primary care patients. Journal of affective disorders, 2019; 252(2), 114-121. https://doi.org/10.1016/j.jad.2019.04.032
11. Viswanathan M, Wallace IF, Middleton JC, Kennedy SM, McKeeman J, Hudson K, Kahwati L. Screening for anxiety in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force. JAMA, 2022; 328(14): 1445-1455. https://doi.org/10.1001/jama.2022.16303
12. Yupanqui-Lorenzo DE, Caycho-Rodríguez T, Baños-Chaparro J, Arauco-Lozada T, Palao-Loayza L, Rivera ME, Barrios I, Torales J. Mapping of the network connection between sleep quality symptoms, depression, generalized anxiety, and burnout in the general population of Peru and El Salvador. Psicologia: Reflexão e Crítica, 2024; 37(1): 27-37. https://doi.org/10.1186/s41155-024-00312-3
13. Carbone EA, Menculini G, de Filippis R, D’Angelo M, De Fazio P, Tortorella A, Steardo Jr L.. Sleep disturbances in generalized anxiety disorder: the role of calcium homeostasis imbalance. International Journal of Environmental Research and Public Health, 2023; 20(5): 1-10. https://doi.org/10.3390/ijerph20054431
14. Hoyos C, Glozier N, Marshall N. Recent evidence on worldwide trends on sleep duration. Current Sleep Medicine Reports, 2015; 1(1): 195–204. https://doi.org/10.1007/s40675-015-0024-x
15. Su Y, Wang SB, Zheng H, Tan WY, Li X, Huang ZH, Jia FJ. The role of anxiety and depression in the relationship between physical activity and sleep quality: A serial multiple mediation model. Journal of Affective Disorders, 2021; 290(1): 219–226. https://doi.org/10.1016/j.jad.2021.04.047
16. Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Medicine Reviews, 2016; 25, 52–73. https://doi.org/10.1016/j.smrv.2015.01.009
17. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Text Revision DSM-5-TR. Washington, D.C.: American Psychiatric Association. 2022. https://www.psychiatry.org/psychiatrists/practice/dsm
18. Hetkamp M, Schweda A, Bäuerle A, Weismüller B, Kohler H, Musche V, Dörrie N, Schöbel C, Teufel M, Skoda EM. Sleep disturbances, fear, and generalized anxiety during the COVID-19 shut down phase in Germany: relation to infection rates, deaths, and German stock index DAX. Sleep medicine, 2020; 75(1): 350-353. https://doi.org/10.1016/j.sleep.2020.08.033
19. Garner A.R, Stuart GL. Integrating mindfulness and acceptance into traditional cognitive behavioral therapy during the covid-19 pandemic: A case study of an adult man with generalized anxiety disorder. Clinical Case Studies, 2023; 22 (2): 120-137. https://doi.org/10.1177/15346501221123568
20. Yonkers KA, Bruce SE, Dyck IR, Keller MB. Chronicity, relapse, and illness—course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow‐up. Depression and anxiety, 2003; 17 (3): 173-179. https://doi.org/10.1002/da.10106
21. Ruscio AM, Hallion LS, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Scott KM. Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. JAMA psychiatry, 2017; 74 (5): 465-475. https://doi.org/10.1001/jamapsychiatry.2017.0056
22. Timulak L, Keogh D, Chigwedere C, Wilson C, Ward F, Hevey D, Griffin P, Jacobs L, Hughes S, Vaughan C, Beckham K. A comparison of emotion-focused therapy and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: Results of a feasibility randomized controlled trial. Psychotherapy, 2022; 59 (1): 84–95. https://doi.org/10.1037/pst0000427
23. O’Connell Kent JA, Jackson A, Robinson M, Rashleigh C, Timulak L. Emotion‐focused therapy for symptoms of generalised anxiety in a student population: An exploratory study. Counselling and Psychotherapy Research, 2021; 21 (2): 260-268. https://doi.org/10.1002/capr.12346
24. Timulak L, Keogh D, Chigwedere C, Wilson C, Ward F, Hevey D, Griffin P, Jacobs L, Irwin B. A comparison of emotion-focused therapy and cognitive-behavioural therapy in the treatment of generalised anxiety disorder: study protocol for a randomised controlled trial. Trials, 2018; 19 (1): 1-11. https://doi.org/10.1037/pst0000427
25. Timulak L, McElvaney J. Emotion-focused therapy for generalized anxiety disorder: An overview of the model. Journal of Contemporary Psychotherapy, 2016; 46 (1): 41-52. http://dx.doi.org/10.1007/s10879-015-9310-7
26. Greenberg LS, Rice LN, Elliott R. Facilitating emotional change: The moment-by-moment process. Guilford Press. 1993. https://www.guilford.com/books/Facilitating-Emotional-Change/Greenberg-Rice-Elliott/9781572302013
27. Timulak L, McElvaney J. Transforming generalized anxiety: An emotion-focused approach. Routledge. 2017. https://www.routledge.com/
28. Timulak L, Keogh D. Transdiagnostic emotion-focused therapy: A clinical guide for transforming emotional pain. American Psychological Association, 2022. https://www.apa.org/pubs/books/transdiagnostic-emotion-focused-therapy
29. Murphy J, Rowell L, McQuaid A, Timulak L, O'Flynn R, McElvaney J. Developing a model of working with worry in emotion‐focused therapy: A discovery‐phase task analytic study. Counselling and Psychotherapy Research, 2017; 17 (1): 56-70. http://dx.doi.org/10.1002/capr.12089
30. Watson JC, Greenberg LS. Emotion - focused therapy for generalized anxiety. American Psychological Association. 2017. https://www.apa.org/pubs/books/4317438
31. Omrani S, Baratian M, Zareh Hoseinzadeghan Z, Jedari Seyedi Z. The effectiveness of emotionally focused therapy on mental toughness and sleep quality among people with a history of hospitalization because of Coronavirus. Journal of Applied Family Therapy, 2022; 2(Covid-19 articles collection)): 215-228. [In Persian] https://doi.org/10.22034/aftj.2022.325945.1363
32. Dana M, Keshavarzi F, Hasani F.. Comparing the effectiveness of emotion-focused therapy and mindfulness-based cognitive therapy on sleep disorder, rumination, and emotional dyslexia in patients with irritable bowel syndrome. Journal of Psychological Science, 2024; 23(137), 1017-1034. [In Persian] http://dx.doi.org/10.52547/JPS.23.137.1017
33. Nikbagha SM, Tabesh Mofrad N, Naseri Manesh M, Karami S. The effect of Mindfulness-based cognitive therapy in Anxiety sensitivity, Deficits in emotional processing and Distress tolerance of Nurses with Symptoms of Generalized Anxiety Disorder. Iranin of Psychiatric Nursing, 2023; 11 (1): 52-64. [In Persian]. http://dx.doi.org/10.22034/IJPN.11.1.52
34. Williams M, Honan C, Skromanis S, Sanderson B, Matthews AJ. Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis. Current Psychology, 2023; 1 (2): 1-23. http://dx.doi.org/10.1007/s12144-023-04695-x
35. Segal Z, Williams M, Teasdale J. Mindfulness-based cognitive therapy for depression. Guilford Publications. 2018. https://www.guilford.com/books/
36. Jiang SS, Liu XH, Han N, Zhang HJ, Xie WX, Xie Z, Huang X. Effects of group mindfulness-based cognitive therapy and group cognitive behavioural therapy on symptomatic generalized anxiety disorder: a randomized controlled noninferiority trial. BMC psychiatry, 2022; 22 (1): 1-11. https://doi.org/10.1186/s12888-022-04127-3
37. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of consulting and clinical psychology, 2010; 78 (2): 169-179. https://doi.org/10.1037%2Fa0018555
38. Segal ZV, Anderson AK, Gulamani T, Dinh Williams LA, Desormeau P, Ferguson A, Walsh K, Farb NA. Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy. Journal of Consulting and Clinical Psychology, 2019; 87 (2): 161–170. https://doi.org/10.1037/ccp0000351
39. Torres-Platas SG, Escobar S, Belliveau C, Wu J, Sasi N, Fotso J, Potes A, Thomas Z, Goodman A, Looper K, Segal M. Mindfulness-based cognitive therapy intervention for the treatment of late-life depression and anxiety symptoms in primary care: a randomized controlled trial. Psychotherapy and Psychosomatics, 2019; 88 (4): 254-256. https://doi.org/10.1159/000501214
40. Burgess EE, Selchen S, Diplock BD, Rector NA. A brief mindfulness-based cognitive therapy (MBCT) intervention as a population-level strategy for anxiety and depression. International Journal of Cognitive Therapy, 2021; 14 (2): 380-398. https://doi.org/10.1007/s41811-021-00105-x
41. Javadi Z, Ghorbani M. The Effectiveness of Mindfulness- Based Cognitive Therapy (MBCT) On the Improvement of Sleep Quality in Patients with Generalized Anxiety Disorder. Intern Med Today 2019; 25 (2) :117-126. [In Persian] http://imtj.gmu.ac.ir/article-1-2945-fa.html
42. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 2006; 166 (10): 1092-1097. https://doi.org/10.1001/archinte.166.10.1092
43. Naeinian M, Shaeiri M, Sharif M, Hadian M. To Study Reliability and Validity for A Brief Measure for Assessing Generalized Anxiety Disorder (GAD-7). Clinical Psychology and Personality, 2011; 9(1): 41-50. [In Persian]. https://dorl.net/dor/20.1001.1.23452188.1390.9.1.5.7
44. Johnson SU, Ulvenes PG, Øktedalen, T, Hoffart A. Psychometric properties of the GAD-7 in a heterogeneous psychiatric sample. Frontiers in psychology, 2019; 10 (1): 1-10. https://doi.org/10.3389/fpsyg.2019.01713
45. Stewart AL, Hays RD, Ware JE. The MOS short-form general health survey: reliability and validity in a patient population. Medical care, 1988; 1 (1): 724-735. https://doi.org/10.1097/00005650-198807000-00007
46. Derogatis LR, Lipman, RS, Covi L. SCL-90. Administration, scoring and procedures manual-I for the R (revised) version and other instruments of the Psychopathology Rating Scales Series. Chicago: Johns Hopkins University School of Medicine. 1977. http://www.westerparc.nl/wp-content/uploads/2011/12/SCL-90-Engels.pdf
47. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 1989; 28(2): 193-213. https://doi.org/10.1016/0165-1781(89)90047-4
48. Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep and Breathing, 2012; 16(1): 79-82. https://doi.org/10.1007/s11325-010-0478-5
49. Torabi AA, Afrooz GA, Hassani F, Golshani F. Designing a Family-Centered Behavioral Management Program (FBMP) and Evaluating its Effectiveness in Marital Satisfaction of Parents of Children with ADHD. Quarterly Journal Family and Research, 2021; 18 (3): 25-42. [In Persian]. http://dorl.net/dor/20.1001.1.26766728.1400.18.3.2.5
50. Timulak L, McElvaney J, Keogh D, Martin E, Clare P, Chepukova E, Greenberg LS. Emotion-focused therapy for generalized anxiety disorder: An exploratory study. Psychotherapy, 2017; 54(4): 361–366. https://doi.org/10.1037/pst0000128
51. Timulak L, Keogh D, Chigwedere C, Wilson C, Ward F, Hevey D, Griffin P, Jacobs L, Irwin B. Emotion-focused therapy as a transdiagnostic treatment for depression, anxiety and related disorders: Protocol for an initial feasibility randomised control trial. HRB open research, 2020; 3(1): 1-10. https://doi.org/10.12688%2Fhrbopenres.12993.1
52. Watson J, Timulak L, Greenberg LS. Emotion-focused therapy for generalized anxiety disorder. In L. S. Greenberg & R. N. Goldman (Eds.): Clinical handbook of emotion-focused therapy (pp. 315–336). 2019. American Psychological Association. https://doi.org/10.1037/0000112-014
53. Watson J, Sharbanee J. Emotion Focused Therapy–Case Conceptualization and Treatment: Adults. In Comprehensive Clinical Psychology, 2022; 145(1): 241-251. https://doi.org/10.1016/B978-0-12-818697-8.00210-7
54. Rajaei M, Nasri M, Shahabizadeh F. The Effectiveness of Emotion Focused Therapy on Cognitive Fusion and Emotional Self-Regulation of Spouses of Veterans. Journal of Modern Psychological Researches, 2024; 19(73): 47-56. [In Persian] : http://dx.doi.org/10.22034/jmpr.2023.56106.5526
55. Greenberg LS. Emotion–focused therapy. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 2004; 11(1): 3-16. https://doi.org/10.1002/cpp.388
56. Frei JM, Sazhin V, Fick M, Yap K. Emotion-oriented coping style predicts self-harm in response to acute psychiatric hospitalization. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2021; 42(3): 232–238. https://doi.org/10.1027/0227-5910/a000713