پیش‌بینی اضطراب فراگیر و اضطراب اجتماعی بر اساس انعطاف¬پذیری شناختی در مادران کودکان اوتیسم با نقش میانجی تنظیم هیجان
محورهای موضوعی : روانشناسیلیلا پیرمحمدی پورفرد 1 , راضیه اسمعیلی 2 , ملیحه بیدقی 3 , ملیحه السادات زرگر مرادی 4
1 - کارشناس ارشد روانشناسی بالینی، گروه مشاوره و روانشناسی، واحد رودهن، دانشگاه آزاد اسلامی، تهران، ایران، lp.porfard@gmail.com
2 - (نویسنده مسئول)، کارشناس ارشد روانشناسی، گروه مشاوره و روانشناسی، واحد تهران جنوب، دانشگاه پیام نور، تهران، ایران raha.esmaeili.94@gmail.com, tell: 09369661541
3 - کارشناس ارشد روانشناسی، گروه مشاوره و روانشناسی، واحد تهران شمال، دانشگاه آزاد اسلامی، تهران، ایران، malihe@gmail.com
4 - دانشجوی دکتری روانشناسی سلامت، گروه مشاوره و روانشناسی، دانشگاه تهران، تهران، ایران، zargar@gmail.com
کلید واژه: اضطراب اجتماعی, اضطراب فراگیر, انعطافپذیری شناختی, تنظیم هیجان, مادران کودکان اوتیسم,
چکیده مقاله :
چکیده مقدمه: نگهداری از کودکان طیف اوتیسم، خانواده به‌ویژه مادران را با استرس، اضطراب و مشکلات گوناگون روبهرو مینماید، بنابراین با توجه به لزوم تحقیق در این خصوص هدف از پژوهش حاضر پیش‌بینی اضطراب فراگیر و اضطراب اجتماعی بر اساس انعطاف¬پذیری شناختی در مادران کودکان اوتیسم با نقش میانجی تنظیم هیجان بود. روش پژوهش: طرح پژوهش توصیفی همبستگی از نوع تحلیل مسیر است. جامعۀ پژوهش کلیه مادران کودکان اوتیسم که در 6 ماهه دوم سال 1401 به مراکز اوتیسم شهر تهران مراجعه کردند، بود که از بین آنها به‌صورت در دسترس 122 نفر دارای کودکان پسر 7 تا 11 سال، به‌عنوان نمونه انتخاب شدند. ابزارهای این پژوهش شامل مقیاس کوتاه اختلال اضطراب فراگیر اسپیتزر و همکاران (2006)، مقیاس اضطراب اجتماعی کانر و همکاران (2000)، پرسشنامه انعطاف¬پذیری شناختی دنیس و وندروال (2010) و پرسشنامه تنظیم هیجان گروس و جان (2003) بود. یافتهها: نتایج نشان داد انعطافپذیری شناختی با اضطراب فراگیر (44/0-r= و 01/0p<) و اضطراب اجتماعی (37/0-r= و 01/0p<) رابطه منفی و معنادار دارد و بین انعطافپذیری شناختی و تنظیم هیجان نیز (56/0r= و 01/0p<) رابطه مثبت و معنادار وجود دارد. همچنین رابطه منفی معناداری بین تنظیم هیجان و اضطراب فراگیر (42/0-r= و 01/0p<) و اضطراب اجتماعی (38/0-r= و 01/0p<) به دست آمد. نتایج تحلیل مسیر جهت بررسی الگوی پیشنهادی، نشان داد تنظیم هیجان در رابطه انعطافپذیری شناختی با اضطراب فراگیر و اضطراب اجتماعی نقش میانجی دارد. نتیجهگیری: باتوجه‌به نتایج می‌توان گفت، تنظیم هیجان به‌عنوان مولفهای اثرگذار بر اضطراب فراگیر و اضطراب اجتماعی متأثر از انعطافپذیری شناختی است.
Abstract Introduction: Taking care of autistic children makes the family, especially the mothers, face stress, anxiety and various problems, therefore, considering the necessity of research in this regard, the purpose of this research is to predict generalized anxiety and social anxiety based on cognitive flexibility in mothers of autistic children. It was with the mediator role of regulating excitement. Research method: The research design is a descriptive correlation of the path analysis type. The research population was all the mothers of autistic children who referred to autism centers in Tehran in the second 6 months of 2022, and among them, 122 people with male children between 7 and 11 years of age were selected as a sample. The tools of this research included the Short Generalized Anxiety Disorder Scale by Spitzer et al. (2006), Social Anxiety Scale by Conner et al. (2000), Cognitive Flexibility Questionnaire by Dennis and Vander Wal (2010) and Emotion Regulation Questionnaire by Gross and John (2003). Findings: The results showed that cognitive flexibility has a negative and significant relationship with generalized anxiety (r=-0.44, p<0.01) and social anxiety (r=-0.37, p<0.01) and between cognitive flexibility and adjustment There is also a positive and significant relationship with emotion regulation (r=0.56, p<0.01). Also, a significant negative relationship was found between emotion regulation and generalized anxiety (r=-0.42, p<0.01) and social anxiety (r=-0.38, p<0.01). The results of path analysis to examine the proposed model showed that emotion regulation plays a mediating role in the relationship between cognitive flexibility and generalized anxiety and social anxiety. Conclusion: According to the results, it can be said that emotion regulation as a component affecting generalized anxiety and social anxiety is affected by cognitive flexibility.
1- Loblein HJ, Vukmirovich PW, Donofrio MT, Sanz JH. Prevalence of neurodevelopmental disorders in a clinically referred sample of children with CHD. Cardiology in the Young. 2023 Apr; 33(4): 619-26 https://doi:10.1017/S1047951122001469
2- Francés L, Caules J, Ruiz A, Soler CV, Hervás A, Fernández A, Rodríguez-Quiroga A, Quintero J. An approach for prevention planning based on the prevalence and comorbidity of neurodevelopmental disorders in 6-year-old children receiving primary care consultations on the island of Menorca. BMC pediatrics. 2023 Jan 20;23(1):32. https://doi.org/10.1186/s12887-023-03844-2
3- American Psychiatric Association. The American Psychiatric Association practice guideline for the treatment of patients with eating disorders. American Psychiatric Pub; 2023 Feb 1. https://doi.org/10.1176/appi.ajp.23180001
4- Gillett G, Leeves L, Patel A, Prisecaru A, Spain D, Happé F. The prevalence of autism spectrum disorder traits and diagnosis in adults and young people with personality disorders: A systematic review. Australian & New Zealand Journal of Psychiatry. 2023 Feb;57(2):181-96. https://doi.org/10.1177/00048674221114603
5- Kulasinghe K, Whittingham K, Mitchell AE, Boyd RN. Psychological interventions targeting mental health and the mother–child relationship in autism: Systematic review and meta‐analysis. Developmental Medicine & Child Neurology. 2023 Mar;65(3):329-45. https://doi.org/10.1111/dmcn.15432
6. Lovell B, Wetherell MA. Social support mediates the relationship between dispositional gratitude and psychological distress in caregivers of autistic children. Psychology, Health & Medicine. 2023 Jan 9: 1-1. https://doi.org/10.1080/13548506.2022.2162939
7- Ketcheson LR, Wengrovius CM, Staples KL, Miodrag N. MYTime: A mindfulness and yoga program to promote health outcomes in parents of children with autism spectrum disorder. Global Advances in Health and Medicine. 2022 Jun 17; 11: 21 https://doi.org/10.1177/2164957X221110154
8- Chen KL, Iao LS, Wu CC. Impact of Child Behavior Problems on Parenting Stress and Depressive Symptoms Among Mothers of Children with Autism Spectrum Disorder: Mediation of Coping Strategies. Journal of Developmental and Physical Disabilities. 2023 Jul 10:1-21. https://doi.org/10.1007/s10882-023-09919-3
9- Kymes J. Increasing Quality of Life: Providing Education and Resources for Parents of Children with Autism Spectrum Disorder. https://scholarworks.wmich.edu/capstone_projects/30
10- Lin X, Lin L, Wang X, Li X, Cao M, Jing J. Association between Mothers’ Emotional Problems and Autistic Children’s Behavioral Problems: The Moderating Effect of Parenting Style. International Journal of Environmental Research and Public Health. 2023 Mar 5;20(5):4593. https://doi.org/10.3390/ijerph20054593
11- Strawn JR, Moldauer L, Hahn RD, Wise A, Bertzos K, Eisenberg B, Greenberg E, Liu C, Gopalkrishnan M, McVoy M, Knutson JA. A Multicenter Double-Blind, Placebo-Controlled Trial of Escitalopram in Children and Adolescents with Generalized Anxiety Disorder. Journal of Child and Adolescent Psychopharmacology. 2023 Apr 1;33(3):91-100. https://doi/abs/10.1089/cap.2023.0004
12- Gottschalk MG, Domschke K. Genetics of generalized anxiety disorder and related traits. Dialogues in clinical neuroscience. 2022 Apr 1. https://doi.org/10.31887/DCNS.2017.19.2/kdomschke
13- Crocq MA. The history of generalized anxiety disorder as a diagnostic category. Dialogues in clinical neuroscience. 2022 Apr 1. https://doi.org/10.31887/DCNS.2017.19.2/macrocq
14- Erceg-Hurn DM, Campbell BN, McEvoy PM. What explains the failure to identify replicable moderators of symptom change in social anxiety disorder?. Journal of Anxiety Disorders. 2023 Mar 1;94:102676. https://doi.org/10.1016/j.janxdis.2023.102676
15- Rapee RM, McLellan LF, Carl T, Trompeter N, Hudson JL, Jones MP, Wuthrich VM. Comparison of transdiagnostic treatment and specialized social anxiety treatment for children and adolescents with social anxiety disorder: a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry. 2023 Jun 1; 62(6): 646-55. https://doi.org/10.1016/j.jaac.2022.08.003
16. Rassaby M, Smith T, Taylor CT. Examining Safety Behavior Subtypes Across Distinct Social Contexts in Social Anxiety Disorder and Major Depression. Behavior Therapy. 2023 May 1;54(3):572-83. https://doi.org/10.1016/j.beth.2022.12.009
17- Jacobsen HB, Lyby P, Johansen T, Reme SE, Klungsøyr O. Can cognitive inflexibility reduce symptoms of anxiety and depression? Promoting the structural nested mean model in psychotherapy research. Psychotherapy Research. 2023 Nov 17:1-21. doi.org/10.1080/10503307.2023.2221808
18- Conroy K, Curtiss JE, Barthel AL, Lubin R, Wieman S, Bui E, Simon NM, Hofmann SG. Emotion regulation flexibility in generalized anxiety disorder. Journal of Psychopathology and Behavioral Assessment. 2020 Mar; 42: 93-100. https://doi.org/10.1007/s10862-019-09773-8
19- Samsell B, Lothman K, Samsell EE, Ideishi RI. Parents’ experiences of caring for a child with autism spectrum disorder in the United States: A systematic review and metasynthesis of qualitative evidence. Families, Systems, & Health. 2022 Mar; 40(1): 93. doi.org/10.1177/1049732314552455
20- Wu CW, Chen WW, Jen CH. Emotional intelligence and cognitive flexibility in the relationship between parenting and subjective well-being. Journal of Adult Development. 2021 Jun; 28: 106-15. https://doi.org/10.1007/s10804-020-09357-x
21- Bezanson S, Nichols ES, Duerden EG. Postnatal maternal distress, infant subcortical brain macrostructure and emotional regulation. Psychiatry Research: Neuroimaging. 2023 Jan 1; 328: 111-577. https://doi.org/10.1016/j.pscychresns.2022.111577
22- Rossi AA, Panzeri A, Mannarini S. The italian version of the difficulties in emotion regulation scale–short form (IT-DERS-SF): a two-step validation study. Journal of Psychopathology and Behavioral Assessment. 2023 Jun; 45(2): 572-90. https://doi.org/10.1007/s10862-022-10006-8
23- Munoz-Navarro R, Medrano LA, Limonero JT, González-Blanch C, Moriana JA, Ruiz-Rodríguez P, Cano-Vindel A. The mediating role of emotion regulation in transdiagnostic cognitive behavioural therapy for emotional disorders in primary care: Secondary analyses of the PsicAP randomized controlled trial. Journal of Affective Disorders. 2022 Apr 15; 303: 206-15. https://doi.org/10.1016/j.jad.2022.01.029
24- Rosa-Alcázar Á, Olivares-Olivares PJ, Martínez-Esparza IC, Parada-Navas JL, Rosa-Alcázar AI, Olivares-Rodríguez J. Cognitive flexibility and response inhibition in patients with Obsessive-Compulsive Disorder and Generalized Anxiety Disorder. International Journal of Clinical and Health Psychology. 2020 Jan 1; 20(1): 20-8.. https://doi.org/10.1016/j.ijchp.2019.07.006
25- Liu X, Qian W, Liang P, Xie T, Wang J. The relationship between peer victimization and social anxiety among adolescents: a moderated mediation model with cognitive flexibility and affect intensity. Psychology, Health & Medicine. 2022 Mar 16; 27(3): 663-75. doi: 10.1080/13548506.2021.1971729
26- Kadovic M, Mikšić Š, Lovrić R. Ability of Emotional Regulation and Control as a Stress Predictor in Healthcare Professionals. International Journal of Environmental Research and Public Health. 2022 Dec 29; 20(1): 541. https://doi.org/10.3390/ijerph20010541
27- Akkuş K, Peker M. Exploring the relationship between interpersonal emotion regulation and social anxiety symptoms: The mediating role of negative mood regulation expectancies. Cognitive Therapy and Research. 2022 Apr; 46(2): 287-301. https://doi.org/10.1007/s10608-021-10262-0
28- Surkhi, Zohreh, Sharifi Avaradi, Parviz, Rezaei, Saeed. The effectiveness of group training based on acceptance and commitment on self-concept and mother-child interaction in mothers of children with autism spectrum disorders. Empowerment of exceptional children, 1401; 13(3): 11-23. https://doi:10.22034/CECIRANJ.2022.306027.1597 [in Persian]
29- Tabatabai, Seyyed Musa, Aghaei, Hakimeh, Saberi, Soheila. The effectiveness of the intervention based on acceptance and commitment on perceived social support, cognitive flexibility and emotional exchange in mothers with autistic children. Empowerment of exceptional children, 1401; 13(2): 78-67. https://doi:10.22034/ceciranj.2022.296548.1572 [in Persian]
30- Sepahvand T. The role of cognitive flexibility in the generalized anxiety of people with neuroticism. Shenakht Journal of Psychology and Psychiatry 2021; 8 (3) :89-100
URL: http://shenakht.muk.ac.ir/article-1-1162-fa.html [in Persian]
31- Shabannezhad A, Fazlali M, Mirzaian B. The mediating role of emotion regulation difficulty in the relationship between psychological flexibility and loneliness in infertile women. IJPN 2021; 9 (4) :74-83, http://ijpn.ir/article-1-1800-fa.html [in Persian]
32- Mohammadi, Rahim, Taghipour, Behzad, Barzgaran, Ruqiya, Peaceful, Haniyeh, Rahimi, Saeed, Jokar, Sajjad. The effectiveness of emotion regulation training on rumination and control perception of students with social behavior disorder. School and school psychology, 1401; 11 (4): 130-141. https://doi:10.22098/jsp.2023.2044 [in Persian]
33- Kline RB. Principles and practice of structural equation modeling. Guilford publications; 2023 May 24. Principles and Practice of Structural Equation Modeling - Rex B. Kline - Google Books
34- Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine. 2006 May 22;166(10):1092-7. https://doi:10.1001/archinte.166.10.1092
35- Garcia‐Garcia M, Barceló F, Clemente IC, Escera C. The role of the dopamine transporter DAT1 genotype on the neural correlates of cognitive flexibility. European Journal of Neuroscience. 2010 Feb;31(4):754-60. https://doi.org/10.1111/j.1460-9568.2010.07102.x
36- Nainian, Mohammadreza, Shoairi, Mohammadreza, Sharifi, Masoumeh, Hadian, Mehri. Checking the reliability and validity of the short scale of generalized anxiety disorder (GAD). Clinical psychology and personality, 1390; 9(1): 41-50. https://dorl.net/dor/20.1001.1.23452188.1390.9.1.5.7
37- Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Foa, E., Weisler, R. H. (2000). Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. Br J Psychiatry,176: 379-86. https://doi.org/10.1192/bjp.176.4.379
38- Hassanvand Amouzadeh M. Validity and Reliability of Social Phobia Inventory in Students with Social Anxiety. J Mazandaran Univ Med Sci 2016; 26 (139) :166-177
URL: http://jmums.mazums.ac.ir/article-1-8146-fa.html. [in Persian]
39- Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research. 2010 Jun;34:241-53. https://doi.org/10.1007/s10608-009-9276-4
40- Kohandani, Mahdia, Abol-Maali Al-Husseini, Khadijah. Factor structure and psychometric properties of the Persian version of Dennis, Vanderwaal and Jillon cognitive flexibility questionnaire. Scientific Quarterly Journal of Psychological Methods and Models, 2016; 8(29): 53-70. https://dorl.net/dor/20.1001.1.22285516.1396.8.29.3.2
41- Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of personality and social psychology. 2003 Aug;85(2):348 https://psycnet.apa.org/doi/10.1037/0022-3514.85.2.348
42- Pasandideh, Mohammad Mehdi, Salek Mehdi, Frank. Comparison of perceived stress, emotion regulation strategies and cognitive flexibility in gastrointestinal patients and normal people. Health Psychology, 2018; 8(29): 82-100 https://doi:10.30473/hpj.2019.40179.3992. [in Persian]
43- Bagheri Sheykhangafshe F, Sharifipour Choukami Z, Tajbakhsh K, Hamideh Moghadam A, Hajialiani V. Relationship between social networks, cognitive flexibility and anxiety sensitivity in predicting students' corona phobia. Psychological Achievements. 2022 Jun 22;29(1):209-28. https://doi.org/10.22055/psy.2022.36702.2673 [in Persian]
46- Dixon ML, Moodie CA, Goldin PR, Farb N, Heimberg RG, Gross JJ. Emotion regulation in social anxiety disorder: reappraisal and acceptance of negative self-beliefs. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 2020 Jan 1;5(1):119-29. doi.org/10.1016/j.bpsc.2019.07.009
44- Li F, Tang Y, Li F, Fang S, Liu X, Tao M, Wu D, Jiang L. Psychological distress in parents of children with autism spectrum disorder: A cross-sectional study based on 683 mother-father dyads. Journal of Pediatric Nursing. 2022 Jul 1;65:e49-55. https://doi.org/10.1016/j.pedn.2022.02.006
45- Zsido AN, Arato N, Lang A, Labadi B, Stecina D, Bandi SA. The role of maladaptive cognitive emotion regulation strategies and social anxiety in problematic smartphone and social media use. Personality and Individual Differences. 2021 Apr 1;173:110647. https://doi.org/10.1016/j.paid.2021.110647
46- Ganjari MG, Khanmohammadzadeh Z, Nobakht H, Kenarsari HE. The role of cognitive emotion regulation strategies, cognitive flexibility, and distress tolerance in death anxiety among women with hypertension: A descriptive correlation study. Jundishapur Journal of Chronic Disease Care. 2020 Oct 31;9(4) https://doi.org/10.5812/jjcdc.104117 [in Persian]
47- Guetta RE, Cassiello-Robbins C, Trumbull J, Anand D, Rosenthal MZ. Examining emotional functioning in misophonia: The role of affective instability and difficulties with emotion regulation. Plos one. 2022 Feb 11;17(2):e0263230. https://doi.org/10.1371/journal.pone.0263230
48- Stellern J, Xiao KB, Grennell E, Sanches M, Gowin JL, Sloan ME. Emotion regulation in substance use disorders: A systematic review and meta‐analysis. Addiction. 2023 Jan;118(1):30-47.
49- Becerra R, Gainey K, Murray K, Preece DA. Intolerance of uncertainty and anxiety: The role of beliefs about emotions. Journal of Affective Disorders. 2023 Mar 1;324:349-53. https://doi.org/10.1016/j.jad.2022.12.064
50- Deng W, Acquah K, Joormann J, Cannon TD. Cognitive flexibility and emotion regulation: Dual layers of resilience against the emergence of paranoia. Behaviour Research and Therapy. 2023 Jun 25:104360. https://doi.org/10.1016/j.brat.2023.104360