اثربخشی درمان شناختی رفتاری بر نشخوار فکری، نگرانی و حساسیت اضطرابی در افراد با نشانه‌های اختلالات اضطرابی

محورهای موضوعی : روانشناسی تربیتی

مهدیه تقوی قراملکی ¹ , نعیمه محب ²

1 - دانش آموخته کارشناسی‌ارشد، گروه روان شناسی، واحد تبریز، دانشگاه آزاد اسلامی، تبریز، ایران
2 - استادیار گروه روان‌شناسی، واحد تبریز، دانشگاه آزاد اسلامی، تبریز، ایران

تاریخ دریافت : 1400/04/28 تاریخ پذیرش : 1400/04/28 تاریخ انتشار : 1400/03/01

کلید واژه: حساسیت اضطرابی, نگرانی, نشخوار فکری, درمان شناختی رفتاری, نشانه‌های اختلالات اضطرابی,

چکیده مقاله :

پژوهش حاضر با هدف اثربخشی درمان شناختی رفتاری بر نشخوار فکری، نگرانی و حساسیت اضطرابی در افراد با نشانه های اختلالات اضطرابی انجام شد. طرح پژوهش حاضر تحقیق موردی منفرد بود، شرکت کننده‌های پژوهش شامل 3 آزمودنی با نشانه‌های اختلالات اضطرابی با تشخیص روان پزشک مبنی بر داشتن نشانه‌های اختلالات اضطرابی به روش نمونه‌گیری هدفمند به عنوان شرکت‌کنندگان آزمایش انتخاب شدند. ابزار جمع‌آوری اطلاعات شامل پرسشنامه حساسیت اضطرابی، پرسشنامه حالت نگرانی پنسیلوانیا و پرسشنامه نشخوار فکری نولن هوکسما و مارو بود. قبل از شروع مداخله، هر 3 شرکت کننده در یک جلسه مورد ارزیابی با ابزارهای پژوهش قرار گرفتند. سپس 8 جلسه یک ساعته به مدت دو بار در هفته مداخله درمان شناخت رفتاری بر روی نمونه اجرا شد. لازم به ذکر است که هر شرکت کننده در ابتدای هر جلسه پرسشنامه های پژوهش را تکمیل نمودند. به منظور بررسی فرضیه‌ها از آزمون شاخص های درصدی به صورت مطالعه موردی استفاده شد. نتایج حاصل از شاخص درصد بهبودی بلانچارد و اسکوارز نشان داد که درمان شناختی رفتاری بر نشخوار فکری، نگرانی و حساسیت اضطرابی در افراد با نشانه های اختلالات اضطرابی تأثیر دارد

چکیده انگلیسی:

The purpose of this study aimed to determine the effectiveness of cognitive behavioral therapy on rumination, worry and anxiety sensitivity in people with anxiety disorders. The research method was single case. Research participants included 3 people with anxiety disorder symptoms who were selected as a single case with a psychiatrist's diagnosis of having anxiety disorder symptoms using the purposive sampling method. Anxiety Sensitivity Questionnaire, Pennsylvania Worry Questionnaire (PSWQ), Nolan Hoxma and Murrow Rumination Questionnaire, and Beck Cognitive Behavioral Therapy Packagewas used to collect data. Prior to the intervention, all 3 cases were evaluated in one session using research questionnaires. Then, 8 sessions of behavioral cognition therapy were administered to the subjects twice a week.in order to test the hypothesis Percentage indexes test was used. The results obtained through Blanchard and Schwars improvement rate showed that cognitive behavioral therapy affects rumination, worry and anxiety sensitivity in people with symptoms of anxiety disorders

منابع و مأخذ:

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Ali Mehdi, M., Ehteshamzadeh, P., Naderi, F., Eftekhaesaadi, Z., & Pasha, R. (2015). The effectiveness of cognitive-behavioral therapy on uncertainty intolerance and anxiety sensitivity in people with generalized anxiety disorder. Thought and Behavior, 10(38): 43-49 [In Persian].

Bagheri Nejad, M., Salehi Fadredi, J., & Tabatabai, S. M. (2010). The relationship between rumination and depression in a sample of Iranian students. Journal of Educational Studies and Psychology, 11(1): 38-21 [In Persian].

Barlow, D. H., Craske, M. G., Cerney, J., & Klosko, J. (1989). Behavioral treatment of panic disorder. Journal Behavior Therapy, 20(2): 261–282.

Beck, A. T. (1996). Cognitive therapy. In R. J. Corsini & D. Wedding (Eds)., Current Psychotherapies.

Bernstein, A., & Zolensky, M. J. (2007). Anxiety sensitivity: Selective review of promising research and future directions. Expert Review of Aerotherapeutics, 7(2): 97–101.

Bernstein, A., Zvolensky, M. J., Kotov, R., Arrindell, W. A., Taylor, S., Sandin, B., Cox, B.J., Stewart, S. H., & Bouvard M. (2006). Taxonicity of anxiety sensitivity: a multi-national analysis. Anxiety Disorders, 20(1): 1–22.

Borkovec, T. D., Newman, M. G., & Castonguay L.G. (1993). Cognitive-behavioral therapy for generalized anxiety disorder with integrations from interpersonal and experiential therapies. CNSSpectr. 8(5): 382-389.

Cintron, J. A., Carter, M. M., Suchday, S., Sbrocco, T., & Gray J. (2005). Factor structure and construct validity of the Anxiety Sensitivity Index among island Puerto Ricans. Anxiety Disorders 19(1), 51–68.

Cox, B. J., Borger, S. C., Taylor, S., Fuentes, K., & Ross, L. M. (1999). Anxiety sensitivity and the five factor model of personality. Behavior Research and Therapy, 37(7), 633-641.

Davey G. C. L& Wells A, (2006). Worry and its psychological disorders. John Wiley & Sons.

Dehshiri, Gh., Golzari, M., Borjali, A., & Borjali, F. (2009) Psychometrics Particularity of Farsi Version of Pennsylvania State Worry Questionnaire for College Students, Clinical Psychology, 1(4): 67-75[In Persian].

Denis, K., & Beker, R (2015). The effect of cognitive behavioral therapy on the irrational beliefs and anxiety in M.S. Journal of Personality assessment, 63(2): 262 - 274.

Dugas, M. J., & Robichaud, M. (2010). Cognitive-behavioral treatment for generalized anxiety disorder: from science to practice. New York: Routledge.

Flett, G. L., Greene, A., & Hewitt, P. L. (2004). Dimensions of perfectionism and anxiety sensitivity. Rational Emotive & Cognitive- Behavior Therapy, 22(1): 39-57.

Forghani Toroghi, O., Javanbakht, M., Bayazi, M. H., Sahebi, A., Vahidi, Sh., & Derogar Kh. (2012)The effectiveness of group cognitive-behavioral training and group reality therapy (based on choice theory) on self-esteem of high school students. Journal of Fundamentals of Mental Health 14(2): 172-80 [In Persian].

Ghasemi, N. (2012).The Comparison of Anxiety Sensitivity and Happiness in Irritable Bowel Syndrome Patients with Normal Matched Group in Shiraz. Journal of Fasa Univercity Medical Sciemce, 2(2):101-112 [In Persian].

Hazlett-Stevens H. (2008). Psychological approaches togeneralized anxiety disorder: A clinician’s guide to assessment and treatment. New York, NY: Springer.

Joormann, J. (2006). Differentioal effect of rumination and dysphoria on the inhibition of irrelevant emotional material: Evidance from a negative priming task. Cognitive and Research Therapy, 30(2): 149- 160.

Jorj, A. (2014). The effect of cognitive behavioral therapy on the intensity of insomnia and obsessive rumination of M.S. Cog Behave There; 39(1): 64-71.

Junwen, Chena., (2013). Mediators of the relationship between social anxiety and post-event rumination, Journal of Anxiety Disorders. 27(5): 480–486.

Kashdan, T. B., Barrios, V., Forsyth, J., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: comparisons with coping and emotion regulation strategies. Behavior research and therapy. 44(9): 1301-1320.

Kodala., A., Fjermestadb, K., Bjellanda, I., Gjestadc, R., L. G., Östb., Jon, F. Bjaastadb, D. G., Bente, S. M. Hauglandb, D., Odd, E., Havikb, f., Heiervangb, E., & Gro Wergelanda, J. (2018). Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. Journal of Anxiety Disorders. 58(12): 58-67

Luminet, O. (2004). Measurment of Depressive Rumination and Associated Constructs. In C.

Mansouri, A., Bakhshipour roodsari, A., Mahmoud Alilo, M., Farnam, A. & fakhari, A. (2012). The compare of worry, obsession and rumination in individual with Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Major Depression Disorder (MDD), and normal individual, Psychological Studies, 7(4): 195-189 [In Persian].

Mantanr, A., Yemez, B., & Alkin, T. (2010). The validity and reliability of the Turkish version of the Anxiety Sensitivity Index-3. Turkish Journal of Psychiatry (Türk Psikiyatri Dergisi), 21(3): 225-234.

Marshall, G. N., Miles, J. N. V., & Stewart, S. H. (2010). Anxiety sensitivity and PTSD symptom severity are reciprocally-related: Evidence from a longitudinal study of physical trauma survivors. Journal of Abnormal Psychology, 119(1): 143–150.

Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and Validation of the Penn State Worry Questionnaire. Behavioral Research and Therapy. 28(6): 487-495.

Moghtader, L. (2016). The effectiveness of mindfulness based therapy in reducing rumination, dysfunctional attitude and negative automatic thoughts in patients with generalized anxiety disorders. Journal of Urmia University Medical Scencei. 27(9): 825-835 [In Persian].

Moradimanesh, F. (2007). Anxiety Sensitivity. Concepts and Perspectives. Psychotherapy News. 11(39&40): 42-28 [In Persian].

Morgan, B., & Hoff, L. A. (2011).  psychiatric and mental health Essentialsin primary care. 698 wH, editor. New York.

Muris, P., Roelofs, J., Rassin, E., Franken, I., & Mayer, B. (2005).Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression. Personality and Individual Differences 39(6): 1105-1111.

Muris, P. (2012). An expanded childhood anxiety sensitivity index. Its factor structure, reliablity and validity in a non-clinical adolescent sample.Behaviour Research and therapy, 40(3): 299-311.

Nolen-Hoeksema, S., & Morrow, J. (1991). Response styles and the duration of episodes of depressed mood. Journal of Abnormal Psychology, 102(1): 20-28.

Olatunji, B. O., Sawchuk, C. N., Arrindell, W., & Lohr, J. M. (2005).Disgust sensitivity as a mediator of the Sex Difference in Contamination fears. Personality and Individual Differences, 38(3: 713-722.

Psychiatrists Association of America. (2013). StatisticalManual of Mental Disorders and classification (DSM.5) Translated by Seyyed Mohammadi (1st ed). Tehran: ravan; 2013 [In Persian].

Rodriguez., B. F., Bruce, S. E., Pagano, M.E., Spencer, M.A., & Keller M.B. (2004). Factor structure and stability of the Anxiety Sensitivity Index in a longitudinal study of anxiety disorder patients. Behaviour Research and Therapy, 42(1): 79-91.

Schmidt, N. B., Keough, M. E., Mitchell, M. A., Reynolds, E. K., MacPherson, L., Zvolensky, M. J., & Lejuez, C. W. (2010). Anxiety sensitivity: Prospective prediction of anxiety among early adolescents. Journal of Anxiety Disorders, 24(5): 503–508.

Tabibzadeh, F., & Sepehrian azar, F., (2017). The Effect of Cognitive-Behavioral Therapy on the Resilience and Obsessive Rumination among Multiple Sclerosis (MS) Patients. MEJDS. 7 (3): 45-45[In Persian].

Tello-Bernabe. E, Sanz-Cuesta, T., Del Cura-Gonzalez, I., de Santiago-Hernando M, L., Jurado-Sueiro M, Fernandez- Giron M, et al. (2011).Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial. Strategies. 95(6),12 25.

 Treynor, W., Gonzalez, R., & Nolen-Hoeksema. (2003). Ruminative Reconsidered: A Psychometric Analysis. Cognitive Therapy and Research. 21(9): 211-203.

Verkuila, B., Brosschota, J. F., & Thayer, J. F, (2007). Capturing worry in daily life: Are trait questionnaires sufficient? Behaviour Research and Therapy,45(8): 1835. 1844.

Ali Mehdi, M., Ehteshamzadeh, P., Naderi, F., Eftekhaesaadi, Z., & Pasha, R. (2015). The effectiveness of cognitive-behavioral therapy on uncertainty intolerance and anxiety sensitivity in people with generalized anxiety disorder. Thought and Behavior, 10(38): 43-49 [In Persian].

Bagheri Nejad, M., Salehi Fadredi, J., & Tabatabai, S. M. (2010). The relationship between rumination and depression in a sample of Iranian students. Journal of Educational Studies and Psychology, 11(1): 38-21 [In Persian].

Barlow, D. H., Craske, M. G., Cerney, J., & Klosko, J. (1989). Behavioral treatment of panic disorder. Journal Behavior Therapy, 20(2): 261–282.

Beck, A. T. (1996). Cognitive therapy. In R. J. Corsini & D. Wedding (Eds)., Current Psychotherapies.

Bernstein, A., & Zolensky, M. J. (2007). Anxiety sensitivity: Selective review of promising research and future directions. Expert Review of Aerotherapeutics, 7(2): 97–101.

Bernstein, A., Zvolensky, M. J., Kotov, R., Arrindell, W. A., Taylor, S., Sandin, B., Cox, B.J., Stewart, S. H., & Bouvard M. (2006). Taxonicity of anxiety sensitivity: a multi-national analysis. Anxiety Disorders, 20(1): 1–22.

Borkovec, T. D., Newman, M. G., & Castonguay L.G. (1993). Cognitive-behavioral therapy for generalized anxiety disorder with integrations from interpersonal and experiential therapies. CNSSpectr. 8(5): 382-389.

Cintron, J. A., Carter, M. M., Suchday, S., Sbrocco, T., & Gray J. (2005). Factor structure and construct validity of the Anxiety Sensitivity Index among island Puerto Ricans. Anxiety Disorders 19(1), 51–68.

Cox, B. J., Borger, S. C., Taylor, S., Fuentes, K., & Ross, L. M. (1999). Anxiety sensitivity and the five factor model of personality. Behavior Research and Therapy, 37(7), 633-641.

Davey G. C. L& Wells A, (2006). Worry and its psychological disorders. John Wiley & Sons.

Dehshiri, Gh., Golzari, M., Borjali, A., & Borjali, F. (2009) Psychometrics Particularity of Farsi Version of Pennsylvania State Worry Questionnaire for College Students, Clinical Psychology, 1(4): 67-75[In Persian].

Denis, K., & Beker, R (2015). The effect of cognitive behavioral therapy on the irrational beliefs and anxiety in M.S. Journal of Personality assessment, 63(2): 262 - 274.

Dugas, M. J., & Robichaud, M. (2010). Cognitive-behavioral treatment for generalized anxiety disorder: from science to practice. New York: Routledge.

Flett, G. L., Greene, A., & Hewitt, P. L. (2004). Dimensions of perfectionism and anxiety sensitivity. Rational Emotive & Cognitive- Behavior Therapy, 22(1): 39-57.

Forghani Toroghi, O., Javanbakht, M., Bayazi, M. H., Sahebi, A., Vahidi, Sh., & Derogar Kh. (2012)The effectiveness of group cognitive-behavioral training and group reality therapy (based on choice theory) on self-esteem of high school students. Journal of Fundamentals of Mental Health 14(2): 172-80 [In Persian].

Ghasemi, N. (2012).The Comparison of Anxiety Sensitivity and Happiness in Irritable Bowel Syndrome Patients with Normal Matched Group in Shiraz. Journal of Fasa Univercity Medical Sciemce, 2(2):101-112 [In Persian].

Hazlett-Stevens H. (2008). Psychological approaches togeneralized anxiety disorder: A clinician’s guide to assessment and treatment. New York, NY: Springer.

Joormann, J. (2006). Differentioal effect of rumination and dysphoria on the inhibition of irrelevant emotional material: Evidance from a negative priming task. Cognitive and Research Therapy, 30(2): 149- 160.

Jorj, A. (2014). The effect of cognitive behavioral therapy on the intensity of insomnia and obsessive rumination of M.S. Cog Behave There; 39(1): 64-71.

Junwen, Chena., (2013). Mediators of the relationship between social anxiety and post-event rumination, Journal of Anxiety Disorders. 27(5): 480–486.

Kashdan, T. B., Barrios, V., Forsyth, J., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: comparisons with coping and emotion regulation strategies. Behavior research and therapy. 44(9): 1301-1320.

Kodala., A., Fjermestadb, K., Bjellanda, I., Gjestadc, R., L. G., Östb., Jon, F. Bjaastadb, D. G., Bente, S. M. Hauglandb, D., Odd, E., Havikb, f., Heiervangb, E., & Gro Wergelanda, J. (2018). Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. Journal of Anxiety Disorders. 58(12): 58-67

Luminet, O. (2004). Measurment of Depressive Rumination and Associated Constructs. In C.

Mansouri, A., Bakhshipour roodsari, A., Mahmoud Alilo, M., Farnam, A. & fakhari, A. (2012). The compare of worry, obsession and rumination in individual with Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Major Depression Disorder (MDD), and normal individual, Psychological Studies, 7(4): 195-189 [In Persian].

Mantanr, A., Yemez, B., & Alkin, T. (2010). The validity and reliability of the Turkish version of the Anxiety Sensitivity Index-3. Turkish Journal of Psychiatry (Türk Psikiyatri Dergisi), 21(3): 225-234.

Marshall, G. N., Miles, J. N. V., & Stewart, S. H. (2010). Anxiety sensitivity and PTSD symptom severity are reciprocally-related: Evidence from a longitudinal study of physical trauma survivors. Journal of Abnormal Psychology, 119(1): 143–150.

Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and Validation of the Penn State Worry Questionnaire. Behavioral Research and Therapy. 28(6): 487-495.

Moghtader, L. (2016). The effectiveness of mindfulness based therapy in reducing rumination, dysfunctional attitude and negative automatic thoughts in patients with generalized anxiety disorders. Journal of Urmia University Medical Scencei. 27(9): 825-835 [In Persian].

Moradimanesh, F. (2007). Anxiety Sensitivity. Concepts and Perspectives. Psychotherapy News. 11(39&40): 42-28 [In Persian].

Morgan, B., & Hoff, L. A. (2011).  psychiatric and mental health Essentialsin primary care. 698 wH, editor. New York.

Muris, P., Roelofs, J., Rassin, E., Franken, I., & Mayer, B. (2005).Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression. Personality and Individual Differences 39(6): 1105-1111.

Muris, P. (2012). An expanded childhood anxiety sensitivity index. Its factor structure, reliablity and validity in a non-clinical adolescent sample.Behaviour Research and therapy, 40(3): 299-311.

Nolen-Hoeksema, S., & Morrow, J. (1991). Response styles and the duration of episodes of depressed mood. Journal of Abnormal Psychology, 102(1): 20-28.

Olatunji, B. O., Sawchuk, C. N., Arrindell, W., & Lohr, J. M. (2005).Disgust sensitivity as a mediator of the Sex Difference in Contamination fears. Personality and Individual Differences, 38(3: 713-722.

Psychiatrists Association of America. (2013). StatisticalManual of Mental Disorders and classification (DSM.5) Translated by Seyyed Mohammadi (1st ed). Tehran: ravan; 2013 [In Persian].

Rodriguez., B. F., Bruce, S. E., Pagano, M.E., Spencer, M.A., & Keller M.B. (2004). Factor structure and stability of the Anxiety Sensitivity Index in a longitudinal study of anxiety disorder patients. Behaviour Research and Therapy, 42(1): 79-91.

Schmidt, N. B., Keough, M. E., Mitchell, M. A., Reynolds, E. K., MacPherson, L., Zvolensky, M. J., & Lejuez, C. W. (2010). Anxiety sensitivity: Prospective prediction of anxiety among early adolescents. Journal of Anxiety Disorders, 24(5): 503–508.

Tabibzadeh, F., & Sepehrian azar, F., (2017). The Effect of Cognitive-Behavioral Therapy on the Resilience and Obsessive Rumination among Multiple Sclerosis (MS) Patients. MEJDS. 7 (3): 45-45[In Persian].

Tello-Bernabe. E, Sanz-Cuesta, T., Del Cura-Gonzalez, I., de Santiago-Hernando M, L., Jurado-Sueiro M, Fernandez- Giron M, et al. (2011).Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial. Strategies. 95(6),12 25.

 Treynor, W., Gonzalez, R., & Nolen-Hoeksema. (2003). Ruminative Reconsidered: A Psychometric Analysis. Cognitive Therapy and Research. 21(9): 211-203.

Verkuila, B., Brosschota, J. F., & Thayer, J. F, (2007). Capturing worry in daily life: Are trait questionnaires sufficient? Behaviour Research and Therapy,45(8): 1835. 1844.