مقایسه اثربخشی پارادوکس درمانی با درمان مبتنی بر پذیرش و تعهد بر اجتناب شناختی و فرانگرانی در زنان دارای اضطراب سلامت
الموضوعات : Cognitive scienceاعظم مدحی 1 , فرناز فرشباف مافی صفت 2 , مهین اعتمادی نیا 3
1 - دانشجوی دکترای روانشناسی عمومی، گروه روانشناسی، واحد ارومیه، دانشگاه آزاد اسلامی، ارومیه، ایران.
2 - استادیار گروه روانشناسی، واحد ارومیه، دانشگاه آزاد اسلامی، ارومیه، ایران.
3 - استادیار گروه روانشناسی، واحد ارومیه، دانشگاه آزاد اسلامی، ارومیه، ایران.
الکلمات المفتاحية: پارادوکس درمانی, درمان مبتنی بر پذیرش و تعهد, اجتناب شناختی, فرانگرانی, اضطراب سلامت.,
ملخص المقالة :
این پژوهش با هدف مقایسه اثربخشی پارادوکس درمانی با درمان مبتنی بر پذیرش و تعهد بر اجتناب شناختی و فرانگرانی در زنان دارای اضطراب سلامت انجام شد. پژوهش نیمهآزمایشی با طرح پیشآزمون-پسآزمون با گروههای آزمایش و کنترل و دوره پیگیری دو ماهه بود. جامعه آماری پژوهش شامل تمامی زنان دارای اضطراب سلامت مراجعهکننده به بیمارستان صیاد شهر گرگان در سال 1402 بود، که با نمونهگیری هدفمند تعداد 60 نفر انتخاب و بهشیوه انتصاب تصادفی در سه گروه مساوی 20 نفری گمارش شدند. گردآوری دادهها با چکلیست اطلاعات دموگرافیک و پرسشنامه اضطراب سلامت (سالوسکیس و همکاران، 2002)، اجتناب شناختی (سکستون و دوگاس، 2008) و فرانگرانی (ولز، 2005) انجام شد. درمان پارادوکسی طی شش جلسه و درمان پذیرش و تعهد طی هشت جلسه برای گروههای آزمایش اعمال شد. دادهها با استفاده از آنالیز واریانس دوطرفه با اندازهگیریهای مکرر با نرمافزار آماری SPSS-v26 تحلیل شد. نتایج نشان داد که هر دو رویکرد درمانی بر کاهش نمرات اجتناب شناختی و فرانگرانی در آزمودنیهای گروههای آزمایش اثربخش بود (05/0>P). همچنین، نتایج آزمون تعقیبی بنفرونی نشان داد که پارادوکس درمانی در مقایسه با درمان پذیرش و تعهد بر کاهش فرانگرانی در در زنان دارای اضطراب تأثیر بیشتری داشته است، اما بین میزان اثربخشی دو رویکرد درمانی بر کاهش اجتناب شناختی تفاوت معنادار نبود (05/0>P). با توجه به نتایج استفاده از مداخلات مبتنی بر پذیرش و تعهد و پارادوکس درمانی میتوانند موجب بهبود کارکردهای شناختی و رفتاری در مبتلایان به اضطراب سلامتی گردند.
Babaie, V., Abolmaali Alhosseini, K., & Hobbi, M.B. (2023). Investigating the efficacy of paradoxical time table therapy on anxiety sensitivity and focused–attention in people with social anxiety disorder. Journal of Psychological Science, 22(125), 967-83. [Persian]. doi: 10.52547/JPS.22.125.967
Besharat, M.A. (2019). Evaluating the effectiveness of paradox therapy for the treatment of social anxiety disorder: A case study. Journal of Psychological Science, 18(76), 383-96. [Persian].20.1001.1.17357462.1398.18.76.12.3
Besharat, M.A. (2020). The application of paradox therapy for the treatment of body dysmorphic disorder: a case report. Journal of psychologicalscience, 19(95), 1371-87. [Persian]. 20.1001.1.17357462.1399.19.95.13.9
Bonnier, R.A., Beames, J.R., Kiekens, G., Van Aubel, E., Schirmbeck, F., & Myin-Germeys, I. (2025). Predicting clinical outcomes in a blended care intervention for early psychosis: Acceptance and Commitment Therapy in Daily-Life (ACT-DL). Translational Psychiatry, 15(1), 1-10. 10.1038/s41398-024-03214-1
Çitak, S., Avci, S.H., & Kahraman, B.B. (2021). The effectiveness of short-term psychodynamic psychotherapy in depression and anxiety disorders. Psychodynamic Practice, 27(4), 372-83. https://doi.org/10.1080/14753634.2021.1951825
Cojocaru, C. M., Popa, C. O., Schenk, A., Suciu, B. A., & Szasz, S. (2024). Cognitive-behavioral therapy and acceptance and commitment therapy for anxiety and depression in patients with fibromyalgia: A systematic review and meta-analysis. Medicine and Pharmacy Reports, 97(1), 26-34. 10.15386/mpr-2661
Coll, S.Y., Eustache, F., Doidy, F., Fraisse, F., Peschanski, D., Dayan, J., Gagnepain, P., & Laisney, M. (2022). Avoidance behaviour generalizes to eye processing in posttraumatic stress disorder. European journal of psychotraumatology, 13(1), 1-12. https://doi.org/10.1080/20008198.2022.2044661
Diamond, P.R., Dysch, L., & Daniels, J. (2023). Health anxiety in stroke survivors: a cross-sectional study on the prevalence of health anxiety in stroke survivors and its impact on quality of life. Disability and Rehabilitation, 45(1), 27-33. https://doi.org/10.1080/09638288.2021.2022778
Eatesamipour, R., & Ramazanzade Moghadam, K. (2023). The Effectiveness of Paradox Therapy on Anger Rumination in People with Anxiety Caused by Corona Disease. Clinical Psychology and Personality, 21(2), 105-16. [Persian]. 10.22070/cpap.2023.17770.1370
Faraji, S.H., Agahheris, M., & Sheybani, H. (2021). The Effectiveness of Acceptance and Commitment Education on Cognitive Avoidance and Marital Satisfaction of Women with Marital Problems. Social Cognition, 10(19),119-34. [Persian]. 20.1001.1.23223782.1400.10.1.6.1
Fatahi, M., Vaisi, A., & Moradi, O. (2024). Effectiveness of acceptance and commitment therapy (ACT) on self-compassion and family resilience of mothers exceptional Children. Journal of Psycho Res and Edu Studies, 2(1), 1-20. [Persian]. https://sanad.iau.ir/Journal/psych/Article/1122737
Hämäläinen, T., Lappalainen, P., Langrial, S. U., Lappalainen, R., & Kiuru, N. (2025). Mechanisms of change in an online acceptance and commitment therapy intervention for insomnia. Scientific Reports, 15(1), 286-299. 10.1038/s41598-025-87018-3
Hannah, K., Marie, K., Olaf, H., Stephan, B., Andreas, D., Wilson Michael, L., ... & Peter, D. (2023). The global economic burden of health anxiety/hypochondriasis-a systematic review. BMC Public Health, 23(1), 223-239. 10.1186/s12889-023-17159-5
Hayes, S.C. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press. https://psycnet.apa.org/record/2012-00755-000
Ingeman, K., Wright, K.D., Frostholm, L., Frydendal, D.H., Ørnbøl, E., & Rask, C.U. (2024). Measurement properties of the Health Anxiety by Proxy Scale (HAPYS): A new questionnaire to assess parents' worries about their child's health. Journal of Psychosomatic Research, 176 (2), 45-57. https://doi.org/10.1016/j.jpsychores.2023.111555
Levin, M. E., Krafft, J., Seifert, S., & Lillis, J. (2022). Tracking valued and avoidant functions with health behaviors: A randomized controlled trial of the acceptance and commitment therapy matrix mobile app. Behavior Modification, 46(1), 63-89. doi: 10.1177/0145445520913987
Martinez, J.H., Eustis, E.H., Arbid, N., Graham-LoPresti, J.R., & Roemer, L. (2022). The role of experiential avoidance in the relation between racial discrimination and negative mental health outcomes. Journal of American college health, 70(2), 461-8. https://doi.org/10.1080/07448481.2020.1754221
Mirshekari, M., & Khakshor Shandiz, F. (2022). Examining the role of self-compassion and dysfunctional cognitive processes (cognitive fusion, rumination and cognitive avoidance) in psychological symptoms (depression) of women with early marriage. Quarterly magazine of new strategies in psychology and educational sciences, 3(10), 89-73. [In Persian]. https://ijpk.ir/showpaper/38531940664b86b892903d
Mohammadi, Z., Soleimani, A., Fatehi Ashtiani, A., Ashrafi, E., & Mokhberi, K. (2020). The Effects of Paradoxical Time Table Therapy on Worry, Rumination, Thought-Action Fusion and Symptoms in Patients with ObsessiveCompulsive Disorder. Middle Eastern Journal of Disability Studies, 10(70), 1-9. [Persian].10.29252/mejds.10.0.70
Navidi Poshtiri, S.H., Hassanzadeh, R., & Emadian, S.O. (2022). The effectiveness of acceptance and commitment therapy on tolerance failure and health anxiety in nursing and midwifery students with health anxiety. Journal of Adolescent and Youth Psychological Studies, 3(1), 222-31. [Persian].https://doi.org/10.61838/kman.jayps.3.1.18
Nikan, A., Lotfi Kashani, F., Vaziri, S., & Mojtabaie, M. (2021). Comparison of paradoxical timetable and cognitive behavioral therapy on worry and rumination of individuals with social anxiety. Rooyesh-e-Ravanshenasi Journal, 10(1),1-4. [Persian]. 20.1001.1.2383353.1400.10.1.15.5
Pal, R. S., Pal, Y., Chaitanya, M. V. N. L., Sharma, N., Rani, A., Kumar, S., & Srivastava, P. (2025). Improving Women's Health and Immunity: A Thorough Mapping Micronutrients and Dietary Recommendations. Current Drug Therapy, 20(2), 180-188. https://doi.org/10.2174/0115748855284781240202054050
Risør, B.W., Frydendal, D.H., Villemoes, M.K., Nielsen, C.P., Rask, C.U., & Frostholm, L. (2022). Cost effectiveness of internet-delivered acceptance and commitment therapy for patients with severe health anxiety: a randomised controlled trial. PharmacoEconomics-Open, 6(2), 179-92. doi: 10.1007/s41669-021-00319-x
Salkovskis, P.M., Rimes, K.A., Warwick, H.M., & Clark, D. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological medicine, 32(5), 843-853. https://doi.org/10.1017/S0033291702005822
Salmaniyan, K., & Marashian, F.S. (2022). The Effectiveness of Sexual Skills Training on Genital Self-Image, Psychological Distress and Meta-worry of Infertile Women. Community Health Journal, 16(3), 70-9. [Persian].20.1001.1.23456248.1401.16.3.7.6
Santiago-Torres, M., Mull, K.E., Sullivan, B.M., Matthews, A.K., Skinta, M.D., & Bricker, J.B. (2025). Do smartphone apps impact long-term smoking cessation for sexual and gender minority adults? Exploratory results from a 2-arm randomized trial comparing acceptance and commitment therapy with standard US clinical practice guidelines. Journal of Homosexuality, 72(1), 107-128. https://doi.org/10.1080/00918369.2024.2309491
Scotta, A.V., Cortez, M.V., & Miranda, A.R. (2022). Insomnia is associated with worry, cognitive avoidance and low academic engagement in Argentinian university students during the COVID-19 social isolation. Psychology, health & medicine, 27(1), 199-214. doi: 10.1080/13548506.2020.1869796
Sexton, K.A., & Dugas, M.J. (2008). The cognitive avoidance questionnaire: validation of the English translation. Journal of anxiety disorders, 22(3), 355-70. https://doi.org/10.1016/j.janxdis.2007.04.005
Seyedtabaei, S.R., Tayebi, K., Akbarabadi, F., & Aghaali, M. The relationship between difficulty in emotion regulation and metaworry and the tolerance of ambiguity in patients with schizophrenia. Shenakht Journal of Psychology and Psychiatry, 9(5):29-39. [Persian]. 10.32598/shenakht.9.5.29
Shi, C., Wu, Y., Wei, H., Xiao, Y., Lv, X., & Ren, Z. (2024). Dropout From Psychological Interventions for Pathological Health Anxiety: A Three‐Level Meta‐Analysis of Randomized Controlled Trials. Clinical Psychology & Psychotherapy, 31(5), 306-318. https://doi.org/10.1002/cpp.3064
Spencer, S.D., Meyer, M.S., & Masuda, A. (2023). A case-series study examining acceptance and commitment therapy for experiential avoidance-related mixed anxiety and depression in a telehealth platform. Clinical Case Studies, 22(1),78-96. https://doi.org/10.1177/15346501221115113
Tabrizi, F., Ghamari, M., Farahbakhsh, K., & Bazzazian, S. (2019). The effectiveness of integrating acceptance and commitment therapy (ACT) with Compassion on worry and rumination of divorced women. Quarterly Journal of Psychological Studies, 15(2), 41-60. [Persian]. 10.22051/psy.2019.23046.1777
Wechsler, T.F., Schmidmeier, M., Biehl, S., Gerczuk, J., Guerrero-Cerda, F.M., & Mühlberger, A. (2022). Individual changes in stress, depression, anxiety, pathological worry, posttraumatic stress, and health anxiety from before to during the COVID-19 pandemic in adults from Southeastern Germany. BMC psychiatry, 22(1), 1-20. doi: 10.1186/s12888-022-04148-y
Weibflog, G., Ernst, J., Esser, P., Platzbecker, U., Vucinic, V., Mehnert-Theuerkauf, A., & Springer, F. (2025). The impact of experiential avoidance on anxiety and depressive disorders in hematological cancer patients. Journal of Behavioral Medicine, 48(2), 394-402. 10.1007/s10865-025-00553-2
Wells, A. (2005). The metacognitive model of GAD: Assessment of meta-worry and relationship with DSM-IV generalized anxiety disorder. Cognitive therapy and research, 29(1), 107-21. doi:10.1007/s10608-005-1652-0
Yarmohamadi Vasel, M., Zoghipaydar, M., & Pakravan, S. (2021). The Effect of Metacognitive Strategies Training on Meta-Worry and Anxiety among Students. Biquarterly Journal of Cognitive Strategies in Learning, 9(17), 183-98. [Persian]. 20.1001.1.24237906.1400.9.17.11.5
Zucchelli, F., White, P., & Williamson, H. (2020). Experiential avoidance and cognitive fusion mediate the relationship between body evaluation and unhelpful body image coping strategies in individuals with visible differences. Journal of Body Image, 32(1),121-7.doi: 10.1016/j.bodyim.2019.12.002
