اثربخش حساسیت زدایی از طریق حرکات چشم و پردازش مجدد(EMDR)در اختلال استرس پس ازضربه(PTSD) مزمن رزمندگان
الموضوعات :
علیرضا ماردپور
1
(گروه روان‌شناسی، علوم و تحقیقات خوزستان، دانشگاه آزاد اسلامی، اهواز)
فرح نادری
2
(عضو هیأت علمی گروه روان‌شناسی، واحد اهواز، دانشگاه آزاد اسلامی، اهواز)
مهناز مهرابی‌زاده هنرمند
3
(عضو هیأت علمی گروه روان‌شناسی، دانشگاه شهید چمران اهواز)
حسن احدی
4
(استاد گروه روان‌شناسی، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران.)
علیرضا حیدریی
5
(دانشیار گروه روان‌شناسی، واحد اهواز، دانشگاه آزاد اسلامی، اهواز، ایران.)
الکلمات المفتاحية: حساسیت‌زدایی از طریق حرکات چشم و پردازش مجدد, اختلال استرس پس از ضربۀ مزمن,
ملخص المقالة :
هدف این پژوهش بررسی اثربخشی حساسیت‌زدایی از طریق حرکات چشم و پردازش مجدد، در اختلال استرس پس از ضربۀ مزمن بود. جامعۀ آماری، همۀ رزمندگان بستری و دارای پروندۀ روانپزشکی در بیمارستان سلمان یاسوج بود که تشخیص اختلال مزبور را دریافت کرده بودند. 32 نفر از این جامعه، به شیوۀ تصادفی ساده انتخاب و به‌صورت تصادفی در دو گروه 16 نفرۀ آزمایش و گواه گمارده شدند. سپس آموزش حساسیت‌زدایی از طریق حرکات چشم و پردازش مجدد، به مدت 5 جلسۀ 90دقیقه‌ای و یک بار در هفته به گروه آزمایشی داده شد ولی به گروه گواه آموزشی داده نشد. ابزارهای پژوهش شامل مقیاس‌های تأثیر واقعۀ تجدیدنظر شده، خودگزارش‌دهی نشانه‌های اختلال پس از ضربه، اضطراب، افسردگی، برآشفتگی ذهنی و اعتبار شناخت‌واره بود.آزمودنی‌ها در پیش‌آزمون، پس‌آزمون و پیگیری ارزیابی شدند. برای تحلیل داده‌ها از تحلیل کواریانس چندمتغیری و تک‌متغیری استفاده شد. روش حساسیت‌زدایی مزبور موجب کاهش میانگین مقیاس‌های تأثیر واقعۀ تجدیدنظر شده، خودگزارش‌دهی نشانه‌های اختلال مزبور، اضطراب و افسردگی شد (001/0P=). همچنین، بین آزمودنی‌های گروه آزمایشی و گواه از لحاظ متغیرهای مورد بررسی در مرحلۀ پیگیری تفاوت معناداری وجود داشت (001/0P=). یافته‌ها نشان داد که این روش درمانی در بهبود علایم اختلال استرس پس از ضربه و نشانه‌های همراه با آن مؤثر بوده است.
American Psychiatry Association. (2000). Diagnostic and statistical manual of mental disorder 4th ed. Washington: American psychiatry Association. Barrowcliff, A.L., Gray, N.S., Freeman, T.C.A., & MacCulloch, M.J. (2004). Eye-movements reduce the vividness, emotional valence and electrodermal arousal associated with negativeautobiographical memories. Journal of Forensic Psychiatry and Psychology, 15, 325-354. Beck, A.T., Steer, R.A., Ball ,R., & Ranieri, W. (1996). "Comparison of Beck Depression Inventories–IA and II in psychiatric outpatients". Journal of Personality Assessment, 67(3): 588-97. Beck, A.T., & Steer, RA. (1990). The beck Anxiety Inventory Manual. San A ntonio, TX: Psychological Corporation. Beck, A.T., Epstin, N., Brown, G., & Steer, R.A. (1998). An inventory For measuring clinical anxiety: Psychometric propertied. Journal of consulting and clinical Psychology, 56:893-897. Beck, A.T., Steer, R.A., & Brown, G.K. (2000). Manual, the Beck Depression Inventory-II. San Antonio, TX: The Psychological Corporation. Bergmann, U.R. (1998). Speculation on the neurobiology of EMDR. Traumatology, 4, 1-5. Bisson, J.I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatment for chronic posttraumatic stress disorder. Systematic review and meta-analysis. British Journal of Psychiatry, 190, 97-104. Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227. Burnet, A., St-Hilaric, A., Jehel, L., & King S., (2003). Validation of French version of the Impact of Event Scale- Revised .Canadian Journal of Psychiatry, 48: 55-60. Creamer, M., Bell, R., & Failla, S. (2003). Psychometric properties of the Impact Event Scale–Revised. Behaviour Research and Therapy, 41: 1489-1496. Davidson, P.R. & Parker, K.C.H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta- analysis. Journal of Consulting and Clinical Psychology, 69, 305-316. Dibajnia, P., Zahirrodin, A., Moghadasin, M., Gheidar, Z. (2012). Eye Movement Desensitization Reprocessing (EMDR) treatment in patients with Post Traumatic Stress Disorder (PTSD). Journal of Basic and Applied Scientific research, 2(9), 9321-9325. Edmond, T., Rubin, A. & Wamback, K.G. (1999). The effectiveness of (EMDR) with adult female survivors of childhood sexual abuse. Social Work Research, 23, 103-116. Foa, E.B., Rothbaum, B.O., Riggs, D.S., Murdock, T.B. (1991). Treatment of post traumatic stress disorder in rape victs: a comparison between cognitive- behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 115-23. Foa, E.B., Riggs, D.S., Dancu, C.V., & Rothbaum, B.O. (1993). Reliability and validity of a brief instrument for assessing post–traumatic stress disorder. Journal of Traumatic stress ,6: 459-473. Gunter, R.W., & Bodner, G.E. (2009). EMDR works… But How? Recent progress in the search for treatment mechanisms. Journal of EMDR Practice and Research, 3, 161-163. Hendler, T., Rotshtein, P., & Hadar, U. (2001). Emotionperceotion interplay in the visual cortex: the eyes follow the heart. Cellular and Molecular Neurobiology, 21, 733-52. Ironson, G., Freund, B., Strauss, JL. & Williams J. (2002). Comparison of two treatments for treatments for traumatic stress, a community based study of EMDR and Prologed exposure, Journal of clinical Psychology, 58, 113-28. Kaplan, H., & Sadock, B. (2003). Kaplan and Sadocks Synopsis of Psychiatry. 8th ed. Baltimore, Meryl and: Williams and Wilkins. Lanius, R.A., Williamson, P.C., Densmore, M., Boksman, K., Neufeld, R.W., Gati, J.S., & etal. The nature of traumatic memories: A 4-T FMRI functional connectivity analysis. American journal of Psychiatry, 161, 36-44. Lee, C.W., & Drummond, P.D. (2008). Effects of eye movement versus therapist instructions on the processing of distressing memories. Journal of Anxiety Disorders, 22, 801-808. Liberzon, I., & Phan, K.L. (2003).Brain-imaging studies of posttraumatic stress disorder. CNS Spectrums, 8, 641-50. Liberzon, I., King ,A.P., Britton, J.C., Phan, K.L., Abelson, J.L., & Taylor, S.F. (2007). Paralimbic and medial prefrontal cortical involvement in neuroendocrine responses to traumatic stimuli. American Jpurnal of Psychiatry, 164, 1250-8. Lindauer, R.J., Booij, J., Habraken, J.B., Van Meijel, E.P., Uylings, H.B., & Olff, E.T. (2008). Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post- traumatic stress disorder: a randomized clinical trial. Psychological Medicine, 38, 543-54. Maercker, A. (1999). Life Span psychological aspect of trauma and PTSD; symptoms and psychological impairment. In: Maercker A, Schutzwohl, Solmon z(eds) Post Traumatic Stress Disorder: A Life span developmental prospective. Hogrete and Hurber Toronto, p:1-41. Marcus, S., Marquis, P. & Sakai, C. (2004). Three- and 6-month follow- up of EMDR treatment of PTSD in an HMO setting. international Journal of Stress Management, 11, 195-208. Maxfield, L., Melnyk, W.T. & Hayman, C.A.G. (2008). Aworking memory explanation for the effects of eye movements in EMDR. Journal of EMDR Practice and Research, 2,247-261. Maxfield, L., & Hyer, L. (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology, 58, 23-41. Mirzamani, S.M., Mohammadi, M.R., Mahmoudi-Gharaei, J., & Mirzamani, M.S. (2007). Validity of the PTSD Symptoms Scale Self report (Pss-SR) in Iran. Iranian Journal of Psychiatry, 2:120-123. Nardo, D., Högberg, G., Looi, J.C., Larsson, S., Hällström, T., & Pagani, M. (2010). Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. Journal of Psychiatric Research, 44(7): 477-85. Pitman, R.K., Shin, L.M.,& Rauch, S.L. (2001). Investigating the pathogenesis of posttraumatic stress disorder with neuroimaging .Journal of Clinical Psychiatry, 62 (Suppl.17), 47-54. Power, K., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Swanson, V., & Karatzias, A. (2002, August). A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of post traumatic stress disorder. Journal of Clinical Psychology and Psychotherapy, 9(5), 299-318. Rothbaum, B.O., Astin, M.C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) For PTSD rape victims. Journal of Traumatic Stress, 18, 607-616. Sadock, B.J., & Sadock, A.V. (2007). Synopsis of psychiatry. philadelphla: Lippincott Williams & Wilkins: G12-21. Schabert, S.J., Lee, C.W., & Drummond, P.D. (2011). The efficacy and psychophysiological correlates of dual-attention tasks in eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorder, 25, 1-11. Seidler, G.H .,& Wagner, F.E. (2006). Comparing the efficacy of EMDR and trauma- focused cognitive- behavioral therapy in the treatment of PTSD: a meta -analytic study. Psychological Medicine, 36, 1515-1522. Shapiro, F. (2001). Eye movement desensitization and reprocessing. Basic Principles, protocols and procedures. pp.128-135. Shapiro, F. (2007). EMDR, adaptive information processing and case conceptualization. Journal of EMDR Practice and Research and Experimental, 1, 68-87. Shaw, M.E., Strother, S.C., McFarlane, A.C., Morris, P., Anderson, J., Clark, CR., & et al. (2002). Abnormal functional connectivity in posttraumatic stress disorder. Neuroimage ,15(3), 661-74. Solomon, R.M., & Shapiro, F. (2008). EMDR and the adaptive information processing model. Journal of EMDR practice and Research, 2, 315-325. Spector, J., & Read, J. (1999). the status of Eye Movement Desensitization and Reprocessing (EMDR). Psychotherapy., 6, 165-74. Taylor, S., Thordarson, D.S., Maxfield, L., Fedoroff, I.C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training .Journal of Consulting and Clinical Psychology, 71, 330-338. Van den Hout, M.A., Engel hard, I.M., Rijke boer, M.M., Koekebakker, J., Horn sveld, H., leer, A., etal. (2011). EMDR: Eye movements superior to beeps in taxing working memory and reducing vividness of recollections. Behaviour Research and Therapy, 49, 92-98. Van der Kolk, B.A., Spinazzola, J., Blaustein, M.E., Hopper, J.W., Hopper, E.K., Korn, D. (2007). A Randomized Clinical Trial of Eye Movement Desensitization and Reprocessing (EMDR), Fluoxetine, and Pill Placebo in the Treatment of Posttraumatic Stress Disorder: Treatment Effects and Long- Term Maintenance. Journal of Clinical Psychiatry, 68(1), 37-46. Weiss, D.S., & Marmar, C.R. (1997). The Impact of Event Scale- Revised. In: Wilson Jp Kean Tm. Assessing Psychological trauma and PTSD. Guilford press, New Yourk ,p: 399-411. Wu K, ChanKs. (2003). The development of Chinese version of Impact of Event Scale – Revised. Social Psychiatry and Psychiatric Epidemiology, 38: 94-98.
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