مقایسه اثربخشی روان‏درمانی وجودی با درمان مبتنی بر پذیرش و تعهد بر علائم روان‏تنی و تحمل پریشانی هیجانی در زنان دارای تعارضات زناشویی

محورهای موضوعی : تکتونواستراتیگرافی

زهرا دهمنی ¹ (دانشجوی دکتری روان‌شناسی عمومی، گروه روان‌شناسی، واحد تنکابن، دانشگاه آزاداسلامی، تنکابن، ایران.)
علی اصغر اصغرنژاد ² (دانشیار، گروه روان‌شناسی بالینی، دانشگاه علوم پزشکی ایران، دانشکده علوم رفتاری و بهداشت روان، تهران، ایران.)
رضا گل پور ³ (استادیار گروه روان‌شناسی، دانشگاه پیام نور، تهران، ایران.)

تاریخ دریافت : 1402/10/30 تاریخ پذیرش : 1403/02/08 تاریخ انتشار : 1403/02/01

کلید واژه: تعارضات زناشویی, درمان مبتنی بر پذیرش و تعهد, تحمل پریشانی هیجانی, روان‏درمانی وجودی, علائم روان‏تنی,

چکیده مقاله :

زمینه و هدف: این پژوهش با هدف مقایسه اثربخشی روان‏درمانی وجودی با درمان مبتنی بر پذیرش و تعهد بر علائم روان‏تنی و تحمل پریشانی هیجانی در زنان دارای تعارضات زناشویی انجام شد. روش­: پژوهش نیمه‏آزمایشی با طرح پیش‏آزمون و پس‏آزمون با گروههای آزمایش و کنترل و دوره پیگیری سه ماهه بود. جامعه آماری شامل تمامی زنان دارای تعارض زناشویی مراجعه‏کننده به مرکز خدمات مشاوره و روان‏درمانی پرهام شهر تهران در سال 1402- 1401 بود، که با روش نمونه‏گیری در دسترس تعداد 45 آزمودنی واجد ملاک‏های ورود به پژوهش انتخاب و در سه گروه (هر گروه 15 نفر) گمارش تصادفی شدند. هر یک از دو رویکرد مداخلاتی طی 8 جلسه برای گروههای آزمایش اجرا شدند، اما گروه کنترل هیچ مداخله‏ای را دریافت نکرد. گردآوری اطلاعات با استفاده از پرسش‌نامه علائم روان‏تنی لاکورت و پرسش‌نامه تحمل پریشانی سیمونز و گاهر انجام شد. داده‏ها با استفاده از تحلیل واریانس با اندازه‏گیری مکرر تحلیل شد. یافته­ ها: نتایج نشان داد هر دو مداخله درمانی بر کاهش علائم روان‏تنی و افزایش تحمل پریشانی آزمودنی‏های گروه آزمایش اثربخش بود (05/0>P). نتایج آزمون تعقیبی بن‏فرونی نیز نشان داد بین میزان تأثیر دو رویکرد درمانی بر علائم روان‏تنی تفاوت معناداری وجود ندارد، اما تأثیر درمان پذیرش و تعهد بر افزایش تحمل پریشانی بیش‎تر از درمان وجودی است (05/0>P). نتیجه ­گیری: با توجه به اثربخشی دو رویکرد مداخلاتی در زنان دارای تعارض زناشویی، به روان‌شناسان و مشاوران شاغل در این حوزه توصیه می‏شود برای بهبود مسائل روان‌شناختی مراجعان از این روش‏های آموزشی و درمانی استفاده کنند.

چکیده انگلیسی:

Background and purpose: This research was conducted with the aim of comparing the effectiveness of existential psychotherapy with treatment based on acceptance and commitment on psychosomatic symptoms and tolerance of emotional distress in women with marital conflicts. Methods: This research was a pre-test and post-test design with experimental and control groups and a three-month follow-up period. The statistical population included all women with marital conflict referring to Parham Counseling and Psychotherapy Service Center in Tehran in 2022-2023, out of which 45 subjects met the criteria for entering the research. They randomly assigned in three groups (15 people in each group). Each of the two intervention approaches were implemented during 8 sessions for the experimental groups, but the control group did not receive any intervention. Data collection was done using the Lacourt Psychosomatic Symptoms Questionnaire and the Simmons and Gaher Distress Tolerance Questionnaire. The data were analyzed using ANOVA with repeated measures Findings: The results showed that both therapeutic interventions were effective in reducing psychosomatic symptoms and increasing distress tolerance of the test group subjects (P<0.05). The results of Benferroni's post hoc test also showed that there is no significant difference between the effect of two treatment approaches on psychosomatic symptoms, but the effect of acceptance and commitment therapy on increasing distress tolerance is greater than existential therapy (P<0.05). Conclusion: Considering the effectiveness of two intervention approaches in women with marital conflict, psychologists and counselors working in this field are recommended to use these educational and therapeutic methods to improve the psychological performance of their clients.

منابع و مأخذ:

1. Grant ZR. Development of Southern Interracial Marriage and Divorce: Why Our Children are Code-Switching. Crossings: Swarthmore Undergraduate Feminist Research Journal, 2023, 1(1), 135-149. https://works.swarthmore.edu/crossings/vol1/iss1/11/


2. Wang X, Zhao K. Partner phubbing and marital satisfaction: The mediating roles of marital interaction and marital conflict. Social Science Computer Review, 41(4), 2023, 1126-1139. https://doi.org/10.1177/08944393211072231


3. Musapur H, Mehravar M, Batue A, Hosseini SH, Changi Ashtiani J. Outcomes of procrastination in marital conflicts: A qualitative study. Razi Journal of Medical Sciences, 2020, 27, 174-185. [In Persian]. http://rjms.iums.ac.ir/article-1-6380-fa.html.


4. Ünal Ö, Akgün S. Conflict resolution styles as predictors of marital adjustment and marital satisfaction: An actor–partner interdependence model. Family Studies, 2022, 28(3), 898-913. https://doi.org/10.1080/13229400.2020.1766542


5. Mikaeili N, Ebadi M. Developing Structural Equations for Marital Relationship Distress Based on Facial Emotion Recognition: The Mediating Role of Relational Aggression in Infertile Women. The Neuroscience Journal of Shefaye Khatam, 2022, 10(2), 22-32. [In Persian]. doi: 10.61186/shefa.10.2.22


6. Nasiri Z, Honarparvaran N, Shahshahani FJ, Samani S. Investigating the precipitating and exhibiting factors of marital infidelity: a qualitative study. Journal of Applied Family Therapy, 2022, 3(1), 110-135. [In Persian]. doi: 10.22034/aftj.2022.305871.1208


7. Cao H, Fine MA, Zhou N. The Divorce Process and Child Adaptation Trajectory Typology (DPCATT) Model: The Shaping Role of Predivorce and Postdivorce Interparental Conflict. Clinical Child and Family Psychology Review, 2022, 25(1), 500-528. https://doi.org/10.1007/s10567-022-00379-3


8. Gerschwer S. Conflicts over intimacy within mature, happy marriages reliance and reliability in intimate relationships: An interpretive phenomenological analysis. Conflict Resolution Quarterly, 2022, 39(3), 261-274. https://doi.org/10.1002/crq.21321


9. Falconier M, Nussbeck F, Bodenmann G, Schneider H, Bradbury T. Stress from daily hassles in couples: Its effects on intradyadic stress, relationship satisfaction, and physical and psychological well‐being. marital and family therapy, 2015, 41(2), 221-235. https://doi.org/10.1111/jmft.12073.


10. Borhani L, Momeni K, Karami J, Mashhadi A. The efficacy of combining therapy cognitive with acceptance and commitment on symptoms of depression and psychosomatic problems firefighters of mashhad city. Journal of Psychological Science. 2021, 20(103), 1171-1192. [In Persian]. doi:10.52547/JPS.20.103.1171


11. Watanabe J, Watanabe M, Yamaoka K, Adachi M, Suzuki A, Tango T. Effects of ‘SPRAT’programme for dietary and lifestyle education to improve psychosomatic symptoms and dietary habits among adolescents: a cluster randomised controlled trial. BMC Public Health, 2022, 22(1), 1-13. https://doi.org/10.1186/s12889-022-12832-7.


12. Birditt KS, Turkelson A, Polenick CA, Cranford JA, Blow FC. Alcohol Use and Blood Pressure Among Older Couples: The Moderating Role of Negative Marital Quality. The Journals of Gerontology, 2022, 77(9), 1592-1602. https://doi.org/10.1093/geronb/gbac015


13. An U, Park HG, Han DE, Kim YH. Emotional suppression and psychological well-being in marriage: The role of regulatory focus and spousal behavior. International journal of environmental research and public health. 2022, 19(2), 973. https://doi.org/10.3390/ijerph19020973.


14. Shahabi S, Jenaabadi H, Tamini BK. The mediating role of marital intimacy in the relationship between distress tolerance and sexual self-concept among couples with marital conflict. Journal of Applied Family Therapy. 2021, 2(3), 361-80. [In Persian]. doi: 10.22034/aftj.2022.332238.1432


15. Arshadi S, Karimi Q, Akbari M, Moradi O. The effectiveness of marital adjustment training on couples distress intolerance, difficulty in emotion regulation and marital conflict referring to counseling centers. Shenakht Journal of Psychology and Psychiatry. 2021, 8(5), 140-151. [In Persian]. doi: 10.32598/shenakht.8.5.140


16. Mazarei Sotoodeh A, Bakhshipour A, Jajarmi M. The Effectiveness of Existential Group Therapy on Increasing Intimacy and Marital Satisfaction in Depressed Married Women. Razi Journal of Medical Sciences. 22, 29(2), 39-50. [In Persian]. doi: 20.1001.1.22287043.1401.29.2.3.6


17. Couture S, Vaillancourt-Morel MP, Hébert M, Fernet. Associations between conflict negotiation strategies, sexual comfort, and sexual satisfaction in adolescent romantic relationships. The Journal of Sex Research. 2023, 60(3), 305-314. https://doi.org/10.1080/00224499.2022.2043230


18. Khodadadi Sangdeh J, Sepehrtaj SA, Mirzaesmaeili M, Sadat Sepehrtaj F. The effectiveness of cognitive existential group therapy on caregiving burden of mothers of children with thalassemia major. Journal of Preventive Medicine. 2020, 7(3), 52-42. [In Persian]. doi: 10.29252/jpm.7.3.52


19. Cheragh Sahar Z, Dayarian M M, Haghayegh A, Gorji Y. The Effectiveness of the Therapeutic Package of Originality in the Three Worlds Based on Rollo May Existential Theory on the Resilience of Women with Marital Conflict. Journal of Research in Behavioural Sciences. 2022, 20(2), 368-379. [In Persian]. doi: 10.52547/rbs.20.2.368


20. Nameni E, Jajarmi M, Soliemanian A. Comparison of the Effectiveness of Existential Therapy and Compassion-based therapy on Psychological Well-being and Marital Disturbance of Conflicting Women, Journal of Sabzevar University of Medical Sciences. 2021, 28(4), 608-620. [In Persian]. https://jsums.medsab.ac.ir/article_1450.html


21. Dukes AT, Gutierrez D, Goshorn JR. Logotherapy infused family therapy: A systematic review of clinical interventions for family counselors.  Humanistic Counseling. 2022, 61(1), 18-29. https://doi.org/10.1002/johc.12168


22. Chisari C, McCracken LM, Cruciani F, Moss-Morris R, Scott W. Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online. Journal of Contextual Behavioral Science. 2022, 23(2), 15-30. https://doi.org/10.1016/j.jcbs.2021.11.003


23. Thompson EM, Destree L, Albertella L, Fontenelle LF. Internet-based acceptance and commitment therapy: a transdiagnostic systematic review and meta-analysis for mental health outcomes. Behavior Therapy. 2021, 52(2), 492-507. https://doi.org/10.1016/j.beth.2020.07.002


24. Aghili SM, Kashiri S. The Effectiveness of Acceptance and Commitment-Based Therapy on Uncertainty Intolerance, Turmoil Tolerance, and Sexual Function in Betrayed Women. The Neuroscience Journal of Shefaye Khatam. 2022, 10(3), 57-67. [In Persian]. doi: 10.52547/shefa.10.3.57


25. Zohrehvandi Z, Babakhani N, Taheri A. The Effectiveness of Acceptance and Commitment Therapy (ACT) on Perceived stress & Psycho-Somatic Signes & emotional distress in IVF infertile women. Applied Family Therapy Journal. 2022, 3(2), 496-516. [In Persian]. doi: 10.22034/aftj.2022.310062.1230


26. Irannezhad Z, Hamidi Poor R, Heidari H, Davoudi H. The effectiveness of Acceptance and Commitment Therapy (ACT) group training on attachment, intimacy and sexual satisfaction in women with sexual reluctance. medical journal of mashhad university of medical sciences. 2021, 64(2), 2865-2875. [In Persian]. doi: 10.22038/MJMS.2021.18899


27. Hayes SA, Orsillo SM, Roemer L. Changes in proposed mechanisms of action during an acceptance-based behavior therapy for generalized anxiety disorder. Behaviour research and therapy. 2010, 48(3), 238-245. https://doi.org/10.1016/j.brat.2009.11.006


28. Charny IW. Existential/dialectical marital therapy: Breaking the secret code of marriage: Psychology Press. 1992, https://www.routledge.com/ExistentialDialectical-Marital-Therapy-Breaking-The-Secret-Code-Of-Marriage/Charny/p/book/9781138869172


29. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change. Second Edition. New York: Guilford Press. 2016, https://www.guilford.com/books/Acceptance-and-Commitment-Therapy/Hayes-Strosahl


30. Lacourt T, Houtveen J, Van Doornen L. Functional somatic syndromes, one or many?: an answer by cluster analysis. Journal of psychosomatic research. 2013, 74(1), 6-11. https://doi.org/10.1016/j.jpsychores.2012.09.013


31. Shabbeh Z, Feizi A, Afshar H, Hassanzade Kashtali A, Adibi P. Identifying the Profiles of Psychosomatic Disorders in an Iranian Adult Population and their Relation to Psychological Problems. J Mazandaran Univ Med Sci. 2016, 26 (137),82-94.  [In Persian]. http://jmums.mazums.ac.ir/article-1-7714-fa.html


32. Simons JS, Gaher RM. The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion. 2005, 20(9), 83-102. https://doi.org/10.1007/s11031-005-7955-3.


33. Parham R, Namdarpour F, Dayarian M. The effectiveness of the emotion-oriented approach on distress tolerance and cognitive emotion regulation of married women. Rooyesh-e-Ravanshenasi Journal. 2023, 12(7),113-22. [In Persian]. 20.1001.1.2383353.1402.12.7.12.8


34. Ma TW, Yuen AS, Yang Z. The efficacy of acceptance and commitment therapy for chronic pain: A systematic review and meta-analysis. The Clinical Journal of Pain. 2023, 39(3),147-57. doi: 10.1097/AJP.0000000000001096


35. Han A, Wilroy JD, Yuen HK. Effects of acceptance and commitment therapy on depressive symptoms, anxiety, pain intensity, quality of life, acceptance, and functional impairment in individuals with neurological disorders: a systematic review and meta-analysis. Clinical Psychologist. 2023, 27(2), 210-231. https://doi.org/10.1080/13284207.2022.2163158.


36. Weng J, Pachman DR, Wild E, Ingram CJ. Dignity conserving therapy: an intervention for addressing psychosocial and existential distress in patients with serious illness. Palliative Medicine Reports. 2022, 3(1), 206-210. https://doi.org/10.1089/pmr.2022.0016.


37. Lebel S, Maheu C, Tomei C, Mutsaers B, Bernstein LJ, Courbasson C, et al. Mechanisms of change of a cognitive-existential group intervention for fear of cancer recurrence: Mediation analyses of the FORT trial. Journal of Psychosocial Oncology Research and Practice. 2022, 4(3), 23-36. Doi: 10.1097/OR9.0000000000000077


38. Safdari H, Naderi F, Moradi Manesh F, Makvandi B. The Effectiveness of Acceptance Based Therapy on Anxiety Sexual satisfaction and depression in infertile women. Medical Journal of Mashhad University of Medical Sciences. 2022, 65(5), 1249-1258. [In Persian]. doi: 10.22038/MJMS.2022.67174.3982.


39. Sun FK, Hung CM, Yao Y, Fu CF, Tsai PJ, Chiang CY. The effects of logotherapy on distress, depression, and demoralization in breast cancer and gynecological cancer patients: A preliminary study. Cancer Nursing. 2021, 44(1), 53-61. doi: 10.1097/NCC.0000000000000740


40. Alizadeh S, Taklavi S, Mahmoud Alilou M. The effectiveness of existential therapy on intolerance of uncertainty, accepting death, and feeling empty in recovered covid-19 patients in urmia city. Nursing and Midwifery Journal. 2022, 20(1), 17-30. [In Persian]. doi: 10.52547/unmf.20.1.17


41. Babahasani K, Amini N, ShafieAbadi A, Deyreh E. Effectiveness of Existential Group Therapy on Experience and Perception of Suffering, Emotional Regulation and Happiness in Migraine patients. Scientific Journal of Social Psychology. 2020, 14(58), 295-309. [In Persian]. https://psychology.ahvaz.iau.ir/article_680984.html

Shirali S, DashtBozorgi Z. Effect of existential group therapy on distress tolerance, existential anxiety, meta-worry and health worry in elderly women with cardiovascular disease. Cardiovascular Nursing Journal. 2019, 7(4), 24-33. [In Persian]. http://journal.icns.org.ir/article-1-579-fa.html