اثربخشی شناخت درمانی مبتنی بر ذهن آگاهی بر افسردگی و سبک پاسخ دهی نشخواری زنان مبتلا به دیابت نوع 2

محورهای موضوعی : زن و خانواده

محمود جاجرمی ¹ (استادیار ، گروه روانشناسی، دانشگاه ازاد اسلامی واحد بجنورد، بجنورد، ایران)
بی بی زهره رضوی زاده تبادکان ² (دانشجوی دکتری ، گروه روانشناسی عمومی، دانشگاه آزاد اسلامی واحد بجنورد، بجنورد، ایران،)
یعقوب وکیلی ³ (استادیار ، گروه تحقیقات روانپزشکی، دانشگاه علوم پزشکی گلستان، گرگان، ایران،)

تاریخ دریافت : 1397/11/20 تاریخ پذیرش : 1398/02/21 تاریخ انتشار : 1398/03/01

کلید واژه: افسردگی, دیابت نوع 2, شناخت درمانی مبتنی بر ذهن آگاهی, نشخوار ذهنی,

چکیده مقاله :

پژوهش حاضر با هدف بررسی اثر بخشی شناخت درمانی مبتنی بر ذهن آگاهی بر افسردگی و نشخوار ذهنی زنان دیابتی انجام شده است.طرح پژوهش آزمایشی و از نوع طرح های تک عاملی با پیش آزمون و پس آزمون با استفاده از گروه گواه بود. نمونه متشکل از 30بیمار زن مبتلا به دیابت عضو هیات ورزشهای همگانی استان خراسان شمالی بودند که به طور تصادفی به یک گروه آزمایش( شناخت درمانی مبتنی بر ذهن آگاهی) و یک گروه کنترل گمارده شدند. بیماران گروه آزمایش در 8 جلسه 120 دقیقه ای در هفته درمان ذهن آگاهی شرکت کردند. افسردگی و نشخوار ذهنی بیماران در پیش آزمون و پس آزمون با استفاده از ابزارهای افسردگی بک(BDI-II) و سبک پاسخ دهی نشخواری( RRS)اندازه گیری شد.نتایج تحلیل کوواریانس تک متغیره نشان داد اجرای شناخت درمانی مبتنی بر ذهن آگاهی باعث کاهش نمرات افسردگی( p=0/0007) و نشخوار ذهنی( p=0/085) در گروه آزمایش در پس آزمون شد و این تغییرات در گروه آزمایش نسبت به گروه کنترل معنادار بود.اجرای شناخت درمانی مبتنی بر ذهن آگاهی منجر به کاهش افسردگی و نشخوار ذهنی بیماران دیابتی شد.

چکیده انگلیسی:

Objectives: The present study has been performed for investigating the effectiveness of mindfulness-based cognitive therapy (MBCT) on depression and the style of ruminative response in women with type 2 diabetes. Method:  The research design was an experimental study with unit-variable pre-test and post-test with control group. The sample consisted of 30 diabetic women the members of Public Sport Association of North Khorasan were assigned to experimental (mindfulness-based cognitive therapy) and control group, randomly. The patients of experimental group to attended mindfulness-based cognitive therapy in the 8 sessions 120 minutes per week. Depression and rumination were measured in pre-test and post-test by using of Beck Depression Inventory-2nd edition (BDI-II) and Ruminative Responses Scale (RRS). Results: The results of Single-variable covariance analysis demonstrated that mindfulness-based cognitive therapy significantly decreased depression and rumination in experimental group in post-test and these changes were significant in the experimental group compared to the control group. Conclusion: Mindfulness-based cognitive therapy decreased depression and ruminative in women with type 2 diabetes.  

منابع و مأخذ:

References

-  Abdolghaderi, M. Kafee, M. Saberi, A. Aryapouran, S. (2014), The effectiveness of mindfulness-based cognitive therapy (MBCT) and cognitive behavior therapy (CBT) on decreasing pain, depression and anxiety of patients with chronic low back pain. Journal ofShahidSadoughiUniversityofMedicalSciences, 21(6), 795-807(Persion).

-  American Diabetes Association: Medical Management of Type 1 Diabetes. (2008), Alexan-dria, VA, American Diabetes Association.

-  Atalay, M. Laaksonen, D.E. (2002), Diabetes, oxidative stress and physical exercise. Journal of Sports Science and Medicine, 1-14.

-  Astle, F. (2007), Diabetes and depression: A review of the Literature. NursingClinics ofNorth America, 42, 67–78

-  Azargoon, H. Kajbaf, M.B. (2010), The Effect of Mindfulness Training on the Dysfunctional Attitude and Automatic Thinking of Depressed Students of Isfahan University. Journal of Psychology, 14, 94-79(Persian).

-  Bagherinejad, M. Salehi Fadardi, J. Tabatabaei, S.M. (2010), The relationship between rumination and depression in a sample of Iranian university students. Journal of Educational and PsychologicalStudies, 11 (1), 28- 38.

-  Barnard, K.D, Lloyd, C.E, Holt, R.I.G. (2012), Psychological Burden of Diabetes and What It Means to People with Diabetes. Psychology and Diabetes Care, 1-22.

-  Beck, A.T. Steer, R. A, Brown, G. (1996), Beck depression inventory manual.2^nd ed. San Antonio, TX: Psychological Corporation.

-  Carighead, W.E. (2003), Behavioral & cognitive Behavioral psychotherapy. In G. Stricker & T. A. Widiger (vol. Eds.) & I. B. Weiner (Editor in chief) Handbook of psychology vol. 8, Clinical Psychology. NJ: Jone Wiley, & Sons.

-  Crane, R. (2009), Mindfulness- based Cognitive Therapy: Distinctive Features. Taylor & Francis Ltd: London.

-  Das-Munshi, J. Stewart, R. Ismail, K. et al. (2007), Diabetes, common mental disorders, and disability: Findings from the UK National Psychiatric Morbidity Survey. Journal of Psychosomatic Research, 69(6), 543-50.

-  Davidson,  R.J. Kabat – zinn, J. Schumacher, J. Rosenkranz, M. Muller, D. Santorelli, S.F.(2003), Alterations in brain and immune function produced by mindfulness meditiation. PsychosomaticMedicine,65 , 564- 570

-  Dimidjian, S. Beck, A. Felder, J.N. Boggs, J.M. Gallop, R. Segal, Z. (2014), Web – based Mindfulness – based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi – experimental comparison to propensity score matched controls.  Behaviour ResearchandTherapy, 63: 83- 89.

-  Evans, S. Ferrando, S. Findler, M. Stowell, C. Smart, C. Haglin, D. (2008), Mindfulness - based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22, 716 – 721

-  Farhadi, A. Movahedi, Y. Kariminajad, K. Movahedi, M. (2014), The effect of mindfulness-based cognitive therapy on depression in male patients with coronary artery disease. Cardiovascular Nursing Journal, 2 (4), 6-14(Persion).

-  Fata, L. Birashk, B. Atefvahid, M. Dabson, K. (2005), Meaning Assignment Structures/ Schema, Emotional States and Cognitive Processing of Emotional Information: Comparing Two Conceptual Frameworks. Iranian Journal of Psychiatry&Clinical Psychology, 11(3), 312- 326 (Persian).

-  Feili, A.R. Borjali, A. Sohrabi, F. Farrokhi, N. (2012), The Comparitive efficacy of Cognitive – Behavior Therapy and Teasdale MindfulnessBased Cognitive Therapy of Infertile Depressed Women’s Rumination. Yasuj University of Medical Sciences Journal (YUMSJ), 17(1), 14-21(Persion).

-  Ferguson, S.C, Blane, A. Wardlaw, J. Frier, B.M. Perros, P. Mccrimmon, R.J. et al.(2005), Influence of an Early-Onset Age of Type 1 Diabetes on Cerebral Structure and Cognitive Function. Diabetes Care, 28(6), 1431-7.

-  Goldney, R.D. Phillips, P.J. Fisher, L.J. Wilson, D.H. (2004), Diabetes, depression, and quality of life: a population study. Diabetes Care, 27, 1066-70.

-  Grigsby, A.B. Anderson, R.J. Freedland, K.E. Clouse, R.E. Lustman, P.J.(2001), Prevalence of anxiety in adults with diabetes: a systematic review. Journal ofPsychosomatic Research, 53 (6), 1053-60.

-  Haenen, S. Nyklíček, I. Son, J.V. Pop, V. Pouwer, F. (2016), Mindfulness facets as differential mediators of short and long-term effects of Mindfulness-Based Cognitive Therapy in diabetes outpatients: Findings from the DiaMind randomized trial. Journal of Psychosomatic Research, 85, 50-44.

-  Harrison, T.R. (2012), Principles of Internal medicine. (18th edition); New York: MCGRAW-HILL MEDICAL.Kaholokula, J.K, Haynes, S.N, Grandinetti, A, Chang, H.K. (2003),  Biological, psychosocial, and sociodemographic variables associated with depressive symptoms in persons with type 2 diabetes. Journal of Behavioral Medicine, 26(5), 435- 458.

-  Heidarian, A. Zahrakar, K. Mohsenzade, F. (2016), The Effectiveness of Mindfulness Training on Reducing Rumination and Enhancing Resilience in Female Patients with Breast Cancer: a Randomized Trial. Iranian Quarterly Journal of Breast Diseases, 9(2), 52-59(Persion).

-  Hofmann, S.G. Sawyer, A.T. Wit, S.A. Oh, D. (2010), The effect of mindfulness-based therapy on anxiety and depression: A Meta-Analytic review. Journal of Consulting and ClinicalPsychology, 78(2), 169-183.

-  Hyde JS, Mezulis AH, and Abramson LY. (2008), The ABCs of depression: Integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression. Psychological Review, 115(2), 291-313.

-  Imel, Z.E. Malterer, M.B. McKay, K.M. Wampold, B.E. (2008), A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders, 110(3), 197-206.

-  International Diabetes Federation (IDF). (2009), Diabetes Atlas: Prevalence & Projections.

-  Jahangirpour, M. Musavi, S.V. Khosrojavid, M. Salari, A. Rezaei, S. (2013), The effectiveness of Group Mindfulness Training on depression, hostility and anxiety in individuals with coronary heart disease. The Journal of Urmia University of Medical Sciences, 24(9), 739-730(Persion).

-  Kabat-Zinn, J. (1999), Indra's net at work: The mainstreaming of dharma practice in society. In The Psychology of Awakening, Watson G, Batchelor S, and Claxton G (eds). London, UK: Random House/Rider.

-  Kabat-Zinn, J. (2003), Mindfulness - based interventions in context: Past, present, and future. Clinical Psy- chology: Science and Practice, 10,144– 156.

-  Kruse, J. Schmitz, N. Thefeld, W. (2003), On the association between diabetes and mental disorders in a community sample: Results from the German National Health Interview and Examination Survey. Diabetes Care, 26(6), 1841-6.

-  Larijani, Z.S. Mohammadkhani, P. Hasani, P. Sepahmansour, M. Mahmoodi, G.H. (2014), A comparison of the Effectiveness of Mindfulness based cognitive therapy and Metacognitive therapy on depressive symptoms,positive and negative beliefs about rumination and experiential avoidance in students. Quarterly Journal of Pychological Studies, 10, 50-27(Persion).

-  Lo, C.S.L. Ho, S.M.Y. and Hollon, S.D. (2008), The effects of rumination and negative cognitive styles on depression: A mediation analysis. BehaviourResearch and Therapy, 46, 487-495.

-  Luminet, O. (2004), Measurement of depressive rumination and associated constructs. In: C. Papageorgiou, A. Wells, (Eds.), Depressive Rumination: Nature, Theory, and Treatment. Chichester, England: John Wiley & Sons Ltd.

-  Lustman, P.J. Clouse, R.E. (2005), Depression in diabetic patients. The relationship between mood and glycemic control. JournalofDiabetes and Its Complications, 19,113–22.

-  Lustman, P.J. Griffith, L.S. Clouse, R.E. Freedland, K.E. Eisen, S.A. Robin, E.H. et al. (1997), Effects of nortriptyline on depression and glucose regulation in diabetes: results of a duble- blind, placebo- controlled trial. Psychosamatic Medicine, 59, 241-250.

-  Mahmoodi, G.H. Sepahmansour, M. Hasani, F. Mohammadkhani, P.  Sadatlarijani, Z. (2014), A comparison of the Effectiveness of Mindfulness based cognitive therapy and Metacognitive therapy on depressive symptoms,positive and negative beliefs about rumination and experiential avoidance in students. Psychological Studies, 10(2), 27-50(Persion).

-  Mansouri, A. Farnam, A. Bakhshipour Roodsari, A. Mahmood Aliloo, M. (2010), TheComparisonof Rumination in Patientswith Major Depression Disorder, Obsessive- Compulsive Disorder, Generalized Anxiety Disorderand Normal Individuals. Journal of Sabzevar University of Medical Sciences, 17 (3), 189- 195 (Persian).

-  Martin, L.L. Tesser, A. (1989), Toward a motivational and structural theory of ruminative thought. In J. S. Uleman & J. A. Bargh (Eds.), Unintended thought. New York: Guilford Press.

-  Masuda, A. Tully, E.C. (2012),The role of mindfulness and psychological flexibility in somatization, depression, anxiety, and general psychological distress in a nonclinical college sample. Evidence-Based Complementary and Alternative Medicine,17(1), 66-71.

-  Mckim, R.D. (2008), Rumination as a mediator of the effects of mindfulness: Mindfulness –based stress reduction (MBSR) with a heterogeneous community sample experiencing anxiety, depression, and/or chronic pain. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(11 – B), 76-73.

-  Melyani, M.  Alahyari, A.A.  Azadfallah, P. Fathi Ashtiani, A.  Tavoli, A. (2014), Miulness based Cognitive therapy versus Cognitive Behavioral therapy on predictors of relapse in recurent Depression. Journal of Clinical Psychology & Personality, 2(10), 86-75.

-  Mohamadi, J. Mir Drikvand, F. Azizi, A.(2015), Efficacy of Mindfulness on Anxiety and Depression in Patients with Irritable Bowel Syndrome .Journal of Mazandaran University of Medical Sciences, 25(130), 52-61(Persion).

-  Nolen- Hoeksema, S. Morrow, J. (1993), Effects of rumination and distraction on naturally occurring depressed mood, Cognition and Emotion, 61,115- 121.

-  Nyklíček, I. Son, J.V. Pop, V.J. Denollet, J. Pouwer, F. (2016), Does Mindfulness-Based Cognitive Therapy benefit all people with diabetes and comorbid emotional complaints equally? Moderators in the DiaMind trial. Journal of Psychosomatic Research, 91, 47-40.

-  Papageorgiou, C. Wells, A. (2001) Positive beliefs about depressive rumination: development and preliminary validation of a self-report scale. Behavior Therapy, 32, 13-26

-  Paul, N.A. Stanton, S.J. Greeson, J.M. Smoski, M.J. Wang, L. (2013), Psychological and neural mechanisms of trait mindfulness in reducing depression vulnerability. Social Cognitive and Affective Neuroscience, 8(1), 56-64. 

-  Peyrot, M. Rubin, R.R. (1997), Levels and Risks of Depression and Anxiety Symptomatology among Diabetic Adults. Diabetes Care, 20(4), 585-90.

-  Piet J, Hougaard E. (2011), The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Psychology Review, 31, 1032–1040.

-  Powers, A.C. (2005), Diabetes Mellitus. In: Kasper DL, Braunwald E, Hauser S, Longo D, Jameson J.L, Fauci A.S. Harrison's principle of Internal Medicine 16th ed. New York:Mc Graw – Hill companies, 2152-80.

-  Safren, S.A. Gonzalez, J.S. Wexler, D.J. Psaros, C. Delhanty, L.M. Blashill, A.J. Margolina, A.I. Cagliero, E. (2014), A Randomised Controlled Trial of Cognitive Bahavioral Therapy For Adherence and Depression (CBT-AD) in Patient With Uncontrolled Type 2 diabetes.Diabetes Care, (37) 3,625-633.

-  Sattarpour, F. Ahmadi, E. Sadegzadeh, S. (2015), Effect of mindfulness training on reduction of depressive symptoms among students. Journal of Gorgan University of Medical Sciences, 17(3), 81-88(Persian).

-  Saydah, S.H, Imprator, G, Beckles, G.L. (2013), Socioeconomic Status and Mortality: Contribution of Health Care access and Psychological distress among U.S. adults with diagnosed diabetes. Diabetes Care, 36(1), 49-55.

-  Sea Ward, B.L. (2012), Managing stress:Principles and Strategies For health and wellb-eing – Jones and Bartlett publishers.Inc. UK, 19.

-  Segal. Z.V. Williams, J.M.G. Teasdale, J.D. (2007), Mindfulness-based Cognitive Therapy for Depression: A New Approach to Preventing Relaps. Cogn Behav Therapy Book Review, 3,351.

-  Son, J. Nyklíček, I. Victor, J.P. Blonk, M.C. Erdtsieck, R.J. Pouwer, F.(2014), Mindfulness-based cognitive therapy for people with diabetes and emotional problems: Long-term follow-up findings from the DiaMind randomized controlled trial. Journal of Psychosomatic Research, 77, 84-81.

-  Steer, RA. Clark, D.A. Beck, A.T. Ranieri, W.F. (1999), Common and specific dimensions of self- reported anxiety and depression: the BDI- II versus the BDI- IA, BehaviourResearch and Therapy, 37,190- 183.

-  Taimory, S. F. Ramezani, F. Mahjob, N. (2015), The Effectiveness of Mindfulness-Based Group Cognitive Therapy in Reducing Depression and Obsessive Rumination among Women under Methadone Treatment.Research on Addiction, 34, 159-145(Persian).  

-  Teasdale, J. D. Segal, Z.V. Williams, J. M. G. Ridgeway, V. A. Soulsby, J. M. lau, M. A. (2000),  Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and ClinicalPsychology, 68, 615-623.

-  Teasdale, J.D. Williams, J.M. Segal, Z.V. Soulsby, J. (2000), Mindfulness – based cognitive therapy reduces over general autobiographical memory in for merely depressed patients. Journal of Abnormal Psychology, 109, 150-155.

-  Treynor, W. Gonzalez, R. Nolen- Hoeksema, S. (2003), Rumination Reconsidered: A Psychometric Analysis. Cognitive Therapy and Research, 27(3), 247- 259.

-  Vala, M.  Razmandeh, R. Rambod, K. Nasli Esfahani, E. Ghodsi Ghasemabadi, R.(2015), Mindfulness-based Stress Reduction Group Training on Depression, Anxiety, Stress, Self-confidence and Hemoglobin A1c in Young Women with Type 2 Diabetes. Iranian Journal of Endocrinology and Metabolism, 17(5), 382-421(Persian).

-  Wells, A. (1995), Metacognition and worry: A cognitive model of generalized anxiety disorders. Behavioural and CognitivePsychotherapy, 23,273- 280.

-  Watkins, E.d. Baracaia, S. (2001), Why do people ruminate in dysphoric moods? Personality and Individual Differences, 30,723-734.

-  Wenzalaff, R.M. Wengner, D.M. (2000), Thought suppression. AnnualReviewofPhysiology, 51, 91-59.

-  Xu, L. Ren, J. Cheng, M. Tang, K. Dong, M. Hou, X. et al.(2004), Depressive Symptoms and Risk Factors in Chinese Persons with Type 2 Diabetes. ArchivesofMedical Research, 35(4), 301-7.

-  Zare, H. Zare, M. Khalegi Delavar, F. Amirabadi, F. Shahriari, H. (2013), Mindfulness and diabetes: evaluation of effectiveness of mindfulness based stress reductionon glycemic control in diabetes. Razi Journal of Medical Sciences, 20, 47-39(Persion).

-  Zeidan, F. Johnson, S.K. Diamond, B.J. David, Z. Goolkasian, P. (2012), Mindfulness meditation improves cognition: Evidence of brief mental training. ConsciousnessandCognition, 19, 597 –605.

-  Zeneto, J.F. Cardiel, M.H. (2002), Risk factors Associated with Depression in patients with type II Diabetes mellitus. Archives of Medical Research, 33, 53-60.