مقایسه اثربخشی درمان مبتنی بر پذیرش و تعهد غنی‌شده با شفقت به شیوه‌ی حضوری و آنلاین، بر پریشانی روانشناختی، حساسیت انزجاری و علایم فکری- عملی افراد مبتلا به اختلال وسواسی- اجباری
محورهای موضوعی : بالینیسمیه سعیدی دهاقانی 1 * , ایران داوودی 2 , مهناز مهرابی زاده هنرمند 3 , اسماعیل هاشمی 4
1 - دانشجوی دکتری روانشناسی، گروه روانشناسی دانشگاه شهید چمران اهواز، اهواز، ایران.
2 - گروه روانشناسی دانشگاه شهید چمران اهواز، اهواز، ایران.
3 - گروه روانشناسی دانشگاه شهید چمران اهواز، اهواز، ایران.
4 - گروه روانشناسی دانشگاه شهید چمران اهواز، اهواز، ایران.
کلید واژه: درمان مبتنی بر پذیرش و تعهد, شفقت, پریشانی روانشناختی, حساسیت انزجاری, اختلال وسواسی- اجباری,
چکیده مقاله :
در این پژوهش ، تاثیر درمان مبتنی بر پذیرش و تعهد غنی شده با شفقت به دو شیوه حضوری و آنلاین بر پریشانی روانشناختی، حساسیت انزجاری و علایم فکری- عملی افراد دارای نشانه‌های اختلال وسواسی- اجباری مورد بررسی قرار گرفت. این پژوهش، در دسته تحقیقات آزمایشی و از نوع پیش‌آزمون، پس‌آزمون بود که به این منظور، تعداد 30 نفر زن، به روش نمونه‌گیری در دسترس از بین مراجعه کنندگان دارای نشانه‌های اختلال وسواسی – اجباری در سال 1402-1403 به مراکز خدمات مشاوره و روانشناختی یا روانپزشکی شهر تهران و نیز فراخوان‌های منتشر شده در فضای مجازی، انتخاب شدند. شرکت‌کنندگان مقیاس وسواسی- اجباری (Yale- Brown, 1986)، پریشانی روانشناختی (Kessler & et al, 2002) و حساسیت انزجاری (Haidt et al, 1994) را تکمیل کردند. تجزیه و تحلیل داده‌ها با روش تحلیل کواریانس چندمتغیره با استفاده از نرم افزار SPSS نسخه‌ی 26، صورت گرفت. یافته‌ها نشان داد که درمان مبتنی بر پذیرش و تعهد غنی شده با شفقت به روش حضوری در مقایسه با آنلاین، بر تمامی متغیرها به جز حساسیت انزجاری، تاثیر بیشتری دارد (0001/0 >P). بر اساس نتایج این پژوهش، باید گفت هرچند روش حضوری در این پژوهش اثربخشی بیشتری را نشان داد اما در شرایطی که درمان به این شکل امکان نداشته باشد، بهره‌مندی از شیوه آنلاین می‌تواند جایگزینی نسبی به جای عدم دسترسی به درمان قرار گیرد.
The perpouse of the present study was to compare the efficacy of acceptance and commitment therapy enriched with compassion in face-to-face and online manner on psychological distress, disgust sensitivity and OCD Symptoms of Individuals with Obsessive-Compulsive disorder. Using a randomized controlled trial design 30 women with OCD Symptoms, who had referred to counselling and psychological service centers in Tehran, participated in the study through convenient sampling. Participants filled Obsessive-Compulsive scale (Yale- Brown, 1986), Psychological Distress (Kessler & et al, 2002), and Disgust Sensitivity Scale (Haidt et al, 1994). MANCOVA and ANCOVAs using SPSS 26 software revealed that the ACT enriched with compassion face-to-face method had a greater effect on all variables except for disgust sensitivity (p>0/01) compared to the online. On the basis of results. although the face-to-face method showed more effectiveness in this research, but in situations where face-to-face treatment is not possible, using the online method can be a relative replacement instead of not having access to treatment
Asadnia S, Alilou M, M., Bayrami M., Bakhshipour Roodsari A. (2021). Investigating Structural Relationships of temperament Dimensions with Obsessive Compulsive Disorder: Mediated by Disgust Sensitivity, Research in Cognitive and Behavioral Sciences, 11 (1), 20, 144-125.
Asadollahi F., Neshat Doost H, T., Abedi, M. R., Afshar, H. (2020). Comparing the effect of the combination of Acceptance and Commitment Therapy and Compassion Focused Therapy with Cognitive-Behavioral Analysis System of Psychotherapy on depressive symptoms, quality of life, psychological flexibility, and self-compassion in women with persistent depressive disorder, Clinical Psychology Studies, 10 (39), 19-46.
Georg H. Eifert, John P. Forsyth .(2005). Acceptance & Commitment Therapy for Anxiety Disorders: A Practitioner's Treatment Guide to Using Mindfulness, Acceptance, and Values-based Behavior Change Strategies. translate by feizi A., KHajeh pour M. & Bahrami S. (2017). Ebn sina, Tehran.
Hekmati, E., Bakhshipour, A. (2015). Philosophical theoretical foundations and the psychopathological model of acceptance and commitment therapy. Baztab Danesh, 64, 14-25.
Karsazi, H., Nasiri, M., Hashemi-Nosratabad, T. (2017). Factor Analysis and Evaluation of Internal Structure of Disgust Sensitivity Scale, Journal of Clinical Psychology, 8, 4 (32).
Rajezi Esfahani, Motaghipour S, Kamkari K, Zahiredin A, Janbozorgi M. (2012). Reliability and Validity of the Persian Version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Iranian Journal of Psychiatry and Clinical Psychology, 17 (4), 297-303.
Shakernegad S, Moazen N, Hamidy M, Hashemi R, Bazzazzadeh N, Bodaghi M. (2017). Effectiveness of Acceptance and Commitment Therapy on Psychological Distress, Marital Satisfaction and Quality of Life in Women with Multiple Sclerosis, Journal of Health and Care, 19, 1, 7-17.
Tirch, D., Schoendorff, B., Silberstein L, R. (2014). The ACT Practitioner's Guide to the Science of Compassion: Tools for Fostering Psychological Flexibility. translate by Daneshmandi S, Izadi R., Abedi M, R. (2017), Esfahan, kavoshyar.
Zahiri, S., Dehghani, A., Izady, R .(2018). The Effectiveness of Acceptance and Commitment Therapy (ACT) Enriched with Compassion Focus Therapy (CFT)on Obsession Symptoms of Students with ObsessiveCompulsive Disorder, Psychological Studies, 13, 4, 94-104.
Yaghubi H. (2016). Psychometric Properties of the 10 Questions Version of the Kessler Psychological Distress Scale (K-10), Applied Psychological Research Quarterly, 6(4). 45-57.
Adams, T. G., Kelmendi, B., Brake, C. A., Gruner, P., Badour, C. L., & Pittenger, C. (2018). The role of stress in the pathogenesis and maintenance of obsessive compulsive disorder. Chronic Stress, 2. 1-11.
American Psychiatric Association.(2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5, Washington, D.C: American Psychiatric Publishing.
Amir, N., Foa, E. B., & Coles, M. E. (1997). Factor structure of the Yale-Brown Obsessive– Compulsive Scale. Psychological Assessment, 9, 312–316.
Badrasawi, M.M., Zidan, S.J. (2019). Binge eating symptoms prevalence and relationship with psychosocial factors among female undergraduate students at Palestine Polytechnic University: a crosssectional study. Journal of eating disorders, 7(1): 1-8.
Bation, R., Poulet, E., Haesebaert, F., Saoud, M., Brunelin, J. (2016). Transcranial direct current stimulation in treatment-resistant obsessive–compulsive disorder: An open-label pilot study, Progress in Neuro-Psychopharmacology and Biological Psychiatry. 65, 153-157.
Buhrman, M., Skoglund, A., Husell, J., Bergström, K., Gordh, T., Hursti, T., et al. (2013). Guided internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial. Behaviour research and therapy, 51(6), 307-15.
De Jong, P. J., van Overveld, M., & Peters, M. L. (2011). Sympathetic and parasympathetic responses to a core disgust video clip as a function of disgust propensity and disgust sensitivity. Biological psychology, 88(2-3), 174-179.
Den Ouden, L., Tiego, J., Lee, R. S., Albertella, L., Greenwood, L. M., Fontenelle, L., ... & Segrave, R. (2020). The role of experiential avoidance in transdiagnostic compulsive behavior: A structural model analysis. Addictive Behaviors, 108.
Didonna, F. (2009). Mindfulness and obsessivecompulsive disorder: developing a way to trust and validate one’s internal experience. In: Didonna F (ed) Clinical handbook of mindfulness. Springer, New York,189–219.
Drapeau, A., Marchand, A., Beaulieu-Prevost, D. (2012). Epidemiology of Psychological Distress. InTech. In book: Mental Illnesses - Understanding, Prediction and Control. Chapter 5. Edited by L'Abate L.
Fergus, T.A. Bardeen, J.R. (2014). Emotion regulation and obsessive compulsive symptoms: A further examination of associations. Journal of Obsessive compulsive and Related Disorders, 3, 243-248.
Flujas-Contreras, J. M., García-Palacios, A., Castilla, D., & Gómez, I. (2023). Internetbased versus face-to-face Acceptance and Commitment Therapy for parental psychological flexibility. Current Psychology, 1-13.
Gilbert P, Catarino F, Duarte C, Matos M, Kolts R, Stubbs J, et al. The development of compassionate engagement and action scales for self and others. Journal of Compassionate Health Care. 2017;4(1):4.
Gilbert, P. (2005). Compassion: Conceptualisations, Research and Use in Psychotherapy, Routledge.
Gilbert, P. (2009). Introducing compassionfocused therapy. Advances in Psychiatric Treatment, 15(3), 199–208.
Gilbert, P. (2010). Compassion focused therapy: Distinctive features. New York, NY: Routledge.
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53: 6–41.
Gilbert, P., McEwan, K., Catarino, F., & Baião, R. (2014). "Fears of compassion in a depressed population", Journal of Depression and Anxiety, 2, 1- 8.
Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C., Delgado, P., Heninger, G.R., et al. (1989). The Yale-Brown Obsessive Compulsive Scale Validity. Archives of General Psychiatry, 46(11), 1012-1016.
Haidt, J., McCauley, C., Rozin, P. (1994). Individual differences in sensitivity to disgust: a scale sampling seven domains of disgust elicitors. Personality and Individual Differences, 16: 701-13.
Hayes, S.C, Barnes-Holmes, D., Roche, B. (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. New York: Kluwer Academic/Plenum publishers.
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2011). Acceptance and Commitment Therapy, Second Edition: The Process and Practice of Mindful Change. New York: Guilford Publications.
Hayes, S.C., Pistorello, J., & Levin, M. E. (2012). Acceptance and Commitment Therapy as a Unified Model of Behavior Change. The Counseling Psychologist, 40(7), 976- 1002.
Hezel, D.M., Stewart, E., Riemann, B.C., & McNally, R. J. (2019). Clarifying the thought-action fusion bias in obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 20, 75-84.
Hill, M.L., Schaefer, L.W., Spencer, S.D., Masuda, A. (2020). Compassion-focused acceptance and commitment therapy for women with restrictive eating and problematic body-checking: A multiple baseline across participants. Journal of Contextual Behavioral Science, 16, 144-152.
Hoffmann, D., Rask, C.U., Hedman-Lagerlöf, E., Jensen, J.S., Frostholm L. (2020). Efficacy of internet-delivered acceptance and commitment therapy for severe health anxiety: results from a randomized, controlled trial, Psychological Medicine, 51(15):2685-2695.
Hudson, M.P., Thompson, A.R., Emerson, L.M .(2019). Compassion-focused self-help for psychological distress associated with skin conditions: a randomized feasibility trial. Psychology & Health, 35(9), 1095-1114.
Husted, D., Shapira, N., Goodman, W. (2006). The neurocircuitry of obsessive– compulsive disorder and disgust. Prog Neuropsychopharmacol Biol Psychiatry. 30, 389–399.
Iglesias, J. (2015). The Use of Cognitive Interventions in Reducing the Effects of Ego-Depletion. The BYU Undergraduate Journal in Psychology, 11(2).
J.S. Abramowitz, Blakey S M , Reuman L , Buchholz J L .(2018). New directions in the cognitive-behavioral treatment of OCD: Theory, research, and practice. Behavior Therapy. 49(3):311-322.
Hoefnagelsو J.W., Fischer, K., Bos, R.A.T., Driessens M.H.E., Meijer, S.L.A., Schutgens, R.E.G., Schrijvers. L., H. (2020). A feasibility study on two tailored interventions to improve adherence in adults with haemophilia, Pilot and Feasibility Studies, 6 (1), 1-11.
Elander J , Stalker C , Arborg M, Coyne E , Kapadi R, Taal M W, M. Selby N , Mitchell K. (2023). Living well on haemodialysis: Feasibility and acceptability trial of an online Acceptance and Commitment Therapy (ACT) programme for people receiving kidney haemodialysis, Journal of Contextual Behavioral Science, 30, Pages 41-49.
Kapel. L. K., ona, p. z., Moller, C., & Twohig, M.P. (2023). An Open Trial of Acceptance and Commitment Therapy With Exposure and Response Prevention in an Intensive Outpatient Setting for Adults With OCD. Cognitive and Behavioral Practice, 30(2), 218-228.
Kawa, M. H., & Shafi, H. (2015). Evaluation of Internet Addiction, Impulsivity and Psychological Distress among University Students. International Journal Clinical Therapy Diagnostige, 3(1), 70-76.
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959-976.
Kohlenberg, R. J., & Tsai, M. (1994). Functional analytic psychotherapy: A radical behavioral approach to treatment and integration. Journal of Psychotherapy Integration, 4(3), 175–201.
Knowles, K, A., Viar-Paxton, M A., Riemann, B C., Jacobi, D M., B, O. Olatunji. (2016). Is disgust proneness sensitive to treatment for OCD among youth? Examination of diagnostic specificity and symptom correlates. Journal of Anxiety Disorders, 44, 47-54.
Knowles, K. A., Jessup, S. C., & Olatunji, B. O. (2018). Disgust in anxiety and obsessivecompulsive disorders: recent findings and future directions. Current psychiatry reports, 20(9), 1-10.
Krieger, T., Martig, D. S., van den Brink, E., & Berger, T. (2016). Working on self-compassion online: A proof of concept and feasibility study. Internet Interventions, 6, 64–70.
Krieger, T., Reber, F., von Glutz, B., Urech , A., Moser, C.T., Schulz, A., Berger, T. (2019). An Internet-Based Compassion-Focused Intervention for Increased Self-Criticism: A Randomized Controlled Trial, Behavior therapy, 50(2), 430-445.
Lee Sang. W., Choi, M., Lee Jae. S. (2023). A randomized controlled trial of group-based acceptance and commitment therapy for obsessive-compulsive disorder, Journal of Contextual Behavioral Science, 27, 45-53.
Leeuwerik, T., Cavanagh, K., & Strauss, C. (2020). The Association of Trait mindfulness and self compassion with obsessive compulsive disorder symptoms: Results from a large survey with treatment seeking adults. Journal of Cognitive Therapy and Research, 44(1), 120-135.
Luo C., Sanger N., Singhal N., Pattrick K., Shams I., Shahid H., & Samaan Z. (2020). A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis. EClinical Medicine, 24, 100442.
Marcks, B.A., & Woods, D.W. (2007). Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: An analog to obsessive– compulsive disorder. Behaviour Research and Therapy, 45, 2640–2651.
Mattoff, M. (2018). Circumstances to integrate acceptance and commitment therapy with short-term psychodynamic psychotherapies. Cogent Psychology, 5 (1) ,1- 24.
Mojaradi, A., Yamini, M., Mafakheri, A. (2022). Comparing the effectiveness of online acceptance and commitment therapy and behavioral activation therapy on repetitive negative thinking in obsessive patients. Journal of Fundamentals of Mental Health, 24 (3), 161-168.
Neff, K. (2003). Self-compassion: Analternative conceptualization of a healthy attitude towards oneself. Self and Identity, 2, 85–102.
Neff, K. D., & McGehee, P. (2010). Selfcompassion and psychological resilience among adolescents and young adults. Self and Identity, 9(3), 225-240.
Olatunji, B O., and McKay, D. (2007). Disgust and psychiatric illness: Have we remembered?, The British Journal of Psychiatry, 190, 457-459.
Olatunji, B. O., Berg, H., Cox, R. C., & Billingsley, A. (2017). The effects of cognitive reappraisal on conditioned disgust in contamination-based OCD: An analogue study. Journal of anxiety disorders, 51, 86- 93.
Olatunji, B. O., Cisler, J., McKay, D., & Phillips, M. L. (2010). Is disgust associated with psychopathology? Emerging research in the anxiety disorders. Psychiatry research, 175(1-2), 1-10.
Ong, C. W., Krafft, J., Panoussi, F., Petersen, J. M., Levin, M. E., & Twohig, M. P. (2021). In-person and online-delivered acceptance and commitment therapy for hoarding disorder: A multiple baseline study. Journal of Contextual Behavioral Science. 20, 108-117.
Ong, C.W., Barney, J.L., Barrett, T.S., Lee E.B., Levin, M.E., & Twohig, M.P. (2019). The role of psychological inflexibility and self-compassion in acceptance and commitment therapy for clinical perfectionism. Journal of Contextual Behavioral Science, 13, 7-16.
Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40,156–169.
Carlbring, P., Andersson, G. , Cuijpers, P., Riper, H.., Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis, Cogn Behav Ther ;47.
Petrocchi, N., Cosentino, T., Pellegrini, V., Femia, G., D’Innocenzo, A., Mancini, F. (2021). Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design, Frontiersin Psychology, 11.
Prudenzi, A., Graham, C. D., Flaxman, P.E., Wilding, S., Day, F., O’Connor, D. B. (2022). A workplace Acceptance and Commitment Therapy (ACT) intervention for improving healthcare staff psychological distress: A randomised controlled trial. PLoS ONE, 17(4).
Räsänen, P., Muotka, J., Lappalainen, R. (2020). Examining mediators of change in wellbeing, stress, and depression in a blended, Internet-based, ACT intervention for university students, Internet Interventions. 22, 100343.
Rozin, P., Millman, L., Nemeroff, C.(1986). Operation of the laws of sympathetic magic in disgust and other domains. J. Pers. Soc. Psychol. 50 (4), 703.
Sherlock, J.M., Zietsch, B.P., Tybur, J.M., Jern, P., 2016. The quantitative genetics of disgust sensitivity. Emotion 16, 43–51.
Stevenson, R.J., Oaten, M.J., Case, T.I., Repacholi, Wagland, P., 2010. Children's response to adult disgust elicitors: development and acquisition. Dev. Psychol. 46, 165–177.
Skinta, M.D., Lezama, M., Wells, G., Dilley, J. (2015). Acceptance and compassion-based group therapy to reduce HIV stigma. Cognitive and Behavioral Practice, 22, (4) 481-490.
Spendelow, J. S., & Joubert, H. E. (2018). Does experiential avoidance mediate the relationship between gender role conflict and psychological distress? American Journal of Men's Health, 12(4), 688-695.
Trindade, I.A., Ferreira, C., Pinto-Gouveia, J. (2020). Acceptability and preliminary test of efficacy of the mind programme in women with breast cancer: an acceptance, mindfulness, and compassion-based intervention. Journal of Contextual Behavioral Science,15, 162-171.
Twohig, M. P., Hayes, S.C., Plumb, H. C., Pruitt, L. D., Collins, A. B., Hazlett, & Woidneck, M. R. (2010). Arandomized clinical trial of Acceptance and Commitment Therapy vs. Progressive Relaxation Training for obsessive compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705-716.
Villardefrancos, E ., Otero-López J. M. (2016). Prevalence, sociodemographic factors, psychological distress, and coping strategies related to compulsive buying: a cross sectional study in Galicia, Spain. Comprehensive Psychiatry, 65, 128-135.
Watkins, P.L., Clum, G.A. (2007). Handbook of selfhelp therapie, Routledge.
Weingarden, H., & Renshaw, K. D. (2015). Shame in the obsessive compulsive related disorders: A conceptual review. Journal of Afective Disorders, 171, 74–84.