مقایسه تأثیر درمان شناختی-رفتاری با درمان روانی-اجتماعی بر پاسخ های نشخواری و نگرشهای ناکارآمد مبتلایان به افسردگی مزمن

نوع مقاله : پژوهشی

نویسندگان

دانشگاه اصفهان

چکیده

هدف: هدف از این پژوهش مقایسه تأثیر درمان شناختی -رفتاری با درمان روانی-اجتماعی بر پاسخ های نشخواری و نگرشهای ناکارآمد مبتلایان به افسردگی مزمن بود.
روش: روش پژوهش از نوع نیمه آزمایشی و طرح پیش آزمون- پس آزمون همراه با دوگروه آزمایش، بود. جامعه آماری پژوهش تمامی بیماران مبتلاء به افسردگی مزمن بودند که به شیوه نمونه گیری هدفمند از میان مراجع کنندگان به مراکز مشاوره و یا مطب روانپزشکان شهر اصفهان تعداد 30 نفر انتخاب شد و سپس براساس تخصیص تصادفی افراد به دو گروه­ آزمایش با درمان روانی-اجتماعی و شناختی-رفتاری، (هرگرو15نفر) گمارده شدند. آزمودنی­ها به پرسشنامه­های نگرشهای ناکارآمد (DAS) و پاسخ های نشخواری(RRS) پاسخ دادند. داده­ها با استفاده از روش تحلیل آزمون واریانس با اندازه گیری های مکرر مورد تحلیل قرار گرفتند.
یافته ها: نتایج نشان میدهند؛ میزان نشخوار فکری و نگرش های ناکارآمد با هر دو درمان کاهش یافته است. اما بین دو درمان در میزان نشخوار فکری تفاوت معنی داری وجود داشته و  اثربخشی  درمان روانی-اجتماعی به نسبت درمان شناختی-رفتاری بیشتر بوده است. اما بین دو درمان در نگرش های ناکارآمد تفاوت معنی داری وجود نداشته است. همچنین اثربخشی درمان روانی-اجتماعی در مردان در مقایسه با زنان بیشتر بوده است.

کلیدواژه‌ها


Akdemir A, Örsel S, Dağ İ, Türkçapar H, İşcan N, Özbay H.( 1996). Hamilton dep-resyon derecelendirme ölçeğinin geçerliliği, güvenilirliği ve klinikte kullanımı.Psikiyatri Psikoloji Psikofarmakoloji Dergisi; 4:251-259.
Akiskal, H.S., Hirschfeld, R.M.A. & Yerevanian, B.I. (1983). The relationship of personality to affective disorders: a critical review. Archives of General Psychiatry,40, 801–810.
American Psychiatric Association. (2013). Diagnostic and statistical manual for mental disorders (5th ed.). Washington, DC: Author.
Beck A, Rush A, Shaw B, Emery G. (1979). Cognitive Therapy for Depression. New York: Guilford Press.
Beck A. T, Steer R.A, Brown G. K.( 1996). Beck Depression Inventory –2nd edition manual. San Antonio: The Psychological Corporation.
Beck AT, Brown G, Steer RA, Weissman AN.( 1991). Factor analysis of the Dysfunctional Attitude Scale in a clinical population.Psychological Assessment. 3(3):478–83.
Beck, A. T. (1988). Anxiety and depression: An information processing perspective. Anxiety Research, 1, 23­36.
Beck, A.T; Freeman, A.M; Davis, D. D. (2003). Cognitive therapy of personality disorder.Second edition.Newyork; Guilford press: 92-115.
Brockmeyer, T., Kulessa, D., Hautzinger, M., Bents, H., Backenstrass, M.(2015). Differentiating early-onset chronic depression from episodic depression in terms of cognitive-behavioral and emotional avoidance. Affect;175,418–423.
Clark, D. A., & Beck, A. T. (2010). Cognitive Theory and Therapy of Anxiety and Depression: Convergence with Neurobiological Findings. Trends in Cognitive Science, 14, 418-424.
Cuijpers, P., van Straten, A., Schuurmans, J., van Oppen, P., Hollon, S. D., &Andersson, G. (2010). Psychotherapy for chronic major depression and dysthymia:a meta-analysis. Clinical Psychology Review, 30(1), 51-62.
Davis, R. N., & Nolen-Hoeksema, S. (2000). Cognitive inflexibility among ruminators and nonrumiators. Cognitive Therapy and Research, 24, 699-711.
De Jong R, Treiber R, Henrich G.( 1986). Effectiveness of two psychological treatments for inpatients with severe and chronic depressions. Cog Ther Res 10:645–663.
DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., John P. O'Reardon, Margaret L. Lovett, Madeline M. Gladis, Laurel L. Brown, Robert Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62(4), 409-41.
Dimidjian, S., Hoollon, S.D., Dobson, K. s., Schmaling, K.B.,Kohlenberg, R.J., Addis, M.e., al. (2006). Randomized trial of behavioral activation, cognitive therapy and antidepressant medication I the acute treatment of adults with majordepression. Journal of consulting and clinical psychology, 74(4),658- 670.
Dowd, E. T. (2004). Depression: theory, assessment and new direction in practice. International Journal of Clinical and Health Psychology, 4(2), 413-423.
Dunner DL, Schmaling KB, Hendrickson H, Becker J, Lehman A, Bea C .(1996).Cognitive therapy versus fluoxetine in the treatment of dysthymic disorder.Depression 4:34–41.
Ebrahimi A, Mosavi. S. GH.(2013). Psychometric Properties of The Dysfunctional Attitude Scale-26 DAS-26) in Patients with Mood Disorders. Scientific Journal of Ilam University of Medical Sciences.21(5):20-28.
Fati, Laden (1991). Comparison of the efficacy of confrontation with the prevention of clomipramine response and the combination of these two methods in the treatment of the obsessive-compulsive disorder. Master's thesis for clinical psychology. Tehran Psychiatric Institute. (In Persian)
Fawzy, T. I.; Hecker, J. E. and Clark, J. (2006); The relationship between cognitive avoidance and attentional bias forsnake-related thoughts. J Anxi diso; 20: 1103-1117.
First, Mb., Gibbon M, Spitzer RL, Williams, JBW, Benjamin LS. (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders, (SCID-II). Washington, D.C.: American Psychiatric Press, Inc.
Gharaee, B. (1993) A Study of Some Cognitive Patterns in Patients with Comorbidity of Anxiety and Depression. The thesis of Master of Science (MSc), Iran University of Medical Sciences (In Persian).
Gilmer WS, Trivedi MH, Rush AJ, Wisniewski SR, Luther J, Howland RH,(2005). Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand.112(6):425-33.
Gonzales L, Lewinsohn P, Clarke G.( 1985). Longitudinal follow-up of unipolar depressives: An investigation of predictors of relapse. J Consult Clin Psychol 53:461–469.
Grant, J.E. Steinberg, M.A. Kim, S.W. Rounsaville, B.J. Potenza M.N. (2004).Preliminary validity and reliability testing of a structured clinical interview for pathological gambling.Psychiatry Research, 128 (1) : 79-88.
Hamilton, M. (1960). A rating scale for Depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.
Harpin RE, Liberman RP, Marks I, Stern R, Bohannon WE.( 1982). Cognitive-behavior therapy for chronically depressed patients: a controlled pilot study. J Nerv Men Dis 170:295–301.
Hellerstein, D. Erickson, G. Stewart, J.W. McGrath, P.J. Hunnicutt-Ferguson K., Reynolds, S.K. O’Shea, S. Chen, Y. Withers, A. Wang.Y.(2015). Behavioral activation therapy for return to work in medication-responsive chronic depression with persistent psychosocial dysfunction. Comprehensive Psychiatry, 57, 140-147
Kërqeli A, Kelpi M, Tsigilis N.( 2013). Dysfunctional attitudes and their effect on depression. Procedia - Social & Behavioral Sciences, 84:196–204.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E..(2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry,62(6), 593-602.
Klein, D. N., Shankman, S. A., & Rose, S.. (2006). Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression.The American Journal of Psychiatry, 163(5), 872-880.
Klein, J.F. Becker, B. Hurlemann, R. Scheibe, C. Colla, M. Heuser.I.(2014). Effect of specific psychotherapy for chronic depression on Neural Responses to emotional faces. Journal of Affective Disorders, 166, 93-97.
Kumari, N., and Blackburn, I. M. (2002). How specific are negative automatic thoughts to a depressed population? An exploratory study. British Journal of Medical Psychology, 65(2), 167-176.
Leahy, R. L. (2003). Cognitive therapy techniques: A practitioner's guide. New York: Guilford Press.
Lotfi Kashni, F. (2008). The effect of group counseling with regard to cognitive., 2(8), 67-78. (In Persian)
Malogiannis, I.A.; Arntz, A.; Spyropoulou, A.; Tsartsara, E.; Aggeli, A.; Karveli, S.; Vlavianou, M.; Pehlivanidis, A.; Papadimitriou, G.N.; Zervas, I.(2014). Schema therapy for patients with chronic depression: A single case series study. Journal of Behavior Therapy and Experimental Psychiatry. 45(3), 319-29.
McCullough JP.(2000). Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy. New York: Guilford Press.
Mercier M, Stewart J, Quitkin J.( 1992).A pilot sequential study of cognitive therapy and pharmacotherapy of atypical depression. J Clin Psychiatry 53:166–among ruminators
Michael B. First, M.D., Janet B. W. Williams, Ph.D., Rhonda S. Karg, Ph.D., and Robert L. Spitzer, M.D.(2016). Structured Clinical Interview for DSM-5®Disorders-Clinician Version (SCID-5-CV). American Psychiatric Association
Miranda, J., Gross, J. J. Persons J. B. & Hahn, J. (2003). Mood matters: Negative mood induction activates dysfunctional attitudes in women vulnerable to depression cognitive. Therapy and Research, 22, 363-376.
Molavi, Hossein. (2007). SPSS10-13-14 Practical Guide to Behavioral Sciences. Isfahan: Pouyesh Andisheh.
Moore, R.& Garland, A.(2003). cognitive therapy for chronic and persistent depression. Wiley Editorial.
Morris, BH.(2005). Does emotion predict the course of major depressive disorder? A review of prospective studies. Br. J. Clin. Psychol.48:255–273.
Mufson, L., Moreau, D. & Weissman, M. (1994). Modification of interpersonal psychotherapy with depressed adolescence (IPT-A): phase I and phase II studies. Journal of the American Academy of Child and Adolescent Psychiatry, 33:695-705.
Nolen-Hoeksema S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol 109:504–511.
Nolen-Hoeksema, S. & Jackson, S. (2001). Mediators of the gender difference in rumination. Psychology of Women Quarterly, 25, 37–47
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569- 582.
Nolen-Hoeksema, S., & Morrow, J. (1991). Effects of rumination and distraction on naturally occurring depressed mood. Cognition and Emotion, 7, 561-570.
Nolenn-Hoeksema, S., Parker, L. E., & Larsen, J. (1994). Ruminative coping with depressed mood following loss. Journal of Personality and Social Psychology, 64,92-104.
Oliver, J., M. Klocek, J. & Wells, A. (2003). Depressed and anxious moods mediate relations among perceived socialization, self–focused attention, and dysfunctional attitudes. Journal of Clinical Psychology, 51, 726-739.
Papageorgiou, C., & Wells, A. (2001). Positive beliefs about depressive rumination: Development and preliminary validation of a self-report scale. Behavior Therapy, 32, 13-26.
Roberts‚ J. E.‚ Gilboa‚ E.‚ & Gotlib‚ I. H. (1998). Ruminative response style and vulnerability to episodes of dysphoria: Gender‚ neuroticism‚ and episode duration. Cognitive Therapy and Research ‚ 22‚401-423.
Roelofs, J., Huibers, M., Peeters, F., Arntz, A., & van Os, J. (2008). Rumination and worrying as possible mediators in the relation between neuroticism and symptoms of depression and anxiety in clinically depressed individuals.Behaviour Research and Therapy, 26., 1283–1289.
Samsam Shariat SMR, Neshat Doost HT, Kalantari M, Oreyzi Samani SHR.(2017). Treatment based on the native model of psycho-social vulnerability to chronic depression. Journal of Cultural psychology. Iran. 1(1):52-84. (In Persian).
Samsam Shariat SMR, Neshat Doost HT, Kalantari M, Oreyzi Samani SHR.(2017). Applied Indicators in Treatment Approaches to Chronic Depressive Disorders. International Journal of Behavioral Sciences. 15(3):386-396 (In Persian).
Samsam Shariat SMR, Neshat Doost HT, Kalantari M, Oreyzi Samani SHR.(2017). Formulating the psychosocial vulnerability model of chronic depression: The grounded theory. Knowledge & Research in Applied Psychology. 18(1) 67: 83-99. (In Persian).
Sharifi, V., Assadi, S. M., Mohammadi, M. R., Amini, H., Kaviani, H., Semnani, Y., Shabani, A., Shahrivar, Z., Davari-Ashtiani, R. Hakim-Shooshtari, M., Seddigh, A., & Jalali, M. (2009). A Persian translation of the structured clinical interview for diagnostic and statistical manual of mental disorders, fourth edition: Psychometric properties. Comprehensive Psychiatry,50, 86-91 (In Persian).
Smit, F., Cuijpers, P., Oostenbrink, J., Batelaan, N., de Graaf, R., & Beekman, A.. (2006).Costs of nine common mental disorders: implications for curative and preventive psychiatry. The Journal of Mental Health Policy and Economics, 9(4), 193-200.
Swan, J.S. Vicar, R.M. Christmas, D. Durham, R. Rauchhaus, P. McCullough JrJ.P., Matthews. K. (2014). Cognitive Behavioural Analysis System of Psychotherapy (CBASP) for chronic depression: Clinical characteristics and six-month clinical outcomes in an open case series. Journal of Affective Disorders, (152,154), 268-276.
Taubner.S. (2013). Working with Unconscious and Explicit Memories in Psychodynamic Psychotherapy in Patients with Chronic Depression. Hurting Memories and Beneficial Forgetting: 153-163.
Thase ME, Reynolds CF, Frank E, Simons AD, Garamoni GD, McGeary J, Harden T, Fasiczka AL, Cahalane JF. ( 1994). Response to cognitive-behavioral therapy in chronic depression. J Psychother Pract Res 3:204–214.
Torpey, D. C., & Klein, D. N. (2008). Chronic depression: update on classification and treatment.Current Psychiatry Reports, 10(6), 458-464.
Wenzlaff RM, Wegner DM. (2000). Thought suppression. Annu. Rev. Psychol. 51:59–91
Williams, A. D., & Moulds, M. L. (2007). Cognitive avoidance of intrusive memories: recall vantage perspective and associations with depression. Behavior Research and Therapy, 45, 1141-1153.
Yang, C.; Klasko, J.; Vyshar, d(2007).SchemaTherapy. Translation of Hmy dp vrand Z. Andrews .Tehran Venerable.
You, S., Merrit, R. D., & Conner, K. R. (2009). Do gender differences in the role of dysfunctional attitudes in depressive symptoms depend on depression history? Journal of Personality and individual differences, 46, 218-223.
CAPTCHA Image