تأثیر درمان یکپارچه فراتشخیصی بر افکار اضطرابی و انعطاف‌پذیری شناختی در نوجوانان با نشانه‌های سندروم روده تحریک‌پذیر

مقالات آماده انتشار

نوع مقاله : مقاله پژوهشی

نویسندگان

سمانه صادقی هفشجانی ¹

بهمن کرد تمینی ²

زهرا نیک منش ²

فرهاد کهرازئی ²

¹ کارشناسی ارشد، گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه سیستان و بلوچستان،‌ زاهدان، ایران

² دانشیار، گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه سیستان و بلوچستان،‌ زاهدان، ایران

10.22067/tpccp.2026.95640.1868

چکیده

هدف: پژوهش حاضر با هدف بررسی تأثیر درمان یکپارچه فراتشخیصی بر افکار اضطرابی و انعطاف‌پذیری شناختی در نوجوانان دختر با نشانه‌های سندروم روده تحریک‌پذیر انجام شد.
روش: این پژوهش با روش شبه‌آزمایشی و در قالب طرح پیش‌آزمون-پس‌آزمون همراه با گروه کنترل انجام شد. جامعه آماری پژوهش را تمامی نوجوانان دختر مبتلا به نشانه‌های سندروم روده تحریک‌پذیر در مدارس دولتی مقطع متوسطه دوم شهر زاهدان طی سال تحصیلی ۱۴۰۳-۱۴۰۲ تشکیل دادند. از میان آنان، تعداد ۳۲ نفر با استفاده از شاخص علائم سندروم روده تحریک‌پذیر و سیستم نمره‌گذاری شدت سندروم روده تحریک‌پذیر به‌صورت تصادفی چندمرحله‌ای انتخاب و سپس از طریق همتاسازی در دو گروه آزمایش و کنترل جایگزین شدند. گروه آزمایش طی چهارده جلسه هفتگی، هر جلسه به مدت نود دقیقه، تحت درمان گروهی یکپارچه فراتشخیصی قرار گرفت. ابزار گردآوری داده‌ها شامل پرسشنامه افکار اضطرابی ولز و مقیاس انعطاف‌پذیری شناختی دنیس و وندروال بود. داده‌ها با بهره‌گیری از تحلیل کوواریانس چندمتغیره مورد تحلیل قرار گرفتند.
یافته­‌ها: یافته‌ها نشان داد که درمان یکپارچه فراتشخیصی موجب کاهش افکار اضطرابی و ارتقای انعطاف‌پذیری شناختی گردید (001/<0 p).
نتیجه‌گیری: بنابراین، درمانگران حوزه سلامت روان می‌توانند از پروتکل یکپارچه فراتشخیصی به‌عنوان رویکردی اثربخش برای کاهش افکار اضطرابی و تقویت انعطاف‌پذیری شناختی نوجوانان استفاده کنند.

کلیدواژه‌ها

افکار اضطرابی

انعطاف‌پذیری شناختی

درمان فراتشخیصی

سندروم روده تحریک‌پذیر

موضوعات

• مداخلات روان شناسی شناختی

---

مراجع

Abdelaziz, H. A., Ellakany, W. I., Ellakany, A., Dean, Y. E., Rouzan, S. S., Bamousa, B. A. A., Shebl, M. A., Elawady, S. S., Verma, S., Gir, D., Sbitli, T., Zaki, I., Motwani, L., Eweis, R., Iqbal, N., Shah, J., & Aiash, H. (2023). The relationship between anxiety and irritable bowel syndrome symptoms among females: A cross-sectional study in Egypt. Medicine (Baltimore), 102(32), e34777. https://doi.org/10.1097/md.0000000000034777

Almario, C. V., Sharabi, E., Chey, W. D., Lauzon, M., Higgins, C. S., & Spiegel, B. M. R. (2023). Prevalence and Burden of Illness of Rome IV Irritable Bowel Syndrome in the United States: Results From a Nationwide Cross-Sectional Study. Gastroenterology, 165(6), 1475-1487. https://doi.org/10.1053/j.gastro.2023.08.010

American Gastroenterological Association medical position statement: irritable bowel syndrome. (1997). Gastroenterology, 112(6), 2118-2119. https://doi.org/10.1053/gast.1997.1122118

Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410-422. https://doi.org/10.1038/nrn2648

Asadollahi, F., Neshatdoost, H., Kalantary, M., Mehrabi, H., Afshar, H., & Daghaghzadeh, H. (2014). Effectiveness of spiritual therapy on somatic symptoms in female patients with irritable bowel syndrome. Journal of Research in Behavioral Sciences, 12(3). (Text in Persian)

Canas, J. J., Fajardo, I., & Salmeron, L. (2006). Cognitive flexibility. International encyclopedia of ergonomics and human factors, 1(3), 297-301. https://doi.org/10.13140/2.1.4439.6326

Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: a clinical review. Jama, 313(9), 949-958. https://doi.org/10.1001/jama.2015.0954

Deffenbacher, J. L. (1980). Worry and Emotionality in Test Anxiety. In I. G. Sarason (Ed.), Test Anxiety: Theory, Research, and Applications (pp. 111–128). Lawrence Erlbaum Associates.

Delavar A. The Theoretical and Practical Foundations of Research in Human and Social Sciences, second ed. Tehran: Roshd Publication: 2009. (Text in Persian)

Dennis, J. P., & Vander Wal, J. S. (2010). The Cognitive Flexibility Inventory: Instrument Development and Estimates of Reliability and Validity. Cognitive therapy and research, 34(3), 241-253. https://doi.org/10.1007/s10608-009-9276-4

Drossman, D. A. (2016). Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. https://doi.org/10.1053/j.gastro.2016.02.032

Ebrahimi Daryani, N., Shirzad, S., & Taher, M. . (2011). An overview on irritable bowel syndrome and new treatment. Journal of Medical Council of I.R.I, 29(1), 49-68. (Text in Persian)

Ehrenreich-May, J., Kennedy, M. S., Sherman, A. J., Bilek, L. E., Buzzella, A. B., Bennett, M. S., & Barlow, H. D. (2017). Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (F. Zarghami, M. Akbari, & F. Sorouri, Trans.). Arjmand Publications.

Fata, L. L., Mootabi, F., Moloodi, R., & Ziayee, K. (2010). Psychometric Properties of Persian Version of Thought Control Questionnaire and Anxious Thought Inventory in Iranian Students. Journal of Psychological Models and Methods, 1(1), 81. https://www.magiran.com/paper/827182 (Text in Persian)

Francis, C. Y., Morris, J., & Whorwell, P. J. (1997). The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Alimentary Pharmacology & Therapeutics, 11(2), 395-402. https://doi.org/10.1046/j.1365-2036.1997.142318000.x

Gholamrezaei, A., Zolfaghari, B., Farajzadegan, Z., Nemati, K., Daghaghzadeh, H., Tavakkoli, H., & Emami, M. H. (2011). Linguistic validation of the Irritable Bowel Syndrome-Quality of Life Questionnaire for Iranian patients. Acta Med Iran, 49(6), 390-395.

Giannotta, F., Nilsson, K. W., Åslund, C., & Larm, P. (2022). Among the swedish generation of adolescents who experience an increased trend of psychosomatic symptoms. Do they develop depression and/or anxiety disorders as they grow older? BMC Psychiatry, 22(1), 779. https://doi.org/10.1186/s12888-022-04432-x

Holakouee, A., Ghasemzadeh, S., & Arjmandnia, A. A. (2022). The Effectiveness of unified protocol of trans-diagnostic treatment on Adolescent Anxiety and maternal parenting methods [Research]. Razi Journal of Medical Sciences, 29(4), 150-159. http://rjms.iums.ac.ir/article-1-7465-fa.html (Text in Persian)

Hreinsson, J. P., Törnblom, H., Tack, J., Drossman, D. A., Whitehead, W. E., Bangdiwala, S. I., Sperber, A. D., Palsson, O. S., & Simrén, M. (2023). Factor Analysis of the Rome IV Criteria for Major Disorders of Gut-Brain Interaction (DGBI) Globally and Across Geographical, Sex, and Age Groups. Gastroenterology, 164(7), 1211-1222. https://doi.org/10.1053/j.gastro.2023.02.033

Hu, Z., Li, M., Yao, L., Wang, Y., Wang, E., Yuan, J., Wang, F., Yang, K., Bian, Z., & Zhong, L. L. D. (2021). The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis. BMC Gastroenterology, 21(1), 23. https://doi.org/10.1186/s12876-020-01593-5

Ionescu, T. (2012). Exploring the nature of cognitive flexibility. New Ideas in Psychology, 30(2), 190-200. https://doi.org/10.1016/j.newideapsych.2011.11.001

Koerner, N., & Dugas, M. J. (2006). A Cognitive Model of Generalized Anxiety Disorder: the Role of Intolerance of Uncertainty. In Worry and its Psychological Disorders (pp. 201-216). https://doi.org/10.1002/9780470713143.ch12

Lackner, J. M., Gudleski, G. D., Radziwon, C. D., Krasner, S. S., Firth, R. S., Naliboff, B. D., Vargovich, A. M., Borden, A. B., & Mayer, E. A. (2022). Cognitive flexibility improves in cognitive behavioral therapy for irritable bowel syndrome but not nonspecific education/support. Behaviour Research and Therapy, 154, 104033. https://doi.org/10.1016/j.brat.2022.104033

Lackner, J. M., Jaccard, J., Keefer, L., Brenner, D. M., Firth, R. S., Gudleski, G. D., Hamilton, F. A., Katz, L. A., Krasner, S. S., Ma, C. X., Radziwon, C. D., & Sitrin, M. D. (2018). Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome. Gastroenterology, 155(1), 47-57. https://doi.org/10.1053/j.gastro.2018.03.063

Martin, M. M., & Rubin, R. B. (1995). A new measure of cognitive flexibility. Psychological reports, 76(2), 623-626. https://doi.org/10.2466/pr0.1995.76.2.623

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. Journal of Evidence-Based Complementary & Alternative Medicine, 17(1), 66-71. https://doi.org/10.1177/2156587211423400

Mohsenabadi, H., Zanjani, Z., Shabani, M. J., & Arj, A. (2018). A randomized clinical trial of the Unified Protocol for Transdiagnostic treatment of emotional and gastrointestinal symptoms in patients with irritable bowel syndrome: evaluating efficacy and mechanism of change. Journal of Psychosomatic Research, 113, 8-15. https://doi.org/10.1016/j.jpsychores.2018.07.003 (Text in Persian)

Nasri, m., Ahadi, H., & Dortaj, F. (2017). The Effectiveness of Transdiagnostic Treatment on Cognitive Flexibility, Emotion Regulation and Hb Factor in Patients with Type 2 Diabetes. Psychological Achievements, 24(2), 81-100. https://doi.org/10.22055/psy.2018.20969.1741

Owyang, C. (2022). Irritable Bowel Syndrome. In J. Loscalzo, A. Fauci, D. Kasper, S. Hauser, D. Longo, & J. L. Jameson (Eds.), Harrison's Principles of Internal Medicine, 21e. McGraw-Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookid=3095&sectionid=265428379

Rahimi, F., Mashhadi, A., & Hosseinzadeh Maleki, Z. (2023). Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) on Emotional Regulation, Cognitive Flexibility, Mindful Emotional Awareness and Quality of Life in Breast Cancer: A Pilot Study [Original/Research Article]. Multidisciplinary Cancer Investigation, 7(2), 19-29. https://doi.org/10.30699/mci.7.4.392-2

Roudi, F., Khayyatzadeh, S. S., Ghazizadeh, H., Ferns, G. A., Bahrami-Taghanaki, H., Mohammad-Zadeh, M., & Ghayour-Mobarhan, M. (2021). The relationship between dietary intakes and prevalence of irritable bowel syndrome in adolescent girls: A cross-sectional study. Indian Journal of Gastroenterology, 40(2), 220-226. https://doi.org/10.1007/s12664-020-01126-8

Sadeghi Hafshejani, S., Nikmanesh, Z., Kord Tamini, B., & Kahrazei, F. (2025). The Effectiveness of the Unified Protocol for Transdiagnostic Treatment on Meta-Worry and Emotional Flexibility of Adolescent Girls with Symptoms of Irritable Bowel Syndrome. Journal of Psychological Studies, 21(3). https://doi.org/10.22051/psy.2025.50329.3114 (Text in Persian)

Sauer-Zavala, S., Rosellini, A. J., Bentley, K. H., Ametaj, A. A., Boswell, J. F., Cassiello-Robbins, C., Wilner Tirpak, J., Farchione, T. J., & Barlow, D. H. (2021). Skill Acquisition During Transdiagnostic Treatment With the Unified Protocol. Behavior Therapy, 52(6), 1325-1338. https://doi.org/10.1016/j.beth.2021.03.001

Schaeuffele, C., Bär, J., Buengener, I., Grafiadeli, R., Heuthaler, E., Strieder, J., Ziehn, P., Knaevelsrud, C., Renneberg, B., & Boettcher, J. (2022). Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol. Cognitive therapy and research, 46(2), 273-286. https://doi.org/10.1007/s10608-021-10272-y

Schniering, C., & Rapee, R. (2020). Evaluation of a transdiagnostic treatment for adolescents with comorbid anxiety and depression. Journal of Affective Disorders Reports, 2, 100026. https://doi.org/10.1016/j.jadr.2020.100026

Shahkaram, H., Yaztappeh, J. S., Sadeghi, A., Kianimoghadam, A. S., Soltanabadi, S., Bakhtiari, M., & Arani, A. M. (2024). Comparing the effectiveness of transdiagnostic treatment with acceptance and commitment therapy on emotional disorders, rumination, and life satisfaction in patients with irritable bowel syndrome: a randomized clinical trial. BMC Gastroenterology, 24(1), 66. https://doi.org/10.1186/s12876-024-03142-w

Sharafi, M., Jafari, D., & Bahrami, M. (2023). Comparison of the Effectiveness of Cognitive Behavioral Therapy and Unified Transdiagnostic Therapy on the Depression and Anxiety Symptoms of Adolescents with Generalized Anxiety Disorder [Research]. Journal of Research in Behavioural Sciences, 21(1), 138-150. https://doi.org/10.48305.21.1.138 (Text in Persian)

Shareh, H., Farmani, A., & Soltani, E. (2014). Investigating the Reliability and Validity of the Cognitive Flexibility Inventory (CFI-I) among Iranian University Students [Research]. Practice in Clinical Psychology, 2(1), 43-50. http://jpcp.uswr.ac.ir/article-1-163-en.html

Stout, D. M., Shackman, A. J., Johnson, J. S., & Larson, C. L. (2015). Worry is associated with impaired gating of threat from working memory. Emotion, 15(1), 6-11. https://doi.org/10.1037/emo0000015

Tatayeva, R., Ossadchaya, E., Sarkulova, S., Sembayeva, Z., & Koigeldinova, S. (2022). Psychosomatic Aspects of The Development of Comorbid Pathology: A Review [Review Article]. Medical Journal of the Islamic Republic Of Iran, 36(1), 1160-1168. https://doi.org/10.47176/mjiri.36.152

Toghiani, A., Maleki, I., Afshar, H., & Kazemian, A. (2016). Translation and validation of the Farsi version of Rome III diagnostic questionnaire for the adult functional gastrointestinal disorders. J Res Med Sci, 21, 103. https://doi.org/10.4103/1735-1995.193175

Velasco-Benítez, C. A., Gómez-Oliveros, L. F., Rubio-Molina, L. M., Tovar-Cuevas, J. R., & Saps, M. (2021). Diagnostic Accuracy of the Rome IV Criteria for the Diagnosis of Functional Gastrointestinal Disorders in Children. Journal of Pediatric Gastroenterology and Nutrition, 72(4), 538-541. https://doi.org/10.1097/MPG.0000000000003030

Wells, A. (1994). A multi-dimensional measure of worry: Development and preliminary validation of the Anxious Thoughts Inventory. Anxiety, Stress and Coping, 6(4), 289-299.

Włodarczyk, M., & Sobolewska-Włodarczyk, A. (2020). 8 - Clinical diagnosis of irritable bowel syndrome. In J. Fichna (Ed.), A Comprehensive Overview of Irritable Bowel Syndrome (pp. 99-106). Academic Press. https://doi.org/10.1016/B978-0-12-821324-7.00008-3