مقایسه اثربخشی دارو درمانی (پاروکستین)، درمان شناختی- رفتاری واحد پردازه‌ای و ترکیب آنها بر تحمل آشفتگی، تحمل ابهام و فرانگرانی در دانشجویان دختر مبتلا به اضطراب فراگیر

نویسندگان
مهدیه کاوئی 1
حسن توزنده‌جانی 2
محبوبه طاهر 1
1 گروه روانشناسی، دانشکده علوم انسانی، واحد شاهرود، دانشگاه آزاد اسلامی، شاهرود، ایران
2 گروه روانشناسی، دانشکده علوم انسانی، واحد نیشابور، دانشگاه آزاد اسلامی، نیشابور، ایران
چکیده
مقدمه

در دو دهه گذشته علاقه به درک ماهیت اضطراب فراگیر و گسترش روش‌های مؤثر بر آن در بین روان‌شناسان فزونی یافته است. هدف این پژوهش مقایسه اثربخشی دارو درمانی، درمان شناختی- رفتاری واحدپردازه‌ای و ترکیب آنها بر تحمل آشفتگی، تحمل ابهام و فرانگرانی در دانشجویان دختر مبتلا به اضطراب فراگیر بود.

مواد و روش­ها

این پژوهش از نوع پژوهش‌های نیمه تجربی (طرح پیش آزمون، پس آزمون، آزمون پیگیری با گروه کنترل) بود. از بین دانشجویان دختر دانشگاه آزاد اسلامی شهر مشهد، 60 نفر به‌صورت نمونه‌گیری هدفمند انتخاب و به‌صورت تصادفی در سه گروه آزمایش (دارو درمانی، درمان واحدپردازه‌ای و درمان ترکیبی) و یک گروه کنترل جایگزین گردیدند. شرکت‌کنندگان با کمک پرسشنامه اضطراب فراگیر اسپیتزر و همکاران (2006)، افکار اضطرابی ولز (2005)، مقیاس تحمل آشفتگی سیمونز و گاهر (2005) و مقیاس تحمل ابهام مک دونالد (1970) مورد پیش آزمون قرار گرفتند. در پایان دوره درمان و سه ماه بعد از آن، شرکت کنندگان مورد پس آزمون و آزمون پیگیری قرار گرفتند. داده‌ها بر اساس آزمون تحلیل واریانس با اندازه‌گیری‌های مکرر تجزیه و تحلیل شد.

یافته­ها

نتایج تحلیل واریانس با اندازه‌گیری‌های مکرر نشان داد که هر سه رویکرد درمانی در مقایسه با گروه کنترل بر کاهش تحمل آشفتگی، تحمل ابهام و فرانگرانی اثربخش بوده‌اند (مجذور اتا 0/37، 0/22 و 0/45)، اما درمان ترکیبی بر دو رویکرد درمانی دیگر به‌تنهایی برتری معناداری داشته‌ است (0/05>p).

نتیجه­گیری

با توجه به زیربنای زیستی و روان شناختی اختلال اضطراب فراگیر، به‌نظر می‌رسد که ترکیب درمان‌های روانشناختی و دارودرمانی در بهبود حالات اضطرابی رویکردی موثرتر باشد.
کلیدواژه‌ها
اضطراب فراگیر
تحمل آشفتگی
تحمل ابهام
فرانگرانی
درمان واحدپردازه‌ای
دارو درمانی
درمان تلفیقی

عنوان مقاله English

Comparing the effectiveness of pharmacotherapy (paroxetine), modular cognitive-‎ behavioral therapy ‎‌‌and their combination in distress tolerance, ambiguity tolerance and meta-worry‎ in female university students with generalized anxiety disorder

نویسندگان English

mahdiye kaveyi 1
Hasan Toozandehjani 2
Mahboobe Taher 1
1 Department of Psychology, Faculty of Humanities, Shahrood Branch, Islamic Azad University, Shahrood, Iran
2 Department of Psychology, Faculty of Humanities, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
چکیده English

Introduction

In the last two decades, the interest in understanding the nature of generalized anxiety disorder (GAD) and the development of effective treatment methods for GAD has increased among psychologists. This study aimed to compare the effectiveness of pharmacotherapy, modular cognitive-‎behavioral therapy ‎‏‏and their combination in distress tolerance, ambiguity tolerance and meta-worry‎ in female students with generalized anxiety.

Materials and Methods

This study was a ‎semi-experimental ‎research with a pretest-‎posttest and follow-‎up ‎control group design. The selection of 60 students among the female students of the Islamic Azad University of Mashhad was done by purposive sampling and were randomly assigned into three experimental groups (pharmacotherapy, modular therapy and combination therapy) and a control group. The participants were pretested using Generalized Anxiety Disorder Questionnaire (GAD-7; Spitzer et al., 2006), Wells Anxious Thoughts Inventory (2005), Simmons and Gahr turbulence tolerance scale (2005) and McDonald Ambiguity Tolerance Scale (1970). At the end of the treatment and three months after it, participants underwent post-test and follow-up test. The data in this article was analysed with repeated measures analysis of variance (ANOVA).

Results

The results of the repeated measures ANOVA showed that all three treatment approaches were effective in reducing turbulence tolerance, ambiguity tolerance and meta-worry compared to the control group (Eta-squared 0.37, 0.22, 0.45, respectively), but combination therapy had a significant advantage over the other two therapeutic approaches alone (p <0.05).

Conclusion

Based on the biological and psychological underpinnings of generalized anxiety disorder, it seems that the combination of psychological therapies and pharmacotherapy is a more effective approach in improving anxiety conditions.

کلیدواژه‌ها English

Generalized Anxiety
Distress Tolerance
Ambiguity Tolerance
Meta-Worry‎
Modular Therapy
Pharmacotherapy
Combination Therapy
1. Sadok BC, Sadok WA, & Ruiz P. Psychiatric Abstract: Behavioral Sciences / Clinical Psychiatry. Translated by: Farzin Rezaei, 2, Arjmand Publications, Tehran. (2016).
2. Blood, GW, Blood, IM. Long-term consequences of childhood bullying in adults who stutter: Social Anxiety, Fear of Negative Evaluation, Self-esteem, and Satisfaction with Life. J Fluency Disorder (2016); 72-84.
3. Dimaggio G, Shahar G. Behavioral activation as a common mechanism of change across different orientations and disorders. American psychological association (2017); 54(3): 221–224.
4. Kaplan H. Sadock B. Diagnostic and statistical manual of mental disorders. Translated by Y. Seyyed Mohammadi. First Edition (2015); Tehran: Arjmand. (2013). [Persian]
5. Ha Kim E, Crouch T. Adaptation of behavioral activation in the treatment of chronic pain. American Psychological Association (2017); 54(3): 237–244.
6. Letzring TD, Rone CC, Colman DE. Implications of fear of negative evaluation, state anxiety, and implied level of target-dominance on perceptions of personality traits.J Soc Psychol (2016); 581-593.
7. Van Kessel K, Moss-Morris R, Willoughby EA. randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosom Med; (2011). 70 (2): 205-13.
8. Mitten F, Dash SR, Scarlet ALS, Davey GCL. Investigating the effect of uncertainty on catastrophic worry and med. Journal of Behavior Research and Therapy (2012); 50(11): 690- 698.
9. Simons JS, Gaher RM. The distress tolerance scale: Development& validation of a self-report measure. Motivation & emotion (2005); 20(9): 83- 102.
10. Razurel C, Kaiser B, Antonietti JP, Epiney M & Sellenet C. )2017(. Relationship between perceived perinatal stress and depressive symptoms, anxiety, and parental self-efficacy in primiparous mothers and the role of social support. Women Health 154-172.
11. Holaway RM, Heimberg RG, Coles ME. A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder. Journal of Anxiety Disorders (2007); 20: 158–174.
12. Ruggiero GM, Stapinski L, Caselli G, Fiore F, Gallucci M, Sassaroli S, Rapee RM. Beliefs over control and meta-worry interact with the effect of intolerance of uncertainty on worry. Personality and Individual Differences (2012). Vol 53, Issue 3, August: 224-230.
13. Wells A, Matthews G. Attention and emotion, a clinical perspective. Hove: Erlbum. 1994.
14. Wells A. Cognition about cognition: metacognition therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice (2007); 14 (1): 18-25.
15. Spiel Berger CD, Anton WD, Bedell J. Test anxiety interventions for children and adolescents: A systematic review of treatment studies from 2000-2010. Psychology in the Schools (2015); 50: 57-71.
16. Chorpita B, Taylor A, Francis S, Moffitt C, Austin A. Efficacy of modular cognitive Behavior therapy for childhood anxiety disorders. Behavior therapy (2004); 35: 263-287.
17. Eisen AR, Silverman WK. Prescriptive treatment for generalized anxiety disorder in children. Behavior therapy (2012); 29: 105-121.
18. Song MF, Zhang YH. Modified suanzaorentang had the treatment effect for generalized anxiety disorder for the first 4 weeks of paroxetine medication: A pragmatic randomized controlled study. Evid based complement alternate med (2017); 8391637.
19. Irons C, Lad S. Using compassion focused therapy work with shame and self-criticism in complex trauma. Australian Clinical Psychobiologist (2017); 3: 47-54.
20. Chorpita BF, Daleiden EL, & Weisz JR. Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research (2005); 7(1), 5-20.
21. Shiran Khorasani Z. Comparing the effectiveness of modular cognitive-‎behavioral therapy ‌and quality of life skills in intolerance of uncertainty, generalized anxiety symptoms and motivational beliefs of students with test anxiety. PhD Thesis in Psychology, Khorasan Razavi Science and Research Branch, Islamic Azad University, Neyshabur Branch. (2019). [Persian]
22. Ramezani M. The effectiveness of modular cognitive-‎behavioral therapy ‌ in generalized anxiety symptoms and intolerance of uncertainty in female students of Mashhad Islamic Azad University. Master’s Thesis in Clinical Psychology, Islamic Azad University, Neyshabur Branch (2018). [Persian]
23. Song MF, Zhang YH. Modified suanzaorentang had the treatment effect for generalized anxiety disorder for the first 4 weeks of paroxetine medication: A pragmatic randomized controlled study. Evid Based Complement Alternate Med. 8391637. (2017).
24. Susan HS, Ronald MR. Behavior Research and Therapy The etiology of social anxiety disorder. An evidence-based model. (2016); 1100-1109.
25. Denise D, Ben-Porath P. Dialectical behavior therapy applied to parent skills training: adjunctive treatment for parents with difficulties in affect regulation. Cogn & Behav Pract. (2013); 17(4): 458–46.
26. Abbasi M, Bagian Koleh Marz MJ, Qasemi Jovineh R, Dargahi Sh. Comparing hypochondriasis, social anxiety and cognitive avoidance in mothers of students with and without specific learning difficulties. Exceptional Education (2015); 15(6): 6-14. Serial number 134. [Persian]
27. Spada MM, Wells A. Metacognitions, emotion and alcohol use. Clinical Psychology and Psychotherapy 2005; 12: 150-155.
28. Taherifar Z, Fati L, Gharaei B. A model of predicting social phobia in university students based on cognitive-behavioral components. Iranian Journal of Psychiatry and Clinical Psychology (2010); 16(1): 34-45. [Persian]
29. Wells A, & Carter K. Further Tests of a Cognitive Model of Generalized Anxiety Disorder: Metacognitions and Worry in GAD, Panic Disorder, Social Phobia, Depression and Non-patients. Behav Ther (2001); 32: 85-102.
30. Simons JS, Gaher RM. The distress tolerance scale: Development & validation of a self-report measure. Motivation & emotion (2005); 20(9): 83-102.
31. Alavi Kh, Modarres Gharavi M, Amin Yazdi A, Salehi Fadardi J. The effectiveness of dialectical behavioral group therapy in depression symptoms among students. Journal of Principles of Mental Health. (2011). [Persian]
32. Azizi M. Comparing the effectiveness of acceptance and commitment group therapy and interpersonal group therapy in improving the symptoms of mental health, resilience and pain in people with chronic headaches. Master’s thesis in Clinical Psychology, Ferdowsi University of Mashhad. (2014). [Persian]
33. Gholami F, Ranjbar MJ, Karimian Pour Gh, Dolati H. The effectiveness of emotion regulation group training in adolescent adjustment. National Conference on Psychology of Educational and Social Sciences, Mazandaran, Scientific-Research Institute of Kumeh Elm Avaran Danesh. (2015). [Persian]
34. Lee Hee RL, Tirch D, Poltiano LA. Emotion regulation techniques in psychotherapy. Translated by A. R. Mansouri Rad (2013). Tehran: Arjmand. (2011).
35. Khaje Rashidan F. Investigating the level of observance of social norms by high school female students in Semnan Province. Social Sciences Research Journal (2008). 2(1). [Persian]
36. 48. Ha Kim E, Crouch T. Adaptation of behavioral activation in the treatment of chronic pain. American Psychological Association (2017); 54,(3): 237–244.
37. Ekers D, Webster L, Straten AV, Cuijpers P, Richards D, Gilbody S. Behavioural activation for depression; An update of meta-analysis of effectiveness and sub group analysis. Plose One (2014); 237–244.
38. Mineka S, Zinbarg RA. Contemporary learning theory perspective on the etiology of anxiety disorders: It's not what you thought it was. American Psychologist (2006). 61: 10−26.
39. Susan HS, Ronald MR. Behavior Research and Therapy ؛The etiology of social anxiety disorder.An evidence – based model, 1100-1109. (2016).
40. Dalaham L. The compersion effect of beahaioral actination group therapy and sedative drougs on depression and anxiety for breast cancer woman. Journal Anxiety Disorder (2012); (11): 279, 315.