مقایسه اثربخشی درمان تلفیقی هیجان مدار مبتنی بر شفقت با درمان مبتنی بر شفقت بر کمال‌گرایی و عدم تحمل بلاتکلیفی بیماران مبتلا به علائم سردرد اولیه

فصلنامه علمی روش ها و مدل های روانشناختی

مقاله 9، دوره 12، شماره 43، خرداد 1400، صفحه 114-130   

نوع مقاله: مقاله پژوهشی

شناسه دیجیتال (DOI): 10.30495/jpmm.2021.4727

نویسندگان

ندا بهوندی¹؛ فلور خیاطان^{* 2}؛ محسن گل پرور³

¹دانشجوی دکتری گروه روانشناسی، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران

²استادیار گروه روانشناسی، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران

³دانشیار گروه روانشناسی، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی،اصفهان، ایران

تاریخ دریافت: 30 بهمن 1399،  تاریخ بازنگری: 05 خرداد 1400،  تاریخ پذیرش: 27 تیر 1400 

چکیده

هدف: در مقیاس جهانی  علائم  سردرد اولیه کم توانی های  روانشناختی  بیشتری در مقایسه با سایر مشکلات نورولوژیک را سبب می شود. از  شایع ترین کم­توانی های روانشناختی در بیماران با علائم سردرد اولیه کمال گرایی و عدم تحمل بلاتکلیفی می باشد. پژوهش حاضر با هدف مقایسه اثربخشی درمان تلفیقی هیجان مدار مبتنی بر شفقت با درمان مبتنی بر شفقت بر کمال گرایی و عدم تحمل بلاتکلیفی بیماران مبتلا به علائم سردرد اولیه انجام شد.
روش­: مطالعه از نوع نیمه آزمایشی با طرح پیش آزمون، پس آزمون و پیگیری با گروه گواه بود. نمونه پژوهش شامل 45 نفر از بیماران مبتلا به علایم سردرد اولیه مراجعه کننده به درمانگاه مغز و اعصاب بیمارستان خاتم الانبیاء تهران بود که به روش نمونه گیری هدفمند انتخاب و  به صورت تصادفی در دو گروه آزمایش و یک گروه گواه (هر گروه15 نفر) قرار داده شدند. گروه های آزمایش تحت درمان تلفیقی هیجان مدارمبتنی بر شفقت(10 جلسه 60 دقیقه ای) و درمان مبتنی بر شفقت(8 جلسه 60 دقیقه ای) قرار گرفتند. از پرسشنامه های کمال گرایی و عدم تحمل بلاتکلیفی به عنوان ابزار پژوهش استفاده شد. داده ها با استفاده از نرم افزار آماری spss  نسخه 24 و آزمون تحلیل واریانس اندازه های تکرار شده تحلیل شدند.
یافته­ها: یافته­های پژوهش نشان می­دهد در متغیرکمال گرایی با توجه به عدم رعایت پیش‏‏فرض کرویت در بخش اثر درون گروهی و در عامل زمان(33/6=F، 001/1=df و 05/0>p) و تعامل عامل زمان و گروه(23/5=F، 003/2=df و 01/0>p) و منغیر عدم تحمل بلاتکلیفی با توجه به عدم رعایت پیش‏‏فرض کرویت  در بخش اثر درون گروهی و در عامل زمان(86/134=F، 08/1=df و 01/0>p) و تعامل عامل زمان و گروه (72/30=F، 17/2=df و 01/0>p) بین مراحل پیش‏‏آزمون، پس‏‏آزمون و پیگیری و تعامل زمان با گروه(سه گروه پژوهش) تفاوت معناداری (01/0p<) وجود دارد. نتایج آزمون تعقیبی بونفرونی برای مقایسه­های جفتی نشان داد  متغیر کمال گرایی  در مرحله پس­آزمون و پیگیری گروه درمان تلفیقی هیجان­مدار مبتنی بر شفقت و  گروه درمان مبتنی بر شفقت با گروه گواه دارای تفاوت معنادار می باشد(01/0>p)، اما بین دو گروه درمان با یکدیگر تفاوت معناداری وجود ندارد (05/0<p) .  متغیر عدم تحمل بلاتکلیفی در مرحله پس­آزمون گروه درمان تلفیقی هیجان­مدار مبتنی بر شفقت و  گروه درمان مبتنی بر شفقت  با یکدیگر و با گروه گواه  دارای تفاوت معنادار می باشد(01/0>p). در مرحله پیگیری  نیز بین دو گروه درمان  با گروه گواه تفاوت معنادار وجود دارد(01/0>p) اما دو گروه درمان با یکدیگر تفاوت معناداری ندارد(05/0<p ). بر پایه نتایج به دست آمده، درمان تلفیقی هیجان­مدار مبتنی بر شفقت، درمانی قابل استفاده برای کاهش عدم تحمل بلاتکلیفی افراد مبتلا به سردرد اولیه و درمان تلفیقی هیجان مدار مبتنی بر شفقت و  درمان مبتنی بر شفقت به یک اندازه جهت کاهش کمال گرایی  بیماران مبتلا به علائم سردرد اولیه مناسب هستند.

کلیدواژه‌ها

درمان تلفیقی هیجان مدار مبتنی بر شفقت؛ درمان مبتنی بر شفقت؛ کمال‌گرایی؛ عدم تحمل بلاتکلیفی؛ علائم سردرد اولیه

عنوان مقاله [English]

Comparing the Effectiveness of Compassionate Emotion-Based Integrated Therapy With Compassion Focused Therapy on Perfectionism and Intolerance of Uncertainty Irrational Beliefs in Patients With Early Headache Symptoms

نویسندگان [English]

neda behvandi¹؛ felor khayatan²؛ mohsen gol parvar³

¹PhD Student, Department of Psychology, Isfahan Branch (Khorasgan), Islamic Azad University, Isfahan, Iran

²Assistant Professor, Department of Psychology, Isfahan Branch (Khorasgan), Islamic Azad University, Isfahan, Iran

³Associate Professor, Department of Psychology, Isfahan Branch (Khorasgan), Islamic Azad University, Isfahan, Iran

چکیده [English]

Introduction:Globally, the symptoms of primary headache cause more psychological disabilities than other neurological problems. One of the most common psychological disabilities in patients with primary headache symptoms is perfectionism and intolerance of uncertainty. The aim of this study was to compare the effectiveness of Compassionate emotion-based integrated therapy with compassion-based therapy on perfectionism and intolerance of uncertainty in patients with primary headache symptoms.
Methods:The study was a quasi-experimental study with pre-test, post-test and follow-up with a control group. The sample consisted of 45 patients with primary headache symptoms referred to the neurology clinic of Khatam Al-Anbia Hospital in Tehran who were selected by purposive sampling method and randomly divided into two experimental groups and a control group (15 people in each group). The experimental groups underwent a Compassionate emotion-based integrated therapy (10 sessions of 60 minutes) and compassion-based therapy (8 sessions of 60 minutes). Data were analyzed using SPSS software version 24 and repeated measures analysis of variance test.
Findings: The results showed that in the variable of perfectionism due to the non-observance of the spheric default in the intra group effect section and in the time factor (F = 6/33, df = 1/001 and p <0/05) and the time factor interaction and Group (F = 5/23, df = 2/003 and p <0/01) and uncertainty intolerance due to non-observance of spheric default in intra group effect and time factor (F = 134.86) , df = 1.08 and p <0/01) and time and group factor interaction (F = 30/72, df = 2/17 and p <0/01) between pre-test, post-test and There was a significant difference (p <0/01) with time tracking and interaction with the group (three research groups). Based on the results, Compassionate emotion-based integrated therapy, a treatment that can be used to reduce intolerance in people with primary headache, and a Compassionate emotion-based integrated therapy and compassion-based therapy to reduce patients' perfectionism to the same extent. Suitable for early headache symptoms.

کلیدواژه‌ها [English]

Compassionate emotion-based integrated therapy, compassion focused therapy, perfectionism, intolerance of uncertainty, early headache symptoms

مراجع

1. Global Burden of Disease Study. (2017). Global, regional, and national incidence, prevalence, and  years lived with disability for 301 acute and chronic diseases and injuries in 188 countries: a systematic analysis for the Global Burden of Disease Study. Northern Colorado3, 418-420. DOI: https://DOI.org/10.1016/S0140-6736(18)32279-7.
2. International Classification of Headache Disorders. (2018). 3rd edition. Cephalalgia, 38, 1–211. DOI: 10.1177/0333102417738202.
3. Casper, D., Fossi, A., Husser, A., Longo, D., Jameson, L.,  Loskalzo, J. (2015). Principles of Harrison Internal Medicine (Neurological Diseases). Translator: Mansoori Rad, M. Tehran, 629-632. https://accessmedicine.mhmedical.
4. Gatta, M., Spitaleri, C., Balottin, U., Spoto, A., Balottin, L., Mangano, S., et al. (2016). Alexithymia   characteristics in pediatric patients with primary headache: a    comparison  between migraine and tension-type headache. Headache Pain, 16, 98–106. DOI:10.1186/s10194-015-0572-y.  
5.  American Psychiatric Association. (2016). Diagnostic and statistical manual of mental disorders. American Psychiatric Association. Washington, DC, 106-115. https://DOI.org/10.1176/appi.books.9780890425596.
6. Azizi, M.; Agha Mohammadian Sharabaf, H.; Mashhadi, A.; Asghari Ebrahimabad, M. (2016). Comparison of psychological status of patients with migraine headache and healthy individuals, Sabzevar University of Medical Sciences. 23: (4), 713-706. https://www.sid.ir/fa/JOURNAL/ViewPaper.aspx?id=286859.
7. Herpertz, SC., Herzog, W., Taubner, S. (2016). Prevention of mental and psychosomatic disorders in occupational and training settings. Mental Health & Prevention, 4 (1) ,1-2. DOI:10.1016/j.mhp.2016.02.004.
8. Balottin, U., Ferri, M., Racca, M., Rossi, M., Rossi, G., Beghi, E., Chiappedi, M., Termine, C. (2018). Psychotherapy versus usual care in pediatric migraine and tension type headache: a single-blind controlled pilot study. Italian journal of pediatrics, 40(1) ,6-18. D0I: 10.1186/1824-7288-40-6
9. Vieira ,R., Vieira, D., Gomes, W., Gauer, M. (2017). Clinical features, pathophysiology and treatment of medication-overuse headache. Lancet Neurol, (4),391–401. https://DOI.org/10.1016/S1474-4422(10)70008-9
10. Vieira, R., Vieira, D., Gomes, W., Gauer, G. (2018). Alexithymia and its impact on   quality of life in a group of Brazilian women with migraine without aura. J Headache Pain, 14(1), 18-34. DOI: 10.1186/1129.
11. Blumenfeld, A. M., Varon, S. F., Wilcox, S. (2017). Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS), Cephalalgia, 31(3),  301–315. DOI: 10.1177/0333102410381145.
12. Andress-Rothrock, D., King, W., Rothrock, J. (2018). An analysis of migraine triggers in a clinic-based population. Headache, 50,166–185. https://DOI.org/10.1111/j.1526-4610.2010.01753.
13. Manzoni, G.C., Taga, A., Russo, M., Torelli, P. (2017). Age of onset of episodic and chronic        cluster headache - A review of a large case series from a single headache centre. J Headache  Pain, 7:44-68. DOI:10.1186/s10194-016-0626-9.
14. Vicent, M., Aparicio-Flores, M.P., Inglés, C.J., Gómez-Núñez, M.I., Fernández-Sogorb, A., Aparisi-Sierra, D. (2017). Perfeccionismo infantil: Diferencias en función del sexo y la edad. Int. J. Dev. Educ. Psychol, 121-134. DOI:10.3389/fpsyg.2016.01403
15. Amrai, K; Mokhtari, Fathi, L; Saki, K. (2020). The relationship between perfectionism and personality traits with the severity of migraine headache: A cross-sectional study, Journal of Lorestan University of Medical Sciences. Year 22: (2), 94-84. http://yafte.lums.ac.ir/article-1-2857-en.html.
16. Lozano, L. M., Valor-Segura, I., García-Cueto, E., Pedrosa, I., Llanos, A., Lozano L. )2019(. Relationship betweenchild perfectionism and psychological disorders.Front. Psychol, 10, 185-201. DOI: 10.3389/fpsyg.2019.01855
17. San Martín, N.L., Luengo M.P.(2018). Diferencias en ansiedad escolar, autoestima y perfeccionismo en función del nivelescolar y el sexo en estudiantes chilenos de educación primaria.Rev. Reflex. Investig. Educ,1, 57–69. http://revistas.ubiobio.cl/index.
18. Johari Fard, R; Boroumand, A; Edward Sheet, K ; Mehrabizadeh Artist, M. (2016). The role of cognitive and personality factors in predicting migraine headache. Journal of Thought and Behavior. 9: (42), 76-67. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=553186.
19. Johnston, J., Shu, C.Y., Hoiles, K.J., Clarke, P.J.F., Watson, H.J., Dunlop, P.D., Egan S.J.(2018). Perfectionism isassociated with higher eating disorder symptoms and lower remission in children and adolescents diagnosedwith eating disorders. Eat. Behav , 30, 55–60. https://DOI.org/10.1016/j.eatbeh.
20. Mortazavi Nasiri, F ; Pakdaman, Sh; Dehghani, M. (2018). The relationship between disaster and pain-related anxiety with disability due to headache in people with migraines. Journal of Behavioral Science Research. 13: (4), 616-609. http://rbs.mui.ac.ir/article-1-438-fa.
21. Lauriola, M., Mosca, O., Trentin, i. C., Foschi, R ., Tambelli, R. ., Carleton  N. (2018). The Intolerance of Uncertainty Inventory: Validity and Comparison of Scoring Methods to Assess Individuals Screening Positive for Anxiety and Depression, Front. Psychol, 336-352. https://DOI.org/10.3389/fpsyg.2018.00388.
22. Alschuler, K., Beier M. (2015). Intolerance of Uncertainty: Shaping an Agenda for Research on Coping with Multiple Sclerosis, Int J MS Care, 17(4), 153–158.  https://DOI.org/10.7224/1537-2073.2014-044.
23. Bottesi ,G., Ghisi, M., Carraro, E., Barclay, N., Payne, R., Freeston, M. H. (2016). Revising the intolerance of uncertainty model of generalized anxiety disorder: evidence from UK and Italian undergraduate samples, Front. Psychol, 7, 173-182. https://DOI.org/10.3389/fpsyg.2016.01723.
24. Hale W, Richmond M, Bennett J, Berzins T, Fields A, Weber D, et al. Resolving uncertainty about the intolerance of uncertainty scale-12: application of modern psychometric strategies. J. Pers. Assess, 2016; 98: 200–208. DOI:10.1080/00223891.2015.1070355
25. Mc Cracken, LM., Zhao-O’Brien, J. (2016). General psychological acceptance and chronic pain: There is more to accept than the pain itself, Euro J Pain, (14) , 170-175. DOI:10.1016/j.ejpain.03.004.
26. Brosschot, J., van der DM. (2016). Daily worrying and somatic health complaints: Testing the effectiveness of a simple worry reduction intervention. Psychology and Health,  21(1),34-48.  https://DOI.org/10.1080/14768320500105346.
27.  Sheikhi, G; Rajabpour, M.; Sheibani, H. (2019). Relationship between perfectionism, anxiety, cognitive emotion regulation with academic involvement of Payame Noor University students in Piranshahr. Culture in Islamic University. 9: (2), 294-271. DOI.10.22054/jep.2019.40560.2622.
28. Wu, D., Wang, K.,  Wei, D., Chen, Q., Du, X., Yang, J., Qiu,  J. (2017). Perfectionism mediated the relationship between brain structure variation and negative emotion in a nonclinical sample, Cognitive, Affective, & Behavioral Neuroscience, 17,  211–223. https://DOI.org/10.3758/s13415-016-0474-8.
29. Ahmadian, A.; Forgiving, f; Solgi, z; Kazemi, F; Mushashei, K. (1394). Investigating the relationship between cognitive strategies of emotion regulation and perfectionism in attempting suicide in the emergency department of Imam Khomeini Hospital in Kermanshah. International Conference on Humanities, Psychology and Social Sciences. : (3).  DOI. HPSCONF01.
30. Greenberg L. (2010). Emotion-focused therapy:a clinical synthesis. Focus:The Journal of    Lifelong Learning in Psychiatry, 8 (1) , 32–42.  https://doi.org/10.1176/foc.8.1.foc32.
31. Nazemi Mehrz, AH; Shirazi, M.; Mohammadi, R.; Maqsoodloo, F. (2018). The effect of emotion therapy on reducing the symptoms of anxiety and depression in patients with sclerosis. Journal of Mashhad University of Medical Sciences. 61: (10), 200-190. DOI.10.22038/mjms.2019.14605.
32.  Nazari Kamal, M.; Ahi, c; , Follow, m; Mohammadi Nia, L. (1397). The relationship between perfectionism and emotional cognitive regulation strategies in crisis management units. International Conference on Clinical Psychology: Evaluation, Diagnosis, Treatment. (6), 105-118. DOI.ICPCPO 1.
33.  Pires, C., Sole, E., Miro, J. (2017). Catastrophizing and pain impact in migraineurs. J Headache Pain, 14(Suppl 1),147-163. https://DOI.org/10.1186/1129-2377-14-S1-P147 .
34. Sherafat ،H; Taheri, A.; Asmai Majd, S; Amiri, M. (2016). The effectiveness of cognitive therapy based on the Dougas model on intolerance of uncertainty, cognitive avoidance and positive anxiety beliefs in patients with generalized anxiety disorder. Journal of Clinical Psychology. 9: (2), 29-15.  https://www.sid.ir/fa/journal/ViewPaper.aspx?id=309824.
35. Koerner, N., Mejia, T., Kusec A.(2017). What's in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder. Cogn Behav Ther, 46(2) ,141-61.  DOI:10.1080/16506073.2016.1211172
36. Verhiel, S.H.W.L., Greenberg, J., Zale, EL., Chen, NC., Ring, DC., Vranceanu AM. (2019). What role does positive psychology play in understanding pain intensity and disability among patients with hand and upper extremity conditions? Clin Orthop Relat Res, 47(8) , 1769-1776.  DOI: 10.1097/CORR.0000000000000694.
37. Gilbert P.(2010). The origins and nature of compassion focused therapy,  BJCP, 53(1), 6-41.  DOI:10.3389/fpsyg.2020.586161.
38. Kolts R.(2016). CFT made simple: a clinician's guide to practicing compassion-focused therapy, Oakland, CA: New Harbinger Publications, p. 3. ISBN 10: 1626253099 .
39. Ghaffari Jahed, Z; Amini, N; Direh، A ; Mirzaei, K. (2020). The effectiveness of compassion-based therapy on pain perception and perfectionism in men with irritable bowel syndrome. Journal of the School of Medicine. 63: (4), 35-25.  DOI:10.22038/mjms.2020.17479.
40. Leopold SS. (2019). Editor's Spotlight/Take 5: What role does positive psychology play in understanding pain intensity and disability among patients with hand and upper-extremity conditions? Clin Orthop Relat Res, 477(8) ,1765-1768. DOI: 10.1097/CORR.0000000000000858.
41. Fatolahzadeh، N; Majlisi, Z; Mazaheri, Z; Rostami, M.; Nawabi Nejad, Sh. (2017). The effectiveness of compassion-focused therapy on internalized and self-critical shame in emotionally abused women. Psychological studies. (2), 112-102. DOI: 10.22051/psy.2017.12381.1274.
42. Hill, R .W., Huelsmann, T. J., Furr, R. M., Kibler, J., Vicente, B. B., Kennedy, C. A. (2004). new measure of perfectionism Inventory. Journal of Personality Assessment, 82,80-91.
43. Freeston, M., Rhéaume, J., Letarte, H., Dugas, M. J., Ladouceur, R. (1994). Why do people   worry? Personality and Individual Differences, 17, 791-802.
44. Qanawati, M.; Bahrami, F .; Goodarzi, M.; Roozbehani, H. (2017). The effect of compassion-based therapy on ruminant and anxiety in women with breast cancer. Journal of Health Psychology. 7: (27), 152-142. DOI: 10.30473/hpj.2018.38658.3886.

42.   Britton، G. I; Neale، S. E; Davey، G. C.L. (2019). The effect of worrying on intolerance of uncertainty and positive and negative beliefs about worry. Journal of Behavior Therapy and Experimental Psychiatry, (62)7, 65-71. https://doi.org/10.1016/j.jbtep.2018.09.002.

45.   Behvandi, N; Khayatan, F; Golparvar,  M.(2021). Develop an empathy-based emotion therapy package and compare its effectiveness with compassion-based therapy on sleep quality, quality of life, perfectionism, intolerance of uncertainty and irrational beliefs of patients with early headache symptoms. Ph.D. Thesis. Isfahan Azad University

46.   Abdulpour, AH; Hashemi, I; Sheri، M; Alizadeh, F. (2017). The relationship between intolerance, uncertainty and metacognitive beliefs with anxiety in people with depressive symptoms. Journal of Cognitive Psychology and Psychiatry. 5: (2), 26-15. http://shenakht.muk.ac.ir/article-1-296-fa.