اثربخشی درمان مبتنی بر پذیرش و تعهد بر ادراک استرس، انعطاف‏پذیری شناختی و عملکرد روانی مبتلایان به آسم

کجباف, محمدباقر; سیاه‌پوش منفرد, مسلم

doi:10.30473/hpj.2025.74525.6245

نوع مقاله : علمی- پژوهشی

نویسندگان

¹ استاد، گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه اصفهان، اصفهان، ایران.

² دانشجوی دکتری، گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه اصفهان، اصفهان، ایران.

10.30473/hpj.2025.74525.6245

چکیده

مقدمه: پژوهش حاضر با هدف بررسی اثربخشی درمان مبتنی بر پذیرش و تعهد (Acceptance and Commitment Therapy؛ ACT) بر استرس ادراک‌ شده، انعطاف‌پذیری شناختی و عملکرد روانی در میان بیماران مبتلا به آسم انجام شد. آسم نه‌تنها یک وضعیت مزمن تنفسی است، بلکه اختلالی محسوب می‌شود که بار روان‌شناختی قابل‌توجهی بر افراد وارد می‌کند و غالباً منجر به افزایش استرس، راهبردهای مقابله‌ای ناسازگار و کاهش کیفیت زندگی می‌گردد. بنابراین، پرداختن به جنبه‌های روان‌شناختی بیماری در کنار درمان‌های پزشکی، از اهمیت بسزایی برخوردار است.
روش: این مطالعه شبه‌آزمایشی با طرح پیش‌آزمون-پس‌آزمون و گروه کنترل بود. جامعه شامل بیماران مبتلا به آسم مراجعه‌کننده به کلینیک‌های خرم‌آباد در سال ۱۴۰۲ بود که با نمونه‌گیری هدفمند انتخاب و به‌صورت تصادفی در دو گروه آزمایش و کنترل (هرکدام ۱۵ نفر) گمارده شدند. گروه آزمایش طی هشت جلسه درمان گروهی مبتنی بر ACT شرکت کرد و گروه کنترل فقط مراقبت‌های معمول پزشکی را دریافت نمود. داده‌ها با استفاده از مقیاس‌های PSS، CFI و DASS-21 در دو مرحله گردآوری و با آزمون‌های t و تحلیل کوواریانس چندمتغیره (MANCOVA) در نرم‌افزار SPSS-26 تحلیل شد.
یافته‌ها: میانگین سنی شرکت‌کنندگان در گروه آزمایش ۳۴/۱ ± ۱۱/۵ سال و در گروه کنترل ۳۱/۸ ± ۱۴/۲ سال بود. نتایج آزمون t همبسته نشان داد که پس از مداخله‌ی ACT، شرکت‌کنندگان گروه آزمایش کاهش معناداری در استرس ادراک‌شده و افزایش معناداری در انعطاف‌پذیری شناختی و کارکرد روان‌شناختی نشان دادند (P < 0.05). در مقابل، در گروه کنترل هیچ تغییر معناداری مشاهده نشد. همچنین نتایج آزمون t مستقل نشان داد که بین دو گروه در پس‌آزمون تفاوت معناداری وجود داشت. تحلیل کوواریانس چندمتغیره (MANCOVA) نشان داد که حدود ۶۷/۷ درصد از تغییرات مشاهده‌شده در متغیرهای وابسته، به مداخله‌ی ACT نسبت داده می‌شود.
نتیجه‌گیری: یافته‌ها نشان داد که درمان مبتنی بر ACT یک مداخله‌ی روان‌شناختی مؤثر برای بیماران مبتلا به آسم است. درمان ACT با کاهش استرس ادراک‌شده و افزایش انعطاف‌پذیری شناختی، موجب بهبود کارکرد روان‌شناختی و ارتقای بهزیستی کلی می‌گردد. این نتایج بر اهمیت ادغام مداخلات روان‌شناختی مبتنی بر ACT در برنامه‌های جامع مدیریت آسم تأکید دارد، به‌گونه‌ای که هر دو بُعد جسمی و روان‌شناختی بیماری به‌طور هم‌زمان مورد توجه قرار گیرند. پیشنهاد می‌شود پژوهش‌های آینده با نمونه‌های بزرگ‌تر و در بازه‌های زمانی طولانی‌تر، پایداری اثرات درمان پذیرش و تعهد را در بیماری‌های مزمن تنفسی بررسی کنند.

کلیدواژه‌ها

موضوعات

مداخلات روانشناختی در سلامت و بیماریها

عنوان مقاله [English]

Cognitive Flexibility and Psychological Function in Asthmatics

نویسندگان [English]

Kajbaf Mohammad Bagher ¹
Moslem Siahpoush monfared ²

¹ Professor of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.

² Ph.D. Student in Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran

چکیده [English]

Objective: The present study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) on perceived stress, cognitive flexibility, and psychological functioning among patients with asthma. Asthma is not only a chronic respiratory condition but also a disorder that exerts a profound psychological burden on individuals, often leading to heightened stress, maladaptive coping strategies, and diminished quality of life. Therefore, addressing psychological aspects alongside medical treatment is of paramount importance. Method: This research employed a quasi-experimental design with pre-test and post-test assessments and a control group. The study population comprised asthma patients who attended specialized asthma and allergy clinics in Khoramabad during 2022. Using purposive sampling, 30 eligible participants were selected based on specific inclusion and exclusion criteria. The inclusion criteria required having a confirmed asthma diagnosis within the past year, being between 20 and 45 years of age, willingness and ability to regularly attend therapeutic sessions, and sufficient literacy to respond to questionnaires. Exclusion criteria included absence from more than two therapeutic sessions, lack of cooperation, unwillingness to continue participation, comorbid medical or psychological conditions, substance abuse, or incomplete responses to research instruments. Participants were randomly assigned into two equal groups (n = 15 per group). The experimental group received eight structured sessions of group-based ACT, while the control group continued to receive only routine medical treatment. Data were collected using three standardized self-report measures: the Perceived Stress Scale (PSS), the Cognitive Flexibility Inventory (CFI), and the Depression-Anxiety-Stress Scale (DASS-21). Pre-test questionnaires were administered to both groups before the intervention, and post-tests were administered after completion of the therapeutic sessions. Statistical analyses were conducted using descriptive indicators, paired and independent t-tests, as well as multivariate analysis of covariance (MANCOVA) via SPSS version 26. Results: The average age of participants was 39.76 ± 11.05 years in the experimental group and 39.66 ± 9.74 years in the control group. The results of paired-sample t-tests indicated that, following the ACT intervention, participants in the experimental group experienced statistically significant improvements in perceived stress, cognitive flexibility, and psychological functioning (P<0.05). In contrast, no significant changes were observed within the control group. Furthermore, independent t-test results confirmed that there were no significant differences between the two groups in pre-test scores, ensuring initial homogeneity. Assumptions of normality and equality of variances were also met, as confirmed by the Kolmogorov-Smirnov and Levene’s tests (P>0.05). MANCOVA results revealed significant between-group differences in the post-test phase, favoring the experimental group, with an effect size (Eta squared) of 0.66. This suggests that approximately 66% of the observed changes in outcome measures were attributable to the ACT intervention. Conclusion: The findings demonstrate that Acceptance and Commitment Therapy is an effective psychological intervention for asthma patients. By reducing perceived stress and enhancing cognitive flexibility, ACT contributes to improved psychological functioning and overall well-being. These results underscore the importance of integrating psychological therapies such as ACT into comprehensive asthma management programs, thereby addressing both physical and psychological dimensions of the illness. Future research is recommended to replicate these findings with larger samples and to explore the long-term effects of ACT in chronic respiratory conditions.

کلیدواژه‌ها [English]

Acceptance and Commitment Therapy
Asthma
Cognitive Flexibility
Mental Function

مراجع

Abbasi, F., Moradimansh, F., Naderi, F., & Bakhtiarpour, S. (2021). The effectiveness of acceptance and commitment therapy on perceived stress and illness perception in individuals with asthma. Health Psychology, 10(37), 7–20. (In Persian). https://hpj.journals.pnu.ac.ir/article_7631.html

Agin-Liebes, G., Zeifman, R., Luoma, J. B., Garland, E. L., Campbell, W. K., & Weiss, B. (2022). Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca. Journal of Psychopharmacology, 36(3), 295–308.https://doi.org/10.1177/02698811221080165

Arslan, G., & Allen, K. A. (2021). Exploring the association between coronavirus stress, meaning in life, psychological flexibility, and subjective well-being. Psychology, Health & Medicine, 1–12. https://doi.org/10.1080/13548506.2021.1876892

Asani L, Sabet M, Rafieipour A. (2022). Effectiveness of Health-Promoting Lifestyle Education on Physical Symptoms and Illness Perception of Patients With Asthma. J Prevent Med; 9 (4) :402-411. doi: 10.32598/JPM.9.4.467.1

Bahrami-Abdolmaleki, Sh., Homayouni, A., & Ali-Yali, M. (2021). The effectiveness of acceptance and commitment therapy on resilience, psychological well-being, and life expectancy in asthmatic patients. Toloo-e-Behdasht, 20(1), 55–68. (In Persian).

https://www.sid.ir/paper/1250432/fa

Bhatt, S., Pai, K. S. R., Patil, C. R., Manjula, S. N., & Mohana Lakshmi, S. (2022). Role of brain–gut–microbiome axis in depression comorbid with asthma. In Microbiome in inflammatory lung diseases (pp. 135–151). Springer, Singapore.https://doi.org/10.1007/978-981-16-8957-4_9

Boloursaz Mashhadi, H., Jafari, E., & Moghadamzadeh, A. (2024). The effectiveness of acceptance and commitment therapy on anxiety sensitivity, perceived pain intensity, and emotion regulation in elderly women with rheumatoid arthritis. Health Psychology, 13(52), 81–96. (In Persian).https://doi.org/10.30473/hpj.2025.70492.6009

Bradding, P., Redington, A. E., & Holgate, S. T. (2020). Airway wall remodelling in the pathogenesis of asthma: Cytokine expression in the airways. In Airway wall remodelling in asthma (pp. 29–63). CRC Press. https://doi.org/10.1201/9781003068792

Byrne, G., Ghráda, Á. N., O’Mahony, T., & Brennan, E. (2021). A systematic review of the use of acceptance and commitment therapy in supporting parents. Psychology and Psychotherapy: Theory, Research and Practice, 94, 378–407. https://doi.org/10.1111/papt.12282

Cherry, K. M., Vander Hoeven, E., Patterson, T. S., & Lumley, M. N. (2021). Defining and measuring “psychological flexibility”: A narrative scoping review of diverse flexibility and rigidity constructs and perspectives. Clinical Psychology Review, 101973.

https://doi.org/10.1016/j.cpr.2021.101973

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior, 385-396. https://doi.org/10.2307/2136404

Coyne, L. W., Gould, E. R., Grimaldi, M., Wilson, K. G., Baffuto, G., & Biglan, A. (2021). First things first: Parent psychological flexibility and self-compassion during COVID-19. Behavior Analysis in Practice, 14(4), 1092–1098. https://doi.org/10.1007/s40617-020-00435-w

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, 241-253. https://doi.org/10.1007/s10608-009-9276-4

Depp, C. A., Moore, D. J., Patterson, T. L., Lebowitz, B. D., & Jeste, D. V. (2022). Psychosocial interventions and medication adherence in bipolar disorder. Dialogues in Clinical Neuroscience.https://doi.org/10.31887/DCNS.2008.10.2/cadepp

Duangkham, S., Welch, N., Vega, M., Shahbandar, S., & Tarbox, J. (2022). Approaches to studying the pathogenesis of asthma. The Southwest Respiratory and Critical Care Chronicles, 10(42), 7–11.https://doi.org/10.12746/swrccc.v10i42.987

Garner, E. V., & Golijani-Moghaddam, N. (2021). Relationship between psychological flexibility and work-related quality of life for healthcare professionals: A systematic review and meta-analysis. Journal of Contextual Behavioral Science. https://doi.org/10.1016/j.jcbs.2021.06.007

Ghorbani, V., Jandaghiyan, M., Jokar, S., & Zanjani, Z. (2021). Prediction of depression, anxiety, and stress levels during the COVID-19 pandemic based on personality traits in residents of Kashan. Rafsanjan Medical Journal, 20(4), 503–518. http://journal.rums.ac.ir/article-1-5916-fa.html. https://doi.org/10.3390/ijms222111822

Goharshahi, R., Mofakhri, A., & Mohammadi Pour, M. (2024). The effect of schema therapy and acceptance and commitment therapy on self-acceptance and rumination in women with diabetes and binge eating disorder. Health Psychology, 13(51), 7–20. (In Persian).https://doi.org/10.30473/hpj.2024.70061.5978

Huang, C. Y., Hu, R. C., Li, J., Chen, B. B., & Dai, A. G. (2021). α1-Antitrypsin alleviates inflammation and oxidative stress by suppressing autophagy in asthma. Cytokine, 141, 155454. https://doi.org/10.1016/j.cyto.2021.155454

Jeong, J., & Lee, H. K. (2021). The role of CD4+ T cells and microbiota in the pathogenesis of asthma. International Journal of Molecular Sciences, 22(21), 11822.

Karimzadeh J. (2022). Effectiveness of treatment based on acceptance and commitment on the anxiety of patients with asthma. JNIP; 13 (17) :1-10. http://jnip.ir/article-1-735-fa.html

Katon, W. J. (2022). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience. https://doi.org/10.31887/DCNS.2011.13.1/wkaton

Khani, S., & Babakhani, N. (2016). Comparison and relationship of spiritual growth and perceived stress with happiness in infertile and fertile women in Tehran. J Health Psychol Res, 5(17), 93–102. https://hpj.journals.pnu.ac.ir/article_3377.html

Kim, Y. Y., Joh, J. S., & Lee, J. Y. (2020). Importance of microbial extracellular vesicle in the pathogenesis of asthma and chronic obstructive pulmonary disease and its diagnostic potential. Asia Pacific Allergy, 10(3), 123–144. https://doi.org/10.5415/apallergy.2020.10.e25

Lim, J., Miller, B. D., & Wood, B. L. (2022). An application of the Biobehavioral Family Model: Examining the impact of maternal depression on child asthma mediated by insecure attachment and child depression. Family Process, e12755. https://doi.org/10.1111/famp.12755

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy, 33(3), 335-343.

https://doi.org/10.1016/0005-7967(94)00075-U

McCarty, M. F., DiNicolantonio, J. J., & Lerner, A. (2021). Review–Nutraceuticals can target asthmatic bronchoconstriction: NADPH oxidase-dependent oxidative stress, RhoA and calcium dynamics. Journal of Asthma and Allergy, 14, 685. https://doi.org/10.2147/JAA.S307549

Morton, E., Ho, K., Barnes, S. J., & Michalak, E. E. (2021). Digital health literacy in bipolar disorder: International web-based survey. JMIR Mental Health, 8(10), e29764.https://preprints.jmir.org/preprint/29764

Nasiri, R., Moradi, Q., Esmaeimajd, S., & Khanpour, F. (2018). Effectiveness of mindfulness-based cognitive therapy on reducing anxiety and depression in patients with asthma. Zanko Journal of Medical Sciences, 19(62), 70–83. http://zanko.muk.ac.ir/article-1-391-fa.html

Nezhadmohammad Namegi A, nosrati Beighzadeh M. (2018). The Effectiveness of Acceptance and Commitment Therapy on Increasing the Psychological Flexibility of Infertile Females: Designing a Therapeutic Protocol. IJNR; 13 (3) :41-48. http://ijnr.ir/article-1-1925-fa.html

Nishimi, K., Borsari, B., Marx, B. P., Rosen, R. C., Cohen, B. E., Woodward, E., et al. (2022). Clusters of COVID-19 protective and risky behaviors and their associations with pandemic, socio-demographic, and mental health factors in the United States. Preventive Medicine Reports, 25, 101671.https://doi.org/10.1016/j.pmedr.2021.101671

Paulos-Guarnieri, L., Linares, I. M. P., & El Rafihi-Ferreira, R. (2022). Evidence and characteristics of Acceptance and Commitment Therapy (ACT)-based interventions for insomnia: A systematic review of randomized and non-randomized trials. Journal of Contextual Behavioral Science, 23, 1–14. https://doi.org/10.1016/j.jcbs.2021.11.001

Peter, J., Anthony, S., Fauci, B., and Kasper, e. (2008). Harrison's principles of internal medicine. 17th Ed. New York: McGraw-Hill; 1596-1607.

Riahi, S., Maleki, M., Riahi, F., & Mousavi, H. (2016). Asthma and physical activity: A systematic review. Journal of Research in Health, 2(1), 57–66. https://www.magiran.com/p1651582

Ryu, H. J., Lee, S., & Chung, J. H. (2022). Association between asthma and Generalized Anxiety Disorder-7 (GAD-7) in Korean adolescents. Journal of Asthma, (just-accepted), 1–17. https://doi.org/10.1080/02770903.2022.2032137

Sajjadinezhad M S, Asgari K, Molavi H, Adibi P. Comparing the Effectiveness of Cognitive-Behavioral Stress Management, Optimism Training and Medical Therapy on Somatic Symptoms, Perceived Stress, Illness Perception and Quality of Life in Patients with Ulcerative Colitis. J Arak Uni Med Sci 2016; 18 (10) :40-54.

Samani, S., & Jokar, B. (2007). Validity and reliability of the short form of the Depression, Anxiety and Stress Scale (DASS-21). Social Sciences and Humanities of Shiraz University, 26(3, Serial No. 52, Special Issue on Educational Sciences), 65-76. (In Persian).

https://sid.ir/paper/391033/fa

Sanderson, C. A. (2020). Health psychology (F. Johari et al., Trans.). Sarafraz Publishing. Tehran. (In Persian).

Sarafino, E. P. (2021). Health psychology (A. Nadim et al., Trans.). Roshd Publishing. Tehran. (In Persian)

Sumaily, M. A., Tayel, S., & Noureldin, E. M. (2022). The prevalence of depression among adult asthmatic patients in Jizan Region, Saudi Arabia. The Egyptian Journal of Hospital Medicine, 86(1), 156–164.https://dx.doi.org/10.21608/ejhm.2022.210792

Zargar, F., Rabiei, M., Naderi, F., & Tarrahi, M. J. (2022). The Effect of Group Acceptance and Commitment Therapy on the Management of Asthma: A Randomized Clinical Trial. International Journal of Psychological and Behavioral Sciences, 16(4), 133–138.

روانشناسی سلامت

اثربخشی درمان مبتنی بر پذیرش و تعهد بر ادراک استرس، انعطاف‏پذیری شناختی و عملکرد روانی مبتلایان به آسم

مراجع

مراجع

دوره 14، شماره 55
آذر 1404
صفحه 41-56

اثربخشی درمان مبتنی بر پذیرش و تعهد بر ادراک استرس، انعطاف‏پذیری شناختی و عملکرد روانی مبتلایان به آسم

مراجع

مراجع

دوره 14، شماره 55آذر 1404صفحه 41-56

دوره 14، شماره 55
آذر 1404
صفحه 41-56