نوع مقاله : علمی- پژوهشی

نویسندگان

• مینو ایرانی ¹
• حسین زارع ²
• محمد اورکی ²
• عزت الله کردمیرزانیکوزاده ³
• امین رفیعی پور ³

¹ دانشجوی دکتری، گروه روان‌شناسی، دانشگاه پیام نور، تهران، ایران.

² استاد، گروه روان‌شناسی، دانشگاه پیام نور، تهران، ایران.

³ دانشیار، گروه روان‌شناسی، دانشگاه پیام نور، تهران، ایران.

چکیده

مقدمه: هدف از مطالعه حاضر مقایسه اثربخشی مداخله مبتنی بر شفقت‌ورزی بر خود و مداخله مبتنی بر پذیرش و تعهد بر اصلاح شاخص‌های روانی، اجتماعی و زیستی،  زنان مبتلابه لوپوس بود.
روش: این مطالعه به روش نیمه‌آزمایشی با طرح پیش‌آزمون – پس‌آزمون با گروه گواه و دوره پیگیری دو ماهه بود. جامعه آماری پژوهش شامل زنان بیمار دارای بیماری لوپوس (45 نفر) که در زمان مطالعه ساکن تهران بودند و برای درمان به  بیمارستان‌های دولتی تحت پوشش دانشگاه علوم پزشکی تهران مراجعه داشتند. نمونه آماری به حجم 45 نفر از بین زنان بیمار دارای بیماری لوپوس، به‌صورت در دسترس انتخاب و به‌صورت تصادفی با روش قرعه‌کشی در سه گروه 15 نفری شامل دو گروه آزمایش (آموزش مبتنی بر پذیرش و تعهد و آموزش مبتنی بر شفقت‌ورزی و گروه گواه) گمارده شدند. سپس آزمودنی‌های دو گروه آزمایش به مدت 8 جلسه 90 دقیقه‌ای تحت آموزش مبتنی بر پذیرش و تعهد و آموزش مبتنی بر شفقت‌ورزی قرار گرفتند و در طول دوره مداخله گروه گواه تحت آموزشی قرار نگرفتند و صرفاً در جلسات مشاوره با پزشک معالج خود بودند. ابزار جمع‌آوری اطلاعات پرسش‌نامه‌های  کیفیت زندگی سازمان بهداشت جهانی (1996)  و پرسشنامه مقیاس اضطراب و افسردگی هاسپیتال^[1] (1983) بود که قبل، بلافاصله بعد از آموزش و دو ماه بعد از آموزش توسط هر سه گروه تکمیل شد.
یافته‌ها: نتایج نشان داد، بین دو گروه آزمایش (مداخله آموزشی مبتنی بر شفقت‌ورزی با آموزش مبتنی بر پذیرش و تعهد) ازنظر بهبود شاخص روانی بلافاصله بعد از مداخله (974/0=P) و دو ماه بعد (995/0=P)، بهبود شاخص اجتماعی بلافاصله بعد از مداخله (216/0=P)و دو ماه بعد از مداخله (851/0=P)  و بهبود شاخص زیستی بلافاصله بعد از مداخله (458/0=P)  و دوماه بعد از مداخله (951/0=P)  تفاوت معنی‌داری مشاهده نشد.
نتیجه‌گیری: به‌طورکلی نتایج به‌دست‌آمده از پژوهش نشان داد هر دو روش مداخله آموزشی در زنان موثر بوده است و هر دو روش مداخله موجب بهبود میانگین زیستی، بهبود شاخص روانی شاخص اجتماعی شده است.

کلیدواژه‌ها

• شاخص زیستی
• شاخص روانی
• شاخص اجتماعی
• مداخله آموزشی مبتنی بر شفقت‌ورزی به خود
• مداخله آموزشی مبتنی بر تعهد و پذیرش
• لوپوس77

موضوعات

• 1. فرایندهای روانشناختی و اجتماعی مرتبط با علائم بیماری ها

عنوان مقاله [English]

Comparing Effectiveness of Compassion and Acceptance and Commitment Interventions on Improving Psychological, Social, and Biological Indicators of Patients with SLE

نویسندگان [English]

• Minoo Irani ¹
• Hossein Zare ²
• ‌Mohammad Oraki ²
• Ezatallah Kordmirza Nikoozadeh ³
• Amin Rafieipoor ³

¹ Ph.D. Student, Department of Psychology, Payame Noor University, Tehran, Iran

² Professor, Department of Psychology, Payame Noor University, Tehran, Iran.

³ Associate Professor, Department of Psychology, Payame Noor University, Tehran, Iran

چکیده [English]

Objective: One of the autoimmune diseases is Systematic Lupus Erythematosus (SLLE) (Riaz et al., 2022). Lupus is a chronic autoimmune disease affecting multiple systems and organs at different times and incurring extensive damage to the patient (Chen et al., 2022). Lupus can affect various aspects of patients' lives and their psychological and physical health and lead to impairing their quality of life (Hanly et al., 2019). The study done by Wang et al. (2022) in a group of lupus patients reported that the majority of patients expressed problems such as feelings of depression, anxiety and psychological distress, stress and inability to accept changes in mental image. The results of the research by Hanley et al. (2022) indicated that lupus, with its effects on the central nervous system, brings about significant psychological distress and anxiety in such patients. By reviewing the research cases performed in this area, psychological interventions on this disease can improve the secondary disease relevant symptoms and even help with biological therapies for individuals (Irani et al. 2019, Nabi et al. 2020, Oreki et al. 2021). Consistent with psychological interventions, one of such interventions is compassion-focused therapy(CFT), which has appealed modern therapists for unique diseases (Rezaei et al. 2021). Another intervention run among the affected patients is acceptance and commitment therapy(ACT). The aspects under the influence of SLE, which are one of its most important aspects, are often overlooked and little research has been done on it, and considering domestic research, few studies have been conducted on psychological interventions in SLE suffering patients. Pursuant to the performed studies, the effectiveness of compassion-focused therapy in the patients with lupus has not been much studied. On the other hand, in the performed studies, the component of social acceptance in SLE patients has received less attention and improving social acceptance in such patients requires training. As a result, it seems that concentrating on the patient's own psychological issues (such as reducing or controlling stress, focusing on their self-care, and social acceptance) is one of the best treatment methods for the patient. Regarding the above stated statements, the current study was developed and implemented targeting to compare the effectiveness of acceptance and commitment-based therapy training and a compassion-focused therapy on enhancing the psychological, social and biological indicators in the patients with systematic lupus erythematosus(SLE) in public hospitals covered by Tehran University of Medical Sciences. Method: This study was applied in terms of goal and experimental in terms of method with a pre-and post-test design, a control group and a two-month follow-up. Once the research topic was selected and approved and the relevant code of ethics (IR.PNU.REC.1403. 666) and the due permits were granted by the authorities, 45 patients who referred to the hospital were interviewed with their consent, and this interview was held in a separate room for convenience and thanks to the relevant authorities. In the interview, all the conditions of the subjects were checked according to the pre-designed items and the relevant questionnaires were handed to them simultaneously for being completed. Next, the subjects were randomly assigned to three 15-person groups, including the experimental groups (the ACT and CFT training and the control group) by drawing lots. Subsequently, the subjects in the two experimental groups attended eight 90-minute sessions of acceptance and commitment therapy(ACT) and compassion-focused therapy(CFT), while the control group did not undergo training during the intervention and were merely in the consultation sessions with their therapist. Finally, all three experimental and control groups took the post-test. Results:  The results of one-way ANOVA in the psychological and social indicators in the two groups based on CFT and ACT indicated a statistically significant difference between the mean scores of post-test and considering the effect of time in the variables of depression (P<0.001, F=41.95, η²=0.666), anxiety (P<0.001, F=44.38, η²=0.679) and quality of life (P<0.001, F=110.342, η²=0.840). The results of one-way ANOVA with repeated measures in the psychological and social indicators in the two groups based on CFT and ACT revealed a statistically meaningful difference between the mean scores of post-test and considering the effect of time in the variables of depression (P<0.001, F=28.42, η²=0.668), anxiety (P<0.001, F=38.42, η²=0.759), and quality of life (P<0.001, F=35.124η²=0.856). pursuant to results of the Cochrane’s Q test, a tangible difference was observed between the three groups in terms of Antinuclear Antibody (ANA) Test immediately after the intervention (Mean rank = 1.83, p=0.0001). Conclusion: The present study was done to compare the effectiveness of acceptance and commitment-based therapy and compassion-focused therapy on enhancing the biological, psychological and social indicators in female patients with SLE in Tehran. The findings displayed that both training methods were effective in improving the psychological, social and biological indicators of women with lupus and no significant difference was reported between these two educational methods. Overall, it indicated that acceptance and commitment therapy and compassion-focused therapy were equally effective on the biological, psychological and social indicators of the SLE suffering women. This result can demonstrate the key role of interventions such as ACT-based and CFT in enhancing the biological, psychological and social indicators. This finding can be a basis for developing educational programs for the women with lupus and can also help psychologists and counselors to use this educational plan to promote women's health. Like any other research, this study has its own limitations, which include short-term follow-up of the effect of the implemented educational program, small sample size, data collection through questionnaires, and failure to hold a follow-up phase due to lack of access to patients living in different regions. Therefore, it is recommended to conduct follow-up periods to address the effect of this intervention during a long-term period and to add others.

کلیدواژه‌ها [English]

• Biological index, Psychological index, Social index
• Self-compassion-oriented training intervention
• acceptance-&commitment-based training intervention
• systematic lupus erythematous (SLE)
• women