Middle Eastern Journal of Disability Studies

fa مقایسهٔ اثربخشی درمان‎ فراشناختی و درمان هیجان‎مدار بر افسردگی، طرح‌واره‎های ناسازگار اولیه و عود در افراد مبتلا به اختلال افسردگی اساسی Comparing the Effectiveness of Metacognitive and Emotionally-Focused Therapies on Depression, Early Maladaptive Schemas, and Recurrence in People With Major Depressive Disorder روانشناسی Psychology مقاله پژوهشی اصیل Original Research Article چکیده زمینه و هدف: درمان&lrm;های&lrm; فراشناختی و هیجان&lrm;مدار از درمان&lrm;های مؤثر بر افسردگی هستند. پژوهش حاضر باهدف مقایسهٔ اثربخشی درمان&lrm;های&lrm; فراشناختی و هیجان&lrm;مدار بر افسردگی و طرح‌واره&lrm;های ناسازگار اولیه و عود در مبتلایان به اختلال افسردگی &lrm;اساسی انجام شد. روش‌بررسی: روش پژوهش، نیمه&lrm;آزمایشی با طرح پیش&lrm;آزمون و پس&lrm;آزمون و پیگیری سه&lrm;ماهه همراه با گروه گواه بود. جامعهٔ آماری را تمام افراد افسردهٔ اساسی مراجعه&lrm;کننده به کلینیک&lrm;ها و مراکز مشاوره و روان&lrm;درمانی شهرستان گچساران تشکیل دادند. از میان آن‌ها ۵۱ داوطلب واجد شرایط به‌شیوهٔ دردسترس وارد مطالعه شدند و با تخصیص تصادفی در دو گروه درمان و یک گروه گواه (هر گروه هفده&lrm; نفره) قرار گرفتند. ابزارهای پژوهش پرسش‌نامهٔ&lrm; افسردگی بک-نسخهٔ دوم (بک و همکاران، ۱۹۹۶)، مقیاس&lrm; دشواری در تنظیم هیجان (گراتز و رومر، ۲۰۰۴)، مقیاس&lrm; باورهای مثبت و منفی دربارهٔ نشخوار فکری (پاپاجرجیو و ولز، ۲۰۰۱) و فرم کوتاه پرسش‌نامهٔ طرح‌واره&lrm;های ناسازگار اولیهٔ یانگ (یانگ، ۱۹۹۸) بود. داده&lrm;ها بااستفاده از تحلیل&lrm; واریانس یک&lrm;طرفه، تحلیل &lrm;واریانس با اندازه&lrm;گیری &lrm;مکرر و آزمون تعقیبی بونفرونی در سطح &lrm;معنا&lrm;داری ۰٫۰۵ در نرم&lrm;افزار SPSS نسخهٔ ۲۱ تحلیل شدند. یافته&lrm;ها: در پس&lrm;آزمون و پیگیری، گروه&lrm;های درمان درمقایسه با گروه گواه در افسردگی بهبودی نشان&lrm; دادند (۰٫۰۰۱>p). همچنین، میزان بهبودی افسردگی در درمان هیجان&lrm;مدار درمقایسه با درمان&lrm; فراشناختی بیشتر و تفاوت معنادار بود (۰٫۰۰۱>p). در پس&lrm;آزمون، مداخلات گروه&lrm;های درمان در مقایسه با گروه گواه در کاهش طرح‌واره&lrm;ها به‌طور معناداری تأثیر داشت و میزان کاهش طرح‌واره&lrm;ها در درمان هیجان&lrm;مدار درمقایسه با درمان&lrm; فراشناختی بیشتر و تفاوت معنادار بود (۰٫۰۰۱>p). در پیگیری، درمان&lrm; فراشناختی (۰٫۰۰۲=p) و درمان هیجان&lrm;مدار (۰٫۰۰۱>p) درمقایسه با گروه گواه در کاهش طرح‌واره&lrm;ها به‌طور معناداری تأثیر داشت و میزان کاهش طرح‌واره&lrm;ها در درمان هیجان&lrm;مدار درمقایسه با درمان فراشناختی بیشتر و تفاوت معنادار بود (۰٫۰۰۱>p). نتیجه&lrm;گیری: درمان&lrm; فراشناختی و درمان&lrm; هیجان&lrm;مدار در بهبود افسردگی و کاهش طرح‌واره&lrm;های ناسازگار اولیه مؤثر است؛ اما اثربخشی درمان هیجان&lrm;مدار بیشتر است و درجهٔ&lrm; عود کمتری دارد. Abstract Background & Objectives: Major depressive disorder (MDD) is the classic condition within the group of mood disorders and is considered one of the most common psychiatric illnesses. In many cases, depression is a recurrent or chronic condition, and the presence of previous depressive episodes can predict future relapses. Improving the outcomes of depression treatment is highly important, as fewer than one–third of patients achieve remission after treatment, and the relapse rate is estimated to be 50% within 2 years. Given the moderate initial response to treatment and the high rate of relapse after therapy, there is a pressing need to develop treatments with more rapid and lasting effects. Metacognitive therapy of depression can be effective in treating depression by affecting metacognitive knowledge and metacognitive beliefs that feed rumination and cognitive–attentional syndrome, as well as emotionally–focused therapy by adjusting or changing emotions can affect patients' narratives. Therefore, the present study compared the effectiveness of metacognitive therapy and emotion–focused therapy on mood, early maladaptive schemas, and relapse in people with MDD. Methods: The current research design was quasi–experimental, with a pretest–posttest and 3–month follow–up, and a control group. The statistical population included all depressed people who referred to counseling and psychotherapy centers in Gachsaran City, Iran. Of whom, 51 eligible volunteer patients were randomly assigned to two intervention groups and one control group (17 people in each group) using a random number table. The experimental groups include the metacognitive therapy group and the emotionally–focused therapy group; each group had 17 people with symptoms and signs of MDD, and the control group was the same as the experimental groups and had signs and symptoms of MDD. The inclusion criteria for the subjects in the research were as follows: a minimum age of 18 years; at least having a third year of middle school (cycle); having diagnosed with MDD in a clinical interview by both a psychiatrist and a clinical psychologist; lacking any psychiatric diagnoses other than MDD, not using substance or dependence, not having immediate suicide risk or psychosis; no psychological disorders co–occurring with MDD; and no specific medical disorders, such as hypothyroidism, hyperthyroidism, or other medical conditions that cause major psychological symptoms and signs. Exclusion criteria for the research subjects were unwillingness to continue cooperating at any stage of the study and use of any other psychotherapy or counseling services during the study. In this research, metacognitive therapy for depression was performed in eight 45–minute sessions, and emotionally–focused therapy in eight 1–hour sessions. The research tools include the Beck Depression Inventory–II (Beck et al., 1996), the Difficulty Emotion Regulation Scale (Gratz & Roemer, 2004), the Positive metacognitive Beliefs Scale (Papageorgiou &Wells, 2001), the Positive and Negative Beliefs about Rumination Scales (Papageorgiou & Wells, 2001), and the Young Schemas Questionnaire–Short Form (Young, 1998). They were implanted in all sample subjects under almost identical, controlled conditions during the pretest, posttest, and 3–month follow–up. The data were analyzed using 1–way analysis of variance, repeated–measures analysis of variance, and the Bonferroni post hoc test at a significance level of 0.05 using SPSS software version 21. Results: At posttest and follow–up, the treatment groups (metacognitive therapy and emotionally–focused therapy) showed improvement in depressive symptoms and signs compared with the control group (p<0.001). Also, the improvement in depressive symptoms and signs was greater in emotionally–focused therapy compared to metacognitive therapy, and the difference was significant (p<0.001). At posttest, the interventions of the treatment groups had a significant effect on reducing early maladaptive schemas compared to the control group. The reduction in early maladaptive schemas in emotionally–focused therapy was greater than in metacognitive therapy, and the difference was significant (p<0.001). At follow–up, metacognitive therapy (p=0.002) and emotionally–focused therapy (p<0.001) had a significant effect on reducing early maladaptive schemas compared to the control group, and the reduction in early maladaptive schemas in emotionally–focused therapy was greater than in metacognitive therapy, with the difference significant (p<0.001). Conclusion: The results show that metacognitive and emotionally–focused therapies reduce the signs and symptoms of depression and early maladaptive schemas. However, the emotionally–focused therapy showed a greater reduction and a lower degree of relapse than metacognitive therapy. درمان فراشناختی, درمان هیجان‎مدار, طرح‌واره‎های ناسازگار اولیه, اختلال افسردگی اساسی Metacognitive therapy, Emotionally–focused therapy, Early maladaptive schemas, Major depressive disorder 121 121 http://jdisabilstud.org/browse.php?a_code=A-12-3520-1&slc_lang=fa&sid=1 Abouzar Fattahiasl ابوذر فتاحی اصل abouzar2009@gmail.com 100319475328460068639 100319475328460068639 Yes PhD Student, Department of Clinical Psychology, Shiraz University, Shiraz, Iran Abdolaziz Aflakseir عبدالعزیز افلاک سیر aaflakseir@shirazu.ac.ir 100319475328460068640 100319475328460068640 No Associate Professor, Department of Clinical Psychology, Shiraz University, Shiraz, Iran Norallah Mohammadi نوراله محمدی nmohamadi@shirazu.ac.ir 100319475328460068641 100319475328460068641 No Professor, Department of Clinical Psychology, Shiraz University, Shiraz, Iran Javad Molazadeh جواد ملازاده molazade@shirazu.ac.ar 100319475328460068642 100319475328460068642 No Associate Professor, Department of Clinical Psychology, Shiraz University, Shiraz, Iran