Middle Eastern Journal of Disability Studies

fa تأثیر حساسیت‌زدایی چشم و پردازش مجدد (EMDR) بر رضایت از تصویر بدنی و عزت‌نفس در افراد قطع‌عضوشدهٔ مبتلا به درد عضو خیالی Effect of Eye Movement Desensitization and Reprocessing on Body Image Satisfaction and Self-Esteem in Amputees with Phantom Limb Pain روانشناسی Psychology مقاله پژوهشی اصیل Original Research Article زمینه و هدف: «درد عضو خیالی»، ماهیتی شایع و مبهم دارد و باور به داشتن ساختار معیوب ابعاد مهم عزت‌نفس و تصویر بدنی را در افراد قطع ‌عضو شده تحت‌ تأثیر قرار می‌دهد. در حالیکه درمان‌های دارویی و فیزیکی، اغلب با اثربخشی موقت و عود دوباره همراه هستند، روان‌درمانی، نتایج پایاتری را در پی داشته است. هدف پژوهش حاضر تعیین اثر درمان «حساسیت‌زدایی منظّم چشم و پردازش مجدّد» بر شدّت درد، تصویر بدنی و عزت‌نفس در بیماران مبتلا به درد عضو خیالی بود. روش بررسی: در این مطالعهٔ نیمه ‌آزمایشی که در سال ۹۵-۱۳۹۴ در سازمان جمعیت هلال احمر استان تهران انجام شد، با استفاده از روش نمونه‌گیریِ قضاوتی، از بین ۴۷ بیمار قطع ‌عضو شده، ۲۶ نفر از نظر ابتلا به درد عضو خیالی غربال شده و به روش جای‌گماریِ تصادفی به دو گروه «مداخله» (۱۳نفر) و «کنترل» (۱۳نفر) اختصاص یافتند؛ سپس به‌وسیلهٔ ابزار عزت‌نفس روزنبرگ (RSE)، روابط چند بُعدی خود-بدن (MBSRQ) و پرسش‌نامهٔ درد مک‌گیل (SF-MPQ) مورد سنجش قرار گرفتند. همچنین از آزمون‌های تحلیل کوواریانس چند متغیره، هم‌بستگی پیرسون و هم‌بستگی پاره‌ای استفاده شد. یافته‌ها: نتایج آنالیز کوواریانس نشان داد که تفاوت نمرهٔ پیش‌آزمون و پس‌آزمون بین دو گروه مداخله و کنترل در سه حیطهٔ درد (۰٫۰۰۱>p)، عزت‌نفس (۰٫۰۰۱>p)، و تصویر تَن (۰٫۰۰۱>p) معنادار است. نتایج، نشان‌دهندهٔ کاهش معنادار درد و افزایش عزت‌نفس و رضایت از تصویر بدنی می‌باشد. نتیجه‌گیری: درمان «حسّاسیّت‌زدایی منظّم چشم و پردازش مجدّد» قادر است درد عضو خیالی را کاهش داده و از طریق بی‌اعتبار کردن شناخت‌های ناکارآمد پیرامون نقص عضو، تصوّر فرد از نقص و نازیبایی بدنش را تعدیل کند و عزت‌نفس فرد را ارتقا دهد. Background: Limb amputation is often an inevitable procedure in the advanced condition of various diseases, which may result in trauma or infection with a dramatic impact on a patient’s life. After the physical loss of a limb, patients experience several limitations. Limp amputation disturbs the integrity of the human body and causes low self-esteem due to reduced mobility and pain. Central nervous system changes seem to be the major determinant of phantom-limb pain, though psychological factors may influence the outcome. The two main aspects of one’s perception of his/her appearance are body image and self-esteem. The importance of the concepts of body image and self-esteem lies in the fact that a person feels that his or her body image will affect interactions, playing a significant role in his/her social and interpersonal relationships. A new therapy that emerged independently of neuroscience, though it coheres well with the kind of approach implied by neuroscience, is Eye Movement Desensitization and Reprocessing (EMDR). In this method, change is driven by a combination of bottom-up sensory stimulation and top-down attention processes and cognitive reevaluation. The aim of this study was to investigate the effect of systematic desensitization and reprocessing on pain, body image and self-esteem in amputees with phantom limb pain. Materials & Methods: This quasi-experimental study was conducted in 2015 and 2016 in Iranian Red Crescent Society - Tehran Province. The participants were recruited through purposive sampling. A total of 47 amputees who suffered from phantom limb pain were selected initially, of whom 39 patients were judged to meet the inclusion criteria.  Yet, only 26 patients continued to participate in the research project up to the final assessment phase. In order to protect the participants’ rights, the participants were asked for a written consent for participating in the research project.  Then, using the random placement method, the researchers assigned half of the participants to the EMDR condition (N=13), namely, intervention group, while the rest were assigned to the control group (N=13). The EMDR method was applied for each patient individually at consultation room of Technical orthopedic clinic (Arsham Teb Clinic in Tehran) during weekly 90 minute sessions for ten weeks. The dependent variables included the results of pain intensity tests, body image and self-esteem, which were measured in the intervention and control groups in similar and double-blind conditions. Psychological questionnaires including revised scale in Body-Self Relations Questionnaire (MBSRQ), the Rosenberg Self-esteem (RSE) & Mc-Gill Pain Questionnaire (SF-MPQ-2) were administered to the patients. The intervention group was treated for 10 sessions (90 minutes each session) with Eye movement Desensitization and Reprocessing (EMDR), while the control group received only the Treatment-As-Usual (TAU), namely, talk therapy. Various statistical tests including partial correlation and MANCOVA were utilized. Results: Covariance analysis results indicated that the pre-test and post-test difference score among the two intervention and control groups in three areas of pain (F=177.2  and p<0.001), self-esteem (F=24.54  and p<0.001) and self-image (F=199.01  and p<0.001) is statistically significant. The results indicate a significant decrease in pain and increase in self-esteem and body image satisfaction. Pearson correlation was used to investigate the relationship between the variables under investigation by sub-criteria (P <0.001) to find out whether the relationship between the variables of self-esteem and body image is directive or it is caused by influence of pain variable. The partial correlation between self-esteem scores and body image after the removal of pain  showed that after omitting the effect of phantom pain, EMDR  was statistically significant correlated with self-esteem and body image in two subscales, namely, Appearance Orientation and Fitness Orientation (p<0.05). However, EMDR  was not statistically significant  correlated the other four subscales, namely, Appearance Evaluation, Fitness Evaluation, Body Areas Satisfaction Scale, Self-classified Weight). The results suggest that the relationship between the above mentioned variables is due to pain reduction. Conclusion: The obtained results revealed that Eye Movement Desensitization and Reprocessing reduced phantom limb pain in amputated patients. Besides, it was revealed that it was an effective therapy for improving self-esteem and body image. Therefore, its use as a therapeutic and alleviative method could be suggested for patients suffering from phantom limb pain. Unexpectedly, the partial correlation results showed this treatment does not have any direct effect on self-esteem and body image. To sum up, by reducing dysfunctional cognition about disability and amputation, EMDR therapy can also reduce phantom limb pain and perception of defects and dissatisfaction of body while enhancing self-esteem. Yet, in the absence of pain reduction, it is not effective on some self-image dimensions. حساسیت‌زدایی منظّم چشم و پردازش مجدد, درد عضو خیالی, عزت‌نفس, تصویر بدنی Eye Movement Desensitization Reprocessing, Phantom limb pain, Body image, Self esteem. 1 1 http://jdisabilstud.org/browse.php?a_code=A-10-606-2&slc_lang=fa&sid=1 Sara Namjoo سارا نامجو namjoopsy@gmail.com 100319475328460026504 100319475328460026504 Yes Karaj branch, Islamic Azad University دانشگاه آزاد اسلامی، واحد کرج Hasan Ahadi حسن احدی ahadi@at.ac.ir 100319475328460026505 100319475328460026505 No Allameh Tabataba’i University دانشگاه علامه طباطبایی Ahmad Borjali احمد برجعلی a.borjali@gmail.com 100319475328460026506 100319475328460026506 No Allameh Tabataba’i University دانشگاه علامه طباطبایی Mohamadreza Seirafi محمد رضا صیرفی seirafi-moh@gmail.com 100319475328460026507 100319475328460026507 No Karaj Branch, Islamic Azad University دانشگاه آزاد اسلامی، واحد کرج