کاربرد فراشناخت درمانی در کاهش نشانه‌ها و افزایش سطح عملکرد در اختلال وسواس – اجبار مقاوم به درمان دارویی: مطالعه موردی

نوع مقاله: گزارش مورد

نویسندگان

1 دکتری روانشناسی بالینی، مرکز تحقیقات علوم رفتاری دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

2 دکتری روانشناسی بالینی، استادیار دانشگاه شاهد، تهران، ایران.

3 دکتری روانشناسی بالینی، استادیار دانشگاه علوم پزشکی ایران، تهران، ایران

4 دکتری روانشناسی بالینی، استادیار دانشگاه شاهد ، تهران، ایران

5 استاد گروه روانپزشکی، مرکز تحقیقات علوم رفتاری دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

6 استادیار گروه روانپزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

7 کارشناس ارشد روانشناسی، مرکز تحقیقات علوم رفتاری دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

10.22037/jrm.2016.1100168

چکیده

مقدمه و اهداف
نسبت معناداری از افرادی‌که گرفتار به اختلال وسواس– اجبار هستند به درمان‌های دارویی و روان‌شناختی معمول پاسخ نمی‌دهند. خلأ درمانی موجود باعث مزمن شدن بیماری و افزایش میزان ناتوانی بیماران در انجام اعمال اجتماعی، شغلی و افزایش هزینه‌های تحمیل‌شده به جامعه می‌گردد. هدف از مطا‌‌لعه حاضر، ارزیابی نقش مدل فراشناختی ولز در کاهش نشانه‌ها و توان‌بخشی بیماران گرفتار به اختلال وسواس– اجبار است.
مواد و روش‌ها
مطالعه حاضر، یک بررسی تک موردی آزمایشی ۱۰ جلسه‌ای روی یک بیمار پیچیده مقاوم به درمان دارویی با پیگیری یک، سه و شش‌ماهه است. ابزار مورد استفاده مصاحبه بالینی نیمه ساختاریافته تشخیصی برای اختلالات-TR  DSM-IV، مقیاس وسواس- اجبار ییل براون، مقیاس افسردگی بک دو، مقیاس آشفتگی ذهنی، پرسشنامه فراشناخت ولز و برنامه ناتوانی عملکرد سازمان بهداشت جهانی است. برای تحلیل داده‌ها از روش ترسیم نمودار و محاسبه نرخ بهبودی استفاده شد.
یافته‌ها:
نمرات آزمودنی به ترتیب در پیش‌آزمون و پس‌آزمون در مقیاس شدت براون از ۳۶ به ۸ کاهش یافت (نرخ بهبودی: ۷۷%). هم‌چنین میزان افسردگی، آشفتگی ذهنی و ضعف عملکرد بیمار کاهش معناداری داشتند.
بحث و نتیجه‌گیری
برابر نتایج این پژوهش، درمان فراشناختی که به نحوه پاسخگویی فرد به افکارش و شکل ارتباط با آن‌ها تأکید دارد، می‌تواند یک برنامه درمانی جایگزین برنامه‌های قبلی در نظرگرفته شود که موجب تغییرات معناداری در نشانه‌های بیماران می‌شود و فواید درمانی آن تا مرحله پیگیری ادامه می‌یابد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Meta-Cognitive Therapy in Drug-Resistant Patients with Obsessive - Compulsive Disorder: Case Report

نویسندگان [English]

  • Sepideh Rajeziesfahani 1
  • Ladan Fata 2
  • HamidReza Hassanabadi 3
  • Hamid Yaghuobi 4
  • Alireza Zahiroddin 5
  • SeyedSaeid Sadr 6
  • Noiloofar Mahdavi 6
  • Simasadat Noorbakhsh 7
1 PhD in Clinical Psychology, Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Assistant Professor, Iran University of Medical Sciences, Tehran, Iran.
3 Assistant Professor Kharazmi University, Tehran, Iran
4 Assistant Professor, Shahed University, Tehran, Iran
5 Professor of Psychiatry, Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
6 Assistant professor, Psychiatry Ward, Shahid Beheshti University of Medical Sciences, Tehran, Iran
7 7. MSc, Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Introduction and Aim: A significant ratio of people who suffer from Obsessive-Compulsive Disorder (OCD) do not respond well to common drugs and psychological treatments. The treatment gap increases the chronicity of the disorder and develops morbidity in social functioning, employment, and costs imposed to society. The purpose of the present study was to assess the role of Wells' metacognitive model in reducing OCD symptoms and rehabilitation in the patients.
Materials and Methods: The current study is a single case study carried out in 10 sessions on a drug-resistant patient with one, three, and six month follow-ups. The tools were Structured Clinical Interview (SCID-I), Yale Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Scale (BDI-II), the Scale of Mental Distress (SUDs), Metacognition Questionnaire (MCQ-30), and World Health Organization's Disability Scale (WHODAS 2.0). To analyze the data, diagrams were used and the rate of recovery was calculated.
Results: Test scores, from pre-test to post-test for (Y-BOCS) intensity scale was reduced from 36 to 8 (recovery rate: 77%). Also, the rate of depression, mental distress, and disability of patient had a significant reduction.
Conclusion: The meta-cognitive therapy which insists on the form of thoughts and the relationship with intrusions can be an alternative choice for drug-resistant patients with OCD and they will benefit from its therapeutic effects even in the follow-up stages.

کلیدواژه‌ها [English]

  • Obsessive-Compulsive Disorder (OCD)
  • Metacognition
  • depression
  • Rehabilitation
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