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

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
  1. Sadock, B.J., H.I. Kaplan, and V.A. Sadock, Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. 2007: Lippincott Williams & Wilkins.##
  2. Abramowitz JS, Taylor S, McKay D. Obsessive-compulsive disorder. The Lancet. 2009;374(9688):491-9##
  3. Pallanti S. Transcultural observations of obsessive-compulsive disorder. American Journal of Psychiatry. 2008 Feb;165(2):169-70.##
  4. Pigott TA. Obsessive compulsive disorder: Symptom overview and epidemiology. Bulletin of the Menninger clinic. 1998 Oct 1;62(4).##
  5.  Torres AR, Prince MJ, Bebbington PE, Bhugra DK., Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. Am J Psychiatry, 2006. 163(11): p. 1978-85.##
  6. Bland, R.C., S.C. Newman, and H. Orn, Period prevalence of psychiatric disorders in Edmonton. Acta Psychiatr Scand Suppl, 1988. 338(S338): p. 33-42.##
  7. Tenney NH, Denys DA, van Megen HJ, Glas G, Westenberg HG., Effect of a pharmacological intervention on quality of life in patients with obsessive-compulsive disorder. Int Clin Psychopharmacol, 2003. 18(1): p. 29-33.##
  8. rino, R., T. Slade, and G. Andrews, The changing prevalence and severity of obsessive-compulsive disorder criteria from DSM-III to DSM-IV. Am J Psychiatry, 2005. 162(5): p. 876-82.##
  9. Hollander E, Greenwald S, Neville D, Johnson J, Hornig CD,. Weissman MM., Uncomplicated and comorbid obsessive-compulsive disorder in an epidemiologic sample. Depress Anxiety, 1996. 4(3): p. 111-9.##
  10. Huppert, J.D., Simpson, H.B., Nissenson, K.J., Liebowitz, M.R., Foa, E.., Quality of life and functional impairment in obsessive–compulsive disorder: A comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depression and Anxiety, 2009. 26(1): p. 39-45.##
  11. Denys, D., H. Van Megen, and H. Westenberg, The adequacy of pharmacotherapy in outpatients with obsessive-compulsive disorder. Int Clin Psychopharmacol, 2002. 17(3): p. 109-14.##
  12. Flavell, J.H., Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry. American psychologist, 1979. 34(10): p. 906.##
  13. Wells, A. and G. Matthews, Attention and emotion: A clinical perspective. 1994: Psychology Press.##
  14. Wells, A. and G. Matthews, Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther, 1996. 34(11-12): p. 881-8.##
  15. Wells, A., Advances in Metacognitive Therapy. International Journal of Cognitive Therapy, 2013. 6(2): p. 186-201.##
  16. Normann, N., A.A. van Emmerik, and N. Morina, The efficacy of metacognitive therapy for anxiety and depression: a meta-analytic review. Depress Anxiety, 2014. 31(5): p. 402-11.##
  17. Rees, C.S. and R.A. Anderson, A review of metacognition in psychological models of obsessive–compulsive disorder. Clinical Psychologist, 2013. 17(1): p. 1-8.##
  18. Rees, C.S. and K.E. van Koesveld, An open trial of group metacognitive therapy for obsessive-compulsive disorder. J Behav Ther Exp Psychiatry, 2008. 39(4): p. 451-8.##
  19. Shareh, H., Gharraee B, Atef-Vahid M, Eftekhar M, Metacognitive therapy (MCT), fluvoxamine, and combined treatment in improving obsessive-compulsive, depressive and anxiety symptoms in patients with obsessive-compulsive disorder (OCD). Iranian Journal of Psychiatry and Behavioral Sciences, 2010. 4(2): p. 17-25.##
  20. Myers, S.G., Fisher, P.L., and Wells.,  , An empirical test of the metacognitive model of obsessive-compulsive symptoms: Fusion beliefs, beliefs about rituals, and stop signals. Journal of anxiety disorders, 2009. 23(4): p. 436-442.##
  21. Moritz, S., Jelinek, L., Hauschildt, M., Naber, L.., How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive-compulsive disorder. Dialogues in clinical neuroscience, 2010. 12(2): p. 209.##
  22. Irak, M. and A. Tosun, Exploring the role of metacognition in obsessive--compulsive and anxiety symptoms. J Anxiety Disord, 2008. 22(8): p. 1316-25.##
  23. Fisher, P.L., Obsessive Compulsive Disorder: A Comparison of CBT and the Metacognitive Approach. International Journal of Cognitive Therapy, 2009. 2(2): p. 107-122.##
  24. Fisher, P.L. and A. Wells, Metacognitive therapy for obsessive-compulsive disorder: a case series. J Behav Ther Exp Psychiatry, 2008. 39(2): p. 117-32.##
  25. Fitt, S. and C. Rees, Metacognitive Therapy for Obsessive Compulsive Disorder By Videoconference: A Preliminary Study. Behaviour Change, 2012. 29(4): p. 213-229.##
  26. Andouz Z, Dolatshahi B, Moshtagh N, Dadkhah A., et al., The efficacy of metacognitive therapy on patients suffering from pure obsession. Iranian journal of psychiatry, 2012. 7(1): p. 11.##
  27. Simons, M., S. Schneider, and B. Herpertz-Dahlmann, Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder. A case series with randomized allocation. Psychother Psychosom, 2006. 75(4): p. 257-64.##
  28. Simons, M., Thinking Differently–Metacognitive Therapy for Children and Adolescents with Obsessive-Compulsive Disorder: A Treatment Plan. Verhaltenstherapie, 2012. 22: p. 000-000.##
  29. Hutton, P., Taylor, P. J., Morrison, A. P, Metacognitive therapy in treatment-resistant psychosis: a multiple-baseline study. Behav Cogn Psychother, 2014. 42(2): p. 166-85.##
  30. Papageorgiou, C. and A. Wells, Group Metacognitive Therapy for Severe Antidepressant and CBT Resistant Depression: A Baseline-Controlled Trial. Cognitive Therapy and Research, 2014: p. 1-9.##
  31. Bennett, H. and A. Wells, Metacognition, memory disorganization and rumination in posttraumatic stress symptoms. J Anxiety Disord, 2010. 24(3): p. 318-25.##
  32. Maher-Edwards L.M., Fernie, B.A., Murphy, G., Wells, A., Spada., Metacognitions and negative emotions as predictors of symptom severity in chronic fatigue syndrome. Journal of Psychosomatic Research, 2011. 70(4): p. 311-317.##
  33. Solanto MV, Marks DJ, Mitchell K, Wasserstein J, Kofman MD., Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry, 2010. 167(8): p. 958-68.##
  34. Solanto, M.V., Mark, D. J., Mitchee, K. J., Wasserstein, J., & Kofman, M. D, Development of a new psychosocial treatment for adult ADHD. J Atten Disord, 2008. 11(6): p. 728-36.##
  35. Bailey, R. and A. Wells, Metacognitive Therapy in the Treatment of Hypochondriasis: A Systematic Case Series. Cognitive Therapy and Research, 2014. 38(5): p. 541-550.##
  36. Hayes, S.C., Single case experimental design and empirical clinical practice. J Consult Clin Psychol, 1981. 49(2): p. 193-211.##
  37. Wells, A., Metacognitive therapy for anxiety and depression. 2011: Guilford press.##
  38. First, MB., Gibbon M, Spitzer RL, Williams, JBW, Benjamin LS., Structured Clinical Interview for DSM-IV Axis I Disorders Research Version (SCID-I). New York, New York State Psychiatric Institute. Biometrics Research, 1996.##
  39. Sharifi, V., Assadi, SM., Mohammadi, MR., Amini, H., Kaviani, H., Semnani, Y., Shabani, A, Reliability and feasibility of the Persian version of the structured diagnostic interview for DSM-IV (SCID). Advances in cognitive science, 2004.##
  40. Dabson, K.,Mohammadkhani, p, Psychometric characteristics of beck depression inventory–II in patients with major depressive disorder. Journal of rehabilitation, 2007.##
  41. Organization, W.H. and W.H. Organization, Whodas II disability assessment schedule. 2001, Geneva: WHO.##
  42. Gold, L.H., DSM-5 and the Assessment of Functioning: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Journal of the American Academy of Psychiatry and the Law Online, 2014. 42(2): p. 173-181.##
  43. Rajezi Esfahani, S., Motaghipour, Y., Kamkari, K., Zahiredin, A., Janbozorgi, M., Reliability and Validity of the Persian Version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Iranian journal of psychiatry and clinical psychology, 2012. 17(4): p. 297-303.##
  44. Shirinzadeh Dastgiri, S., S. nateghian, and M. Goodarzi, comparison of thought-action fusion beliefs among patients with obsessive-compulsive disorder, generalized anxiety disorder and normal people. Psychological Research 2010. 12(3&4)(97-111).##
  45. Barlow, D.H.N., Hersen M. ., Single case experimental designs: Strategies for studying behavior for change. 2009.##
  46. Ogles, B.M., K.M. Lunnen, and K. Bonesteel, Clinical significance: History, application, and current practice. Clinical psychology review, 2001. 21(3): p. 421-446.##
  47. Normann, N., A.A. Emmerik, And N. Morina, The Efficacy Of Metacognitive Therapy For Anxiety And Depression: A Meta‐Analytic Review. Depression And Anxiety, 2014. 31(5): P. 402-411.##
  48. Association, A.P., DSM 5. 2013: American Psychiatric Association.##
  49. Farris, S.G., McLean, CP., Van Meter, PE., Simpson, HB., Foa, EB, Treatment response, symptom remission and wellness in obsessive-compulsive disorder. The Journal of clinical psychiatry, 2013. 74(7): p. 685.##
  50. Raffin, A.L., Guimaraes JM, Ferrao YA, Predictors of response to group cognitive-behavioral therapy in the treatment of obsessive-compulsive disorder. European Psychiatry, 2009. 24(5): p. 297-306.##
  51. Irak, M. and A. Tosun, Exploring the role of metacognition in obsessive–compulsive and anxiety symptoms. Journal of anxiety disorders, 2008. 22(8): p. 1316-1325.##
  52. Solem, S.,  Haland, A.T., Vogel, P.A., Hansen, B. and Wells, A, Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention. Behaviour research and therapy, 2009. 47(4): p. 301-307.##
  53. Ghasempour, A., Akbari A., IL-Beigi R. and Hasanzadeh Sh , Predicting Obsessive-Compulsive Disorder on the Basis of Emotion Regulation and Anxiety Sensitivity. Zahedan Journal of Research in Medical Sciences, 2013. 15(2): p. 94-97.##
  54. Briñol, P., R.E. Petty, and D.D. Rucker, The role of meta-cognitive processes in emotional intelligence. Psicothema, 2006. 18(Suplemento): p. 26-33.##
  55. Wells, A., Metacognitive Theory and Therapy for Worry and Generalized Anxiety Disorder: Review and Status. Journal of Experimental Psychopathology, 2010. 1(1): p. 133-145.##