اثربخشی درمان شناختی رفتاری متمرکز بر اندیشناکی و شناخت درمانی مبتنی بر ذهن‌آگاهی بر علائم خلقی/ اضطرابی و اندیشناکی نوجوانان افسرده اقدام کننده به خودکشی

پژوهش های روان شناسی بالینی و مشاوره

مقاله 4، دوره 10، شماره 2 - شماره پیاپی 20، اسفند 1399، صفحه 65-88   

نوع مقاله: مقاله پژوهشی

شناسه دیجیتال (DOI): 10.22067/tpccp.2021.67390.1001

نویسندگان

هادی ایزانلو¹؛ فاطمه شهابی زاده^{* 2}؛ سید کاوه حجت³؛ سید عبدالمجید بحرینیان⁴

¹دانشجوی دکتری روانشناسی بالینی/ واحد بیرجند، دانشگاه آزاد اسلامی. بیرجند، ایران.

²دانشیار گروه روانشناسی/ واحد بیرجند، دانشگاه آزاد اسلامی، بیرجند، ایران.

³دانشیار روانپزشکی،گروه روانشناسی/ واحد بیرجند، دانشگاه آزاد اسلامی، بیرجند، ایران. دانشگاه علوم پزشکی مشهد، مرکز تحقیقات روانپزشکی

⁴استاد روانشناسی بالینی، گروه روانشناسی/ واحد بیرجند، دانشگاه آزاد اسلامی، بیرجند، ایران

چکیده

هدف: افسردگی در بین نوجوانان در حال افزایش است و می‌تواند به صورت چشمگیری عملکردها را مختل کند؛ لذا، هدف از این پژوهش بررسی اثر بخشی درمان شناختی رفتاری مبتنی بر اندیشناکی در مقابل درمان شناختی مبتنی بر ذهن آگاهی بر علائم خلقی/ اضطرابی و اندیشناکی نوجوانان افسرده اقدام کننده به خودکشی است.
روش: سی نوجوان دختر نوجوان افسرده که با مشکل اقدام به خودکشی به واحد اورژانس از اول آبان تا 15 اسفند 1398 مراجعه کرده بودند به روش هدفمند و پس از داشتن ملاک‌های شمول وارد پژوهش شدند و پرسشنامه‌ها تکمیل شدند. شرکت‌کنندگان پس از انتخاب به صورت تصادفی در دو گروه آزمایش و گروه کنترل (10 نفری) تقسیم شدند. یک گروه درمان شناختی رفتاری مبتنی بر اندیشناکی و گروه دیگر درمان شناختی مبتنی بر ذهن آگاهی در ده جلسه انفرادی دریافت کردند. ابزارهای پژوهش مقیاس افسردگی بک-2، مقیاس پاسخ نشخواری، مقیاس تشخیصی علائم خلقی و اضطرابی  و پرسشنامه اضطراب بک  بودند. جهت تحلیل داده‌ها از تحلیل واریانس تک و چند متغیره با اندازه‌گیری مکرر و نسخه 25 نرم افزار SPSS استفاده شد.
یافته‌ها: هر دو مداخله اثر معنی دار ی بر کاهش نشانه های خلقی/ اضطراب و اندیشناکی داشته است و در طول دوره پیگیری دو ماهه نیز پایدار بوده است.

کلیدواژه‌ها

شناختی رفتاری؛ اندیشناکی؛ شناخت درمانی؛ ذهن‌آگاهی؛ افسردگی؛ علائم خلقی و اضطرابی؛ بلاتکلیفی؛ تحمل ابهام

مراجع

Assumpcao, A. A., Pena, C. S., Neufeld, C. B., & Teodoro, M. M. (2019). Mindfulness-based cognitive therapy for University students with depression, anxiety, and stress symptoms: a randomized controlled trial. Asia Pacific Journal of Clinical Trials: Nervous System Diseases, 4(3), 51-59.

Bagherinezhad, M., Salehi Fadardi, J., & Tabatabaee, S. M. (2010). Relationship between rumination and depression in a sample ofiranian students. The Journal of Educational Psychology, 11(1), 21-38.(in Persian)

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893-897.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Bessette, K. L., Jacobs, R. H., Heleniak, C., Peters, A. T., Welsh, R. C., Watkins, E. R., & Langenecker, S. A. (2020). Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial. Public Library of Science one, 15(6), 1-24. e0233539.

Carballo, J., Llorente, C., Kehrmann, L., Flamarique, I., Zuddas, A., Purper-Ouakil, D., . . . Dittmann, R. (2019). Psychosocial risk factors for suicidality in children and adolescents. European Child & Adolescent Psychiatry, 29, 759-776.

Chen, X., Pu, J., Shi, W., & Zhou, Y. (2020). The impact of neuroticism on symptoms of anxiety and depression in elderly adults: The mediating role of rumination. Current Psychology, 39(1), 42-50.

Chesin, M. S., Benjamin-Phillips, C. A., Keilp, J., Fertuck, E. A., Brodsky, B. S., & Stanley, B. (2016). Improvements in executive attention, rumination, cognitive reactivity, and mindfulness among high–suicide risk patients participating in adjunct mindfulness-based cognitive therapy: Preliminary findings. The journal of alternative and complementary medicine, 22(8), 642-649.

Cook, L., & Watkins, E. (2016). Guided, internet-based, rumination-focused cognitive behavioural therapy (i-RFCBT) versus a no-intervention control to prevent depression in high-ruminating young adults, along with an adjunct assessment of the feasibility of unguided i-RFCBT, in the REducing Stress and Preventing Depression trial (RESPOND): study protocol for a phase III randomised controlled trial. Trials, 17(1), 1-11.

Farb, N., Anderson, A., Ravindran, A., Hawley, L., Irving, J., Mancuso, E., . . . Segal, Z. V. (2018). Prevention of relapse/recurrence in major depressive disorder with either mindfulness-based cognitive therapy or cognitive therapy. Journal of Consulting and Clinical Psychology, 86(2), 200-204.

Fata, L., Birashk, B., Atefvahid, M., & Dabson, K. (2005). Meaning assignment structures/schema, emotional states and cognitive processing of emotional information: comparing two conceptual frameworks. Iranian journal of psychiatry and clinical psychology, 11(3), 312-326. (in Persian)

Feldhaus, C. G., Jacobs, R. H., Watkins, E. R., Peters, A. T., Bessette, K. L., & Langenecker, S. A. (2020). Rumination-Focused Cognitive Behavioral Therapy Decreases Anxiety and Increases Behavioral Activation Among Remitted Adolescents. Journal of Child and Family Studies, 29, 1982-1991.

First, M. B., Williams, J. B. W., Benjamin, L. S., & Spitzer, R. L. (2016). Structured Clinical Interview for DSM-5 Disorders, Clinical Version (Scid-5-CV) (T. Shadloo, S. Karimian, & B. Shadloo, Trans.). Tehran: Ebnesina.

Fortuna, L. R., Porche, M. V., & Padilla, A. (2018). A treatment development study of a cognitive and mindfulness‐based therapy for adolescents with co‐occurring post‐traumatic stress and substance use disorder. Psychology and Psychotherapy: Theory, Research and Practice, 91(1), 42-62.

Frostadottir, A. D., & Dorjee, D. (2019). Effects of mindfulness based cognitive therapy (MBCT) and compassion focused therapy (CFT) on symptom change, mindfulness, self-compassion, and rumination in clients with depression, anxiety, and stress. Frontiers in psychology, 10, 1-11.

Gallego, J., Aguilar-Parra, J. M., Cangas, A. J., Langer, Á. I., & Mañas, I. (2014). Effect of a mindfulness program on stress, anxiety and depression in university students. The Spanish journal of psychology, 17(109), 1-6.

Garnefski, N., & Kraaij, V. (2018). Specificity of relations between adolescents’ cognitive emotion regulation strategies and symptoms of depression and anxiety. Cognition and Emotion, 32(7), 1401-1408.

Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Kearney, D. J., & Simpson, T. L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis. Cognitive behaviour therapy, 48(6), 445-462.

Heininga, V. E., Dejonckheere, E., Houben, M., Obbels, J., Sienaert, P., Leroy, B., van Roy J, Kuppens P. (2019). The dynamical signature of anhedonia in major depressive disorder: positive emotion dynamics, reactivity, and recovery. BMC psychiatry, 19(1), 1-11.

Hvenegaard, M., Moeller, S. B., Poulsen, S., Gondan, M., Grafton, B., Austin, S. F., Kistrup, M., Rosenberg, NG., Howard, H., Watkins, E. R. (2020). Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial. Psychological Medicine, 50(1), 11-19.

Izadi Dehnavi, S., Yaghobi, H., Heydari Nasab, L., & Montshloo, S. (2016). Psychometric Properties of the Transdiagnostic Mood and Anxiety Symptoms Questionnaire MASQ-D30 in a Sample of Iranian Population. Health Breeze, 4(3), 1-6. (in Persian)

Jury, T. K., & Jose, P. E. (2019). Does Rumination Function as a Longitudinal Mediator Between Mindfulness and Depression? Mindfulness, 10(6), 1091-1104.

Khansa, W., Haddad, C., Hallit, R., Akel, M., Obeid, S., Haddad, G., Soufia, M., Kheir, N., Abi Elias Hallit, C., Khoury, R., Salameh P. (2019). Interaction between anxiety and depression on suicidal ideation, quality of life, and work productivity impairment: Results from a representative sample of the Lebanese population. Perspectives in psychiatric care. 56(2):270-279.

Kuringe, E., Materu, J., Nyato, D., Majani, E., Ngeni, F., Shao, A., Mjungu, D., Mtenga, B., Nnko, S., Kipingili, T., Mongi, A. (2019). Prevalence and correlates of depression and anxiety symptoms among out-of-school adolescent girls and young women in Tanzania: A cross-sectional study. Public Library of Science one, 14(8), 1-22. e0221053.

Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., Hayes, R., Huijbers, M., Ma, H., Schweizer, S., Segal, Z. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials. JAMA psychiatry, 73(6), 565-574.

Law, K. C., & Tucker, R. P. (2018). Repetitive negative thinking and suicide: a burgeoning literature with need for further exploration. Current opinion in psychology, 22, 68-72.

Lim, G. Y., Tam, W. W., Lu, Y., Ho, C. S., Zhang, M. W., & Ho, R. C. (2018). Prevalence of depression in the community from 30 countries between 1994 and 2014. Scientific reports, 8(1), 1-10.

Luoma, J. B., & Villatte, J. L. (2012). Mindfulness in the treatment of suicidal individuals. Cognitive and behavioral practice, 19(2), 265-276.

MacKenzie, M. B., & Kocovski, N. L. (2016). Mindfulness-based cognitive therapy for depression: trends and developments. Psychology research and behavior management, 9, 125-132.

Mullarkey, M. C., Marchetti, I., & Beevers, C. G. (2019). Using network analysis to identify central symptoms of adolescent depression. Journal of Clinical Child & Adolescent Psychology, 48(4), 656-668.

Parmentier, F. B., García-Toro, M., García-Campayo, J., Yañez, A. M., Andrés, P., & Gili, M. (2019). Mindfulness and symptoms of depression and anxiety in the general population: The mediating roles of worry, rumination, reappraisal and suppression. Frontiers in psychology, 10, 1-10. E506.

Rogers, M. L., & Joiner, T. E. (2017). Rumination, suicidal ideation, and suicide attempts: A meta-analytic review. Review of General Psychology, 21(2), 132-142.

Sado, M., Park, S., Ninomiya, A., Sato, Y., Fujisawa, D., Shirahase, J., & Mimura, M. (2018). Feasibility study of mindfulness-based cognitive therapy for anxiety disorders in a Japanese setting. BMC Research Notes, 11(1), 1-7.

Sarmad, Z., Bazargan, A., & Hejazi, E. (2014). Research methods in behavioral science. Tehran: Agah. (In Persian)

Segal, Z. V., Dimidjian, S., Beck, A., Boggs, J. M., Vanderkruik, R., Metcalf, C. A., Gallop, R., Felder, J.N., Levy, J. (2020). Outcomes of online mindfulness-based cognitive therapy for patients with residual depressive symptoms: a randomized clinical trial. JAMA psychiatry, 77(6), 563-573.

Segal, Z. V., Williams, M., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for depression. New York, NY: Guilford Publications.

Sharaf, A. Y., Lachine, O. A., & Thompson, E. A. (2018). Rumination, social problem solving and suicide intent among Egyptians with a recent suicide attempt. Archives of psychiatric nursing, 32(1), 86-92.

Sharifi, V., Asadi, S. M., Mohammadi, M. R., Amini, H., Kaviani, H., Semnani, Y., Shabanikia, A., Shahrivar, Z., Davari Ashtiani, R., Hakim Shoushtari, M., Sedigh, A. (2004). Reliability and feasibility of the Persian version of the structured diagnostic interview for DSM-IV (SCID). Advances in cognitive science, 6(1), 10-22. (In Persian)

Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. The Lancet, 379(9820), 1056-1067.

Topper, M., Emmelkamp, P. M., Watkins, E., & Ehring, T. (2017). Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: A randomized controlled trial. Behaviour research and therapy, 90, 123-136.

Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247-259.

Tabachnick, B. G., Fidell, L. S., & Ullman, J. B. (2007). Using multivariate statistics (Vol. 5, pp. 481-498). Boston, MA: Pearson.

Uhl, K., Halpern, L. F., Tam, C., Fox, J. K., & Ryan, J. L. (2019). Relations of emotion regulation, negative and positive affect to anxiety and depression in middle childhood. Journal of Child and Family Studies, 28(11), 2988-2999.

Van Droogenbroeck, F., Spruyt, B., & Keppens, G. (2018). Gender differences in mental health problems among adolescents and the role of social support: results from the Belgian health interview surveys 2008 and 2013. BMC psychiatry, 18(1), 1-6.

Volkaert, B., Wante, L., Van Beveren, M.-L., Vervoort, L., & Braet, C. (2019). Training Adaptive Emotion Regulation Skills in Early Adolescents: The Effects of Distraction, Acceptance, Cognitive Reappraisal, and Problem Solving. Cognitive Therapy and Research, 44(3), 678-897.

Wardenaar, K. J., van Veen, T., Giltay, E. J., de Beurs, E., Penninx, B. W., & Zitman, F. G. (2010). Development and validation of a 30-item short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ). Psychiatry research, 179(1), 101-106.

Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression (E. Eshtad, Trans.). Tehran: Ebnesina.

Yapan, S., Türkçapar, M. H., & Boysan, M. (2020). Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety. Current Psychology, 1-17.

Zhang, Z., Zhang, L., Zhang, G., Jin, J., & Zheng, Z. (2018). The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis. BMC psychiatry, 18(1), 1-14.

Zuzama, N., Fiol-Veny, A., Roman-Juan, J., & Balle, M. (2020). Emotion Regulation Style and Daily Rumination: Potential Mediators between Affect and Both Depression and Anxiety during Adolescence. International Journal of Environmental Research and Public Health, 17(18), 6614.