اثربخشی درمان شناختی مبتنی بر مدل داگاس بر بهبود تحمل نکردن بلاتکلیفی، اجتناب شناختی و باورهای مثبت در مورد نگرانی در بیماران مبتلا به اختلال اضطراب منتشر

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری، دانشکده علوم تربیتی و روانشناسی، دانشگاه اصفهان، اصفهان، ایران

2 استاد، دانشکده علوم تربیتی و روانشناسی، دانشگاه اصفهان، اصفهان، ایران

3 استادیار، دانشکده علوم تربیتی و روانشناسی، دانشگاه اصفهان، اصفهان، ایران

چکیده

زمینه و هدف: نگرانی یک مؤلفه بنیادین شناختی اختلال اضطراب منتشر (GAD) ‌است. GAD اختلالی مزمن است اما مطالعات اندکی در خصوص متغیرهای سبب‌شناختی این اختلال صورت گرفته است. پژوهش حاضر، در پی بررسی اثربخشی درمان شناختی داگاس بر تحمل نکردن بلاتکلیفی، اجتناب شناختی و باورهای مثبت در مورد نگرانی در GAD بود.
مواد و روش‌ها: پژوهش حاضر، مطالعه نیمه‌آزمایشی همراه با گروه کنترل است. جامعه آماری شامل کلیه افراد مبتلا به GAD مراجعه‌کننده به مراکز مشاوره شهر اصفهان بودند. نمونه آماری پژوهش ۳۰ نفر بودند که به‌صورت نمونه‌گیری در دسترس و داوطلبانه انتخاب و به‌صورت تصادفی در گروه آزمایش (۱۵ نفر) و گروه کنترل (۱۵ نفر) قرار گرفتند. تأیید تشخیص GAD براساس مصاحبه بالینی ساختاریافته DSM-5(SCID-5-CV) و تشخیص بالینی انجام شد. برای سنجش در پیش‌آزمون، پس‌آزمون و پیگیری از مقیاس نداشتن تحمل بلاتکلیفی، پرسش‌نامه اجتناب شناختی و پرسش‌نامه چرا نگرانی استفاده شد. مداخله در قالب ۱۲ جلسه ۹۰ دقیقه‌ای انجام شد. به‌منظور تحلیل داده‌ها از آزمون تحلیل واریانس با اندازه‌گیری مکرر (مختلط) استفاده شد.  
یافته‌ها: نتایج نشان داد که درمان شناختی داگاس باعث کاهش معنادار نمرات میانگین علائم GAD گروه آزمایش در مقایسه با گروه کنترل شد.
نتیجه‌گیری: یافته‌های پژوهش نشان می‌دهند که شناخت‌درمانی داگاس بر تحمل نکردن بلاتکلیفی، اجتناب شناختی و باورهای مثبت در مورد نگرانی، تأثر مثبتی داشته و موجب کاهش علائم شده ‌است (0/05>P). این درمان می‌تواند یکی از گزینه‌های مؤثر در کاهش علائم GAD در کنار سایر مداخلات دارویی باشد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Effectiveness of Dugas’ Cognitive Therapy on Intolerance of Uncertainty, Cognitive Avoidance and Positive Believes about Worry in Generalized Anxiety Disorder

نویسندگان [English]

  • Seyed Mohammad Davud Hosseini 1
  • shole amiri 2
  • Koroush Namdari 3
  • Hossein Molavi 2
1 Phd Student, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
2 Professor, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
3 Assistant Professor, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
چکیده [English]

Introduction: Objectives Worry is a fundamental cognitive component of Generalized Anxiety Disorder (GAD). GAD is a chronic disorder. However, few studies have been conducted on the etiologic variables of this disorder. The present study sought to investigate the effectiveness of Dugas’ cognitive therapy on Intolerance of uncertainty, cognitive avoidance, and positive beliefs about worry.
Materials and Methods: This study was a semi-experimental study with control group. The statistical population included all people with GAD referred to Isfahan counseling centers. The statistical sample of the study was 30 people who were selected by convenient sampling and were randomly assigned to the experimental group (15) and the control group (15). Diagnosis of GAD was performed based on a structured clinical interview with DSM-5 (SCID-5-CV) and clinical diagnosis. For measuring pre-test, post-test and follow-up, the questionnaire of intolerance of uncertainty, cognitive avoidance questionnaire, and why-worry questionnaire were used. The intervention was completed in the form of 12 sessions of 90 minutes. To analyze the data, repeated variance analysis (mixed) was used.
Results: The results showed that Dugas’ cognitive therapy significantly reduced the mean scores of GAD symptoms in the experimental group compared to the control group.
Conclusion: The findings of this research indicate that Dugas’ cognitive therapy has had a positive effect on the intolerance of uncertainty, cognitive avoidance and positive beliefs about worry and reduced symptoms (P<0/05). This treatment can be one of the effective ways to reduce the symptoms of GAD along with other drug interventions.

کلیدواژه‌ها [English]

  • Dugas’ Cognitive Therapy
  • intolerance of uncertainty
  • Cognitive Avoidance
  • Positive believes about worry
  • GAD
  1. Perez-Pinar M, Ayerbe L, Gonzalez E, Mathur R, Foguet-Boreu Q, Ayis S. Anxiety disorders and risk of stroke: A systematic review and meta-analysis. European Psychiatry J.2017; 41: 102–108.
  2. Kelly K, Mezuk B. Predictors of remission from generalized anxiety disorder and major depressive disorder. J Affective Disorders. 2017; 208: 467–474.
  3. Sadock B J, Sadock V A, Ruiz P. Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. Oxford: Oxford University Press. (11th ed); 2014.
  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: Washington DC: American Psychiatric Association. (5th ed); 2016.
  5. Hearn C S, Donovan CL, Spence SH, March S. A worrying trend in social anxiety: to what degree are worry and its cognitive factors associated with youth social anxiety disorder? J Affective Disorder. 2017; 208: 33-40.
  6. Skodzik T, Leopold A, Ehring T. Effects of a training in mental imagery on worry: A proof of principal study. J Anxiety Disorders. 2016; 45: 24-33.
  7. Hearn C S, Donovan CL, Spence SH, March S, Holmes M. What’s the worry with social anxiety? Comparing cognitive processes in children with generalized anxiety disorder and social anxiety disorder. Child Psychiatry and Human Development. 2016; 5:5-12.
  8. Lader M. Generalized anxiety disorder. Encyclopedia Psychopharmacology. Berlin, Heidelberg: Springer. 2015.
  9. Hoge E A, Bui E, Marques L, Metcalf C A, Morris L K, Robinaugh D J, et al. Randomized Controlled Trial of Mindfulness Meditation for Generalized Anxiety Disorder: Effects on Anxiety and Stress Reactivity. J Clinical Psychiatry.2013; 74(8): 786–792.
  10. Richards D, Richardson T, Timulak L, McElvaney J.The efficacy of internet-delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis. J Internet Interventions. 2015; 2: 272-282.
  11. Sharafati H, Taheri E, Asmaimajd S, Amiri M. The efficacy of cognitive therapy based on Dugas’ model on intolerance of uncertainty, cognitive avoidance and positive believes about worry in patients suffering from Generalized Anxiety Disorder. J Clinical psychology. 2017; 9(2): 15-27. [Persian]
  12. Borza, L. Cognitive-behavioral therapy for generalized anxiety. Dialogues Clinical Neuroscience.2017; 19(2), 203–208.
  13. 13-Gentes E L, Rusico A M. Perceptions of functioning in worry and generalized anxiety disorder. J Cognitive Therapy and Research.2014; 38(5): 518-529.
  14. Bhat N. A, Hassan R, Shafiq M, & Sheikh S. Sociodemographic factors: A major predictor of anxiety and depression among pregnant women. Delhi Psychiatry Journal. 2015; 1, 86-94.
  15. Llera S J, Newman MG. Rethinking the role of worry in generalized anxiety disorder: Evidence supporting a model of emotional contrast avoidance.  J Behavior Therapy. 2014; 45(3): 283-229.
  16. Dugas M. J, Brillon P, Savard P, Turcotte J, Gaudet A, Ladouceur R, Leblanc R, Gervais J. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behavior Therapy.2010; 41(1), 46–58.
  17. Bruce S. E, Yonkers K. A, Otto M. W, Eisen J. L, Weisberg R. B, Pagano M, Shea M. T, Keller M. B. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. American Journal of Psychiatry.2014; 162, 11-79.
  18. Dugas M J, Freeston M H, Ladouceur R. Intolerance of uncertainty and problem orientation in worry. J Cognitive Therapy Research. 2010; 21: 593-606.
  19. Michael B, First M D, Janet B W, Williams D, Rhonda S, Robert L, et al. Structured Clinical Interview for DSM-5: Disorders—Clinician Version (SCID-5-CV). Arlington: American Psychiatric Association. 2016.
  20. Khaleghi M, Mohammad Khani Sh, Hassani J. The effectiveness of Emotive Schema therapy on decrease of worry, signs and symptoms of anxiety among patints with GAD: case study. Journal of Clinical Psychology. 2016; 8(2), 43-55. [Persian].
  21. Bomyeaa J, Ramsawhb H, Ballc T. M, Taylora C. T, Paulusad M. P, Langae A. J, Stein M. B. Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder. Journal of Anxiety Disorders.2015; 33, 90-94.
  22. Aviram A, Westra H. A, Constantino M. J, & Antony M. M. Responsive management of early resistance in cognitive–behavioral therapy for generalized anxiety disorder. Journal of Consulting and Clinical Psychology. 2016; 84(9), 783-794.
  23. Ghamkhar Z, Bakhtiari M, Tahmasebian K, Torabi Mazrae Maleki N, Amrollahi Nia M. The Effectiveness of cognitive-behavioral group therapy on increase of perceived anxiety control among 11-13 years old girls with GAD. Journal of psychological Studies. 2015; 11(1), 29-50. [Persian].
  24. Buhr K, Dugas MJ. Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry. J Anxiety Disorder. 2006; (20): 222-236.
  25. Hamidpour H, Akbari M, Andooz Z, The psychometric properties of the scale of intolerance Negative orientation to the problem, (WWQ-II) Why worry questionnaire-2, (IUS) dilemmas. (PSWQ) AND Penn State Worry Questionnaire (CAQ) Inventory cognitive avoidance. 2009. [Persian].
  26. Sekston KA, Dugas MJ. An investigation of the factors leading to cognitive avoidance in worry. Poster presented at the Annual Convention of the Association for Advancement of Behavior Therapy, New Orleans. 2004.
  27. Holowka DW, Dugas MJ, Francis K, Laugesen N. Measuring beliefs about worry: A psychometric evaluation of the worry-II Questionnaire. Poster presented at the annual convention of the Association for Advancement of Behavior Therapy, New Orleans.2000.  
دوره 28، شماره 5
آذر و دی 1400
صفحه 700-712
  • تاریخ دریافت: 20 شهریور 1397
  • تاریخ بازنگری: 30 شهریور 1398
  • تاریخ پذیرش: 31 شهریور 1398
  • تاریخ اولین انتشار: 17 مهر 1400