اثربخشی درمان مبتنی بر ذهنی‌سازی بر نشخوارهای فکری و نگرانی بیماران دارای اختلال اضطراب فراگیر

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری تخصصی روان شناسی بالینی، دانشکده علوم انسانی، واحد بیرجند، دانشگاه آزاد اسلامی، بیرجند، ایران

2 گروه روانشناسی بالینی، دانشکده علوم انسانی، واحد بیرجند، دانشگاه آزاد اسلامی، بیرجند، ایران

3 گروه روانشناسی، دانشکده علوم انسانی، واحد بیرجند، دانشگاه آزاد اسلامی، بیرجند، ایران

10.22034/jmpr.2024.62065.6255

چکیده

پژوهش حاضر با هدف بررسی اثربخشی درمان مبتنی بر ذهنی‌­سازی بر نشخوارهای فکری و نگرانی بیماران دارای اختلال اضطراب فراگیر انجام گرفت. پژوهش حاضر کاربردی، از نوع نیمه‌آزمایشی با طرح پیش‌آزمون- پس‌آزمون با گروه گواه و دوره پیگیری دوماهه بود. جامعه آماری شامل بیماران دارای اختلال اضطراب فراگیر مراجعه‌کننده به مراکز مشاوره منطقه یک شهر تهران در سه ماهه پاییز سال 1402 بودند. در این پژوهش تعداد 34 فرد دارای اختلال اضطراب فراگیر با روش نمونه‌گیری هدفمند انتخاب و با شیوه تصادفی در گروه‌های آزمایش و گواه جای‌دهی شدند (17 نفر در گروه آزمایش و 17 نفر در گروه گواه). بیماران حاضر در گروه آزمایش درمان مبتنی بر ذهنی­سازی را طی هشت هفته در هشت جلسه 90 دقیقه‌ای دریافت نمودند. در این پژوهش از پرسشنامه اختلال اضطراب فراگیر (GADQ)، پرسشنامه نشخوارهای فکری (RQ) و پرسشنامه نگرانی ایالتی پنسیلوانیا (PSWQ) استفاده شد. داده‌ها با تحلیل واریانس آمیخته با استفاده از نرم‌افزار آماری SPSS23 تجزیه و تحلیل شد. نتایج نشان داد که درمان مبتنی بر ذهنی‌­سازی بر نشخوارهای فکری (0/001>P؛ 0/62=Eta؛ 52/19=F) و نگرانی (0/001>P؛ 0/58=Eta؛ 45/23=F) بیماران دارای اختلال اضطراب فراگیر تأثیر معنادار دارد. بر اساس یافته‌های حاصل از پژوهش حاضر، درمان مبتنی بر ذهنی­‌سازی با بهره‌گیری از آموزش مهارت‌ها و نگرش‌های بهنجار، تقویت انعطاف‌پذیری و مقابله با استرس، افزایش ظرفیت ارتباطی، پذیرا بودن نسبت به دیدگاه دیگران و ایجاد ذهنیت موفق می‌تواند به عنوان درمانی کارآمد در جهت کاهش نشخوارهای فکری و نگرانی بیماران دارای اختلال اضطراب فراگیر مورد استفاده قرار داد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

The Effectiveness of Mentalization-Based Treatment on Rumination and Worry of Patients with Generalized Anxiety Disorder

نویسندگان [English]

  • Elham Farahani 1
  • Seyed Abdolmajid Bahrainian 2
  • Maryam Nasri 3
  • Fatemeh Shahbizadeh 3
1 PhD student in Clinical Psychology, Faculty of Humanities, Birjand Branch, Islamic Azad University, Birjand, Iran
2 Department of Clinical Psychology, Faculty of Humanities, Birjand Branch, Islamic Azad University, Birjand, Iran
3 Department of Psychology, Faculty of Humanities, Birjand Branch, Islamic Azad University, Birjand, Iran
چکیده [English]

The present study was conducted to investigate the effectiveness of mentalization-based treatment on rumination and worry of patients with Generalized anxiety disorder. The current study was a semi-experimental application with a pre-test-post-test design with a control group and a two-month follow-up period. The statistical population included patients with Generalized anxiety disorder who referred to the counseling centers of district one of Tehran in the Fall quarter of 2023. In this research, 34 patients with Generalized anxiety disorder were selected by purposive sampling and randomly assigned to experimental and control groups (17 people in the experimental group and 17 people in the control group). The people in the experimental group received mentalization-based treatment during eightweeks in eight 90-minute sessions. General Anxiety Disorder Questionnaire (GADQ), Rumination Questionnaire (RQ) and Penn State Worry Questionnaire (PSWQ) were used in the present study. The data were analyzed through mixed ANOVA via SPSS23 software. The results showed that treatment based on mentalization has significant effect on the rumination (p<0.001, Eta=0.62, F=52.19) and worry (p<0.001, Eta= 0.58, F=45.23) of patients with Generalized anxiety disorder. According to the findings of the present study, mentalization-based treatment can be used as an efficient method to decrease rumination and worry of patients with Generalized anxiety disorder through employing techniques such focusing on the teaching normal skills and attitudes, strengthening flexibility and dealing with stress, increasing communication capacity, being receptive to others' points of view, and creating a successful mindset.

کلیدواژه‌ها [English]

  • generalized anxiety disorder
  • rumination
  • mentalization-based treatment
  • worry
Abolghasemi, A., Lotfibakhsh, R., Taherifard, M. (2020). The Comparison of Emotion Regulation Strategies, Worry, Meta Mood and Cognitive Failures in Individual with and without Generalized Anxiety Disorder. Quarterly Journal of Psychological Studies, 16(2), 91-108. (In Persian)  10.22051/psy.2020.26678.1951
Aghayousefi, A., Kharbo, A., & Hatami, H. (2015). the role of rumination on psychological well-being and anxiety the spouses' cancer patients. Quarterly Journal of Health Psychology, 4(14), 79-97. (In Persian) 20.1001.1.23221283.1394.4.14.6.0
 Basharpoor, S., Einy, S. (2020).  The Effectiveness of Mentalization-Based Therapy on Emotional Dysregulation and Impulsivity in Veterans with Post-Traumatic Stress Disorder. The Neuroscience Journal of Shefaye Khatam, 8(3), 10-19. 10.29252/shefa.8.3.10
Batman, P., Fonagy, P. (2016). Mentalization-based treatment for personality disorders. 1 st ed. United Kingdom: Oxford University Press.
Bleiberg, E. (2013). Mentalizing-Based Treatment with Adolescents and Families. Child and Adolescent Psychiatric Clinics, 22, 295–330. 10.1016/j.chc.2013.01.001
Chen, D., Ying, J., Liu, S., Xu, Z., Wu, H., Zhou, X., You, J. (2023). The protective effects of meaning in life on the relationships between attachment anxiety, rumination, and nonsuicidal self-injury: A moderated mediation model. Children and Youth Services Review, 155, 1072-1077. https://doi.org/10.1016/j.childyouth.2023.107277
Connolly, S.L., Alloy, L.B. (2017). Rumination interacts with life stress to predict depressive symptoms: An ecological momentary assessment study. Behaviour Research and Therapy, 97, 86-95. https://doi.org/10.1016/j.brat.2017.07.006
Donohue, H.E., Modini, M., Abbott, M.J. (2024). Psychological interventions for pre-event and post-event rumination in social anxiety: A systematic review and meta-analysis. Journal of Anxiety Disorders, 102, 1028-1033. https://doi.org/10.1016/j.janxdis.2023.102823
Ghaderi, F., Akrami, N., NAmdari, K., Abedi, A. (2022). Comparing the Effects of Integrated Cognitive-Behavioral Therapy and Transdiagnostic Treatment on Symptoms of Patients with Generalized Anxiety Disorder Comorbid with Depression. Iranian Journal of Psychiatry and Clinical Psychology, 27(4), 440-457. http://dx.doi.org/10.32598/ijpcp.27.4.3067.3
Goenka, A., Yu, S.G., Chikkannaiah, M., George, M.C., MacDonald, S., Stolfi, A., Kumar, G. (2022). Generalized Anxiety Disorder: A Predictor for Poor Responsiveness to Botulinum Toxin Type A Therapy for Pediatric Migraine. Pediatric Neurology, 130, 21-27. https://doi.org/10.1016/j.pediatrneurol.2022.02.002
Hajmohammadhoseani, T., Mirzahosini, H., Zargham, M. (2021).  Comparison of the effectiveness of mentalization and Affect phobia therapy treatment in reducing the symptoms of borderline personality disorder. Scientific Journal of Social Psychology, 61(9), 133-148. 10.22038/mjms.2021.19026
Hallion, L.S., Steinman, S.A., Kusmierski, S.N. (2018). Difficulty concentrating in generalized anxiety disorder: An evaluation of incremental utility and relationship to worry. Journal of anxiety disorders, 53(1), 39-45 https://doi.org/10.1016/j.janxdis.2017.10.007
Herring, M.P., Rasmussen, C.L., McDowell, C.P., Gordon, B.R., Kenny, R.A., Laird, E. (2024). Physical activity dose for generalized anxiety disorder & worry: Results from the Irish longitudinal study on ageing. Psychiatry Research, 332, 1157-1162. https://doi.org/10.1016/j.psychres.2024.115723
Jørgensen, M.S., Storebø, O.J., Bo, S., Poulsen, S., Gondan, M., Beck, E., Chanen, A.M., Bateman, A., Pedersen, J., Simonsen, E. (2021). Mentalization-based treatment in groups for adolescents with Borderline Personality Disorder: 3- and 12-month follow-up of a randomized controlled trial. European Children and Adolescent Psychiatry, 30, 699–710. https://doi.org/10.1007/s00787-020-01551-2
Karimi, F., Farahbakhsh, K., Salimi bajestani, H., Motamedi, A. (2020). The Effectiveness of Mentalization Based Therapy (MBT-A) on Increasing the Quality of Family Relationships and Reducing Self harm in Adolescent Girls. Journal of Sabzevar University of Medical Sciences, 27(2), 257-265. (In Perian) https://jsums.medsab.ac.ir/article_1295.html?lang=en
Lavender, S.R., Waters, C.S., Hobson, C.W. (2023). The efficacy of group delivered mentalization-based parenting interventions: A systematic review of the literature. Clinical Child Psychology and Psychiatry, 28(2), 1171-1175. https://doi.org/10.1177/13591045221113392
Lieberman, M.D. (2017). Social cognitive neuroscience: A review of core processes. Annul Review Psychology, 58, 259-289. https://doi.org/10.1146/annurev.psych.58.110405.085654
Liu, J., Peh, P., Simard, S., Griva, K., Mahendran, R.(2018). Beyond the fear that lingers: The interaction between fear of cancer recurrence and rumination in relation to depression and anxiety symptoms. Journal of Psychosomatic Research, 111, 120-126. https://doi.org/10.1146/annurev.psych.58.110405.085654
Malberg, N.T. (2021). Working with Autistic Children and their Families from a Mentalization Based Therapy for Children (MBT-C) Approach. Psychoanalytic Perspectives, 18(1), 22-42. https://doi.org/10.1080/1551806X.2021.1845033
Meyer, T.J., Miller, M.L., Metzger, R.L., Borkovec, T.D. (1990). Development and validation of the Penn State Worry Questionnaire. Behavior Research and Therapy, 28(6), 487-495 https://doi.org/10.1016/0005-7967(90)90135-6
Mohammadi, I., Tajeri, B., Sodager, SH., Bahrami Heidaji, M., Atadokht, A. (2020). The Effect of Mentalization-Based Therapy on the Amount of Health Promoting Behaviors in People with Coronary Heart Disease. The Neuroscience Journal of Shefaye Khatam, 8(3), 39-48. 10.29252/shefa.8.3.39
Mori, M., & Tanno, Y. (2015). Mediating role of de-centering in the associations between self-reflec-tion, self-rumination, and depressive symptoms. Psychology, 6, 613-621. 10.4236/psych.2015.65059 
Newman, M.G., Llera, S.J (2014). Rethinking the role of worry in generalized anxiety disorder: Evidence supporting a model of emotional contrast avoidance. Behavior Therapy, 45(3), 283-299. https://doi.org/10.1016/j.beth.2013.12.011
Nilsson, J., Sigström, R., Östling, S., Waern, M., and Skoog, I. (2019). Changes in the expression of worries, anxiety, and generalized anxiety disorder with increasing age: A population study of 70 to 85 year olds. International Journal of Geriatric Psychiatry, 34(2), 249-257. https://doi.org/10.1002/gps.5012
Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61, 115-121. https://doi.org/10.1037/0022-3514.61.1.115
Nolen-Hoeksema, S., Wisco, E.B., Lyubomirsky, S. (2008). Rethinking rumination. Journal of Perspectives on Psychological Science, 3(5), 400-424. https://doi.org/10.1111/j.1745-6924.2008.00088.x
Oliveira, C.D., Rahioui, H., Smadja, M., Gorsane, M.A., Louppe, F. (2016). Mentalization based treatment and borderline personality disorder. L’Encéphale, 43(4), 340-345. https://doi.org/10.1016/j.encep.2016.02.020
Ozisik, G.G., Kiraz, S. (2023). Evaluation of retinal thickness measured by optical coherence tomography in patients with generalized anxiety disorder. Photodiagnosis and Photodynamic Therapy, 44, 1037-1041. https://doi.org/10.1016/j.pdpdt.2023.103766
Pawluk, E.J., Koerner, N., Kuo, J.R., Antony, M.M. (2021). An experience sampling investigation of emotion and worry in patients with Generalized anxiety disorder. Journal of Anxiety Disorders, 84, 1024-1028. https://doi.org/10.1016/j.janxdis.2021.102478
Pischiutta, L., Garzitto, M., Zamparutti, G., Moratti, E., Albert, U., Colizzi, M., Balestrieri, M. (2023). Mentalization in young patients undergoing opioid agonist treatment: Implications for clinical management. Addictive Behaviors Reports, 17, 1004-1009. https://doi.org/10.1016/j.abrep.2023.100497
Plag, J., Schmidt-Hellinger, P., Klippstein, T., Mumm, J.L.M., Wolfarth, B., Petzold, M.B., Ströhle, A. (2020). Working out the worries: A randomized controlled trial of high intensity interval training in generalized anxiety disorder. Journal of Anxiety Disorders, 76, 1023-1028. https://doi.org/10.1016/j.janxdis.2020.102311
Polnay, A., McIntosh, L.G., Burnett, A., Williams, A., Cahill, C., Wilkinson, P., Mohammad, F., Patrick, J. (2021). Examining the factor structure, reliability, and validity of the main outcome measure used in mentalization-based therapy skills training. Health Science Reports, 4(1), 245-254.  https://doi.org/10.1002/hsr2.245
Porta-Casteràs, D., Fullana, M.A., Tinoco, D., Martínez-Zalacaín, I., Pujol, J., Palao, D.J., Soriano-Mas, C., Harrison, B.J., Via, E., Cardoner, N. (2020). Prefrontal-amygdala connectivity in trait anxiety and generalized anxiety disorder: Testing the boundaries between healthy and pathological worries. Journal of Affective Disorders, 267, 211-219. https://doi.org/10.1016/j.jad.2020.02.029
Pour, H,. Mansouri, A. (2021). The mediating role of worry and rumination in the relationship between behavioral brain systems and generalized anxiety disorder in students. Journal of Clinical Psychology and Personality, 19(1), 121-130. 10.22070/cpap.2020.3047
Probst, G.H., Wolf, M., Vîslă, A., Flückiger, C. (2024). How resilient are former CBT patients with generalized anxiety disorder in times of COVID-19? A follow-up study considering post-treatment depressive symptoms. Journal of Affective Disorders Reports, 15, 1007-1011. https://doi.org/10.1016/j.jadr.2023.100701
Rosen, F.N., LaFreniere, L.S. (2023). Savoring, worry, and positive emotion duration in generalized anxiety disorder: Assessment and interventional experiment. Journal of Anxiety Disorders, 97, 1027-1032. https://doi.org/10.1016/j.janxdis.2023.102724
Rubel, J., Väth, T., Hanraths, S., Pruessner, L., Timm, C., Hartmann, S., Barnow, S., Lalk, C. (2024). Evaluation of an online-based self-help program for patients with generalized anxiety disorder - A randomized controlled trial. Internet Interventions, 35, 1007-1010. https://doi.org/10.1016/j.invent.2024.100716
Sadr, A., Doustkam, M., Shareh, H., Bolghanabadi, M. (2021). Comparison of Effectiveness of Transdiagnostic and Emotion Regulation Therapy in the Rumination and Emotional Regulation on People with Generalized Anxiety Disorder (single-subject study). J Neyshabur Univirsity Medicine Science, 9(4), 42-59. (In Persian) http://journal.nums.ac.ir/article-1-963-fa.html
Simonsen, S., Popolo, R., Juul, S., Frandsen, F.W., Sørensen, P., Dimaggio, G. (2021). Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment: A Pilot Study. The Journal of Nervous and Mental Disease, 26, 213-219. 10.1097/NMD.0000000000001432
Smits, M.L., Feenstra, D.J., Blankers, M., Kamphuis, J.H., Bales, D.L., Dekker, J.J.M., Verheul, R., Busschbach, J.J.V., Luyten, P. (2024). Impact of clinical severity on treatment response in a randomized controlled trial comparing day hospital and intensive outpatient mentalization-based treatment for borderline personality disorder. Personality and Mental Health, 18(1), 1932-1937.  https://doi.org/10.1002/pmh.1603
Spitzer, R.L., Kroenke, K., Williams, J. B., Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-1097. 10.1001/archinte.166.10.1092
Steinmair, D., Horn, R., Richter, F., Wong, G., Löffler-Stastka, H. (2021). Mind reading improvements in mentalization-based therapy training. Bulletin of the Menninger Clinic, 85(1), 128-133. https://doi.org/10.1521/bumc.2021.85.1.59
Tahmasebiashtiani, E., Vatankhah Amjad, F., karimgholipour, N., Soleimani, H. (2022). The effectiveness of mentalization-based therapy on insecure attachment, fear of intimacy and suicidal ideation in people with major depressive disorder. Iranian Journal of Psychiatric Nursing, 10(2), 85-97. (In Persian)  http://ijpn.ir/article-1-1975-fa.html
Xiao, H., Shen, Y., Zhang, W., Lin, R. (2023). Applicability of the cognitive model of generalized anxiety disorder to adolescents’ sleep quality: A cross-sectional and longitudinal analysis. International Journal of Clinical and Health Psychology, 23(4), 1004-1008. https://doi.org/10.1016/j.ijchp.2023.100406