مقايسهٔ اثربخشي درمان‌هاي تحريك جدار جمجمه‌اي با جريان مستقيم (tDCS) و شناختي-رفتاري (CBT) بر ولع مصرف و اضطراب در افراد داراي اضافه‌وزن

Comparing the Effects of Transcranial Direct Current Stimulation and Cognitive-Behavioral Therapy on Craving and Anxiety in Overweight Individuals

زمينه‌ و ‌‌هدف: يكي از انواع اختلالات رواني كه باعث مصرف بي‌رويهٔ مواد غذايي و درنتيجه ايجاد چاقي در بيماران مي‌شود، ولع مصرف مواد غذايي است. هدف از پژوهش حاضر مقايسهٔ اثربخشي درمان‌ تحريك با جريان مستقيم ازطريق جمجمه (tDCS) و درمان شناختي-رفتاري (CBT) بر ولع مصرف و اضطراب در افراد داراي اضافه‌وزن بود. روش‌بررسي: روش پژوهش آزمايشي با طرح پيش‌آزمون-پس‌آزمون با گروه گواه بود. جامعهٔ آماري پژوهش تمامي افراد داراي اضافه‌ وزن مراجعه‌كننده به مركز روان‌شناسي آرامش تهران در سال 1398 بودند كه ابتدا تعداد 36 نفر از افراد داوطلب واجد شرايط وارد مطالعه شدند. سپس در دو گروه آزمايش و يك‌گروه گواه (هر گروه 12 نفر) به‌صورت تصادفي قرار گرفتند. به‌منظور گردآوري اطلاعات از پرسشنامه‌هاي ولع مصرف مواد غذايي (كپدا-بنيتو و همكاران، 2000) و سياههٔ اضطراب بك (استير و بك، 1997) استفاده شد. گروه‌هاي آزمايشي تحت مداخلات درماني قرار گرفتند؛ اما گروه گواه مداخله‌اي دريافت نكرد. جلسات مداخله طي دو روز در هفته در مركز مشاورهٔ آرامش شهر تهران اجرا شد. داده‌ها با استفاده از تحليل كوواريانس تك‌متغيره تجزيه‌و‌تحليل شدند. سطح معناداري آزمون‌ها 0٫05 در نظر گرفته شد. يافته‌ها: نتايج نشان داد كه درمان‌هاي تحريك با جريان مستقيم ازطريق جمجمه و شناختي-رفتاري بر كاهش ولع مصرف (مؤلفه‌هاي تمايلات و شدت ولع مصرف) (0٫001>p) و اضطراب (0٫001>p) مؤثر است؛ اما بين اثربخشي درمان‌هاي تحريك با جريان مستقيم ازطريق جمجمه و شناختي-رفتاري بر ولع مصرف (مؤلفهٔ تمايلات) (0٫884=p) و ولع مصرف (مؤلفهٔ شدت ولع مصرف) (0٫972=p) و اضطراب (0٫165=p) در افراد داراي اضافه‌وزن تفاوت معناداري وجود ندارد. نتيجه‌گيري: براساس يافته‌هاي اين پژوهش مي‌توان گفت درمان تحريك با جريان مستقيم ازطريق جمجمه و درمان شناختي-رفتاري بر ولع مصرف و اضطراب اثربخش است.

Background & Objectives: A mental health condition that causes the excessive consumption of food, leading to obesity, is food craving. According to brain imaging data, the Dorsal Lateral Prefrontal Cortex (DLPFC) plays an important role in craving. Anxiety can also occur in overweight individuals. Anxiety and obesity affect each other and are related. Furthermore, anxiety is a negative emotion that in some individuals, causes emotional eating behavior. Besides, weight gain increases anxiety, which requires neuropsychological therapies. A therapy used in the present study was Transcranial Direct Current Stimulation (tDCS), i.e., a non-invasive, painless, and safe method of cerebral stimulation. The tDCS seems to be able to modulate cortical irritability and be applied as a treatment for managing psychiatric disorders. Another intervention implemented in the present study was Cognitive-Behavioral Therapy (CBT). Psychological factors significantly impact the development of obesity. Thus, such interventions could significantly help to reduce weight and modify the negative perception of body image, and of course, self-concept and social anxiety among overweight and obese individuals. Therefore, the present study aimed to compare the effects of tDCS and CBT on craving and anxiety in overweight individuals. Methods: This was an applied and experimental study with a pretest-posttest and a control group design. The statistical population of the study included all overweight individuals who referred to Aramesh Psychology Center in Tehran City, Iran, in 2019. Using the targeted sampling method, 36 of them were selected as the study participants and placed in two experimental groups and one control group (n=12/group). The study inclusion criteria included having a diploma and higher education, the age range of 18 to 47 years, having a body mass index of <40 kg/m2, presenting an uncontrollable tendency to consume at least one of the following foods three times a week during at least the last month: sweets and nuts, too much of fatty foods, the concurrent consumption of fast food and drugs, due to no other disorder. The study exclusion criteria included a history of epilepsy; a history of concussion or brain surgery; using anticonvulsants or antipsychotics or the regular use of benzodiazepines in the past month; a major cognitive or psychiatric condition, e.g., a history of suicidal attempt; having metal objects, like electronic implants, e.g., pacemakers or cochlear implants; pregnancy; a personal or family history of seizures; a history of endocrine or autoimmune diseases; a history of brain surgery or the loss of consciousness for >15 minutes, and a history of consuming weight loss medications or attending frequent weight loss programs. The Food Craving Questionnaire (Cepeda-Benito et al., 2000) and the Beck Anxiety Inventory (Steer & Beck, 1997) were used to collect the required information. The tDCS intervention sessions were performed for 3 sessions every other day and the CBT sessions were conducted in 8 weekly 90-minute sessions; however, the controls received no intervention. The obtained data were analyzed in SPSS using descriptive statistics, e.g., mean and standard deviation; the employed inferential statistics consisted of Analysis of Covariance (ANCOVA) and Bonferroni post-hoc test. Results: The mean posttest scores of craving and anxiety, after controlling the pretest scores, were significant in both test groups; in other words, both provided interventions were effective in reducing craving (p<0.001), craving intensity (p<0.001), and anxiety (p<0.001) among the study subjects. The mean of squares for cravings (a component of craving), craving (a component of craving intensity), and anxiety were 0.74, 0.68, and 0.68, respectively. Bonferroni post-hoc test was used to compare the study participants’ posttest scores after controlling the pretest values. The relevant results indicated a significant difference between the tDCS and control groups in terms of craving (inclination component) (p=0.023), craving (craving intensity component) (p<0.001), and anxiety (p<0.001). The research findings also suggested a significant difference between the CBT and control groups concerning craving (inclination component) (p=0.035), and craving (craving intensity component) (p<0.001). However, there was no significant difference between the tDCS and CBT groups for craving (inclination component) (p=0.884). Additionally, there was no significant difference between the mean scores of tDCS and CBT groups in craving (the component of craving intensity) (p=0.972). Furthermore, there was no significant difference between the mean anxiety values of the tDCS and CBT groups (p=0.165). Conclusion: The provided tDCS and CBT approaches were effective in reducing craving and anxiety in the study participants. Therefore, these interventions could be used as therapeutic or educational methods to improve these conditions in overweight individuals.