اثربخشي درمان مبتني بر پذيرش و تعهد بر انعطاف پذيري شناختي دانشجويان دانشگاه علوم پزشكي گرگان

Acceptance and Commitment Therapy on Cognitive Flexibility on Gorgan University of Medical Sciences Students

زمينه و هدف انعطاف پذيري، يكي از متغيرهاي سبك زندگي سالم است. بررسي ميزان اثربخشي درمان مبتني بر پذيرش و تعهد بر انعطاف پذيري، مي تواند بيانگر كارآمدي اين درمان در دانشجويان پزشكي باشد؛ بنابراين هدف مطالعه حاضر، تعيين تاثير درمان مبتني بر پذيرش و تعهد بر انعطاف پذيري شناختي بود. روش بررسي اين مطالعه در قالب طرح شبه آزمايشي با پيش آزمون و پس آزمون و پيگيري با گروه گواه از ميان دانشجويان رشته پزشكي دانشگاه علوم پزشكي گرگان در سال تحصيلي 1397-1396 انجام شد و 30 نفر به شيوه هدفمند بر اساس معيارهاي ورود انتخاب شدند و به طور تصادفي در دو گروه (گروه آزمايش 15 نفر و گروه گواه 15 نفر) جاي گذاري شدند. پروتكل درماني به مدت هشت جلسه هفتگي به گروه آزمايش ارائه شد و گروه گواه در ليست انتظار قرار گرفت. انعطاف پذيري با پرسش نامه دنيس-وندروال (2010) ارزيابي شد و داده هاي حاصل با استفاده از نرم افزار SPSS و به كمك شاخص هاي آمار توصيفي چون ميانگين و انحراف معيار، آزمون لوين، كولموگروف اسميرنوف و تحليل واريانس با اندازه گيري هاي مكرر تجزيه وتحليل شدند. يافته ها نتايج حاصل از تحليل نشان داد كه اثربخشي درمان مبتني بر پذيرش و تعهد در پس آزمون در گروه آزمايش نسبت به گروه گواه بر شاخص انعطاف پذيري شناختي معنادار بود (0٫001>p). همچنين درمان مذكور در مرحله پيگيري در گروه آزمايش ماندگار بود (0٫001>p). نتيجه گيري بر اساس يافته هاي پژوهش حاضر، درمان مبتني بر پذيرش و تعهد، مي تواند به عنوان يك مداخله اثربخش در افزايش انعطاف پذيري دانشجويان پزشكي محسوب شود.

Background & Objective: Cognitive flexibility is one of the variables of healthy lifestyle; cognitive flexibility has a positive effect on the individual's ability to control inner and outer stresses. Formation of flexibility is an evolutionary process, because it succeeds in overcoming unpleasant situations, self–efficacy and increasing confidence in its ability to influence the environment. One of the treatment methods that increase the psychological flexibility of individuals is cognitive therapy based on admission and commitment. Acceptance and commitment therapy emphasizes the role of individual psychological resources in dealing with stressors. This evidence–based treatment is used to treat various types of mental disorders and medical conditions. The main goal of teaching admission and commitment is mental flexibility. It means the ability to make practical choices among the different choices that are appropriate, rather than just acting in order to avoid disturbing thoughts, emotions, memories or desires. In fact, this treatment emphasizes the role of the individual's psychological resources in dealing with stressors. Investigating the effectiveness of treatment based on admission and commitment on cognitive flexibility of individuals can indicate the efficacy of this treatment in medical students. Therefore, the purpose of this study was to determine the effect of cognitive therapy based on admission and commitment on cognitive flexibility on Gorgan University of Medical Sciences students. Methods: The research method was quasi–experimental with pre–test and post–test with control and follow–up groups. The statistical population included all students of Gorgan University of Medical Sciences. Among them 30 students were selected based on entry criteria. Criteria for entering including informed consent from the company in the research, exit criteria from the intervention, absence in more than 2 educational sessions. They randomly divided into two groups (experimental and control groups, n=15 for each group) and informed consent was obtained. Treatments were provided to the experimental group for eight weeks sessions and the control group was placed on the waiting list. Flexibility was evaluated in three stages: pre–test, post–test and follow–up with Dennis Wonderwall (2010). Data were analyzed using SPSS 23 software and descriptive statistics such as mean and standard deviation, F Levin's test, Kolmogorov–Smirnov and covariance analysis with repeated multivariate measurements (p<0.001). Results: Kolmogorov–Smirnov test showed a normal distribution of data. In addition, the results of the Lone test for homogeneity of variances showed that cognitive flexibility variables (p=0.807), replacement (p=0.417), control (p=0.205) and replacement for human behavior (p=0.067) had homogeneity of variances among the research groups. Results of the Mbox test showed that covariance flexibility variables (p=0.050), replacement (p=0.158), control (p=0.022) and substitution for human behavior (p=0.008) with covariance homogeneity between research groups. Accordingly, the assumption of the normality and homogeneity of variances was established. In addition, time–related resources in all variables except for the subsample of control were meaningful. Group–time resources were meaningful in all variables. Considering the design of the control group, pre–test, post–test and follow–up period, the results showed that acceptance–based therapy and commitment had a significant effect on cognitive flexibility (p<0.001). The effect of this intervention on the interaction of time and group on the total score of cognitive flexibility was 46% (p<0.001), replacement of 33% (p<0.001), control 39% (p<0.001), and substitution for behavior human was 10% (p<0.048). Therefore, acceptance and commitment therapy had a significant effect on cognitive flexibility. Conclusion: It could be concluded that acceptance and commitment therapy, cognitive flexibility and its components in medical students increased and the results are stable in the follow–up phase. Therefore, it seems that people with little flexibility are beginning to forget their early learning and insist on their previous learning that has negative consequences, and this insistence on damage to their compatibility leads to new conditions. Therefore, acceptance and commitment therapy increases the ability to continue valuable activities when faced with negative feelings and thoughts. This treatment is considered as an effective intervention in increasing the flexibility of medical students.