مقايسه اثربخشي درمان برنامه زماني پارادوكسي، درمان مواجهه سازي و جلوگيري از پاسخ و دارودرماني بر كاهش علائم بيماران مبتلا به اختلال وسواسي اجباري

Comparison of the effectiveness of Paradoxical Time Table Therapy, Exposure and Response Prevention and pharmacotherapy on Reducing Symptoms in Patients with Obsessive-Compulsive Disorder

زمينه و هدف اختلال وسواسي-اجباري يك اختلال روان شناختي رايج است كه اختلال شديدي در زندگي فردي ايجاد مي كند. از جمله درمآن هاي رايج براي اختلال وسواس مي توان به دارو درماني، درمآن هاي شناختي و درمآن هاي رفتاري اشاره نمود. هدف از اين مطالعه، مقايسه اثربخشي درمان برنامه زماني پارادوكسي و درمان مواجهه و جلوگيري از پاسخ و دارودرماني بر كاهش علائم بيماران مبتلا به اختلال وسواسي-اجباري بود. روش بررسي در اين پژوهش، از طرح مطالعه تجربي تك موردي استفاده شد. جامعه پژوهش را، افراد با تشخيص اختلال وسواس مراجعه كننده به كلينيك آرامش نوين در شهر تهران تشكيل دادند كه داراي پرونده فعال در ماه هاي بهار 97 بودند. از اين افراد، 3 بيمار درمان مواجهه سازي و جلوگيري از پاسخ، 3 بيمار درمان با يكي از مهاركننده هاي بازجذب سروتونين و 3 بيمار درمان برنامه زماني پارادوكسي دريافت كردند. به منظور جمع آوري داده ها، مقياس شدت وسواس فكري- عملي ييل- براون (1989)، استفاده شد. براي تجزيه و تحليل داده، از روش هاي تحليل نمودار، شاخص تغيير پايا، معناداري باليني، درصد بهبودي استفاده شد (0٫05=α). يافته ها نتايج اين مطالعه نشان داد كه درمان برنامه زماني پارادوكسي و درمان مواجهه و جلوگيري از پاسخ مقادير شاخص پايا بيشتر از مقدار ملاك (1٫96) بود كه نشان از معناداري اين دو درمان داشت (0٫05>p). شاخص پايا، معناداري باليني و درصد بهبود برنامه زماني پارادوكسي از درمان مواجه و جلوگيري از پاسخ و دارودرماني در هر سه آزمودني و در مجموع، بهتر بود. نتيجه گيري براساس يافته هاي اين پژوهش درمان برنامه زماني پارادوكسي، روش مناسب و زودبازدهي براي كاهش علائم وسواس است و مي تواند به عنوان درمان پيشنهادي، استفاده شود.

Background & Objective: Obsessive-compulsive disorder is a common psychological disorder that causes severe disruption in personal life. Common treatments for obsessive-compulsive disorder include pharmacotherapy, cognitive therapy, and behavioral therapy. Much experimental evidence suggests that Exposure and Response Prevention (ERP) therapy is at the forefront of the treatments of patients with obsessivecompulsive disorder. Some researchers believe that exposure and Response Prevention therapy requires alternative or complementary approaches. One of the newest of these integrated approaches is the paradoxical time table therapy. An approach that incorporates systemic, behavioral, and analytical aspects into treatment can be an appropriate approach for all disorders, including anxiety and obsessive-compulsive disorder. This study aimed to compare the effectiveness of Paradoxical Time Table Therapy, Exposure and Response Prevention therapy and pharmacotherapy on Reducing Symptoms in Patients with Obsessive-Compulsive Disorder. Methods: In this research, the single-case experimental method used. The population of the present study was people with OCD who referred to the Aramesh Novin Clinic in Tehran, who had an active case in the spring of 2019. Among these, three patients received exposure and prevention of response therapy; three patients received pharmacotherapy with one of the serotonin reuptake inhibitors, and three patients received paradoxical time table therapy. The sample of this study selected among purposive sampling. Exposure and Response Prevention Therapy consists of 17 sessions presented by Foa, Yadin, and Lichner (2012) for patients with obsessive-compulsive disorder. The paradoxical time table therapy consists of six therapeutic sessions consisting of two basic paradoxical techniques and a time table. Yale-Brown Obsessive-Compulsive Scale used for collecting data. Chart analysis, reliable change index, clinical significance and Improvement percentage of paradoxical time table used for data analysis. Results: The results showed that in the paradoxical time table group, considering that the reliability index values were higher than the criterion value of 1. 96, it can be concluded that the results were not due to measurement error and unreliability of the test and they were the result of therapeutic intervention. Notably, a significant amount remained after the intervention, and it indicated that the paradoxical time table therapy maintained its consistency of reducing the symptoms in all three subjects at the follow-up phase. In the first, second, and third subject, the reliability index values were higher than the criterion value of 1. 96, so ERP therapy was effective in reducing OCD. The effectiveness of ERP therapy retained its significant effect on reducing obsessive-compulsive disorder in the follow-up phase for the first, second, and third subjects. In pharmacotherapy, reliability index values indicated that this method has not been effective in reducing the obsessive-compulsive disorder symptoms in these subjects. However, this intervention was effective for subject number 2 and reduced his obsessive-compulsive disorder symptoms initially, but lost its effectiveness in the follow-up phase. Regarding the reliability index and improvement percentage, the paradoxical time table therapy was significantly more effective than the exposure and response prevention therapy and pharmacotherapy in reducing symptoms of obsessive compulsive disorder. Conclusion: Regarding the effectiveness of both paradoxical time table therapy and exposure and response prevention therapy in compare to pharmacotherapy, it can be said both of these approaches can be well target source of obsessive-compulsive disorder the communication between cue and anxiety. Paradoxical time table therapy can have a more significant impact because it increases the power of ego as well as disrupts communication between cue and anxiety, and it changes their meaning well. By the way, pharmacotherapy has a different mechanism of action and cannot target the underlying causes of obsessive-compulsive disorder. This intervention can eliminate the symptoms by the only effect at reducing anxiety. However, once the pharmacotherapy is discontinued, the link between cue and anxiety will return.