اثر بخشي مديريت استرس به شيوه شناختي- رفتاري بر كاهش نشانگان استرس در زنان مبتلا به مولتيپل اسكلروزيس (MS)

Cognitive-Behavioral Stress Management Training (CBSM) on Reducing Stress Symptoms of Women with Multiple Sclerosis (MS

زمينه و هدف: بيماري مولتيپل‌اسكلروزيس از بيماري‌هاي شايع در كشور ما، به‌خصوص در بانوان است. نقش استرس در تشديد بيماري اهميت بسيار دارد؛ بنابر‌اين پژوهش حاضر با هدف تعيين ميزان اثر‌بخشي آموزش مديريت استرس به‌شيوهٔ شناختي‌رفتاري بر كاهش نشانگان استرس و ابعاد آن در زنان مبتلا به مولتيپل‌اسكلروزيس انجام شد. روش‌بررسي: اين مطالعه شبه‌آزمايشي از نوع پيش‌آزمون و پس‌آزمون و پيگيري با گروه گواه بود. جامعهٔ آماري را تمامي بيماران زن مبتلا به ام‌اس عضو انجمن ام‌اس شهر تهران در سال 1396 تشكيل دادند. نمونه‌گيري به‌روش داوطلبانه انجام شد و نمونه‌ها به‌شيوهٔ همتا‌سازي در دو گروه آزمايش و گواه، هر گروه 15 نفر قرار گرفتند. ابزار پژوهش، مقياس سنجش نشانگان‌ استرس سيدخراساني‌ صديقاني (1377) بود. در فاصلهٔ بين پيش‌آزمون و پس‌آزمون، برنامهٔ مداخلهٔ مديريت استرس به‌شيوهٔ شناختي‌رفتاري آنتون و ايرونسون و اشنايدر‌من (2007) در طي هشت جلسهٔ 90دقيقه‌اي روي گروه آزمايش اجرا شد. داده‌هاي پژوهش پس از استخراج با استفاده از روش اندازه‌گيري مكرر و با نرم‌افزار SPSS تجزيه‌وتحليل شدند. يافته‌ها: نتايج نشان داد آموزش مديريت استرس به‌شيوهٔ شناختي‌رفتاري بر كاهش نشانگان كلي استرس و ابعاد آن (نشانگان جسماني، رفتاري، هيجاني، شناختي) مؤثر است. (0٫001>p). نتيجه‌گيري: نتايج پس‌آزمون و پيگيري در گروه آزمايش بيانگر ماندگاري تأثير مديريت استرس به‌شيوهٔ شناختي‌رفتاري با گذشت زمان است؛ بنابراين مي‌توان اين روش را براي كاهش نشانگان استرس در مبتلايان به بيماري مولتيپل‌اسكروزيس به‌كار برد.

Background & Objective: Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system with unknown causes. Beginning often in the late adolescence and early adult life. Prevalence among women is more than men is. MS can produce a wide variety of symptoms, including loss of function or feeling in limbs, loss of bowel or bladder control, sexual dysfunction, debilitating fatigue, blindness, loss of balance, pain, loss of cognitive functioning and emotional changes. Chronic illnesses like MS cause to increase stress levels. The belief that stress causes exacerbation is widespread among people with MS. Among the effective therapies for deduction of stress symptoms, cognitive– behavioral stress management approach has been successfully applies to combine stress reduction methods such as muscle relaxation, cognitive rehabilitation, effective copying training, and anger management. Therefore this studies aimed to review the effectiveness of cognitive– behavioral stress management training on reducing stress symptoms of women with Multiple Sclerosis (MS). Methods: The design of this study was quasi–experimental with pre–test, post–test and control group. The study population consisted of all female MS patients who were member of Tehran MS associations in the year of 2017. The sample consisted of 30 patients, who were selected by volunteer sampling method and were placed by matching method in experimental and control groups. For collecting the data, stress symptoms inventory of Khorasani (designed in year 1998) was used. The experimental group was trained in cognitive–behavioral stress management approach, designed by Antoni, Ironson and Schneider in year 2007 and the control group received no intervention. The duration of the treatment sessions consisted of 8 sessions of 90 minutes, performed as a group once a week in the MS center. Research data were analyzed by repeated measurement analysis using SPSS software. Results: To analyze the variance for repeated measures, we examined the assumptions of this test. Shapiro Wilk test was used to check the normal scores. The result showed that the distribution of data is normal. Levin Levin's findings also showed that the homogeneous assumption of covariance of data and the slope of regression was established. The mean of the stress symptoms variable for the experimental group in the pre–test was 184.47 which decreased in the post–test into 146.80 and in the follow up reached to 143.73 but there was no meaningful changes in control group. The mean of the physical stress symptom for experimental group in pre–test was 81.07 which reached in the post– test into 66.40 and in the follow up reached to 67 )p<0.001(. There was no significant changes in control group in 3 stages. The mean of the behavioral stress symptom for experimental group in pre–test was 42.27 which reached in the post– test into 37.47 and in the follow up reached to 36.60 (p<0.001). There was no significant changes in control group in 3 stages. The mean of the emotional stress symptom for experimental group in pre–test was 34.07, which reached in the post– test into 30.33 and in the follow up reached to 30.87.There was no significant changes in control group in 3 stages (p<0.001), but there was no significant changes in control group in 3 stages. The mean of the cognitive stress symptom for experimental group in pre–test was 27.07 which reached in the post–test into 22.80 and in the follow up reached to 22.60. There was no significant changes in control group in 3 stages (p<0.001). Result of Bonferroni correction showed there was significant difference in comparing mean of pre–test with post–test and pre–test with follow up in stress symptoms and its components. Based on the results of the repeated measurement analysis test, there was significant difference between the pre–test scores with post–test and follow up scores, therefore stress management training had a meaningful effect on the reduction of stress symptoms. Conclusion: Trainings presented in form of stress management in a cognitive–behavioral approach have significant positive effects on the reduction of all stress symptoms of women with multiple sclerosis (MS). Therefore, it can be used as a useful intervention to reduce the stress symptoms of women with MS and benefit from it in educational and health centers.