اثربخشي مداخله شناختي رفتاري مبتني بر ذهن آگاهي بر حافظه فعال در بيماران مبتلا به مالتيپل اسكلروزيس و افراد سالم

The Effectiveness of Mindfulness integrated Cognitive Behaviour Therapy on Working Memory in Patients with Multiple Sclerosis and Healthy People

ﺑﯿﻤﺎري ﻣﺎﻟﺘﯿﭙﻞ اﺳﮑﻠﺮوزﯾﺲ )MS( ﺑﯿﻤﺎري ﺳﻨﯿﻦ ﺟﻮاﻧﯽ اﺳﺖ. از ﻣﯿﺎن ﻣﺸﮑﻼﺗﯽ ﮐﻪ اﻓﺮاد ﻣﺒﺘﻼ، ﺑﺎ آن روﺑﻪ رو ﻫﺴﺘﻨﺪ ﻣﯽﺗﻮان ﺑﻪ ﻣﺸﮑﻼت ﺷﻨﺎﺧﺘﯽ اﺷﺎره ﮐﺮد. اﻏﻠﺐ اﺧﺘﻼﻻت ﺷﻨﺎﺧﺘﯽ در ﺑﯿﻤﺎران MSﻣﺮﺑﻮط ﺑﻪ ﺣﺎﻓﻈﻪ ﻓﻌﺎل و ﺣﻔﻆ ﺗﻮﺟﻪ ﻣﯽﺑﺎﺷﺪ. درﻣﺎن ﺷﻨﺎﺧﺘﯽ -رﻓﺘﺎري ﻣﺒﺘﻨﯽ ﺑﺮ ذﻫﻦ آﮔﺎﻫﯽ )MiCBT( ﯾﮑﯽ از روﯾﮑﺮدﻫﺎي روان درﻣﺎﻧﮕﺮاﻧﻪ ﻏﯿﺮ داروﯾﯽ اﺳﺖ. وﺟﻮد درﻣﺎﻧﯽ ﻏﯿﺮ داروﯾﯽ در ﮐﻨﺎر دارودرﻣﺎﻧﯽ، ﺿﺮوري ﺑﻪ ﻧﻈﺮ ﻣﯽرﺳﺪ. اﯾﻦ ﭘﮋوﻫﺶ ﺑﻪ ﻣﻨﻈﻮر ﺑﺮرﺳﯽ ﺗﺎﺛﯿﺮ ﻣﺪاﺧﻠﻪ ﺑﻪ روش MiCBTﺑﺮ ﻋﻤﻠﮑﺮد ﺣﺎﻓﻈﻪ ﻓﻌﺎل از ﻃﺮﯾﻖ ﺗﻌﺪادي از ﺧﺮده آزﻣﻮنﻫﺎي ﭘﮑﯿﺞ PCAPو آزﻣﻮن ﻫﻮش وﮐﺴﻠﺮ ﺑﺰرﮔﺴﺎﻻن ﺑﺮ ﺑﯿﻤﺎران ﺑﺰرﮔﺴﺎل ﻣﺒﺘﻼ ﺑﻪ ﻣﺎﻟﺘﯿﭙﻞ اﺳﮑﻠﺮوزﯾﺲ و اﻓﺮاد ﺳﺎﻟﻢ اﻧﺠﺎم ﺷﺪه اﺳﺖ. ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﺟﺰ ﭘﮋوﻫﺶ ﻫﺎي ﻧﯿﻤﻪ ﺗﺠﺮﺑﯽ اﺳﺖ. ﺟﺎﻣﻌﻪ در ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﺷﺎﻣﻞ ﺑﯿﻤﺎران ﻣﺮاﺟﻌﻪﮐﻨﻨﺪه ﺑﻪ اﻧﺠﻤﻦ ام اس ﮐﺮﻣﺎن ﺑﺎ ﺿﺮﯾﺐ ﻧﺎﺗﻮاﻧﯽ 3ﺗﺎ 6و اﻓﺮاد ﺳﺎﻟﻢ از ﻫﻤﺮاﻫﺎن اﯾﻦ ﺑﯿﻤﺎران ﺑﻮدﻧﺪ. 28ﻧﻔﺮ ﺑﯿﻤﺎر و 28ﻧﻔﺮ ﺳﺎﻟﻢ ﺑﺎ اﺳﺘﻔﺎده از روش ﻧﻤﻮﻧﻪﮔﯿﺮي ﻫﺪﻓﻤﻨﺪ اﻧﺘﺨﺎب ﺷﺪﻧﺪ، ﺳﭙﺲ ﺑﻪ ﻃﻮر ﺗﺼﺎدﻓﯽ ﺑﻪ دو ﮔﺮوه ﻣﺪاﺧﻠﻪ MiCBT) 14ﻧﻔﺮ( و دو ﮔﺮوه ﮐﻨﺘﺮل ) 14ﻧﻔﺮ( ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ. داده ﻫﺎي ﭘﯿﺶ و ﭘﺲ از ﻣﺪاﺧﻠﻪ ﺑﻪ ﮐﻤﮏ روشﻫﺎي آﻣﺎري ﺗﻮﺻﯿﻔﯽ و اﺳﺘﻨﺒﺎﻃﯽ در ﻣﺤﯿﻂ ﻧﺮم اﻓﺰار آﻣﺎري SPSSﺗﺤﻠﯿﻞ ﺷﺪﻧﺪ. ﻧﺘﺎﯾﺞ ﺗﺤﻠﯿﻞ اﻧﺪازه ﮔﯿﺮي ﻣﮑﺮر، ﻧﺸﺎندﻫﻨﺪه ﺗﺎﺛﯿﺮ ﻣﺜﺒﺖ ﻣﺪاﺧﻠﻪ MiCBTﺑﺮ ﺑﻬﺒﻮد ﺣﺎﻓﻈﻪ ﻓﻌﺎل ﺑﯿﻤﺎران MSو اﻓﺮاد ﺳﺎﻟﻢ ﺑﻮده اﺳﺖ )P≤0.05(. ﺑﻪ ﻋﺒﺎرت دﯾﮕﺮ ﻧﺘﺎﯾﺞ ﺗﺤﻠﯿﻞ اﻧﺪازه ﮔﯿﺮي ﻣﮑﺮر، اﻓﺰاﯾﺶ ﻣﻌﻨﺎداري در ﺣﺎﻓﻈﻪ ﻓﻌﺎل ﺑﯿﻤﺎران ام اس و اﻓﺮاد ﺳﺎﻟﻢ در ﮔﺮوه ﻣﺪاﺧﻠﻪ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﮐﻨﺘﺮل ﻧﺸﺎن داد. ﺑﻨﺎﺑﺮاﯾﻦ ﻣﺪاﺧﻠﻪ ﺷﻨﺎﺧﺘﯽ رﻓﺘﺎري ﺗﻠﻔﯿﻖ ﺷﺪه ﺑﺎ ذﻫﻦ آﮔﺎﻫﯽ MiCBTﺑﻪ ﻋﻨﻮان ﯾﮏ درﻣﺎن ﻣﻨﺎﺳﺐ در ﺑﻬﺒﻮد ﺣﺎﻓﻈﻪ ﻓﻌﺎل ﭘ ﯿﺸﻨﻬﺎد ﻣﯽ ﺷﻮد

Background and purpose: Multiple Sclerosis is a disease of young age. Cognitive problems are among the problems that people with disabilities are faced with. Most of the cognitive disorders in patients with MS are related to working memory and attention retention. Mindfulness-integrated Cognitive Behaviour Therapy [MiCBT] is a non-pharmacological psychotherapeutic approach. Non-pharmacological treatment along with drug therapy seems necessary in dealing with the MS condition. Materials and methods: This study is designed to investigate the effectiveness of MiCBT on working memory in adults with multiple sclerosis and healthy people using subscales from the PCAP and Wechsler adult intelligence scale. The design of the study was semi-experimental. The study population included patients who referred to the Kerman MS society with a disability rating of 3 to 6 and healthy were companions of these patients. 24 patients and 24 healthy were selected as study sample using a convenience sampling method, then they were randomly divided into two intervention groups (n=14), MiCBT, and two control groups (n=10). Pre and post-intervention data subjected to descriptive and inferential statistics using SPSS. Results: Results of repeated measure ANOVA have shown that the working memory was significantly increased in the MiCBT group when compared to the MS control and healthy people. Conclusion: Hence, MICBT is suggested as a suitable intervention in improving the working memory.