پديد آورندگان :
توكلي، حديث دانشگاه آزاد اسلامي واحد رشت , اكبري، بهمن دانشگاه آزاد اسلامي واحد رشت - گروه روانشناسي , سالاري، ارسلان دانشگاه علومپزشكي گيلان - دانشكدهٔ پزشكي - گروه قلب و عروق
كليدواژه :
درد قفسهٔ سينهٔ غيرقلبي , درمان مبتني بر پذيرش و تعهد , كيفيت زندگي , انعطاف پذيري روانشناختي
چكيده فارسي :
زمينه و هدف: از دلايل بسيار شايع مراجعهٔ افراد به كلينيك‌هاي قلب و عروق، درد قفسهٔ سينه است. علت دردهاي قفسهٔ سينه با منشأ غيرقلبي مي‌تواند جسمي يا رواني باشد؛ اما علل رواني كمتر مدنظر قرار مي‌گيرد؛ بنابراين داراي اهميت زيادي براي تشخيص و درمان است. پژوهش حاضر با هدف تعيين اثربخشي درمان مبتني‌بر پذيرش و تعهد بر كيفيت زندگي و انعطاف‌پذيري روانشناختي در بيماران با درد قفسهٔ سينهٔ غيرقلبي انجام شد.
روش‌بررسي: اين پژوهش از نوع نيمه‌آزمايشي با پيش‌آزمون و پس‌آزمون و پيگيري (پس از دو ماه) بود. از بيماران مراجعه‌كننده به مركز تخصصي قلب دكتر حشمت شهر رشت، نمونهٔ 40نفره به‌صورت دردسترس انتخاب شده و به‌طور تصادفي در دو گروه آزمايش و كنترل قرار گرفتند. آزمودني‌ها به دو پرسشنامهٔ كيفيت زندگي و انعطاف‌پذيري روانشناختي پاسخ دادند. گروه آزمايش هشت جلسه درمان مبتني‌بر پذيرش و تعهد دريافت كرد. پس از جمع‌آوري داده‌ها، نتايج با استفاده از آزمون‌هاي آماري تي دو گروه مستقل و تحليل واريانس با اندازه‌گيري مكرر و آزمون تعقيبي بونفروني توسط نرم‌افزار SPSS نسخهٔ 23 بررسي شد.
يافته‌ها: يافته‌ها نشان داد كه پس از مداخله، ميانگين نمرات زيرمقياس‌هاي سلامت روانشناختي و جسماني كيفيت زندگي (0٫001>p) و انعطاف‌پذيري روانشناختي در گروه آزمايش افزايش مي‌يابد (0٫001>p). اين افزايش در مرحلهٔ پيگيري نيز حفظ شده بود.
نتيجه‌گيري: درمان مبتني‌بر پذيرش و تعهد بر كيفيت زندگي و انعطاف‌پذيري روانشناختي بيماران با درد غيرقلبي قفسهٔ سينه كه دچار ناتواني‌هاي جسمي شدند، مؤثر بوده و متخصصان حوزهٔ درمان با استفاده از روش حاضر مي‌توانند كيفيت زندگي آنان را بهبود بخشند.
چكيده لاتين :
Background & Objective: Chest pain is one of the most common reasons for referring people to cardiovascular clinics. The cause of chest pain
with non–cardiac origin can be physical or mental. Because mental causes are less of a concern for specialists, therefore, they are more important
for diagnosis and treatment. The aim of this study was to determine the effectiveness of acceptance and commitment therapy on quality of life
and psychological flexibility in patients with non–cardiac chest pain.
Methods: This study was a semi–experimental and clinical intervention, pre–test, post–test, and follow up test (two months later), with the
control group. The statistical population of this study included all patients with non–cardiac chest pain referring to Dr. Heshmat Hospital in
Rasht city (Northern of Iran) in 2017–2018. All of them were residents of Rasht city. During referrals within three months prior to the beginning
of this study, a list of patients referred to the emergency department and echocardiography were extracted. The 40 samples were selected by
convenience sampling and randomly divided into two groups. Participants responded to two questionnaires: SF–36 and AAQ–II. The
experimental group received 8 sessions of training for 90 minutes based on acceptance and commitment. The psychological flexibility and quality
of life of these individuals were first assessed (pre–test), after the end of the sessions (post–test) and again two months later in the next follow–
up. The required information was collected by questionnaires as well as the results of the medical examinations of these people. The control
group responded to all the questionnaires at the third time, but they did not receive any treatment. The summary of the content of the sessions
and activities performed in the ACT group is as follows: Session 1: Introduction and treatment agenda (including familiarity and introduction of
exercises); Session 2: Options and setting a course of treatment (behavior change and mindfulness); Session 3: Learning to live with chronic
pain (acceptance, values, and mindfulness); Session 4: Clarification of values and objectives; Session 5: Motivation, thoughts and emotions
(initiating plans and acting); Session 6: Desire to act, move forward; Session 7: Commitment; Session 8: Practicing and retaining therapeutic
achievements throughout life. After collecting data, results were analyzed by T test with independent groups, variance with repeated
measurements and Bonferroni method and, using SPSS version 23 software.
Results: Mean scores of psychological quality of life scale and physical quality of life scale and psychological flexibility in the treatment group
have increased. The results of repeated–measures variance analysis for these three variables in three stages of pre–test, post–test and follow–up
showed there was a significant difference in the treatment based on acceptance and commitment on the psychological quality of life (F=7.23,
p<0.001), physical quality of life (F=13.15, p<0.001) and psychological flexibility (F=74.52, p<0.001). The results of the Bonferroni test for the
experimental group showed that there was a significant difference in the psychological quality of life between the two methods (p<0.001), pre–
test–post–test (p<0.001), and pre–test–follow–up (p<0.027) but there was no significant difference between the mean post–test and follow–up
stages. In the variable of physical quality of life, there was a significant difference between the two pre–test and post–test phases (p<0.001) and
pre–test–follow–up (p<0.016), but in comparison no significant difference was observed between the post–test and follow–up stages. In addition,
in the case of psychological flexibility, there was a significant difference between the comparison between two pre–test, post–test and pre–test–
follow–up (p<0.001). However, no significant difference was observed between the mean post–test and follow–up stages.
Conclusion: Overall, the findings of this study showed that admission and commitment therapy is an effective approach to improving the
physical and psychological quality of life and increasing the psychological flexibility of patients with non–cardiac chest pain; and can be used
as a therapeutic therapy Supplemented with medication.
