اثر بخشي روان‌ درماني مبتني‌ بر پذيرش و تعهد (ACT) بر كاهش استرس، افسردگي و اضطراب امتحان در دانش‌ آموزان مبتلا به تالاسمي

Acceptance and Commitment Therapy on Stress, Depression, and Test Anxiety in Students with Thalassemia

زمينه و هدف: بيماري‌هاي مزمن ازجمله تالاسمي در همهٔ گروه‌هاي سني و طبقات اجتماعي-اقتصادي و فرهنگ‌هاي مختلف بروز مي‌كند. اين كودكان و خانواده‌هاي آن‌ها درمعرض انواع مشكلات هيجاني و رفتاري قرار مي‌گيرند. هدف از اين پژوهش بررسي اثربخشي روان‌درماني مبتني‌بر پذيرش و تعهد بر كاهش استرس و افسردگي و اضطراب امتحان در دانش‌آموزان مبتلا به تالاسمي بود. روش‌ بررسي: پژوهش حاضر از انواع طرح‌هاي نيمه‌آزمايشي به‌صورت دوگروهي با پيش‌آزمون و پس‌آزمون و پيگيري با گروه گواه بود. جامعهٔ آماري را 209 بيمار مبتلا به تالاسمي شهر زابل تشكيل دادند كه در مركز بيماران خاص شهر زابل تحت درمان قرار داشتند. نمونهٔ پژوهش شامل سي نفر بود كه با درنظرگرفتن حداقل نمونه در طرح‌هاي آزمايشي و به‌روش داوطلب واجد شرايط انتخاب شدند و به‌طور تصادفي در دو گروه پانزده‌نفري آزمايش و گواه قرار گرفتند. آموزش‌ روان‌درماني مبتني‌بر پذيرش و تعهد به‌‌مدت ده جلسهٔ 90دقيقه‌اي‌ روي گروه ‌آزمايش‌ اجرا ‌شد‌.‌ بعد از ‌اتمام ‌جلسات ‌پس‌آزمون و يك‌ماه بعد دورهٔ پيگيري انجام پذيرفت. از پرسشنامهٔ افسردگي، اضطراب، استرس لاويبوند و لاويبوند (1995) و مقياس اضطراب امتحان ساراسون (1975) ‌براي‌ جمع‌آوري‌ اطلاعات ‌استفاده ‌شد. تجزيه‌وتحليل داده‌ها با تحليل آزمون اندازه‌گيري مكرر و با استفاده از نرم‌افزار SPSS نسخهٔ 23 صورت گرفت. يافته‌ها: نتايج نشان داد كه آموزش مبتني‌بر پذيرش و تعهد موجب كاهش استرس و افسردگي و اضطراب امتحان در دانش‌آموزان مبتلا به تالاسمي مي‌شود (0٫001≥p)؛ علاوه‌براين باتوجه به اثر زمان (پيش‌آزمون و پس‌آزمون و پيگيري) بين سه دورۀ زماني در استرس و افسردگي و اضطراب امتحان تفاوت معناداري وجود دارد (0٫001≥p). همچنين اثر تعامل بين زمان اندازه‌گيري و گروه بر ميانگين نمرات استرس و افسردگي و اضطراب امتحان دانش‌آموزان تالاسمي معنادار بوده است (0٫001≥p). اندازۀ اثر نمرات استرس و افسردگي و اضطراب امتحان به‌ترتيب 0٫20 و 0٫19 و 0٫15 به‌دست آمد. نتيجه‌گيري: براساس يافته‌هاي اين پژوهش، آموزش روان‌‌درماني مبتني‌بر پذيرش و تعهد بر كاهش استرس و افسردگي و اضطراب امتحان در دانش‌آموزان مبتلا به تالاسمي در مرحلهٔ پس‌آزمون و پيگيري مؤثر است.

Background & Objectives: Chronic diseases, including thalassemia, occur in all age groups, socioeconomic classes, and cultures. Thalassemia is a chronic and life–threatening condition that limits the quality of life of the affected patients. It also impacts them clinically; their children and families are exposed to various emotional and behavioral problems and stress. Psychological issues could negatively influence the immune system and disrupt the central nervous system. Paying adequate attention to these psychological states is of significant importance. Acceptance and Commitment Therapy (ACT), i.e., derived from cognitive therapy, is among the third wave of therapies. The present study aimed to examine the effects of ACT on reducing stress, depression, and test anxiety in students with thalassemia. Methods: This was a quasi–experimental study with a pretest–posttest–follow–up and a control group design. The statistical population of this research included 209 patients with thalassemia who were treated at the Center for Special Diseases in Zabol City, Iran. The study participants were selected based on the inclusion criteria; medical diagnosis, patients’ test records, as well as studying and residing in the mentioned city. The individuals with intellectual disabilities and other mental and behavioral disorders were excluded from the study. In total, 30 qualified subjects voluntarily participated in the study. Besides, they were randomly divided into the experimental and control groups (n=15/group ). The experimental group received ten 90–minute sessions of ACT. Moreover, after the completion of the project course, the posttest was performed; one month later, the follow–up sessions were held. The Lovibond and Lovibond's Depression Anxiety Stress Scales (DASS) (1995) and Sarason Test Anxiety Scale (1975) were used to collect the required data. The collected data were analyzed by repeated–measures Analysis of Variance (ANOVA) in SPSS. Results: The mean values of stress, depression, and test anxiety has increased in the experimental group; this change was more stable in the posttest, compared to the follow–up stage. The same scores in the control group faced fewer changes in the control group; therefore, repeated– measures ANOVA was used to determine differences in inferential statistics. To perform repeated–measures ANOVA, its aspects were first examined. Kolmogorov–Smirnov test was used to inspect the normality of the data. The relevant results indicated that the score distribution of stress, depression, and test anxiety was normal in pretest and post–test steps. Levene's test was used to determine the homogeneity of variances. The related results confirmed the homogeneity of variances of stress, depression, and test anxiety. Furthermore, the Box's M test data revealed that the covariances were homogeneous. Therefore, repeated–measures ANOVA could be performed. First, Mauchly's sphericity was examined; then, the level of Greenhouse–Geisser estimate of epsilon was evaluated. The repeated–measures ANOVA was used (2×3 design) to explore the significant differences between the mean scores of the study groups. Mauchly's sphericity test result was significant (p=0.001). Besides, Greenhouse–Geisser Estimate Epsilon data demonstrated that the epsilon level was <0.75; therefore, Feldt–Huynh correction was used. Considering the effect of time between the three study stages (i.e., pretest, posttest, & 3–month follow–up), there was a significant difference in stress, depression, and test anxiety (p≤0.001) between the study groups. In addition, ACT training effectively reduced stress, depression, and test anxiety in the assessed students with thalassemia at posttest and follow–up steps (p≤0.001). The effect scores of test stress, depression and test anxiety were 0.20, 0.19 and 0.15, respectively.. Conclusion: The present study findings suggested that ACT training effectively reduced stress, depression, and test anxiety in the evaluated students with thalassemia at the posttest and follow–up stages. It is suggested that the Ministry of Education provide some workshops on this therapy for the counselors and psychologists in the schools and the families of students with this condition.