تعيين اثر بخشي هيپنوتيزم‌ درماني شناختي بر كاهش وضعيت ناتواني گسترش‌ يافته در بيماران مبتلا به ام‌ اس

Effects of Cognitive Hypnotherapy on Expanded Disability in Patients With Multiple Sclerosis

زمينه‌ و هدف: مولتيپل‌ اسكلروزيس بيماري ناتوان‌كنندهٔ مغز و نخاع است كه مي‌تواند موجب بروز مشكلات بينايي، تعادل، مهار عضلات، راه‌رفتن، خستگي، ضعف عضلاني، تاري ‌ديد و دوبيني، بي‌حسي و مورمورشدن، جنسي، مثانه و روده، درد، تمركز و حافظه شود؛ بنابراين پژوهش حاضر با هدف تعيين‌ اثربخشي‌ هيپنوتيزم‌‌درماني ‌شناختي بر كاهش‌ وضعيت ناتواني‌ گسترش‌يافته در بيماران مبتلا به ام‌اس انجام شد. روش‌‌‌ بررسي: اين پژوهش از نوع نيمه‌آزمايشي با طرح پيش‌آزمون و پس‌آزمون و پيگيري دوماهه با گروه‌ گواه بود. تعداد 30 بيمار مبتلا به ام‌اس از مراجعان به يك ‌كلينك‌ خصوصي مغز و اعصاب در تهران در سال 97-1396 با نمونه‌گيري دردسترس انتخاب شدند و‌ به‌صورت‌ تصادفي در گروه‌هاي ‌مساوي آزمايش و گواه قرار گرفتند. جمع‌آوري داده‌هاي پژوهش ازطريق ارزيابي ناتواني‌ها توسط نورولوژيست به‌صورت انفرادي در هشت سيستم عملكردي و‌ وضعيت ناتواني ‌گسترش‌‌يافته طبق مقياس EDSS (كورتزك، 1983) براي هر دو گروه انجام پذيرفت. مداخلهٔ ‌درماني مبتني‌بر پروتكل محقق‌ساخته در هشت جلسهٔ يك‌ساعتهٔ انفرادي براي‌ گروه ‌آزمايش اجرا شد. داده‌ها به‌كمك نرم‌افزار SPSS نسخهٔ 21 با استفاده از آزمون‌هاي ناپارامتريك فريدمن و ويلكاسون با سطح معناداري 0٫05 تحليل شدند. يافته‌ها: نتايج نشان داد كه اجراي هيپنوتيزم‌درماني شناختي، ناتواني در مؤلفه‌هاي پيراميدال، بينايي، ذهني و وضعيت ناتواني‌گسترش‌يافتۀ كل را در مراحل پيش‌آزمون-پس‌آزمون (0٫05>p)، پيش‌آزمون-پيگيري (0٫05>p) و پس‌آزمون-پيگيري (0٫05

Background & Objectives: Multiple Sclerosis (MS) is a disease of the central nervous system with a heterogeneous clinical and pathological composition that can develop suddenly and lead to death within only a few weeks or months. MS can cause problems with vision, balance, muscle control, and other basic body functions, such as troubled walking, fatigue, muscle weakness or spasms, blurred or double vision, numbness and tingling, sexual dysfunction, poor bladder or bowel control, pain, depression, as well as impairments in focusing or remembering. Considering the degenerative and progressive nature of this disease, it may result in biopsychological conditions. Accordingly, it may impose increased medical costs on these patients, which finally leads to death in them. Furthermore, various complementary non–pharmacotherapies have been used for these patients. Thus, this study aimed to investigate the effects of cognitive hypnotherapy on reducing the expanded disability status of patients with MS. Methods: This was a quasi–experimental study with a pretest–posttest, 2–month follow–up, and a control group design. The statistical population included 236 patients with replacing–remitting MS referring to a private neurology clinic from January to June 2018 in Tehran City, Iran. Accordingly, based on clinical interviews conducted according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to investigate the inclusion and exclusion criteria of the study, 50 volunteers were considered for the statistical sample of the study. The inclusion criteria for the study participants consisted of an age range of 20–50 years, a minimum education of high school diploma, hypnotism ability of above the average rate, not to be restricted to a wheelchair, being able to talk, the lack of major depressive, bipolar, psychotic, as well as personality disorders, such as paranoid, borderline, schizotypal, and antisocial, i.e., controlled through Millon Clinical Multiaxial Inventory (MCMI–III), clinical interview, and developmental history, and providing informed consent forms to participate in the study. The exclusion criteria also included absence from >2 sessions, simultaneously attending another psychological intervention, and not performing weekly assignments. In total, 30 patients were selected by convenience sampling method and randomly assigned into two equal groups of experimental and control. The expanded disability status of the study groups was rated through Expanded Disability Status Scale (EDSS) (Kurtzke, 1983) by assessing 8 Functional Systems (FSs), such as pyramidal, cerebellar, brain stem, sensory, bowel and bladder, visual, cerebral (mental), and other by a neurologist in 3 stages of research. Considering the ethical aspects, individualized treatment using cognitive hypnotherapy was performed in eight 1–hour weekly sessions based on the protocol established by Namdarpour Naghani et al. (2018) to reduce the expanded disability of the patients in the experimental group; however, no intervention was provided to the control group. The obtained data were analyzed at two levels of descriptive and inferential by SPSS. Shapiro–Wilk test results indicated that the data significantly deviated from a normal distribution (p>0.05) and did not meet the assumption of parametric test for the mixed design of Analysis of Variance (ANOVA). Therefore, the inferential data were analyzed by nonparametric tests of Friedman and Wilcoxon at the significance level of 0.05. Results: The present research results indicated that cognitive hypnotherapy has reduced the disability of FSs, such as pyramidal (pretest–posttest: p=0.014, pretest–follow–up: p=0.020, posttest–follow–up: p=0.317), visual (pretest–posttest: p=0.025, pretest–follow–up: p=0.020, posttest– follow–up: p=0.157), cerebral (pretest–posttest: p=0.005, pretest–follow–up: p=0.008, posttest–follow–up: p=0.157) and total expanded disability status (pretest–posttest: p=0.002, pretest–follow–up: p=0.002, posttest–follow–up: p=0.083). Cognitive hypnotherapy has not reduced 5 of the 8 FSs, including cerebellar, sensory, brain stem, bowel and bladder, and others in the study subjects. Conclusion: Based on the obtained results, cognitive hypnotherapy intervention could effectively and significantly provide a stable reduction of disability in FSs, such as pyramidal, visual, cerebral (mental), and expanded disability status in patients with MS.