اثربخشي درمان مبتني‌بر پذيرش و تعهد بر نشخوار فكري و بهزيستي روان‌شناختي نوجوانان مبتلا به اختلال اضطراب فراگير

The effectiveness of acceptance and commitment therapy (ACT) on rumination and well-being in adolescents with general anxiety disorder

هدف: اختلال اضطراب فراگير نوعي اختلال اضطرابي است كه به‌صورت نگراني بيش‌از‌اندازه دربارهٔ اتفاقات روزمره تعريف مي‌شود. هدف از انجام پژوهش حاضر بررسي اثربخشي درمان مبتني‌بر پذيرش و تعهد بر بهزيستي روان‌شناختي و نشخوارفكري در نوجوانان مبتلا به اضطراب فراگير بود. روش‌بررسي: طرح پژوهش حاضر آزمايشي پيش‌آزمون-پس‌آزمون با گروه گواه بود. جامعهٔ آماري شامل تمامي نوجوانان دختر 13 تا 15 سالهٔ شهر تهران در سال تحصيلي 97-96 بود. نمونهٔ مطالعه به‌شيوهٔ غربالگري تصادفي چند‌مرحله‌اي انتخاب شدند. به اين‌صورت كه از بين دانش‌آموزان، آن‌هايي كه در پرسشنامهٔ اضطراب فراگير (اسپيتزر، 2006) داراي نمرهٔ بالاتر از ميانگين (بالاتر از 10) بودند، 40 نفر به‌طور تصادفي انتخاب گرديده و در دو گروه گواه و آزمايش قرار گرفتند. آزمودني‌هاي گروه آزمايش به‌مدت 12 جلسه آموزش ديدند. با استفاده از پرسشنامه‌هاي بهزيستي روان‌شناختي (ريف، 1980) و نشخوارفكري (نالن و هوكسما، 1991) پيش‌آزمون و پس‌آزمون اجرا شد. داده‌ها در سطح آمار توصيفي (ميانگين و انحراف‌معيار) و استنباطي (تحليل كوواريانس) توسط نرم‌افزار SPSS-21 تجزيه‌ و‌ تحليل شدند. يافته‌ها: نتايج حاصل از داده‌ها نشان داد كه درمان مبتني‌بر پذيرش و تعهد باعث كاهش نشخوارفكري (پس‌آزمون گروه آزمايش: 17/15±41/15 و گواه: 47/55±8/61 و 0/003=P) مي‌شود و همچنين ميزان بهزيستي روان‌شناختي را در نوجوانان مبتلا به اضطراب فراگير افزايش مي‌دهد (پس‌آزمون گروه آزمايش 15٫51±348 و گواه 318/35±13/97 و 0/001

Background & Objective: Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive and unreasonable worries about everyday event and activities. In general, anxiety disorder has a more chronic course than a panic attack, and can last for months. The prevalence of anxiety disorders in women, in general, is twice that of men. The 12-month prevalence of generalized anxiety disorder in adolescent and adult in the American public community is 9 percent and 9.2 percent respectively. The risk of developing a lifespan of 9.9% is estimated. The main difference that can be seen in different categories of patients is the concern of the individual. Children and adolescent are more concerned about school and sports issues, while older people are more concerned about family health and physical well-being, so it seems that the content of an individual's concerns is appropriate to his or her age. The severity of the symptoms in younger adults is higher than in older adults. The purpose of this study was to determine the effectiveness of acceptance commitment therapy on rumination and well-being of adolescent with generalized anxiety disorder. Rumination is defined in psychology as the necessary focus of one’s attention on the symptom and cause of distress. and the consideration of its reasons and its results rather than focusing on its solution. The similar rumination is a concern, with the difference that rumination focuses on bad feelings and past experiences, while worries about the potential for adverse events in the future Acceptance commitment therapy is a form of counseling similar to cognitive-behavior therapy. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways. With commitment and behavior-change strategies, to increase psychological flexibility. The approach was initially called comprehensive distancing. As begun in 1982 by Steven C. Hayes and was first tested by Robert Zettle in 1985, but was built out into its modern form in the late 1980s. There are a variety of protocols for ACT, depending on the target behavior or setting. Methods: The method of this study is a quasi-experimental type with pre-test and post-test. That 40 male students with a generalized anxiety disorder are selected randomly and are considered randomly and evenly in experimental and control groups. Treatment has been performed in 12 sessions through 1-hour session over three months on the experimental group. To collect data, researchers there have been used generalized anxiety questionnaire (2006), psychological well-being questionnaire of Ryff (1980) and rumination questionnaire (Nollen Hoeksema, 1991). Generalized anxiety questionnaire is easy to use the 7-item instrument, based on DSM-IV criteria, for identifying probable GAD cases. It has excellent psychometric properties, is easy to administer and does not involve any burden for the patient or the clinician. Carol ryff develops ryff psychological well-being. Carol Ryff has conceptualized psychological well-being as consisting of 6 dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, self-acceptance. Nolen-Hoeksema of rumination questionnaire is a selfreport measure of rumination that has 22 items and excellent psychometric properties. Results: The result shows that acceptance commitment therapy can increase psychological well -being and reduce rumination. The mean for psychological well-being in the experimental group was 306.60 in pretest, and in post-test it was 348. While in the control group it was 326.75 in pre-test and 318.35 in post-test. Covariance analysis shows that there is a significant difference between two groups (P<0.05). Also, the result shows that the mean of rumination in the experimental group was 60.60 in pretest and 41.15 in the posttest. While in the control group it was 47.10 in pretest and 47.55 in the posttest. Conclusion: In acceptance and commitment therapy, participants are encouraged to improve their commitment to have a healthier, better life, this also includes behavioral strategies when faced with negative thoughts and emotions. Therefore, acceptance and commitment therapy can improve psychological well- being and reduce rumination, for this reason, the use of this treatment was recommend to psychologist and counselors.