اثربخشي درمان مبتني بر پذيرش و تعهد بر ميزان پذيرش و سبك هاي دفاعي والدين كودكان اوتيسم با مكانيسم دفاعي انكار

The effectiveness of acceptance commitment therapy on acceptance and defense style of parent with autistic children. Therapy on the parent with denial defense mechanism

زمينه و هدف: براي والدين داراي فرزند مبتلا به اختلالات طيف اوتيسم، پذيرش بيماربودن فرزندشان دشوار است. هدف از انجام اين پژوهش تعيين اثربخشي درمان مبتني‌بر پذيرش و تعهد بر ميزان پذيرش و سبك‌هاي دفاعي مادران داراي فرزند اوتيسم با مكانيسم دفاعي انكار بود. روش‌بررسي: پژوهش حاضر نيمه‌آزمايشي با طرح پيش‌آزمون‌پس‌آزمون با گروه كنترل بود. جامعهٔ آماري را مادران كودكان مبتلا به اختلال طيف اوتيسمي مراجعه‌كننده به مراكز كودكان استثنايي شهرستان اصفهان در سه‌ماههٔ اول سال 1394، تشكيل دادند. بااستفاده از روش نمونه‌گيري دردسترس، 40 زن انتخاب شدند كه حداقل داراي يك‌ فرزند اوتيسم بوده و در مقياس انكار نمرهٔ بيشتري كسب كرده بودند. پرسشنامه‌هاي سبك‌هاي دفاعي DSQ و پذيرش و عمل، نسخهٔ دوم AAQ-2، براي آن‌ها به‌كار گرفته شد؛ سپس به‌صورت تصادفي به دو گروه آزمايش و كنترل تقسيم شدند. گروه آزمايش در هشت جلسهٔ 90دقيقه‌اي تحت‌درمان مبتني‌بر پذيرش و تعهد قرار گرفت. مجدداً از هردو گروه پس‌آزمون به‌ عمل آمد. از روش تحليل كوواريانس به‌ منظور تحليل نتايج استفاده شد. يافته‌ها: نتايج نشان داد كه پذيرش مادران تحت‌مداخله به‌طور معناداري افزايش‌يافته (0٫032=p) و ميزان استفادهٔ آنان از سبك‌هاي دفاعي رشدنايافته كمتر شده است (0٫011=p). نتيجه‌گيري: برمبناي نتايج اين پژوهش مي‌توان به درمان‌گران درحيطهٔ كار با والدين داراي فرزند مبتلا به اوتيسم توصيه كرد: درمان مبتني‌بر پذيرش و تعهد را جهت افزايش پذيرش مادران و كاهش استفاده از سبك‌هاي دفاعي رشدنايافته به‌ كار گيرند.

Objective: Autism spectrum disorder is a nerve growth disorder that is classified as affecting social interaction including limited interests, repetitive activities and behavioral patterns. This disorder initiates prior to age 36 months, and generally manifests itself when the patients are less than three years old. Autism is one the most chronic and unknown children disorder with many unknown aspects. It is necessary to devote a noticeable amount of research and clinical practice to this disorder due to its large spread (1% among the population) and its chronic nature. Parents like to have healthy and successful children; therefore, accepting that their children are sick is difficult for them and often provokes denial. By the time parents accept their children’s problem, they don’t know how to help them. Acceptance and Commitment therapy (ACT) is one of the third wave's cognitive behavioral therapies and is currently being used in the treatment of a number of psychological conditions and disorders. It also enhances psychological flexibility and subsequently improves individual’s mental health. Acceptance and Commitment therapy invites people to open up to unpleasant feelings, and learn not to overreact to them, and not to avoid situations where they are invoked. This research investigates the effect of Acceptance and Commitment therapy on acceptance and defense style in mothers of autistic children with denial defense style. Methods: This is a two-group pretest-posttest quasi-experimental study. The population consisted of all clients with autism spectrum referring to special children’s school in 2015. Convenience sampling was used to recruit 40 participants. The participants were assigned to the experimental and control groups in equal numbers. The experimental group received Acceptance and Commitment Therapy in 8 sessions- each 90 minutes. The research instruments were Defense Style Questionnaire (DSQ) and Acceptance and Action Questionnaire-2(AAQ-2). DSQ questionnaire was developed by Bond in 1983 to evaluate 3 defense mechanisms: mature, immature and neurotic styles. AAQ2 was developed by Abbasi in Iran. Alpha Cronbach for this questionnaire is 0/89. Co-variance analysis was used to examine the research hypotheses. Results: The results showed that Acceptance and Commitment therapy can increase acceptance in mothers of autistic children. The mean scores for acceptance measure in the experimental group increased from 18.2 in pre-test to 28 in the post-test, while in control group it increased from 16.8 in the pre-test to 17.2 in the post-test. Covariance analysis showed that there was a significant difference between two groups (P<0.05) on this measure. However, there was no significant difference between two groups in commitments of mothers (P>0.05). The mean score for commitment measure in the experimental group increased from 7.9 in the pre-test to 11.3 in the post- test. In the control group the same mean score increased from 9.7 in the pre-test to 9.6 in the post- test. The result showed that Acceptance and Commitment therapy can reduce use of immature defense styles in mothers of autistic children (p=0.01). Also, the results of covariance analysis showed that there was no significant difference between mature and neurotic defense styles in experimental and control groups in the posttest. Conclusion: In acceptance and commitment therapy, the participants are encouraged to improve their commitment to have healthier lives, including behavioral strategies when facing negative thoughts and emotions. Therefore, ACT can have effective influence on adjustment of parents.