اثر بخشي درمان برنامهٔ زماني پارادوكسي بر كاهش نگراني، نشخوار فكري، درهم‌ آميختگي فكر-عمل و علائم بيماران مبتلا به اختلال وسواسي-اجباري

The Effects of Paradoxical Time Table Therapy on Worry, Rumination, Thought-Action Fusion and Symptoms in Patients with Obsessive- Compulsive Disorder

زمينه و هدف: اختلال وسواسي-جبري (OCD) بيماري عصبي-روان‌پزشكي است كه اغلب در دوران كودكي ايجاد مي‌شود و در بلندمدت باعث مشكلات درخورتوجهي در زندگي فردي مي‌شود. مطالعهٔ حاضر به‌دنبال بررسي اثربخشي برنامهٔ زماني پارادوكسي بر كاهش نگراني، نشخوار فكري، درهم‌آميختگي فكر-عمل و علائم بيماران مبتلا به اختلال وسواسي-اجباري بود. روش‌بررسي: در اين پژوهش از طرح مطالعهٔ تجربي تك‌موردي استفاده شد. از ميان طرح‌هاي تك‌آزمودني، در اين پژوهش طرح خطوط پايهٔ چندگانه به‌كار رفت جامعهٔ آماري پژوهش حاضر را افراد با تشخيص اختلال وسواس مراجعه‌كننده به كلينيك مركز آرامش نوين در شهر تهران تشكيل ‌دادند كه داراي پروندهٔ فعال در ماه‌هاي فصل بهار 1397 بودند. در اين مطالعه تعداد 3 بيمار، درمان برنامهٔ زماني پارادوكسي را دريافت كردند. به‌منظور جمع‌آوري داده‌ها، مقياس شدت وسواس فكري-عملي ييل-براون (1998)، مقياس تجديدنظرشدهٔ آميختگي فكر-عمل (شفران و همكاران، 1996)، پرسشنامهٔ نگراني پن ‌استت (زينبارگ و بارلو، 1990) و مقياس پاسخ‌هاي نشخوارگري (نولن-هوكسما و مارو، 1993) استفاده شد. در پژوهش حاضر تجزيه‌وتحليل داده‌ها به‌كمك روش‌هاي تحليل نمودار، شاخص تغيير پايا، معناداري باليني و درصد بهبودي صورت گرفت. يافته‌ها: نتايج اين مطالعه نشان داد كه به‌طوركلي درمان برنامهٔ زماني پارادوكسي تأثير معناداري بر كاهش نگراني، نشخوار فكري، درهم‌آميختگي فكر-عمل و علائم وسواسي جبري دارد (0٫05≥p)؛ همچنين شاخص پايا و معناداري باليني و درصد بهبود برنامهٔ زماني پارادوكسي در هر سه آزمودني داراي كاهش مطلوبي است. نتيجه‌گيري: به‌نظر مي‌رسد درمان برنامهٔ زماني پارادوكسي مي‌تواند مداخلهٔ مؤثري براي كاهش علائم وسواس فكري‌عملي و نشانه‌هاي همراه آن باشد؛ بنابراين توصيه مي‌شود تا پژوهشگران و درمانگران از اين روش براي بيماران خود استفاده كنند.

Background & Objectives: Obsessive–Compulsive Disorder (OCD) is a prevalent mental disorder that causes severe disruption in personal life. Extensive experimental evidence suggests behavioral therapy as the first–line treatment for OCD. Some researchers believe that behavioral therapy requires alternative or complementary approaches. One of the newest of these integrated approaches is the Paradoxical Time Table Therapy (PTTT). An approach that incorporates systemic, behavioral, and analytical aspects into treatment could be an appropriate method for managing all disorders, including anxiety disorders and OCD. The present study aimed to explore the effects of PTTT on worry, rumination, thought–action fusion, and symptoms in patients with OCD. Methods: In this research, a single–case experimental method was used. Among the single–subject approaches, multiple baselines method was applied in this study. The study population consisted of individuals with OCD who referred with an active case to the Aramesh Novin Clinic in Tehran City, Iran, in the spring of 2019. Among them, 3 patients received PTTT. The study participants were selected by purposive sampling approach. Patients who were diagnosed with OCD by a psychiatrist were referred to the therapist. The study inclusion criteria included receiving OCD diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM–5) criteria for OCD by a psychiatrist; not receiving any psychological treatment before entering the study; having a minimum age of 20 years, and a maximum of 40 years; having at least high–school diploma, and providing consent to participate in the research. The PTTT consists of 6 therapeutic sessions, including two basic paradoxical techniques and a time table. To collect the required data, the Yale–Brown Obsessive–Compulsive Scale (1989), Thought Action Fusion Scale–Revised (Shafran et al., 1996), Penn State Worry Questionnaire (Zingbarg & Barlow, 1990), and Ruminative Response Scale (Nolen–Hoeksema et al., 1993) were employed. Besides, chart analysis, reliable change index, clinical significance, and the improvement percentage of paradoxical time table were used for data analysis. Results: The paradoxical treatment group participants aged between 25 and 34 years with a mean±SD age of 30.33±4.72 years. The obtained data suggested that in the paradoxical schedule treatment, the reliability index values for worry in the first, second, and third subjects were – 4.19, –3.44, and –5.27, respectively. For rumination, the same value in the three subjects were –3.76, –2.42, and –4.46, respectively. The thought– action fusion values were –4.41, –4.32, and –4.73, respectively. Symptoms scores were also –4.42, –3.78, and –5.18, respectively. Furthermore, in the paradoxical time table group, the reliability index values were higher than the criterion value of 1.96; thus, the results were not caused by the measurement error and unreliability of the test, and they were due to the therapeutic intervention. The current study findings demonstrated that PTTT has remarkably reduced worry, thought rumination, the intertwining of thought and action (thought–action fusion), and OCD symptoms (p≥0.05). Notably, a significant level of symptoms remained declined after the intervention, indicating that the PTTT maintained its consistency in reducing the symptoms in all three study subjects at the follow–up phase. Conclusion: In general, PTTT is an appropriate and effective method for reducing OCD symptoms. Accordingly, it can be used as a proposed treatment in this area. PTTT could present a greater impact, because it increases the power of ego, and disrupts communication between cue and anxiety, and it changes their meaning. However, this is a novel treatment approach. Moreover, studies that have previously addressed the use of contradictory intention elements only considered one intervention of the paradoxical schedule treatment. It is recommended to use this treatment for other patients, including those with anxiety and mood disorders.