بررسي اثر بخشي آموزش خودشفقتي ذهن‌ آگاهانه با تأكيد بر سبك زندگي اسلامي- ايراني بر كيفيت زندگي مادران داراي كودك با اختلال اوتيسم

The Effects of Mindful Self-Compassion Training With Focus on the Islamic-Iranian Lifestyle on the Quality of Life Mothers of Children With Autism

زمينه و هدف: مادران داراي كودك با اختلال اوتيسم سطوح شديدي از استرس را تجربه مي‌كنند كه تأثير منفي بر كيفيت زندگي آن‌ها مي‌گذارد. تدوين برنامهٔ مناسب براي بهبود كيفيت زندگي آنان اهميت دارد؛ بنابراين اين پژوهش با هدف بررسي اثربخشي آموزش برنامهٔ خودشفقتي ذهن‌آگاهانه با تأكيد بر سبك زندگي اسلامي-ايراني بر كيفيت زندگي مادران داراي كودك با اختلال اوتيسم انجام شد. روش‌ بررسي: پژوهش حاضر از نوع نيمه‌آزمايشي با طرح پيش‌آزمون، پس‌آزمون و پيگيري سه‌ماهه بود. جامعهٔ آماري را تمامي مادران داراي كودك با اختلال اوتيسم در انجمن اوتيسم شهر كاشان در سال 1398 تشكيل دادند. نمونهٔ آماري شامل 24 مادر داراي كودك با اختلال اوتيسم بود كه داوطلب مشاركت در مطالعه شدند. به‌روش نمونه‌گيري دردسترس و با جايگزيني تصادفي 12 مادر در گروه آزمايش و 12 مادر در گروه گواه قرار گرفتند. گروه آزمايش به‌مدت هشت جلسه در برنامهٔ آموزش خود‌شفقتي ذهن‌آگاهانه با تأكيد بر سبك زندگي اسلامي-ايراني شركت كرد و گروه گواه در فهرست انتظار براي آموزش قرار گرفت. براي سنجش كيفيت زندگي از فرم كوتاه پرسشنامهٔ كيفيت زندگي سازمان جهاني بهداشت (1996) استفاده شد. تجزيه‌و‌تحليل يافته‌هاي به‌دست‌آمده با استفاده از آزمون‌هاي تي‌استودنت، خي‌دو، بونفروني و تحليل واريانس با اندازه‌گيري مكرر و نرم‌افزار SPSS نسخهٔ 22 صورت گرفت. سطح معناداري آزمون‌هاي آماري 0٫05 بود. يافته‌ها: نتايج حاصل از تحليل داده‌ها نشان داد كه آموزش برنامهٔ خودشفقتي ذهن‌آگاهانه با تأكيد بر سبك زندگي اسلامي-ايراني در بهبود مؤلفه‌هاي كيفيت زندگي مادران داراي كودك با اختلال اوتيسم يعني در سلامت جسماني، سلامت رواني و روابط اجتماعي، عامل گروه (0٫001>p)، عامل زمان (0٫001>p) و تعامل زمان و گروه (0٫001>p) معنادار است و در سلامت محيط، عامل گروه (0٫440=p)، عامل زمان (0٫875=p)و تعامل زمان و گروه (0٫071=p) معنادار نيست؛ همچنين در سلامت جسماني، سلامت رواني و روابط اجتماعي، تفاوت معناداري بين ميانگين‌ها، در مراحل پيش‌آزمون با پس‌آزمون و پيگيري وجود دارد (0٫001≤p). نتيجه‌گيري: باتوجه به يافته‌ها، نتيجه گرفته مي‌شود كه آموزش برنامهٔ خودشفقتي ذهن‌آگاهانه با تأكيد بر سبك زندگي اسلامي-ايراني در بهبود كيفيت زندگي مادران داراي كودك با اختلال اوتيسم مؤثر است.

Background & Objectives: Autism Spectrum Disorders (ASDs) are neurodevelopmental conditions, i.e., characterized by impairments in domains, such as social interaction and communication across multiple contexts as well as the presence of repetitive and stereotyped behaviors. ASD imposes high stress on parents or caregivers. The stress negatively impacts parents’ Quality of Life (QoL) and coping styles, and disrupts their daily and social functioning. Findings indicate that caregivers, especially the mothers of children with autism, experience a poor QoL. Considering the effects of caregiving for a child with ASD on the family members and particularly parents and their QoL, it is essential to provide a solution to improve their QoL. Therefore, the present study aimed to investigate the effects of mindful self–compassion training with a focus on the Islamic–Iranian lifestyle on the QoL of the mothers of children with ASD. Methods: This was a quasi–experimental study with a pretest–posttest and three–month follow–up and a control group design. The statistical population of the study was all the mothers of children with ASD who were registered in the Autism Association of Kashan City, Iran, in 2019. The statistical sample included 24 mothers who volunteered to participate in the current study. They were divided into two groups of test and control (n=12/group). The inclusion criteria for the mothers were holding high school diploma or higher degrees, being married, not being pregnant, not having respiratory and cardiovascular diseases (according to their medical records), not receiving any psychological or psychiatric treatments (according to their medical and psychological records), and scoring ≤50 in the World Health Organization Quality of Life (WHOQOL–BREF) (1996). Absence in two training sessions and not performing homework assignments were the exclusion criteria for the mothers. To develop a mindful self–compassion program focused on Islamic–Iranian lifestyle, based on the theoretical framework of cognitive– behavioral approach and Islamic teachings, the material was firstly extracted from works of Kabat–Zinn on mindfulness (2003), Neff and Germer on self–compassion (2013), Germer and Neff mindful self–compassion (2020), Gilbert and Procter on the compassionate mind (2006), Kalhori et al.’s mindfulness–based on Islamic–Iranian Teachings (2020), as well as the Islamic sources and texts, the Holy Quran, Nahj al–Balaghah, Bihar al–Anwar, Mizan al–Hikmah, Ghurar al–Hikam, the Masnavi by Rumi, the Divan by Hafez, and Saadi’s Divan. Subsequently, they were organized using the content analysis method and the content and tasks of each session were designed under the supervision of the advisors of this research. To evaluate the content validity, the program was presented to 9 specialists (6 clinical, general, & exceptional children’s psychologists with the academic rank of professor and assistant professor and >10 years of clinical experience, 2 specialist in theology, religions, and mysticism with the academic rank of assistant professor, and 1 Persian literature expert with the academic rank of an assistant professor). After obtaining the opinions of experts and applying them, to quantify the content validity of the program, the Content Validity Ratio (CVR), proposed by Lawshe (1975) and Waltz and Bausell’s Content Validity Index (CVI) (1983) were used per session. The CVR and CVI amounts were approved at 0.78 and 0.88, respectively. The program was first applied to a preliminary single–group study, consisting of 5 mothers of children with ASD, and a poor QoL; then, it was prepared for the final implementation. To measure the explored mothers’ QoL, the WHOQOL– BREF, a short version of QoL, i.e., developed by the World Health Organization was used in the pretest, posttest, and follow–up stages of this study. The experimental group received an 8–session training, one session per week, and each session lasted two and a half hours; the training was performed by the first researcher and the control group remained on a waiting list for training. A 15–minute break was included in all sessions. First, the obtained data were analyzed by descriptive statistical measures, such as mean and standard deviation. The collected data were also analyzed by Student's t–test, Bonferroni test, Chi–squared test, and repeated–measures Analysis of Variance (ANOVA) in SPSS. The significance level of statistical tests was α=0.05. Results: The repeated–measures ANOVA results for the QoL components indicated that in physical health, mental health, and social relationships, group factor (p<0.001), time factor (p<0.001), and time and group relation (p<0.001) was significant. In environment health, group factor (p=0.440), time factor (p=0.875), and time and group relation (p=0.071) were not significant. The results of Bonferroni post–hoc test suggested a significant difference between the mean scores of physical health, mental health, and social relationships in the pretest and posttest stages (p≤0.001), also in the pretest and follow–up stages (p≤0,001); however, no significant difference was found between the mean scores in the posttest and follow–up stages. Plus, there was no significant difference between the mean values of environment health, in the pretest and posttest stages (p=0.077), as well as the pretest and follow–up stages (p=0.091). Conclusion: The present research findings revealed that the mindful self–compassion with a focus on Islamic–Iranian lifestyle program training was effective in improving the QoL of mothers of children with ASD. Therefore, educational and medical centers can use this training to improve the individual and social functions of the parents and caregivers of children with ASD or other developmental disorders.