مقايسۀ اثر بخشي درمان ذهن‌ آگاهي، معنا درماني و درمان فعال‌ سازي رفتاري بر كيفيت خواب دانشجويان دختر افسرده

Comparing the Effects of Mindfulness-Based Therapy, Logo therapy, and Behavioral Activation Therapy on Sleep Quality in Depressed Female Students

زمينه و هدف: يكي از نشانه‌هاي رايج اختلال‌هاي رواني و هيجاني كه به‌ويژه براي افسردگي و خودكشي ذكر شده‌ است، اختلال در خواب است. هدف پژوهش حاضر تعيين تفاوت اثربخشي ذهن‌آگاهي، معنادرماني و درمان فعال‌سازي رفتاري بر كيفيت خواب دانشجويان دختر افسرده بود. روش‌ بررسي: روش پژوهش از نوع نيمه‌آزمايشي با طرح پيش‌آزمون، پس‌آزمون و پيگيري با گروه گواه بود. جامعهٔ آماري پژوهش حاضر را مراجعان دانشجوي دختر مقطع كارشناسي تشكيل دادند كه براساس فراخوان به مركز مشاورهٔ اميد مهر در سال 1398 مراجعه كردند. از ميان آن‌ها 60 نفر به‌روش نمونه‌گيري دردسترس انتخاب شدند و با همگن‌سازي سن در چهار گروه درمان ذهن‌آگاهي، معنادرماني، درمان فعال‌سازي رفتاري و گواه قرار گرفتند. شركت‌كننده‌ها در مراحل پيش‌آزمون، پس‌آزمون و پيگيري به شاخص كيفيت خواب پيتزبورگ (بويسي و همكاران، 1989) و سياهۀ افسردگي بك (بك، 1961) پاسخ دادند. گروه‌هاي آزمايش هشت جلسه درمان ذهن‌آگاهي، ده جلسه معنادرماني و ده جلسه فعال‌سازي رفتاري دريافت كردند. براي تحليل داده‌ها از روش تحليل واريانس با اندازه‌گيري‌هاي مكرر و آزمون تعقيبي بونفروني به كمك نرم‌افزار SPSS نسخۀ 25در سطح معناداري 0٫05 استفاده شد. يافته‌ها: نتايج نشان داد كه تفاوت معنادار بين گروه‌هاي درمان‌ ذهن‌آگاهي، معنادرماني و فعال‌سازي رفتاري با گروه گواه در متغير كيفيت خواب وجود دارد (0٫001>p) و بين سه گروه درماني تفاوت معنادار وجود ندارد. همچنين نتايج حاكي‌از تفاوت ميانگين‌ها در مراحل پيش‌آزمون با پس‌آزمون (0٫001>p) و پيش‌آزمون با پيگيري (0٫001>p) براي متغير كيفيت خواب است و نشان‌‌دهندۀ تداوم تأثير مداخلات در مرحلۀ پيگيري است (0٫001=p). نتيجه‌گيري: براساس نتايج پژوهش، هر سه رويكرد درمان ذهن‌آگاهي، معنادرماني و درمان فعال‌سازي رفتاري هريك با هدف قراردادن يك ‌بُعد از افسردگي بر كيفيت خواب دختران افسرده اثربخش هستند و اثر كاهنده دارند.

Background & Objectives: Depressive disorders are chronic and debilitating conditions that affect numerous individuals worldwide. Sleep disorders are among the most frequent symptoms of mood and emotional conditions, especially depression and suicidal ideation and attempts; sleep problems have been identified as a risk factor for suicide. Depressed patients present decreased mindfulness than others; therefore, Mindfulness–Based Therapies (MBTs) can facilitate treating depressed patients and improving their symptoms. Logotherapy is used to treat depressed patients and offers the acceptance of life and the search for its meaning in the most tragic circumstances. Behavioral Activation Therapy (BAT) is a novel psychotherapy approach used by psychotherapists to treat depressive disorders. This study aimed to compare the effects of MBT, Logotherapy, and BAT on sleep quality in depressed female students. Methods: This was a quasi–experimental study with a pretest–posttest–follow–up and a control group design. The statistical population of the present study included female undergraduate students who were referred to Omidmehr Counseling Center in Tehran City, Iran, in 2019. The study participants were recruited by a call. In total, 60 subjects were selected by convenience sampling method and divided into 4 age–matched groups; MBT, Logotherapy, BAT, and control (n=15/group). The inclusion criteria of the study were obtaining a score higher than the cut–off line (>5) on the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989) and a score of >17 on the Beck Depression Inventory (BDI; Beck et al., 1961); no chronic bio psychological illnesses, not abusing drugs and alcohol (clinical tests were conducted on very suspicious cases); not using antidepressants (medical records were reviewed), and not receiving concurrent psychological interventions (the records of suspicious cases were reviewed). The exclusion criteria of the study included absence from one–third of intervention sessions, as well as encountering a particular crisis or failure to meet the inclusion criteria of the research during th received 8 sessions of MBT per Wolf and Serpa’s intervention protocol (2015); 10 sessions of Logotherapy based on Hutzell’s intervention protocol (2002), and 10 sessions of BAT per the intervention protocol of Lejuez and associates (2011). However, the control group received no e intervention sessions. The study participants completed the PSQI and BDI at pretest, posttest, and follow–up stages. The experimental groups intervention. The obtained data were analyzed using repeated–measures Analysis of Variance (ANOVA) and Bonferroni posthoc test in SPSS at the significance level of 0.05. Results: The present study data suggested the significant effect of an intervention in the experimental group on sleep quality (p<0.001). Accordingly, at least one of the provided interventions affected the sleep quality of the explored depressed students. The effect of time was also significant on sleep quality (p<0.001). Thus, the presented intervention altered the posttest and follow–up scores of the study subjects, compared to the pretest phase. The interaction of time and group was significant for sleep quality (p<0.001). Additionally, repeated–measures ANOVA data concerning the effect of the group demonstrated a significant difference between the mean scores of the experimental and control groups (p<0.001). Bonferroni posthoc test data indicated a significant difference between MBT, Logo therapy, and BAT groups and the controls (p<0.001). There existed no significant difference between the three treatment groups in this respect (p=1.000). Bonferroni test data indicated a difference between the pretest and posttest mean scores (p<0.001) as well as pretest and follow–up values (p<0.001) for sleep quality; such findings highlighted the positive effects of the provided interventions and the continuation of such impacts until the follow–up stage (p=1.000). Conclusion: The present study results revealed that all presented approaches, including MBT, Logotherapy, and BAT, each targeting a dimension of depression, were effective on the sleep quality of depressed females and improved the relevant symptoms in them.