مقايسهٔ‌ اثر بخشي آموزش روان‌ شناسي مثبت‌ نگر و آموزش ايمن‌ سازي در مقابل استرس بر بهزيستي روان‌ شناختي در زنان باردار مبتلا به افتادگي دريچهٔ ميترال

Comparing the Effects of Positive Psychology and Immunization against Stress on Psychological Wellbeing in Pregnant Women With Mitral Valve Prolapse

زمينه ‌و‌ هدف: با توجه به مشكلات زنان باردار مبتلا به بيماري‌هاي قلبي‌عروقي، مداخلات روان‌شناختي در بهبود بهزيستي روان‌شناختي آنان مفيد است؛ بنابراين پژوهش حاضر با هدف مقايسهٔ اثربخشي آموزش ايمن‌سازي ‌درمقابل استرس و آموزش روان‌شناسي مثبت‌نگر بر بهزيستي روان‌شناختي زنان باردار مبتلا به افتادگي دريچهٔ ميترال انجام شد. روش‌ بررسي: روش پژوهش، نيمه‌آزمايشي با طرح پيش‌آزمون، پس‌آزمون و پيگيري با گروه گواه بود. جامعهٔ ‌آماري را تمامي زنان باردار مبتلا به افتادگي دريچهٔ ميترال بيمارستان امام‌خميني شهر تهران در سال 1398 تشكيل دادند. از بين آن‌ها تعداد 45 نفر از افراد واجد شرايط داوطلب به‌صورت دردسترس وارد مطالعه ‌شدند. سپس به‌طور تصادفي در سه گروه روان‌شناسي مثبت‌نگر، ايمن‌سازي درمقابل استرس و گواه قرار گرفتند. گروه روان‌شناسي مثبت‌نگر طي چهارده جلسه به‌صورت هفتگي و گروه آموزش ايمن‌سازي درمقابل استرس طي نُه جلسه به‌صورت هفتگي درمان را دريافت كردند. داده‌ها با استفاده از پرسشنامهٔ بهزيستي روان‌شناختي (ريف، 1989) جمع‌آوري شد. تحليل داده‌ها با روش تحليل واريانس با اندازه‌گيري مكرر، آزمون‌هاي تعقيبي بونفروني و توكي با استفاده از نرم‌افزار SPSS نسخهٔ 22 در سطح معناداري 0٫05 صورت گرفت. يافته‌ها: نتايج نشان داد عامل درون‌گروهي (زمان) براي تمامي مؤلفه‌هاي بهزيستي روان‌شناختي شامل روابط مثبت با ديگران، استقلال، تسلط محيطي، رشد فردي، هدف‌مندي و پذيرش خود، معنادار است (0٫001>p)؛ همچنين عامل بين‌گروهي و اثر متقابل زمان و گروه براي تمامي مؤلفه‌هاي ذكرشدۀ بهزيستي روان‌شناختي معنادار است (0٫05>p). در نمرهٔ مؤلفه‌هاي ذكرشدۀ بهزيستي روان‌شناختي تفاوت معنا‌دار بين مراحل پيش‌آزمون با پس‌آزمون (0٫001>p) و مراحل پيش‌آزمون با پيگيري (0٫001>p) وجود دارد و تفاوت معنادار بين مراحل پس‌آزمون با پيگيري مشاهده نشد؛ همچنين مؤلفه‌هاي ذكرشدۀ بهزيستي روان‌شناختي در گروه روان‌شناسي مثبت‌نگر (0٫001>p) و گروه ايمن‌سازي درمقابل استرس (0٫001>p) پس از مداخله درمقايسه با گروه گواه افزايش پيدا كرده است. نتيجه‌گيري: براساس يافته‌هاي اين پژوهش مي‌توان نتيجه گرفت، آموزش ايمن‌سازي درمقابل استرس و آموزش روان‌شناسي مثبت‌نگر منجربه بهبود بهزيستي روان‌شناختي در زنان باردار مبتلا به افتادگي دريچهٔ ميترال مي‌شود.

Background & Objectives: One of the heart diseases is Mitral Valve Prolapse (MVP). The tendency of the mitral valve to fall to the left atrium of the heart during cardiac contraction is called MVP. The psychological symptoms of this complication include panic attacks, anxiety, depression, and fatigue. Furthermore, pregnancy is a new, beautiful, and of course, unfamiliar experience for numerous women. For many women, pregnancy is a stressful time and requires some kind of psychological adjustment to ensure the health of the mother and fetus. Psychological wellbeing is among the characteristics that play an important role in pregnancy. One of the other treatment methods that can help these patients is stress immunization training. Due to the problems of pregnant women with cardiovascular diseases, psychological interventions could be useful in improving their psychological wellbeing. The present study aimed to compare the effects of the training of immunization against stress and the training of positive psychology on the psychological wellbeing of pregnant women with MVP. Methods: This was a quantitative study in terms of the nature of the collected data. In terms of purpose, it was an applied study, and respecting method, it was a quasi–experimental study with a pretest–posttest–follow–up and a control group design. The statistical population of the study included all pregnant women with MVP who were admitted to Imam Khomeini Hospital in Tehran City, Iran, in 2019. Of whom, 45 eligible volunteer individuals were selected by the convenience sampling method. Accordingly, they were randomly divided into three groups of positive psychology training, stress immunization training, and control. The inclusion criteria of the current study included receiving the diagnosis of MVP based on medical records (diagnosis by a cardiologist), an age range of 18–45 years, not receiving treatment in the past 6 months, and not having personality disorders, psychosis, and substance abuse (non–addiction and drug use were established based on the patient's medical records). The exclusion criteria of the study were non–compliance with the group rules stated in the first session and absence from >2 intervention sessions. The positive psychology training group received 14 weekly sessions based on Seligman’s (2002) training package. Besides, the stress immunization training group was treated based on Meichenbaum and Deffenbacher’s (1988) training package in nine 90–minute weekly sessions. The required data were collected using the Psychological Well–Being Questionnaire (Ryff, 1989). In the descriptive statistics section, central indicators and dispersion, such as mean and standard deviation were used; in the inferential statistics section, the repeated–measures Analysis of Variance (ANOVA) was used. Statistical analyses were performed using SPSS at the significance level of 0.05. Results: The results of repeated–measures ANOVA for intragroup factor (time) were significant for all components of psychological wellbeing, including positive relationships with others, independence, environmental dominance, personal growth, purposefulness, and self–acceptance (p<0.001). Additionally, intergroup factor for all components of psychological wellbeing, including positive relationships with others (p<0.001), independence (p=0.005), environmental dominance (p=0.016), personal growth (p=0.005), purposefulness (p<0.001), and self–acceptance (p=0.007) were significant. Furthermore, the interaction of time and group for all components of psychological wellbeing, including positive relationships with others (p<0.001), independence (p<0.001), environmental dominance (p<0.001), personal growth (p<0.001), purposefulness (p<0.001), and self–acceptance (p=0.005) was significant. The Bonferroni test data indicated a significant difference between the pretest and posttest stages (p<0.001) as well as the pretest and follow–up stages (p<0.001) in the scores of the mentioned components of psychological wellbeing. The results of the Tukey test revealed that the components of psychological wellbeing in the positive psychology group (p<0.001) and the stress immunization group (p<0.001) increased after the intervention, compared to the control group. Conclusion: Training immunization against stress and positive psychology training are practical and effective approaches to improve the psychological wellbeing of pregnant women with MVP; thus, they can be used by counselors and therapists to increase psychological wellbeing in this population.