مقايسه درمان شناختي- رفتاري و درمان مبتني بر پذيرش و تعهد بر خشم در زنان مبتلا به افسردگي پس از زايمان

Comparison of Cognitive-behavioral Therapy and Acceptance and Commitment Therapy on Anger in Women with Postpartum Depression

زﻣﯿﻨﻪ و ﻫﺪف: اﺧﺘﻼل اﻓﺴﺮدﮔﯽ ﭘﺲاز زاﯾﻤﺎن، ﻣﺴﺌﻠﻪ اي ﺑﻬﺪاﺷﺘﯽ ﺑﺎ ﺷﯿﻮع ﺑﺎﻻ ﻣﯽﺑﺎﺷﺪ. ﻫﺪف ﭘﮋوﻫﺶ، ﻣﻘﺎﯾﺴﻪ اﺛﺮﺑﺨﺸﯽ درﻣﺎنﻫﺎي ﺷﻨﺎﺧﺘﯽرﻓﺘﺎري و ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ ﺑﺮ ﺧﺸﻢ در زﻧﺎن ﻣﺒﺘﻼ ﺑﻪ اﻓﺴﺮدﮔﯽ ﭘﺲ از زاﯾﻤﺎن ﺑﻮد. ﻣﻮاد و روشﻫﺎ: روش ﭘﮋوﻫﺶ، ﻧﯿﻤﻪآزﻣﺎﯾﺸﯽ ﺑﺎ ﻃﺮح ﭘﯿﺶآزﻣﻮن- ﭘﺲ آزﻣﻮن-و ﭘﯿﮕﯿﺮي 3ﻣﺎﻫﻪ ﺑﺎ ﮔﺮوه ﮐﻨﺘﺮل ﺑﻮد. ﺟﺎﻣﻌﻪ آﻣﺎري، زﻧﺎن ﻣﺒﺘﻼ ﺑﻪ اﻓﺴﺮدﮔﯽ ﭘﺲ از زاﯾﻤﺎن ﻣﺮاﺟﻌﻪﮐﻨﻨﺪه ﺑﻪ ﻣﺮاﮐﺰ ﺳﻼﻣﺖ ﻏﺮب اﺳﺘﺎن اﻟﺒﺮز، در ﺳﺎل 1398 ﺑﻮد. 45ﻧﻔﺮ از اﯾﻦ ﺑﯿﻤﺎران ﺑﺎ ﻣﻘﯿﺎس اﻓﺴﺮدﮔﯽ ﭘﺲ از زاﯾﻤﺎن ادﯾﻨﺒﻮرگ، اﻓﺴﺮدﮔﯽ آنﻫﺎ ﺗﺄﯾﯿﺪ ﺷﺪ و ﺑﺎ روش ﻧﻤﻮﻧﻪﮔﯿﺮي در دﺳﺘﺮس اﻧﺘﺨﺎب و ﺑﺎ روش ﻧﻤﻮﻧﻪﮔﯿﺮي ﺗﺼﺎدﻓﯽ در دو ﮔﺮوه آزﻣﺎﯾﺶ و ﯾﮏ ﮔﺮوه ﮐﻨﺘﺮل )ﻫﺮ ﮔﺮوه 15ﻧﻔﺮ( ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﮔﺮوهﻫﺎ ﺑﻪﻣﻨﻈﻮر ﭘﯿﺶآزﻣﻮن ﺑﻪ ﻧﺴﺨﻪ ﻓﺎرﺳﯽ ﺳﯿﺎﻫﻪ اﺑﺮاز ﺧﺸﻢ ﺻﻔﺖ-ﺣﺎﻟﺖ - 2اﺳﭙﯿﻠﺒﺮﮔﺮ، ﭘﺎﺳﺦ دادﻧﺪ. اﻋﻀﺎي ﮔﺮوه آزﻣﺎﯾﺶ 1درﻣﺎن ﺷﻨﺎﺧﺘﯽرﻓﺘﺎري، و ﮔﺮوه آزﻣﺎﯾﺶ 2درﻣﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ، درﯾﺎﻓﺖ ﮐﺮدﻧﺪ. ﮔﺮوه ﮐﻨﺘﺮل ﻫﯿﭻ ﻧﻮع ﻣﺪاﺧﻠﻪاي را درﯾﺎﻓﺖ ﻧﮑﺮدﻧﺪ. در ﭘﺲ آزﻣﻮن، اﺟﺮاي اﯾﻦ ﭘﺮﺳﺶﻧﺎﻣﻪ ﻣﺠﺪد اﻧﺠﺎمﮔﺮدﯾﺪ. ـﯾﺎﻓﺘـﻪﻫـﺎ: ﻣﯿـﺎﻧﮕﯿﻦ و اﻧﺤﺮافﻣﻌﯿـﺎر ﺧﺸـــﻢ، در ﭘﯿﺶآزﻣﻮن 96±21 /76/182 ، ﭘﺲآزﻣﻮن 143 /13±40 /07و ﭘﯿﮕﯿﺮي 142 /31±40 /55ﺑﻮد. ﺗﻔـﺎوت ﻣﯿـﺎﻧﮕﯿﻦ ﺑﯿﻦ ﮔﺮوهﻫـﺎي آزﻣـﺎﯾﺶ ﺷـــﻨـﺎﺧﺘﯽرﻓﺘـﺎري و درﻣـﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ـﭘﺬﯾﺮش و ﺗﻌﻬـﺪ ـﺑﺎ ﮔﺮوه ﮐﻨﺘﺮل، ﻣﻌﻨـﺎدار ﺑﻮد )0 /000=P(. ﺗﻔـﺎوت ﻣﯿـﺎﻧﮕﯿﻦ ﺑﯿﻦ ﮔﺮوهﻫـﺎي آزﻣـﺎﯾﺶ ﺷـــﻨـﺎﺧﺘﯽرﻓﺘـﺎري و درﻣـﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘـﺬﯾﺮش و ﺗﻌﻬـﺪ، ﻣﻌﻨـﺎدار ﻧﺒﻮد )1 /000=P(. در ﭘﯿﮕﯿﺮي، ﺗﻔـﺎوت ﻣﯿـﺎﻧﮕﯿﻦ ﺑﯿﻦ ﮔﺮوهﻫـﺎي آزﻣـﺎﯾﺶ ﺷـــﻨـﺎﺧﺘﯽرﻓﺘـﺎري و ﮐﻨﺘﺮل، ﻣﻌﻨـﺎدار ﻧﺒﻮد )P=0 /054(، ﺗﻔـﺎوت ﻣﯿـﺎﻧﮕﯿﻦ ﺑﯿﻦ ﮔﺮوهﻫـﺎي آزﻣـﺎﯾﺶ درﻣـﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘـﺬﯾﺮش وﺗﻌﻬـﺪ ﺑـﺎ ﮐﻨﺘﺮل، ﻣﻌﻨﺎدار ﺑﻮد )P=0 /018(. ﻧﺘﯿﺠﻪﮔﯿﺮي: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﺛﺮﺑﺨﺸـﯽ ﭘﺎﯾﺪارﺗﺮ درﻣﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ، ﭘﯿﺸـﻨﻬﺎد ﻣﯽﮔﺮدد ﮐﻪ ﺑﺮاي ﮐﺎﻫﺶ ﺧﺸـﻢ در زﻧﺎن ﻣﺒﺘﻼ ﺑﻪ اﻓﺴﺮدﮔﯽ ﭘﺲاز زاﯾﻤﺎن، درﻣﺎن ﺗﺮﺟﯿﺤﯽ درﻧﻈﺮ ﮔﺮﻓﺘﻪﺷﻮد.

The Postpartum depression is a high prevalence health issue. Aim of study was to compare the effectiveness of cognitive-behavioral and acceptance and commitment therapies to anger in women with postpartum depression. Materials and Methods: The research method was quasi-experimental with pre-test-post-test design and 3-month follow-up with the control group. The statistical population was women with postpartum depression who referred to health centers in the west of Alborz province in 2019. 45 of these patients with Edinburgh Postpartum Depression Scale, their depression was confirmed, selected by available sampling method and by random sampling method in two experimental groups and one control (15 people in each group), Were located. The groups responded to the Persian version of the Spielberger state-trait anger expression inventory-2, for a pre-test. The members of Experimental group 1 received cognitive-behavioral therapy, and experimental group 2 received acceptance-commitment therapy. Control group did not receive any intervention. In the post-test, this questionnaire was administered again. Results: The mean and standard deviation of anger were 182.96±21.76 in the pre-test, 143.13±40.07 in the post-test, and 142.31±40.55 in the follow-up. Mean difference between cognitive-behavioral groups and acceptance and commitment therapy with the control was significant (P=0.000). Mean difference between the groups of cognitive-behavioral and acceptance and commitment therapy was not significant (P=1.000). In follow-up, mean difference between cognitive-behavioral and control was not significant (P=0.054), mean difference between acceptance and commitment therapy and control was significant (P=0.018). Conclusion: Considering the more stable effectiveness of acceptance and commitment therapy, it is suggested that, to reduce anger in women with postpartum depression, preferential treatment be considered.