اثربخشي بستهٔ فراتشخيصي مبتني‌بر درمان پذيرش و تعهد، درمان متمركز بر شفقت و رفتاردرماني دياليكتيكي بر رفتار خوردن و خودكارآمدي سبك زندگي مربوط به وزن زنان مبتلا به اضافه وزن و چاقي

The Effectiveness of Diagnostics Educational Package Based on Acceptance and Commitment Therapy, Compassion Focused Therapy and Dialectical Behavior Therapy on the Eating Behavior and the Weight- Efficacy of life style in the Overweight and Obese Woman

هدف: چاقي ‌و اضافه وزن به‌عنوان مشكلي جدي و جهاني به شمار مي‌رود. پژوهش حاضر ‌با هدف اثربخشي بستهٔ آموزشي فراتشخيصي ‌مبتني بر درمان پذيرش و تعهد، درمان متمركز بر شفقت و رفتاردرماني ‌دياليكتيكي بر رفتار خوردن و خودكار آمدي سبك زندگي مربوط به وزن‌ در زنان مبتلا به ‌اضافه‌ وزن‌ و چاقي انجام‌ گرفت. روش‌ بررسي: پژوهش ‌حاضر آزمايشي ‌از نوع پيش‌آزمون - پس‌آزمون با‌ گروه‌ گواه بود. جامعه شامل زنان مراجعه‌كننده به ‌كلينيك تغذيهٔ شهر تنكابن در سال 96-‌1395 بود كه ‌از بين آن‌ها 20 زن مبتلا‌به اضافه‌ وزن‌ و چاقي (هر گروه ‌ده‌نفر) از طريق‌ انتساب تصادفي ساده به‌روش قرعه‌‌كشي، ‌در‌ دوگروه ‌آزمايش و گواه قرار گرفتند. اين افراد پرسشنامه‌هاي‌ خودكارآمدي سبك‌ زندگي ‌مربوط ‌به ‌وزن (كلارك، 1991) و رفتار خوردن ‌هلندي (فورمن، 2009) را پيش‌ از شروع جلسات و دوهفته بعد از پايان جلسهٔ دوازدهم و سه ماه پس ‌از آموزش ‌تكميل كردند. داده‌ها ازطريق روش‌هاي ‌آمار توصيفي (ميانگين، انحراف استاندارد) و آمار استنباطي ‌تحليل‌ كواريانس‌ چند‌متغيره (MANCOVA) و با استفاده از نرم‌افزار SPSS20 تجزيه‌ و تحليل شد. يافته‌ها: نتايج نشان داد كه ميانگين نمرهٔ پيش‌آزمون خودكارآمدي سبك‌زندگي ‌مربوط به وزن و رفتار خوردن گروه‌ آزمايش برابربا 85٫10 و 118٫80 است. درحالي‌ كه ميانگين‌ پس‌آزمون ‌و پيگيري خودكارآمدي سبك‌ زندگي ‌مربوط به وزن ‌و رفتار خوردن به‌ ترتيب برابر با (145٫30 و 151٫20) و (84 و 78٫60) است. همچنين ميانگين پيش‌آزمون خودكارآمدي ‌سبك ‌زندگي ‌مربوط به‌ وزن ‌و رفتار خوردن گروه گواه برابر با 70٫80 و 128٫60 است‌ و ميانگين پس‌آزمون و پيگيري ‌خودكارآمدي سبك زندگي مربوط به وزن و رفتار خوردن گروه گواه به‌ترتيب برابر با (66٫90 و 66٫20) و (119٫90 و 125٫50) است. نتايج تحليل كواريانس چندمتغيره نشان مي‌دهد بستهٔ فرا تشخيصي مبتني‌بر شفقت، درمان‌ مبتني‌بر پذيرش و تعهد و رفتاردرماني ‌دياليكتيكي‌ در افزايش‌ خودكارآمدي سبك زندگي مربوط به وزن و كاهش رفتار خوردن مؤثر بوده است (0٫001>p). نتيجه‌گيري: با توجه به يافته‌هاي پژوهش، كاربرد بستهٔ آموزشي فراتشخيصي مبتني‌بر درمان پذيرش و تعهد، درمان متمركز بر شفقت و رفتاردرماني دياليكتيكي مي‌تواند در ارتقاي بهزيستي جامعه مؤثر باشد.

Background & Objective: One of the most serious worldwide health problems is overweight and obesity, especially is associated with significantly different somatic and psychological problems (such as heart attack, blood pressure, arthritis, type 2 diabetes, heart failure, stroke, increased all-cause mortality, higher rates of depression, anxiety, reduced quality of interpersonal relationships), Additionally overweight and obesity reflecting negative self-evaluations of one´s weight and physical appearance and perceived discrimination, so it causes to impair of quality of life and self-efficacy. Also when the most common obesity interventions have focused primarily on weight loss like low-calorie diet and physical activity prescription, without full consideration of psychological factors, not surprisingly weight gain following these interventions is common; however, by 3–5 years post-treatment, most patients have returned to or exceeded their pretreatment weight. Due to the important role of psychological factors in overweight and obesity, the aim of this research was to study the effect of diagnostic's educational package based on acceptance and commitment therapy, Compassion Focused Therapy and dialectical behavior therapy on the eating behavior and the Weight- Efficacy of lifestyle in overweight and obese women. Methods: This study was experimental with pretest, posttest and control group that was conducted on 20 women suffering from overweight and obesity (Body Mass Index more than 25) referring to the nutrition clinic in Tonkabon in 2016-2017. The women were selected by random sampling and were randomly classified into the experimental group (n=10) and the control group (n=10). The overweight and obsess women into two groups were matched in some demographic variables and completing two scales Dutch Eating behavior questionnaire and weight efficacy lifestyle questionnaire as a pretest, posttest and follow up to assessment after three months. The intervention consisting of twelve sessions of training diagnostic's educational package based on acceptance and commitment therapy, Compassion Focused Therapy and dialectical behavior therapy was given to the experimental group at three months. The obtained data were analyzed statistical tests of MANCOVA by SPPSS20. Results: The results of multivariate analysis of variance (MANOVA) showed that the ratio of pre-test and post-test differences in the rates of eating behavior in the test and control groups was equal to (34.140) , F ratio obtained between the two groups GD related test and followed the equal rates of eating behavior (F=67.331) analysis of variance and differences related to pretesting scores and Weight- Efficacy of lifestyle in the test groups and control test was F=53. 639 and analysis of variance related to differences steps after the step follow-up test related to Weight- Efficacy of lifestyle test and control groups was equal to (F=73.353). Data analysis showed that diagnostic's educational package caused the increase of Weight- Efficacy of lifestyle (p<0.001). and the decrease of eating behavior of the experimental group of women in comparison with the control groups (p<0.001). Conclusion: According to the finding from this study, use of diagnostic's educational package based on acceptance and commitment therapy, Compassion Focused Therapy and dialectical behavior therapy allow overweight and obsess women to step out of the trap of stigma, self-critical, negative affect and emotional eating by basic and advanced mindfulness skills, emotion regulation, acceptance, self-compassion strategies and helps them to clarify their personal values and fallowing meaningfulness behavior and becoming the self-compassion with yourself. Also, Participants learn to tolerate aversive states related to eating (cravings, boredom, discomfort) while continuing to engage in the desired behaviors such as removal, or ‘experiential avoidance’ of aversive urges or feelings by overeating or eating unhealthful foods. Additionally, the intervention helps overweight and obsessed women to increase awareness of the perceptual, cognitive and affective experiences and being more presentcentered and aware, thereby reducing “mindless” eating. These skills interrupt automatic, non-conscious influences on eating behavior that can lead to overeating and/or sedentary so improving the quality of lifestyle of overweight and obsessed women. Due to the increasing overweight and obesity, the use of diagnostic's educational package based on acceptance and commitment therapy, Compassion Focused Therapy and dialectical behavior therapy improves the well-being of society.