اثربخشی درمان شناختی مبتنی بر ذهن‌آگاهی بر کنترل بازداری و توجه انتخابی بزرگسالان مبتلا به اختلال بیش‌فعالی/نقص توجه

مقدمه: اختلال نقص توجه/‌بیش ‌فعالی، یکی از نافذترین اختلالات عصبی تحولی می ‌باشد که با نقایصی در ابعاد شناختی_رفتاری همراه بوده و گاهی تا بزرگسالی ادامه دارد. امروزه به دلیل عوارض جانبی داروها، از درمان ‌های غیردارویی برای درمان این اختلال استقبال شده است. پژوهش حاضر درصدد بررسی اثربخشی درمان شناختی مبتنی بر ذهن ‌آگاهی بر کنترل بازداری و توجه انتخابی افراد بزرگسال مبتلا به اختلال بیش ‌فعالی/نقص توجه بود.روش کار: پژوهش حاضر نیمه آزمایشی با طرح پیش ‌آزمون و پس‌آزمون بود. جامعه آماری، کلیه افراد مبتلا به اختلال نقص توجه/بیش‌ فعالی شهر رشت بود. انتخاب نمونه (30 مرد، 15 نفر در هر گروه) به صورت هدفمند و در دسترس از طریق فراخوان اینترنتی بر اساس تشخیص اولیه روان شناس، مصاحبه بالینی پژوهشگر و آزمون تشخیصی پژوهش انجام شد. مداخلات شناخت درمانی مبتنی بر ذهن ‌آگاهی شامل 8 جلسه 90 دقیقه‌ ای، و تکالیف خانگی 45 دقیقه‌ ای و 3 روز در هفته انجام شد. پس از اتمام مداخله آموزشی (بهمن ماه 1399)، مرحله پس‌ آزمون اجرا و در نهایت مرحله پیگیری سه ماه پس از برگزاری پس‌ آزمون انجام شد. ابزارها شامل مقیاس غربال گری نقص توجه بزرگسالان/بیش‌ فعالی conners، ، و تست go/nogo بود. به منظور تجزیه و تحلیل داده‌ها، از تحلیل واریانس با اندازه‌های مکرر استفاده شد.یافته‌ ها: نتایج نشان داد که درمان شناختی مبتنی بر ذهن‌ آگاهی بر بهبود کنترل بازداری و توجه انتخابی در مراحل پس‌آزمون و پیگیری موثر بوده است.نتیجه‌ گیری: توصیه می ‌شود روش درمان شناختی مبتنی بر ذهن‌ آگاهی در کلینیک ‌ها و مراکز خدمات روان ‌شناسی به عنوان یک روش مداخله ‌ای موثر به کار گرفته شود. 

effectiveness of mindfulness-based cognitive therapy on inhibitory control and selective attention in adults with attention-deficient/hyperactivity disorder

introductionattentiondeficit/hyperactivity disorder (adhd) is a psychological disorder that begins in childhood and involves disproportionate levels of development in the areas of inattention, impulsivity, and hyperactivity. the prevalence of this disorder in children is 3.53%. in many cases, it showed that they persist into adulthood, and the prevalence of adhd in adulthood is 3.4%. this disorder is one of childhood’s most pervasive developmental neurological disorders, which has been shown to be hyperactive, inattentive, or both, and is associated with numerous deficits in cognitive dimensions such as attention and inhibition control. other cognitive deficiencies in this disorder include attention, controlling, and scheduling problems, indicating that the disorder is in the context of executive functions. today, due to the side effects of drugs, the compulsion to continue consumption in order to maintain the effects, and weak adherence to drug therapy, nondrug treatments have been welcomed for this disorder. nondrug treatments such as cognitive therapy based on mindfulness are a combination of cognitivebehavioral therapy and mindfulness and use sustainable attention training methods that include attention regulation, emotional regulation, and physical awareness. thus, in this study, an attempt is made to improve the dimensions of selective attention and inhibitory control in adhd by using cognitive therapy based on mindfulness.methodsthe present study is applied in terms of purpose. in terms of control of variables, it is an experimental type with a pretestposttest design in which the experimental group was exposed to mindfulnessbased cognitive therapy training. the control group did not receive any intervention. the statistical population of this study includes all people with adhd in rasht. the number of participants in this study was 30 (1835 years old) males (n: 15 in each group) that were selected in a targeted and accessible way and also through an online call based on the initial diagnosis of a psychologist, clinical interview researcher, and diagnostic test. the inclusion criteria in this study are the presence of adhd syndrome from childhood. criteria for exclusion were other psychological disorders (other than adhd). mindfulnessbased cognitive therapy interventions are based on segal, williams & teasdale treatment program (19). the program consisted of eight 90minute sessions and 45minute homework three days a week (february 2021). the posttest was held for all members of the groups after the intervention sessions. a followup session was performed after three months to evaluate the durability of the intervention method. pretest and posttest data analysis were performed by spss statistical calculation software version 25. instruments include the connors adult adhd screening scale, the  test, and the go/nogotest. in order to analyze the data, in addition to descriptive methods (mean and standard deviation) for inferential analysis of test hypotheses, repeated measures analysis of variance was used.resultsthe mean of pretest, posttest, and followup inhibition control in the mindfulness group was 17.60, 14.47, and 14.40, with a standard deviation of 1.35, 1.95, and 1.50, respectively. the mean of pretest, posttest, and followup inhibition control in the control group is equal to 18.00, 16.87 and 17.20, with a standard deviation of 1.89, 1.52, and 1.85, respectively. the mean of pretest, posttest, and followup selective attention in the mindfulness group are 16, 12.80, and 11.60, with a standard deviation of 1, 0.86, and 0.73, respectively. also, the mean of pretest, posttest, and followup selective attention in the control group is equal to 16.80, 15.93, and 15.53, with a standard deviation of 1.61, 1.22, and 1.06, respectively. in the mindfulness group, posttest scores, and followup inhibition control and selective attention decreased compared to the pretest (p<0.01), while in the control group, there was no significant difference in the three stages of the test (p<0.05). therefore, mindfulness therapy has been effective in improving inhibition control and selective attention in the posttest and followup stages. conclusionthe treatment is a combination of relaxation and mindfulness. the use of relaxation techniques in mindfulnessbased cognitive therapy has had a positive effect on reducing impulsivity in patients with adhd. according to neuroimaging studies, mindfulness exercises cause structural changes in the prefrontal areas and strengthen cognitive mechanisms, including attention located in the prefrontal area. based on the current study’s findings, it is recommended to perform cognitive therapy on mindfulness in clinics and psychological service centers as an effective intervention method of treatment.ethical considerations compliance with ethical guidelinesthis article is taken from a phd thesis. the present study observes ethical principles such as obtaining written consent to participate in the research, respecting the principle of confidentiality of participants, and their freedom to exit the research process. this research was approved by the ethics committee of guilan medical sciences university with the ethics code: ir.gums.rec.1399.160. the research was designed in such a way that its implementation did not cause any physical or psychological harm to the subjects. subjects of the mindfulness group also received the relevant training for free.author’s contributionssara moradi kelarde: responsible for sample collection, implementing the project and intervention sessions, and analyzing results. niloufar mikaieli: guided the implementation of the research and correction of the article. mohammad narimani: responsible for supervising the research process and data analysis. abbasali hosseinkhanzadeh: provided uptodate data and ideation during the compilation of the research topic and guidance in writing the article.fundingthe first author funded this study. acknowledgmentsthe authors would like to thank everyone who participated in this study despite the long distance and difficult weather conditions, for regular participation, as well as the respected professors who provided guidance and advice in this work.conflict of interestthe authors declare no conflicts of interest.