تاثیر آموزش روان شناختی بر تاب‌آوری مراقبان خانوادگی مددجویان مبتلا به اختلال دو‌قطبی

زمینه و هدف: اختلال دوقطبی، از اختلالات شایع روانپزشکی در قرن 21 است. این بیماری، مزمن، تکرار شونده و همراه با نوسانات خلق، بین شیدایی و افسردگی می‌باشد. تشخیص اختلال دوقطبی برای فرد و خانواده یک موضوع استرس‌زا است، مراقبان زمانی می‌توانند بر استرس مراقبت از مددجوی مبتلا به اختلال روانپزشکی غلبه کنند که تاب آور باشند. تاب‌آوری در خانواده، به الگوی رفتاری انعطاف‌پذیر و رشد یافته‌ی رفتاری مراقبان مددجویان، در مواجهه با مصائب و چالش‌های پیش‌آمده با مددجوی تحت مراقبت، اطلاق می‌گردد. لذا این مطالعه با هدف تعیین تاثیر برنامه آموزش روان شناختی بر تاب‌آوری مراقبان مددجویان مبتلا به اختلال دوقطبی بستری در مرکز روانپزشکی شهر سنندج انجام گرفته است. روش بررسی: مطالعه حاضر یک مطالعه نیمه تجربی است که در پاییز و زمستان سال 1398 در مورد 64 مراقب خانوادگی مددجویان مبتلا به اختلال دوقطبی بستری در مرکز روان پزشکی شهر سنندج، انجام شد. نمونه‌‌گیری، به شیوه در دسترس انجام گرفت. و نمونه‌ها در دو گروه آزمون (32 نفر) و کنترل (32 نفر) قرار گرفتند. قبل از مطالعه از مراقبان خواسته شد که فرم اطلاعات فردی و پرسشنامه تاب آوری (connor-davidson cd-risc) را تکمیل نمایند. مراقبان گروه مداخله در هفت گروه 4 تا 5 نفره، آموزش روان شناختی را طی چهار جلسه، به صورت هفته‌ای یک بار، در مدت زمان 45 تا60 دقیقه‌ دریافت نمودند. پس از گذشت چهار هفته از مداخله مجدداّ پرسشنامه تکمیل شد. گروه کنترل، برنامه‌ای جز برنامه آموزش معمول بیمارستان دریافت نکرد و همانند گروه مداخله پس آزمون در مورد آنان نیز اجرا شد. داده‌ها با استفاده از نرم افزار spss نسخه 16 و با استفاده از آمار توصیفی (فراوانی، درصد، میانگین و انحراف معیار) و آمار استنباطی (تی مستقل و تی زوجی) مورد تجزیه و تحلیل قرار گرفتند.یافته‌ها: نتایج نشان داد که بین دو گروه مداخله و کنترل از نظر توزیع متغیرهای زمینه‌ای تفاوتی وجود نداشت. میانگین نمره پیش آزمون تاب‌آوری در دو گروه کنترل و مداخله به ترتیب 5.80 ± 22.65 و 5.61 ± 23.44 بود، دو گروه از نظر آماری اختلاف معنی‌داری با هم نداشتند (0.59 = p)، در حالی که میانگین نمره‌ی پس آزمون تاب‌آوری در گروه کنترل6.12 ± 23.19 و در گروه مداخله 3.36 ± 33.97 بود، که اختلاف آماری معنی‌داری را نشان می‌دهد (0.001>p). مقایسه نمره‌ی تاب‌آوری در مراحل پیش آزمون و پس آزمون در هر گروه به صورت جداگانه نشان می‌دهد که نمره تاب‌آوری در مراحل پیش آزمون و پس آزمون در گروه کنترل اختلاف آماری معنی‌داری با هم نداشتند (0.11p=)، در حالی که افزایش آماری معنی‌داری در مرحله‌ی پس آزمون نسبت به پیش آزمون در گروه مداخله مشاهده شد (0.001>p). نتیجه‌گیری کلی: نتایج مطالعه حاضر نشان داد آموزش روان شناختی بر تاب‌آوری مراقبان مددجویان مبتلا به اختلال دوقطبی تاثیرگذار است. ضروری است برنامه‌هایی همچون آموزش روان شناختی به عنوان یکی از راهکارهای ارتقای تاب‌آوری در مددجویان و مراقبان آنان مد نظر قرار گیرد.

Effect of Psychoeducation on the Resilience of the Family Caregivers of Patients with Bipolar Disorder

Background Aims: Bipolar disorder is one of the most common psychiatric disorders in the 21st century. It is a chronic, recurrent disorder causing mood swings, and patients alternate between episodes of mania and depression. Diagnosis of bipolar disorder is a stressful issue for the individual and his family. The disease not only causes anxiety and stress for the client, but also causes severe disturbances to his family. The family caregivers of clients with a psychiatric disorder and the resulting stress do not react in the same way and choose different ways to deal with the illness. Denial, anger, feelings of shame, as well as indifference and change in the relationships between family members are among the negative feelings in caregivers. Caregivers can only overcome the stress of caring for a client with a psychiatric disorder and maintain their health and that of their family when they are resilient. The concept of resilience in caregivers of clients with psychiatric disorders refers to the flexible and welldeveloped behavioral pattern of caregivers in response to the difficulties and challenges encountered while caring for the client. Resilience in caregivers of clients with psychiatric disorders is a dual concept. On the one hand, caregivers overcome the difficulties and challenges of caring for the client and take steps to maintain and improve his physical and mental health. On the other hand, by promoting their mental health, they are able to act stronger than before in the face of advanced troubles and problems. Therefore, this study aimed to determine the effect of a psychoeducation program on the resilience of caregivers of patients with bipolar disorder hospitalized in Sanandaj Psychiatric Center.Materials Methods: This is a quasiexperimental study conducted during autumn and winter, 2019. The samples included 64 caregivers of a client with bipolar disorder hospitalized in Sanandaj Psychiatric Center. Convenience sampling was employed, and the samples were randomly divided into experimental (32) and control (32) groups. For sampling, the researcher first visited the psychiatric center and identified caregivers of clients with bipolar disorder. Then, the researcher introduced the study and obtained written informed consent. In the next stage, the caregivers who met the inclusion criteria were selected. First, the caregivers of the control group and then the caregivers of the experimental group entered the study (to prevent the transfer of information in the groups). Caregivers were asked prior to the study to complete a demographic questionnaire and the ConnorDavidson resilience scale (CDRISC). The caregivers of the experimental group underwent psychoeducation in groups of 4 to 5. The training lasted four weeks and was performed one a week for about 45 to 60 minutes. Psychoeducation followed a systematic and structured approach in order to raise awareness and change the attitude of families about the nature of the disease, how to treat it, increasing communication skills, and problemsolving skills during the training sessions. Some components of psychoeducation, which were appropriate to the community under study, were discussed by providing examples and past experiences. After 4 weeks of intervention, the questionnaire was completed again. During this period, the control group did not receive any program other than the usual hospital training program and, like the experimental group, took the posttest. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent ttest and paired samples ttest) in SPSS 16.Results: The results showed no difference between the experimental and control groups in terms of the distribution of background variables. The mean pretest scores of resilience in the control and experimental groups were 22.65 ± 5.80 and 23.44 ± 5.61, respectively, which shows that the two groups were not statistically different (P=0.59). The mean scores of resilience posttest in the control group and the experimental group were 23.19 ± 6.12 and 33.97 ± 3.36 respectively, which shows a statistically significant difference (P<0.001). Comparison of resilience scores in the pretest and posttest scores of both groups shows that resilience scores were not statistically different in the pretest and posttest scores of the control group (P=0.11), while a statistically significant increase was observed in the posttest of the experimental group compared to the pretest (P<0.001).Conclusion: The results of the present study showed that psychoeducation is effective on the resilience of caregivers of clients with bipolar disorder. Accepting the fact that a family member is diagnosed with a psychiatric disorder scares the family. Caregivers find it difficult to talk about the client they are caring for, and caring for a client with a psychiatric disorder causes despair, helplessness, and ultimately depression in the caregiver. Considering that in our country the only sources of support for patients are families and shortterm hospitalization centers and family plays the main role of caring and treatment, in case of recurrence of the disease, the client is hospitalized which will exert more pressure and stress on the family. In this regard, resilient caregivers show more independence, are able to think well, and believe in their abilities to change their environment. When family members feel that they too are part of the treatment team, they can provide adequate support to the client. Thus, psychoeducation, as an effective method with the intervention of caregivers to help the client needing care is an important step towards the challenges and tragedies in the family. On the one hand, psychoeducation will change the family #39;s attitude towards the client and the disease, and on the other hand, it also significantly affects the client #39;s view of his current situation. Therefore, this educational program can be implemented alongside familybased programs in psychiatric centers, and it is necessary to consider programs such as psychoeducation as one of the ways to promote resilience in clients and their caregivers.