مقایسه اثربخشی طرحواره درمانی با درمان پذیرش وتعهد(act) بر آشفتگی روان شناختی زنان با پراشتهایی عصبی

هدف: هدف این پژوهش تعیین اثربخشی آموزش طرحواره درمانی در مقایسه با آموزش رویکرد پذیرش وتعهد با آشفتگی روانشناختی زنان با پر اشتهایی روانی صورت گرفت.روش: پژوهش مطالعه نیمه تجربی با طرح پیش آزمون- پس آزمون و گروه گواه با پی گیری دو ماهه بود. جامعه آماری همه زنان دارای اختلال پر اشتهای روانی شهر مشهد در نیمه اول سال 1402بود که به درمانگاههای پزشکی، مراجعه کرده بودند که تعداد 45 نفر به صورت در دسترس انتخاب و به صورت تصادفی درسه گروه طرحواره درمانی ( 15نفر)، درمان پذیرش وتعهد ( 15نفر) و گروه گواه ( 15نفر) تقسیم شدند. گروه آزمایش طرحواره درمانی تحت مداخله بسته آموزشی یانگ و همکاران (2003) و گروه آزمایش پذیرش وتعهد تحت مداخله درمانی هیزوهمکاران(2012) به مدت ده جلسه یک ساعتی قرار گرفتند. داده ها با استفاده از تحلیل واریانس اندازه های مکررتجزیه و تحلیل شدیافته ها: نتایج نشان داد مداخله طرحواره درمانی و پذیرش وتعهد بر آشفتگی روانشناختی (f=49.83; p<0.001) موثر است و این تاثیر در مرحله پی گیری پایدار است. نتایج آزمون تعقیبی شفه نشان داد بین دو گروه پذیرش وتعهد و طرحواره درمانی تفاوت معناداری در اثربخشی کاهش آشفتگی روانی وجود دارد(p<0/05)؛ بنابراین پذیرش وتعهد تاثیر بیشتری بر کاهش آشفتگی روانی زنان داشته است. نتیجه گیری: تاثیر بیشتر درمان پذیرش وتعهد از طریق تکنیک های گسلش شناختی می باشدکه به زنان کمک می کند بین افکار برخاسته از الگوهای ناسازگارانه و هیجانات منفی فاصله ایجاد کند. آموزش رویکردهای درمانی روان شناختی مانند طرحواره و پذیرش وتعهد به زنان می توان در کاهش وزن و پیشگیری از پرخوری عصبی آنان کمک کرد. همچنین با کنترل پرخوری عصبی میتوان آنان را از عوارض جانبی آسیب های جسمانی، روانی و اجتماعی پرخوری عصبی حفظ کرد و بدین ترتیب مادران سالم تر و جامعه سالم تری داشت.

comparing the effectiveness of schema therapy in comparison with acceptance and commitment therapy (act) on the psychological distress of women with bulimia nervosa

introduction: bulimia nervosa is an eating disorder in which periods of overeating and inappropriate compensatory behaviors are repeated at least twice a week. the disorder causes various psychological difficulties leading to problems in the private, family, and social life of those who suffer from the disorder. among the most significant determining factors of the health status of people with bulimia nervosa is the level of their distress tolerance. psychological distress is characterized by such issues as sadness, grief, anger, anxiety, depression, and various negative emotional states. people with low anxiety tolerance find their arousal response more overwhelming, therefore; their anxiety increases in response to the stimuli. accordingly, this issue plays a significant role in developing and continuing bulimia nervosa. some interventions have been applied to enhance distress tolerance and reduce psychological disturbance. among the treatments are schema therapy and acceptance and commitment therapy (act). schema therapy is an integrated type of psychotherapy developed by young et al. (1994) and based on the concepts and methods of cognitive-behavioral therapy. moreover, acceptance and commitment therapy (act), derived from the third wave of behavioral therapies, was introduced by hayes (1987). the aim of act is to improve the psychological status of people by increasing mindfulness, facing thoughts without judging them, creating commitment towards active engagement in the world and trying to build a meaningful and authentic life. this study was conducted to compare the effectiveness of two therapeutic methods (schema therapy versus act) on overcoming the psychological distress of women with bulimia nervosa.method: this semi-experimental study was done using a pre-test, post-test with a control group design accompanied with a two-month follow-up stage for ensuring the stability of the findings. the statistical population consisted of all female with bulimia nervosa who visited several medical centers of mashhad over approximately a six month period (from the beginning of april to the end of september 2023). among them, using purposeful sampling method and considering the inclusion criteria including not receiving psychological and psychiatric treatments and cosmetic surgery, 45 people were selected and then randomly divided into three groups: schema training group (15 participants), acceptance and commitment training group (15 participants), and control group without any intervention (15 participants). the first experimental group was subjected to the schema therapy intervention developed by young et al. (2003) and the second experimental group was subjected to the act intervention developed by hayes et al. (2012), both for ten one-hour sessions. kessler's (2003) psychological distress scale was applied to assess the dependent variable in pre-test, post-test, and follow-up stages. the data were analyzed using repeated measures analysis of variance.results: the results showed that there is a significant difference between the average scores of psychological distress in the two experimental and control groups (f=49.83; p<0.001). these findings show that both intervention methods had a significant effect on reducing the psychological distress of women with bulimia nervosa. the results also showed that this effect was significant and stable over the follow-up stage. regarding the study hypothesis, the results indicated a significant difference between acceptance and commitment therapy and schema therapy in terms of reducing the psychological distress (p=0.05). it was found that acceptance and commitment therapy had a greater effect on reducing the psychological distress of women with bulimia nervosa, compared to schema therapy.discussion and conclusion: this study aimed to examine the effectiveness of acceptance and commitment and schema therapy in reducing psychological distress among women with bulimia nervosa. the results showed that both interventions reduced the amount of psychological distress that these people experience. regarding the effectiveness of schema therapy, it is assumed that this approach helps people with bulimia nervosa evaluate the correctness of their own schemas. applying this approach will help them view the schemas as external realities and, through applying cognitive, behavioral, and experimental techniques, they can change the underlying structures. the other aim of this study was comparing the effectiveness of the two methods. this study showed a higher effectiveness of acceptance and commitment, compared to schema therapy. acceptance and commitment therapy is an intervention based on the behavioral evidence that employs acceptance and mindfulness strategies as well as commitment and behavior change strategies leading to an increase in women’s psychological flexibility. considering the results we might conclude that we can help women lose weight and prevent their bulimia nervosa through teaching them psychological treatments such as schema therapy and acceptance and commitment therapy. the more people are aware, open to experiences, and show committed behaviors that based on good values, they have a higher quality of life and respond to the challenges of life in a more effective way. in addition, through controlling their bulimia, they can protect themself from the physical, psychological, and social damage of the disorder.