اثر بخشی مدیریت استرس به شیوه شناختی رفتاری بر کاهش نشانگان استرس در زنان مبتلا به مولتیپل اسکلروزیس (ms)

زمینه و هدف: بیماری مولتیپل اسکلروزیس از بیماری های شایع در کشور ما، به خصوص در بانوان است. نقش استرس در تشدید بیماری اهمیت بسیار دارد؛ بنابر این پژوهش حاضر با هدف تعیین میزان اثر بخشی آموزش مدیریت استرس به شیوهٔ شناختی رفتاری بر کاهش نشانگان استرس و ابعاد آن در زنان مبتلا به مولتیپل اسکلروزیس انجام شد.روش بررسی: این مطالعه شبه آزمایشی از نوع پیش آزمون و پس آزمون و پیگیری با گروه گواه بود. جامعهٔ آماری را تمامی بیماران زن مبتلا به ام اس عضو انجمن ام اس شهر تهران در سال 1396 تشکیل دادند. نمونه گیری به روش داوطلبانه انجام شد و نمونه ها به شیوهٔ همتا سازی در دو گروه آزمایش و گواه، هر گروه 15 نفر قرار گرفتند. ابزار پژوهش، مقیاس سنجش نشانگان استرس سیدخراسانی صدیقانی (1377) بود. در فاصلهٔ بین پیش آزمون و پس آزمون، برنامهٔ مداخلهٔ مدیریت استرس به شیوهٔ شناختی رفتاری آنتون و ایرونسون و اشنایدر من (2007) در طی هشت جلسهٔ 90دقیقه ای روی گروه آزمایش اجرا شد. داده های پژوهش پس از استخراج با استفاده از روش اندازه گیری مکرر و با نرم افزار spss تجزیه وتحلیل شدند.یافته ها: نتایج نشان داد آموزش مدیریت استرس به شیوهٔ شناختی رفتاری بر کاهش نشانگان کلی استرس و ابعاد آن (نشانگان جسمانی، رفتاری، هیجانی، شناختی) موثر است. (0٫001>p).نتیجه گیری: نتایج پس آزمون و پیگیری در گروه آزمایش بیانگر ماندگاری تاثیر مدیریت استرس به شیوهٔ شناختی رفتاری با گذشت زمان است؛ بنابراین می توان این روش را برای کاهش نشانگان استرس در مبتلایان به بیماری مولتیپل اسکروزیس به کار برد.

CognitiveBehavioral Stress Management Training (CBSM) on Reducing Stress Symptoms of Women with Multiple Sclerosis (MS)

Background & Objective: Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system with unknown causes. Beginning often in the late adolescence and early adult life. Prevalence among women is more than men is. MS can produce a wide variety of symptoms, including loss of function or feeling in limbs, loss of bowel or bladder control, sexual dysfunction, debilitating fatigue, blindness, loss of balance, pain, loss of cognitive functioning and emotional changes. Chronic illnesses like MS cause to increase stress levels. The belief that stress causes exacerbation is widespread among people with MS. Among the effective therapies for deduction of stress symptoms, cognitive–behavioral stress management approach has been successfully applies to combine stress reduction methods such as muscle relaxation, cognitive rehabilitation, effective copying training, and anger management. Therefore this studies aimed to review the effectiveness of cognitive–behavioral stress management training on reducing stress symptoms of women with Multiple Sclerosis (MS).Methods: The design of this study was quasi–experimental with pre–test, post–test and control group. The study population consisted of all female MS patients who were member of Tehran MS associations in the year of 2017. The sample consisted of 30 patients, who were selected by volunteer sampling method and were placed by matching method in experimental and control groups. For collecting the data, stress symptoms inventory of Khorasani (designed in year 1998) was used. The experimental group was trained in cognitive–behavioral stress management approach, designed by Antoni, Ironson and Schneider in year 2007 and the control group received no intervention. The duration of the treatment sessions consisted of 8 sessions of 90 minutes, performed as a group once a week in the MS center. Research data were analyzed by repeated measurement analysis using SPSS software.Results: To analyze the variance for repeated measures, we examined the assumptions of this test. Shapiro Wilk test was used to check the normal scores. The result showed that the distribution of data is normal. Levin Levin’s findings also showed that the homogeneous assumption of covariance of data and the slope of regression was established. The mean of the stress symptoms variable for the experimental group in the pre–test was 184.47 which decreased in the post–test into 146.80 and in the follow up reached to 143.73 but there was no meaningful changes in control group. The mean of the physical stress symptom for experimental group in pre–test was 81.07 which reached in the posttest into 66.40 and in the follow up reached to 67 (p<0.001). There was no significant changes in control group in 3 stages. The mean of the behavioral stress symptom for the experimental group in pre–test was 42.27 which reached in the post– test into 37.47 and in the follow up reached to 36.60 (p<0.001). There was no significant changes in the control group in 3 stages. The mean of the emotional stress symptom for the experimental group in pretest was 34.07, which reached in the posttest into 30.33 and in the follow up reached to 30.87. There was no significant changes in control group in 3 stages (p<0.001), but there were no significant changes in control group in 3 stages. The mean of the cognitive stress symptom for experimental group in pretest was 27.07 which reached in the post–test into 22.80 and in the follow up reached to 22.60. There was no significant changes in control group in 3 stages (p<0.001). Results of Bonferroni correction showed there was significant difference in comparing mean of pre–test with post–test and pre–test with follow up in stress symptoms and its components. Based on the results of the repeated measurement analysis test, there was significant difference between the pre–test scores with post–test and follow up scores, therefore stress management training had a meaningful effect on the reduction of stress symptoms.Conclusion: Trainings presented in form of stress management in a cognitive–behavioral approach have significant positive effects on the reduction of all stress symptoms of women with multiple sclerosis (MS). Therefore, it can be used as a useful intervention to reduce the stress symptoms of women with MS and benefit from it in educational and health centers.