مقایسهٔ اثربخشی درمان برنامهٔ زمانی پارادوکسی، درمان مواجهه‌سازی و جلوگیری از پاسخ و دارودرمانی بر کاهش علائم بیماران مبتلا به اختلال وسواسی‌اجباری

زمینه و هدف: اختلال وسواسیاجباری یک اختلال روان شناختی رایج است که اختلال شدیدی در زندگی فردی ایجاد می کند. از جمله درمآن های رایج برای اختلال وسواس می توان به دارو درمانی، درمآن های شناختی و درمآن های رفتاری اشاره نمود. هدف از این مطالعه، مقایسه اثربخشی درمان برنامه زمانی پارادوکسی و درمان مواجهه و جلوگیری از پاسخ و دارودرمانی بر کاهش علائم بیماران مبتلا به اختلال وسواسی اجباری بود.روش بررسی: در این پژوهش، از طرح مطالعهٔ تجربی تک موردی استفاده شد. جامعهٔ پژوهش را، افراد با تشخیص اختلال وسواس مراجعه کننده به کلینیک آرامش نوین در شهر تهران تشکیل دادند که دارای پروندهٔ فعال در ماه های بهار 97 بودند. از این افراد، 3 بیمار درمان مواجهه سازی و جلوگیری از پاسخ، 3 بیمار درمان با یکی از مهارکننده های بازجذب سروتونین و 3 بیمار درمان برنامهٔ زمانی پارادوکسی دریافت کردند. به منظور جمع آوری داده ها، مقیاس شدت وسواس فکری عملی ییل براون (1989)، استفاده شد. برای تجزیه و تحلیل داده، از روش های تحلیل نمودار، شاخص تغییر پایا، معناداری بالینی، درصد بهبودی استفاده شد (0٫05=α).یافته ها: نتایج این مطالعه نشان داد که درمان برنامهٔ زمانی پارادوکسی و درمان مواجهه و جلوگیری از پاسخ مقادیر شاخص پایا بیشتر از مقدار ملاک (1٫96) بود که نشان از معناداری این دو درمان داشت (0٫05>p). شاخص پایا، معناداری بالینی و درصد بهبود برنامهٔ زمانی پارادوکسی از درمان مواجه و جلوگیری از پاسخ و دارودرمانی در هر سه آزمودنی و در مجموع، بهتر بود.نتیجه گیری: براساس یافته های این پژوهش درمان برنامهٔ زمانی پارادوکسی، روش مناسب و زودبازدهی برای کاهش علائم وسواس است و می تواند به عنوان درمان پیشنهادی، استفاده شود.

Comparison of the effectiveness of Paradoxical Time Table Therapy, Exposure and Response Prevention and pharmacotherapy on Reducing Symptoms in Patients with ObsessiveCompulsive Disorder

Background & Objective: Obsessivecompulsive disorder is a common psychological disorder that causes severe disruption in personal life. Common treatments for obsessivecompulsive disorder include pharmacotherapy, cognitive therapy, and behavioral therapy. Much experimental evidence suggests that Exposure and Response Prevention (ERP) therapy is at the forefront of the treatments of patients with obsessivecompulsive disorder. Some researchers believe that exposure and Response Prevention therapy requires alternative or complementary approaches. One of the newest of these integrated approaches is the paradoxical time table therapy. An approach that incorporates systemic, behavioral, and analytical aspects into treatment can be an appropriate approach for all disorders, including anxiety and obsessivecompulsive disorder. This study aimed to compare the effectiveness of Paradoxical Time Table Therapy, Exposure and Response Prevention therapy and pharmacotherapy on Reducing Symptoms in Patients with ObsessiveCompulsive Disorder.Methods: In this research, the singlecase experimental method used. The population of the present study was people with OCD who referred to the Aramesh Novin Clinic in Tehran, who had an active case in the spring of 2019. Among these, three patients received exposure and prevention of response therapy; three patients received pharmacotherapy with one of the serotonin reuptake inhibitors, and three patients received paradoxical time table therapy. The sample of this study selected among purposive sampling. Exposure and Response Prevention Therapy consists of 17 sessions presented by Foa, Yadin, and Lichner (2012) for patients with obsessivecompulsive disorder. The paradoxical time table therapy consists of six therapeutic sessions consisting of two basic paradoxical techniques and a time table. YaleBrown ObsessiveCompulsive Scale used for collecting data. Chart analysis, reliable change index, clinical significance and Improvement percentage of paradoxical time table used for data analysis.Results: The results showed that in the paradoxical time table group, considering that the reliability index values were higher than the criterion value of 1. 96, it can be concluded that the results were not due to measurement error and unreliability of the test and they were the result of therapeutic intervention. Notably, a significant amount remained after the intervention, and it indicated that the paradoxical time table therapy maintained its consistency of reducing the symptoms in all three subjects at the followup phase. In the first, second, and third subject, the reliability index values were higher than the criterion value of 1. 96, so ERP therapy was effective in reducing OCD. The effectiveness of ERP therapy retained its significant effect on reducing obsessivecompulsive disorder in the followup phase for the first, second, and third subjects. In pharmacotherapy, reliability index values indicated that this method has not been effective in reducing the obsessivecompulsive disorder symptoms in these subjects. However, this intervention was effective for subject number 2 and reduced his obsessivecompulsive disorder symptoms initially, but lost its effectiveness in the followup phase. Regarding the reliability index and improvement percentage, the paradoxical time table therapy was significantly more effective than the exposure and response prevention therapy and pharmacotherapy in reducing symptoms of obsessive compulsive disorder.Conclusion: Regarding the effectiveness of both paradoxical time table therapy and exposure and response prevention therapy in compare to pharmacotherapy, it can be said both of these approaches can be well target source of obsessivecompulsive disorder the communication between cue and anxiety. Paradoxical time table therapy can have a more significant impact because it increases the power of ego as well as disrupts communication between cue and anxiety, and it changes their meaning well. By the way, pharmacotherapy has a different mechanism of action and cannot target the underlying causes of obsessivecompulsive disorder. This intervention can eliminate the symptoms by the only effect at reducing anxiety. However, once the pharmacotherapy is discontinued, the link between cue and anxiety will return.