اثربخشی درمان مواجهه و بازداری از پاسخ بر احساس مسئولیت افراطی و عدم تحمل تردید، در بیماران مبتلا به اختلال وسواسی-اجباری

هدف: در شکل گیری، تداوم و درمان اختلال وسواسیاجباری، باورهای معینی به طور اختصاصی عامل اصلی این اختلال شناخته شده اند. پژوهش حاضر با هدف اثربخشی درمان مواجهه و جلوگیری از پاسخ بر احساس مسئولیت افراطی وعدم تحمل تردید در بیماران مبتلا به اختلال وسواسیاجباری انجام شد.روش بررسی: طرح پژوهش نیمه آزمایشی از نوع پیش آزمون، پس آزمون و پیگیری با گروه گواه بود. جامعهٔ آماری شامل تمامی افرادی در شهرستان محلات بود که در سال 97 با تشخیص روان پزشک مبتلا به اختلال وسواسیاجباری بودند. با روش نمونه گیری دردسترس 16 بیمار مبتلا به اختلال وسواسیاجباری انتخاب و با آرایش تصادفی در دو گروه آزمایش و گواه قرار گرفتند. افراد در گروه درمان، 12جلسهٔ درمان منطبق با پروتکل درمانی سالکوسکیس دریافت کردند. آزمودنی ها قبل از مداخله، در پایان مداخله و سه ماه بعد در مرحلهٔ پیگیری به وسیلهٔ مقیاس وسواسیاجباری یل براون (ybocs، گودمن، 1989)، مقیاس نگرش مسئولیت (ras؛ سالکوسکیس، 2000)، و مقیاس عدم تحمل تردید (ius؛ فریستون، 1994) سنجش شدند. برای تجزیه وتحلیل داده های پژوهش، از شاخص های آمار توصیفی مانند میانگین و انحراف معیار و برای تحلیل داده ها باتوجه به نرمال بودن توزیع داده ها، از آزمون های تی مستقل و تحلیل واریانس با اندازه گیری مکرر استفاده شد. داده های پژوهش با استفاده از نرم افزار spss 23 تحلیل گردید.یافته ها: نتایج تحلیل واریانس مکرر نشان داد که درمان مواجهه و بازداری از پاسخ باعث کاهش مسئولیت پذیری افراطی و عدم تحمل تردید بیماران مبتلابه اختلال وسواسیاجباری در مرحلهٔ پس آزمون شد (0٫001>p)، همچنین ماندگاری اثر درمان پس آز سه ماه حفظ شد (0٫001>p).نتیجه گیری: نتایج این پژوهش نشان داد درمان مواجهه و جلوگیری از پاسخ در بهبود احساس مسئولیت افراطی و عدم تحمل تردید در بیماران مبتلا به اختلال وسواسیاجباری اثربخشی کارا دارد.

Exposure and Response Prevention therapy on Inflated Sense of Responsibility, and Intolerance of Uncertainty, in Patients with Obsessive Compulsive Disorder

Background & Objective: Obsessivecompulsive disorder is a heterogeneous disorder and has different therapeutic approaches. Over the past few decades, we have witnessed tremendous advances in the role of cognitive systems in the formation, continuity, and treatment of the obsessivecompulsive disorder (OCD). Certain beliefs have been identified as a significant contributor to the creation and continuation of this disorder, Cognitive models of OCD also indicating that responsibility assessment is involved in the etiology and preservation of OCD symptoms. According to Salkovskis (1985), the Inflated Sense of responsibility in OCD has a central role. Intolerance of uncertainty (IU), which means the tendency to avoid ambiguous situations and the inability to deal with uncertainty, is considered significant damage to OCD. ERP as a standard golden treatment, including the gradual inclusion of anxiety due to obsessivecompulsive disorder, and the prevention or limitation of obsessivecompulsive procedures and reduction of anxiety. Aim of this study was the efficacy of Exposure and Response Prevention Therapy (ERP) in Inflated Sensory Responsibility and Intolerance of Uncertainty in Patients with OCD.Methods: The research design was a semiexperimental study with pretest, posttest, and followup. The statistical population consisted of all the people of Mahallat city, which is located in Markazi province in Iran in 2018. Sixteen patients with OCD were selected through the available sampling method and randomly within two groups: ERP and control group. (8 patients in each group). Each person in the treatment group received 12 treatment sessions by the Salkovskis exposure and Response prevention therapy method for OCD. Subjects were measured both before and at the end of interventions as well as three months later in the followup phase by the YaleBrown ObsessiveCompulsive Scale (YaleBOCS; Goodman, 1989), the Salkovskis Responsibility Attitude Scale; (RAS; Salkovskis, Wroe, Morrison, Richards, Reynolds & Thorpe, 2000) and The Intolerance of Uncertainty Scale; (IUS; Freeston et al, 1994) . The YaleBrown ObsessiveCompulsive Scale is a reliable instrument; with internal stability of 0.89 by Goodman and in Iran with internal stability for the sign index (SC) and severity scale (SS) were 0.97 and 0. 95 for the Persian version by Rajazi Esfahani et al. Responsibility Attitude Scale is a 26item scale, consistency (α=0.91), excellent testretest reliability over a fiveweek period (r=0.78), and Intolerance of Uncertainty Scalexcellent internal consistency (α=0.89), and satisfactory testretest reliability (r=0.74). Postextraction research data analyzed by repeated measurements analysis using SPSS23 software.Results: To test the hypothesis of the research, about the existence of the pretest variables and the possibility of the primary difference between the two intervention and control groups, as well as reducing the initial difference and comparing the groups, the multivariate analysis of variance, and used repeated measure design. In the semiexperimental design, before analyzing the hypothesis of the research, Levin’s findings showed that the homogeneous assumption of covariance of data and regression slope established. The results of Mocheli’s test also showed that there is no spheroidal assumption (p<0.050). The findings showed that there is a significant difference between the mean variables of the inflated sense of responsibility and uncertainty of intolerance in the experimental group with the control group. Therefore, the effectiveness of treatment on the reduction of the inflated sense of responsibility and uncertainty of intolerance can be verified (p<0.001), and this effect was lasting after three months (p<0.001).Conclusion: The results of this study have shown the effectiveness of exposure and Response prevention therapy in improving an inflated sense of responsibility and uncertainty of intolerance in patients with OCD.