اثربخشی درمان برنامهٔ زمانی پارادوکسی بر کاهش نگرانی، نشخوار فکری، درهم‌آمیختگی فکر-عمل و علائم بیماران مبتلا به اختلال وسواسی-اجباری

زمینه و هدف: اختلال وسواسی-جبری (ocd) بیماری عصبی-روان‌پزشکی است که اغلب در دوران کودکی ایجاد می‌شود و در بلندمدت باعث مشکلات درخورتوجهی در زندگی فردی می‌شود. مطالعهٔ حاضر به‌دنبال بررسی اثربخشی برنامهٔ زمانی پارادوکسی بر کاهش نگرانی، نشخوار فکری، درهم‌آمیختگی فکر-عمل و علائم بیماران مبتلا به اختلال وسواسی-اجباری بود. روش‌بررسی: در این پژوهش از طرح مطالعهٔ تجربی تک‌موردی استفاده شد. از میان طرح‌های تک‌آزمودنی، در این پژوهش طرح خطوط پایهٔ چندگانه به‌کار رفت جامعهٔ آماری پژوهش حاضر را افراد با تشخیص اختلال وسواس مراجعه‌کننده به کلینیک مرکز آرامش نوین در شهر تهران تشکیل ‌دادند که دارای پروندهٔ فعال در ماه‌های فصل بهار 1397 بودند. در این مطالعه تعداد 3 بیمار، درمان برنامهٔ زمانی پارادوکسی را دریافت کردند. به‌منظور جمع‌آوری داده‌ها، مقیاس شدت وسواس فکری-عملی ییل-براون (1998)، مقیاس تجدیدنظرشدهٔ آمیختگی فکر-عمل (شفران و همکاران، 1996)، پرسشنامهٔ نگرانی پن ‌استت (زینبارگ و بارلو، 1990) و مقیاس پاسخ‌های نشخوارگری (نولن-هوکسما و مارو، 1993) استفاده شد. در پژوهش حاضر تجزیه‌وتحلیل داده‌ها به‌کمک روش‌های تحلیل نمودار، شاخص تغییر پایا، معناداری بالینی و درصد بهبودی صورت گرفت. یافته‌ها: نتایج این مطالعه نشان داد که به‌طورکلی درمان برنامهٔ زمانی پارادوکسی تاثیر معناداری بر کاهش نگرانی، نشخوار فکری، درهم‌آمیختگی فکر-عمل و علائم وسواسی جبری دارد (0٫05≥p)؛ همچنین شاخص پایا و معناداری بالینی و درصد بهبود برنامهٔ زمانی پارادوکسی در هر سه آزمودنی دارای کاهش مطلوبی است. نتیجه‌گیری: به‌نظر می‌رسد درمان برنامهٔ زمانی پارادوکسی می‌تواند مداخلهٔ موثری برای کاهش علائم وسواس فکری‌عملی و نشانه‌های همراه آن باشد؛ بنابراین توصیه می‌شود تا پژوهشگران و درمانگران از این روش برای بیماران خود استفاده کنند.

The Effects of Paradoxical Time Table Therapy on Worry, Rumination, Thought-Action Fusion and Symptoms in Patients with Obsessive-Compulsive Disorder

Background & Objectives: Obsessive–Compulsive Disorder (OCD) is a prevalent mental disorder that causes severe disruption in personal life. Extensive experimental evidence suggests behavioral therapy as the first–line treatment for OCD. Some researchers believe that behavioral therapy requires alternative or complementary approaches. One of the newest of these integrated approaches is the Paradoxical Time Table Therapy (PTTT). An approach that incorporates systemic, behavioral, and analytical aspects into treatment could be an appropriate method for managing all disorders, including anxiety disorders and OCD. The present study aimed to explore the effects of PTTT on worry, rumination, thought–action fusion, and symptoms in patients with OCD.Methods: In this research, a single–case experimental method was used. Among the single–subject approaches, multiple baselines method was applied in this study. The study population consisted of individuals with OCD who referred with an active case to the Aramesh Novin Clinic in Tehran City, Iran, in the spring of 2019. Among them, 3 patients received PTTT. The study participants were selected by purposive sampling approach. Patients who were diagnosed with OCD by a psychiatrist were referred to the therapist. The study inclusion criteria included receiving OCD diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM–5) criteria for OCD by a psychiatrist; not receiving any psychological treatment before entering the study; having a minimum age of 20 years, and a maximum of 40 years; having at least high–school diploma, and providing consent to participate in the research. The PTTT consists of 6 therapeutic sessions, including two basic paradoxical techniques and a time table. To collect the required data, the Yale–Brown Obsessive–Compulsive Scale (1989), Thought Action Fusion Scale–Revised (Shafran et al., 1996), Penn State Worry Questionnaire (Zingbarg & Barlow, 1990), and Ruminative Response Scale (Nolen–Hoeksema et al., 1993) were employed. Besides, chart analysis, reliable change index, clinical significance, and the improvement percentage of paradoxical time table were used for data analysis.Results: The paradoxical treatment group participants aged between 25 and 34 years with a mean±SD age of 30.33±4.72 years. The obtained data suggested that in the paradoxical schedule treatment, the reliability index values for worry in the first, second, and third subjects were –4.19, –3.44, and –5.27, respectively. For rumination, the same value in the three subjects were –3.76, –2.42, and –4.46, respectively. The thought–action fusion values were –4.41, –4.32, and –4.73, respectively. Symptoms scores were also –4.42, –3.78, and –5.18, respectively. Furthermore, in the paradoxical time table group, the reliability index values were higher than the criterion value of 1.96; thus, the results were not caused by the measurement error and unreliability of the test, and they were due to the therapeutic intervention. The current study findings demonstrated that PTTT has remarkably reduced worry, thought rumination, the intertwining of thought and action (thought–action fusion), and OCD symptoms (p≥0.05). Notably, a significant level of symptoms remained declined after the intervention, indicating that the PTTT maintained its consistency in reducing the symptoms in all three study subjects at the follow–up phase.Conclusion: In general, PTTT is an appropriate and effective method for reducing OCD symptoms. Accordingly, it can be used as a proposed treatment in this area. PTTT could present a greater impact, because it increases the power of ego, and disrupts communication between cue and anxiety, and it changes their meaning. However, this is a novel treatment approach. Moreover, studies that have previously addressed the use of contradictory intention elements only considered one intervention of the paradoxical schedule treatment. It is recommended to use this treatment for other patients, including those with anxiety and mood disorders.