اثربخشی روان‌درمانی مبتنی‌بر پذیرش و تعهد (act) بر کاهش استرس، افسردگی و اضطراب امتحان در دانش‌آموزان مبتلا به تالاسمی

زمینه و هدف: بیماری‌های مزمن ازجمله تالاسمی در همهٔ گروه‌های سنی و طبقات اجتماعی-اقتصادی و فرهنگ‌های مختلف بروز می‌کند. این کودکان و خانواده‌های آن‌ها درمعرض انواع مشکلات هیجانی و رفتاری قرار می‌گیرند. هدف از این پژوهش بررسی اثربخشی روان‌درمانی مبتنی‌بر پذیرش و تعهد بر کاهش استرس و افسردگی و اضطراب امتحان در دانش‌آموزان مبتلا به تالاسمی بود. روش‌بررسی: پژوهش حاضر از انواع طرح‌های نیمه‌آزمایشی به‌صورت دوگروهی با پیش‌آزمون و پس‌آزمون و پیگیری با گروه گواه بود. جامعهٔ آماری را 209 بیمار مبتلا به تالاسمی شهر زابل تشکیل دادند که در مرکز بیماران خاص شهر زابل تحت درمان قرار داشتند. نمونهٔ پژوهش شامل سی نفر بود که با درنظرگرفتن حداقل نمونه در طرح‌های آزمایشی و به‌روش داوطلب واجد شرایط انتخاب شدند و به‌طور تصادفی در دو گروه پانزده‌نفری آزمایش و گواه قرار گرفتند. آموزش‌ روان‌درمانی مبتنی‌بر پذیرش و تعهد به‌‌مدت ده جلسهٔ 90دقیقه‌ای‌ روی گروه ‌آزمایش‌ اجرا ‌شد‌.‌ بعد از ‌اتمام ‌جلسات ‌پس‌آزمون و یک‌ماه بعد دورهٔ پیگیری انجام پذیرفت. از پرسشنامهٔ افسردگی، اضطراب، استرس لاویبوند و لاویبوند (1995) و مقیاس اضطراب امتحان ساراسون (1975) ‌برای‌ جمع‌آوری‌ اطلاعات ‌استفاده ‌شد. تجزیه‌وتحلیل داده‌ها با تحلیل آزمون اندازه‌گیری مکرر و با استفاده از نرم‌افزار spss نسخهٔ 23 صورت گرفت.یافته‌ها: نتایج نشان داد که آموزش مبتنی‌بر پذیرش و تعهد موجب کاهش استرس و افسردگی و اضطراب امتحان در دانش‌آموزان مبتلا به تالاسمی می‌شود (0٫001≥p)؛ علاوه‌براین باتوجه به اثر زمان (پیش‌آزمون و پس‌آزمون و پیگیری) بین سه دورۀ زمانی در استرس و افسردگی و اضطراب امتحان تفاوت معناداری وجود دارد (0٫001≥p). همچنین اثر تعامل بین زمان اندازه‌گیری و گروه بر میانگین نمرات استرس و افسردگی و اضطراب امتحان دانش‌آموزان تالاسمی معنادار بوده است (0٫001≥p). اندازۀ اثر نمرات استرس و افسردگی و اضطراب امتحان به‌ترتیب 0٫20 و 0٫19 و 0٫15 به‌دست آمد. نتیجه‌گیری: براساس یافته‌های این پژوهش، آموزش روان‌‌درمانی مبتنی‌بر پذیرش و تعهد بر کاهش استرس و افسردگی و اضطراب امتحان در دانش‌آموزان مبتلا به تالاسمی در مرحلهٔ پس‌آزمون و پیگیری موثر است. 

Acceptance and Commitment Therapy on Stress, Depression, and Test Anxiety in Students with Thalassemia

Background & Objectives: Chronic diseases, including thalassemia, occur in all age groups, socioeconomic ‎classes, and cultures. Thalassemia is a chronic and life–threatening condition that limits the quality ‎of life of the affected patients. It also impacts them clinically; their children and families are exposed to various emotional and behavioral problems and stress. Psychological issues could negatively influence the immune system and disrupt the central nervous system. Paying adequate attention to these psychological states is of significant importance. Acceptance and Commitment Therapy (ACT), i.e., derived ‎ from cognitive therapy, is among the third wave of therapies. The present study ‎aimed to examine the effects of ACT on reducing stress, ‎depression, and test anxiety in students with thalassemia. ‎Methods: This was a quasi–experimental study with a pretest–posttest–follow–up and a control group design. The statistical population of this research included 209 patients with ‎thalassemia who were treated at the Center for Special Diseases in Zabol City, Iran. The study participants were ‎selected based on the inclusion criteria; medical diagnosis, patients’ test records, as well as studying and residing in the mentioned city. The individuals with intellectual disabilities and other ‎mental and behavioral disorders were excluded from the study. In total, 30 qualified subjects voluntarily participated ‎ in the study. Besides, they were randomly divided into the experimental and control groups (n=15/group ‎). The experimental group received ten 90–minute sessions of ACT. Moreover, after the completion of the project course, the posttest was ‎performed; one month later, the follow–up sessions were held. The Lovibond and Lovibond’s ‎Depression Anxiety Stress Scales (DASS) (1995) and Sarason Test Anxiety Scale (1975) were used ‎to collect the required data. The collected data were analyzed by repeated–measures Analysis of Variance (ANOVA) in SPSS.‎Results: The mean values of stress, depression, and test anxiety has ‎increased in the experimental group; this change was more stable in the posttest, compared to ‎ the follow–up stage. The same scores in the control group faced fewer changes in ‎the control group; therefore, repeated–measures ANOVA was used to determine ‎differences in inferential statistics. To perform repeated–measures ANOVA, its ‎aspects were first examined. Kolmogorov–Smirnov test was used to inspect the normality of the ‎data. The relevant results indicated that the score distribution of stress, depression, and test anxiety was ‎normal in pretest and post–test steps. Levene’s test was used to determine the homogeneity of ‎variances. The related results confirmed the homogeneity of variances of stress, depression, and test ‎anxiety. Furthermore, the Box’s M test data revealed that the covariances were homogeneous. Therefore, ‎ repeated–measures ANOVA could be performed. First, Mauchly’s sphericity was ‎examined; then, the level of Greenhouse–Geisser estimate of epsilon was evaluated. The repeated–measures ANOVA was used (2×3 design) to explore the ‎significant differences between the mean scores of the study groups. Mauchly’s sphericity test result was ‎significant (p=0.001). Besides, Greenhouse–Geisser Estimate Epsilon data demonstrated that the ‎epsilon level was <0.75; therefore, Feldt–Huynh correction was used. Considering the ‎effect of time between the three study stages (i.e., pretest, posttest, & 3–month follow–up), ‎there was a significant difference in stress, depression, and test anxiety (p≤0.001) between the study groups. In addition, ACT training effectively reduced stress, depression, and test anxiety in the assessed students with thalassemia at post‎test and follow–up steps (p≤0.001).‎ The effect scores of test stress, depression and test anxiety were 0.20, 0.19 and 0.15, respectively..Conclusion: The present study findings suggested that ACT training effectively reduced stress, depression, and test anxiety in the evaluated students with thalassemia at the posttest and follow–up stages. It is suggested that the Ministry of Education provide ‎some workshops on this therapy for the counselors and psychologists in the schools and the ‎families of students with this condition.