بررسی اثربخشی برنامهٔ فراتشخیصی مبتنی‌بر پذیرش و تعهد بر میزان افکار منفی تکراری و اختلالات افسردگی، اضطراب و وسواس فکری-عملی

زمینه و هدف: برمبنای دیدگاه فراتشخیصی، انواع تفکر منفی تکراری به‌واسطهٔ فرایندهای مشابهی مشخص می‌شود که قابلیت کاربست در انواع محتواهای وابسته به اختلالات خاص را دارد. هدف مطالعهٔ حاضر، بررسی اثربخشی برنامهٔ فراتشخیصی مبتنی‌بر پذیرش و تعهد بر میزان افکار منفی تکراری و اختلالات افسردگی، اضطراب و وسواس فکری-عملی بود.روش‌بررسی: این پژوهش با روش مطالعهٔ تک‌موردی و طرح خط پایهٔ چندگانه انجام شد. جامعهٔ آماری پژوهش را مراجعه‌کنندگان بخش روان‌پزشکی بیمارستان امام‌حسین(ع) طی اسفند1399 تا خرداد1400 تشکیل دادند. با روش نمونه‌گیری هدفمند شش بیمار مبتلا به اختلالات افسردگی اساسی، اضطراب تعمیم‌یافته و وسواس فکری-عملی، انتخاب شدند. به‌منظور جمع‌آوری داده‌ها، پرسش‌نامهٔ افسردگی بک-نسخۀ دوم (بک و همکاران، 1996)، پرسش‌نامهٔ اضطراب بک (بک و همکاران، 1988)، مقیاس وسواس فکری‌-عملی ییل-براون (گودمن و همکاران، 1989) و پرسش‌نامهٔ افکار تکرارشوندهٔ ده‌سوالی (مک‌ایوی و همکاران، 2010) به‌کار رفت. برنامهٔ مداخلهٔ فراتشخیصی مبتنی‌بر پذیرش و تعهد طی چهار جلسه به‌صورت انفرادی اجرا شد. تحلیل داده‌ها برپایهٔ روش‌های تحلیل ترسیمی، شاخص تغییر پایا و درصد بهبودی صورت گرفت‌. یافته‌ها: نتایج نشان داد، برنامهٔ فراتشخیصی مبتنی‌بر پذیرش و تعهد سبب کاهش تفکر منفی تکراری و علائم افسردگی و اضطراب شد؛ اما نشانگان وسواس فکری-عملی به‌طور معناداری کاهش نیافت. نتیجه‌گیری: براساس نتایج پژوهش، می‌توان تفکر منفی تکراری را سازه‌ای فراتشخیصی در نظر گرفت که با مولفه‌های پذیرش و تعهد تعدیل‌پذیر است؛ هرچند نقش عوامل اختصاصی نیازمند بررسی بیشتر است. 

determining the effectiveness of transdiagnostic protocol based on acceptance and commitment on repetitive negative thinking, depression, anxiety, and obsessive-compulsive symptoms

background & objectives: thinking and its interaction with emotions and behavior are the most challenging areas of psychology. the scientific study of thinking has been done to discover its general mechanisms and explain the processes involved in its anomalies. one of the most important forms of abnormal thinking is repetitive negative thinking. the transdiagnostic view of repetitive negative thinking argues that types of repetitive negative thinking are identified by similar processes that can be applied to a variety of disorders-related content. the present study investigated the effectiveness of transdiagnostic protocol based on acceptance and commitment repetitive negative thinking, depression, anxiety, and obsessive-compulsive symptoms.methods: to conduct the study, we used the single-subject method of multiple baseline design. the statistical population of the research comprised the patients of the psychiatry department of imam hossein hospital from february 2021 to may 2021. a single case study method was used during the initial baseline period and multiple separate assessment courses. in this way, we can examine the changes in the desired behaviors and symptoms in the subject. then, the effectiveness of this treatment program based on acceptance and commitment focused on repetitive negative thinking individually and in 4 sessions was evaluated on reducing the rate of repetitive negative thinking and disorders of depression, anxiety, and obsessive-compulsive disorder. thirty-seven patients were evaluated, of whom, due to not completing the baseline steps, unwillingness to continue the process and request drug treatment, and explicit expression of suicidal ideation, during the evaluation and sample selection period, 6 people were finally stabilized and asynchronously entered the intervention program and completed the intervention steps. beck depression inventory-ii (beck et al., 1996), beck anxiety inventory (beck et al., 1988), yale-brown obsessive-compulsive scale (goodman et al., 1989), and repetitive thinking questionnaire-10 (mcevoy et al., 2010) were used to collect data. the data were analyzed based on analytic drawing, stable change index, and recovery rate methods.results: results show that with the training considered, the change in the magnitude of repetitive negative thinking in the depression group was decreasing and this decreasing trend was significant by taking into account the stable change index and the percentage of the recovery obtained. the greatest reduction in the size of negative thinking has occurred in depressed people. the percentage of improvement in the recurring thoughts of anxiety patients in this study in the treatment phase did not reach more than 50%. it should be noted that the final evaluation of the treatment phase is related to the implementation of the evaluation after the third session of treatment. but in the follow-up phase, which took place after the fourth session of treatment, two weeks apart, the recovery rate increased significantly. this percentage is ultimately above the recovery standard in the recovery percentage index. in addition, the stable change coefficient confirms the significance of this decreasing change. the effect of the intervention program in reducing repetitive negative thoughts of patients with obsessive-compulsive disorder after the third treatment session and the last evaluation of the treatment phase was weak. neither of the two clinical specimens reached the standard of recovery. one person from the obsessive-compulsive disorder group has grown to more than 50% in the rate of repetitive thoughts in the follow-up phase. the lowest mean decrease in the rate of repetitive thoughts among groups is related to obsessive-compulsive disorder.