مقایسهٔ اثربخشی درمان مبتنی‌بر پذیرش و تعهد و طرح‌واره‌درمانی بر اضطراب و کاهش تکانشگری در افراد معتاد متجاهر

زمینه و هدف: اعتیاد و پیامدهای ناخوشایند ناشی‌از آن، از مشکلات بسیار مهم سلامت عمومی در سراسر جهان به‌شمار می‌رود. پژوهش حاضر با هدف مقایسهٔ اثربخشی درمان مبتنی‌بر پذیرش و تعهد و طرح‌واره‌درمانی بر کاهش اضطراب و تکانشگری در افراد معتاد متجاهر انجام شد. روش‌بررسی: روش پژوهش، نیمه‌آزمایشی با طرح پیش‌آزمون، پس‌آزمون و پیگیری دوماهه همراه با گروه گواه بود. جامعهٔ آماری پژوهش را تمامی معتادان مرد متجاهر مادهٔ شانزده قانون مبارزه با مواد مخدر در استان گیلان در سال 1400-1399 تشکیل دادند. تعداد 45 معتاد مرد واجد شرایط داوطلب وارد مطالعه شدند و به‌روش تصادفی در دو گروه آزمایش درمان مبتنی‌بر پذیرش و تعهد و طرح‌واره‌درمانی و یک گروه گواه قرار گرفتند (هر گروه پانزده نفر). به‌منظور انجام مداخلات، درمان مبتنی‌بر پذیرش و تعهد (پترسون و همکاران، 2009) و طرح‌واره‌درمانی (یانگ و همکاران، 2003) هریک در هشت جلسه صرفاً برای گروه‌های آزمایش اجرا شد. ابزارهای استفاده‌شده، پرسش‌نامۀ اضطراب بک-ویرایش دوم (بک و همکاران، 1996) و مقیاس تکانشگری بارت (بارت و همکاران، 1997) بود. داده‌ها با استفاده از آزمون تحلیل واریانس با اندازه‌گیری مکرر و آزمون تعقیبی بونفرونی در نرم‌افزار ssps نسخهٔ 22 در سطح معناداری 0٫05 تحلیل شد. یافته‌ها: تغییر در سه مرحلهٔ پیش‌آزمون، پس‌آزمون و پیگیری صرف‌نظر از عامل گروه برای متغیرهای تکانشگری و اضطراب معنادار بود (0٫001>p). سه گروه در متغیرهای مذکور تفاوت معناداری داشتند (0٫001>p). همچنین بین میانگین نمرات گروه‌های آزمایش با گروه گواه در متغیرهای تکانشگری و اضطراب تفاوت معناداری وجود داشت (0٫001>p)؛ اما بین میانگین نمرات تکانشگری و اضطراب در دو گروه آزمایش تفاوت معناداری مشاهده نشد (به‌ترتیب 0٫195=p و 0٫999=p) و براساس میانگین‌ نمرات، با گذشت زمان دوماهه اثربخشی درمان‌ها پایدار بود. نتیجه‌گیری: براساس یافته‌های این پژوهش، درمان مبتنی‌بر پذیرش و تعهد و طرح‌واره‌درمانی هر دو بر کاهش تکانشگری و اضطراب افراد معتاد متجاهر اثربخش‌ است؛ اما بین اثربخشی دو درمان تفاوت معنادار وجود ندارد.

comparing the effectiveness of acceptance and commitment-based therapy and schema therapy on the anxiety and reduction of impulsivity in flagrant addicts

background and objectives: addiction to drugs and its quitting are always a big concern for people addicted to drugs and their families. drug addiction is a chronic, progressive, and recurrent disease that includes a set of cognitive, emotional, behavioral, and physiological symptoms, indicating that a drug addict continues to use drugs despite being aware of the consequences. people with substance abuse are twice as likely as normal people to have mood disorders, and anxiety is the most common mood disorder in these people. anxiety is a warning sign that warns of impending danger and prepares a person to deal with a threat. one of the known mechanisms that affects people’s tendency to use and dependence on drugs is impulsivity. impulsivity includes a wide range of behavioral and cognitive tendencies such as difficulty in delaying or inhibiting the voluntary response, short response threshold, defect in delaying pleasure, and difficulty in paying attention. in this regard, the present study was conducted to compare the effectiveness of acceptance and commitment–based therapy and schema therapy on reducing anxiety and impulsivity in addicts.methods: this study is quasi–experimental with a pretest–posttest and a two–month follow–up design with a control group. the statistical population of the study consisted of all male addicts of article 16 (the anti–narcotics law means the compulsory treatment of drug addicts) who are kept in government centers of guilan province, iran for one to three months for treatment from 2020 to 2021 by order of a judicial official. the research sample consisted of 45 male addicts who were selected by purposive sampling method. the inclusion criteria were as follows: dominant and simultaneous use of heroin and glass, length of stay of three months, not being treated with psychological intervention and being treated with mmt (methadone maintenance treatment). then, they were randomly divided into three groups based on acceptance and commitment therapy, schema therapy, and control group. the exclusion criteria were as follows: having psychotic disorders, staying less than 3 months in the center, absence of more than two sessions, and unwillingness to continue participating in the study. fifteen people were counted for each group. beck anxiety inventory–ii (beck et al., 1996) and barratt impulsivity scale (barratt et al., 1997) were administered at the pretest, posttest, and follow–up stages for three groups. the first experimental group received eight 60–min sessions of acceptance and commitment treatment. for the second group, eight 60–minute sessions of group schema therapy intervention were presented. at the end of the training sessions, the tests were repeated for all three groups, and after two months of posttest, the follow–up test was performed. to statistically analyze the data, descriptive and inferential statistics were used. mean and standard deviation were used for descriptive analysis of data, and analysis of variance with repeated measures and bonferroni’s post hoc test were used for inferential statistics in spss version 22. the significance level of the tests was considered to be 0.05.results: the results showed that the change in the three stages of pretest, posttest, and follow–up was significant regardless of the group factor for impulsivity and anxiety variables (p<0.001). the three groups had significant differences in impulsivity and anxiety variables (p<0.001). also, there was a significant difference between the average scores of the experimental groups and the control group in the dependent variables of impulsivity and anxiety (p<0.001). however, no significant difference was observed between the average scores of impulsivity and anxiety in the two experimental groups (p=0.195 and p=0.999, respectively). based on the average scores, the effectiveness of these treatments has been stable over two months.