اثربخشی بستهٔ توان‌بخشی شناختی ابر بر تعدیل سوگیری توجه به محرک‌های تهدیدآمیز در دو سطح هشیار و ناهشیار در نوجوانان عراقی دارای نشانگان اختلال اضطراب فراگیر

زمینه و هدف: در افراد مبتلا به اختلال اضطراب فراگیر، هدایت منابع پردازش اطلاعات به‌سمت تهدید منجربه سوگیری توجه می‌شود و می‌تواند اضطراب و نگرانی بیمار را افزایش دهد. پژوهش حاضر با هدف بررسی اثربخشی بستهٔ توان‌بخشی شناختی (ابر) بر تعدیل سوگیری توجه در دو سطح هشیار و ناهشیار در نوجوانان عراقی مبتلا به این اختلال انجام شد.روش‌بررسی: روش پژوهش، نیمه‌آزمایشی با طرح پیش‌آزمون و پس‌آزمون و دورۀ پیگیری سه‌ماهه بود. جامعهٔ آماری را دانش‌آموزان عراقی 15تا18ساله دارای اختلال اضطراب فراگیر تشکیل دادند. بعد از غربالگری دانش‌آموزان، هفده نفر (هفت دختر و ده پسر) با روش نمونه‌گیری هدفمند از جامعه انتخاب شدند و تکلیف شناختی دات پروب را در سطوح ناهشیار (زمان ارائهٔ محرک 200 میلی‌ثانیه) و هشیار (زمان ارائهٔ محرک 500 میلی‌ثانیه) در سه نوبت زمانی تکمیل کردند. برنامهٔ توان‌بخشی شناختی در دوازده ‌جلسه‌ اجرا شد. تحلیل داده‌ها با آزمون تحلیل واریانس با اندازه‌گیری مکرر و آزمون تعقیبی lsd توسط نرم‌افزار spss انجام شد. یافته‌ها: در متغیرهای زمان واکنش به محرک‌های همخوان و شاخص سوگیری توجه در وضعیت هشیار، از پیش‌آزمون تا پیگیری تفاوت معناداری وجود داشت (0٫001>p)؛ همچنین زمان واکنش به محرک ناهمخوان از پیش‌آزمون تا پیگیری تفاوت معناداری را نشان داد (0٫018=p). در متغیر زمان واکنش به محرک همخوان در وضعیت هشیار، بین نمرات پیش‌آزمون با پس‌آزمون (0٫002=p) و پیگیری (0٫001>p) تفاوت معناداری وجود داشت؛ اما بین نمرات پس‌آزمون و پیگیری تفاوت معناداری مشاهده نشد (0٫490=p). شاخص سوگیری توجه در وضعیت هشیار، در پس‌آزمون و پیگیری درمقایسه با پیش‌آزمون با کاهش همراه بود؛ اما بین نمرات پس‌آزمون و پیگیری در شاخص سوگیری توجه در وضعیت هشیار تفاوت معناداری مشاهده نشد (0٫390=p). در وضعیت ناهشیار برای زمان واکنش به محرک ناهمخوان، تنها بین نمرات پیش‌آزمون و پس‌آزمون تفاوت معنادار بود (0٫021=p).نتیجه‌گیری: برنامهٔ توان‌بخشی شناختی اصلاح سوگیری توجه (بستهٔ ابر) می‌تواند در هر دو سطح هشیار و ناهشیار، سوگیری توجه به محرک‌های تهدیدکننده را در افراد دارای اختلال اضطراب فراگیر کاهش دهد.

the effectiveness of cognitive rehabilitation (abr) on modulation of attention bias to threatening stimuli at both conscious and unconscious levels in iraqi adolescents with symptoms of generalized anxiety disorder

abstractbackground & objectives: generalized anxiety disorder (gad) is one of the most frequent and pervasive anxiety disorders characterized by persistent and excessive worrying or anxiety about some events or activities. these people’s difficulties in controlling worry cause many personal and social problems that need to be addressed. gad’s information processing models show how anxious individuals process threatening information as a causal role in developing and preserving worry. substantial evidence exists in which individuals with gad and high worry and anxiety levels demonstrate attentional bias to threatening information. based on the literature, it is possible to rehabilitate attentional biases in these people through potential attention training programs. training attention may decrease attention biases to threatening information, cause reduced anxiety and worry levels in individuals with gad, and improve their personal and social functions. therefore, the present study aimed to evaluate the effectiveness of cognitive rehabilitation of attentional bias to reduce the attentional bias on conscious and unconscious levels in iraqi adolescents with gad.methods: the present study was a quasi–experimental study with a pretest–posttest design and a three–month follow–up in a group of iraqi adolescents with gad. the statistical population was all the iraqi adolescents between the ages of 15 and 18 living in najaf city, suffering from gad. the sample included 17 adolescents (7 girls and 10 boys) with gad selected from the statistical population using the targeted sampling method. instruments used to screen anxiety disorders and assess attention biases in the sample were the screen for child anxiety–related emotional disorders (scard) (birmaher et al., 1997) and the dot–probe test. the dot–probe test was used to evaluate unconscious (stimulus presentation time of 200 ms) and conscious (stimulus presentation time of 500 ms) levels of attention bias for the fearful and neutral facial emotion expressions. after screening participants between 15 and 18 for gad with the scared by a certified psychiatrist, those qualified to attend our study completed the dot–probe task before, immediately after, and three months after the intervention. the intervention consisted of 12 one–hour sessions of a cognitive rehabilitation program called abr, which was created by its creator. to analyze the collected data, repeated measures of variance analysis and post hoc test lsd were done using spss software. time levels (pretest, posttest, and follow–up) were used as within–subject factors in repeated measure analyses. differences in reaction times to congruent and incongruent stimuli were assessed for conscious and unconscious situations. results: the results of repeated measures analysis of variance showed a significant difference in reaction time variables to congruent stimuli and attention bias index in the conscious situation from pretest to follow–up (p<0.001). however, there was no significant difference between the reaction time to the incongruent stimulus from the pretest to the follow–up (p=0.250). also, in the unconscious situation, between the reaction time to the congruent stimulus (p=0.111) and the attention bias index (p=0.061), no significant difference was observed from the pretest to follow–up. however, the reaction time to the incongruent stimulus from the pretest to follow–up showed a significant difference (p=0.018). the results of the post hoc test lsd showed a significant difference between the pretest and posttest scores (p=0.002) and follow–up (p<0.001) in the reaction time variable to the congruent stimulus in the conscious situation, and according to the average values, the posttest and follow–up scores compared to pretest decreased. however, no significant difference was observed between the posttest and follow–up scores, which indicated the persistence of the intervention effect over time (p=0.490). for the index of attention bias in the conscious situation, the follow–up test results indicated a significant difference between the pretest, posttest, and follow–up scores (p=0.004). in other words, the index of attention bias in the posttest and follow–up compared to the pretest was accompanied by a decrease. however, no significant difference was observed between the posttest and follow–up scores in the attention bias index in the conscious situation, indicating the intervention effect’s durability over time (p=0.390). in the unconscious situation, the results showed only a significant difference between the pretest and posttest scores for reaction time to the incongruent stimulus (p=0.021). conclusion: based on the findings, the cognitive rehabilitation intervention of correction of attention bias (abr) can penetrate and be effective at the unconscious level in addition to correcting the attention bias at the conscious level, and can create changes in the attention bias at two levels in people with gad.