اثربخشی طرحواره‌درمانی بر نشخوار فکری، افسردگی و کارکرد شخصیت زنان مبتلاء به پرخوری عصبی

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری، گروه روان‌شناسی، دانشکدۀ علوم انسانی، دانشگاه تربیت مدرس، تهران، ایران.

2 کارشناسی ارشد، گروه روان‌شناسی بالینی، دانشکدۀ علوم تربیتی و روان‌شناسی، دانشگاه الزهرا، تهران، ایران.

3 کارشناسی ارشد، گروه روان‌شناسی بالینی، دانشکدۀ علوم انسانی، واحد اردبیل، دانشگاه آزاد اسلامی، اردبیل، ایران.

4 کارشناسی ارشد، گروه روان‌شناسی عمومی، دانشکدۀ علوم انسانی، دانشگاه پیام‌نور، واحد اردبیل، اردبیل، ایران.

5 کارشناسی ارشد، گروه روان‌شناسی بالینی و سلامت، دانشکدۀ پزشکی، واحد نجف‌آباد، دانشگاه آزاد اسلامی، اصفهان، ایران.

چکیده

پژوهش حاضر با هدف بررسی اثربخشی طرحواره‌درمانی بر نشخوار فکری، افسردگی و کارکرد شخصیت زنان مبتلا به پرخوری عصبی انجام شد. روش پژوهش نیمه‌تجربی از نوع پیش‌آزمون-پس‌آزمون با گروه کنترل بود. جامعۀ آماری پژوهش، زنان مبتلا به پرخوری عصبی شهر تهران در سال 1402 بودند. با توجه به ملاک‌های ورود به پژوهش، 30 زن به‌صورت تصادفی در گروه آزمایش و گواه جای‌دهی شدند. گروه‌ها با پرسشنامه‌های نشخوار فکری (RQ)، افسردگی بک (BDI) و کارکرد شخصیت (PFQ) سنجش شدند. پس از ده جلسۀ 90 دقیقه‌ای طرحواره‌درمانی برای گروه آزمایش، مجدداً شرکت‌کنندگان به پرسشنامۀ پژوهش پاسخ دادند. در انتها داده‌ها با آزمون تحلیل کوواریانس چندمتغیره با نرم‌افزار SPSS-24 تحلیل شدند. نتایج نشان داد طرحواره‌درمانی به‌صورت معناداری موجب کاهش نشخوار فکری (F=23/51)، افسردگی (F=50/04)، و افزایش صمیمیت (F=47/16)، همدلی (F=41/83)، خودجهت‌دهی (F=30/04) و هویت (F=32/77) در زنان مبتلا به پرخوری عصبی می‌شود (0/01>P). براساس نتایج، طرحواره‌درمانی توانسته است اختلالات روان‌شناختی را کاهش دهد و کارکرد شخصیت زنان مبتلا به پرخوری عصبی را بهبود بخشد. از آنجا که همه‌گیری کووید-19 تغییرات بسیار گسترده‌ای در سبک زندگی افراد ایجاد کرد، می‌بایست تدابیری در جهت شناسایی و درمان گروه‌های آسیب‌پذیر اتخاذ کرد.

کلیدواژه‌ها

عنوان مقاله [English]

The Efficacy of Schema Therapy on Rumination, Depression, and Personality Function of Women with Bulimia Nervosa

نویسندگان [English]

  • Farzin Bagheri Sheykhangafshe 1
  • Fereshteh Rezazadeh Khalkhali 2
  • Vahid Savabi Niri 3
  • Maryam Zolfagharnia 4
  • Nahid Mikelani 5
1 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
2 Department of Clinical Psychology, Faculty of Educational and Psychology, Alzahra University, Tehran, Iran.
3 Department of Clinical Psychology, Faculty of Humanities, Ardabil Branch, Islamic Azad University, Ardabil, Iran.
4 Department of General Psychology, Faculty of Humanities, Payam-Noor University, Ardabil Branch, Ardabil, Iran.
5 Department of Helth and Clinical Psychology, School of Medicine, Najaf-Abad Branch, Islamic Azad University, Isfahan, Iran.
چکیده [English]

The present study was conducted to investigate the effectiveness of schema therapy on rumination, depression, and personality function of women with bulimia nervosa. The semi-experimental research method was pre-test-post-test with a control group. The statistical population of this study consisted of women in Tehran who were diagnosed with bulimia nervosa in 2023. 30 women were randomly assigned to the experimental and control groups in accordance with the research's inclusion criteria. Rumination (RQ), Beck depression (BDI), and personality function (PFQ) questionnaires were implemented to evaluate the groups. Following ten 90-minute schema therapy sessions for the experimental group, the participants responded to the research questionnaire again. Finally, the data were subjected to multivariate analysis of covariance using SPSS-24. Schema therapy significantly decreased rumination (F=23.51), depression (F=50.04), and increased intimacy (F=47.16), empathy (F=41.83), and self-direction (F=30/04) and identity (F=32/77) in women with bulimia nervosa (P<0.01). The results indicate that schema therapy has reduced psychological disorders and enhanced the personality function of women with bulimia nervosa. Measures should be implemented to identify and treat vulnerable populations in light of the significant changes in people's lifestyles that the COVID-19 pandemic has induced.

کلیدواژه‌ها [English]

  • Bulimia Nervosa
  • Depression
  • Personality Function
  • Rumination
  • Schema Therapy

مراجع

استاد نوروزی، م.، و زمستانی، م. (1399). بررسی مقایسه‌ای ارتباط بین تروماهای دوران کودکی با کارکرد شخصیت و صفات مرضی در بیماران دارای اختلال شخصیت مرزی و گروه غیربیمار. مجلۀ روان‌شناسی و روان‌پزشکی شناخت. 7(6)، 99-85. http://dorl.net/dor/20.1001.1.25886657.1399.7.6.8.5
استفان‌دابسون، ک.، محمدخانی، پ.، و مساح‌چولابی، ا. (1386). مختصات روان‌سنجی پرسشنامۀ افسردگی بک-۲ در یک نمونۀ بزرگ مبتلایان به اختلال افسردگی اساسی. مجلۀ توان‌بخشی. 8، 86-80. http://rehabilitationj.uswr.ac.ir/article-1-135-fa.html
رهبریان، ا.، صالحی، ح.، غریب‌دوست، م.، و محمودی، ح. (1399). نقش نشخوار فکری و سرسختی روان‌شناختی در پیش‌بینی خطرپذیری دانش آموزان. فصلنامۀ سلامت روان کودک. 7(2)، 40-31. http://dorl.net/dor/20.1001.1.24233552.1399.7.2.15.9
رحمتی، ص.، و برجعلی، ا. (1400). اثربخشی گروه‌درمانی شناختی-رفتاری بر تن‌انگاره، سبک دلبستگی و تنظیم هیجان در زنان مبتلا به اختلال خوردن. فصلنامۀ پژوهش‌های کاربردی روان‌شناختی. 12(4)، 196-175. https://doi.org/10.22059/japr.2022.317446.643734
شباهنگ، ر.، شجاعی، م.، باقری شیخانگفشه، ف.، حسین خانزاده، ع. ع.، و نیکوگفتار، م. (1398). تحلیل ساختاری ارتباط احتکار با مشکلات بین‌فردی: نقش میانجی دشواری در تنظیم هیجان. فصلنامۀ پژوهش‌های کاربردی روان‌شناختی. 10(4)، 67-49. https://doi.org/10.22059/japr.2019.268699.643044
References
American Psychiatric Association. (2015). Feeding and eating disorders: DSM-5® selections. American Psychiatric Pub.
Archonti, C., Simpson, S., Castelnuovo, G., & Pietrabissa, G. (2019). Behavioral pattern breaking in schema therapy for eating disorders: Learning from other evidence-based approaches. In Schema Therapy for Eating Disorders (pp. 121-135). Routledge.
Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck depression inventory–II. Psychological Assessment, 78(2), 490-508. https://doi.org/10.1037/t00742-000
Bender, D. S., Morey, L. C., & Skodol, A. E. (2014). Toward a model for assessing level of personality functioning in DSM-5, part I: A review of theory and methods. Personality assessment in the DSM-5, 35-49.
Birmachu, A. M., Heidelberger, L., & Klem, J. (2021). Rumination and perceived social support from significant others interact to predict eating disorder attitudes and behaviors in university students. Journal of American College Health, 69(5), 488-494. https://doi.org/10.1080/07448481.2019.1682001
Brelet, L., Flaudias, V., Désert, M., Guillaume, S., Llorca, P. M., & Boirie, Y. (2021). Stigmatization toward People with Anorexia Nervosa, Bulimia Nervosa, and binge eating disorder: a scoping review. Nutrients, 13(8), 2834. https://doi.org/10.3390/nu13082834
Calvert, F., Smith, E., Brockman, R., & Simpson, S. (2018). Group schema therapy for eating disorders: study protocol. Journal of Eating Disorders, 6, 1-7. https://doi.org/10.1186/s40337-017-0185-8
Crone, C., Fochtmann, L. J., Attia, E., Boland, R., Escobar, J., Fornari, V., ... & Medicus, J. (2023). The American Psychiatric Association practice guideline for the treatment of patients with eating disorders. American Journal of Psychiatry, 180(2), 167-171. https://doi.org/10.1176/appi.ajp.23180001
Dondzilo, L., Rieger, E., Palermo, R., Byrne, S., & Bell, J. (2017). The mediating role of rumination in the relation between attentional bias towards thin female bodies and eating disorder symptomatology. PLoS One, 12(5), e0177870. https://doi.org/10.1371/journal.pone.0196143 
Eddy, K. T., Tabri, N., Thomas, J. J., Murray, H. B., Keshaviah, A., Hastings, E., ... & Franko, D. L. (2017). Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. The Journal of Clinical Psychiatry, 78(2), 17085. https://doi.org/10.4088/jcp.15m10393
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. https://doi.org/10.3758/bf03193146
Goldstein, A., & Gvion, Y. (2019). Socio-demographic and psychological risk factors for suicidal behavior among individuals with anorexia and bulimia nervosa: A systematic review. Journal of Affective Disorders, 245, 1149-1167. https://doi.org/10.1016/j.jad.2018.12.015
Hernando, A., Pallás, R., Cebolla, A., García-Campayo, J., Hoogendoorn, C. J., & Roy, J. F. (2019). Mindfulness, rumination, and coping skills in young women with Eating Disorders: A comparative study with healthy controls. PLoS One, 14(3), e0213985. https://doi.org/10.1371/journal.pone.0213985
Jones, H., McIntosh, V. V., Britt, E., Carter, J. D., Jordan, J., & Bulik, C. M. (2022). The effect of temperament and character on body dissatisfaction in women with bulimia nervosa: The role of low self-esteem and depression. European Eating Disorders Review, 30(4), 388-400. https://doi.org/10.1002/erv.2899
Joshua, P. R., Lewis, V., Kelty, S. F., & Boer, D. P. (2023). Is schema therapy effective for adults with eating disorders? A systematic review into the evidence. Cognitive Behaviour Therapy, 52(3), 213-231. https://doi.org/10.1080/16506073.2022.2158926
Keshishian, A. C., Tabri, N., Becker, K. R., Franko, D. L., Herzog, D. B., Thomas, J. J., & Eddy, K. T. (2021). Comorbid depression and substance use prospectively predict eating disorder persistence among women with anorexia nervosa and bulimia nervosa. Journal of Behavioral and Cognitive Therapy, 31(4), 309-315. https://doi.org/10.1016/j.jbct.2021.09.003
Khabir, L., Sajjadi, S. F., & Aflakseir, A. (2016). The prevalence and intensity of DSM-V feeding and eating disorders and its sub-thresholds among Iranian women. International Journal of Applied Behavioral Sciences, 3(1), 25-30.
Khairallah, C., Zoghbi, M., & Richa, S. (2019). Disgust, impulsivity and depressive dimensions in subjects at risk for bulimia nervosa and/or binge eating disorder. Asian Journal of Psychiatry, 39, 32-34. https://doi.org/10.1016/j.ajp.2018.11.019
Levallius, J., Clinton, D., Högdahl, L., & Norring, C. (2020). Personality as predictor of outcome in internet-based treatment of bulimic eating disorders. Eating Behaviors, 36, 101360. https://doi.org/10.1016/j.eatbeh.2019.101360
Maher, A., Cason, L., Huckstepp, T., Stallman, H., Kannis-Dymand, L., Millear, P., ... & Allen, A. (2022). Early maladaptive schemas in eating disorders: A systematic review. European Eating Disorders Review, 30(1), 3-22. https://doi.org/10.1002/erv.2866
McIntosh, V. V., Jordan, J., Carter, J. D., Frampton, C. M., McKenzie, J. M., Latner, J. D., & Joyce, P. R. (2016). Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy. Psychiatry Research, 240, 412-420. https://doi.org/10.1016/j.psychres.2016.04.080
Melunsky, N. D., Solmi, F., Haime, Z., Rowe, S., McIntosh, V. V., Carter, J. D., & Jordan, J. (2022). Personality traits and night eating syndrome in women with bulimia nervosa and binge eating disorder. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 27(2), 803-812. https://doi.org/10.1007/s40519-021-01221-5
Miles, S., Nedeljkovic, M., & Phillipou, A. (2023). Investigating differences in cognitive flexibility, clinical perfectionism, and eating disorder-specific rumination across anorexia nervosa illness states. Eating Disorders, 1-22. https://doi.org/10.1080/10640266.2023.2206751
Miller, A. E., Racine, S. E., & Klonsky, E. D. (2021). Symptoms of anorexia nervosa and bulimia nervosa have differential relationships to borderline personality disorder symptoms. Eating Disorders, 29(2), 161-174. https://doi.org/10.1080/10640266.2019.1642034
Murga, C., Cabezas, R., Mora, C., Campos, S., & Núñez, D. (2023). Examining associations between symptoms of eating disorders and symptoms of anxiety, depression, suicidal ideation, and perceived family functioning in university students: A brief report. International Journal of Eating Disorders, 56(4), 783-789. https://doi.org/10.1002/eat.23787
Muzi, L., Tieghi, L., Rugo, M. A., & Lingiardi, V. (2021). Personality as a predictor of symptomatic change in a residential treatment setting for anorexia nervosa and bulimia nervosa. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 26, 1195-1209. https://doi.org/10.1007/s40519-020-01023-1
Naumann, E., & Svaldi, J. (2021). Influence of suppression and reappraisal on eating-related symptoms and ruminative thinking in anorexia nervosa and bulimia nervosa. Behavior Research and Therapy, 141, 103851. https://doi.org/10.1016/j.brat.2021.103851
Naumann, E., Tuschen-Caffier, B., Voderholzer, U., Schäfer, J., & Svaldi, J. (2016). Effects of emotional acceptance and rumination on media-induced body dissatisfaction in anorexia and bulimia nervosa. Journal of Psychiatric Research, 82, 119-125. https://doi.org/10.1016/j.jpsychires.2016.07.021
Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology, 61(1), 115. https://doi.org/10.1037/0022-3514.61.1.115
Ostad Noroozi, M., & Zemestani, M. (2021). Comparative study of the relationship between childhood traumas with personality function and pathological traits in patients with borderline personality disorder and non-patient group. Shenakht Journal of Psychology and Psychiatry, 7(6), 85-99. http://dx.doi.org/10.52547/shenakht.7.6.85 (In Persian)
Palmieri, S., Mansueto, G., Scaini, S., Caselli, G., Sapuppo, W., Spada, M. M., ... & Ruggiero, G. M. (2021). Repetitive negative thinking and eating disorders: a meta-analysis of the role of worry and rumination. Journal of Clinical Medicine, 10(11), 2448. https://doi.org/10.3390/jcm10112448
Puttevils, L., Vanderhasselt, M. A., Horczak, P., & Vervaet, M. (2021). Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: A systematic review and meta-analysis. Comprehensive Psychiatry, 109, 152262. https://doi.org/10.1016/j.comppsych.2021.152262
Rahbarian, A., Salehi, H., Gharibdoust, M., & Mahmoudi, H. (2020). The role of rumination and psychological hardiness in predicting high-risk behaviors in students. Quarterly Journal of Child Mental Health, 7(2), 31-40. http://dx.doi.org/10.29252/jcmh.7.2.4 (In Persian)
Rahmati, S., & Borjali, A. (2022). The effect of cognitive behavioral group therapy on body image, attachment style and emotion regulation in women with eating disorder. Journal of Applied Psychological Research, 12(4), 175-196. https://doi.org/10.22059/japr.2022.317446.643734 (In Persian)
Ridout, S. J., Ridout, K. K., Kole, J., Fitzgerald, K. L., Donaldson, A. A., & Alverson, B. (2021). Comparison of eating disorder characteristics and depression comorbidity in adolescent males and females: An observational study. Psychiatry Research, 296, 113650. https://doi.org/10.1016/j.psychres.2020.113650
Rohde, J., Obbarius, A., Voigt, B., Sarrar, L., Biesenthal-Matthes, S., Kind, C. S., ... & Hofmann, T. (2023). Differences and similarities in personality functioning across different types of eating disorders. Frontiers in Psychiatry, 14, 1155725. https://doi.org/10.3389/fpsyt.2023.1155725
Rozakou-Soumalia, N., Dârvariu, Ş., & Sjögren, J. M. (2021). Dialectical behaviour therapy improves emotion dysregulation mainly in binge eating disorder and bulimia nervosa: A systematic review and meta-analysis. Journal of Personalized Medicine, 11(9), 931. https://doi.org/10.3390/jpm11090931
Sagiv, E., & Gvion, Y. (2020). A multi factorial model of self-harm behaviors in Anorexia-nervosa and Bulimia-nervosa. Comprehensive Psychiatry, 96, 152142.
Shabahang, R., Shojaei, M., Bagheri Sheykhangafshe, F., Hossien Khanzadeh, A. A., & Nikogoftar, M. (2020). Structural analysis of relationship between hoarding and interpersonal problems: Mediating Role of Difficulties in Emotional Regulation. Journal of Applied Psychological Research, 10(4), 49-67. https://doi.org/10.22059/japr.2019.268699.643044 (In Persian)
Silén, Y., & Keski-Rahkonen, A. (2022). Worldwide prevalence of DSM-5 eating disorders among young people. Current Opinion in Psychiatry, 35(6), 362-371. https://doi.org/10.1097/yco.0000000000000818
Simpson, S. (2019). Schema therapy conceptualisation of eating disorders. In Schema Therapy for Eating Disorders (pp. 56-66). Routledge.
Simpson, S., Azam, F., Brown, S., Hronis, A., & Brockman, R. (2022). The impact of personality disorders and personality traits on psychotherapy treatment outcome of eating disorders: A systematic review. Personality and Mental Health, 16(3), 217-234. https://doi.org/10.1002/pmh.1533
Simpson, S., Hartmann, S., Files, N., & Smith, E. (2019). Review of the schema model and therapeutic application in eating-disordered populations. Schema Therapy for Eating Disorders, 12-22.
Slade, E., Keeney, E., Mavranezouli, I., Dias, S., Fou, L., Stockton, S., ... & Kendall, T. (2018). Treatments for bulimia nervosa: A network meta-analysis. Psychological Medicine, 48(16), 2629-2636. https://doi.org/10.1017/s0033291718001071
Smith, K. E., Mason, T. B., & Lavender, J. M. (2018). Rumination and eating disorder psychopathology: A meta-analysis. Clinical Psychology Review, 61, 9-23. https://doi.org/10.1016/j.cpr.2018.03.004
Stefan-Dabson, K., Mohammadkhani, P., & Massah-Choulabi, O. (2007). Psychometrics characteristic of Beck Depression Inventory-II in patients with major depressive disorder. Archives of Rehabilitation, 8, 80-86. http://rehabilitationj.uswr.ac.ir/article-1-135-en.html (In Persian)
Svaldi, J., Schmitz, F., Baur, J., Hartmann, A. S., Legenbauer, T., Thaler, C., ... & Tuschen-Caffier, B. (2019). Efficacy of psychotherapies and pharmacotherapies for bulimia nervosa. Psychological Medicine, 49(6), 898-910. https://doi.org/10.1017/s0033291718003525
Van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34(6), 515. https://doi.org/10.1097%2FYCO.0000000000000739
Wang, S. B., & Borders, A. (2018). The unique effects of angry and depressive rumination on eating-disorder psychopathology and the mediating role of impulsivity. Eating Behaviors, 29, 41-47. https://doi.org/10.1016/j.eatbeh.2018.02.004
Williamson, D. A., Lawson, O. D., Bennett, S. M., & Hinz, L. (2021). Behavioral treatment of night bingeing and rumination in an adult case of bulimia nervosa. In Case Studies in Mental Health Treatment (pp. 33-38). Routledge.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2006). Schema therapy: A practitioner's guide. Guilford press.
Zheng, A., Chen, X., Li, Q., Ling, Y., Liu, X., Li, W., ... & Chen, H. (2023). Neural correlates of Type A personality: Type A personality mediates the association of resting-state brain activity and connectivity with eating disorder symptoms. Journal of Affective Disorders, 333, 331-341. https://doi.org/10.1016/j.jad.2023.04.063
فصل‌نامه پژوهش‌های کاربردی روانشناختی
دوره 15، شماره 3
آبان 1403
صفحه 23-40

فایل ها

سابقه مقاله

  • تاریخ دریافت: 10 مرداد 1402
  • تاریخ بازنگری: 24 مرداد 1402
  • تاریخ پذیرش: 10 مهر 1402
  • تاریخ اولین انتشار: 02 بهمن 1402
  • تاریخ انتشار: 01 مهر 1403

هم رسانی

ارجاع به این مقاله

آمار