Razi Journal of Medical Sciences

fa مقایسه تاثیر تربیت روانی خانواده مبتنی بر مدل اتکینسون - کویا و تربیت روانی خانواده مبتنی بر توجه آگاهی بر هیجان ابراز شده مراقبان بیماران مبتلا به اسکیزوفرنیا Comparison of the effect of Family Psychoeducation Based on Atkinson - Coia's Model and Mindfulness-Based Family Psychoeducation on Expressed Emotion of Caregivers of Patients with Schizophrenia روانشناسی بالینی Clinical Psychiatry پژوهشي Research زمینه و هدف: اسکیزوفرنی یکی از ناتوان ‌کننده‌ترین اختلالات روانی و از شدیدترین بیماری‌های روانی و استرس‌زا برای بیمار و خانواده‌اش است هدف از انجام تحقیق حاضر مقایسه تاثیر تربیت روانی خانواده مبتنی بر مدل اتکینسون - کویا و تربیت روانی خانواده مبتنی بر توجه آگاهی بر هیجان ابراز شده مراقبان بیماران مبتلا به اسکیزوفرنیا بود. روش کار: برای انجام تحقیق نیمه آزمایشی حاضر از بین مراقبان اصلی بیماران مبتلا به اختلال اسکیزوفرنیا به صورت در دسترس 45 نفر انتخاب و به صورت تصادفی به سه گروه تربیت روانی خانواده مبتنی بر مدل اتکینسون - کویا، تربیت روانی خانواده مبتنی بر توجه آگاهی و کنترل تقسیم شدند. در ادامه و در سه مرحله قبل، بلافاصله بعد و پیگیری سه ماهه، تمام آزمودنیها مقیاس سطح هیجان ابراز شده (LEE) را تکمیل کردند. همچنین گروه آزمایش اول طی 10 جلسه 90 دقیقهای هفتهای یک جلسه به مدت شش هفته به صورت گروهی تحت پروتکل تربیت روانی خانواده (مدل اتکینسون - کویا) قرار گرفت. گروه آزمایش دوم نیز طی هشت جلسه 90 دقیقهای هفتهای یک جلسه، به مدت دو ماه به صورت گروهی تحت درمان پروتکل تربیت روانی خانواده مبتنی بر توجه آگاهی بر اساس شناخت درمانی مبتنی بر توجه آگاهی کرین (2017) قرار گرفت. یافتهها: نتایج نشان داد بین اثربخشی دو نوع مداخله در کاهش میزان هیجان ابراز شده مراقبان خانوادگی بیماران مبتلا به اسکیزوفرنیا تفاوت معناداری وجود دارد. همچنین تربیت روانی خانواده مبتنی بر توجه آگاهی تاثیر بیشتری دارد. نتیجهگیری: با توجه به نتایج استفاده از هر دو نوع مداخله و مخصوصا تربیت روانی خانواده مبتنی بر توجه آگاهی به مراقبان خانوادگی بیماران مبتلا به اسکیزوفرنیا توصیه میشود.   Introduction Schizophrenia, in fact, is one of the most debilitating mental disorders and one of the most severe and stressful mental illnesses for the patient and his family, during which the inevitable and heavy consequences of schizophrenia and its recurring nature and heavy costs have caused this disorder to be among the debilitating disorders. be placed (2). So that the consequences of emotional, social and financial life experienced by people with schizophrenia have significant effects on their families (6). Therefore, the higher the family pressure, the lower the mental health of other members. In this regard, researchers are looking to use different treatment methods to reduce the effects of mental burden on the caregivers of these patients, and in the meantime, different treatment methods have also been used. In the meantime, one of the models of family group education was invented by Anderson and its purpose is to raise awareness about the nature of the disease and the treatment of schizophrenia. Based on the Atkinson-Koya model, in family group training sessions, materials about schizophrenia, including etiology, prognosis of the disorder, treatment methods, common drugs, awareness of emotions expressed in the family, management and control of the patient's disturbed behavior, examination of emotional tensions and the effect of negative emotions on relapse The patient's symptoms are taught. These trainings can be done in groups or individually and include various methods that are used to increase social capabilities, self-reliance, practical skills and interpersonal relationships in patients with schizophrenia (9). According to the above materials, the researchers are trying to answer the question, is there a difference between the effect of family psychological training based on the Atkinson-Koya model and family psychological training based on awareness attention on the emotions expressed by caregivers of patients with schizophrenia? Method To conduct the present semi-experimental research, which was carried out with a pre-test-post-test design with two experimental groups and a control group with a three-month follow-up. 45 people were selected from among the main caregivers of patients suffering from schizophrenia whose patients were being treated in Razi Medical Education Center (University of Welfare and Rehabilitation Sciences) in Tehran in 1402, provided they met the criteria for entering the research. And they were randomly divided into three groups: family psychological training based on the Atkinson-Koya model, family psychological training based on awareness and control. In the following and in the three stages before, immediately after and the three-month follow-up, all the subjects used the level of expressed emotion (LEE) scale, which is used to evaluate the level of expressed emotion of first-degree relatives (people who are considered important in the patient's life, such as father, mother, wife, sister, brother and others) completed the patient's questionnaire. Also, the first experimental group underwent the family psychological training protocol (Atkinson-Koya model) in 10 sessions of 90 minutes per week for two and a half months. The second experimental group also underwent eight 90-minute sessions once a week for two months as a group under the mindfulness-based family psychological training protocol based on Crane's (2017) mindfulness-based cognitive therapy (18). . The control group did not receive any intervention. Finally, descriptive statistics, Shapiro-Wilk test and analysis of variance mixed with Bonferroni's repeated measures and post hoc using spss software version 24 were used to test the research hypotheses. Results The results of analysis of variance with repeated measures showed that the main effects of time (p<0.001), group are significant (p<0.001) and the interaction of time and group on expressed emotion is significant (<0.001). p). The effect of time shows that there is a significant difference between pre-test, post-test, and follow-up. The effect size in the main effect of the group shows that 29% of the changes in the expressed emotion variable of the participants are due to the group membership. Also, the effect size in the time variable shows that 97% of the changes in the expressed emotion variable are caused by time changes. Also, the size of the interaction effect of time and group is 0.96, which shows that 96% of the changes in the variance of expressed emotion are caused by time changes in at least one of the two groups. The results of the LSD post hoc test showed that the difference between the family psychological education group based on the Atkinson-Koya model and the control group is significant (p<0.05). Also, the difference between the family psychological training group based on awareness and the control group is significant (p<0.05). Also, there is a significant difference between the average of the family psychological education group based on the Atkinson-Koya model and the family psychological education based on mindfulness (p=1.00). The results of the analysis of variance test with repeated measurements showed that there is a significant difference between the pre-test and post-test and pre-test and follow-up in the family psychological education group based on the Atkinson-Koya model (p<0.001), but between the post-test and the follow-up There was no significant difference (p=0.685). There was a significant difference between pre-test and post-test and pre-test and follow-up in the group of family psychological education based on mindfulness (p<0.001). Also, there was no significant difference between post-test and follow-up (p=1.00). Discussion The results showed that there is a significant difference between the effectiveness of two groups of family psychological training based on the Atkinson-Koya model and family psychological training based on mindfulness in reducing the level of emotion expressed by family caregivers of patients with schizophrenia, and family psychological training based on the Atkinson-Koya model Awareness had a greater effect on the expressed emotion of family caregivers than family psychological education based on attention. In explaining this finding, it can be said that family caregivers feel less pressure after participating in training sessions due to increased awareness and information about schizophrenia disorder and also learning communication skills techniques with the patient, and as before without any reason. They do not blame the family member for causing the illness, which can lead to a decrease in the level of excitement expressed by the family caregivers of patients with schizophrenia. Many people with acute mental illnesses, including schizophrenia, live with their family members or are in direct contact with them (21). However, increasing the family's ability to manage the mental pressure caused by the child's illness can help to reduce the mental pressure caused by the disease. Various studies have shown that family therapeutic interventions reduce the rate of relapse and repeated hospitalizations of patients with schizophrenia. The importance of these interventions becomes more obvious when we know that 30 to 60% of these patients live with their families and a significant percentage of them continue their relationship with their family members (9). Therefore, although families with a member suffering from schizophrenia report the prevalence of health problems twice as much as the normal population, family psychological education can improve the general health of families and make them more compatible with their children's conditions.   تربیت روانی خانواده, مدل اتکینسون – کویا, توجه آگاهی, هیجان ابراز شده, مراقبان خانوادگی, اسکیزوفرنیا family psychoeducation, Atkinson - Coia's model, mindfulness, expressed emotion, family caregivers, schizophrenia 0 0 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8194-1&slc_lang=fa&sid=1 Mokhtar Seyfi مختار سیفی mokhtar.sayfi@gmail.com 3900319475328460090912 0009-0009-7084-4763 No Islamic Azad University دانشگاه آزاد اسلامی Biouk Tajeri بیوک تاجری btajeri@yahoo.com 3900319475328460090913 3900319475328460090913 Yes Islamic Azad University دانشگاه آزاد اسلامی Sheida Sodagar شیدا سوداگر sh_so90@yahoo.com 3900319475328460090914 3900319475328460090914 No Islamic Azad University دانشگاه آزاد اسلامی Malek Mirhashemi مالک میرهاشمی mirhashemimalek@gmail.com 3900319475328460090915 3900319475328460090915 No Islamic Azad University دانشگاه آزاد اسلامی