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Research code: کد اخلاق IR.SUMS.REC.1401.29365230
Ethics code: کد اخلاق IR.SUMS.REC.1401.29365230
Clinical trials code: كــــد IRCT20220808055640N1 از مرکز ثبت کارآزمایی بالینی ایران

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Abstract:   (272 Views)
Background & Aims:
Irritable bowel syndrome is a type of chronic functional disorder of the gastrointestinal tract in which patients experience various digestive symptoms such as abdominal pain, diarrhea, constipation and other intestinal symptoms in the absence of any structural or biological abnormalities. . The cause of the disease is unclear, but the possible role of the abnormal activity of the sensory-motor nerves of the intestine, disorders of the central nervous system, mental disorders, stress, and internal factors have been reported (1). This disease, which often affects young people, is usually observed before the age of 45 and affects women 2 to 3 times more than men (2). The prevalence of this syndrome in Iran is reported to be approximately 5.8% (3). It seems that in some geographical areas, disease symptoms are related to taboos, social roles, and cultural differences; And such cases show that psychological, social and environmental variables play a decisive role in this disease in addition to biological factors (4). Indeed, psychiatric symptoms and disorders are an independent risk factor for the development of irritable bowel syndrome (5) and can exacerbate or perpetuate symptoms (6). According to what was said and considering the importance of important psychological symptoms such as emotion regulation and feeling of shame on the development and continuation of this disease, identifying effective treatment methods is one of the basic concerns. One of the psychological interventions of the third wave of cognitive-behavioral therapies that has recently attracted the attention of many researchers is the therapy based on acceptance and commitment. During this intervention, participants are encouraged to change their relationships with their thoughts and physical feelings through the mechanisms of acceptance, mindfulness, and value-based action (18). The overall goal of ACT is to increase psychological flexibility, that is, the ability to be aware of experiences in the present moment, with a method based on acceptance and in a non-judgmental manner, along with the continuation of behavior based on one's values, even when the person's thoughts and feelings are against valuable action (19). According to (20), to enhance psychological flexibility, acceptance-based therapy and commitment to six related and overlapping processes of acceptance (a willingness to fully open up to unwanted experiences such as difficult thoughts, memories, or feelings), contact with the present moment (e.g., being mindful and aware of one's experiences), self as context (maintaining a view of oneself within experiences), cognitive disengagement (ability to distance oneself from unwanted experiences without engaging with them), committed action (engaging in actions that move toward important aspects of life), and values ​​(in It relies on staying connected to personal values ​​or important areas of life. Considering that this treatment focuses on thoughts and physical feelings at the same time, it can probably also have an effect on improving emotion regulation and feelings of shame in patients with irritable bowel syndrome. On the other hand, past studies have emphasized the effectiveness of this intervention on emotional regulation and reducing negative emotions such as shame in different societies. In another study, the effect of acceptance and commitment therapy on reducing feelings of shame in methamphetamine users; (21) the effectiveness of the intervention of acceptance and commitment along with awareness on emotion regulation; (22) The effectiveness of acceptance and commitment therapy on the difficulty of emotional regulation in women with MS and (23) the effectiveness of acceptance and commitment therapy on the psychological stress of patients with inflammatory bowel disease have been confirmed.
The present study was conducted with the aim of comparing the effectiveness of acceptance and commitment therapy and intensive short-term dynamic psychotherapy on emotion regulation and shame in people with irritable bowel syndrome.
Method
This research was a semi-experimental study with a pre-test, post-test design with experimental and control groups and a 3-month follow-up. The statistical population of the research included all patients with irritable bowel syndrome over 20 years old in Shiraz in 2021, among them there were 45 people (15 people from the first experimental group, 15 people from the second experimental group and 15 people from the control group) who were selected by Purposive sampling and randomly assigned to three groups. The first experimental group underwent acceptance and commitment therapy (eight one-hour sessions) and the second experimental group underwent intensive short-term dynamic psychotherapy (eight one-hour sessions) and the control group did not receive any intervention. Research tools included Gratz and Roemer's (2004) emotional regulation difficulty scale and Cook's internalized shame scale (1993). After receiving a letter from the university and presenting it to the medical centers, including internal specialists, and also distributing notices in these centers, the patients were invited to participate in the research. After selecting the subjects, they were first explained about the purpose of the research, its duration and the benefits of participating in it. They were told that they would participate in a research study and that all information received from them would remain confidential. Then a written consent was obtained from them. It was also explained to the witness group that after the end of the research work, treatment sessions will be held for them as well. In the following, therapy sessions based on acceptance and commitment and short-term dynamic psychotherapy were held for the subjects of the experimental group along with assignments during the sessions and related assignments.
Results:
The results of analysis of covariance and analysis of variance with repeated measurements showed that both interventions increased emotion regulation and all its components and decreased feelings of shame (p<0.01) and this effect was maintained during the follow-up period. Also, the findings of the research indicated that there is a significant difference between the acceptance and commitment therapy and intensive short-term dynamic psychotherapy, and intensive short-term dynamic psychotherapy has been more effective in increasing emotion regulation and all its components and reducing feelings of shame. It shows the results of repeated measures analysis of variance. The F value obtained for the within-group effect of the time factor in the variable of emotion regulation and feeling of shame is significant, so there is a significant difference between the three stages of measurement (pre-test, post-test and follow-up). The F value obtained for the between-group effect in the dependent variables of emotion regulation and shame is also significant; That is, there is a significant difference between the scores of the test groups of acceptance and commitment therapy and short-term intensive psychodynamics and the control group in the follow-up phase. Also, the interaction effect of time on the groups was also significant.
Conclusion:
According to the results of the research, it is recommended that counselors and therapists use both approaches as an effective treatment method to help improve emotional regulation and reduce shame in people with irritable bowel syndrome. In general, according to the findings of the present research, it can be said that despite the difference in the effectiveness of two treatments based on acceptance and commitment and intensive and short-term dynamic psychotherapy on the regulation of emotions and feelings of shame in patients with irritable bowel syndrome, both therapeutic interventions have tried their best. to reduce the shame of the subjects and ultimately increase the level of emotional regulation; Therefore, according to the findings of the research, it is suggested that in future studies and considering the importance of emotion regulation variables and feelings of shame in patients with irritable bowel syndrome, researches should be conducted on a larger number of people and other cities with different cultural characteristics so that the ability Increase the generalizability of the research. Considering the effectiveness of both interventions in this research, it is suggested to examine the effectiveness of these treatments in different clinical situations and people suffering from other diseases so that these treatments can be used in different clinical situations with more confidence. Finally, considering the effectiveness of both approaches, it is suggested to use integrated methods based on acceptance and commitment and intensive and short-term dynamic psychotherapy in order to influence the variable used in this research.
 
     
Type of Study: Research | Subject: Psychiatry

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