Razi Journal of Medical Sciences

fa مقایسه اثربخشی شناخت درمانی مبتنی بر ذهن آگاهی و درمان مبتنی بر پذیرش و تعهد بر استرس ادراک شده افراد مبتلا به کبد چرب غیر الکلی Compare the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) on Perceived Stress in Non-Alcoholic Fatty Liver Disease (NAFLD) روانشناسی بالینی Clinical Psychiatry پژوهشي Research زمینه و هدف: مطالعه حاضر با هدف مقایسه اثربخشی شناخت درمانی مبتنی بر ذهن آگاهی (Mindfulness-Based Cognitive Therapy -MBCT) و درمان مبتنی بر پذیرش و تعهد (Acceptance and Commitment Therapy -ACT) بر استرس ادراک شده، در افراد مبتلا به بیماری کبد چرب غیر الکلی (Nonalcoholic Fatty Liver Disease-NAFLD) انجام شد. روش کار: این مطالعه یک طرح نیمه تجربی با دو گروه آزمایش و یک گروه گواه با اجرای پیشآزمون، پسآزمون و پیگیری دو ماهه بود. این پژوهش در سال  1398 در شهر تهران در جامعه آماری افراد با تشخیص NAFLD انجام شد. در این پژوهش 45 فرد مبتلا به NAFLD بهشیوه هدفمند انتخاب شدند و بر حسب تصادف در سه گروه گمارده شدند و از آنها پیشآزمون دریافت شد. سپس هر یک از گروههای آزمایش در طول ده جلسه دو ماهه تحت مداخله گروهی قرار گرفتند و گروه گواه همان مداخلات معمول خود را از مراکز درمانی دریافت میکرد. در هر سه مرحله سنجش، مقیاس استرس ادراک شده اجرا شد. بهمنظور تحلیل دادهها از آزمون تحلیل واریانس اندازهگیریهای مکرر با  نرمافزار SPSS-22 استفاده شد.   یافته ها: نتایج نشان داد که مداخلات MBCT و ACT در طول زمان بهطور معنیداری موجب کاهش استرس ادراک شده در شرکتکنندگان شد، اما در گروه گواه هیچ تفاوت معنیداری در طول زمان مشاهده نشد (001/0>p) و مداخلات روانشناختی تا 37% باعث کاهش استرس در شرکتکنندگان شدهاند.  نتیجه گیری: در مجموع میتوان نتیجه گرفت که مداخلات روانشناختی با داشتن ظرفیتهای مناسب و ارائه تغیرات مطلوب نقش موثری در کاهش استرس در افراد مبتلا به NAFLD داشتند. Background & Aims: Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the leading causes of referral to hepatology clinics in adults. It occurs in people who have accumulation triglyceride levels in liver cells without a history of drinking alcohol or consuming very little. Behavioral therapies include psychological therapies that commonly used to improve the health of chronic patients. Today, various treatment methods have been introduced and used in this field. Recently, however, third-wave behavioral therapies such as Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) over existing therapies have been shown to have a lasting effect which are gaining more acceptance. Instead of focusing on changing beliefs, these therapies try to increase a person's psychological connection to his or her thoughts and emotions. Today, MBCT and ACT are widely used to modify behavior and reduce stress and psychological distress in people with chronic diseases. Therefore, psychological intervention in NAFLD should be considered by clinicians to prevent the severe consequences of this disease. The purpose of this study was to compare the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) on perceived stress in people with Non-Alcoholic Fatty Liver Disease (NAFLD). Methods: This study was a quasi-experimental design with two experimental groups and one control group with pre-test, post-test and two-month follow-up. This study was conducted in 2019 in the statistical population of individuals with NAFLD in Tehran. The statistical population of this study included all people with NAFLD who referred to liver and gastrointestinal clinics in Tehran who had referred to these centers between July 1 and the end of September 2018. For this purpose, four specialized gastrointestinal and liver clinics (Massoud, Behbood, Ibn Sina and Ayatollah Taleghani hospitals) were selected with cluster random sampling and the invitation to participate in a psychological training course was distributed among the people who referred to these centers. 70 people with NAFLD announced their readiness to participate in the study. Considering the inclusion and exclusion criteria, 60 patients were eligible to participate in the study. After explaining the goals of the study and the content of the treatment sessions, 15 people withdrew from the study and finally the number of applicants was reduced to 45. Finally, in this study, 45 patients with NAFLD were selected by purposive sampling and were randomly assigned to three groups, and the pre-test was received from them. Then, each of experimental group underwent group intervention during two months of ten sessions, and the control group received the typical routine interventions from medical centers. Perceived Stress Scale (Cohen et al., 1986) was conducted in the all of three stages of measurement In this study, SPSS-25 software was used to analyze the data. In the descriptive part, mean scattering and standard deviation indices were used and in the inferential part, repeated measures analysis of variance test was used. Also, the level of error in this study was considered 0.05. Results: A total of 45 people with NAFLD participated in the study, which included three groups of 15 people. The mean age (in terms of year) for each MBCT, ACT and control groups was 49.73, 48.73 and 48.46, respectively. The results showed that MBCT and ACT interventions significantly reduced the perceived stress in the participants over time, but in the control group, no significant difference was observed over time (P <0.001) and in participant’s psychological interventions reduced stress up to 37%. Bonferroni post hoc test was used for pairwise comparison of assessment steps. The results showed that there was a significant difference between the experimental groups and the control group in the pre-test-post-test stage of the perceived stress variable. This means that therapeutic interventions have a significant effect on the perceived stress of people with NAFLD and this treatment has remained stable over time, ie in the follow-up phase. Tukey post hoc test was used to compare the pairs of ACT and MBCT experimental groups and the control group. As shown, there is a significant difference in stress reduction between ACT and control groups and between MBCT and control groups. Conclusion: Finally, the results of the present study indicate that MBCT and ACT interventions with appropriate capacities in changing attitudes and creating appropriate behaviors, can play an effective role in reducing stress. Overall, third-wave behavioral therapies encourage people to treat their self-assessments as simple, transient thoughts, rather than trying to avoid or change them. These therapies seek to weaken empirical avoidance and increase one's actual exposure to all experiences and emotions, and encourage individuals to accept fully their illnesses, thoughts, feelings, emotions, and impulses and set valuable goals for themselves. Cognitive integration is also impaired in people with chronic diseases through the process of cognitive defusion and acceptance and cognitive dysfunctions and rationalizations are reduced and pursuing valuable goals in life and committed action to achieve those goals will reduce unpleasant emotions and create a productive life. Absence of some participants and lack of timely attendance of some of them in treatment sessions, non-random selection of individuals and implementation of a randomized clinical trial plan, lack of nutrition control and sports activities which in turn play an important role in stress, also, the lack of investigation of stressful events during the study period from pre-test to follow-up is one of the limitations of this study. It can be concluded that psychological interventions with proper capacities and presenting favorable changes have an effective role in reducing stress in people with NAFLD. In the practical field, it is suggested that psychological interventions be considered to improve the quality of life of people with NAFLD and to facilitate the medical treatment process. It is recommended that the NAFLD treatment process be presented to patients in a group setting, consisting of a set of specialists. استرس, درمان مبتنی بر پذیرش و تعهد, ذهن آگاهی, کبد چرب غیر الکلی Stress, Acceptance and Commitment Therapy, Mindfulness, Non-Alcoholic Fatty Liver Disease 186 196 http://rjms.iums.ac.ir/browse.php?a_code=A-10-4960-1&slc_lang=fa&sid=1 Mohammad Oraki محمد اورکی orakisalamat@gmail.com 3900319475328460055783 3900319475328460055783 Yes Payame Noor University, Tehran, Iran دانشگاه پیام نور، تهران، ایران Hossein Zare حسین زارع h_zare@pnu.ac.ir 3900319475328460055784 3900319475328460055784 No Payame Noor University, Tehran, Iran دانشگاه پیام نور، تهران، ایران Ali Hosseinzadeh Ghasemabad علی حسین زاده قاسم آباد arefmobin74@yahoo.com 3900319475328460055785 3900319475328460055785 No Faculty of Educational Sciences and Psychology, Payame Noor University, Tehran, Iran دانشگاه پیام نور، تهران، ایران