Razi Journal of Medical Sciences
مجله علوم پزشکی رازی
RJMS
Medical Sciences
http://rjms.iums.ac.ir
39
journal39
2228-7043
2228-7051
en
jalali
1402
4
1
gregorian
2023
7
1
30
4
online
1
fulltext
fa
تاثیر درمان ذهنی سازی و هنر درمانی مبتنی بر ذهن آگاهی بر مولفههای انگ ناباروری
The Effectiveness of Mentalization-based Treatment and Mindfulness-Based Art Therapy on Components of Infertility Stigma
روانشناسی بالینی
Clinical Psychiatry
پژوهشي
Research
<div style="text-align: justify;"><span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:#0070c0">زمینه و هدف: </span></span></span></span></b><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">انگ ناباروری شامل بی ارزشی شخصی، کناره گیری اجتماعی، انگ عمومی، انگ خانوادگی بوده و فرد نابارور را از محیطش متمایز میکند. هنر درمانی مبتنی بر ذهن آگاهی، بیان خلاقانه عواطف و احساسات است و سبب کاهش آشفتگیهای روانشناختی میگردد. درمان ذهنی سازی، توانایی فرد در تعبیر حالات ذهنی خود و دیگریست و در یک رابطه دلبستگی ایمن شکل میگیرد. هدف، مقایسه اثربخشی هنردرمانی مبتنی بر ذهن­آگاهی و درمان ذهنی‏سازی بر مولفههای انگ ناباروری زنان نابارور شهر اصفهان بود.</span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:#0070c0">روش کار:</span></span></span></span></b><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"> پژوهش نیمه آزمایشی با طرح پیش­آزمون،پس­آزمون با دو گروه آزمایش و یک گروه گواه بود. </span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">جامعه آماری شامل زنان با تشخیص ناباروری اولیه مراجعه کننده به پزشکی قانونی اصفهان در سال</span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">۱۴۰۰</span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"> بودند .</span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"> با توجه به ملاک‏های ورود و خروج، 45 نمونه هدفمند انتخاب و بطور تصادفی دردو گروه آزمایشی هنردرمانی مبتنی برذهن آگاهی و ذهنی سازی و یک گروه گواه قرار گرفتند. ابزار پژوهش، پرسشنامه انگ ناباروری بود. گروههای آزمایشی درمانها را طبق پروتکل هنر درمانی مبتنی بر ذهن آگاهی و درمان ذهنی­سازی، طی دو و نیم ماه دریافت نمودند. گروه گواه بدون مداخله بود. برای تحلیل داده‏ها از تحلیل واریانس با اندازه‏گیری مکرر با طرح آمیخته استفاده شد.</span></span></span></span><b><span dir="LTR" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span></b></span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:#0070c0">یافتهها:</span></span></span></span></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">نمره بی ارزشی خود، کناره گیری اجتماعی، انگ عمومی و انگ خانوادگی در مرحله پس آزمون کاهش یافت و درمان ذهنی سازی اثربخشتر از هنر درمانی مبتنی بر ذهن آگاهی بر مولفههای انگ ناباروری بود . </span></span></span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:#0070c0">نتیجهگیری: </span></span></span></span></b><span lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">هر دو درمان باعث کاهش انگ ناباروری شدند که سبب کاهش اضطراب و کناره گیری اجتماعی زنان نابارور میشود. </span></span></span></span></span></span></span></span></span></span></span></span></div>
<div style="text-align: justify;"><span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:#0070c0">Background & Aims:</span></span></span></span></b> <span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse .Infertility affects millions of people of reproductive age worldwide – and has an impact on their families and communities. Primary infertility refers to couples who have not become pregnant after at least 1 year having sex without using birth control methods.Secondary infertility refers to couples who have been able to get pregnant at least once, but now are unable </span></span></span></span><span lang="EN" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">(1)</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">. Worldwide, 48/5million of couples experience fertility problems</span></span></span></span><span lang="EN" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"> (2).</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"> In Iran, around 20/2 percent are estimated to have difficulty conceiving or staying pregnant</span></span></span></span><span lang="EN" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"> (3)</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">. Infertility stigma includes the components of personal worthlessness,social withdrawal,public stigma and family stigma,along with secrecy ,which distinguishes the infertile person from her environment and considers her an awkward patch. Infertility stigma puts strain on relationships, may lead individuals to hide their diagnoses from friends or family and delay or avoid treatment (5-7). In turn, this could lead to worse prognoses for these patients </span></span></span></span><span lang="EN" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">(8-11)</span></span></span></span><span lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">(</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">Kaya and Oskay 2020</span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">)</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">. The MBAT, mindfulness-based art therapy, as a new intervention method which combines art therapy and psychotherapy. MBAT integrates mindfulness practices and with making art therapeutically.The therapist creates a supportive container which includes: mindfulness teachings, guided meditations, and sensitive exploration of the art images created. Mindfulness-based art therapy takes place in either group or individual sessions .MBAT invites kindness and care and encourages a non - judgmental responses in mindfulness and art-making practices and orientates towards having patience to allow change to occur. Rather than focusing on how we want to be, we open to how we are in this moment, and then change can occur .The benefits of mindfulness-based art therapy include: reduced stress and anxiety, improved mood and self-esteem, more fulfilling personal relationships, deeper insight and ways to develop compassion for yourself and others .Mindfulness practice involves self-exploration and awareness of our minds, bodies, feelings and thoughts. Art making is a way to express ourselves beyond words. It encourages us to be in our present moment experiences, through noticing the sensations we are experiencing. This includes the sensate qualities of using art materials, involving touch, movement and play, which supports presence and awareness (12, 15). Mentalization -based therapy (MBT) is a type of long-term psychotherapy. Mentalization is the ability to think about thinking. Mentalization is a normal capacity that we all use in everyday life.MBT is an integrative treatment approach for borderline and other severe personality disorders. It combines ideas from both psychoanalysis and modern research and is based on the unique human capacity to mentalize , or understand mental states underlying one's own actions as well as those of others .Anthony Bateman and peter Fonagy applied the concept of mentalization to treating people with borderline personality, creating Mentalization-Based Therapy. They believe people with borderline personality (BPD) have a limited ability to mentalize, due either to genetic predisposition or early exposure to neglect</span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">.</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">MBT can be an effective intervention for depression and eating disorders but the evidence is currently limited. Professionals supporting mothers of children at risk may benefit from receiving training in the principles of MBT</span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">.</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"> Mentalization refers to the ability to reflect upon, and to understand one's state of mind; to have insight into what one is feeling, and why</span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">.</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">Poor mentalizing of our own thoughts and emotions means that we do not have a good understanding of our own reasons for acting the way we do (16-19)</span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">.</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"> The aim of this research was to study Comparison of the effectiveness of Mindfulness-Based Art Therapy and Mentalization-based treatment on infertility stigma of infertile women In Isfahan.</span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:#0070c0">Methods</span></span></span></span></b><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:#0070c0">: </span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">The present study used a pretest-posttest design with 3 groups: 2 experimental groups and 1 control group.</span></span></span></span> <span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">Code of ethics was</span></span></span></span> <span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">IR.IAU.SHK.REC.1400.010</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">. The study population consisted of all woman with primary infertility referring to the forensic medicine organization of isfahan, Iran, in winter and spring 2021. The sample group consisted of 45 individuals selected by the available sampling method. The inclusion criteria included interest in participating in the study . The exclusion criteria included diagnosis without psychological disorders, severe physical diseases and don’t absent more than two sessions. The participants were randomly divided into 3 groups each with 15 members. The experimental groups underwent therapeutic interventions. The first experimental group received (MBAT), mindfulness-based art therapy and the second one received (MBT), Mentalization-based therapy. The experimental group attended in ten sessions MBAT protocol and 20 sessions MBT protocol .Two month after the intervention, three groups were assessed again using the same tool(follow up). The control group received no intervention. The data were collected by (ISS), infertility stigma scale ,by Fu et al</span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">. </span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"></span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"></span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"></span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span><span dir="RTL" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"></span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"></span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"></span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black">(29)</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"> The questionnaire was introduced by Rajabi etal. It includes 27 statements .The statements are designed based on 5- Likert spectrum scale </span></span></span></span><span lang="EN" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">(30)</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">. The participants filled out the tool before and after the intervention. The data were analyzed by SPSS V.23. Data were evaluated by ANOVA with repeated measure. </span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:#0070c0">Results</span></span></span></span></b><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:#0070c0">: </span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">The effectiveness of mindfulness-based art therapy and Mentalization-based treatment on components of infertility stigma in woman with primary infertility was examined. In terms of the components of infertility stigma, the findings indicated differences among the mean scores at pretest and posttest stages in all groups. The results of ANOVA with repeated measures supported the effect of both treatments and decrease all of components of infertility stigma,except family stigma .The mindfulness-based art therapy and Mentalization-based treatment had significant effect on infertility stigma. Mentalization-based treatment was more effective than mindfulness-based art therapy .<i> </i>Jalambadani et al.</span></span></span></span> <span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">showed that of mindfulness-based art therapy was effective in the quality of life in woman with breast cancer </span></span></span></span><span lang="EN" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">(20).</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"> Markin, McCarthy argued that Mentalization-based treatment was effective in pregnancy after loss </span></span></span></span><span lang="EN" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">(25). </span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">These findings are consistent with </span></span></span></span><span lang="EN" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">(20-23).</span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:#0070c0">Conclusion</span></span></span></span></b><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:#0070c0">: </span></span></span></span><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black">Mindfulness-based art therapy, as a new intervention method which combines art therapy and psychotherapy, seems to decrease infertility stigma of infertile women and helps the individual to concentrate on the moment rather than the future so that it increases awareness about one’s body by improving self-supervision. Such intervention leads to a notable decrease in psychological symptoms and higher self-care. On the other hand, people feel less motivated to control their environment, following the unexpected diagnosis of infertility. And also, Mentalization-based treatment decrease infertility stigma of infertile women . It helps to make sense of our thoughts, beliefs, wishes and feelings and to link these to our actions and behaviours .Using MBAT and specially MBT, is recommended in large scale in the population of infertile women. Through learning coping skills in the face of stressful events, people learn to deal with such situations with self-confidence and optimistically.</span></span></span></span><span dir="RTL" lang="FA" style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="tab-stops:10.5pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:"Times New Roman",serif"><span style="color:black"></span></span></span></span></span></span></span></span></span></span></div>
ناباروری, انگ ناباروری ,هنردرمانی مبتنی برذهن آگاهی,درمان ذهنی سازی
Infertility, I,Nfertility stigma,Mindfulness-based art therapy,Mentalization-based treatment
62
73
http://rjms.iums.ac.ir/browse.php?a_code=A-10-6393-3&slc_lang=fa&sid=1
Neda
Izadi Firoozabadi
ندا
ایزدی فیروزآبادی
3900319475328460075949
3900319475328460075949
No
PhD Student of General Psychology, Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
دانشجوی دکتری روانشناسی عمومی، گروه روانشناسی، واحد شهرکرد، دانشگاه آزاد اسلامی، شهرکرد، ایران
Ahmad
Ghazanfari
احمد
غضنفری
Aghazan5@yahoo.com
3900319475328460075950
3900319475328460075950
Yes
Associate Professor, Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
دانشیار، گروه روانشناسی، واحد شهرکرد، دانشگاه آزاد اسلامی، شهرکرد، ایران
Shahram
Mashhadizadeh
شهرام
مشهدی زاده
Smzl@yahoo.com
3900319475328460075951
3900319475328460075951
No
Assistant Professor, Department of Basic Medical Sciences, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
استادیار، گروه علوم پایه پزشکی، واحد شهرکرد، دانشگاه آزاد اسلامی، شهرکرد، ایران
Tayebeh
Sharifi
طیبه
شریفی
3900319475328460075952
3900319475328460075952
No
Associate Professor, Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
دانشیار، گروه روانشناسی، واحد شهرکرد، دانشگاه آزاد اسلامی، شهرکرد، ایران