Razi Journal of Medical Sciences

fa مقایسه اثربخشی درمان شناختی-رفتاری ودرمان ذهن‌آگاهی برنشخوارفکری منفی وخودکارآمدی اجتماعی درافراد مبتلابه اختلال اضطراب اجتماعی Comparison of the Efficacy of Cognitive-Behavioral Therapy and Mindfulness Therapy on Negative rumination and Social Sefl-efficacy in Social Anxiety Disorder Patients روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: پژوهش حاضر با هدف مقایسه تاثیر درمان شناختی رفتاری و درمان ذهن‌آگاهی بر نشخوار فکری منفی و خودکارآمدی اجتماعی در افراد مبتلا به اختلال اضطراب اجتماعی انجام پذیرفت. روش کار:روش پژوهش نیمه آزمایشی با طرح پیشآزمون، پسآزمون با گروه کنترل بود. جامعه آماری شامل تمامی مراجعه کنندگانی بود که در سال 1398 با علایم اختلال اضطراب اجتماعی به کلینیکهای روانشناختی شهر شیراز مراجعه کرده بودند. 45 نفر از افراد جامعه فوق بعد از سنجش با مقیاس اضطراب اجتماعی کانور و همکاران (2000) و مصاحبه بالینی براساس DSM-5 و نمره خط برش انتخاب شدند. از بین این 45 نفر، 3 گروه 15نفری بر حسب تصادف انتخاب، سپس 2 گروه مداخله و گروه کنترل نیز به تصادف نامگذاری گردید. برای اجرای مداخلات از پروتکل شناختی-رفتاری (هافمن و اوتو، 2008) و پروتکل پذیرش و ذهن‌آگاهی (فلمینگ و کوکووسکی، 2007) استفاده شد. دادهها از طریق مقیاس نشخوار فکری (نولن هوکسما و مارو، 1991)و مقیاس خودکارآمدی اجتماعی (اسمیت و بتز، 2000) جمع آوری گردید. پردازش داده‌های پژوهش بااستفاده ازآمار توصیفی واستنباطی (تحلیل کوواریانس)انجام شد. یافته‌ها:نتایج نشان داد گروههای مداخله درمان شناختی-رفتاری و درمان مبتنی بر ذهن‌آگاهی نسبت به گروه کنترل باعث کاهش معنادار نشخوار فکری منفی و افزایش خودکارآمدی اجتماعی شده‌اند؛ ولی تفاوت معناداری بین گروه‌های مداخله دیده نشد. نتیجه‌گیری: مقایسه دو رویکرد ذهن‌آگاهی و شناختی-رفتاری حاکی از عدم تفاوت معناداری در کاهش معنادار نشخوار فکری منفی و افزایش خودکارآمدی اجتماعی در مبتلایان به اضطراب اجتماعی بود؛ لذا پیشنهاد می‌گردد از این دو روش تلفیقی برای بهبود نشخوار فکری منفی و خودکارآمدی اجتماعی استفاده شود.  </div> <div style="text-align: justify;">Background & Aims: In social anxiety disorder, a person is afraid of the possible scrutiny of others and is worried about doing something that may cause him embarrassment or humiliation (1). One of the important psychological constructs related to social anxiety disorder is rumination (6 and 7). Some results also indicate the indirect effects of rumination on social anxiety (8). Rumination is a maladaptive way to deal with negative emotions that people focus on their negative self-referential thoughts and repeat them in their mind instead of more adaptive processing of their emotions. Rumination and worry are the central core of the cognitive processes of many psychological and functional injuries in people (9). In addition to rumination, another psychological construct related to social anxiety is social self-efficacy (11). Social self-efficacy is based on the concept of self-efficacy in Albert Bandura's theory of social cognitive learning, and it expresses people's estimation of their ability to establish and maintain interpersonal relationships (13). The widespread prevalence of social anxiety, along with the disabilities and problems arising from it and the psychological, emotional and economic costs it imposes on the individual and the society, shows the necessity of addressing the explanatory models and treatment methods of this disorder. Among the treatments that are widely used in the field of reducing negative emotions in people with social anxiety disorder is cognitive behavioral therapy (16 and 17). This treatment reduces physiological arousal in social situations, using Cognitive restructuring, reforming the information processing system and reducing negative thoughts about oneself, tries to reduce negative cognitive components (18). Among the various treatments that were examined, the findings of various researches have considered mindfulness therapy as a useful intervention in people with social anxiety. Correlation results also show that increasing mindfulness is related to reducing social anxiety symptoms and better performance (21). Mindfulness-based treatments aim to reduce negative reactions to cognitive, social, and physical processes, through training the two skills of awareness and acceptance (22). The main emphasis of this treatment is targeted attention, moment by moment and non-judgmental. People are trained to be aware of their thoughts, emotions and physical sensations without any kind of judgment and to accept them (23). In this research, an attempt has been made to compare the effectiveness of cognitive-behavioral therapy and mindfulness therapy on negative rumination and social self-efficacy in people with social anxiety disorder. Methods: The research method was quasi-experimental with pre-test, post-test design, and control group. The research population included all applicants who referred to psychiatric clinics in Shiraz in 2018 with the signs of social anxiety disorder. selected from the aforementioned community based on the cut-off score after being measured with the clinical interview based on DSM_5 and social anxiety scale (Connor et al., 2000). Then, three groups of 15 people were randomly selected, and then two intervention groups (cognitive-behavioral therapy and mindfulness therapy) and a control group were randomly named. The tools of this study include the social anxiety scale of Connor et al., SPIN, the rumination scale of Hoeksma and Maro (1991): the social self-efficacy scale of Smith and Betz (2000). Cognitive behavioral therapy based on the model of Hoffman and Otto (2008) was used for cognitive behavioral therapy training, which included 12 2-hour group training sessions and 2 individual training sessions for each client in order to adjust the treatment according to the needs and conditions of each client. For the training of mindfulness therapy, the group therapy protocol based on acceptance and mindfulness of Fleming and Kukowski (2000) was used, which included 12 2-hour group training sessions and 2 individual training sessions for each client in order to adjust the treatment according to the needs and conditions of each client. In order to test the data, multivariate covariance analysis and Benferoni's post hoc test were used. Results: The results showed that the intervention groups of cognitive-behavioral therapy and mindfulness-based therapy significantly reduced negative rumination and increased social self-efficacy compared to the control group; It also shows that cognitive behavioral therapy and mindfulness did not have different effectiveness in the components of symptom-oriented rumination and antecedent-consequence-oriented rumination. However, in the field of rumination and social self-efficacy, mindfulness therapy has been more effective compared to cognitive-behavioral therapy. Conclusion: Considering that mindfulness as a lifestyle, consistent with human nature, has the ability to influence people's emotional system, i.e. their thoughts, physical sensations, raw emotions and action impulses, change people's outlook on life and the quality of their relationship with themselves. , others and the world, with compassionate and realistic acceptance. With the help of mindfulness techniques, people learn to observe without judgment and criticism, along with compassion towards themselves and others; By observing stressful and sad thoughts and emotions, they learn to identify negative thought patterns before they become a vicious cycle. Thus, in the long term, mindfulness creates many changes in people's mood and level of happiness and health. It seems that mindfulness techniques improve social self-efficacy. Mindfulness helps people make informed decisions and communicate effectively by increasing psychosocial and interpersonal skills; Develop coping skills and personal management and have a healthy and fruitful life.  </div> درمان شناختی رفتاری, درمان ذهن‌آگاهی, نشخوارفکری منفی, خودکارآمدی اجتماعی, اختلال اضطراب اجتماعی Cognitive-Behavioral Therapy, Mindfulness Therapy, Rumination, Social Sefl-Efficacy, Social Anxiety Disorder 1 12 http://rjms.iums.ac.ir/browse.php?a_code=A-10-6814-1&slc_lang=fa&sid=1 Leila Mirzaei لیلا میرزائی 3900319475328460080543 3900319475328460080543 No PhD Student, Department of Psychology , Marvdasht Branch, Islamic Azad University, Marvdasht, Iran دانشجوی دکتری، گروه روانشناسی، واحد مرودشت، دانشگاه آزاد اسلامی، مرودشت، ایران Hossein Baghooli حسین بقولی bhossein@gmail.com 3900319475328460080544 3900319475328460080544 Yes Assistant Professor, Department of Psychology , Marvdasht Branch, Islamic Azad University, Marvdasht, Iran استادیار، گروه روانشناسی، واحد مرودشت، دانشگاه آزاد اسلامی، مرودشت، ایران Hojatollah Javidi حجت‌اله جاویدی 3900319475328460080545 3900319475328460080545 No Assistant Professor, Department of Psychology, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran استادیار، گروه روانشناسی، واحد مرودشت، دانشگاه آزاد اسلامی، مرودشت، ایران Majid Barzegar مجید برزگر 3900319475328460080546 3900319475328460080546 No Assistant Professor, Department of Psychology, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran استادیار، گروه روانشناسی، واحد مرودشت، دانشگاه آزاد اسلامی، مرودشت، ایران