Razi Journal of Medical Sciences

fa تقویت سبک‌های مقابله‌ای و کاهش هیجانات منفی در بیماران قلبی از طریق شناخت درمانی مبتنی بر بهبودی Enhancing Coping Styles and Alleviating Negative Emotions in Cardiac Patients through Recovery-Oriented Cognitive Therapy روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: در تلاش برای بهزیستی روان‌شناختی بیماران قلبی که جز بیماری‌های اثرگذار بر وضعیت روانشناختی و جسمانی افراد است، این مطالعه به بررسی تأثیر شناخت درمانی مبتنی بر بهبودی (CT-R- Recovery-oriented cognitive therapy) بر سبک‌های مقابله‌ای و هیجان‌های منفی می‌پردازد. روش کار: این پژوهش از نوع نیمه آزمایشی بوده و نمونه‌گیری در مرحله‌ی اول به صورت در دسترس و در مرحله‌ی جایگذاری از تصادفی ساده استفاده شده که در آن 24 بیمار قلبی در گروه آزمایشی و 30 بیمار در گروه کنترل قرار داشتند. مداخله در هشت جلسه به صورت دو جلسه در هفته اجرا شد. از پرسش نامه های DASS-21 برای سنجش افسردگی-اضطراب-استرس و سبک های مقابله ای پارکر و اندلر برای سنجش سبک های مقابله ای بیماران استفاده شد. یافته‌ها: <a name="_Hlk163751944">یافته‌های این مطالعه که براساس تحلیل واریانس با اندازه گیری های مکرر انجام شده است، نشان می‌دهد که  </a> CT-R تأثیر مثبت قابل‌توجهی بر بهبود سبک‌های مقابله‌ای در بیماران قلبی دارد (001/0P=) و آن  ها را قادر می‌سازد تا عوامل استرس‌زا و نگرانی‌های مربوط به وضعیت خود را بهتر بررسی کنند. تفاوت معناداری میان دو گروه آزمایشی و کنترل در سبک‌های مقابله‌ای پس از مداخله مشاهده شد. علاوه بر این، این درمان به کاهش قابل توجه هیجانات منفی مانند استرس و افسردگی کمک می‌کند (001/0P=) و بهزیستی روانی کلی بیماران را بیشتر می‌کند. گروه آزمایشی و کنترل در پیگیری سه و شش ماهه تفاوت معناداری در تجربه هیجانات منفی نشان دادند. نتیجه‌گیری: شناخت درمانی مبتنی بر بهبودی می‌تواند بر کاهش هیجانات منفی و اصلاح سبک مقابله‌ای اثرگذار باشد و در نتیجه اطلاعات مفیدی به مراقبین سلامت ارائه داده و به آن‌ها در پیشبرد اهداف درمانی بیماران قلبی یاری رساند. </div> <div style="text-align: justify;">& Aims: The psychological health of people with cardiovascular disorders is profoundly impacted, frequently resulting in elevated stress levels and unpleasant emotional experiences (15). Promoting improved outcomes and overall coping patterns in cardiac patients requires improving coping mechanisms and reducing negative feelings (6,8). Applying Recovery-oriented cognitive therapy(CT-R) in this situation has been identified as a promising strategy to deal with these difficulties. CT-R is a therapeutic approach that places an emphasis on the patient's capacity for recovery and places a strong emphasis on improving cognitive and emotional capabilities (24, 25, 26). Patients can develop a more robust and adaptable thinking by learning to challenge and reframe unhelpful beliefs using various strategies, such as cognitive restructuring. The therapy seeks to provide patients with useful coping mechanisms that might be helpful in managing the difficulties related to their life by helping them to adopt a more optimistic and constructive viewpoint. Additionally, in order for patients to properly detect and control their emotions, the therapeutic process also entails encouraging self-awareness and emotional regulation (24, 25) . This factor is especially important when it comes to cardiac patients because elevated negative emotions, such worry and despair, can increase the physical symptoms and perhaps impede the healing process. CT-R helps patients to build emotional resilience through individualized interventions and support, encouraging a sense of control and well-being even in the face of health-related problems (27, 26). Methods: The goal of this semi-experimental study is to evaluate the efficacy of CT-R in treating cardiac patients. The study used a repeated control and measurement group, as well as a pre-test-post-test strategy. Quantitative data was acquired for the information. Cardiovascular patients who sought cardiac rehabilitation at the Tehran Heart Center hospital in 2022–2023 were included in this study. A convenience selection of 54 patients from the Cardiac Rehabilitation Unit who were qualified to take part in the study was selected, and a straightforward random sampling approach was employed to divide them into experimental (24 participants) and control (30 participants) groups. The sample size was between 15 and 30 in accordance with the standards of experimental research (28). The hospital gave a list of the neighborhood that was the focus of the study after discussing the start time and how cardiovascular patients participated in the treatment sessions with the staff. The next stage began with obtaining consent to participate in therapy, pre-planned interventions, and therapeutic procedures. Prior to the start of the therapy session, patients in both groups were given the questionnaires to complete. Two weekly sessions of intervention lasting an hour and a half each were provided to the experimental group. Following the implementation of the intervention, patients underwent a second evaluation utilizing the questionnaires. Following the intervention, patients were reassessed using questionnaires as part of the assessment procedure during follow-up examinations held at three and six months. 1. The Andler and Parker Coping Style Questionnaire is a psychometric tool created by psychologists Andler and Parker to evaluate how individuals cope with stress, challenges, and adverse life events. It aims to provide understanding of individuals' typical responses to various stressors and difficulties they face. This questionnaire comprehensively assesses coping strategies, including problem-solving coping, emotion-focused coping, and avoidant coping. This revised questionnaire includes 48 items that are scored based on the Likert scoring system. Each item is scored from 1 (never) to 5 (very much) (endler, parker, 1990). 2. The DASS-21 is a well-known self-report questionnaire that evaluates the severity of common emotional symptoms like depression, anxiety, and stress. It provides valuable insights into an individual's emotional state in the previous week. The DASS-21 is a shorter version of the original DASS, designed by researchers to efficiently and accurately assess these psychological constructs. The questionnaire consists of 21 items, with each subscale containing seven items that specifically measure symptoms of depression, anxiety, and stress. Participants are required to rate the extent to which they have experienced each symptom over the past week using a four-point Likert scale, ranging from "Did not apply to me at all" to "Applied to me very much, or most of the time"(loviband, loviband, 1996). Results: To check the normality of the distribution of research variables, we used the Kalmogorov Smirnov test that was greater than 0.05 for variables. Therefore, we used parametric testing to assess the study hypotheses. Box test was used to test the hypothesis of homogeneity of variance-covariance matrices that the results showed that the significance level of the box test is not significant at the 0.05 level. Levine's test was used to check the equality of variance of the groups. Mochli's sphericity test was used to check the equality of covariance assumption. The chi-square value obtained in this test was not significant and therefore the assumption of equality of covariance was confirmed. the results showed that the time variable significantly affects the coping styles and negative emotions at all four levels (pre-test, post-test, follow-up test 1, and follow-up test 2). This shows that there are substantial differences between the scores of cardiac patients at each of these four time points. The findings also demonstrate a significant interaction between time and group in coping styles, and negative emotions that demonstrating the importance of the link between time and group. In conclusion, CT-R significantly increased the coping styles and life expectancy in cardiac patients. Additionally, coping styles and life expectancy the impact of the group (experimental and control) is also significant that demonstrating a significant gap in two groups. Conclusion: In summary, the introduction of CT-R is a major step forward in enhancing the coping mechanisms and emotional state of cardiac patients. This therapeutic approach helps individuals with cardiovascular conditions by promoting adaptive cognitive and emotional reactions, ultimately leading to a holistic recovery and better quality of life. CT-R can included in the treatment plan for cardiac patients in order to supplement traditional medical therapies and address the psychological effects of the disease. This therapy contributes to a comprehensive care strategy that recognizes the interdependence of physical and mental health by encouraging a proactive approach to emotional well-being. </div> بیماری‌های قلبی, هیجانات منفی, سبک‌های مقابله‌ای, شناخت درمانی مبتنی بر بهبودی, بهزیستی روانی Cardiovascular Disease, Negative Emotions, Coping Styles, Recovery-Oriented Cognitive Therapy, Psychological Well-Being 1 12 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7825-1&slc_lang=fa&sid=1 Somayeh Naghavi سمیه نقوی 3900319475328460089990 3900319475328460089990 No PhD Student, Department of Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran دانشجوی دکتری روانشناسی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران Fariborz Dortaj فریبرز درتاج f_dortaj@yahoo.com 3900319475328460089991 3900319475328460089991 Yes Professor, Department of Educational Psychology, University of Allameh Tabataba’i, Tehran, Iran استاد، گروه روانشناسی تربیتی، دانشکده روانشناسی، دانشگاه علامه طباطبائی، تهران، ایران Fatemeh Ghaemi فاطمه قائمی 3900319475328460089992 3900319475328460089992 No Associate Professor, Ministry of Health, Treatment and Medical Education, Tehran, Iran دانشیار وزارت بهداشت، درمان و آموزش پزشکی، تهران، ایران Mojtaba Salarifar مجتبی سالاری فر 3900319475328460089993 3900319475328460089993 No Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran university of Medical Sciences, Tehran, Iran مرکز قلب تهران، پژوهشکده بیماری‌های قلب و عروق، دانشگاه علوم پزشکی تهران، تهران، ایران