Razi Journal of Medical Sciences

fa مطالعه تجریه زیسته شناختی در افراد مبتلا به اختلال وسواسی- اجباری؛ یک پژوهش کیفی با تاکید بر جنسیت Study of Biocognitive Experience in People with Obsessive-Compulsive Disorder; A Qualitative Research with an Emphasis on Gender روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: اگرچه مطالعات کمی فراوانی ویژگی‌های بالینی و روش‌های درمان اختلال وسواس را بررسی نموند، ولی تحقیقات کیفی که تجربه زیسته افراد مبتلا به این اختلال بویژه در ابعاد شناختی را مطالعه نماید؛ محدود است. لذا هدف این مطالعه مطالعه تجریه زیسته شناختی در افراد مبتلا به اختلال وسواسی- اجباری؛ یک پژوهش  کیفی با تاکید بر جنسیت بود. روش کار: روش مطالعه پژوهش کیفی و از نوع پدیدار شناسی به روش تحلیل مضمون بود. جامعه آماری شامل کلیه افراد مراجعه کننده به کلینیک‌ها و مراکز مشاوره شهر رفسنجان بود که بصورت هدفمند و بر اساس مصاحبه نیمه ساختاریافته تشخیصی DSM-5 مبتلا به OCD تشخیص داده شد به پژوهش دعوت و با روش پژوهش پدیدارشناسی توصیفی به این سؤال پاسخ دادند که اهمّ عناصر و مولفههای شناختی در تجارب زیسته شان کدامند. لذا، از بین مراجعین تا حد رسیدن به اشباع اطلاعات، 12 فرد با تشخیص اختلال مصاحبه شدند. تجزیه و تحلیل داده ها پس از ضبط و بازنویسی مصاحبه ها، مفاهیم کدگذاری با استفاده از روش کلایزی مضامین اصلی و فرعی استخراج و گزارش گردید. یافته‌ها: آنچه از کدهای استخراجی حاصل از مصاحبه مشخص شد تجربه زیسته شناختی در افراد مبتلا به اختلال وسواسی اجباری بوده که مبتنی بر 6 مضمون اصلی و 54 مضمون فرعی بود. مضامین اصلی در قالب پیامدهای فردی، اجتماعی، اقتصادی، فرهنگی، احساسی و اجرایی به دست آمد. همچنین مضامین فرعی مستخرج از این مضامین اصلی بر پایه تجارب زیسته شناختی افراد مشتمل بر  عدم کارایی ذهنی و کار کشیدن افراطی از ذهن، مسئولیت پذیری افراطی، پیروی سختگیرانه قواعد، کمال‌گرایی تحصیلی، اجبار برای انجام مکرر کارها، حساس دل‌شوره و اضطراب، حس اذیت شدن هنگام انجام ندادن کارها، تنفر از افراد به صورت افراطی، حس بی اعتمادی، احساس تنهایی، کنترل فکر و ... بود. نتیجه‌گیری: نتایج مطالعه حاضر ضمن استخراج و تبیین تجارب زیسته با مبنای فرایندهای شناختی در افراد دارای اختلال OCD، شواهدی تکمیلی در دفاع از نقش تفسیری عنصر اطلاعاتی شناخت، در پیشبینی گرایش به این اختلال را فراهم نمود. به نحوی که با بهبود فرایندها و مولفه های شناختی افراد مبتلا به اختلال OCD گرایش این افراد را به لحاظ شناختی بسوی انواع وسواس ها می¬توان مدیریت نمود. از اینرو درمانگران و متخصصان این حوزه ضرورت دارد به این تجارب زیسته در ابعاد شناختی توجه و در جهت تعیین راهبردهای درمانی خود به ویژه در زنان دارای این اختلال به کار گیرند.  </div> <div style="text-align: justify;"> Background & Aims: Obsessive-compulsive disorder according to the DSM-5 concept has a separate category that includes repeated and permanent thoughts, desires, or mental images. This disorder forces a person to repeat behaviors or repeated mental actions in response to a session, which causes helplessness and disrupts his daily performance. ObObsessive-compulsive disorder is considered a cognitive processing disorder; In such a way that any type of cognitive belief is significantly and positively related to obsessive-compulsive symptoms. Due to the correlation of cognitive models in obsessive-compulsive disorder, researchers identified three different levels in the cognitive models of obsessive-compulsive disorder and named them under the headings of disturbing thoughts, evaluations, and assumptions. These levels of cognition and meaning-making are in linear interaction with each other and influence each other. InCognitiveimensions, in general, and areas of certain beliefs, in particular, can be considered cognitive characteristics of obsessive-compulsive disorder patients. The cognitive model in this disorder believes that people with OCD interpret their thoughts, images, and impulses as very important and meaningful, and ineffective beliefs are the basis for the formation of these thoughts, images, and impulses. It seems that certain dysfunctional beliefs such as control and importance of thoughts, sense of responsibility and evaluation, sense of danger and threat, perfectionism, and uncertainty play a role in the formation of this disorder. In such a way that the primary ineffective evaluation in connection with the disturbing thoughts and the type of look and analysis of the person's disturbing thoughts leads to the secondary ineffective evaluation or ineffective coping. McFall and Wollersheim (1979) identified the cognitive dimensions of obsession in the area of individual capability and ability, certainty and certainty, and the need to avoid criticism, and on the other hand, Warren and Guides (1979) identified obsessive patients in terms of the intensity of their beliefs in the field of perfectionism. They know certainty and non-acceptance of certain types of thoughts and impulses. All these beliefs are formed in response to and in response to disturbing thoughts and increasing excessive attention to disturbing thoughts; In a way that in a comprehensive review and according to the view of the Obsessive-Compulsive Cognitions Working Group, there are three dysfunctional cognitive aspects in Obsessive-Compulsive Disorder, which include: responsibility/threat overestimation, importance and control of thoughts, and perfectionism/certainty. The cognitive belief of responsibility/threat assessment includes the misunderstanding of the probability and severity of harm or other negative consequences, as well as the individual's sense of responsibility against their occurrence. According to the cognitive belief about the importance and control of thoughts, people suffering from obsessions have the experience that having obsessive thoughts is a sign of their importance and control of these thoughts is possible and necessary. Responsibility is one of the basic components in the cognitive profile of the experiences of obsessive-compulsive people, which of course has been emphasized in the research literature, in a way that Taylor and Purdon proposed in a study that with increasing responsibility The adaptability of the person becomes self-perpetuating. On the other hand, it seems that people suffering from obsessions focus on their sense of certainty and do not have confidence in their memory, so patients with this symptom have an extreme sense of responsibility and suffer from a very disgusting and unbearable doubt. Therefore, they perform ritual behaviors compulsorily to gain certainty and reduce the sense of responsibility for the damage. Obsessive compulsive disorder is a very common and chronic disease associated with significant global disability. While there are many quantitative studies that examine the clinical characteristics and treatment methods of OCD, qualitative research that examines the lived experience of people with OCD is limited. Therefore, the purpose of this study is to study the cognitive experience in people with obsessive-compulsive disorder; It was a qualitative research with an emphasis on gender. Methods: The study method was a qualitative and phenomenological research. The statistical population of the research included all people referring to the clinics and counseling centers of Rafsanjan city. By using the purposeful sampling method, the referring people who were diagnosed with obsessive-compulsive disorder based on clinical psychology interview, psychiatrist and DSM-5 diagnostic semi-structured clinical interview, were invited to the research as participants, using the descriptive phenomenological research method. Answer the question of what are the most important cognitive elements and components in their lived experiences. For this purpose, 12 people (6 men and 6 women) diagnosed with OCD disorder and aged 18-50 were interviewed from among the clients referred to the centers until the saturation of information was reached. Data analysis After recording and transcribing the interviews, coding concepts were extracted and reported using the Claysey method of main and secondary themes. Results: What was determined from the extracted codes from the interview was the biocognitive experience in people with obsessive-compulsive disorder, which was based on 6 main themes and 54 sub-themes. The main themes were obtained in the form of individual, social, economic, cultural, emotional and operational consequences. Also, sub-themes extracted from these main themes based on the biological experiences of people, including lack of mental efficiency and extreme work of the mind, extreme responsibility, strict adherence to rules, academic perfectionism, compulsion to do tasks repeatedly, giving additional explanations in all tasks, He was sensitive to heartache and anxiety, the feeling of being annoyed when not doing things, extreme hatred of people, feeling of distrust, feeling of loneliness, control of thoughts, etc. On the one hand, according to gender segregation in the presented lived experiences, it was found that women had more frequency and intensity than men in the main and secondary themes presented. Conclusion: The results of the present study, while extracting and explaining lived experiences based on cognitive processes in people with OCD disorder, provided additional evidence in defense of the interpretative role of the informational element of cognition in predicting the tendency to this disorder. In such a way that by improving the cognitive processes and components of people with OCD disorder, the cognitive tendency of these people towards all kinds of obsessions can be managed. Therefore, obsessions continue as long as these misinterpretations and cognitive deviations exist. In fact, the cognitive interpretation of people with OCD is such that those thoughts form the basis of the tendency to perform compulsive actions in order to neutralize the anxiety caused by these thoughts and cognitive processes. Therefore, it is necessary for therapists and specialists in this field to pay attention to these lived experiences in cognitive dimensions and to determine their treatment strategies, especially for women with this disorder. </div> اختلال وسواسی اجباری, تجربه زیسته, شناخت, پدیدار شناسی, جنسیت Obsessive-Compulsive Disorder, Lived Experience, Cognition, Phenomenology 335 345 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7934-1&slc_lang=fa&sid=1 Mojtaba Farzadi مجتبی فرزادی 3900319475328460082205 3900319475328460082205 No MA in General Psychology, Department of Psychology, Rafsanjan Branch, Islamic Azad University, Rafsanjan, Iran. کارشناسی ارشد روانشناسی عمومی، گروه روانشناسی، واحد رفسنجان، دانشگاه آزاد اسلامی، رفسنجان، ایران. Fatemeh Akhlaghi Yazdinejad فاطمه اخلاقی یزدی نژاد f.akhlaghi@iaurafsanjan.ac.ir 3900319475328460082206 3900319475328460082206 Yes PhD in Clinical Psychology, Department of Psychology, Rafsanjan Branch, Islamic Azad University, Rafsanjan, Iran, دکترای تخصصی روانشناسی بالینی، گروه روانشناسی، واحد رفسنجان، دانشگاه آزاد اسلامی، رفسنجان، ایران