Razi Journal of Medical Sciences

fa مقایسه تاثیر تربیت روانی خانواده مبتنی بر مدل اتکینسون - کویا و تربیت روانی خانواده مبتنی بر توجه آگاهی بر هیجان ابراز شده مراقبان بیماران مبتلا به اسکیزوفرنیا Comparison of the effect of Family Psychoeducation Based on Atkinson - Coia's Model and Mindfulness-Based Family Psychoeducation on Expressed Emotion of Caregivers of Patients with Schizophrenia روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: اسکیزوفرنی یکی از ناتوان ‌کننده‌ترین اختلالات روانی و از شدیدترین بیماری‌های روانی و استرس‌زا برای بیمار و خانواده‌اش است هدف از انجام تحقیق حاضر مقایسه تاثیر تربیت روانی خانواده مبتنی بر مدل اتکینسون - کویا و تربیت روانی خانواده مبتنی بر توجه آگاهی بر هیجان ابراز شده مراقبان بیماران مبتلا به اسکیزوفرنیا بود. روش کار: برای انجام تحقیق نیمه آزمایشی حاضر از بین مراقبان اصلی بیماران مبتلا به اختلال اسکیزوفرنیا به صورت در دسترس 45 نفر انتخاب و به صورت تصادفی به سه گروه تربیت روانی خانواده مبتنی بر مدل اتکینسون - کویا، تربیت روانی خانواده مبتنی بر توجه آگاهی و کنترل تقسیم شدند. در ادامه و در سه مرحله قبل، بلافاصله بعد و پیگیری سه ماهه، تمام شرکت کنندگان  مقیاس سطح هیجان ابراز شده (LEE) را تکمیل کردند. همچنین گروه آزمایش اول طی 10 جلسه 90 دقیقهای هفتهای یک جلسه به مدت ده هفته به صورت گروهی تحت پروتکل تربیت روانی خانواده (مدل اتکینسون - کویا) قرار گرفت. گروه آزمایش دوم نیز طی هشت جلسه 90 دقیقهای هفتهای یک جلسه، به مدت دو ماه به صورت گروهی تحت درمان پروتکل تربیت روانی خانواده مبتنی بر توجه آگاهی بر اساس شناخت درمانی مبتنی بر توجه آگاهی کرین (2017) قرار گرفت. یافته ها: نتایج نشان داد بین اثربخشی دو نوع مداخله در کاهش میزان هیجان ابراز شده مراقبان خانوادگی بیماران مبتلا به اسکیزوفرنیا تفاوت معناداری وجود دارد. همچنین تربیت روانی خانواده مبتنی بر مدل اتکینسون–کویا در مقایسه با تربیت روانی خانواده مبتنی بر توجه‌آگاهی، تأثیر بیشتری در کاهش هیجان ابراز شده مراقبان خانوادگی بیماران مبتلا به اسکیزوفرنیا دارد. نتیجه گیری: با توجه به نتایج پژوهش، استفاده از هر دو مداخله برای کاهش هیجان ابرازشده مراقبان خانوادگی بیماران مبتلا به اسکیزوفرنیا توصیه می‌شود. با این حال، تربیت روانی خانواده مبتنی بر مدل اتکینسون–کویا نسبت به تربیت روانی خانواده مبتنی بر توجه‌آگاهی اثربخشی بیشتری نشان داد و می‌تواند به عنوان مداخله‌ای مؤثرتر در کاهش هیجان ابرازشده مراقبان مورد استفاده قرار گیرد.</div> <div style="text-align: justify;">Background & Aims: Schizophrenia, in fact, is one of the most debilitating mental disorders and one of the most severe and stressful mental illnesses for the patient and his family, during which the inevitable and heavy consequences of schizophrenia and its recurring nature and heavy costs have caused this disorder to be among the debilitating disorders. be placed (2). So that the consequences of emotional, social and financial life experienced by people with schizophrenia have significant effects on their families (6). Therefore, the higher the family pressure, the lower the mental health of other members. In this regard, researchers are looking to use different treatment methods to reduce the effects of mental burden on the caregivers of these patients, and in the meantime, different treatment methods have also been used. In the meantime, one of the models of family group education was invented by Anderson and its purpose is to raise awareness about the nature of the disease and the treatment of schizophrenia. These training can be done in groups or individually and include various methods that are used to increase social capabilities, self-reliance, practical skills and interpersonal relationships in patients with schizophrenia (9). Despite the documented effectiveness of both psychoeducational and mindfulness-based interventions, limited evidence is available regarding their comparative effectiveness in reducing expressed emotion among family caregivers of patients with schizophrenia. Therefore, the present study aimed to compare the effectiveness of family psychoeducation based on the Atkinson–Coia model and mindfulness-based family psychoeducation in reducing expressed emotion among family caregivers of patients with schizophrenia. Methods: This quasi-experimental study employed a pretest-posttest design with two experimental groups and one control group, including a three-month follow-up. The sample consisted of 45 primary caregivers of patients with schizophrenia who were undergoing treatment in Razi Medical Education Center (University of Social Welfare and Rehabilitation Sciences) in Tehran, Iran, in 2023. Participants were selected using a convenience sampling method based on inclusion criteria and were then randomly assigned into three groups of 15: family psychoeducation based on the Atkinson-Coia model, mindfulness-based family psychoeducation, and a control group. The caregivers' composition was as follows: 71% (n=32) were female and 29% (n=13) were male. Among the female caregivers, 56% were mothers, 38% were wives, and 6% were sisters. Among the male caregivers, 77% were fathers and 23% were brothers. The mean duration of caregiving was 12.8 years (range: 2 to 25 years), and all caregivers lived with the patient. It is noteworthy that all patients in this study were male. In the following and in the three stages before, immediately after and the three-month follow-up, all the subjects used the level of expressed emotion (LEE) scale, which is used to evaluate the level of expressed emotion of first-degree relatives (people who are considered important in the patient's life, such as father, mother, wife, sister, brother and others) completed the patient's questionnaire. Also, the first experimental group underwent the family psychological training protocol (Atkinson-Coia model) in 10 sessions of 90 minutes per week for two and a half months. The second experimental group also underwent eight 90-minute sessions once a week for two months as a group under the mindfulness-based family psychoeducation protocol based on Crane's  mindfulness-based cognitive therapy (18). . The control group did not receive any intervention. Finally, descriptive statistics, Shapiro-Wilk test and analysis of variance mixed with Bonferroni's repeated measures and post hoc using spss software version 24 were used to test the research hypotheses. Results: The results of analysis of variance with repeated measures showed that the main effects of time (p<0.001), group are significant (p<0.001) and the interaction of time and group on expressed emotion is significant (<0.001). p). The effect of time shows that there is a significant difference between pre-test, post-test, and follow-up. The effect size in the main effect of the group shows that 29% of the changes in the expressed emotion variable of the participants are due to the group membership. Also, the effect size in the time variable shows that 97% of the changes in the expressed emotion variable are caused by time changes. Also, the size of the interaction effect of time and group is 0.96, which shows that 96% of the changes in the variance of expressed emotion are caused by time changes in at least one of the two groups. The results of the LSD post hoc test showed that the difference between the family psychoeducation group based on the Atkinson- Coia model and the control group is significant (p<0.05). Also, the difference between the mindfulness-based family psychoeducation and the control group is significant (p<0.05). Also, there is a significant difference between the average of the family psychoeducation group based on the Atkinson–Coia model and the mindfulness-based family psychoeducation group (p=0.046). The results of the analysis of variance test with repeated measurements showed that there is a significant difference between the pre-test and post-test and pre-test and follow-up in the family psychoeducation group based on the Atkinson–Coia  model (p<0.001), but between the post-test and the follow-up There was no significant difference (p=0.685). There was a significant difference between pre-test and post-test and pre-test and follow-up in the group of mindfulness-based family psychoeducation group (p<0.001). Also, there was no significant difference between post-test and follow-up (p>0.05). Conclusion: The results showed that there is a significant difference between the effectiveness of two groups of family psychoeducation based on the Atkinson–Coia model and mindfulness-based family psychoeducation in reducing the level of expressed emotion by family caregivers of patients with schizophrenia, and family psychoeducation based on the Atkinson–Coia model had a greater effect on reducing expressed emotion among family caregivers than mindfulness-based family psychoeducation. In explaining this finding, it can be said that family caregivers feel less pressure after participating in training sessions due to increased awareness and information about schizophrenia disorder and also learning communication skills techniques with the patient, and as before without any reason. They do not blame the family member for causing the illness, which can lead to a decrease in the level of expressed emotion by the family caregivers of patients with schizophrenia. Many people with acute mental illnesses, including schizophrenia, live with their family members or are in direct contact with them (21). However, increasing the family's ability to manage the mental pressure caused by the child's illness can help to reduce the mental pressure caused by the disease. Various studies have shown that family therapeutic interventions reduce the rate of relapse and repeated hospitalizations of patients with schizophrenia. The importance of these interventions becomes more obvious when we know that 30 to 60% of these patients live with their families and a significant percentage of them continue their relationship with their family members (9). Therefore, although families with a member suffering from schizophrenia report the prevalence of health problems twice as much as the normal population, family psychoeducation can improve the general health of families and make them more compatible with their children's conditions. </div> تربیت روانی خانواده, مدل اتکینسون – کویا, توجه آگاهی, هیجان ابراز شده, مراقبان خانوادگی, اسکیزوفرنیا Family Psychoeducation, Atkinson - Coia's Model, Mindfulness, Expressed Emotion, Family Caregivers, Schizophrenia 1 10 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8194-1&slc_lang=fa&sid=1 Mokhtar Seyfi مختار سیفی 3900319475328460091395 0009-0009-7084-4763 No Department of Health & Clinical Psychology, Ka.C., Islamic Azad University, Karaj, Iran گروه روان شناسی سلامت و بالینی، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران Biouk Tajeri بیوک تاجری Biuk.tajeri@iau.ac.ir 3900319475328460091396 3900319475328460091396 Yes Department of Health & Clinical Psychology, Ka.C., Islamic Azad University, Karaj, Iran گروه روان شناسی سلامت و بالینی، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران Sheida Sodagar شیدا سوداگر 3900319475328460091397 3900319475328460091397 No Department of Health & Clinical Psychology, Ka.C., Islamic Azad University, Karaj, Iran گروه روان شناسی سلامت و بالینی، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران Malek Mirhashemi مالک میرهاشمی 3900319475328460091398 3900319475328460091398 No Department of Psychology, Ro.C., Islamic Azad University, Roudehen, Iran گروه روان شناسی، واحد رودهن، دانشگاه آزاد اسلامی، رودهن، ایران