Razi Journal of Medical Sciences

fa اثربخشی روان‌درمانی پویشی بر افکار خودکشی و عملکرد شناختی در بیماران مبتلا به شخصیت مرزی Effectiveness of Dynamic Psychotherapy on Suicidal Thoughts and Cognitive Functioning in Patients with Borderline Personality Disorder روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: اختلالات شخصیت از اهمیت ویژهای برخوردار است و تشخیص این اختلال از چالش برانگیزترین اختلالات شخصیت است و درمان پویشی میتواند نقش مؤثری در بهبود علائم روانشناختی داشته باشد؛ لذا پژوهش حاضر با هدف تعیین اثربخشی درمانپویشی بر افکار خودکشی، عملکرد شناختی در بیماران مبتلا به شخصیت مرزی انجام شد. روش کار: این مطالعه به روش نیمهتجربی با طرح پیش‌آزمون، پس‌آزمون و پیگیری دو‌ماهه با گروه کنترل بود. جامعه مورد نظر تمامی بیماران مبتلا به شخصیت مرزی مراجعهکننده به کلینیک تخصصی روانشناسی شهر تهران در سال 1403 بود. حجم نمونه مورد بررسی با مراجعه به جدول Cohen تعیین شد. به این طریق که در سطح اطمینان 95 درصد، اندازه اثر 30/0 و توان آماری 83/0، برای هر گروه 12 نفر تعیین شد. اما از آنجایی که احتمال ریزش برخی نمونهها وجود داشت و همچنین در جهت تعمیم‌پذیری بیشتر نتایج، حجم نمونه در هر گروه 15 نفر تعیین شد. در مرحله اول به شیوه نمونهگیری در دسترس 30 نفر انتخاب و این 30 نفر در گام دوم به صورت تصادفی ساده (به شیوه قرعه کشی) در یک گروه آزمایش (15 نفر) و یک گروه کنترل (15 نفر) جایگزین شدند. یافته‌ها: میانگین و انحراف معیار سنی گروه آزمایش و کنترل به ترتیب 92/3 ± 40/43 و 49/4 ± 07/44 سال بود (669/0=P). نتایج آزمون t دو نمونه مستقل در مورد سن و آزمون دقیق فیشر در خصوص جنسیت، سطح تحصیلات و وضعیت تأهل نشان داد که بین گروه آزمایش و کنترل تفاوت آماری معنیداری وجود ندارد (05/0<P).میانگین نمرات عملکرد شناختی و افکار خودکشی  قبل از مداخله به ترتیب در گروه درمان 25/72، 08/24 و در گروه کنترل 12/72، 52/23 بود (05/0p<)، اما پس از مداخله، میانگین نمرات افکار خودکشی کاهش  و عملکرد شناختی در گروه درمان به صورت معنی داری نسبت به گروه کنترل افزایش نشان داد (01/0p<). نتیجه‌گیری: نتایج مطالعه حاضر بیانگر آن بود که استفاده از درمانپویشی فشرده و کوتاه‌مدت بر روانپویشی فشرده و کوتاه مدت بر عملکرد شناختی و افکار خودکشی در زنان مبتلا به شخصیتمرزی مؤثر است. </div> <div style="text-align: justify;">Background & Aims: Borderline personality disorder (BPD) is a complex mental health issue that holds significant importance compared to other personality disorders. Diagnosing this condition is one of the most challenging tasks in mental health, and dynamic therapy can play a crucial role in improving psychological symptoms. In particular, cognitive dysfunction is increasingly recognized as a common factor in borderline personality disorder, and impairments in attention, working and episodic memories, processing speed, and executive function were observed. These cognitive defects are the main cause of the deterioration of mental performance and psycho-social adaptations such as job performance, interpersonal relationships, and life satisfaction. In addition, it is known that this disorder continues even between mood episodes and is associated with a worse prognosis. The first step in the formation of suicidal behavior in a person is the emergence of suicidal thoughts, which may arise in a critical situation and the person commits suicide. During the student period, people experience much academic stress and pressure. They have to make important decisions about their life goals and future careers, and they experience the feeling of loneliness caused by being away from their families. This study aimed to assess the effectiveness of dynamic therapy in reducing suicidal thoughts and enhancing cognitive functioning in patients with BPD. Methods: This quasi-experimental study utilized a pretest-posttest design with a two-month follow-up and a control group. The population included all patients with BPD referred to a specialized psychology clinic in Tehran in 2024. The sample size was determined using Cohen's table, with a confidence level of 95%, an effect size of 0.30, and a statistical power of 0.83, resulting in 12 participants per group. To account for potential dropouts and improve generalizability, the sample size was increased to 15 participants per group. In the first stage, 30 participants were selected through convenience sampling. In the second stage, they were randomly assigned (via simple lottery) to an experimental group (15 participants) and a control group (15 participants). Results: In explaining the effect of intensive and short-term dynamic therapy intervention on the reduction of cognitive function in people with borderline personality, according to the theoretical point of view, it can be stated that in this treatment, due to the person's exposure to unwanted emotions, his anxiety increases at first, which It can, in turn, increase the symptoms, but after a few sessions when the emotions are released and processed and controlled and the mood or emotional symptoms decrease. The active position of the therapist and the correct application of techniques in this position make the patient or client identify the depth of their feelings and thoughts in the shortest time. In the process of psychodynamic therapy, by acquiring the ability to experience deep emotions and express them, a person can regulate cognitive and arousal processes by reducing inhibitions and establishing a real understanding of himself and his capabilities and coping skills. It also improves interpersonal relationships and in this way provides the context for appropriate emotional interaction and increases emotional expression. During therapy sessions, when the unconscious is opened and emotions are released, the emotions deposited in the person are significantly reduced, and by adjusting the anxiety, defense styles are developed and the emotional regulation of the person is experienced more virtually, and the person can better understand positive emotions. In the process of treatment, people become aware of the physical symptoms of their anxiety and can identify their emotions in different situations and learn how to experience, express, and control them, and thus this Difficulty in dyslexia is reduced in these people. Such encounters lead to the reorganization of the self and the abandonment of pathological defenses, increase a person's mental capacity, and ultimately improve his mental health. In psychodynamic therapy, when clients gain insight into the internal conflicts of the conflict triangle and become aware of how these conflicts are repeated in the person's triangle, they do not hide their emotions behind defenses, it leads them to moderation and emotional self-regulation. Of course, it causes the mental growth of the person. The mean age and standard deviation of the experimental and control groups were 43.40 ± 3.92 and 44.07 ± 4.49 years, respectively (P = 0.669). Independent t-tests for age and Fisher's exact tests for gender, education level, and marital status showed no significant statistical differences between the groups (P > 0.05). Before the intervention, the mean scores for cognitive functioning and suicidal thoughts were 72.25 and 24.08 in the treatment group, and 72.12 and 23.52 in the control group, respectively (P < 0.05). After the intervention, the treatment group showed a significant reduction in suicidal thoughts and an improvement in cognitive functioning compared to the control group (P < 0.01). Conclusion: The findings suggest that short-term intensive dynamic therapy effectively enhances cognitive functioning and reduces suicidal thoughts in women with BPD. It is recommended that this therapeutic approach be used to improve cognitive functioning and reduce suicidal thoughts in individuals with BPD. Additionally, it can be incorporated alongside other therapeutic methods in psychophysiological and psychological clinics.</div> درمان پویشی فشرده و کوتاه مدت, افکار خودکشی, شخصیت مرزی, عملکرد شناختی Short-Term Intensive Dynamic Therapy, Suicidal Thoughts, Borderline Personality Disorder, Cognitive Functioning 1 11 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8437-1&slc_lang=fa&sid=1 Mohammad Feizabadi محمد فیض آبادی 3900319475328460090060 3900319475328460090060 No Master’s degree, Department of Psychology, Semnan University, Semnan, Iran کارشناسی ارشد، گروه روانشناسی، دانشگاه سمنان، سمنان، ایران. Hossein Gandomkar حسین گندمکار 3900319475328460090061 3900319475328460090061 No Specialist in General Surgery, Department Surgical Oncology, Tehran University of Medical Medicine, Tehran, Iran. متخصص جراحی عمومی، گروه جراحی عمومی، دپارتمان جراحی سرطان، دانشگاه تهران، تهران، ایران Pooya Samian پویا سمعیان 3900319475328460090062 3900319475328460090062 No Master’s degree, Department of Curriculum Planning, Shahid Madani University of Tabriz, Tabriz, Iran کارشناسی ارشد، گروه برنامه ریزی درسی، دانشگاه شهید مدنی تبریز، تبریز، ایران Reza Bidian Soula رضا بیدیان سولا 3900319475328460090063 0009-0001-2224-2671 No Master’s degree, Department of Curriculum Planning, Ardabil Branch, Islamic Azad University, Ardabil, Iran. کارشناسی ارشد، گروه برنامه ریزی درسی، واحد اردبیل، دانشگاه ازاد اسلامی، اردبیل Sareh Sadat Ahmadi ساره سادات احمدی Saraahmadi.psy.ir@gmail.com 3900319475328460090064 3900319475328460090064 Yes Master’s degree, Department of Psychology, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran. کارشناسی ارشد، گروه روانشناسی، واحد نیشابور، دانشگاه آزاد اسلامی، نیشابور، ایران Soheil Jafari سهیل جعفری 3900319475328460090065 3900319475328460090065 No Master’s degree, Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran. کارشناسی ارشد، گروه روانشناسی، واحد اهواز، دانشگاه آزاد اسلامی، اهواز، ایران.