Razi Journal of Medical Sciences

fa اثربخشی درمان شناختی- رفتاری بر انعطاف پذیری روانشناختی و اضطراب سلامت در بیماران مبتلا به استرس پس از سانحه The Effectiveness of Cognitive-Behavioral Therapy on Psychological Flexibility and Health Anxiety in Patients with Post-Traumatic Stress Disorder روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: PTSD  از جمله اختلالات مزمن و ناتوان‌کننده روانپزشکی است که براساس پنجمین راهنمای آماری و تشخیصی اختلالات روانی جزء مجموعه تشخیصی اختلالات وابسته به استرس است که می‌تواند پس از مواجه با یک رویداد آسیب‌زا ایجاد شود. هدف مطالعه حاضر مقایسه اثربخشی درمان شناختی رفتاری بر انعطافپذیری شناختی و اضطراب سلامت در افراد مبتلا به اختلال استرس پس از سانحه بود. روش کار: این مطالعه از نوع نیمهآزمایشی با دو گروه آزمایشی و یک گروه کنترل بود که با طرح پیش‌آزمون، پسآزمون و پیگیری انجام شد. جامعه آماری شامل بزرگسالان 18 تا 40 سال دارای اختلال پس از سانحه مراجعهکننده به مراکز روانشناختی شهر تهران در سال 1403 بود. حجم نمونه 30 نفر بود که به‌صورت هدفمند انتخاب و بهصورت تصادفی به دو گروه آزمایش و یک گروه کنترل (در هر گروه 15 نفر) تقسیم شدند. گروه آزمایش درمان شناختی رفتاری را طی 8 جلسه 90 دقیقهای دریافت کردند، در حالی که گروه کنترل مداخلهای دریافت نکرد. برای گردآوری اطلاعات از پرسشنامه انعطافپذیری روانشناختی و پرسش‌نامه اضطراب سلامت استفاده شد. دادهها با استفاده از آنالیز واریانس دوطرفه با اندازهگیریهای مکرر تجزیه و تحلیل شدند. یافته‌ها: نتایج مطالعه حاکی از تأثیر روش درمان شناختی رفتاری بر ابعاد انعطافپذیری روانشناختی و اضطراب سلامت بزرگسالان دارای اختلال PTSD بود (001/0>P). نتیجه‌گیری: با توجه به نتایج، متخصصین فعال در حوزه  اختلال پس از سانحه میتوانند در درمان این افراد استفاده از روش شناختی رفتاری  در کنار سایر درمانها مدنظر قرار دهند.</div> <div style="text-align: justify;"> Background & Aims: Post-Traumatic Stress Disorder (PTSD) is a chronic and debilitating psychiatric condition classified under stress-related disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It can develop following exposure to a traumatic event. Although the presence of anxiety in the current state of human life is somewhat favorable and creates positive and beneficial effects in advancing people's life goals. However, increasing the duration and intensity of anxiety may damage the person's normal functioning and threaten the person's mental health. Cognitive flexibility can be seen as the skill and ability to choose between two topics or two different thoughts at the same time, and the meaning of cognitive flexibility is the ability to differentiate and change cognitive strategies based on changes in environmental feedback that require planning. It is an organized search and the ability to use environmental feedback to change cognitive cues. Cognitive flexibility is the ability of people to adjust the cognitive process to face new and unpredictable situations. Cognitive flexibility is also defined as a person's ability to inhibit a dominant but ineffective and inappropriate response and the ability to reach alternative responses that are more distant, so it is thought to include two sub-branches of inhibiting irrelevant items and transferring attention and focus to the assignment or mental intentions are different. Preliminary studies have shown that people with underlying diseases are at a higher risk of developing complications and mortality due to the disease; this can be a cause of anxiety for such people. Stress and anxiety caused by accidents can weaken the body's immune system and make it vulnerable to diseases. Because the inherent function of anxiety is to protect people from life-threatening factors, in the event of the emergence of life-threatening diseases, health-related concerns may appear in the form of anxiety states. This study aimed to compare the effectiveness of cognitive-behavioral therapy (CBT) on psychological flexibility and health anxiety in individuals with PTSD. Methods: This semi-experimental study involved two experimental groups and one control group, utilizing a pre-test, post-test, and follow-up design. The statistical population included adults aged 18 to 40 years diagnosed with PTSD who referred to psychological centers in Tehran in 2024. A sample of 30 individuals was selected purposively and randomly assigned to two experimental groups and one control group (15 participants in each group). The experimental groups underwent eight 90-minute sessions of CBT, while the control group received no intervention. Data were collected using the Psychological Flexibility Questionnaire and the Health Anxiety Questionnaire. Repeated measures ANOVA was used for data analysis. Results: Psychological flexibility means a person's ability to accept negative thoughts and emotions and use adaptive strategies to manage stress. This feature is severely impaired in PTSD patients, as they tend to avoid stressful stimuli and use maladaptive mechanisms such as thought suppression. Cognitive-behavioral therapy (CBT) helps to increase psychological flexibility to change negative beliefs and strengthen acceptance. Studies have shown that CBT can significantly reduce PTSD symptoms and replace dysfunctional ones with more flexible thought patterns. Health anxiety is one of the common consequences of PTSD, which can severely reduce the quality of life of patients. Patients with health anxiety often misinterpret minor physical symptoms as signs of serious diseases. CBT helps reduce this anxiety by modifying dysfunctional thoughts and providing stress management skills. In particular, techniques such as cognitive restructuring and confronting anxiety-provoking thoughts in CBT enable patients to have more rational interpretations of physical symptoms. For example, a study conducted by Abramowitz et al. showed that CBT was very effective in reducing health anxiety in patients with PTSD and resulted in stable results. In addition, relaxation training and mindfulness exercises, often included in CBT, help patients better connect with their bodies and reduce hypersensitivity to physical symptoms. These techniques not only reduce health anxiety but also allow patients to have a more positive and balanced approach to their health. Cognitive behavioral therapy is often described as metacognitive monitoring of thoughts, emotions, perceptions, and feelings. This process shows that taking a conscious approach eliminates the need for ego performance in situations. It is thought that thoughts and emotions go up and down with time, and since emotional therapy requires acceptance of the individual's experience, there is no need to actively deal with them. Cognitive-behavioral therapy (CBT) is one of the effective treatment methods for improving PTSD symptoms, increasing psychological flexibility, and reducing health anxiety. Using techniques such as cognitive restructuring, gradual exposure, and coping skills training, this method enables patients to deal with maladaptive thoughts and emotions and improve their quality of life. The findings indicated that cognitive-behavioral therapy significantly improved psychological flexibility and reduced health anxiety in adults with PTSD (P < 0.001). Conclusion: Based on the results, specialists working with PTSD patients are encouraged to consider using cognitive-behavioral therapy alongside other therapeutic approaches for treating these individuals.</div> انعطاف‌پذیری روانشناختی, اضطراب سلامت, اختلال پس از سانحه, درمان شناختی-رفتاری Psychological Flexibility, Health Anxiety, Post-Traumatic Stress Disorder, Cognitive-Behavioral Therapy 1 10 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8436-1&slc_lang=fa&sid=1 Ali Sayadi علی صیادی 3900319475328460090054 3900319475328460090054 No Master's Degree, Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran کارشناسی ارشد، گروه روانشناسی، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران. Nazanin Haghighat-Bayan نازنین حقیقت بیان nazanin-_haghighatbayan@yahoo.com 3900319475328460090055 3900319475328460090055 Yes PhD, Department of Psychology, Roudehen Branch, Islamic Azad University, Tehran, Iran دکتری تخصصی، گروه روانشناسی، واحد رودهن، دانشگاه آزاد اسلامی، تهران، ایران Atefeh Bidokhti عاطفه بیدختی atefeh.bidokhti@gmail.com 3900319475328460090056 3900319475328460090056 No PhD, Department of Psychology, Farhangian University, Al-Zahra Campus, Semnan, Iran دکتری تخصصی، گروه روانشناسی، دانشگاه فرهنگیان، پردیس الزهرا، سمنان، ایران Amir Mohseni-Mahani امیر محسنی ماهانی 3900319475328460090057 0009-0007-4900-0174 No Master's Degree, Department of Psychology, West Tehran Branch, Islamic Azad University, Tehran, Iran. کارشناسی ارشد، گروه روانشناسی، واحد تهران غرب، دانشگاه آزاد اسلامی، تهران، ایران Pooya Samian پویا سمعیان 3900319475328460090058 3900319475328460090058 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 Kamran Pourmohammad-Ghochani کامران پورمحمدقوچانی 3900319475328460090059 3900319475328460090059 No PhD, Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran. دکتری تخصصی، گروه روانشناسی، واحد بین الملل کیش، دانشگاه آزاد اسلامی، جزیره کیش، ایران