فراتحلیل مقایسه اثربخشی درمان‌های موج سوم رفتاری بر افسردگی در ایران: مقایسه درمان‌های مبتنی بر پذیرش و تعهد، درمان مبتنی بر توجه‌آگاهی و درمان فراشناختی (سال‌های ۱۳۸۰ تا ۱۳۹۶)

نویسندگان

1 دانشگاه خوارزمی

2 دانشگاه زنجان

چکیده

مقدمه: در سال‌های اخیر، پژوهش‌های بسیاری، اثربخشی درمان‌های موسوم به «موج سوم رفتاری» را برای اختلال‌های افسردگی مورد بررسی قرار داده‌اند. پژوهش حاضر به‌منظور مقایسه نتایج پژوهش‌‌های مرتبط با اثربخشی درمان‌های مبتنی بر پذیرش و تعهد، درمان‌های مبتنی بر توجه‌آگاهی و فراشناخت درمانی بر علائم افسردگی جامعه ایرانی صورت گرفته است.
روش: در این پژوهش از روش فراتحلیل استفاده گردید و پس از بررسی پژوهش‌های صورت گرفته بین سال‌های ۱۳۸۰ تا ۱۳۹۶، ۶۸ مطالعه که از لحاظ روش‌شناختی ملاک‌های ورود به فراتحلیل را داشتند، انتخاب شدند. همچنین در جهت رعایت ملاک‌‌های ورود و استخراج اطلاعات مربوط به هر مطالعه از چک‌لیست استفاده گردید و در نهایت ۶۹ اندازه اثر گزارش شد.
نتایج: یافته‌‌های حاصل نشان می‌‌دهد که درمان‌های مبتنی بر پذیرش و تعهد، مبتنی بر توجه‌آگاهی و فراشناخت درمانی به‌‌طور معنی‌‌دار و در سطح خطای کمتر از 0.05 بر کاهش علائم افسردگی مؤثر بوده‌‌اند و اندازه اثر ترکیبی (بر حسب مقیاس تفاوت میانگین‌‌های استاندارد) آن‌ها به ترتیب 1.565، 1.206 و 1.837 گزارش شده است. همچنین مطالعه متغیر نوع درمان به‌عنوان متغیر تعدیل‌کننده و مقایسه دو به دو درمان‌های فوق نشان داد که تنها فراشناخت درمانی نسبت به درمان‌های مبتنی بر توجه‌آگاهی در کاهش نشانه‌‌های افسردگی بهتر عمل می‌کند.
بحث و نتیجه‌گیری: با توجه به یافته‌ها می‌توان چنین گفت که درمان‌‌های موج سوم رفتاری، به‌خصوص درمان‌های فراشناخت درمانی بر کاهش نشانه‌های افسردگی مؤثر هستند، همچنین پیشنهاد می‌گردد تا در پژوهش‌های آینده درمان‌های موج سوم با دیگر درمان‌های دارای حمایت تجربی نیز مورد مقایسه قرار گیرند.

کلیدواژه‌ها


Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., Üstün, T. B. & Wang, P. S (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiology and Psychiatric Sciences. 18, pp.23-33. Kessler, R. C. & Bromer, E. J (2013). The epidemiology of depression across cultures. Annual Review of Public Health. 34, 119-138. Chapman, D. P. & Perry, G. S (2008). Peer Reviewed: Depression as a Major Component of Public Health for Older Adults. Preventing chronic disease. 5, 1-9. Kessler, R. C. & Üstün, T. B (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research. 13, 93–121. Wells, K., Jones, L., Chung, B., Dixon, E. L., Tang, L., Gilmore, J., Sherbourne, C., Ngo, V. K., Ong, M. K., Stockdale, S. & Ramos, E (2013). Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression Disparities. Journal of General Internal Medicine. 28, 1268–1278. Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J., Angermeyer, M. C., Bernert, S. D., De Girolamo, G., Morosini, P. & Polidori, G (2004). WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association. 291, 2581–2590. Segal, Z. V., Williams, J. M. G.& Teasdale, J. D (2002). Mindfulness-based cognitive therapy for depression: A new approach to relapse prevention. New York: Guilford. Cuijpers, P., Van Straten, A., Warmerdam, L. & Smits, N (2008). Characteristics of effective psychological treatments of depression; A meta-regression analysis. Psychotherapy Research. (18): 225-236. Wells, A (2002). Emotional disorders and metacognition: Innovative cognitive therapy. John Wiley & Sons. Wells, A (2009). Metacognitive therapy for anxiety and depression. New York: Guilford press. Hayes, S. C., Strosahl, K. D. & Wilson, K. G (2012). Acceptance and commitment therapy: the process and practice of mindful change (2nd ed.). New York: Guilford. Herbert, JD. & Forman, EM (2011). The evolution of cognitive behavior therapy: the rise of psychological acceptance and mindfulness. In: J. D. Herbert, & E. M. Forman (Eds.), Acceptance and mindfulness in cognitive behavior therapy: understanding and applying the new therapies. Hoboken, NJ: Wiley. pp. 3–25. Karlin, B. E., Brown, G. B., Trockel, M., Cunning, D., Zeiss, A. M. & Taylor, C.B (2012). National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs Health Care System: therapist and patient-level outcomes. Journal of Consulting and Clinical Psychology. 80, 707-718. Karlin, B. E., Walser, R. D., Yesavage, J., Zhang, A., Trockel, M. & Taylor, C. B (2013). Effectiveness of acceptance and commitment therapy for depression: comparison among older and younger veterans. Aging Mental Health. 17, 555-563. Gaudiano, B. A., Nowlan, K., Brown, L. A., Epstein-Lubow, G. & Miller, I. W (2012). An open trail of a new acceptance-based behavioral treatment for major depression with psychotic features. Behavior Modification. 37, 324-355. Dalrymple, K. L., Morgan, T. A., Lipschitz, J. M., Martinez, J. H., Tepe, E. & Zimmerman, M (2014). An integrated acceptance-based behavioral approach for depression with social anxiety: preliminary results. Behavior Modification. 39,1-33. Zettle, R. D., Rains, J. C. & Hayes, S. C (2011). Do acceptance and commitment therapy and cognitive therapy for depression work via the same process: a reanalysis of Zettle and Rains (1989). Behavior Modification. 35, 265-283. Forman, E. M., Chapman, J. E., Herbert, J.D., Goetter, E. M., Yuen, E. K. & Moitra, E (2012). Using session-by-session measurement to compare mechanisms of action for acceptance and commitment therapy and cognitive therapy. Behavior Therapy. 43, 341-354. Teasdale, J. D., Segal, Z. & Williams, J. M (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behavior Research Therapy. (33):25−39. Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder, R. & Williams, J. M. G. (2009). Mindfulness-based cognitive therapy as a treatment for chronic depression: a preliminary study. Behavior Research Therapy. (47):366-373. Goldfrin, K. A. & Hearing, C (2010). The effects of mindfulness- bused cognitive therapy on recurrence of depressive episodes, Mental Health and quality of life a randomized controlled study. Behavior Research Therapy. 48(8):738-746. Papageorgiou, C. & Wells, A (2004). Nature, functions, and beliefs about depressive rumination. Depressive rumination: Nature, theory and treatment, 1-20. Wells, A., Fisher, P., Myers, S., Wheatley, J., Patel, T. & Brewin, C (2009). Metacognitive Therapy in Recurrent and Persistent Depression: A Multiple-Baseline Study of a New Treatment. Cogn Ther Res. 33, 291-300. Wells, A., Fisher, P., Myers, S., Wheatley, J., Patel, T. & Brewin, C. R (2012). Metacognitive therapy in treatmentresistant depression: a platform trial. Behavior Research Therapy. 50, 367-373. Papageorgiou, C. & Wells, A (2009). A Prospective Test of the Clinical Metacognitive Model of Rumination and Depression. International Journal of Cognitive Therapy. 2, 123-131. Dammen, T., Papageorgiou, C. & Wells, A (2015). An open trial of group metacognitive therapy for depression in Norway. Nordic journal of psychiatry. 69, 126-131. Dimidjian, S., Davis, K. J. (2009). Newer variation of cognitive behavioral therapy: Behavioral activation and mindfulness- based cognitive therapy. Curr Psychiatry Rep. 11, 453-458. Howitt, D. & Cramer, D (2005). An introduction to statistics in psychology. 3rd ed. edition. (3rd ed.). Harlow: Pearson/Prentice Hall. Light, R. J., Pillemer, D. B. (1986). Summing Up: The Science of Reviewing Research Harvard University Press: Cambridge, MA, Educational Researcher. 15, 7-16. Rosenthal, R (1979). The file drawer problem and tolerance for null results. Psychological bulletin. 86, 638-641. Lau, J., Ioannidis, J. P., Schmid, C. H. (1997). Quantitative synthesis in systematic reviews. Annals of internal medicine. 127, 820-826. Borenstein, M., Hedges, L. & Rothstein, H (2007). Meta-analysis: Fixed effect vs. random effects. Meta-analysis com. Mahdavi, A., Yazdanbakhsh, K., Sharifi, M. (2016). The Effectiveness of Mindfulness-Based Cognitive Therapy in Reducing Psychological Symptoms, Meta-Worry and Thought Fusion of Multiple Sclerosis Patients. Annals of Military & Health Sciences Research, 14, 16-21. Zemestani, M., Davoodi, I., Honarmand, M. M., Zargar, Y., Ottaviani, C. (2016). Comparative effects of group metacognitive therapy versus behavioural activation in moderately depressed students. Journal of Mental Health. 25, 479-485. Song, F., Patrekh, S., Hooper, L., Loke, Y. K., Ryder, J., Sutton, A. J., Hing, C., Kwok, C. S., Pang, C. & Harvey, I (2010). Dissemination and publication of research findings: an updated review of related biases. Health Technology Assessment. 14, 1-193. Higgins, J., Thompson, S. G., Deeks, J. J. & Altman, D. G (2003). Measuring inconsistency in meta-analyses [journal article as teaching resource, deposited by John Flynn]. British medical journal. 327, 557-560. Zhang, M. F., Wen, Y. S., Liu, W. Y., Peng, L. F., Wu, X. D. & Liu, Q. W (2015). Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: a meta-analysis. Medicine. 94, 897-906. Ruiz, F. J (2012). Acceptance and Commitment Therapy versus Traditional Cognitive Behavioral Therapy: A Systematic Review and Meta-analysis of Current Empirical Evidence. International Journal of Psychology & Psychological Therapy. 12, 333-357. Normann, N., van Emmerik, A. A. P. & Morina, N (2014). Efficacy of Metacognitive Therapy for Anxiety and Depression: a Meta-Analytic Review. Depression and Anxiety. 31, 402-411. Hagen, R., Hjemdal, O., Solem, S., Edward, L., Kennair, O., Nordahl, H. M., Fisher, P. & Wells, A (2017). Metacognitive Therapy for Depression in Adult: A Waiting List Randomized Controlled Trial with Six Months Follow-Up. Clinical and Health Psychology. 8. 112-121. Hofmann, S. G., Sawyer, A. T. & Fang, A (2010). The empirical status of the ‘new wave’of cognitive behavioral therapy. Psychiatric Clinics of North America. 33, 701–710. Kahl, K. G., Winter, L., Schweiger, U. & Sipos, V (2011). The third wave of cognitivebehavioural psychotherapies: concepts and efficacy [in German]. Fortschr Neurol Psychiatr. 79, 330–339. Ost, LG. (2008). Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behavior Research Therapy. 46, 296–321.