مقایسه اثربخشی درمان شناختی-رفتاری و درمان مبتنی بر شفقت بر کیفیت زندگی در زنان مبتلا به پسوریازیس

Introduction:
Psoriasis is a chronic inflammatory disease that affects approximately 2–3% of the world's population, and the pathogenesis of psoriasis is complex and involves dysregulation of immune regulation, increased proliferation, and angiogenesis. Several comorbidities have been associated with psoriasis, including psoriatic arthritis, cardiovascular disease, metabolic syndrome, obesity, inflammatory bowel disease, and psychiatric disorders that are associated with systemic inflammation. In addition to these physical and physiological problems, people with psoriasis experience psychological and emotional problems, including low levels of quality of life. Psoriasis affects most psychosocial areas of a patient's life, and coping with these everyday life issues remains a challenge for patients in their daily lives, so the goal of psoriasis management should include measures to improve quality of life along with long-term remission of physical symptoms. Numerous studies have shown the role of psoriasis in reducing the quality of life of patients and have found that psoriasis is a significant threat to reducing the quality of life of these patients. Due to such problems, it is important to use psychological interventions for these patients. The purpose of this study was to comparison of the comparing effectiveness of cognitive-behavioral therapy and compassion-focused therapy on quality of life in women with psoriasis.
Method: This semi-experimental study was conducted with a pretest-posttest design with control group and follow-up 2 month. The statistical population of the research was all women with psoriasis who referred to the dermatology clinics of Tehran city in autumn of year 2024. Then the number of 45 women patients diagnosed by a physician were randomly divided into two groups, including an cognitive-behavioral therapy group (15 women), compassion-focused therapy group (15 women) and a control group (15 women). Then the first experimental group underwent 8 sessions of 90 minute cognitive-behavioral therapy and the second experimental group underwent 10 sessions of 90 minute of compassion-focused therapy. To collect data Dermatology life quality index (DLQI) of Finlay and Khan (1994). The inclusion criteria for the study were the absence of chronic physical diseases such as cancer, etc., according to the individual's self-report, at least one year after receiving a psoriasis diagnosis, and an age range of 20 years and above (because the sample was selected from married women). Also, missing more than 2 sessions in the treatment process, receiving psychotherapy services in parallel and simultaneously, having experience with one of the treatments examined in the present study, and incomplete completion of the questionnaires in the post-test and follow-up stages were exclusion criteria. Analysis of variance with repeated measures and Bonferroni post hoc test was used for data analysis. The data analysis software was SPSS version 28.
Results:
Based on the results, the mean and standard deviation of age in the cognitive-behavioral therapy group were 34.73 and 2.91; the mean and standard deviation of age in the compassion-focused therapy group were 33.40 and 3.27; and the mean and standard deviation of age in the control group were 34.20 and 3.34. The F statistic obtained from comparing the means of the 3 groups in the age variable was F=0.67, which is not statistically significant (sig=0.518), indicating that the 3 groups of women were similar in terms of age. In terms of academic, in the compassion-focused therapy group, 1 people had a diploma (6.6%), 2 had an associate's degree (13.33%), 6 people had a bachelor's degree (40%), and 6 people had a master's degree or higher (40%). In the cognitive-behavioral therapy group, 2 people had a diploma (13.33%), 4 people had an associate's degree (26.67%), 4 people had a bachelor's degree (26.67%), and 5 people had a master's degree or higher (33.33%). In the control group, 2 people had a diploma (13.33%), 3 people had an associate's degree (20%), 6 people had a bachelor's degree (40%), and 4 people had a master's degree or higher (67.26%). The chi-square analysis statistic resulting from comparing the frequency and percentage of the 3 groups in terms of education was Chi-Square = 1.97, which is not statistically significant (sig = 0.923), indicating that the three groups of women were similar in terms of education. The results showed that both interventions had a significant effect on quality of life (P<0.05). Then, a pairwise comparison of the mean modified of the test stages (pre-test, post-test, and follow-up) in quality of life was examined, and the results showed that cognitive-behavioral therapy and compassion-focused therapy had an effect on quality of life and its dimensions in the post-test stage, and their therapeutic effects were persistent and stable after 2 months. The results also showed that the mean difference between the compassion-focused therapy group and the control group was greater than the mean difference between the cognitive-behavioral therapy group and the control group, which indicates that compassion-focused therapy is more effective than cognitive-behavioral therapy on the quality of life of women with psoriasis.
Conclusion: Compassion can manifest in three different directions (streams of compassion): the compassion we feel for others, the compassion we feel on behalf of others, and the compassion we have for ourselves (self-compassion). The primary goal of compassion-based therapy is to cultivate compassionate motivation in all three directions, allowing distress to be regulated through our evolved physiological infrastructures, which are activated in response to dependent behaviors. How compassion-focused therapy can improve quality of life compassion-focused therapy can be said to eliminate shame and self-criticism by activating our pain-relieving system, which is related to compassion, satisfaction, and safety. The goal of many compassion-focused therapy exercises is to connect with the pain-relieving system by creating a compassionate mind, thus creating a sense of security, satisfaction, and peace, which in turn can eliminate shame and self-criticism. Therefore, when a person with psoriasis participates in compassion therapy sessions, they develop a compassionate mind and will feel less shame and self-criticism due to their disease, which will be effective in improving their quality of life. Therefore, it is reasonable to say that compassion-focused therapy is more effective than cognitive-behavioral therapy in improving the quality of life in women with psoriasis. Based on the results of the present study, it can be said that cognitive-behavioral therapy and compassion-focused therapy can be used as a treatment method to on quality of life in women with psoriasis and priority of use in in increase quality of life women with psoriasis is with compassion-focused therapy.