نوع مقاله : مقاله پژوهشی
نویسندگان
1 دانشجوی دکتری روانشناسی بالینی، دانشگاه علم و فرهنگ، تهران، ایران.
2 استادیار و عضو هیأت علمی گروه روانشناسی دانشکده علوم انسانی دانشگاه علم و فرهنگ، تهران، ایران.
3 استادیار و عضو هیأت علمی گروه روانشناسی، دانشکده علوم انسانی، دانشگاه علم و فرهنگ، تهران، ایران.
4 استادیار و عضو هیأت علمی گروه روانشناسی، دانشکده علوم تربیتی-روانشناسی، دانشگاه تربیت مدرس، تهران، ایران.
چکیده
کلیدواژه‌ها
عنوان مقاله [English]
نویسندگان [English]
Introduction: Researchers have found the combination of metacognitive and psychodynamic therapy to be beneficial. In this context, the present study aimed to design and conduct a feasibility investigation of metacognitive analytic therapy to enhance ego strength and reduce anxiety and depression among nurses working in COVID-19 wards.
Method: This research employed an exploratory qualitative approach. The statistical population consisted of psychology specialists, from which 36 individuals were purposefully selected as the research sample. Following a review of the literature to identify risk and treatment factors, 10 additional individuals were interviewed to gather further insights. The content validity ratio and content validity index for both risk factors and treatment factors were assessed with the input of 14 participants. Additionally, the content validity ratio and content validity index for treatment sessions, as well as the feasibility of the treatment protocol, were evaluated with 12 participants.
Results: The results indicated that the risk components, treatment components, and therapy sessions demonstrated a strong content validity ratio and content validity index. Additionally, the feasibility results revealed that metacognitive analytic therapy had exhibited acceptability, applicability applicability, integrity, adaptability, resources resource availability, and generalizability.
Discussion and conclusion: The metacognitive analytic treatment protocol can be assessed for its suitability in clinical interventions, as it demonstrates strong validity in its risk components, treatment components, and metacognitive analytic therapy. Additionally, this therapy have exhibits acceptability, and applicability, adaptability, resources and resource availability, generalizability. Therefore, researchers are recommended to encouraged the investigate and effectiveness of this protocol, while protocol. Psychologists are also advised to use metacognitive implement therapy to strengthen ego and enhance clients' ego strength and alleviate of clients, depression, particularly among nurses.
Extended Abstract
Introduction
The mental well-being of nurses is crucial for disease control and prevention, particularly in the aftermath of the COVID-19 outbreak, which has resulted in elevated levels of anxiety and depression within this population. The importance of providing psychological care services to nurses is emphasized by the increased occupational risks and decreased efficiency that arise from this situation. Research indicates that ego strength effectively reduces anxiety and depression, enabling individuals to demonstrate greater resilience in challenging work conditions. Conversely, a weakened ego is associated with the development of anxiety and depression. Therefore, the present study aimed to design and assess the feasibility of an analytic-metacognitive therapy protocol for nurses working in COVID-19 wards. This study suggests that a dominant superego may contribute to psychological disorders through rumination and deficiencies in metacognition. This model examines the reciprocal relationship between ego weakness and superego intensification, which exacerbates anxiety and depression, thereby creating a self-sustaining cycle of psychological distress. Within the analytic-metacognitive framework, psychodynamic therapy aims to strengthen the ego and modify maladaptive metacognitive patterns by analyzing early maladaptive experiences and developmental traumas. This process moderates the superego and alleviates symptoms of cognitive-attentional syndrome, leading to an enhancement in metacognition. Similarly, metacognitive therapy enhances metacognitive resilience by modifying maladaptive metacognitive patterns, thereby paving the way for superego moderation and further strengthening of the ego. Ultimately, the reinforcement of metacognition and ego strength leads to a reduction in anxiety and depression.
Method
This study is an exploratory qualitative research project involving a statistical population of 36 individuals, which includes psychology specialists and doctoral psychology students. These participants were purposefully selected and divided into three groups. The first group consisted of 10 doctoral students and psychology specialists who employed psychodynamic and metacognitive approaches. Each participant had a minimum of 5 years of clinical experience and was interviewed to identify factors related to pathology and treatment. The second group comprised 14 specialists with doctoral degrees in psychology who evaluated the content validity of the identified factors. The third group consisted of 12 specialists, each with a minimum of 10 years of clinical experience, who assessed the content validity of the treatment sessions and the feasibility of the protocol. The researcher utilized the Feasibility Scale for Educational and Psychotherapeutic Programs (FSEPP) as the data collection instrument. Initially, the literature was reviewed to extract factors related to pathology and treatment. This was followed by individual interviews with ten specialists in metacognitive and psychodynamic therapy to identify additional factors. The content validity ratio and index were utilized to assess the content validity of these factors. A logical model outlining the issues and functional objectives was developed, taking into account the characteristics and needs of the target population. Subsequently, the metacognitive therapy protocol was designed, and detailed specifications for the treatment sessions—including objectives, assignments, and timelines—were established through necessary revisions. Finally, the content validity of the sessions and the feasibility of the treatment protocol were re-evaluated using the content validity ratio and index. The data were calculated manually.
Results
The findings indicate that the components of pathology, treatment factors, and the therapeutic sessions designed for the analytic-metacognitive therapy protocol possess an appropriate content validity ratio and index. In other words, all components and elements of the protocol have been validated for scientific accuracy and content credibility. The content validity ratio and content validity index, which are commonly used to evaluate the alignment of content with scientific objectives and concepts, are deemed acceptable for all pathology and treatment factors associated with metacognitive and psychodynamic approaches (object relations), as well as for general treatment factors. This demonstrates the accuracy and credibility of the research content, indicating that the selected components for pathology and treatment analysis are appropriately aligned with the therapeutic needs of patients and scientific principles. In addition to confirming content validity, the feasibility results indicate that the metacognitive analytical treatment protocol has high acceptability and appropriateness. This reveals that the protocol's content is well-suited to the therapeutic needs of the target population and is both acceptable and effective for patients. Furthermore, the treatment protocol can be effectively implemented in practice to meet therapeutic needs, highlighting that it is not only theoretically valid but also practically applicable in therapeutic settings. The indicators related to integration and adaptability demonstrate that this protocol can be seamlessly incorporated into existing health and treatment systems and is flexible enough to accommodate different groups and diverse conditions. In practice, this protocol can be tailored to various cultural, social, and economic characteristics. Additionally, the results indicate that the protocol is efficient in terms of the required resources, as well as its feasibility and generalizability, demonstrating its applicability across various cultural and social contexts.
Conclusion
The analytic-metacognitive therapy examines and analyzes clients' developmental experiences using psychodynamic methods. By fostering insights into maladaptive experiences and early traumas that contribute to a weakened ego and the formation of dysfunctional metacognitive patterns, such as cognitive attentional syndrome, this therapeutic approach enhances ego strength and corrects these maladaptive patterns. Through the process, psychodynamic treatment methods enhance metacognition by alleviating the overwhelming influence of the superego and managing cognitive attentional symptoms, ultimately fortifying the ego. Similarly, metacognitive therapy establishes a basis for regulating the superego by addressing maladaptive metacognitive patterns, which further contribute to the enhancement of the ego. The enhancement of metacognition and ego strength results in a decrease in symptoms of anxiety and depression. This enables individuals to manage their emotions and impulses more effectively, modify harmful behaviors, and cope adaptively with life's stresses and challenges through the skills they develop. Hence, negative thoughts can be identified and addressed by monitoring individual thought patterns, which facilitates the regulation of emotional responses. Consequently, these adaptive functions, arising from enhanced ego strength and robust metacognition, help individuals demonstrate greater resilience in the face of life's pressures, thereby reducing anxiety and depression. Therefore, researchers are encouraged to further investigate the impact and effectiveness of the analytic-metacognitive therapy protocol. Psychologists and counselors can also utilize this protocol to enhance ego strength and alleviate anxiety and depression among clients, particularly in high-stress groups such as nurses.
Ethical Considerations
Compliance with Ethical Guidelines: The Ethics Committee's permission was obtained from the Research Ethics Royan Research Institute—Academic Jihad (Code: IR.ACECR.ROYAN.REC.1401.010). Throughout the study, ethical principles were strictly adhered to, ensuring the confidentiality and privacy of the participants' information. It is essential to note that this study posed no harm or adverse effects to the participants.
Funding: This paper originated from Rahim Shah Bakhsh's PhD dissertation, which was approved by the Department of Psychology, Faculty of Human Sciences, University of Science and Culture, Tehran.
Authors’ Contribution: Conceptualization: All authors; Methodology: Hojjatullah Farahani; Investigation: Rahim Shahbakhsh; Data collection: Rahim Shahbakhsh; Data analysis: Hojjatullah Farahani; Writing the original draft: Rahim Shahbakhsh; Review, editing and supervision: Ali Soleimani, Mohsen Kachooei and Hojjatullah Farahani.
Conflict of Interest: The authors have no conflict of interest.
کلیدواژه‌ها [English]
https://doi.org/10.1016/j.bbi.2020.03.028
https://doi.org/10.1111/jocn.15231
https://doi.org/10.3389/fpubh.2022.1043515.
https://doi.org/10.1038/s41398-023-02488-1
https://doi.org/10.1111/jocn.17079
https://www.gisoom.com/book/11012501
https://doi.org/ 10.1016/j.ajp.2020.102066.
https://doi.org/10.1001/jamapsychiatry.2020.1276
https://doi.org/10.7189%2Fjogh.11.05009
https://doi.org/10.22108/PPLS.2017.2171
https://doi.org/10.3390/ijerph191610364
http://feyz.kaums.ac.ir/article-1-2718-fa.html
https://files.eric.ed.gov/fulltext/EJ1285601
https://scholarsarchive.byu.edu/intuition/vol3/iss1/4
https://www.amazon.com/Object-Relations-Self-Psychology-Introduction/dp/053436280X
https://samta.samt.ac.ir/product/14236/
https://www.routledge.com/Cognitive-Analytic-Therapy
https://www.wiley.com/en-us/Introducing+Cognitive+Analytic+Therapy
https://doi.org/10.1111/bjc.12278
https://www.guilford.com/books/Metacognitive-Therapy
https://doi.org/10.1016/j.jbtep.2006.12.001
https://doi.org/10.1037/0003-066X.34.10.906
https://doi.org/10.1007/s10942-021-00429-9
https://doi.org/10.1080/16506070902991791
https://doi.org/10.1186/s40359-020-00412-6
https://doi.org/10.1007/s12144-020-00662-y
https://doi.org/10.1016/j.cbpra.2006.01.005
https://doi.org/10.1177/00030651000480040701
https://doi.org/ 10.1186/s12888-016-0902-x
https://doi.org/10.1080/20008198.2019.1648173
https://doi.org/10.1080/13548506.2021.1985147
https://doi.org/ 10.1016/j.appet.2023.106975.
https://doi.org/10.1177/2043808718814992
https://doi.org/10.2147/PRBM.S198628
https://doi.org/10.1016/j.amp.2022.05.003
https://doi.org/10.24200/jsshr.vol9iss01pp12-26
https://doi/org/10.52547/JPS.20.108.2239
https://digitalcommons.georgefox.edu/psyd/256
http://edcbmj.ir/article-1-968-fa.html
http://dl6.globalstf.org/index.php/jnhc/article/view/1975
https://doi.org/10.48308/APSY.2021.224241.119
https://doi.org/10.1016/S0193-953X(18)30356-3
https://doi.org/10.1016/j.jad.2021.01.054
)