بررسی کارامد دارودرمانی، درمان‌های شناختی- رفتاری و ترکیب آن‌ها در درمان بیماران مبتلا به اختلال هراس اجتماعی

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه علوم تربیتی، دانشکده‌ی علوم انسانی، دانشگاه آزاد اسلامی، واحد نیشابور، نیشابور، ایران

2 کارشناس، گروه روان‌شناسی بالینی، دانشگاه آزاد اسلامی، واحد نیشابور، نیشابور، ایران

چکیده

مقدمه:. اختلال هراس اجتماعی در برخی موقعیت‌های معین و یا در برابر اشیای خاص در حالی که اغلب خطرناک نیستند، بروز می‌کند. این مطالعه به منظور درمان اختلال هراس اجتماعی انجام شد.روش‌ها: این پژوهش نوعی کارآزمایی بالینی بود که سعی داشت تأثیر جداگانه و ترکیبی دو عامل دارودرمانی و درمان‌های شناختی- رفتاری را (در مقایسه با دارونما) مورد سنجش قرار داد. بدین منظور از بین بیماران مراجعه کننده به کلینیک‌های روان‌شناسی و مطب‌‌های خصوصی روان‌پزشکی شهر نیشابور و مشهد 60 بیمار مبتلا به اختلال هراس اجتماعی به صورت نمونه‌گیری در دسترس انتخاب شدند و به صورت تصادفی جایگزینی به چهار گروه دارو درمانی، درمان‌های شناختی- رفتاری، درمان ترکیبی و دارونما تقسیم گردیدند. آزمودنی‌ها قبل و بعد از دوره‌ی درمان، و همچنین دو ماه پس از پایان دوره‌ی درمان توسط آزمون‌های هراس اجتماعی Davidson، اضطراب‌ Schpillberger، افسردگی  Beckو Hamilton، افکار ناسالم Weismann وMyers ، سازگاری اجتماعیCalifornia ، عزت نفس Eliss-Pope مورد آزمون قرار گرفتند.یافته‌ها: نتایج آزمون Repeated measure ANOVA حاکی از کاهش نشانه‌های هراس اجتماعی، اضطراب، افسردگی، تغییر افکار ناسالم و افزایش سطح سازگاری اجتماعی و عزت نفس بیماران (05/0 > P) بود. نتایج همچنین بیانگر برتری هر یک از درمان‌های دارویی، شناختی- رفتاری و ترکیبی به تنهایی نسبت به دارونما بود (05/0 > P). درمان‌های شناختی- رفتاری و ترکیبی نیز نسبت به دارو درمانی برتری داشتند، اما اثربخشی درمان‌های شناختی- رفتاری و ترکیبی تفاوت معنی‌داری نداشت (05/0 < P).نتیجه‌گیری: به طور کلی می‌توان گفت که دارو درمانی روی نشانه‌های جسمی و خلق بیماران اثر می‌گذارد، اما درمان‌های شناختی- رفتاری به طور عمده روی افکار و تکانه‌های هراس تأثیر دارد و به تدریج به سایر موقعیت‌های واقعی زندگی تعمیم می‌یابد. بنابراین، این دو شیوه‌ی درمان در بسیاری از موارد لازم و ملزوم یکدیگر هستند.

کلیدواژه‌ها

عنوان مقاله [English]

The Efficacy of Pharmacotherapy, Cognitive-Behavioral Therapies and Their combination on Patients with Social Phobia Disorder

نویسندگان [English]

  • Hassan Toozandehjani 1
  • Mahbobeh Ahmadpoor 2
1 Assistant Professor, Department of Educational Sciences, School of Humanities, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
2 Department of General Psychology, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
چکیده [English]

Background: This clinical trial was conducted in order to assess treatment of social phobia disorder. Social phobia is an anxiety disorder that appears in some certain situations or against specific objects that are not commonly known as dangerous.Methods: This clinical trial assessed the separate and combined effects of pharmacotherapy and cognitive-behavioral therapies (in comparison with placebo). Therefore, among the patients who referred to psychology centers and private psychiatry practices in Neyshabur and Mashhad, Iran, 60 patients with social phobia disorder were selected by accessible sampling. The subjects were randomly divided into pharmacotherapy, cognitive-behavioral therapies, combined therapy and placebo groups. The subjects were tested before, immediately after and 2 months after the end of the treatment course. Davidson Social Phobia, Schpillberger Anxiety, Hamilton-Beck Depression, Weismann-Myers Automatic Thought, California Social Adjustment and Eliss-Pope Self-Esteem tests were used to evaluate the patients.Findings: The results of repeated measures one-way analysis of variance (ANOVA) showed decreased symptoms of social phobia, anxiety, and depression, change in automatic thought, and increased social adjustment and self-esteem levels among patients. The results also indicated the superiority of pharmacotherapy, cognitive-behavioral and combined therapies over placebo. Cognitive-behavioral and combined therapies were better than pharmacotherapy. However, the effectiveness of cognitive-behavioral and combined therapies had no significant differences.Conclusion: Generally, pharmacotherapy affects physical and mood symptoms, but cognitive-behavioral therapies mainly affect thoughts and phobia impulse and gradually other real life situations. Therefore, these methods of therapy are interdependent.

کلیدواژه‌ها [English]

  • Social phobia disorder
  • Pharmacotherapy
  • Cognitive-behavioral therapies
  • Combined therapy
  • Placebo
  • Anxiety
  • Depression
  • Social adjustment
  • self-esteem
  • Automatic thought

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مجله دانشکده پزشکی اصفهان
دوره 29، شماره 168 - شماره پیاپی 168
بهمن و اسفند 1390
صفحه 2491-2507

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  • تاریخ دریافت: 02 مهر 1390
  • تاریخ بازنگری: 01 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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