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

مراجع

  1. Clark DM, Forborne KJ. The science and practical methods of cognitive behavior therapy. One version. Trans: Kaviani H. Tehran: Roshd publications; 2001.
  2. Blackburn IM, Davidson KM. Cognitive therapy for depression and anxiety: a practitioner's guide. Trans: Toozandehjani H. Mashhad: Astan Ghods Razavi publications; 1995.
  3. Sadouk B, Sadouk V. A Summary of Psychology. Trans: Pourafkari N. Tehran: Shahr Ab Publications; 1994.
  4. Davidson JR. Social anxiety disorder under scrutiny. Depress Anxiety 2000; 11(3): 93-8.
  5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Arlington, TX: Amer Psychiatric Pub; 2000.
  6. Foa EB, Kozak MJ, Steketee GS, McCarthy PR. Treatment of depressive and obsessive-compulsive symptoms in OCD by imipramine and behaviour therapy. Br J Clin Psychol 1992; 31(Pt 3): 279-92.
  7. Heimberg RG, Barlow DH. New developments in cognitive-behavioral therapy for social phobia. J Clin Psychiatry 1991; 52(Suppl): 21-30.
  8. Steketee G. Treatment of obsessive compulsive disorder. New York: Guilford Press; 2007.
  9. Walker HM, Hops H, Fiegenbaum E. Deviant classroom behavior as a function of combinations of social and token reinforcement and cost contingency. Behavior Therapy 1976; 7(1): 76-88.
  10. Greist JH. An integrated approach to treatment of obsessive compulsive disorder. J Clin Psychiatry 1992; 53(Suppl): 38-41.
  11. Wolpe J, Lang PJ. A Fear Survey Schedule for Use in Behaviour Therapy. Behav Res Ther 1964; 2: 27-30.
  12. Salkovskis PM. Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behav Res Ther 1989; 27(6): 677-82.
  13. Goldfried MR, Davison GC. Clinical behavior therapy. New York: Holt Rinehart & Winston; 1976.
  14. Beadle DC. Social anxiety disorder in children and adolescents symposium. Proceedings of the 20th National Conference for the Anxiety Disorder; 2000; Washington D.C.
  15. Caciopp JT, Glass CR, Merluzzi TV. Self statement and self evaluation a cognitive response. Analysis modification de Conducta 2001; 20: 325-34.
  16. Clark DM, Wells A. A cognitive model of social phobia. In: Heimberg RG, Leibowitz MR, Hope DA, Schneier FR, editors. Social phobia: diagnosis, assessment, and treatment.New York: Guilford Press; 1995.
  17. Stangier U, Heidenreich T, Peitz M, Lauterbach W, Clark DM. Cognitive therapy for social phobia: individual versus group treatment. Behav Res Ther 2003; 41(9): 991-1007.
  18. Hayward C, Killen JD, Kraemer HC, Taylor CB. Linking self-reported childhood behavioral inhibition to adolescent social phobia. J Am Acad Child Adolesc Psychiatry 1998; 37(12): 1308-16.
  19. Wells A. Metacognitive Therapy for Anxiety and Depression. London: Guildford Press; 2009.
  20. Fisher PL, Wells A. Metacognitive therapy for obsessive–compulsive disorder: A case series. Journal of Behavior Therapy and Experimental Psychiatry 2008; 39(2): 117-32.
  21. Rees CS, van Koesveld KE. An open trial of group metacognitive therapy for obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry 2008; 39(4): 451-8.
  22. Daniel R, Strunk B, Melissa A. Cognitive therapy. In: Ellis A, Grieger R, editors. Handbook of rational-emotive therapy.New York: Springer; 2010.
  23. Jarrett RB, Vittengl JR, Doyle K, Clark LA. Changes in cognitive content during and following cognitive therapy for recurrent depression: substantial and enduring, but not predictive of change in depressive symptoms. J Consult Clin Psychol 2007; 75(3): 432-46.
  24. Simpson JS, Carlson LE, Trew ME. Effect of group therapy for breast cancer on healthcare utilization. Cancer Pract 2001; 9(1): 19-26.
  25. Hamamci Z. Integrating psychodrama and cognitive behavioral therapy to treat moderate depression. The Arts in Psychotherapy 2006; 33(3): 199-207.
  26. Chen TH, Lu RB, Chang AJ, Chu DM, Chou KR. The evaluation of cognitive-behavioral group therapy on patient depression and self-esteem. Arch Psychiatr Nurs 2006; 20(1): 3-11.
  27. Marks IM, Stern RS, Mawson D, Cobb J, McDonald R. Clomipramine and exposure for obsessive-compulsive rituals: i. Br J Psychiatry 1980; 136: 1-25.
  28. Hersen M, Bellack AS. Handbook of clinical behavior therapy with adults. New York: Plenum Press; 2001.
  29. Salkovskis PM. Obsessional-compulsive problems: a cognitive-behavioural analysis. Behav Res Ther 1985; 23(5): 571-83.
  30. Evans DR, Hearn MT, Saklofske D. Anger, arousal, and systematic desensitization. Psychol Rep 1973; 32(2): 625-6.
  31. Turner SM, Beidel DC. Treating obsessive-compulsive disorder. New York: Pergamon Press; 2008.
  32. Goldenberg I, Goldenberg H. Family therapy. In: Corsini RJ, Wedding D, editors. Current psychotherapies. 2005.
  33. Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman; 1997.
  34. Slicker EK. Relationship of Parenting Style to Behavioral Adjustment in Graduating High School Seniors. Journal of Youth and Adolescence 2004; 27(3): 345-72.
  35. Elliott SN, Gresham FM. Social Skills Interventions for Children. Behav Modif 1993; 17(3): 287-313.
  36. Brand AE, Brinich PM. Behavior problems and mental health contacts in adopted, foster, and nonadopted children. J Child Psychol Psychiatry 1999; 40(8): 1221-9.
  37. Ballard EM. Effects of a social skills training program on social adjustment of persons with head injuries [PhD Thesis]. Illinois Institute of Technology; 1993.
  38. Willmuth ME. Cognitive-behavioral and insight-oriented psychotherapy of an eleven-year-old boy with obsessive-compulsive disorder. Am J Psychother 1988; 42(3): 472-8.
  39. Emmelkamp PMG, Visser S, Hoekstra RJ. Cognitive therapy vs exposure in vivo in the treatment of obsessive-compulsives. Cognitive Therapy and Research 2012; 12(1): 103-14.
  40. Meichenbaum D. Therapist manual for cognitive behavior modification. Unpublished manuscript: University of Waterloo; 2012.
  41. Salkovskis PM. Obsessions and compulsions. In: Scott J, Williams MG, Beck AT, editors. Cognitive Therapy in Clinical Practice: An Illustrative Casebook. London: Rutledge; 1999.
  42. Rachman S, Marks IM, Hodgson R. The treatment of obsessive-compulsive neurotics by modelling and flooding in vivo. Behav Res Ther 1973; 11(4): 463-71.
  43. Heimberg RG, Ervin BA, Arbuckle J, Schneider F, Liebowitz M. Social anxiety implications for anger and management. Proceedings of the 33rd Annual Convention of the Association for the Advancement of Behavioral Therapy; 2001; New Orleans.
  44. Durham RC. Treatment of generalized anxiety disorder. Journal of health line 2002; 95: 176-81.
  45. Chambless L, Gillis M. Cognitive therapy of anxiety disorder. Journal of Consulting andClinical psychology 1993; 61: 611-9.
  46. Sharif F, Vedad F. The Relationship Between Mental Health and Quality of Life of Hemodialysis Patients Referred to Hospitals Affiliated to Shiraz University of Medical Sciences. Iran Journal of Nursing 2007; 20(51): 61-9.
  47. Dobson KS. A meta-analysis of the efficacy of cognitive therapy for depression. J Consult Clin Psychol 1989; 57(3): 414-9.
  48. Schinke SP, Schilling RF, Barth RP, Gilchrist LD, Maxwell JS. Stress-management intervention to prevent family violence. Journal of Family Violence 1986; 1(1): 13-26.
  49. Schwoeri LD. The impact of divorce on family patterns of behavior, children's social adjustment, and parenting [Thesis]. 1998.
  50. Emery G, Campbell J. Rapid relief from emotional distress. New York: Fawcett; 2007.
  51. Errecart MT, Walberg HJ, Ross JG, Gold RS, Fiedler JL, Kolbe LJ. Effectiveness of Teenage Health Teaching Modules. Journal of School Health 1991; 61(1): 26-30.
  52. Florsheim PW. Family and cultural factors in the psychosocial adjustment of Chinese adolescent immigrants. Evanston, IL: Northwestern University; 2007.
  53. Gurney PW. Enhancing self-esteem by the use of behavior modification techniques. Contemporary Educational Psychology 1987; 12(1): 30-41.
  54. Salkovskis PM, Jones DR, Clark DM. Respiratory control in the treatment of panic attacks: replication and extension with concurrent measurement of behaviour and pco2. Br J Psychiatr 1986; 148: 526-32.
  55. Kahn RHC. The effect of a group support intervention program on depression, social adjustment, and self-esteem of adolescents in an overseas American international school [Thesis]. Washington, DC: Catholic University of America; 1989.
  56. Strauss CC. Behavioral Assessment and Treatment of Overanxious Disorder in Children and Adolescents. Behav Modif April 1988; 12(2): 234-51.
  57. Hughes J. Cognitive Behavior Therapy with in Social. Oxford: Pergamum Press; 2005.
  58. Blackburn IM, Davidson KM. Cognitive therapy for depression and anxiety. London: Wiley-Blackwell; 2012.
  59. Eysenck HJ. A model for personality. New York: Springer-Verlag; 1981.
  60. Chapman DP, Perry GS, Strine TW. The Vital Link between Chronic Disease and Depressive Disorders. Centers for Disease Control and Prevention 2005; 2(1): 1-10.
  61. LindenW, Stossel C, Maurice J. Psychological interventions for patients with coronary artery disease: a meta-analysis. Arch Intern Med 1996; 156: 745-52.
  62. Kanner S, Hamrin V, Grey M. Depression in adolescents with diabetes. J Child Adolesc Psychiatr Nurs 2003; 16(1): 15-24.
  63. Atari YA, Shehni YM, Kouchaki AM, Beshlideh K. Investigating the effectiveness of social skills training on individual- social adjustment of juvenile delinquents in gonbad kavuos. Journal of Education and Psychology 2005; 12(3): 25-46.
  64. Dalgleish T, Watts FN. Biases of attention and memory in disorders of anxiety and depression. Clinical Psychology Review 1990; 10(5): 589-604.
  65. Goodestein LD, Lanyon RT. Adjustment of Behavior and Personality. Tempe, Arizona: Arizona State University; 1995.
  66. Lassiter E. An assessment of the relationship between student perception of school effectiveness and student achievement and social adjustment in zoned comprehensive public high schools [Thesis]. Baltimore, Maryland: Morgan State University; 1995.
  67. Narimani M, Rafigh Irani S. A survey of relationship between coping styles and mental health in patients undergoing hemodialytic treatment. The Journal of Fundamentals of Mental Health 2008; 10(2): 117-22.
  68. Khodayari MF, Abedini Y, Akbari SZ, Ghobari BB, Sohrabi F, Younesi SJ. Cognitive-behavioral interventions effectiveness on prisoners' psychological health. Journal of Behavioral Sciences 2009; 2(4): 283-90.
  69. Samari AA, La'lifaz A. The study of effectiveness of life skills training on family stress and social acceptance. The Journal of Fundamentals of Mental Health 2005; 7(25-26): 47-62.
  70. Kaviani H, Javaheri F, Boheirani H. The effectiveness of cognition therapy based on mind awareness for decreasing of negative automatic thoughts, inefficient attitude, depression and anxiety. Advances in Cognitive Science 2005; 7(1): 49-59.
  71. Nazemian F, Ghafari F, Fotoukian Z, Pour Ghaznin T. Evaluation of stressors and copping methods among haemodialysis patient. Medical Journal of Mashhad University of Medical Sciences 2006; 49(93): 293-8.
  72. Masoudi Alavai N, Sharifi KH, Akbarzadeh Z. Depression and anxiety in patients undertaken renal replacement therapy in kashan during 2008 . Journal of Kashan University of Medical Sciences 2009; 12(4): 46-51.
  73. Hoseininasab D, Ahmadian F, Ravanbakhsh H. Relation of child – rearing practices with self–efficacy and mental health of students. Studies in Education and Psychology 2008; 9(1): 21-38.
  74. Rahimi AR, Shamsai F, Zarabian M, Sedehi M. Efficacy of Pharmacotherapy and Cognitive Therapy, Alone and in Combination in Major Depressive Disorder. Scientific Journal of Hamadan University of Medical Sciences 2008; 15(1): 16-21.
  75. Najmeh H. The effect of muscular training and cognition therapy on anxiety rate of people suffering from heart-failure. Hormozgan Medical Journal 2007; 11(1): 33-50.
  76. Manouchehri K, Zandipour T, Pourshahriari T, Mirdamadi SR. The study of effectiveness of cognitive, emotive, behavioral group counseling on mental health of infertile women. Counseling Research and Development 2007; 5(20): 9-22.
  77. Fathi F. The study of effect of both group social skills training method and Beck group cognitive therapy method for increasing of self-steam [MA Thesis]. Tehran: Tehran Allame University; 1999.
  78. Moshaveri AH. The study of effect of group cognitive-behavioral therapy on social phobia symptoms in new coming students of Esfahan University [MA Thesis]. Isfahan: Isfahan University; 2003.
  79. Khojasteh mehr M. The study of effect of parents relationships quality on social adjustment of girl secondary schools students at third grade in Hamadan [MA Thesis]. Tehran: Tehran Tarbiat Moallem University; 1993.
  80. Beck AT, Weishaar ME. Cognitive therapy. In: Corsini R, Wedding D, editors. Current psychotherapies. 4th ed. Itasca, IL: FE Peacock; 1989.
  81. Pashasharifi H, Nikkhoo M. Mental assessment manual. Tehran: Roshd publications; 1995.
  82. Fata L. The comparison of efficiency of facing with avoidance of answer, Klomipramin and combination of these for curing of obsessive disorder [MA Thesis]. Tehran: Tehran Medical Sciences University; 1992.
  83. Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG. Quantitative rating of depressive states. Acta Psychiatr Scand 1975; 51(3): 161-70.
  84. Mahram B. The norming of Schpilberger state-trait anxiety test in Mashhad [MA Thesis]. Mashhad: Mashhad Ferdowsi University; 1993.
  85. Toozandehjani H, Sedighi K. The study of effectiveness of cognitive-behavioral trainings of self-steam on social adjustment of high school students in Neyshabur. Neyshabur: Islamic Azad University of Neyshabur; 2006.
  86. Akhoundi A. The study of relationship of social percept support with social adjustment of students in Tehran [MA Thesis]. Tehran: Tarbiat Moallem University; 1997.
  87. Emami T, Fatehizade M. The study and comparison of scientific methods of self-steam increasing at secondary school students in Isfahan. Isfahan: Education administration of Isfahan; 2000.
  88. Toozandehjani H, Kamalpour N. Cognitive-behavioral therapy of children in schools. Mashhad: Son bole and Aein Tarbiat publications; 2005.
  89. Ghasemi harandi A. The effect of social skills training on adjustment rate of orphanage centers' pseudo family children [MA Thesis]. 1997.
مجله دانشکده پزشکی اصفهان
دوره 29، شماره 168 - شماره پیاپی 168
بهمن و اسفند 1390
صفحه 2491-2507

فایل ها

سابقه مقاله

  • تاریخ دریافت: 02 مهر 1390
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

هم رسانی

ارجاع به این مقاله

آمار