بررسی تأثیر افزودن نوروفیدبک به درمان انتخابی (درمان شناختی-رفتاری و دارودرمانی) بر باورهای وسواسی و طرحواره‌های ناسازگار اولیه بیماران مبتلا به اختلال وسواس فکری-اجباری

نوع مقاله : مقاله پژوهشی

نویسندگان

1 Associate professor of clinical psychology, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Neurology and Psychiatry, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran.

3 MSc. in clinical psychology, Faculty of Psychology and Education Science, Ferdowsi University of Mashhad, Mashhad, Iran.

4 MSc. in clinical psychology, Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

چکیده

مقدمه: این مطالعه با هدف بررسی اثرات افزودن درمان نوروفیدبک (NFT) به مصرف دارو (مهارکننده‌های انتخابی بازجذب سروتونین (SSRIs) و درمان شناختی رفتاری (CBT) ) بر وسواس فکری و طرحواره های ناسازگار اولیه (EMS)  در بیماران مبتلا به اختلال وسواس فکری- اجباری (OCD) انجام شد.
 
روش‌ کار: در این کارآزمایی بالینی که در سال 1398 در شهر مشهد انجام شد، 10 بیمار مبتلا به OCD با روش نمونه‌گیری هدفمند انتخاب شدند. آنها به طور تصادفی به دو گروه مساوی (گروه 1: NFT + SSRIs + CBT، گروه 2: SSRIs + CBT) تقسیم شدند. آنها با استفاده از پرسشنامه باورهای وسواسی (OBQ) و پرسشنامه طرحواره یانگ-فرم  (YSQ) قبل از مداخله، در جلسه هشتم، پس از درمان و یک پیگیری دو ماهه مورد ارزیابی قرار گرفتند. برای تجزیه و تحلیل آماری از آزمون های ANOVA با اندازه گیری های مکرر استفاده شد.
 
یافته‌ها: اثر مداخله زمان × برای هر پانزده EMS (P<0.05) و سه OB (P<0.05) معنی‌دار بود. با این حال، تعامل زمان × شرایط برای باور برآورد مسئولیت/تهدید (P<0.05) و رهاشدگی، نقص/شرم، درگیر شدن/خود توسعه نیافته، عدم کنترل خود/خود انضباط کافی، بی اعتمادی/سوءاستفاده، انقیاد و اجتماعی دیده شده است. انزوا/بیگانگی و طرحواره های استانداردهای بی امان (P<0.05). ما هیچ تفاوت معنی‌داری بین گروه‌های درمانی در EMS و OB پیدا نکردیم.
 
نتیجه‌گیری: نتایج نشان داد که هر دو طرح درمانی در کاهش باورهای وسواسی و طرحواره‌های ناسازگار اولیه مؤثر هستند. با این حال، افزودن نوروفیدبک به درمان استاندارد منجر به تفاوت های قابل توجهی در کاهش باورهای وسواسی و طرحواره های ناسازگار اولیه در بیماران مبتلا به اختلال وسواس فکری-اجباری نشده است.
 

کلیدواژه‌ها


  1. Sachs G, Erfurth A. Obsessive compulsive and related disorders: From the biological basis to a rational pharmacological treatment. Int J Neuropsychopharmacol 2018; 21(1): 59-62.
  2. Fawcett EJ, Power H, Fawcett JM. Women are at greater risk of OCD than men: A meta-analytic review of OCD prevalence worldwide. J Clin Psychiatry 2020; 81(4): 19r13085.
  3. Oudheusden LJB, Schoot R, Hoogendoorn A, Oppen P, Kaarsemaker M, Meynen G, et al. Classification of comorbidity in obsessive-compulsive disorder: A latent class analysis. Brain Behav 2020; 10(7): e01641.
  4. Abramowitz JS. Presidential address: are the obsessive-compulsive related disorders related to obsessive-compulsive disorder? A critical look at DSM-5’s new category. Behav Ther 2018; 49(1): 1-11.
  5. Bruin W, Denys D, van Wingen G. Diagnostic neuroimaging markers of obsessive-compulsive disorder: initial evidence from structural and functional MRI studies. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91: 49-59.
  6. Reuther ET, Davis III TE, Rudy BM, Jenkins WS, Whiting SE, May AC. Intolerance of uncertainty as a mediator of the relationship between perfectionism and obsessive‐compulsive symptom severity. Depress Anxiety 2013; 30(8): 773-7.
  7. Group OCCW. Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory—Part 2: Factor analyses and testing of a brief version. Behav Res Ther 2005; 43(11): 1527-42.
  8. Hellberg SN, Buchholz JL, Twohig MP, Abramowitz JS. Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions. Clin Psychol Psychother 2020; 27(1): 69-78.
  9. Sunde T, Hummelen B, Himle JA, Walseth LT, Vogel PA, Launes G, et al. Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder. BMC Psychiatry 2019; 19(1): 318.
  10. Basile B, Tenore K, Luppino OI, Mancini F. Schema therapy mode model applied to OCD. Clinical Neuropsychiatry 2017; 14(6): 407-14.
  11. Shariatzadeh M. Prediction of obsessive-compulsive disorder symptoms via early maladaptive schemas. International journal of innovation and research in educational sciences 2017; 4(3): 265-70.
  12. Kizilagac F, Cerit C. [Assessment of early maladaptive schemas in patients with obsessive-compulsive disorder]. Dusunen Adam 2019; 32(1): 14. (Turkish)
  13. Mashhadi ND, Shirkhani M, Mahdavian M, Mahmoudi S. Predicting the severity of obsessive-compulsive syndrome based on perceived parenting style: The mediating role of obsessive beliefs. Journal of fundamentals of mental health 2022; 24(1): 29-37.
  14. Albert U, Di Salvo G, Solia F, Rosso G, Maina G. Combining drug and psychological treatments for Obsessive-Compulsive Disorder: what is the evidence, when and for whom. Curr Med Chem 2018; 25(41): 5632-46.
  15. Abramowitz JS. The psychological treatment of obsessive-compulsive disorder. Can J Psychiatry 2006; 51(7): 407-16.
  16. Vyskocilova J, Stuchlikova L, Kotianova A, Slepecky M, Prasko J. Group CBT for patients with obsessive compulsive disorder–predictors of therapeutic efficacy. Eur Psychiatry 2015; 30: 1496.
  17. Johnco C, McGuire JF, Roper T, Storch EA. A meta‐analysis of dropout rates from exposure with response prevention and pharmacological treatment for youth with obsessive compulsive disorder. Depress Anxiety 2019; 37(5): 407-17.
  18. Højgaard DR, Schneider SC, La Buissonnière-Ariza V, Kay B, Riemann BC, Jacobi D, et al. Predictors of treatment outcome for youth receiving intensive residential treatment for obsessive–compulsive disorder (OCD). Cogn Behav Ther 2020; 49(4): 294-306.
  19. Wilhelm S, Berman NC, Keshaviah A, Schwartz RA, Steketee G. Mechanisms of change in cognitive therapy for obsessive compulsive disorder: Role of maladaptive beliefs and schemas. Behav Res Ther 2015; 65: 5-10.
  20. Haaland AT, Vogel PA, Launes G, Haaland VØ, Hansen B, Solem S, et al. The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behav Res Ther 2011; 49(11): 781-8.
  21. Ferreri F, Bourla A, Peretti C-S, Segawa T, Jaafari N, Mouchabac S. How new technologies can improve prediction, assessment, and intervention in obsessive-compulsive disorder (e-OCD). JMIR Ment Health 2019; 6(12): e11643.
  22. Shahmoradi S, Oraky M. The effect of neuro-feedback on indicators obsessive-compulsive disorder and anxiety. Neuroquantology 2019; 17(7): 1-17.
  23. Hampson M, Stoica T, Saksa J, Scheinost D, Qiu M, Bhawnani J, et al. Real-time fMRI biofeedback targeting the orbitofrontal cortex for contamination anxiety. J Vis Exp 2012; 59: 3535.
  24. Ferreira S, Pego JM, Morgado P. The efficacy of biofeedback approaches for obsessive-compulsive and related disorders: A systematic review and meta-analysis. Psychiatry Res 2019; 272: 237-45.
  25. Masjedi Arani A, Asgharipour N, Banihashem S, Saberi Isfeedvajani M, Dorri Mashhadi N. A comparison of the effectiveness of adding neurofeedback to standard treatment (SSRIs + CBT) in patients with Obsessive-Compulsive Disorder (OCD). J Appl Environ Biol Sci 2019; 9(5): 11-19.
  26. Bandelow B, Sher L, Bunevicius R, Hollander E, Kasper S, Zohar J, et al. Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry Clin Pract 2012; 16(2): 77-84.
  27. Foa EB. Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues Clin Neurosci 2010; 12(2): 199.
  28. Hammond DC. Neurofeedback with anxiety and affective disorders. Child Adolesc Psychiatr Clin N Am 2005; 14(1): 105-23.
  29. Sürmeli T, Ertem A. Obsessive compulsive disorder and the efficacy of qEEG-guided neurofeedback treatment: A case series. Clin EEG Neurosci 2011; 42(3): 195-201.
  30. Lobbestael J, Leurgans M, Arntz A. Inter‐rater reliability of the Structured Clinical Interview for DSM‐IV Axis I disorders (SCID I) and Axis II disorders (SCID II). Clin Psychol Psychother 2011; 18(1): 75-9.
  31. Sharifi V, Asadi S, Mohammadi M, Amini H, Kaviani H, Semnani Y, et al. [Reliability and feasibility of the Persian version of the structured diagnostic interview for DSM-IV (SCID)]. Advances in cognitive science 2004; 6(1-2): 10-22. (Persian)
  32. Shams G, Karam Ghadiri N, Esmaeli Torkanbori Y, Ebrahimkhani N. [Validity and reliability of the Persian version of the Obsessive Beliefs Questionnaire]. Advances in cognitive sciences 2004; 6(1-2): 23-36. (Persian)
  33. Welburn K, Coristine M, Dagg P, Pontefract A, Jordan S. The Schema Questionnaire—Short Form: Factor analysis and relationship between schemas and symptoms. Cognit Ther Res 2002; 26(4): 519-30.
  34. Yalcin O, Marais I, Lee CW, Correia H. The YSQ-R: Predictive validity and comparison to the short and long form young schema questionnaire. Int J Environ Res Public Health 2023; 20(3): 1778.
  35. Ghahari S, Viesy F, Kavand H, Fallah M, Zandifar H, Farrokhi N, et al. [Psychometric properties of Early Maladaptive Schemas Questionnaire Short Form-75 Items (YSQ-SF)]. Nurse and physician within war 2020; 8: 31-40. (Persian)
  36. Diedrich A, Sckopke P, Schwartz C, Schlegl S, Osen B, Stierle C, et al. Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder–a process-outcome study. BMC Psychiatry 2016; 16(1): 220.
  37. Toroslu B, Çırakoğlu OC. Do perfectionism and intolerance of uncertainty mediate the relationship between early maladaptive schemas and relationship and partner related obsessive–compulsive symptoms? Current psychology 2023; 42: 19037-53.
  38. Surmeli T, Eralp E, Mustafazade I, Kos IH, Özer GE, Surmeli OH. Quantitative EEG neurometric analysis–guided neurofeedback treatment in Postconcussion Syndrome (PCS): Forty cases. How is neurometric analysis important for the treatment of PCS and as a biomarker? Clin EEG Neurosci 2017; 48(3): 217-30.
  39. Magda Z, Pelc M. Using neurofeedback as an alternative for drug therapy in selected mental disorders. Biomedical engineering and neuroscience. Proceedings of the 3rd International Scientific Conference on Brain-Computer Interfaces, BCI 2018, March 13-14, Opole, Poland.
  40. Rance M, Zhao Z, Zaboski B, Kichuk SA, Romaker E, Koller WN, et al. Neurofeedback for obsessive compulsive disorder: A randomized, double-blind trial. Psychiatry Res 2023; 328: 115458.