نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکترای روان‌شناسی دانشگاه تربیت مدرس

2 دانشیارروان‌شناسی دانشگاه تربیت مدرس

3 استاد روان‌شناسی دانشگاه خوارزمی

4 دانشیار روان‌شناسی دانشگاه علامه طباطبائی

چکیده

استرس­پس­از­ضربه و افسردگی، شایع­ترین بیماری­های مرتبط با حادثه آسیب­زا هستند. هدف پژوهش حاضر تشخیص اثربخشی درمان مواجهه روایی بر کاهش علائم استرس­پس­از­ضربه و افسردگی همبود است. درمان مواجهه­روایی دربرگیرنده بسیاری از مؤلفه­های مواجهه­سازی است و البته توجه مضاعفی دارد بر مستندسازی روشن فجایعی که قربانی متحمل شده­است. در این مطالعه 24 نفر از زنان تهرانی با تجربه خیانت همسر و دارای استرس­پس­از­ضربه و افسردگی، با گمارش تصادفی در گروه­های کنترل و آزمایش قرار­گرفتند. همه افراد، مورد مصاحبه­بالینی قرار­گرفتند، سپس مقیاس تجدیدنظرشده تأثیررویداد (IES-R) و سیاهه‌افسردگی بک (BDI) را تکمیل­کردند؛ گروه آزمایش هشت جلسه درمان را پشت­سر گذاشتند و افراد هر دوگروه مقیاس و سیاهه را دوباره بلافاصله پس از درمان و سه ماه پس از آن تکمیل نمودند. داده­ها با استفاده از آزمون تحلیل واریانس اندازه­های مکرر مورد تجزیه و تحلیل قرارگرفت. نتایج تحلیل آماری نشان داد استرس‌پس‌از‌ضربه و دومولفه از سه­مولفه آن (افکارناخواسته و برانگیختگی) در گروه آزمایش بلافاصله پس از درمان و سه ماه پس از آن به طور معنادار کاهش پیدا کرده­است. افسردگی نیز در گروه آزمایش بلافاصله پس از درمان به طور معنادار کاهش پیدا کرده و سیر نزولی خود را تا سه ماه بعد حفظ کرده­است. برطبق این پژوهش درمان حاضر می­تواند در حیطه مسائل اجتماعی و برای درمان استرس پس‌از‌ضربه نیز به صورت مؤثر به کار گرفته شود. موفقیت این درمان را در بستر فرهنگ ایرانی می­توان مدیون جنبه روایی درمان تلقی کرد. پژوهش حاضر هم­چنین تأیید می­کند که روابط فرازناشویی، می­تواند منجر به استرس­پس­از­ضربه در فرد قربانی شود.

کلیدواژه‌ها

عنوان مقاله [English]

Narrative Exposure Therapy for Reducing Post-Traumatic Stress Disorder in Iranian Betrayed Wives

نویسندگان [English]

  • Mona Shivarani 1
  • Parviz Azadfallah 2
  • Alireza Moradi 3
  • Hosein Eskandari 4

1 Ph. D. Candidate of Psychology, Tarbiat Modares University.

2 Associate Professor of Psychology, Tarbiat Modares University,

3 Professor of Psychology, Kharazmi University

4 Associate Professor of Psychology, AllamehTabataba’i University

چکیده [English]

PTSD and depression are most prevalent disorders in traumatic events. This research studies reducing symptoms of PTSD and comorbid depression through narrative exposure therapy (NET). NET incorporated many of exposure elements with additional focus of clearly documenting the atrocities endured. 24 betrayed women with PTSD and depression were randomized in experiment and control groups. Participants were clinically interviewed and filled out impact of event scale-revised (IES-R) and Beck Depression inventory (BDI) for three times; once before and once after 8 sessions of experiment group’s therapy. Third time was three months after therapy. Data were analyzed using repeated measures variances analysis. PTSD and its two parameters (intrusion & hyperarousal) significantly reduce in experiment group, immediately after therapy and in three months follow up. Depression also reduces significantly immediately after therapy and continues to reduce three months after therapy. According to this study, NET is beneficial therapy for PTSD even in social fields. NET successfulness in Iranian culture is ascribed to narrative aspect of NET. This study endorses that extra-marital relationship causes PTSD in victims.

کلیدواژه‌ها [English]

  • Post-traumatic stress disorder
  • Depression
  • Narrative exposure therapy
  • Infidelity
  • Extra-marital relationship
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Edition, DSM 5TM). Washington, D.C: American Psychiatric Association.
Baucom, D.H., Snyder, D.K. & Gordon, K.C. (2009). Helping Couples Get Past the Affair: A clinician’s Guide. The Guilford Press.
Bichescu, D., Neuner, F., Schauer, M., & Elbert, T. (2007). Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behavior Research and Therapy, 45, 2212−2220.
Brown EM. (2001). Patterns of infidelity and their treatment. New York, NY: Psychology Press.
Cappas, N.M.; Andres-Hyman, R.; Davidson, L. (2005). What psychotherapists can begin to learn from neuroscience: seven principles of a brain-based psychotherapy.Psychotherapy: Theory, Research, Practice, Training, 42(3), 374-383.
Conway, M. A. (2005). Memory and the self. Journal of memory and language, 53, 594-628.
Elbert, Th.; Shauer, M.; Ruf, M; Weirestall, R.; Neuner, F.; Rockstroh, B.; Junghofer, M. (2011). The Tortured Brain Imaging Neural Representations of Traumatic Stress Experiences Using RSVP With Affective Pictorial Stimuli. Journal of Psychology. 219(3):167–174.
Fairbrother, N., Newth, S., & Rachman, S. (2005). Mental pollution: feelings ofdirtiness without physical contact. Behaviour Research and Therapy, 43, 121–130.
Farahbakhsh,K.; Ghanbari Hashem Abadi, B. (2007). Evaluation of the effectiveness of couple therapy Counseling on Intimacy post-traumatic stress reduction and increased perception of infidelity.Studies of Education and Psychology, Vol. 7, No. 9. (in Persian)
Glass SP, Wright TL. Reconstructing marriages after the trauma of infidelity. In: Halford WK, Markman HJ, editors. Clinical handbook of marriage and couples interventions. New York, NY: John Wiley & Sons; 2007. p. 471-507.
Gordon, K.C. (2004). An integrative intervention for promoting recovery from extramarital affairs. Journal of Marital Family Therapy,30: 213-231.
Jacob, N., Neuner, F., Schaal, S., Maedi, A., & Elbert, T. (2010). Dissemination of psychotherapy for trauma-spectrum disorders in resource-poor post-conflict societies: A randomised controlled trial in Rwanda. PhD Thesis.
Malek A.; Dadashzadeh, H.; Pour Afkari N., Safaiean A.(2012) Ranking of stressful life events in the general population Tabriz.Journal of Tabriz University of Medical Sciences, Vol.30, NO.4, 73-80. (in Persian)
Mared Pour, A; Najafi, M. (2016). The effectiveness of treatment through eye movement desensitization and reprocessing (EMDR) in women with post-traumatic stress disorder caused by the events of civilians. Journal of Clinical Psychology, 6, 23: 41-60. (in pesian).
Moradi, A. R., Herlihey, J., Yasseri, G., Sahraray, M., Turner, S., Dalgleish, T. (2008). Specificity of episodic and semantic aspect of autobiographical memory in relation to symptoms of post traumatic stress disorder (PTSD). Acta psychological, 127, 645-653.
Moradi, A. R.; Abdi, a.; Fathi-Ashtiani, A.; Dalgleish, T.; Jobson, L. (2012). Overgeneral autobiographical memory recollection in Iranian combat veterans with posttraumatic stress disorder. Behaviour Research and Therapy, 50, 435-441.
Naderi, N.; Moradi, A.; Ramazan Zadeh, F.; Vaghefi Nejad, M. (2016). Emotional Schemas (ESs), Depression and Anxiety in Posttraumatic Stress Disorder (PTSD) Patient: As a Risk Factor in PTSD. Journal of Clinical Psychology, 6, 22: page 1-22. (in pesian).
Neuner, F; Catani, C; Ruf, M; Schauer, M; Elbert, Th. (2008). Narrative Exposure Therapy for the Treatment of Traumatized Children and Adolescents (KidNET): From Neurocognitive Theory to Field Intervention.  Child and Adolescent Psychiatric Clinics of North America,17(3), 461-664.
Neuner, F; Shauer, M.; Klaschik, CH.; Karunakara, U.; Elbert, TH. (2004). A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement. Journal of Consulting and Clinical Psychology, 72, 4, 579-587.
Olff, M., Laneland, W., Gersons, B. P., (2005). The psychology of PTSD: Coping with trauma. psychoneuroendocrinology, 30, 974- 982.
Onyut, L.P.; Neuner, F.; Schauer, E.; Ertl, V.; Odenwald, M.; Schauer, M.; Elbert, Th. (2005). Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5:7.
Panaghi, L.; Hakim shooshtari, M.; Atari Mogadam, J. (2006). Persian version validation in impact of event Scale-Revised, Tehran University Medical Journal; Vol. 64, No. 3, 52-60. (in Persian)
Peluso, P.R. (2007). Infidelity: A Practitioner’s Guide to Working with Couples in Crisis. Routledge publisher.
Rachman, S. 2010. Betrayal: A psychological analysis. Behaviour Research and Therapy, 48: 304-311.
Raes, F., Williams, G. M., Hermans, D. (2009). Reducing cognitive vulnerability to depression: A preliminary investigation of Memory Specificity Training (MEST) in inpatients with depressive symptomology. Journal of Behavior Therapy and Experimental psychiatry, 40, 24-38.
Robjant, K.; Fazel, M. (2010). The emerging evidence for Narrative Exposure Therapy: A review. Clinical Psychology Review, 30:1030-1039.
Rubin, D. C., Bernsten, D., & Bohni, M. K. (2008). A memory- based model of post traumatic stress dissordr: evaluating basic assumption underlying the PTSD diagnosis. Psychological Review, 115, 985-1011.
Schaal, S.; Elbert, Th.; Neuner, F. (2009). Narrative Exposure Therapy versus Interpersonal Psychotherapy. Psychother Psychosom, 78:298–306.
Schauer, M.; Neuner, F.; Elbert, Th. (2005). Narrative exposure therapy. Hogrefe & Huber Publishers.
Schauer, M; Elbert, Th. (2010). Dissociation Following Traumatic Stress, Etiology and Treatment. Journal of Psychology, Vol. 218(2):109–127
Soudani, M.; Karimi, J.; Mehrabizadeh, M.; Neisi, A. (2012). Effectiveness of emotion oriented couple therapy on reducing the damage caused by marital infidelity. Researches of behavioral science, Vol 10, NO 4, 258-268. (in pesian).
Steel, J.L.; Dunlavy, A. C.; Stillman, J.; Pape, H. Ch. (2011). Measuring depression and PTSD after truma: Common scaled and checklists. Injury, 42(3), 288-300.
Stefano JD, Oala M. (2008). Extramarital affairs: Basic considerations and essential tasks in clinical work. Journal of Counseling and Therapy for Couples and Families; 16(1): 13-19.