اثربخشی رفتاردرمانی پذیرش محور بر روی رفتارهای متمرکز بر بدن (وسواس موکنی، ناخن جویدن، کندن پوست): یک طرح خط پایه چند گانه با پیگیری سه ماهه

نویسندگان
پریا فاروقی
زینب خانجانی
تورج هاشمی
مجید محمود علیلو
دانشگاه تبریز
10.29252/rph.11.3.13
چکیده
رفتاردرمانی پذیرش محور ترکیب دو روش درمانی پذیرش - تعهد و بازداری از پاسخ است که در پژوهش حاضر سعی شده است تا اثربخشی این نوع درمان در بهبود نشانه های بیماران مبتلا به رفتارهای متمرکز بر بدن از نوع موکنی ، کندن پوست آمیخته و ناخن جویدن مورد بررسی قرار گیرد .این پژوهش در چهارچوب طرح تک موردی از نوع از خطوط چندگانه پلکانی طی 10 جلسه همراه با پیگیری سه ماهه بر روی شش بیمار ( برای هر اختلال دو نفر ) صورت گرفت .داده ها از طریق مقیاس های موکنی ماساچوست، کندن پوست کتن ، شدت ناخن جویدن مسلر و مالون جمع آوری شد .تحلیل داده ها با استفاده از نمودار دیداری، درصد بهبودی و معنی داری بالینی نشان داد که رفتاردرمانی پذیرش محور می تواند در درمان بیماران مبتلا به اختلال موکنی ، کندن پوست و ناخن جویدن موثر باشد. درمان کاهش معنی داری را در نشانه ها ایجاد کرد و اثر درمانی تا سه ماه پیگیری ادامه یافتند. به نظر می رسد افزودن مداخلات مبتنی بر پذیرش به روش های سنتی رفتاردرمانی در کاهش نشانه های متمرکز بر بدن موثر است.
کلیدواژه‌ها
رفتاردرمانی پذیرش محور
موکنی
کندن پوست
ناخن جویدن

عنوان مقاله English

Effectiveness of Acceptance enhanced behavior therapy on Body Focused Repetitive Behavior Disorders (Trichotillomania, Skin Picking, Nail biting): A multiple baseline design with three month follow up

نویسندگان English

Paria Faroughi
Zeynab khanjani
Touraj Hashemi
Majied Mahmoud- Aliloo
Tabriz universit
چکیده English

Acceptance enhanced behavior therapy (AEBT) is a combination of Habit reversal and Acceptance –Commitment Therapy. In the present study the effectiveness of this treatment in reducing symptoms of patients with Body Focused Repetitive Behaviors ( BFRBS) as kind of Trichotillomania, Skin picking and Nail biting disorder was examined. This study used multiplebaseline design which was on of the single subject design. Treatment was conducted on the six patients (two patients for each disorder) through 10 sessions. after tratment session, patients were assessed after three month later. Data was gathered by Massachusetts Hospital – Hair pulling Scale, Skin Picking Scale questionnaire and Nail biting scale. Data were analyized by using visual acuity chart, recovery rate and clinical significance. Findings showed that AEBT could be effective in the treatment of patients with BFRBS. The treatment caused significant reduction in the patient’s symptoms and follow-up over three month revealed that the treatment effects were maintained. it seemed that adding acceptance based intervention to conventional behavioural therapy thechnique could be effective in reducing Body focused repetitive behaviors problems.

کلیدواژه‌ها English

Acceptance enhanced behavior therapy
Trichotillomania
Skin Picking
Nail biting
1 Snorrason I, Ricketts EJ, Flessner CA, Franklin ME, Stein DJ, Woods DW. Skin picking disorder is associated with other body-focused repetitive behaviors: findings from an Internet study. Ann Clin Psychiatry. 2012;24(4):292-9.
.2 Woods DW, Wetterneck CT, Flessner CA. A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behav Res Ther. 2006;44(5):639-56.
.3 Association AP. Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Arlington, VA: American Psychiatric Association. Inc; 2013.
.4 Roberts S, O'Connor K, Aardema F, Bélanger C. The impact of emotions on body-Focused repetitive behaviors: Evidence from a non-treatment-seeking sample. J Behav Ther Exp Psychiatry. 2015;46:189-97.
.5 Tucker BT, Woods DW, Flessner CA, Franklin SA, Franklin ME. The Skin Picking Impact Project: phenomenology, interference, and treatment utilization of pathological skin picking in a population-based sample. J Anxiety Disord. 2011;25(1):88-95.
.6 Williams TI, Rose R, Chisholm S. What is the function of nail biting: an analog assessment study. Behav Res Ther. 2007;45(5):989-95.
.7 Bohne A, Keuthen N, Wilhelm S. Pathologic hairpulling, skin picking, and nail biting. Ann Clin Psychiatry. 2005;17(4):227-32.
.8 Duke DC, Keeley ML, Geffken GR, Storch EA. Trichotillomania: a current review. Clinical Psychology Review. 2010;30(2):181-93.
.9 Christenson GA, Mackenzie TB, Mitchell JE. Characteristics of 60 adult chronic hair pullers. Am J Psychiatry. 1991;148(3):365.
.10 Flessner CA, Woods DW, Franklin ME, Cashin SE, Keuthen NJ, Board TLC-SA. The Milwaukee inventory for subtypes of trichotillomania-adult version (MIST-A): development of an instrument for the assessment of “focused” and “automatic” hair pulling. J Psychopathol Behav Assess. 2008;30(1):20-30.
.11 Christenson GA, Ristvedt SL, Mackenzie TB. Identification of trichotillomania cue profiles. Behav Res Ther. 1993;31(3):315-20.
.12 Walther MR, Flessner CA, Conelea CA, Woods DW. The Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS): initial development and psychometric properties. J Behav Ther Exp Psychiatry 2009;40(1):127-35.
.13 Chawla N, Ostafin B. Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. J Clin Psychol. 2007;63(9):871-90.
.14 Bate KS, Malouff JM, Thorsteinsson ET, Bhullar N. The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: a meta-analytic review. Clinical Psychology Review. 2011;31(5):865-71.
.15 Bloch MH, Landeros-Weisenberger A, Dombrowski P, Kelmendi B, Wegner R, Nudel J, et al. Systematic review: pharmacological and behavioral treatment for trichotillomania. Biological psychiatry. 2007;62(8):839-46.
.16 Fine KM, Walther MR, Joseph JM, Robinson J, Ricketts EJ, Bowe WE, et al. Acceptance-enhanced behavior therapy for trichotillomania in adolescents. Cogn Behav Pract.. 2012;19(3):463-71.
.17 Irandoost F, Neshat doost HT, Nadi MA, Safary S. The effectiveness of Acceptance and Commitment Therapy (ACT) on the rate of chronic pain and pain catastrophizing in women with chronic low back pain. rph. 2014;8(3):31-40.
.18 Twohig MP, Woods DW. A preliminary investigation of acceptance and commitment therapy and habit reversal as a treatment for trichotillomania. Behavior Therapy. 2004;35(4):803-20.
.19 Twohig MP, Hayes SC, Masuda A. A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking. Behav Res Ther. 2006;44(10):1513-22.
.20 Flessner CA, Busch AM, Heideman PW, Woods DW. Acceptance-enhanced behavior therapy (AEBT) for trichotillomania and chronic skin picking: Exploring the effects of component sequencing. Behavior Modification. 2008;32(5):579-94.
.21 Woods DW, Flessner CA, Franklin ME, Keuthen NJ, Goodwin RD, Stein DJ, et al. The Trichotillomania Impact Project (TIP): exploring phenomenology, functional impairment, and treatment utilization. J Clin Psychol. 2006;67(12):1877.
.22 Capriotti MR, Ely LJ, Snorrason I, Woods DW. Acceptance-enhanced behavior therapy for excoriation (skin-picking) disorder in adults: A clinical case series. Cogn Behav Pract 2015;22(2):230-9.
.23 O’Sullivan RL, Keuthen NJ, Hayday CF, Ricciardi JN, Buttolph L, Jenike MA, et al. The Massachusetts General Hospital (MGH) hairpulling scale: 2. reliability and validity. Psychother Psychosom. 1995;64(3-4):146-8.
.24 Keuthen NJ, Wilhelm S, Deckersbach T, Engelhard IM, Forker AE, Baer L, et al. The Skin Picking Scale: scale construction and psychometric analyses. J Psychosom Res. 2001;50(6):337-41.
.25 Rabiei M, Kalantari M, Askari K, Bahrami F. Factor Structure, Validity and Reliability of the Skin Picking Scale Revised Version. Zahedan. J Res Med Sci.. 2014;16(9):40-4.
.26 Leung AK, Robson LM. Nailbiting. Clinical pediatrics. 1990;29(12):690-2.
.27 Koritzky G, Yechiam E. On the value of nonremovable reminders for behavior modification: An application to nail-biting (Onychophagia). Behavior modification. 2011;35(6):511-30.
.28 Woods DW, Twohig MP. Trichotillomania: An ACT-enhanced behavior therapy approach therapist guide: Oxford University Press; 2008.
.29 Beeson PM, Robey RR. Evaluating single-subject treatment research: Lessons learned from the aphasia literature. Neuropsychology review. 2006;16(4):161-9.
.30 Ferguson CJ. An effect size primer: A guide for clinicians and researchers. Professional Psychology: Research and Practice. 2009;40(5):532.
.31 Ogles BM, Lunnen KM, Bonesteel K. Clinical significance: History, application, and current practice. Clinical psychology review. 2001;21(3):421-46.
.32 Kazdin AE. The meanings and measurement of clinical significance. 1999.
.33 Ingram RE, Hayes A, Scott W. Empirically supported treatments: A critical analysis: John Wiley & Sons Inc; 2000.
.34 Imani M, Pourshahbazi M. Prediction of Borderline Personality Disorder Based On Psychological Flexibility Components: Acceptance and Action, Values and Cognitive Defusion. Journal of Research in Psychological Health, 2017, 10(4), 1-9 [Persian]