نوع مقاله : علمی- پژوهشی
نویسندگان
1 عضو هیات علمی دانشگاه بوشهر
2 عضو هیات علمی دانشکده علوم تربیتی و روانشناسی دانشگاه شهید چمران اهواز،اهواز،ایران
چکیده
تحقیق حاضر اثربخشی درمانهای شناختی، تن‌آرامی و رفتاری را در گروهی از دبیران شهر اهواز که مبتلا به کمردرد مزمن بودند مورد ارزیابی قرار داد. روش این تحقیق آزمایشی بود. جمعیت هدف این تحقیق را دبیران مرد شهر اهواز تشکیل می‌دادند. نمونه تحقیق شامل 100 نفر بیمار مبتلا به کمردرد مزمن می‌باشد که به طور تصادفی از بین بیماران مبتلا به کمر درد مزمن انتخاب و به گروههای آزمایشی (شناخت درمانی، رفتار درمانی، تن آرامی) و گروه گواه گمارده شدند (هر گروه 25 نفر). شیوه‌های مداخله (درمان) در این تحقیق عبارت بودند از: الف) مصون‌سازی در مقابل درد (میکنبام و ترک، 1976)، ب) کنترل محرک (کانفر، 1980)، ج) تن آرامی عضلانی پیشرونده (جاکوبسن، 1962). چهار شاخص بهبودی در تحقیق حاضر در نظر گرفته شد که شامل بهبود باورهای درد، بهبود رفتار درد، بهبود خودکفایی درد و بهبود افسردگی بود. ابزارهای درد (زارکوفسکا، 1988)، آزمون خودکفایی درد (نیکولاس، 1989)، آزمون افسردگی (بک، 1961) و آزمون درد مزمن (اصغری‌مقدم، 1374) بودند. نتایج مرحله اول تحقیق بیانگر پایایی و اعتبار مطلوب و رضایت‌بخش این آزمونها می‌باشد. نتایج آماری نشان داد که روشهای درمان در بهبود کمردرد مزمن در آزمودنیها مؤثر بوده‌اند. تحلیل واریانس یک راهه تفاضل میانگین نمره‌های آزمودنیهای گروههای مختلف، در دو مرحله اجرای آزمونهای مربوط به درد مزمن، حاکی از تفاوت معنی‌دار بین گروههای درمانی در شاخصهای بهبودی بود. آزمون توکی، نشان داد که گروه شناخت درمانی و گروه تن آرامی عضلانی در بهبود باورهای درد و کاهش افسردگی تفاوتهای معنی‌داری با گروه گواه ظاهر ساختند. حال آنکه، چنین یافته‌ای در گروه رفتاردرمانی دیده شد. وانگهی، هر سه گروه درمان‌شناختی، تن آرامی و رفتاری در خودکفایی درد و بهبود رفتارهای درد، تفاوتهای معنی‌داری با گروه گواه نشان دادند. افزون بر آنچه گفته شد، نتایج آماری حاصل از بررسی مقایسه‌ای روشهای درمانی نشان داد که این روشها از لحاظ میزان کارایی تفاوتهای معنی‌داری با یکدیگر داشتند
کلیدواژه‌ها
عنوان مقاله [English]
Investigation of the Effectiveness of Cognitive, Relaxation, and Behavioral Therapies in Improving Chronic Backpain among Ahvaz Male High School Teachers
نویسندگان [English]
- A. Pooladi Reyshahri 1
- B. Najarian 2
- H. Shokrkon 2
- M. Meharbizadeh Honarmand 2
1 Faculty member of Bushehr University
2 Faculty member of the Faculty of Educational Sciences and Psychology, Shahid Chamran University, Ahvaz, Ahvaz, Iran
چکیده [English]
Using an experimental research design, the present study exmined the effectiveness of three kinds of therapy in the management of chronic back- pain among Ahvaz male high school teachers. The sample consisted of 100 patients suffering from chronic backpain. Twenty five subjects were randomly assigned to each one of the following four conditions: Three experimental groups (i.e., cognitive, relaxation and behavioral interventions) and one control group. The three management approaches exercised were stress inoculation (Miechenbaum and Turk, 1976), progressive muscular relaxation (Jacobson, 1962), and stimulus control (Kaunfer, 1980). Improvement in pain beliefs, pain behavior, pain self-efficacy, and depression were all employed as the four major improvement indices of pain management and treatment. The Pain Measures (Zarkowfska, 1988), Pain Self-Efficacy Questionnaire (Nickolas, 1989), Beck Depression Inventory (Beck, 1961) and Chronic Pain Test (Asghari Moghaddam, 1995) were used to measure the dependent variables. Results of the preliminary stage indicated that the afore-mentioned pain measures are psychometrically sound, reliable and valid. Data analysis revealed that the treatment methods used are effective in reducing the chronic backpain indices. A one-way analysis of variance showed significant differences among the three treatment conditions; A Tukey test showed that cognitive group and progressive muscular relaxation group were superior to the control group in reducing the pain beliefs and depression. The behavioral group, however, showed no significant difference with the control group. Furthermore, all three experimental conditions were significantly more effective than the control condition in reducing the pain self-efficacy and pain
کلیدواژه‌ها [English]
- : cognitive therapy
- relaxation
- behavior therapy
- chronic backpain
Ajonoff, G. M., & McAlary, P. W. (1990). Multidiciplinary treatment of intractable pain syndromes. In S. Lipton, E. Tunks, & M. Zoppi (Eds.) Advances in Pain Research and Therapy, (Vol, 13) (PP. 267-276). New York:Raven Press.
Bandura, A. (1986). Social loundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.
Barber, J., and Adrian, C. (1982). Ps’chological Approaches to the Management of Pain. New York: Branner Mazel.
Beck, A. T. (1991). Cognitive therapy. American PychokigLcl, 46, 368-375.
Beck, A. T., & Steer, R. A. (1987). Beck Depression Inventory. New York: Harcourt Brace Jovanorich.
Beck, A. T., Rush, A.J., Shaw, B.f., & Emerv.G. (1979). cognitive Therapy of Depression. New York: Guilford Press.
Bilings, A. G., & Moos, R. H. (1984). Coping stress and social resources in attenuating the stress of life events. Journal of Personality and Social Psychology, 46, 877-891.
Blanchard, E. B., & Andrasik, F. (1985). Management of chronic headaches: A psychological. New York: Pergamon Press.
Bogaards, M. C., Terkuile, M. M. (1994). Treatment of recurrent tension headache: a meta analytic review. Pain, 10, 174-190.
Bonica, J. 3. (1977). Neurophysiologic and pathophysiologic aspects of acute and chronic pain. Archives of Surgeiy, 112, 750-761.
Bowsher, D., Rigge, M., & Sopp, L. (1991). Preva]ance of chronic pain in the British papoulation: A telephone survey of 1937 households, Pain (‘linic, 4.
223-230.
Clark, M., Gousnell. M., & Shapiro, D. (1977). The new war on pain. Newsweek (April 25), 89, 48-58.
De Bruijin-Kofman, A. T. Groenman, N. 1-1. (1987). Ontwikkeligen in hehaneligssiralegieen van spanning shoofd pijn. TUdschrft Voor Psychothrapie, 2, 63-67.
Ellis, A. (1973). The no cop-out therapy. Psychokigy Teday, 7, 56-62.
Fishbain, D. A., & Goldberg, M. (1991). Completed Suicide in chronic pain. Pain, 7, 29-39.
Fior, H., Turk, D. C., & Birrnbaumer, N. (1985). Assessment of stress related psychophysiological reactions in chronic low hack pain patiets. Journal of consalling and Clinical P’chology, 53, 354-364.
Follick, M. J., Smith, T. W., & Ahren, D. k. (1985). The Sickness impact profile: A global measure of disability in chronic low back pain. Pain, 21.
67-76.
Fordyc, W. E. (1990). Contingency managment. In: J. J. Bonica (Eds), The managment ol pain. Philadelphia: Lea and febiger.
Fordyce, W. E. (1976). Contingency management. In J.J. Bonica (Eds.), The Management of Pain (2nd ed., 1702-1710). Philadelphia: Lea and Febiger.
Fordvce, W. E. (1976). Behavioral Methods for Chronic Pain. Sydney: Grune and stratton.
Fordyce, W. E. (1986). The behavioral management of chronic pain. Pain, 22,
113-125.
Gamsa, A. (1990). Is emotional disturbance a precipitator or a consequence of chronic pain? Pain, 42, 183-195.
Good, M. (1996). A comparison of the effects of jaw relaxation and music on postoperative pain. Nursing Research, 44, 52-57.
Holmherg, S. (1988). Pain, In Beck, Rawling and Williams (Eds). Mental Health Psychiatric Nursing. Washington: The C. V. Mosby Company.
Inienalional Association for the study of pain. (1986). Classfication of chronic pain. Pain, 3, 51-s226.
Jacobson, E. (1957). You must relar, New York: McGraw.
Jafiray, D. (19 6). Isolated intevrerzebral resorption. Spine, 11, 397.
Jensen, I.B., and Good, H.L. (1999). Patient belief predical patient functioning. Pain, 81, 95-104.
Kanfer, F. H., and Gold foot, D. A. (1986). self control and tolerance of noxious stimulation. Psychological Reports, 18, 79-85.
Kanfer, F.H., and Goldfoot, D.A. (1986). Self-control and tolerance of noxious stimulation. Psychological Reports, 18, 79-58.
Keefe, F. J.. & Dolan, E. (1988). Pain behavior and pain coping strtegies in low back pain. Pain, 24, 49-56.
Keefe, F. J.. Dunsmore, 3., & Burnett. R. (1992a). Behavioural and congnitive behavioural approaches to chronic pain: Recent advance and future direction. Journal of consulting and Clinical Psycholo’, 60, 528-536.
Keefe, F.J., & Wiliams, D.A. (1990). A comparison of coping strategies in chronic pain patients in different age groups. Journal of Gerontolo’, 45,
161-165.
Kleinke. C.L. (1991). Coping with life challenges. Pacific Grove: Brook/cole.
Linton. S. 3., & Melin, L. (1982). The accuracy of remembered Pain. Pain, 13, 281-285.
McCracken, L. M., Gross, R. T., & Sorg, P. J. (1993). Prediction of pain in patients with chronic low back pain. Behavioral Research, 31, 647-657.
Melzack, R. (1992). Phantom limbs. Scientjfic American, 266, 120-126.
Meizack. R.,& Wall, P. (1975). Pain mechanisms: A new theoiy. Science, 50,
971-979.
Miller, L. (1993). Psychotherapeutic approach to chronic pain. Psychoiherapy, 30, 49-57.
Miller, T. Q.. & Smith, T. W. (1990). Meta anaytic review of research on hostility and physical health. Psychological Bulletin, 119, 322-348.
Nachemson, A. L. (1992). Newest Knowledge of low back pain. Clinical Orthopaedics and Related Research, 279, 8-20.
Nicholas. M. K. (1989). Self-efficacy and chronic pain. Paper presented at the annual conlerence of the British Psychological Society, St. Andrews.
Nicholas, M. K., B]anck, A., & Cohen, M.C. (1996). Comparison of three groups of injured workers with different outcomes at 2-4 years post injury. Paper presented at the 17th Australican Scientific of Australican Pain Society. Canberra, Australia.
Pennehaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psycholiigv Science, 8, 162-166.
Philips, H. C.. & Jahanshahi, M. (1986). The components of pain behaviour report. Behaviour Research and Therapy, 24, 117-125.
Pither. C. E., & Nicholas, M. K. (1991). The identification of iatrogenic factors in the development of chronic pain syndrome: abnormal treatment behavior? In M. R. Bond, J. E. Charlion, & C. J. Woolf (Eds.). Proceedings of the Vith World Congress on pain (pp. 429-434). Amsterdam: Elsevier.
Riley, J. F., Ahern, D. K., & Follick, M. J. (1988). Chronic pain and functional impairment: Assessing beliefs about their relationship. Archives of Physical Medicine and Rehabilitation, 59, 579-582.
Saunders, T. (1996). The effect of Stress inoculation training on anziety and Perlormance. Journal of Occpational Health PcholDgv, 1, 170-186.
Sofar, B., and walker. J. (1994). Mood assessment in chronic pain patients. Disably Rechabiliation, 16, 35-38.
Sternbach, R. (1974). Pain patients trails and treatments. San Diego, CA:
Academic Press.
Turk, D. C. (1996). Biopsychosocial perspective on chronic pain, In RJ. Gaichel & D. C. Turk (Eds), Psychological Approaches to Pain Management (pp. 3-32). NewYork: Guilford press.
Turk, D. C., Michenhaum, D. Genest, M. (1983). Pain and behavioral Medicine. New York: Guilford Press.
Turk, D. C., Okifuji, A., & Scharif, L. (1995). Chronic pain and depression:
Role of perceived impact and perceived control in different age cohorts. Pain, 61, 93-101.
Turk, D. C., and Rudy, T. E. (1985). Pain experience: Assessing the cognitive component. Paper presented at the fourth annual meeting of the American Pain Society, Dallas, TX.
Turner, J. A., & Clancy, S. (1987). Relationships of stress appraisals and coping to chronic low back pain. Behavior Research and Therapy, 25,
281-288.
Turner, J. A., & Jensen, M. P. (1993). Efficacy of cognitive therapy for chronic low back pain. Pain, 51, 169-177.
Turner, J. A., and Chapman. C. J. (1982). Psychological intervnetions for chronic pain: A critical review. II. Operant conditioning, hypnosis, and cognitive-behavioral therapy. Pain, 12, 23-46.
Wiliams, D.A., & Thorn, B.C. (1989). An empirical assessment of pain, helifes. Pain, 36, 351-358.
Zarkowska, A.W. (1981). The relationship between subjective and behavioural aspects people suffering from lower back pain. M. Phil. Thesis. University of London.
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