اثر بخشی درمان هیجان مدار براضطراب درد و تاب آوری در بیماران مبتلا به میگرن (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
میگرن به عنوان یکی از شایع ترین اختلالات عصبی، تأثیری جالب توجه بر کیفیت زندگی افراد مبتلا دارد. این اختلال با دردی شدید و ناتوان کننده همراه است که ممکن است ناشی از عوامل هیجانی و شناختی باشد. هدف از پژوهش حاضر بررسی اثربخشی درمان هیجان مدار بر اضطراب درد و تاب آوری در بیماران مبتلا به میگرن بود. این پژوهش از نوع نیمه آزمایشی با پیش آزمون، پس آزمون و گروه کنترل و مرحله پیگیری سه ماهه است. جامعه آماری پژوهش شامل تمامی بیماران مبتلا به میگرن شهر اصفهان است که در سال 1402-1403 به یکی از کلینیک های تخصصی میگرن شهر اصفهان مراجعه کردند. به کمک نمونه گیری در دسترس، 30 نفر از این افراد انتخاب شدند. افراد به طور تصادفی با نسبت 1:1 در گروه کنترل و آزمایش قرار گرفتند. گروه آزمایش مداخله درمان هیجان مدار (بر اساس بسته درمانی درمان هیجان مدار گرینبرگ و همکاران، 2008) را طی 8 جلسه 90دقیقه ای هفته ای یک بار دریافت کردند. داده ها با استفاده از مقیاس اضطراب درد (مک کراکن و دینگرا (2002)) و تاب آوری (کانر و دیویدسون (2003)) جمع آوری و به روش تحلیل واریانس آمیخته با نرم افزار SPSS-26 تجزیه وتحلیل شد. نتایج نشان دهنده کاهش معنادار میانگین نمرات اضطراب و افزایش معنادار میانگین نمرات تاب آوری بیماران در مراحل پس آزمون و پیگیری است. با توجه به تأثیر درمان هیجان مدار بر اضطراب درد و تاب آوری در بیماران مبتلا به میگرن (05/0>P)، پیشنهاد می شود درمانگران در مواجهه با بیماران مبتلا به میگرن با مشکلات هیجانی از این روش درمانی استفاه کنند.The Effectiveness of Emotion-Focused Therapy on Pain Anxiety and Resilience in Patients with Migraine
Migraine as one of the most common neurological disorders, significantly impacts the quality of life in affected individuals. This disorder is accompanied by severe and debilitating pain, which may stem from emotional and cognitive factors. This study aimed to investigate the effectiveness of Emotion-focused Therapy (EFT) on pain anxiety and resilience in patients with migraine. The research employed a quasi-experimental design with a pretest, posttest, and a control group. Thirty patients with migraine were selected via convenience sampling and were randomly assigned to experimental and control groups. The experimental group received eight 90-minute sessions of EFT. Data were collected using the Pain Anxiety Scale (McCracken & Dhingra, 2002) and the Resilience Scale (Connor & Davidson, 2003) and analyzed via mixed variance analysis in SPSS-26. Results indicated a significant decrease in the mean scores of pain anxiety and a significant increase in the mean scores of resilience in the post-test and follow-up assessments (p < 0.05). Given the effectiveness of Emotion-focused Therapy on pain anxiety and resilience in patients with migraine, it is recommended that this therapy be utilized as a complementary intervention in migraine management.IntroductionMigraine, as one of the most common neurological disorders, affects approximately 14.4% of the global population and is associated with severe and debilitating headaches. This disorder, which is more prevalent in women, can be manifested in more severe forms such as chronic migraine or high-frequency migraine (di Cola et al., 2023). Research has shown that emotional and cognitive variables, particularly pain anxiety and resilience, play significant roles in the severity and disability caused by migraine (Crouch et al., 2024). Pain anxiety, as a future-oriented emotional state, involves negative cognitive and physiological responses that exacerbate pain intensity (Bishay et al., 2023). On the other hand, resilience, as the ability to adapt positively to stressful conditions, can reduce the severity of migraine attacks and improve patients' quality of life (Vos et al., 2015).Emotion-focused therapy (EFT), as a psychotherapeutic approach based on deep emotional processing and restructuring attachment patterns, has demonstrated efficacy in reducing psychological issues such as anxiety, depression, and trauma (Elliott et al., 2013). Previous studies have confirmed the effectiveness of EFT and other psychological interventions, such as Cognitive Behavioral Therapy (CBT) and mindfulness, in alleviating symptoms associated with chronic headaches (Mousa Zadeh et al., 2023). However, no specific research has been found that examines the efficacy of EFT on pain anxiety and resilience in migraine patients.Given the high prevalence of migraine and its impact on individuals' quality of life, this study was designed to investigate the efficacy of Emotion-focused Therapy on pain anxiety and resilience in patients with migraine. This research aims to address the existing gap in the literature by providing new empirical evidence and offering effective therapeutic strategies for managing symptoms of this disorder.MethodThis quasi-experimental study employed a pretest-posttest design with a three-month follow-up. The statistical population included migraine patients visiting specialized clinics in Isfahan from 2023 to 2024. Thirty patients were selected based on inclusion criteria and randomly assigned equally to experimental and control groups. The sample size was calculated using GPower software, considering a power of 80% and a significance level of 0.05. Based on the mean and standard deviation reported in Yazdanfar et al.'s study (2020) and accounting for approximately 10% sample attrition, the final sample size was estimated as 30 (15 in the control group and 15 in the experimental group).Data collection tools included the Pain Anxiety Questionnaire (McCracken & Dhingra, 2002) and the Resilience Questionnaire (Connor & Davidson, 2003). The Cronbach's alpha coefficient for pain anxiety in the present study was 0.91, and for resilience, it was 0.835. The intervention group received eight 90-minute group sessions of EFT based on Greenberg et al.'s (2008) therapeutic package. To analyze the data, the normality of the distribution was assessed using the Shapiro-Wilk test. Mixed ANOVA was used to evaluate the efficacy of EFT on pain anxiety and resilience. Analyses were performed using SPSS version 26.FindingsThe results indicated that EFT had a significant effect on pain anxiety and resilience in migraine patients. Specifically, the mean pain anxiety and resilience in the intervention group decreased and increased, respectively, in the post-test and follow-up, whereas no significant changes were observed in the control group (Table 1).The Shapiro-Wilk test confirmed the normal distribution of data in both groups across all assessment stages. Additionally, Levene's test indicated homogeneity of variances for the dependent variables between groups. Multivariate mixed ANOVA revealed significant differences in pain anxiety and resilience based on group, assessment time, and the interaction between group and assessment time (Table 2). These findings highlight the efficacy of EFT in reducing pain anxiety and enhancing resilience in migraine patients. Table 1. Mean and Standard Deviation of Pretest, Posttest, and Follow-up for the Variables of Anxiety, Pain, and Resilience.VariableGroupPretestPosttestFollow-upMSDMSDMSDPain AnxietyEmotion-Focused Therapy49.84.05404.7134.14.79Control Group50.34.3249.84.2449.64.15ResilienceEmotion-Focused Therapy63.66.7769.74.9969.25.03Control Group63.85.6863.95.6263.65.70M: mean, SD: standard deviation Table 2. Results of the Mixed Multivariate Analysis of Variance on Pain Anxiety and Resilience.SourceTestValueFHypothesis dfError df Sig.Eta SquaredEvaluation TimePillai’s Trace0.993283.214290.0010.993Wilks’ Lambda0.007283.214290.0010.993Hotelling’s Trace136.7283.214290.0010.993Roy’s Largest Root136.7283.214290.0010.993Group Evaluation TimePillai’s Trace1.639.4728600.0010.815Wilks’ Lambda0.00528.628580.0010.993Hotelling’s Trace79.279.228560.0010.975Roy’s Largest Root77.4166.0214300.0010.987 Conclusion and DiscussionThe results of this study demonstrated that Emotion-focused Therapy (EFT) is significantly effective in reducing pain anxiety and enhancing resilience in patients with migraines. These findings align with previous studies that have shown the efficacy of EFT in reducing pain intensity, increasing resilience in patients with chronic headaches (Fathi et al., 2020), and alleviating pain anxiety in patients with rheumatoid arthritis (Yazdanfar et al., 2020). EFT, with its structured and phase-oriented approach, helps patients modify their emotional responses to pain by focusing on core emotional experiences and unmet attachment needs, enabling them to develop more adaptive coping strategies. This therapeutic process not only reduced pain-related anxiety but also assisted patients in moving beyond superficial emotions to access deeper emotional layers. By externalizing problems and addressing unmet emotions and needs during therapy sessions, patients were able to view their issues as separate from their identity and gain a better understanding of the emotional roots of their pain (Greenberg & Goldman, 2019). Furthermore, EFT fostered a safe and supportive therapeutic relationship, helping patients identify and regulate negative emotions and create positive changes in emotional patterns. This process enhanced patients' sense of security and control over their pain experience. The therapy sessions also helped patients develop a more positive self-image, improving their self-confidence, emotional self-regulation, and flexibility. This process not only strengthened their ability to manage emotional distress but also enhanced their sense of self-worth and empowerment. By increasing awareness of both positive and negative emotions, EFT facilitated the timely acceptance and expression of emotions, playing a significant role in boosting resilience (Amjadiyan et al., 2023). Ultimately, such dual aspects of EFT simultaneously helped patients reduce pain anxiety, enhance resilience, and cope more effectively with migraine-related challenges. Limitations of this study include the restricted sampling to Isfahan City, which limits the generalizability of the results. Additionally, confounding variables such as subcultures and socioeconomic conditions may have influenced the outcomes. It is recommended that EFT be integrated into conventional treatments as a multimedia educational program and adopted as part of public health education initiatives. Combining EFT with existing therapies could improve mental and physical health outcomes. Future research should investigate the long-term effects of EFT and its integration with other therapeutic methods.
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