پیوندهای مفید
اخبار و اعلانات
آمار
| تعداد نشریات | 49 |
| تعداد شمارهها | 1,289 |
| تعداد مقالات | 11,123 |
| تعداد مشاهده مقاله | 23,005,039 |
| تعداد دریافت فایل اصل مقاله | 15,535,358 |
مقایسه اثربخشی طرحواره درمانی مبتنی بر ذهنیت با و بدون آموزش شفقت خود بر سلامت عمومی و شاخص قند خون هموگلوبین گلیکوزیله در بیماران دیابتی نوع دو | ||
| روانشناسی سلامت | ||
| دوره 15، شماره 57، خرداد 1405، صفحه 79-92 اصل مقاله (1.12 M) | ||
| نوع مقاله: علمی- پژوهشی | ||
| شناسه دیجیتال (DOI): 10.30473/hpj.2026.75252.6288 | ||
| نویسندگان | ||
| جواد ایوبی1؛ ایرج شاکری نیا* 2؛ عذرا زبردست3 | ||
| 1دانشجوی دکتری روانشناسی، گروه روانشناسی، دانشکده ادبیات و علوم انسانی، دانشگاه گیلان، رشت، ایران. | ||
| 2دانشیار، گروه روانشناسی دانشگاه گیلان، دانشکده ادبیات و علوم انسانی، دانشگاه گیلان، رشت، ایران. | ||
| 3استادیار، گروه روانشناسی دانشگاه گیلان، دانشکده ادبیات و علوم انسانی، دانشگاه گیلان، رشت، ایران. | ||
| چکیده | ||
| مقدمه: این پژوهش با هدف بررسی اثربخشی طرحوارهدرمانی مبتنی بر ذهنیت و ترکیب آن با آموزش شفقت به خود بر سلامت عمومی و شاخص قند خون هموگلوبین گلیکوزیله (HbA1C) در بیماران دیابتی نوع دو انجام شد. روش: در این مطالعه نیمهآزمایشی با طراحی پیشآزمون-پسآزمون، پس از غربالگری اولیه با پرسشنامه طرحوارههای ناسازگار یانگ برای تعیین واجد شرایط بودن شرکتکنندگان، از میان افرادی که حداقل یک طرحواره ناسازگار داشتند، ۳۶ بیمار مبتلا به دیابت نوع دو از شهرستان مشهد بهطور تصادفی در دو گروه آزمایشی و یک گروه کنترل جایدهی شدند. ابزارهای پژوهش شامل مقیاس سلامت عمومی گلدبرگ و آزمایش HbA1C بود. درمانها براساس پروتکل طرحوارهدرمانی فارل و همکاران (۲۰۱۲) و آموزش شفقت به خود دزموند (۲۰۱۵) در ۱۰ جلسه هفتگی ارائه شد. دادهها با نرمافزار SPSS نسخه ۲۶ تحلیل شد. ابتدا نرمالبودن دادهها با آزمون شاپیرو-ویلک بررسی و برای مقایسه گروهها از تحلیل کوواریانس تکمتغیره و آزمون تعقیبی بنفرونی استفاده شد. سطح معناداری کمتر از 05/0 و شاخص اندازه اثر گزارش شد. یافتهها: نتایج نشان داد که هر دو مداخله باعث بهبود معنادار سلامت عمومی و کاهش سطح HbA1C شدند .گروه دریافتکننده طرحوارهدرمانی همراه با آموزش شفقت به خود کاهش معنادار بیشتری در نشانهها نسبت به گروه دریافتکننده فقط طرحوارهدرمانی داشت. نتیجهگیری: یافتهها نشان میدهد که آموزش شفقت به خود میتواند اثربخشی طرحوارهدرمانی را در بهبود سلامت عمومی و کنترل قند خون بیماران دیابتی افزایش دهد. این پژوهش اهمیت طراحی مداخلات تلفیقی در مدیریت بیماریهای مزمن را تأکید میکند. | ||
| کلیدواژهها | ||
| طرحوارهدرمانی مبتنی بر ذهنیت؛ شفقت به خود؛ سلامت عمومی؛ دیابت نوع دو؛ شاخص قند خون هموگلوبین گلیکوزیله | ||
| عنوان مقاله [English] | ||
| Comparing the Effectiveness of Mode-Based Schema Therapy with and without Self-Compassion Training on General Health and Glycated Hemoglobin in Type 2 Diabetes Patients | ||
| نویسندگان [English] | ||
| Javad Ayoubi1؛ Iraj Shakerinia2؛ Azra Zebardast3 | ||
| 1Ph.D. Student in Psychology, Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran. | ||
| 2Associated Professor, Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran. | ||
| 3Assistant of Professor, Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran. | ||
| چکیده [English] | ||
| Objective: The management of Type 2 diabetes mellitus (T2DM), a highly prevalent chronic metabolic disorder, necessitates a biopsychosocial framework that addresses its significant psychological comorbidities alongside physical health. The continuous burden of self-care, lifestyle modification, and treatment adherence can lead to chronic stress, anxiety, depression, and diminished general health. Underlying these challenges, maladaptive cognitive schemas and pervasive self-criticism are recognized as key vulnerability factors that exacerbate psychological distress and impede effective glycemic control. To target these core mechanisms, Mode-Based Schema Therapy (MBST) has been established as an effective intervention for modifying dysfunctional schemas and enhancing emotional regulation. In a complementary fashion, self-compassion training aims to mitigate self-criticism and foster emotional acceptance and kindness toward the self. While the separate efficacy of each approach has been documented, their synergistic potential within an integrated treatment model remains largely unexamined. Crucially, there is a lack of empirical research investigating whether combining these interventions yields superior outcomes that span both psychological well-being and objective physiological markers. This gap limits the development of holistic treatment protocols that can simultaneously target the cognitive, emotional, and behavioral facets of diabetes distress. Therefore, the present study aimed to evaluate and compare the effectiveness of MBST alone versus MBST integrated with self-compassion training on improving general health and reducing glycated hemoglobin (HbA1c) levels in patients with T2DM. This comparative approach seeks to determine if augmenting schema-focused work with compassion-based strategies provides added value for comprehensive patient care. Method: This quasi-experimental study employed a pretest-posttest design with a control group. The statistical population included 2,400 patients with type 2 diabetes who were members of the Iranian Diabetes Association in Mashhad in 2024. After initial screening and Considering the criteria for entry and exit from research, 36 eligible participants were selected and randomly assigned to three groups: (1) Mode-Based Schema Therapy, (2) Mode-Based Schema Therapy combined with self-compassion training, and (3) a control group receiving no psychological intervention. Both intervention groups participated in 10 weekly group sessions, each session lasting 90 minutes. Mode-Based Schema Therapy sessions were conducted according to the protocol developed by Farrell et al. (2012), while self-compassion training followed Desmond (2015). Interventions aimed to modify maladaptive schemas, enhance healthy adult status, cultivate self-compassion, and learn adaptive coping with diabetes-related stress. Data collection tools included the General Health Questionnaire (GHQ-28) and HbA1C blood test. Data were analyzed using analysis of covariance (ANCOVA), controlling for pretest scores. Normality assumptions were checked with the Shapiro-Wilk test, and effect sizes were reported. The significance level was set at p<0.05. Results: Data analysis indicated significant improvements in general health and reductions in HbA1c levels in both intervention groups, whereas the control group showed no considerable changes. Results from a multivariate analysis of covariance (MANCOCOVA), controlling for pretest scores, revealed statistically significant differences among the three groups on the combined dependent variables (Wilks' Lambda = 76.14, p< .001). Follow-up univariate ANCOVAs confirmed that these differences were significant for both general health (F = 27.69, p < .001, η² = 0.634) and HbA1c (F = 16.29, p < .001, η² = 0.505). Pairwise comparisons with Bonferroni adjustment confirmed that both intervention groups performed significantly better than the control group. Furthermore, comparisons between the two active groups showed that the combined intervention group (MBST + self-compassion) demonstrated a statistically significant superiority over the MBST-only group in improving general health (p < .05). Regarding HbA1c, although the reduction was greater in the combined group, this difference approached marginal statistical significance (p = .052), indicating a strong trend in favor of the integrated intervention. Overall, this pattern of findings underscores the superior efficacy of the combined approach in achieving optimal psychological and physiological outcomes. Conclusion: The findings of this study demonstrate that Mode-Based Schema Therapy (MBST) is an effective intervention for improving general health and glycemic control (as measured by HbA1c) in patients with type 2 diabetes. Statistical analyses revealed significant and robust differences between the intervention groups and the control group, with the large effect sizes (η² = 0.634 for general health and η² = 0.505 for HbA1c) underscoring the clinical importance of these interventions. Notably, while both active interventions led to improvement, the combination of MBST with self-compassion training demonstrated statistically significant superiority in both psychological and physiological domains. This enhanced efficacy can be attributed to the complementary mechanisms of the two approaches. While MBST directly targets the identification and modification of maladaptive schemas and the de-escalation of negative emotional modes (e.g., the Vulnerable Child or Punitive Parent), self-compassion training directly reduces internal self-criticism, increases non-judgmental acceptance, and fosters a kinder self-attitude. This creates a more favorable emotional foundation for sustained change. Together, this integrated protocol provides a dual framework: it restructures deeper cognitive-emotional structures while simultaneously modifying the patient's daily responses to illness-related stress and potential lapses in self-care management. The combined approach appears to not only reduce rumination and psychological distress but also, by enhancing emotional resilience, facilitates greater adherence to health-promoting behaviors, which is ultimately reflected in the objective reduction of HbA1c levels. Given the chronic and stressful nature of diabetes, these findings emphasize the necessity of integrating deep, multi-dimensional psychological interventions into standard treatment protocols. Combining schema therapy modalities with mindfulness and compassion-based approaches can offer a powerful treatment model for achieving concurrent improvement in psychological and somatic indicators. Future research with larger sample sizes and longer follow-up periods is recommended to examine the sustainability of these effects and to elucidate the precise mediating mechanisms of change. | ||
| کلیدواژهها [English] | ||
| General Health, HbA1C, Mode-Based Schema Therapy, Self-Compassion, Type 2 Diabetes | ||
| مراجع | ||
|
Chehregosha, H., Khamseh, M. E., Malek, M., Hosseinpanah, F., & Ismail-Beigi, F. (2019). A view beyond HbA1c: Role of continuous glucose monitoring. Diabetes Therapy, 10, 853–863. https://doi.org/10.1007/s13300-019-0619-1 Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates. Derese, A., Gebreegzhiabhere, Y., Medhin, G., Sirgu, S., & Hanlon, C. (2024). Impact of depression on self-efficacy, illness perceptions and self-management among people with type 2 diabetes: A systematic review of longitudinal studies. PLOS ONE, 19(5), e0302635. https://doi.org/10.1371/journal.pone.0302635 Desmond, T. (2015). Self‑compassion in psychotherapy: indfulness‑based practices for healing and transformation. W. W. Norton & Company. ISBN 78‑0393711004. DOI: https://doi.org/10.1017/S1041610206004522 Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 317–328. https://doi.org/10.1016/j.jbtep.2009.01.002 Fereydouni, F., Hajian-Tilaki, K., Meftah, N., & Chehrazi, M. (2022). A path causal model in the association between self-efficacy and self-care with quality of life in patients with type 2 diabetes: An application of the structural equation model. Health Science Reports, 5(2), e534. https://doi.org/10.1002/hsr2.534 Gebremariam, G. T., Biratu, S., Alemayehu, M., Welie, A. G., Beyene, K., Sander, B., et al. (2022). Health-related quality of life of patients with type 2 diabetes mellitus at a tertiary care hospital in Ethiopia. PLOS ONE, 17(2), e0264199. https://doi.org/10.1371/journal.pone.0264199 Gobin, K. C., Mills, J. S., & Katz, J. D. (2021). Psychotherapeutic interventions for type 2 diabetes mellitus. In Psychology and Pathophysiological Outcomes of Eating. IntechOpen. https://doi.org/10.5772/intechopen.97653 Goharshahi, R., Mafakheri, A., & Mohammadipour, M. (2024). The effect of schema therapy with acceptance and commitment therapy (ACT) on self-acceptance and rumination in women with diabetes and anorexia nervosa. Health Psychology,13(51),7–20(In persian). https://doi.org/10.30473/hpj.2024.70061.5978 Gregg, E. W., Buckley, J., Ali, M. K., Davies, J., Flood, D., Mehta, R., et al. (2023). Improving health outcomes of people with diabetes: Target setting for the WHO Global Diabetes Compact. The Lancet, 401(10384), 1302–1312. https://doi.org/10.1016/S0140-6736(23)00001-6 Huang, Y.-C. (2019). The impact of illness perception, diabetes management self-efficacy, and emotional distress on type 2 diabetes self-management among Americans with Chinese backgrounds (Doctoral dissertation). Texas State University, San Marcos, TX, USA. https://doi.org/10.26153/tsw/12123 Jamali, M., Dabbaghmanesh, M. H., Kraskian Mojmbarii, A., & Bahrami Hidaji, M. (2025). Comparison of the effectiveness of group reality therapy and dialectical behavior group therapy on lifestyle and adherence to treatment in women with type diabetes. Health Psychology, 14(53),149–165(In persian). https://doi.org/10.30473/hpj.2025.72669.6134 Javadi, M., Zohreh, R., & Rezaie Jamalouei, H. (2021). Evaluation and comparison of the effectiveness of cognitive-behavioral therapy and schema therapy in improving self-compassion in men and women with type 2 diabetes. Journal of Applied Family Therapy, 2(1),244–261. https://doi.org/10.61838/kman.aftj.2.1.13 Kalloo, J., Priscilla, S., & Puttanna, A. (2023). Pharmacological management of type 2 diabetes: Clinical considerations and future perspectives. Metabolism and Target Organ Damage, 3(2), Article26. https://doi.org/10.20517/mtod.2022.26 Karimi, M., & Ghorbani, S. (2025). Prediction of self-care based on problem-solving skills, parent–child relationship and emotional independence with regard to the mediating role of social support in adolescents with diabetes. Health Psychology, 13(52), 47–64. https://doi.org/10.30473/hpj.2025.67634.5808 Khoshnood, G., Shirkavand, N., Ashoori, J., & Arab Salari, Z. (2015). Effects of schema therapy on the happiness and mental health of patients with type II diabetes. Journal of Diabetes Nursing, 3(1), 8–18. Malakouti, S. K., Fatollahi, P., Mirabzadeh, A., & Zandi, T. (2007). Reliability, validity and factor structure of the GHQ‑28 used among elderly Iranians. International Psychogeriatrics, 19(4), 623–634 Mansourzadeh, M., Alizadeh, H., & Ramezani, M. (2024). The impact of schema therapy on anxiety, depression, sleep quality, and fatigue in chronic patients. Iranian Journal of Psychiatry and Behavioral Sciences, 18(1), 20–30 https://doi.org/10.5812/mejrh-132571 Rafiee, Z., & Karami, J. (2018). Effectiveness of self-compassion group training on the reduction of anxiety, stress, and depression in type 2 diabetic patients. International Journal of Behavioral Sciences, 12(3), 102–107. Riaz, B. K., Selim, S., Neo, M., Karim, M. N., & Zaman, M. M. (2021). Risk of depression among early onset type 2 diabetes mellitus patients. Dubai Diabetes and Endocrinology Journal, 27(2), 55–65. https://doi.org/10.1159/000515683 Sandham, C., & Deacon, E. (2023). The role of self-compassion in diabetes management: A rapid review. Frontiers in Psychology, 14, 1123157. https://doi.org/10.3389/fpsyg.2023.1123157 Schmidt, C. B., van Loon, B. P., Vergouwen, A., Snoek, F., & Honig, A. (2018). Systematic review and meta-analysis of psychological interventions in people with diabetes and elevated diabetes distress. Diabetic Medicine, 35(9),1157–1172. https://doi.org/10.1111/dme.13709 Stanković, Ž., Jašović-Gašić, M., & Lečić-Toševski, D. (2013). Psychological problems in patients with type 2 diabetes: Clinical considerations. Vojnosanitetski Pregled, 70(12), 1138–1144. https://doi.org/10.2298/VSP1312138S Tanenbaum, M. L., Adams, R. N., Gonzalez, J. S., Hanes, S. J., & Hood, K. K. (2018). Adapting and validating a measure of diabetes-specific self-compassion. Journal of Diabetes and Its Complications,32(2),196–202. https://doi.org/10.1016/j.jdiacomp.2017.10.009 Tenreiro, K., & Hatipoglu, B. (2025). Mind matters: Mental health and diabetes management. The Journal of Clinical Endocrinology & Metabolism, 110 (Suppl. 2), S131–S136. https://doi.org/10.1210/clinem/dgae607 | ||
|
آمار تعداد مشاهده مقاله: 9 تعداد دریافت فایل اصل مقاله: 11 |
||