اثربخشی رواندرمانی پویشی فشرده و کوتاهمدت بر کاهش علائم و مکانیسمهای دفاعی اختلال شخصیت مرزی
محورهای موضوعی : روانشناسی بالینی و آسیب شناسی روانی
سیده مهسا موسوی
1
*
,
سیف اله آقاجانی
2
1 - گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی اردبیل، ایران.
2 - گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی اردبیل، ایران.
کلید واژه: رواندرماني پویشي فشرده و کوتاهمدت, اختلالالهای شخصیت مرزی, مكانیسمهای دفاعي,
چکیده مقاله :
هدف از پژوهش حاضر، تعیین اثربخشی رواندرمانی پویشی فشرده و کوتاهمدت (ISTDP) بر کاهش علائم بالینی و تغییر مکانیسمهای دفاعی در افراد مبتلا به اختلال شخصیت مرزی بود. این پژوهش از نوع شبهآزمایشی با طرح تکآزمودنی A–B–A انجام شد. جامعه آماری پژوهش شامل کلیه افراد مبتلا به اختلال شخصیت مرزی بود که در سهماهه نخست سال ۱۴۰۳ به مرکز سلامت روان جامعهنگر (سراج) شهرستان میاندوآب مراجعه کرده بودند. از میان جامعه آماری، ۳ نفر که تشخیص اختلال شخصیت مرزی را براساس سیاهه چندمحوری بالینی میلون ۳ (MCMI-III) و مصاحبه روانپزشکی مبتنی بر ملاکهای DSM-5دریافت کرده بودند، به روش نمونهگیری هدفمند انتخاب شدند. ابزارهای مورد استفاده در این پژوهش شامل سیاهه چندمحوری بالینی میلون۳ (MCMI-III)، پرسشنامه مکانیسمهای دفاعی (DSQ-40) و مصاحبه بالینی ساختاریافته برای اختلالهای (SCID) DSM بود. مداخله درمانی براساس پروتکل رواندرمانی پویشی فشرده و کوتاهمدت مطابق با رویکرد دوانلو (1995، 2000) روی آزمودنیها اجرا شد. سنجش آزمودنیها در مرحله خط پایه بهصورت ارزیابیهای مکرر (هر سه جلسه یکبار) انجام گرفت و پساز پایان جلسات درمانی، سه مرحله ارزیابی پیگیری با فواصل یکماهه صورت پذیرفت. دادهها با استفاده از تحلیل دیداری نمودارها و آزمون ناپارامتریک فریدمن و با بهرهگیری از نرمافزار SPSS نسخه ۲۴ تحلیل شدند. یافتههای پژوهش نشان داد که رواندرمانی پویشی فشرده و کوتاهمدت موجب کاهش معنادار علائم اختلال شخصیت مرزی شد (05/0>p). همچنین، نتایج حاکی از تغییر معنادار در مکانیسمهای دفاعی آزمودنیها بود؛ بهگونهای که مکانیسمهای دفاعی رشدنیافته و روانآزرده کاهش و مکانیسمهای دفاعی رشدیافته افزایش یافتند (05/0>p). براساس یافتههای بهدستآمده میتوان نتیجه گرفت که رواندرمانی پویشی فشرده و کوتاهمدت میتواند بهعنوان یک مداخله مؤثر، نقش مهمی در کاهش علائم بالینی و اصلاح الگوهای دفاعی ناکارآمد در افراد مبتلا به اختلال شخصیت مرزی ایفا کند.
The aim of the present study was to determine the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) on reducing symptoms and defense mechanisms of borderline personality disorder. This study was a quasi-experimental study with a single-subject design (A-B-A). The statistical population of this study consisted of all individuals with borderline personality disorder who referred to the Community Mental Health Center (Siraj) in Miandoab during the first quarter of 1403. From the above statistical population, 3 individuals who received a diagnosis of borderline personality disorder based on the Millon Clinical Multiaxial Inventory (III-MCMI) and a psychiatric interview based on DSM-5 criteria were selected through purposive sampling. The instruments used in this study were: Milne Clinical Multiaxial Inventory (III-MCMI), Defense Mechanisms Questionnaire-40, and Structured Clinical Interview for DSM Disorders (SCID). Also, a short-term intensive dynamic psychotherapy protocol was implemented on the research sample according to the approach of Davanloo (1995, 2000). The subjects were initially assessed as a baseline assessment, once every 3 sessions, and after the completion of the therapy sessions, 3 follow-up assessments were conducted at one-month intervals. The data were analyzed using data analysis with eye charts and Friedman's nonparametric analysis of variance and SPSS version 24 software. The findings showed that short-term intensive psychodynamic therapy reduces the symptoms of borderline personality disorders (p <0.05). Also, this treatment was significant in reducing mature, immature, and neurotic defense mechanisms in people with borderline personality disorders (p <0.05). According to the findings, it can be concluded that intensive and short-term psychodynamic therapy has a significant effect on reducing the symptoms and defense mechanisms of borderline personality disorders.
Abbass, A. A., & Town, J. M. (2021). Alliance rupture-repair processes in intensive short-term dynamic psychotherapy: Working with resistance. Journal of Clinical Psychology, 77(2), 398–413. https://doi.org/10.1002/jclp.23115
Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., Gerber, A., Dekker, J., Rabung, S., Rusalovska, S., & Crowe, E. (2014). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, 2014(7), CD004687. https://doi.org/10.1002/14651858.CD004687.pub4
Abbass, A., Kisely, S., & Kroenke, K. (2009). Short-term psychodynamic psychotherapy for somatic disorders. Psychotherapy and Psychosomatics, 78(5), 265–274. https://doi.org/10.1159/000228247
Abbass, A., Sheldon, A., Gyra, J., & Kalpin, A. (2008). Intensive short-term dynamic psychotherapy for DSM-IV personality disorders: A randomized controlled trial. The Journal of Nervous and Mental Disease, 196(3), 211–216. https://doi.org/10.1097/NMD.0b013e3181662ff0
Abbass, A., Town, J., & Driessen, E. (2011). The efficacy of short-term psychodynamic psychotherapy for depressive disorders with comorbid personality disorder. Psychiatry: Interpersonal & Biological Processes, 74(1), 58–71. https://doi.org/10.1521/psyc.2011.74.1.58
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
American Psychiatric Association. (2015). A. Niloufari, F. Reza’ie, F. Shamloo, A. Farmand, A. Fakhraie, & J. Hashemi Azar, Trans.). Arjmand Publication. (Original work published 2013) Anderson, E.,
Lambert, M. (1995). Short-term dynamically Oriented Psychotherapy a review and meta-analysis. Clinical Psychology review. (6): 500-5133. DOI:10.1016/0272-7358(95)00027-M
Bakhtiari, M. (2000). Psychiatric disorders in patients with abnormalities of body deformities [Master's thesis, Tehran University of Medical Sciences]. https://doi.org/10.22038/mjms.2021.18145
Ball, S. A., & Cecero, J. J. (2001). Addicted patients with personality disorders: Traits, schemas, and presenting problems. Journal of Personality Disorders, 15(1), 72–83. https://doi.org/10.1521/pedi.15.1.72.18642
Besharat, M. A. (2007). An attachment theory explanation of personality disorders. Journal of the Iranian Psychological Association, 1(2), 41–48. https://doi.org/10.22034/jepa.2007.502
Bohus, M., Stoffers-Winterling, J., Sharp, C., Krause-Utz, A., Schmahl, C., & Lieb, K. (2021). Borderline personality disorder. The Lancet, 398(10310), 1528–1540. https://doi.org/10.1016/S0140-6736(21)00476-1 Bronstein, C. (2001). Kleinian theory: A contemporary perspective. Whurr Publishers. https://doi.org/10.1016/S0140-6736(21)00476-1
Chiesa, M., Larsen-Paya, M., Martino, M., & Trinchieri, M. (2016). The relationship between childhood adversity, psychiatric disorder and clinical severity: Results from a multi-center study. Psychoanalytic Psychotherapy, 30(1), 79–95. https://doi.org/10.1080/02668734.2016.1145131
Cornelissen, K. (2002). Long term follows up of residential ISTDP with patients suffering from personality disorders. AD HOC Bulletin of Short-Term Dynamic Psychotherapy, 18(3), 20–29. https://doi.org/10.1176/appi.psychotherapy.20240019
Dadfar, M., & Lester, D. (2017). Prevalence of personality disorders and clinical syndromes using the Millon Clinical Multiaxial Inventory III (MCMI-III) in an Iranian clinical sample. International Journal of Biomedical Engineering, 3(1), 36–47. https://doi.org/10.1177/1054137318810232
Davanloo, H. (1995). Unlocking the unconscious: Selected papers of Habib Davanloo, M.D. Wiley.
Della Selva, P. C. (2017). Maximizing effectiveness in dynamic psychotherapy. Routledge.
Di Giuseppe, M., Perry, J. C., Lucchesi, M., Michelini, M., Vitiello, S., Piantanida, A., & Conversano, C. (2020). Preliminary reliability and validity of the DMRS-SR-30, a novel self-report measure based on the Defense Mechanisms Rating Scales. Frontiers in Psychiatry, 11, 870. https://doi.org/10.3389/fpsyt.2020.00870
Eppel, A. (2018). The emergence of short-term psychodynamic psychotherapy. In A. Abbass & H. Town (Eds.), Short-term psychodynamic psychotherapy (pp. 1–24). Springer. https://doi.org/10.1007/978-3-319-74989-8_1
Ford, J. D., & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 9. https://doi.org/10.1186/2051-6673-1-9
Frederickson, J. (2013). Co-creating change. Seven Leaves Press.
Frederickson, J., DenDooven, B., Abbass, A., Solbakken, O. A., & Rousmaniere, T. (2018). Pilot study: An inpatient drug rehabilitation program based on intensive short-term dynamic psychotherapy. Journal of Addictive Diseases, 37(3–4), 195–201. https://doi.org/10.1080/10550887.2019.1658513
González, R. A., Igoumenou, A., Kallis, C., & Coid, J. W. (2016). Borderline personality disorder and violence in the UK population: Categorical and dimensional trait assessment. BMC Psychiatry, 16(1), 180. https://doi.org/10.1186/s12888-016-0885-7
Gunderson, J. G., & Sabo, A. N. (1993). The phenomenological and conceptual interface between borderline personality disorder and PTSD. American Journal of Psychiatry, 150(1), 19–27. https://doi.org/10.1176/ajp.150.1.19
Gunderson, J. G., Weinberg, I., & Choi-Kain, L. (2013). Borderline personality disorder. FOCUS, 11(2), 129–145. https://doi.org/10.1176/appi.focus.11.2.129
Heydari Nasab, L., Mansour, M., Azad Falah, P., & Shairi, M. R. (2007). Validity and validity questionnaire of defense styles in Iranian samples. Daneshvar Raftar, 14(22), 11–26. Jennifer, H., Sangam S., (2020). Histrionic Personality Disorder. https://www.ncbi.nlm.nih.gov/books/NBK542325
Joseph, B. (1997). Psychic change and the psychoanalytic process. In R. Schafer (Ed.), The contemporary Kleinians of London (pp. 395–409). International Universities Press.
Keuroghlian, A. S., Frankenburg, F. R., & Zanarini, M. C. (2013). The relationship of chronic medical illnesses, poor health-related lifestyle choices, and health care utilization to recovery status in borderline patients over a decade of prospective follow-up. Journal of Psychiatric Research, 47(10), 1499–1506. https://doi.org/10.1016/j.jpsychires.2013.06.012
Kvarstein, E. H., Antonsen, B. T., Klungsøyr, O., & Wilberg, T. (2021). Avoidant personality disorder and social functioning: A longitudinal, observational study investigating predictors of change in a clinical sample. Personality Disorders: Theory, Research, and Treatment, 12(6), 594–605. https://doi.org/10.1037/per0000471
Lee, Y. J., Keum, M. S., Kim, H. G., Cheon, E. J., Cho, Y. C., Koo, B. H., Kim, S. J., & Lee, S. H. (2020). Defense mechanisms and psychological characteristics according to suicide attempts in patients with borderline personality disorder. Psychiatry Investigation, 17(9), 840–849. https://doi.org/10.30773/pi.2020.0102
Leichsenring, F., Fonagy, P., Heim, N., & Leweke, F. (2024). Borderline personality disorder: A comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry, 23(1), 4–25. https://doi.org/10.1002/wps.21156
Levy, K. N., Beeney, J. E., & Clarkin, J. F. (2024). Borderline personality organization and identity diffusion: Implications for treatment. Personality Disorders: Theory, Research, and Treatment, 15(1), 47–58. https://doi.org/10.1037/per0000643
McCrae, R. R., Costa, P. T., Jr., & Martin, T. A. (2005). The NEO-PI-3: A more readable revised NEO Personality Inventory. Journal of Personality Assessment, 84(3), 261–270. https://doi.org/10.1207/s15327752jpa8403_05
McCrae, R. R., Costa, P. T., Jr., & Martin, T. A. (2005). The NEO-PI-3: A more readable revised NEO Personality Inventory. Lutz, FL: Psychological Assessment Resources.
Millon, T. (1992). Millon Clinical Multiaxial Inventory: I & II. Journal of Counseling & Development, 70(3), 421–426. https://doi.org/10.1002/j.1556-6676.1992.tb01627.x
Noruzi, N., Abedin, A., Atef Vahid, M. K., & Ghorbani, N. (2009). The relationship between defense styles and the emergence of resistance and transmission in intensive and short-term dynamic psychotherapy. Journal of Applied Psychology, 2(2-3), 535–537. [In Persian]
Nowruzi, N., Abedin, A., Atefvahid, A., & Ghorbani, N. (2008). The relationship between defensive style and emerging of resistance and transference in intensive short term dynamic psychotherapy. Journal of Applied Psychology, 2(3), 518–537.
penders, K. A., Peeters, I. G., Metsemakers, J. F., & Van Alphen, S. P. (2020). Personality disorders in older adults: a review of epidemiology, assessment, and treatment. Current psychiatry reports, 22(3), 1-14
Perrotta, G. (2020). Borderline personality disorder: Definition, differential diagnosis, clinical contexts, and therapeutic approaches. Annals of Psychiatry and Treatment, 4(1), 043–056.
Ripoll, L. H. (2013). Psychopharmacologic treatment of borderline personality disorder. Dialogues in Clinical Neuroscience, 15(2), 213–224.
Russell, L., Abbass, A., & Allder, S. (2022). A review of the treatment of functional neurological disorder with intensive short-term dynamic psychotherapy. Epilepsy & Behavior, 130, 108666. https://doi.org/10.1016/j.yebeh.2022.108666
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kalan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (2nd ed.). Arjmand Publication. (Original work published 2015)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences, clinical psychiatry (11th ed.). Wolters Kluwer.
Hörz-Sagstetter, S., Volkert, J., Rentrop, M., Benecke, C., Gremaud-Heitz, D. J., Unterrainer, H. F., & Feil, M. G. (2020). A bifactor model of personality organization. Journal of Personality Assessment, 102(6), 771-782. https://doi.org/10.1080/00223891.2019.1705463
Schafer, R. E., & Steiner, J. (1997). Problems of psychoanalytic technique: Patient-centered and analyst-centered interpretations. In R. Schafer (Ed.), The contemporary Kleinians of London (pp. 372–392). International Universities Press.
Shekari, H., Hosseinsabet, F., & Borjali, A. (2017). The effectiveness of tactical defenses management based on intensive short-term dynamic psychotherapy on the interpersonal conflict. Journal of Research in Clinical Psychology and Counseling, 7(2), 23–37. https://doi.org/10.22067/ijap.v7i2.53415
Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66(1), 174–184. https://doi.org/10.1037/0022-006X.66.1.174
Solbakken, O. A., & Abbass, A. (2016). Symptom- and personality disorder changes in intensive short-term dynamic residential treatment for treatment-resistant anxiety and depressive disorders. Acta Neuropsychiatrica, 28(5), 257–271. https://doi.org/10.1017/neu.2016.5
Stoffers-Winterling, J. M., Storebø, O. J., Pereira Ribeiro, J., Kongerslev, M. T., Völlm, B. A., & Mattivi, J. T. (2022). Pharmacological interventions for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 11, CD012956. https://doi.org/10.1002/14651858.CD012956.pub2
Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 2020(5), CD012955. https://doi.org/10.1002/14651858.CD012955.pub2
Strachey, J. (1999). The nature of the therapeutic action of psycho-analysis [Reprint of 1934 article]. Journal of Psychotherapy Practice and Research, 8(1), 66–82.
Vahedi, A., Makvand Hosseini, S. H., & Bigdeli, E. (2012). Diagnosis of higher-level personality pathology by using short-term dynamic psychotherapy. Journal of Clinical Psychology, 4(3), 75–85. https://doi.org/10.22075/jcp.2017.2099
Yun, S., Jo, S. H., Jeon, H. J., Kim, H. G., Cheon, E. J., Koo, B. H., Kim, S. J., & Lee, S. H. (2024). The complexity of borderline personality disorder: Network analysis of personality factors and defense styles in the context of borderline personality organization. Psychiatry Investigation, 21(7), 672–679. https://doi.org/10.30773/pi.2024.0085
Zanarini, M. C., & Frankenburg, F. R. (2001). Attainment and maintenance of reliability of axis I and II disorders: A longitudinal study. Comprehensive Psychiatry, 42(5), 369–374. https://doi.org/10.1053/comp.2001.24556
Zanarini, M. C., Weingeroff, J. L., & Frankenburg, F. R. (2009). Defense mechanisms associated with borderline personality disorder. Journal of Personality Disorders, 23(2), 113–121. https://doi.org/10.1521/pedi.2009.23.2.113