اثربخشی پارادوکس درمانی بر سوگیری تصویر تن و راهبردهای مقابله‌ای بدنی افراد چاق با اختلال بدریختی بدن

چکیده مقاله :

مقدمه:  وسواس بیش‌ازحد نسبت به نقص درک شده در ظاهر در افراد چاق بر کیفیت زندگی آنها تاثیر می گذارد. هدف این پژوهش، اثربخشی پارادوکس درمانی بر سوگیری تصویر تن و راهبردهای مقابله­ای بدنی در افراد چاق با اختلال بدریختی بدن است.

روش‌: روش پژوهش نیمه آزمایشی با طرح پیش‌آزمون - پس‌آزمون با گروه کنترل انجام شد. جامعه آماری 49 نفر از افراد چاق با اختلال بدریختی بدن بودند که جهت درمان­های لاغری به کلینیک­های تغذیه مراجعه کرده­اند. با روش نمونه گیری هدفمند 36 نفر از افراد واجد شرایط انتخاب و در دو گروه آزمایش (۱۸ نفر) و کنترل (۱۸ نفر) به‌صورت تصادفی گمارش و پرسش‌نامه‌های وسواس فکری عملی ییل براون برای اختلال بدریختی بدن، چندبعدی رابطه خود-بدن (MBSRQ) و راهبردهای مقابله­ای تصویر بدن (BICSI) را تکمیل کردند.

یافته‌ها: تحلیل داده­ها با آزمون تحلیل کوواریانس تک راهه نشان داد پارادوکس درمانی بر کاهش سوگیری تصویر تن تاثیر مثبت داشته و ارزیابی مثبت از ظاهر و تناسب اندام و رضایت از بدن را افزایش داده و گرایش به ظاهر و وزن ذهنی را کاهش داده است. همچنین بر راهبردهای مقابله­ای بدنی (کاهش ترمیم ظاهر و اجتناب و افزایش پذیرش مثبت منطفی)مؤثر بود ( 05/0 ≥( p .

نتیجه‌گیری: با توجه به اینکه پارادوکس درمانی می‌تواند به تقویت وضعیت عاطفی مراجع کمک کند و او را در درک غیرمنطقی بودن واکنش‌های احساسی‌اش یاری دهد، این رویکرد می‌تواند به توسعه راهبردهای سازگارانه‌تر در زمینه تصویر بدن در اختلال بدریختی بدن پیشنهاد شود.

چکیده انگلیسی :

Introduction: Excessive fixation on perceived flaws in appearance among overweight individuals negatively impacts their quality of life. This study aimed to evaluate the effectiveness of paradoxical therapy on body image bias and coping strategies in overweight individuals with body dysmorphic disorder.

Method: This research utilized a semi-experimental design with pre-test and post-test measures, including a control group. The statistical population comprised 49 obese individuals with body dysmorphic disorder who sought weight loss treatments at nutrition clinics in 2023. A purposive sampling method was employed, resulting in a sample of 36 eligible participants, who were randomly assigned to two groups: the experimental group (18 individuals) and the control group (18 individuals). Participants completed the Yale-Brown Obsessive Compulsive Scale for body dysmorphic disorder, the Multidimensional Body-Self Relations Questionnaire (MBSRQ), and the Body Image Coping Strategies Inventory (BICSI).

Results: Data analysis using one-way analysis of covariance (ANCOVA) revealed that paradoxical therapy significantly reduced body image bias and enhanced positive evaluations of appearance, fitness, and body satisfaction. It also decreased preoccupation with subjective appearance and weight, while proving effective in coping strategies related to body image by reducing appearance fixation and avoidance and increasing positive rational acceptance (p ≤ 0.05).

Conclusion: Given that paradoxical therapy can improve clients' emotional states and help them recognize the irrationality of their emotional responses, this approach is recommended for developing more adaptive strategies regarding body image in individuals with body dysmorphic disorder.

منابع و مأخذ:

1. 1Steptoe, Andrew, and Philipp Frank. "Obesity and psychological distress." Philosophical Transactions of the Royal Society B 378.1888 (2023): 20220225.‏
2. Tabrizi, Jafar Sadegh, et al. "Prevalence and associated factors of overweight or obesity and abdominal obesity in Iranian population: a population-based study of northwestern Iran." Iranian journal of public health 47.10 (2018): 1583.‏
3. Varela C, Andrés A and Saldaña C. The behavioral pathway model to overweight and obesity: coping strategies, eating behaviors and body mass index. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity 2020 March; 25: 1277-1283.
4. Guglielmi, Valeria, et al. "Female obesity: clinical and psychological assessment toward the best treatment." Frontiers in Endocrinology,2024,15: 1349794.‏
5. Sindi S A, Alghamdi MK, Sindi EE, Bondagji M F, Baashar D S, Malibary J A and Alkot M . The Prevalence and Characteristics of Body Dysmorphic Disorder Among Adults in Makkah City, Saudi Arabia. A Cross-Sectional Study. Cureus2023march; 15(2): 25-36.
6. Laughter MR, Anderson J B, Maymone M B and Kroumpouzos G. Psychology of aesthetics: beauty, social media, and body dysmorphic disorder. Clinics in Dermatology2023sep;15(2):36-51.
7. Jassi A, Krebs G. Body Dysmorphic Disorder. Psychiatric Clinics2023; 46(1): 197-209.
8. Murray B,et al.The relationship between body image, eating disorders, and obesity: A review of the literature2021.
9. Tiggemann M, Slater A. Net-Results: The Relationship Between Body Image and Obesity in Adolescents. International Journal of Obesity2021;45(2): 345-348.
10. Collison J, Barnier E . Eating disorders, body dysmorphic disorder, and body image pathology in female Australian models. Clinical Psychologist 2020 September;24(2):155-165.
11. Schmidt M, Taube C O, Heinrich T, Vocks S and Hartmann AS. Body image disturbance and associated eating disorder and body dysmorphic disorder pathology in heterosexual men: A systematic analyses of cognitive, affective, behavioral under perceptual aspects.Plos one 2022may;17(12): 27-58.
12. Levine M, Murnen S. Everybody knows that mass media are/are not [pick one] a cause of eating disorders: A critical review of the evidence for a causal link between media, negative body image, and disordered eating in females. Journal of Social and Clinical Psychology2009jun; 28(1):9-42.
13. Cash F, Pruzinsky T.Cognitive-behavioral perspectives on body image.In Body Image: A HandbookofTheory, Research, and Clinical Practice (pp).19-28.
14. Varela C, Andrés A and Saldaña C. The behavioral pathway model to overweight and obesity: coping strategies, eating behaviors and body mass index. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity 2020 march; 25: 1277-1283.
15. Bianchi D, Schinelli A, Fatta LM, Lonigro A, Lucidi F and Laghi F .Body image impact on quality of life and adolescents’ binge eating: the indirect role of body image coping strategies. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity 2023 may;28(1): 1-10.
16. Cash TF, Santos MT, Williams EF. Coping with body-image threats and challenges: validation of the Body Image Coping Strategies Inventory. J Psychosom Res. 2005;58(2):190–9.
17. Tiggemann M.The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies.International Journal of Eating Disorders 2014fall ;47(3): 230-238.
18. Schmidt M, Taube C O, Heinrich T, Vocks S and Hartmann AS. Body image disturbance and associated eating disorder and body dysmorphic disorder pathology in gay and heterosexual men: A systematic analyses of cognitive, affective, behavioral and perceptual aspects.Plos one 2022may;17(12): 27-58.
19. Newell R, Shrubb S. Attitude change and behaviour therapy in body dysmorphic disorder: Two case reports. Behavioural and Cognitive Psychotherapy 2014; 22(2): 163-169.
20. Singh AR, Veale D. Understanding and treating body dysmorphic disorder. Indian journal of psychiatry 2019 june; 61(Suppl 1): S131.
21. Sheras, P. L. & Jackson, S. R. (1978) Paradox as an Intervention Strategy with Emotionally Disturbed Adolescents. Paper presented at the Annual Convention of the American Psychological Association, Toronto, Canada, August 1978.
22. Besharat MA, The application of paradox therapy for the treatment of body dysmorphic disorder: a case report Journal of Psychological Science2021 February;19(95):1371-1387.
23. Besharat, M. A. (2019). Evaluating the effectiveness of paradox therapy for the treatment of obsessive-compulsive disorder: A case study. Journal of Psychological Studies, 14(4), 7-36.
24. Dowd, E. Thomas, and Joseph S. Swoboda. "Paradoxical interventions in behavior therapy." Journal of Behavior Therapy and Experimental Psychiatry 15.3 (1984): 229-234.‏
25. Besharat MA. Evaluating the effectiveness of paradox therapy for the treatment of social anxiety disorder: A case study. Journal of Psychological Science 2019 may; 18(76): 383-396.
26. Nikan A, Lotfi Kashan F, Vaziri SH, Mojtabaie M.Comparison of paradoxical timetable and cognitive behavioral therapy on worry and rumination of individuals with social anxiety. Rooyesh - e -Ravanshenasi Journal(RRJ) 2021 april; 10(1):5-15.
27. Mohammadpour M, Aslami E.Evaluating the effectiveness of paradox therapy on components of psychological well-Bing of Conflicting Couples. New ideas of psychology2022jun;14(18):1-24.
28. Ghadimi nouran M, SHafiabadi A, KHodabakhshi A and Asgari M. Develop a Therapy Protocol Based on the Paradoxical Timetabling Model and Its Effectiveness on Binge Eating Disorder among Women. Journal of Research in Psychological Health2020 sep;14(2):81-94.
29. jamshidi, A., Manavipour, D., Besharat, M. A., & Mojtabaei, M. (2024). The Effectiveness of Paradox Therapy on Pain Anxiety and Self-Empathy in Women with Breast Cancer. Journal of Clinical Psychology, 2024;16(1):1-76.
30. Rahmani F, Sedighi Arfaee F,Rahman M.The Effectiveness of Schema Therapy on Academic Enthusiasm and Body Dysmorphic Symptoms in Students .etl.journals.2021;2(34):61-74.
31. Cash, TF.The multidimensional body-self relations questionnaire. Unpublished test manual 2000jun;2: 1-12.
32. Raghibi M, Minakhany Gh.Body Management and its Relation with Body Image and Self Concept. Knowledge & Research in Applied Psychology2012 Winter;12(4):72-81.
33. Cash TF, Santos MT, Williams EF. Coping with body-image threats and challenges: validation of the Body Image Coping Strategies Inventory. J Psychosom Res. 2005;58(2):190–9.
34. Farid, Malihe, Mahnaz Akbari Kamrani, and Sedigheh Jafarian. "Psychometric Evaluation of the Persian Version of Body Image Coping Strategies Inventory." Iranian Journal of Psychiatry and Behavioral Sciences.2018 (12)4.
35. Besharat MA. Paradox + Timeline = Treatment: The Complete Model of Treatment for Psychological Disorders: A Practical Guide. Tehran. Roshd2018.
36. Collison J, Barnier E . Eating disorders, body dysmorphic disorder, and body image pathology in female Australian models. Clinical Psychologist 2020 September;24(2):155-165.
37. Weeks, Gerald R., and Luciano L'Abate. Paradoxical psychotherapy: Theory & practice with individuals couples & families. Routledge, 2013.