تدوین درمان‌ شناختی - رفتاری بی‌خوابی مطابق با فرهنگ ایرانی

نوع مقاله : مقاله پژوهشی

نویسندگان

1 گروه روان‌شناسی، پژوهشکدة تحقیق و توسعة علوم انسانی «سمت»، تهران، ایران

2 گروه روان‌شناسی، دانشکدۀ علوم انسانی، دانشگاه تربیت مدرس، تهران، ایران.

3 گروه روان‌شناسی، دانشکدۀ علوم انسانی، دانشگاه تربیت مدرس، تهران، ایران

چکیده

هدف از پژوهش حاضر، بررسی عوامل فرهنگی - اجتماعی مؤثر در مدیریت بی‌خوابی و اثربخشیِ درمان شناختی - رفتاری بی‌خوابی بر مبنای فرهنگ ایرانی است. این پژوهش در دو بخش کیفی و کمّی اجرا شد. در بخش کیفی ابتدا از 19 شرکت‌کنندة بزرگ­سال دارای تجربة غیر بالینی بی‌خوابی مصاحبة کیفی به­عمل آمد. سپس با 7 درمان‌گر دارای تجربة اجرای درمان استاندارد شناختی - رفتاری بی‌خوابی مصاحبه شد و از 5 مراجعِ این درمان نیز مصاحبه به­عمل آمد. متن تمامی مصاحبه‌ها را دو نفر به­صورت جداگانه کدگذاری کردند و در پنج جلسه بین کدگذاران توافق ایجاد شد. سپس نتایج کدگذاری‌ها با روش تحلیل مضمون تحلیل شد و در بخش کمّی درمان انطباق‌یافته روی 10 مراجع دارای بی‌خوابی اجرا شد. به­منظور انطباق فرهنگی این درمان با بافتار اجتماعی - فرهنگی ایران، پنج انطباق در درمان انجام شد: مدت درمان کوتاه شد، اعضای خانواده در فرایند درمان مشارکت داده شدند، از اصول مصاحبة انگیزشی استفاده شد، مؤلفه‌های آموزشی متناسب با فرهنگ به درمان افزوده شد، و برخی مفهوم‌سازی‌های مذهبی در آن گنجانده شد. در بخش کمّی، اثربخشی این درمان در 6 شاخص خواب (ارزش پی = کوچک‌تر از 001/0، مجذور اتا = بین 50/0 تا 80/0) و همچنین در شاخص شدت بی‌خوابی (ارزش پی = کوچک‌تر از 001/0، مجذور اتا= 56/0) مورد تأیید قرار گرفت. نتایج این مطالعه، عوامل فرهنگی - اجتماعی مرتبط با تجربة بی‌خوابی (موانع کمک‌طلبی، راهبردهای رفتاری مورد استفاده، باورهای ناکارآمد رایج درمورد خواب و درمان‌های ترجیحی بی‌خوابی) در جامعة ایران را نشان می‌دهد و از اجرای درمان­شناختی رفتاری بی‌خوابی مطابق با فرهنگ ایران حمایت می‌کند.

کلیدواژه‌ها


عنوان مقاله [English]

Development of a Culturally Adapted Cognitive-Behavior Therapy for Insomnia in Iran

نویسندگان [English]

  • Amir Ali Mazandarani 1
  • Maria E Aguilar-Vafaie 2
  • Maryam Esmaeilinasab 3
1 Department of Psychology, The Institute for Research and Development in the Humanities (SAMT)
2 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
3 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
چکیده [English]

This study aimed to investigate the socio-cultural factors affecting insomnia management and the effectiveness of a cognitive-behavioral therapy for Insomnia  (CBT-I) based on Iranian culture. This research was conducted in two parts: Qualitative and quantitative. The first part examines the socio-cultural factors affecting management and treatment of insomnia. In the qualitative part, qualitative interviews were conducted first with 19 adult participants with non-clinical insomnia experiences. Then, 7 therapists experienced in CBT-I standard treatment were interviewed and 5 clients of this treatment were interviewed as well. The transcripts of all the interviews were coded by two coders, and an agreement was reached between them in five sessions. In order to culturally adapt this treatment to the socio-cultural context of Iran, five adaptations were made in the treatment: The duration of treatment was shortened; family members were involved in the treatment process; the principles of motivational interviewing were used; educational components appropriate to Iranian culture, and religious conceptualizations were included in the  treatment. In the quantitative part, the effectiveness of this treatment was confirmed in 6 sleep indices (p < /em> < .001, η2= .50 to .80) and also in insomnia severity index (p < /em> < .001, η2= 0.56).  The results of this study show socio-cultural factors related to the experience of insomnia in Iran (including barriers to help-seeking, commonly used behavioral strategies, common dysfunctional beliefs about sleep, and insomnia treatments preferences).

کلیدواژه‌ها [English]

  • insomnia
  • Cultural Adaptation
  • cognitive-behavioral therapy
  • Thematic Analysis
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