تأثیر آموزش افشای هیجانی نوشتاری بر شدت افسردگی و کاربرد مکانیسم‌های دفاعی بیماران افسرده

نوع مقاله : مقاله پژوهشی

نویسندگان

1 گروه روانپزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران

2 گروه روانشناسی، دانشگاه پیام نور، تهران، ایران

3 گروه روانشناسی، دانشگاه پیام نور گرمسار، سمنان، ایران

چکیده

مقدمه و هدف: مطالعات مختلف نشان داده­اند که افشای هیجانی نوشتاری تجربیات عاطفی و هیجان­ها با تقویت فرد در نفوذ به خود، کاهش خلق منفی، کاهش بازداری و انتخاب رفتارهای سازش­­یافته را سبب­می­شود؛ از­این­رو، این پژوهش با هدف کاهش شدت افسردگی و کاربرد مکانیسم­های دفاعی سازش نایافته به واسطه افشای هیجانی نوشتاری بیماران افسرده انجام ­شده­است.
 مواد و روش­ها: نمونه مورد بررسـی 38 (26 زن و 12 مرد) آزمودنی با اختلال افسـردگی اساسی بودند که با نمونه ­گیری در دسترس انتخاب و به­صورت تصادفی در دو گروه آزمایش و شاهد جایگزین شدند (هر گروه شامل 19 نفر)؛ همچنین دو گروه از لحاظ نوع، دوز و مدت زمان دریافت داروهای ضدافسردگی همتا شدند. کلیه آزمودنی­ها پیش و پس­از اجرای افشای هیجانی نوشتاری در یک دوره چهار هفته­ ای، به کلیه گویه ­های پرسش­نامه­های افسردگی بک (BDI) و مکانیسم­های دفاعی (DMQ)  در یک جلسه پاسخ­دادند.
 نتایج: تجزیه ­و­تحلیل داده­ها با نسخه شانزدهم نرم ­افزار SPSS و کاربرد آزمون t مستقل نشان­داد که افشای هیجانی نوشتاری کاهش معنادار شدت افسردگی آزمودنی­ های گروه آزمایش نسبت­به گروه شاهد را سبب­شده (0.05P ≤)؛ همچنین مکانیسم­های دفاعی (بازداری، واکنش وارونه و جبران) گروه آزمایش نسبت­به گروه شاهد به­ طور معنادار کاهش ­یافت (0.05P <).
 نتیجه ­گیری: از­آنجا­که افشای هیجانی با ایجاد بینش، همدلی و حمایت­گری، کاهش بار­هیجانی ورودی به سیستم شناختی را باعث­ می­شود، می­تواند عملکرد شناختی فرد را بهبود­­بخشد تا از مکانیزم­های دفاعی سازش ­یافته کمتر استفاده­ کند؛ بنابراین از افشای هیجانی نوشتاری می‌توان در جایگاه راهکاری کارآمد در کنار سایر راهبردهای درمانی استفاده­ کرد.

کلیدواژه‌ها

عنوان مقاله [English]

The effect of emotional disclosure by writing on depression severity and defense mechanisms among depressed patients

نویسندگان [English]

  • Ahmad Ali Noorbala 1
  • Ahmad Alipour 2
  • Farhad Shaghaghi 2
  • Avisa Najimi 2
  • Mojgan Agah Heris 3
1 Psychiatrist and the Professor of Tehran Medical Science University, Tehran, Iran
2 Psychologist and the Professor of Payam-e Noor University, Tehran, Iran.
3 Psychologist and the Fellow of Payam-e Noor University, Semnan, Iran.
چکیده [English]

Background and Objective: Different studies have shown that emotional disclosure by writing in order to express affective and emotional experiences would decline negative affect, inhibition, and would help to select adaptive behaviors by infusing into the self. Thus, this research investigated whether instructing emotional disclosure by writing and applying more adaptive defense mechanisms decline depression severity among depressed individuals.
 Materials and Methods: In this study, 38 subjects (26 females, and 12 males) with major depression were selected and randomly assigned into experimental and control groups (each group contained 19 subjects). These 2 groups were paired by dose and type of medications they received during the period of study. They completed BDI and DMQ items prior to and after instructing and applying emotional disclosure for 4 weeks.
 Results: Data analysis (by SPSS software, version 16) and conducting independent t test revealed that emotional disclosure with writing can significantly reduce depression severity in experimental group in comparison with control group (p<0.05). IN addition, using mal-adaptive defense mechanisms (suppression, reaction formation, and compensation) in experimental group significantly declined in comparison with control group (p<0.05).
 Conclusion: Since creating insight, empathy and support sense due to applying emotional disclosure in depressed individuals can decline the load of input emotional burden to cognitive system and lead to improvement of cognitive performance, so, the individual would reduce using mal-adaptive defense mechanisms. Therefore, performing emotional disclosure is an efficient strategy in companion with other therapeutic strategies.

کلیدواژه‌ها [English]

  • Emotional disclosure by writing
  • Depression
  • Defense mechanisms

مراجع

1-  Lakdawalla Z, Hankin BL, & Mermelstein R. Cognitive Theories of Depression in Children and Adolescents: A conceptual and quantitative review. Child Clinical and Family Psychology Review. 2010, 22(1): 217-235.
 2-   Gotlib I, & Hammen C. (Eds.). Handbook of depression. 2002; New York: Guilford Press.
 3-   Petrie KP, Booth RJ, & Pennebaker JW. The immunological effects of thought suppression. Journal of Personality and Social Psychology. 1998; 75: 1264-1272.
 4-   Lepor SJ, & Greenberg MA. Mending broken hearts: effects of expressive writing on mood, cognitive processing, Social adjustment and health following a relationship break up. Psychology health. 2002; 17: 547-60.
 5-   Davison KP, Pennebaker JW, & Dickerson SS. Who talks? The social psychology of illness support groups. American Psychologist. 2000; 55: 205-217.
 6-   Wellenkamp J. Cultural similarities and differences regarding emotional disclosure. In JW Pennebaker (Ed.) Emotion, Disclosure and Health. Washington, DC: APS. 1995.
 7-   Liehr P, Mehl MR, Summers LC, & Pennebaker JW. Connecting with others in the midst of a stressful upheaval on September 11, 2001. Applied Nursing Research. 2004; 17:2-9.
 8-   Darwin C. The expression of the emotions in man and animals; 1872.  London: John Murray.
 9-   Kennedy-Moore E, & Watson JC. Expressing Emotion: Myth, realties, and therapeutic strategies; 1999.  New York: Guilford.
 10- Milkavich A, Meier JA, & Cooper JR. Emotional writing Effectiveness: Do coping styles and timing of the Event predict outcomes? American Journal of Psychological Research. 2005; 1: 112-122.
 11- Slatcher RB, & Pennebaker JW. How do I love thee? Let me count the words: The social effects of expressive writing. Psychological Science. 2006; 17: 660-664.
 12- Kacewicz E, Slatcher RB, & Pennebaker JW. Expressive writing: An alternative to traditional methods. In L. L’Abate (Ed), Low-cost approaches to promote physical and mental health.2007; 271-284. New York: Springer.
 13- Chung CK, & Pennebaker JW. Variations in spacing of expressive writing sessions. British Journal of Health Psychology. 2008; 13: 15-21.
 14- Pennebaker JW. Physical symptoms and sensations: Causes and correlates. In J. Cacioppo & R. Petty (Eds.), Social psychophysiology: A sourcebook.1983; 543-564. New York: Guilford.
 15- Smyth JM.Written emotional expression: effect sizes, outcome types, and moderating variables, Journal of Consulting and Clinical Psychology.1998; 66: 174-184.
 16- Campbell RS, & Pennebaker JW. The secret life of pronouns: Flexibility in writing style and physical health. Psychological Science.2003; 14: 60-65.
 17- Lepore SJ. Expressive writing moderates the relation between intrusive thoughts and depressive symptoms. Journal of Personality and Social psychology.1997; 73: 1030-1037.
 18- Kniele K. Emotional Expressivity and Working Memory Capacity.2004; Unpublished doctoral dissertation, Drexel University, Philadelphia.
 19- Gortner EM, Rude SS, & Pennebaker JW. Benefits of expressive writing in lowering rumination and depressive symptoms. Behavior Therapy. 2006; 37: 292-303.
 20- Pennebaker JW. Emotion, disclosure, & health; 1995. Washington, DC, US: American Psychological Association.
 21- Pennebaker JW. Writing about emotional experiences as a therapeutic process. In P. Salovey, J.A. Rothman et al (Eds.), Social psychology of health: Key readings in social psychology.2003;  362-368. New York, NY: Psychology Press.
 22- Davidson KW, MacGregor MW, Johnson  E A, Woody  E Z, & Chaplin WF. The relation between defense use and adaptive behavior. Journal of Research in Personality. 2004; 38: 105–129.
 23- Kwon  P. Hope and dysphoria: The moderating role of defense mechanisms. Journal of Personality. 2000; 68: 199–223.
 24- Kwon P. Hope, defense mechanisms, and adjustment: Implications for falsehope and  defensive hopelessness. Journal of Personality. 2002; 70: 207–231.
 25- Kwon P,& Lemon KE. Attributional style and defense mechanisms: A synthesis of cognitive and psychodynamic factors in depression. Journal of Clinical Psychology. 2000; 56: 723–735.
 26- Freud S. The neuro-psychoses of defence. Standard Edition.1894; 3: 45–61. London: Hogarth Press, 1962.
 27- Freud S. Further remarks on the neuro-psychoses of defense. Standard Edition. 1896; 3: 161–185. London: Hogarth Press, 1966.
 28- Freud S. Instincts and their vicissitudes. Standard Edition.1915; 14: 117–140. London:Hogarth Press, 1957.
 29- Freud S. Inhibition, symptoms and anxiety. Standard Edition. 1926; 20: 77–174.London: Hogarth Press, 1959.
 30- Flannery RB, & Perry JC. Self-rated defense style, life stress, and health status. Psychosomatics.1990; 31: 313–320.
 35- Taylor JA. A personality scale of manifest anxiety. Journal of Abnormal and Social Psychology. 1953; 48: 285–290.
 32-Derogatis LR, & Cleary PA. Confirmation of the dimensional structure of the SCL-90: A
     study in construct validation. Journal of Clinical Psychology. 1977; 33: 981–989.1996; 20: 123–126.
 33- Soldz S, & Vaillant GE. A 50-year longitudinal study of defense use amonginner city men: A validation of the DSM-IV defense axis. Journal of Nervous and Mental Disease. 1998; 186: 104–111.
34- Cramer P. Protecting the Self: Defense Mechanisms in Action; 2006. New York: The Guilford Press.
35- Muris P, & Merckelbach H. The short version of the Defense Style Questionnaire: Factor structure and psychopathological correlates. Personality and Individual Differences.
36- Beck AT, Steer RA, Garbing MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin. Psychol. 1988;  Rev. 8: 77–100.
37- Gotlib IH .Depression and general psychopathology in university students. Journal of Abnormal psychology.1984; 93: 19-30.
38- Beck AT, & Steer RA. Internal consistencies of the original and revised Beck Depression. Inventory. Journal of Clinical Psychology.1984; 40:1365-1367.
39- Rajabi GR, Atari YA, Haghighi J. Factor analysis of Beck inventory among students of university. Journal of psychology and Educational sciences of shahid chamran university. 1380; 8 (Numbers 3, 4). (In Persian)
40- Beck AT, Steer RA, & Gorbin, M. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evolution. Clinical Psychology Reviwe.1988; 8: 77-100.
41- Hoseini Z. Primative Constracting and normalization of defense mechanisms questionnaire among Behshahr Payam Noor university students (1386). A dissertation of BS in psychology. Behshahr: Payam Noor university (in Persian).
42- Neiderhoffer KG, & Pennebaker JW. Sharing one’s story: on the benefits of writing or talking about emotional experience. In C.R. Snyder & S.J. Lopez (Eds.), Handbook of positive psychology.2005; 573-583. Oxford: Oxford University Press.
43- Wegner DM. & Lane JD. From secrecy to psychopathology.In  Pennebaker J.W. (Ed.), Emotion, Disclosure, and Health. 1995; 25-46. Washington, DC:American Psychological Association.
44- Esterling  BA, Antoni MH, Fletcher MA, Margulies S, & Scheiderman N. Emotional disclosure through writing or speaking modualtes latent Epstein-Barr Virus antibody titers. Journal of consulting & clinical psychology.1994; 62:130-140.
45- Pennebaker JW, Mehl MR, & Niederhoffer KG. Psychological aspects of natural language use: Our words, our selves. Annual Review of Psychology. 2003; 54: 547-577.
46- Alipour A, Noorbala AA, Yazdanfar M, & Agah Heris M. The effectiveness of the emotional disclosure intervention on declining stress and inhibition among psychosomatic patients. Journal of Jahrom Medical Science. 1390, 9(2): 41-47.
47- Pennebaker JW. Social and perceptual factors influencing symptom reporting and mass psychogenic illness. In M. Colligan, J.W. Pennebaker & L. Murphy (Eds.), Mass psychogenic illness: A social psychological perspective. 1982; 139-153. Hillsdale, NJ: Erlbaum.
48- Pennebaker JW. Writing about emotional experiences as a therapeutic process. Psychological Science.1997b; 8: 162-166.
49- Petrie KJ, Booth RJ, & Davison KP. Repression, disclo- sure, and immune function: Recent findings and methodological issues. In J.W. Pennebaker (Ed.), Emotion, disclosure, and health.1995; 223-237.Washingtin, DC: American Psychological Association.
50- Bootzin RR. Examining the theory and clinical utility of writing about emotional expression. Psychological Science. 1997; 8 (3): 167-170.
51- Pennebaker JW, Zech E, & Rimé B. Disclosing and sharing emotion: Psychological, social, and health consequences. In M.S. Stroebe, R.O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care.2001; 517-544. Washington, DC: American Psychological Association.
52- Pennebaker JW, & Chung CK. Expressive writing, emotional upheavals, and health. In H. Friedman and R. Silver (Eds.), Foundations of Health Psychology.2007; 263-284. New York: Oxford University Press.
53- Slatcher RB, & Pennebaker JW. Emotional processing of Traumatic Events. In C.L.Cooper (Ed), Handbook of Stress Medicine and Health, Second Edition. 2004; New York: CRC Press.
54- Slatcher RB, & Pennebaker JW. Emotional Expression and Health. In Susan Ayers, Andrew Baum, Chris McManus, Stanton Newman, Kenneth Wallston, John Weinman, & Robert West (Eds), Cambridge Handbook of Psychology, Health and Medicine. 2007;  84-88. Cambridge: Cambridge University Press.
55- Klein K, & Boals A. Expressive writing can increase working memory capacity. Journal of Experimental Psychology: General. 2001a; 130: 520-533.
56- VandeCreek L, Janus MD, Pennebaker JW, & Binau B. Praying About Difficult Experiences as Self-Disclosure to God. The International. Journal for The Psychology of Religion. 2002; 12: 29-39.
57- Harrist S, Carlozzi BL, McGovern AR, & Harrist AW. Benefits of expressive writing and expressive talking about life goals. Journal of Research in Personality. 2007; 41: 923-930.
58- Kloss JD, & Lisman SA. An exposure-based examination of the effects of written emotional disclosure. British Journal of Health Psychology. 2002; 7: 31-46.
59- Esterling BA, Labate L, Murry EJ, Kumar M, & Pennebaker JW. Empirical foundations for writing in prevention and psychotherapy, Mental and Physical  Health Outcomes. Clinical psychology Review. 1999; 19 (1): 79-96.
60- Harizchighadam S, Ranjbar FK, Talebi M,  Pezeshki MZ, & Akbari M. Investigating the effectiveness of feeling catharsis with writing on depression and anxiety of Multiple sclerosis patients . Iranian Journal of  Nrain and Neuroscience. 1388; 8 (25): 465-475.
61- Sheffield D, Duncan E, Thomson K, & Johal SS. Written emotional expression and well-being. The Australian. Journal of Disaster and Trauma studies. 2002; 1.
62- Rime B. Mental rumination, Social sharing, and the recovery from emotional experience. In J.W.Pennebaker (Ed.), Emotion, disclosure, & health. 1995; 271-291. Washington, DC,US: American Psychological Association.
63- Pennebaker JW. Opening up: the healthing power of expressing emotion.1997a;  Newyork: Guilford.
64. Pennebaker JW, & Chung CK. Expressive writing and its links to mental andphysical health. In H. S. Friedman (Ed.), Oxford handbook of health psychology. In press; NewYork, NY: Oxford University Press.
65. McAdams DP. The psychology of life stories. Review of General Psychology. 2001; 5: 100-122.
دانشور پزشکی
دوره 19، شماره 2 - شماره پیاپی 93
خرداد و تیر 1390
صفحه 1-10

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