اثربخشی مداخلات روان‌شناختی بر کاهش علائم اختلال استرس پس از سانحه در نظامیان: مرور نظام‌مند

نوع مقاله : مروری

نویسندگان

1 مرکز تحقیقات علوم رفتاری، پژوهشکده سبک زندگی، دانشگاه علوم پزشکی بقیه الله (عج)، تهران، ایران

2 دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران

چکیده

زمینه و هدف: با توجه به ماهیت اختلال استرس پس از سانحه و شغل نظامی­‌گری، چالش­‌هایی در زمینۀ اثربخشی و بهبودی پایدار مداخلات روانشناختی بر علائم این اختلال در جمعیت نظامی گزارش شده است. هدف پژوهش حاضر شناسایی مداخلات روانشناختی اثربخش بر علائم PTSD و مقایسه اثربخشی آن­‌ها در قالب مداخلات خط اول (متمرکز بر تروما) و روان­درمانی­‌های خط دوم (غیر متمرکز بر تروما) بود.
روش‌ها: پژوهش حاضر یک مرور نظام‌­مند بود. مطالعات مرتبط از سال­‌های 2010 تا 2022 مورد بررسی قرار گرفت و از میان آن­‌ها 41 مطالعه واجد شرایط انتخاب شد. پایگاه­‌های اطلاعاتی شامل Elmnet، Magiran، SID، PsycINFO، SienceDirect، Pubmed، Google Scholar بود.
یافته‌ها: مداخلات متمرکز خط اول شامل درمان­‌های مبتنی بر ذهن­‌آگاهی، شناختی-رفتاری، مواجهه‌­سازی طولانی­‌مدت، پردازش شناختی، حساسیت‌­زدایی با حرکت تعقیبی چشم و پردازش مجدد بود که به‌­صورت کارآزمایی بالینی اعمال شده بودند. سایر مداخلات به صورت غیرمتمرکز و با اثر قابل توجهی بر بهبود علائم PTSD در مقابل گروه انتظار داشتند. خطر سوگیری در کارآزمایی­‌های بالینی کم و در مداخلات باز بیشتر بود. با این وجود اغلب وقتی درمان‌­های معمول و خط دوم درمان به عنوان گروه کنترل استفاده می­‌شد، اثربخشی­‌ها هم­‌ارز یا تفاوت کمی داشتند. لحاظ کردن جلسات مستمر و فشرده، فردی، نوشتاری، آنلاین و خانه محور و به­‌خصوص تلفیق درمان­‌های غیرمتمرکز در اثربخشی مداخلات و کاهش نرخ ریزش نقش ویژه‌­ای داشت.
نتیجه‌گیری: مداخلات خط اول در درمان PTSD نیز در کنار کارایی از چالش­‌هایی برخوردار هستند که برای برون­رفت از این چالش‌­ها، تغییراتی از جمله همگن­‌سازی آزمودنی­‌ها، کاهش فواصل جلسات، تلفیق با درمان‌­های معمول و غیرمتمرکز بر تروما، استفاده از ابزارهای نوشتن و گوشی هوشمند، فردی‌­سازی مداخلات و اعتماد به درمان­‌های خط دوم در قالب کارآزمایی بالینی می­‌تواند راهگشا باشد.

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