اثربخشی روان‌درمانی مختصر روابط موضوعی بر ابعاد سازمان شخصیت و علائم افسردگی پس از زایمان

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری روانشناسی، دانشکده روانشناسی و علوم تربیتی، دانشگاه سراسری سمنان، سمنان، ایران.

2 استادیار گروه روانشناسی، دانشکده روانشناسی و علوم تربیتی، دانشگاه سراسری سمنان، سمنان، ایران

3 استادیار گروه روانشناسی، دانشکده روانشناسی و علوم تربیتی، دانشگاه سراسری سمنان، سمنان، ایران.

4 دانشیار گروه روانشناسی، دانشکده روانشناسی و علوم تربیتی، دانشگاه سراسری سمنان، سمنان، ایران

چکیده

مقدمه: افسردگی پس از زایمان، اختلالی است که می­تواند آثار جبران­ناپذیری بر سلامت روان نوزادان و ارتباط مادر_کودک وارد نماید. هدف مطالعه حاضر، بررسی اثربخشی روان­درمانی مختصر روابط موضوعی بر ابعاد سازمان شخصیت و علائم افسردگی پس از زایمان بود.
روش کار: این مطالعه کارآزمایی بالینی، بر روی 30 نفر از زنان مبتلا به افسردگی پس از زایمان (15 نفر گروه آزمایش و 15 نفر گروه کنترل) انجام شد. جمعیت نمونه از میان زنان مراجعه کننده به مراکز بهداشت شهر تهران، به صورت دردسترس انتخاب شدند که در دو  مرحله پیش آزمون و پس آزمون، پرسشنامه افسردگی پس از زایمان ادینبورگ و مصاحبه ساختاریافته سازمان شخصیت را تکمیل نمودند. گروه آزمایش به مدت 15 جلسه تحت روان­درمانی مختصر روابط موضوعی قرار گرفته و گروه کنترل تحت هیچ مداخله­ای قرار نگرفتند. تحلیل داده­ها با استفاده از نرم­افزار SPSS  و آزمون تحلیل کوواریانس چند متغیری انجام شد.
نتایج: بر اساس نتایج آزمون تحلیل کوواریانس، نمره افسردگی پس از زایمان، و نمرات ابعاد مختلف سازمان شخصیت گروه آزمایش در مراحل پس آزمون ، کاهش معناداری نسبت به گروه کنترل داشته است که نشان­دهنده تاثیر روان­درمانی مختصر روابط موضوعی بر کاهش علایم افسردگی پس از زایمان، و تغییرات مثبت در ابعاد سازمان شخصیت می­باشد.
نتیجه­گیری: با استناد به یافته­ها، می­توان گفت روان­درمانی مختصر روابط موضوعی می­تواند درمان مناسبی برای بهبود علائم افسردگی در دوره پس از زایمان و ایجاد تغییرات مثبت در ابعاد سازمان شخصیت باشد.

کلیدواژه‌ها


عنوان مقاله [English]

The Effectiveness of the Object Relations Brief Psychotherapy on Domains of Personality Organization and Postpartum Depression Symptoms

نویسندگان [English]

  • Adeleh Ezzati 1
  • Parvin Rafieinia 2
  • parviz sabahi 3
  • Shahrokh Makvand Hosseini 4
1 PhD. student of psychology, Psychology and Educational Sciences Department, University of Semnan, Semnan, Iran.
2 Assistant Professor, Department of Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
3 Assistant Professor of psychology, Psychology and Educational Sciences Department, University of Semnan, Semnan, Iran.
4 Associate Professor of psychology, Psychology and Educational Sciences Department, University of Semnan, Semnan, Iran.
چکیده [English]

Introduction: Postpartum depression is one of the disorders that can have irreparable effects on neonatal mental health and mother-child relationship. The aim of this study is to determine effectiveness of the object relations brief psychotherapy on personality organization and postpartum depression symptoms.
Materials and Methods: This clinical trial study was conducted on 30 women with postpartum depression (15 experimental group and 15 control group) during the period of 1396-97. The sample population was selected from available women visiting the health centers in Tehran and completed the Edinburg postpartum depression Questionnaire.and Structured Interview of Personality Organization in pre-test and post-test stages. The experimental group received 15 sessions of object relations brief psychotherapy, and the control group was not subjected to any intervention. Data were analyzed using SPSS software and multivariate covariance analysis.
 Results: According to the results of the covariance analysis test, the postpartum depression score, and scores of different dimensions of personality organization, had a significant decrease in the experimental group compared to the control group, in the post-test stage. These results indicated that the brief object relations psychotherapy has been effective in reducing the symptoms of postpartum depression and has led to positive changes in the dimensions of personality organization.
Conclusion: According to the findings, it can be said that brief object relations psychotherapy can be a suitable treatment for decreasing the symptoms of depression in postpartum period and making positive changes in the dimensions of personality organization.

کلیدواژه‌ها [English]

  • Psychotherapy
  • Brief Object Relations Psychotherapy
  • Personality Organization
  • Object Relations
  • Postpartum Depression
  1. Johansson, M., Benderix, Y. & Svensson, I. (2020) Mothers’ and fathers’ lived experiences of
    postpartum depression and parental stress after childbirth: a qualitative study, International
    Journal of Qualitative Studies on Health and Well-being. 15(1): 1-10.
    2. Sylven, S.M., Thomopoulos, T.P., Kollia, N., Jonsson, M. & Skalkidou, A. (2017). Correlates of
    postpartum depression in first time mothers without previous psychiatric contact. European
    Psychiatry, 40: 4–12.
    3. Freeman MP. Perinatal Depression Recommendations for Prevention and the Challenges of
    Implementation. Counseling Interventions to Prevent Depression. 2019; 321(6): 550-552.
    4. Knights JE, Salvatore ML, Simpkins G, Hunter K, Khandelwal M. In search of best practice for
    postpartum depression screening: is once enough? European Journal of Obstetrics & Gynecology
    and Reproductive Biology. 2016; 206: 99–104.
    5. Posmontier B, Bina R, Glasser S, Cinamon T, Benedict S, Sammarco T. Incorporating
    Interpersonal Psychotherapy for Postpartum Depression Into Social Work Practice in Israel.
    Research on social work. 2019; 29(1): 61-68.
    6. Stephens S, Ford E, Paudyal P, Smith H. Effectiveness of Psychological Interventions for
    Postnatal Depression in Primary Care: A Meta-Analysis. Annals of family medicine. 2016; 14(5):
    463-472.
    7. Zarghami M. Perspective of Postpartum Depression Theories: A Narrative Literature Review.
    North American Journal of Medical Sciences. 2016; 8(6): 232-236.
    8. Dennis E .Janssen PA. Singer J. Identifying women at‐risk for postpartum depression in the
    immediate postpartum period. Willy Online Library. 2004;110(5): 338-346.
    9. Fitelson E. Kim S. Baker A. S. Leight K. Treatment of postpartum depression: clinical,
    psychological and pharmacological options. International journal of women's health. 2011; 3(1).
    10. Dennis CL. Psychological treatment is one of the several important components to the effective
    management of postpartum depression. Evidence-based nursing. 2017; 20(1): 9-11.
    11. Molyneaux E. Howard LM. McGeown HR. Karia AM. Trevillion K. Antidepressant treatment for
    postnatal depression. Cochrane Database of Systematic Reviews. 2014; 9.
    12. Turner KM. Sharp D. Folkes L. Chew-Graham C. Women's views and experiences of
    antidepressants as a treatment for postnatal depression: a qualitative study. Family practice.2008;
    25(6): 450-455.
    13. Pearlstein T. Perinatal depression: treatment options and dilemmas. Journal of psychiatry &
    neuroscience: JPN. 2008; 33(4): 302.
    14. Marcus SM. Depression during pregnancy: rates, risks and consequences. Journal of Population
    Therapeutics and Clinical Pharmacology.2009; 16(1).
    15. Howard LM. Megnin-Viggars O. Symington I. Pilling S. Antenatal and postnatal mental health:
    summary of updated NICE guidance. Bmj. 2014; 349.
    16. Besser A. Priel B. Flett GL. Wiznitzer A. Linear and Nonlinear Models of Vulnerability to
    Depression: Personality and Postpartum Depression in a High Risk Population. Individual
    Differences Research. 2007; 5(1): 1-29.
    17. Stone SD. Menken AE. Perinatal and Postpartum Mood Disorders: Perspectives and Treatment
    Guide for the Health Care Practitioner. Springer Publishing Company. 2008: 309-319.
    18. Stadter, M. Object Relations Brief Therapy; the therapeutic relationship in short-term work.
    United States of America: Jason Aronson. 2009.
    19. Blum LD. Psychodynamics of postpartum depression. Psychoanalytic Psychology. 2007; 24(1):
    45–62.
    20. Stern D. The motherhood constellation. A unified view of parent-infant psychotherapy. New
    York: Basic Books. 1995. p.62-63.
    21. Raphael-Leff J. Facilitators and regulators: Conscious and unconscious processes in pregnancy
    and early motherhood. British Journal of Medical Psychology. 1986; 59: 43–55.
  2. 22. Raphael-Leff, J. Psychological processes of childbearing (Rev. ed.). London: Chapman & Hall.
    2001. p. 87-89.
    23. Besser A, Vliegen N, Luyten P, Blatt SJ. Systematic empirical investigation of vulnerability to
    postpartum depression from a psychodynamic perspective. Psychoanalytic Psychology. 2008;
    25(2): 1-19.
    24. Priel B, Besser A. Bridging the gap between attachment and object relations’ theories: A study of
    the transition to motherhood. British Journal of Medical Psychology. 2001; 74: 85–100.
    25. Raphael-Leff J. Parent-infant psychodynamics – wild things, mirrors and ghosts. London, New
    York: Whurr Publishers. 2003. p. 108.
    26. Hopkins J, Marcus M, Campbell SB. Postpartum depression: A critical review. Psychological
    Bulletin. 1984; 95: 498 –515.
    27. Raphael-Leff J. Climbing the walls: Therapeutic intervention for post-partu1m disturbance. In J.
    Raphael-Leff (Ed.), Spilt milk. London: Institute of Psychoanalysis. 2000. p. 67-81.
    28. Clarkin JF, Caligor E, Stern B, Kernberg OF. The Structured Interview for Personality
    Organization-Revised (STIPO-R). Unpublished manuscript, Department of Psychiatry, Weill
    Cornell Medical College, NY, New York. 2019.
    29. Kernberg OF, Caligor E. A psychoanalytic theory of personality disorders. In M.F. Lenzenweger
    & J.F. Clarkin (Eds.). New York, NY: Guilford Press. 2005. p.119-147.
    30. Caligor E, Clarkin JF. An object relations model of personality and personality pathology.
    Psychodynamic psychotherapy for personality disorders: A clinical handbook. Washington, DC:
    American Psychiatric Publishing. 2010. p.121-143.
    31. Caligor E, Kernberg OF, Clarkin JF, Yeomans FE. Psychodynamic therapy for personality
    pathology: Treating self and interpersonal functioning. Washington, DC: American Psychiatric
    Association Publishing. 2018. p.205-211.
    32. Stern BL, Caligor E, Clarkin JF, Critchfield C, Horz S, Maccornack V, Lenzenweger MF,
    Kernberg OF. Structured Interview of Personality Organization (STIPO): Preliminary
    psychometrics in a clinical sample. Journal of Personality Assessment 2010; 92(1): 35-44.
    33. Kernberg OF. Severe personality disorders: Psychotherapeutic strategies. New Haven, CT: Yale
    University Press. 1984.
    34. Mullen LS, Blanco C, Vaughan SC, Vaughan R, Roose SP. Defense mechanisms in personality
    and depression. Depression and Anxiety. 1999; 10: 168-174.
    35. Behn A. Working with clients at the intersection of depression and personality dysfunction:
    Scientific and clinical findings regarding complex depression. Journal of Clinical Psychology.
    2019; 75(5): 819-723.
    36. Guerini R, Marraffa M. & Paloscia C. Mentalization, attachment, and subjective identity.
    Frontiers in Psychology. 2015; 6: 10-22.
    37. Clarkin JF, Petrini M, Diamond D. Complex depression: The treatment of major depression and
    severe personality pathology. Journal of Clinical Psychology. 2019; 75(5): 824-833.
    38. AhmadikaniGolzar A, Golizadeh Z. Validation of Edinburgh Postpartum Depression Scale
    (EPDS) for screening postpartum depression in Iran. Iranian Journal of Psychiatric Nursing.
    2015; 3(3): 1-10. (Full Text in Persian)
    39. Vahedi A, Makvand HSh, Bigdeli I. Diagnosis of higher level personality pathology by using
    short-term dynamic psychotherapy. Journal of Clinical Psychology. 2012; 4 (315): 75-85.
    40. Farjad M, Mohammadi N, Rahimi CH, Hadianfard H. The relationship between personality
    organization and defense mechanisms. Journal of Psychology. 2013; 17(2): 18-32. (Full Text in
    Persian)
    41. Taylor D. Treatment manuals and the advancement of psychoanalytic knowledge: The treatment
    manual of the tavistock adult depression study. The International Journal of Psychoanalysis.
    2015; 96(3): 507-924.
    42. Shakiba S, Mohamadkhani P, Poorshahbaz A, Moshtaghbidokhti N. The efficacy of Brief Object
    Relations Psychotherapy on major depressive disorder comorbid with cluster C personality
    disorders: a single subject study. Medical Journal of Islamic Republic of Iran. 2011; 25(2): 57-65.
  3. 43. Keefe JR, DeRubeis RJ. Changing character: A narrative review of personality change in
    psychotherapies for personality disorder. Psychotherapy Research. 2018; 29(6): 752-769.
    44. Yeomans FE, Levy KN, Kivity Y. Case formulation in transference-focused psychotherapy.
    Elsevier Inc., Cambridge, MA. 2019.
    45. Caligor E, Kernberg OF, Clarkin JF. Hand book of dynamic psychotherapy for higher level
    personality pathology. 2nd ed. Washangton, DC: Am psychiatr publ. 2007.
    46. Werbart A, Bergstedt A, & Levander S. Love, Work, and Striving for the Self in Balance:
    Anaclitic and Introjective Patients’ Experiences of Change in Psychoanalysis. Front. Psychol
    2020; 11, 132-144.
    47. Clarkin JF, Yeomans FE, & Kernberg OF. Psychotherapy for borderline personality disorder
    focusing on object relations. Washington, DC: American Psychiatric. 2006.
    48. Bateman AW, & Fonagy P. Mentalization based treatment for borderline personality disorder: a
    practical guide. Oxford, United Kingdom: Oxford University Press. 2006.
    49. Kramer U, Despland JN, Michel L, Drapeau M, & de Roten Y. Change in defense mechanisms
    and coping over the course of short-term dynamic psychotherapy for adjustment disorder. Journal
    of Clinical Psychology. 2010; 66(12), 1232–1241.
    50. Barber JP, Muran JC, McCarthy KS, & Keefe RJ. Research on Psychodynamic Therapies. In M.
    J. Lambert (Ed.). Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (6th
    ed.) New York: John Wiley & Sons. 2013; 443-494.
    51. Miller A, & Kernberg OF. Instructor’s Manual for Psychoanalytic Psychotherapy for Personality
    Disorders: An Interview with Otto Kernberg. Psychotherapy.net. 2010.
    52. Summers RJ, & Barber JP. Dynamic psychotherapy: A guide to evidence-based practice. New
    York: Guilford Press. 2010.
    53. Moshtaghbidokhti N. Good Mother – Bad Mother. Mehr o Mah Publishing Co. 2011. Full text in
    Persian.
    54. Clarkin JF, Petrini M, & Diamond D. Complex depression: The treatment of major depression
    and severe personality pathology. Journal of Clinical Psychology. 2019; 75(5): 824-833.