حانیه یاورزاده
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مقدمه
با توجه به محدودیت های ناشی از همه گیری COVID-19 جهت مراجعه حضوری برای دریافت درمان های روان شناختی، پژوهش حاضر، با هدف طراحی برنامه رایانه ای آموزش اختصاصی کردن حافظه (MeST) جهت ارتقاء حافظه خودزندگینامه ای و وضعیت عاطفی مراقبان افراد مبتلاء به سرطان صورت گرفت.
روش کارمطالعه حاضر یک طرح پیش آزمون پس آزمون با پیگیری یک ماهه بود که در درمانگاه تخصصی داخلی جهاد دانشگاهی خراسان رضوی (واحد شیمی درمانی) طی بازه زمانی 1401 صورت گرفت. این مطالعه در دو مرحله اصلی ارزیابی اعتبار ابزار طراحی شده و بررسی اثربخشی آن، انجام شد.
یافته ها:
بررسی روایی محتوایی نسخه فارسی نرم افزار MeST حاکی از آن بود که مقدار CVI برای بیشتر موارد برابر یا بیش از 0/8 است که نشان دهنده اهمیت و ضرورت محتوای موجود در نرم افزار طراحی شده می باشد. همچنین، ضرورت محتوای جلسات حاکی از آن بود که میزان شاخص CVR برای همه موارد 0/99 بود. پس از مداخله، مقایسه میانگین افسردگی (2/06=t ،0/04=P) و حافظه خودزندگینامه ای (2/25=Z ،0/02=P) در دو گروه حاکی از کاهش نمرات این دو مقیاس در گروه مداخله نسبت به گروه کنترل بود.
نتیجه گیریبا توجه به این که مداخله مبتنی بر MeST بر خط، دارای اثربخشی، آسان و ارزان می باشد، می تواند در کنار مداخلات سنتی یا برخط دیگر ارائه شود.
کلید واژگان: حافظه خودزندگی نامه ای, آموزش اختصاصی سازی حافظه, سرطان, مراقب, روایی محتواییIntroductionIndividuals experiencing psychological distress symptoms (such as anxiety, mental pressure, depression) and post-traumatic stress often struggle with autobiographical memory and rumination, necessitating psychological interventions. Interventions such as computerized competitive memory training and computerized memory specificity training are available options for psychologists to enhance the condition of these individuals, potentially improving emotional and cognitive symptoms, including autobiographical memory. Cancer caregivers are a population that frequently experiences numerous emotional issues, including anxiety, mental pressure, depression, and post-traumatic stress. The responsibility of assuming the caregiver role and associated feelings of guilt can intensify the pressure on caregivers of children with cancer. Given the constraints of the recent epidemic, it is crucial to offer methods that can effectively improve these individuals’ mental health. Considering the history of Memory Specificity Training (MeST)-based interventions in alleviating depression and post-traumatic stress disorder, the computerized design and localization of this intervention method can be beneficial during epidemic periods when face-to-face activities are limited. The present study aimed to develop an online Persian version of MeST-based training and to assess the content validity and effectiveness of this program.
MethodsThis study was conducted to develop a computerized version of the MeST training intervention sessions using mobile phone software. The tools used in this study included the Structured Clinical Interview for DSM-5 Mental Disorders Clinical Version, DASS-21 scale, Autobiographical Memory Test (AMT), and therapeutic intervention: Memory Specificity Training or MeST.The main structure of this software was designed and localized by adapting the software of Hallford et al. The Persian protocol, compatible with the Android version, was designed and modified by the working group. During the process of compiling the computerized version, the researchers collaborated with several clinical psychologists, computer specialists, software development experts, and patient caregivers. The classical form previously presented by Farhi Menesh et al. was used to prepare the Persian version of the protocol. With the help of the PHP programming language, the management panel and software were written based on React Native, and other sub-languages were also used for coding.In the second stage, the content validity of the intervention program was evaluated based on the necessity of each section’s existence and the relevance of the content to each section’s goals. This evaluation was conducted by ten psychologists and faculty members of Kharazmi University who were experienced in the field of cognitive sciences and familiar with the MeST tool. The content validity of the Farsi MeST protocol was calculated by evaluating the Content Validity Ratio (CVR) and Content Validity Index (CVI).Then, to check for bugs and changes in the content and notifications, modifications were made in the software’s space based on feedback from a small sample of applicants. Initially, a semi-structured interview was conducted separately by two trained psychologists, and if signs of psychological distress were observed, the individual was included in the study. The selected samples were randomly divided into two groups: an intervention group (15 people) and a control group (15 people). Individuals in the intervention group received seven treatment sessions based on the MeST intervention, held weekly, while no intervention was conducted in the control group. In the end, the effectiveness of the specific computerized memory intervention in reducing pathological symptoms and autobiographical memory of caregivers was investigated.
ResultsThe content validity review of the Persian version of the MeST online training software indicated that the CVI value for all items was more than 0.6, demonstrating the importance and necessity of the questions in the designed scale. A content validity index higher than 0.8 was achieved, indicating a satisfactory correlation of all items with the objectives of the constructed tool. However, the CVR and CVI were not appropriate for the materials providing the desired results and the timing of the sessions. Moreover, the content validity review of the session content indicated that the CVR index for all sessions was 0.99, and the CVI index for all sessions was equal to or higher than 0.8. Therefore, the relevance and necessity of the concepts used in the sessions were confirmed. The two groups were homogeneous in terms of variables such as gender, caregiver’s education level, and history of psychiatric diseases (P>0.05). The comparison of DASS-21 indices and autobiographical memory for the two groups is shown in Table 1. The results of the within-andbetween-group variance analysis for the variables of depression, anxiety, stress, and autobiographical memory are shown in Table 5. The results of the within-andbetween-group variance analysis show that no significant effect was observed in the state of depression over time (P=0.51, F=0.43). The interactive effect of the time groupwas also not significant, indicating no significant difference between the two groups (P=0.84, F=0.03). The results of the between-group comparison for the depression variable showed no significant difference between the two groups (P=0.14, F=2.27). The within-group analysis of the anxiety variable (P=0.18, F=1.82) and stress (P=0.27, F=1.23) also indicated the absence of a significant effect. The interactive effect of the time groupwas also not significant for the two variables of anxiety (P=0.96, F=0.001) and stress (P=0.19, F=1.73). The between-group comparison for the variables of anxiety (P=0.45, F=0.58) and stress (P=0.92, F=0.008) indicated no significant difference. Besides, the results of the within-group variance analysis showed that no significant effect was observed in the state of autobiographical memory. The interactive effect of the time groupwas also not significant (P=0.13, F=2.49). The results of the between-group comparison for the autobiographical memory variable also showed no significant difference between the two groups (P=0.78, F=0.07).
ConclusionThis study introduced an online version of the MeST intervention in Persian and confirmed its validity. Although validating the reliability and validity of the questionnaire is a lengthy, multi-step process, challenging the content of research tools aids in better understanding, using, and critiquing the content of a tool with a precise approach. Evidently, the MeST-based intervention has a short-term effect on reducing symptoms of depression. Previous studies have demonstrated that the MeST-based intervention positively impacts post-traumatic stress and depression symptoms. However, this study showed that these effects were transient, and the follow-up assessment largely lost the benefits of MeST over control groups. Other findings from this study indicated that online memory specificity training leads to short-term improvement in autobiographical memory. Other studies have also shown that specific memory training significantly improves specific memory. Nevertheless, this intervention does not impact stress and anxiety levels. Given that the MeST-based intervention is effective, easy, and inexpensive, it can be presented alongside traditional interventions. Although MeST is promising as a new intervention, future studies with larger samples and control groups are recommended to investigate the mechanism of MeST’s action due to its transitory effect.
Keywords: Autobiographical Memory, Memory Specificity Training, Content Validity, Cancer, Caregiver -
مقدمهصرع بیماری مزمنی است که علائم بالینی آن ایجاد تشنجات صرعی است که با حملات ناگهانی و معمولا بدون عامل برانگیزنده، اختلال هشیاری و حرکات غیر ارادی مشخص می شود. هدف پژوهش حاضر بررسی اثربخشی تحریک الکتریکی فراجمجمه ای (tDCS) بر بازداری کودکان مبتلا به صرع کانونی پیچیده ی گیجگاهی مقاوم به درمان بود.روشطرح پژوهش حاضر به صورت تک آزمودنی بود. جامعه پژوهش مراجعه کنندگان به کلینیک بیمارستان قائم مشهد در سال 1394 تا 1396 بودند که توسط پزشک متخصص داخلی اعصاب به صرع کانونی مقاوم به درمان دارویی تشخیص داده شدند. سن مورد نظر افراد نمونه بین 7 تا 11 سال است و تعداد 5 نفر انتخاب شدند. ابزار پژوهش شامل آزمون هوش مازهای پروتئوس و آزمون برو – نرو بودند. نتایج با استفاده از تحلیل دیداری نمودار و درصد بهبودی تحلیل شدند.یافته هانتایج نشان داد که در آزمون برو – نرو نمرات آزمودنی ها در خطای ارتکاب سیر نزولی داشته است. سه آزمودنی درصد بهبودی بالای 50 داشتند که نشان دهنده ی بهبودی و معناداری بالینی در بازداری است. خطای ارتکاب دو آزمودنی دیگر نیز کاهش پیدا کرده بود و بهبودی اندکی گزارش کردند.نتیجه گیریپژوهش حاضر نشان داد که مداخله tDCS می تواند نقش بسزایی در بهبود بازداری کودکان مصروع داشته باشد. بنابراین استفاده از شیوه های نوین درمانی مانند tDCS که نیازمند دارو نیست اثرات مفیدی در وضعیت زندگی این افراد و بهبود عملکردهای روانی آن ها خواهد داشت.کلید واژگان: بازداری, کودکان مصروع, صرع کانونی گیجگاهی مقاوم به درمان دارویی, تحریک الکتریکی فراجمجمه ایIntroductionEpilepsy is a chronic disease characterized by epileptic seizures that are identified by suddenly attacks, usually without eliciting external event, along with disorder of consciousness and involuntary movements. The purpose of the present study was to examine the effect of transcranial direct current stimulation (tDCS) on improving the inhibition of childhood drug-resistant temporal lobe Epilepsy.MethodThe present research use a single subject design. The research population included all clients referred to the clinic of Ghaem Hospital of Mashhad, in 2015 to 2018 and were diagnosed by an expert neurologist with experience on drug-resistant temporal lobe Epilepsy. The age range of subjects were between 6 and 18 years old and 5 patients were selected. The research tools were Porteus Maze Test and the Go-No Go Test. The final results were analyzed using a visual analysis chart and a recovery percentage formula.ResultsResults were shown that in the Go-No Go Test, for the majority of subjects the commission error decreased. The percentage of recovery for 3 subjects were over 50 percent which is a sign of clinical recovery. The other two subjects revealed a lower recovery in commission error.ConclusionThis study suggest that tDCS intervention play a significant role on improving the inhibition of epileptic children. Hence the use of such a new therapies as tDCS that requires no medication will have beneficial effects on patients lives and their mental functioning.Keywords: Inhibition, childhood epilepsy, drug, resistant, temporal lobe epilepsy, transcranial direct current stimulation
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