نوآوری های اخیر در روان‌شناسی

نوآوری های اخیر در روان‌شناسی

ترک زودرس روان‌درمانی و مشاوره در مراجعان به کلینیک‌های روان‌شناسی و روان‌پزشکی: نقش شاخص‌های جمعیت‌شناختی، عزت نفس و اضطراب

نوع مقاله : پژوهشی اصیل

نویسندگان
سمیه صفرزاده 1
مهناز جوکار کمال آبادی 2
فریده السادات حسینی 3
سید موسی گلستانه 3
1 دانشجوی دکتری روان‌شناسی، دانشگاه خلیج فارس، بوشهر، ایران
2 استادیار، گروه روان‌شناسی، دانشگاه خلیج فارس، بوشهر، ایران
3 دانشیار، گروه روان‌شناسی، دانشگاه خلیج فارس، بوشهر، ایران
10.22034/rip.2024.484087.1065
چکیده
روان­ درمانی در درمان اختلالات­ روانی موفقیت چشمگیری داشته است. اما در دههی اخیر عدم رضایت مراجعان از فرآیند روان­ درمانی و ترک زودرس جلسات­درمانی فزونی یافته است. هدف پژوهش حاضر بررسی نقش عوامل جمعیت ­شناختی، عزت­ نفس و اضطراب مراجعان در پدیدآیی ترک زودرس روان ­درمانی و مشاوره بود. طرح پژوهش حاضر توصیفی­ مقطعی بود. جامعه آماری پژوهش تمامی مراجعان به کلینیک ­های روانشناسی و روانپزشکی شهر مشهد بودند. نمونه­ مورد نظر شامل 87 مراجع بودند که با شیوه نمونه­ گیری هدفمند در بازه­ زمانی شهریور ماه سال 1402 تا فروردین ماه 1403 انتخاب شدند. برای سنجش متغیرهای مورد بررسی از پرسشنامه پیامد درمانی (OQ-45)، سیاهه اضطراب بک (BAI)، مقیاس عزت­ نفس روزنبرگ (RSES) و پرسشنامه­ اطلاعات جمعیت­ شناختی برای مراجع (DIQFP) استفاده شد. یافته­ ها نشان داد جنسیت، سن، اضطراب و عزت­ نفس با ترک زودرس روان ­درمانی و مشاوره در ارتباط بوده (0.05>P) و 39 درصد از واریانس آن را پیش بینی می‌کنند. بین تشخیص ­بالینی و ترک زودرس روان­ درمانی و مشاوره همبستگی معناداری وجود نداشت (0.05>P). یافته‌های پژوهش حاضر نشان داد عوامل جمعیت­ شناختی، اضطراب و عزت­ نفس پیش ­بینی ­کننده­ ترک زودرس روان­ درمانی و مشاوره هستند. امید است یافته ­های پژوهش حاضر زمینه بررسی بیشتر فرآیند روان­ درمانی و جلسات درمانی را توسط متخصصین بالینی فراهم کند.
کلیدواژه‌ها
اضطراب
ترک زودرس
روان‌درمانی
شاخص‌های جمعیت‌شناختی
عزت‌نفس
موضوعات

عنوان مقاله English

Premature Dropout from Psychotherapy and Counseling among Clients to Psychological and Psychiatric Clinics: The Role of Demographic Characteristics, Self-esteem and Anxiety

نویسندگان English

Somayeh Safarzade 1
Mahnaz Joukar Kamalabadi 2
Faridehsadat Hoseini 3
Seyed Mousa Golestaneh 3
1 PhD. Student in Psychology, Persian Gulf University, Bushehr, Iran
2 Assistant Professor, Department of Psychology, Persian Gulf University, Bushehr, Iran
3 Associate Professor, Department of Psychology, Persian Gulf University, Bushehr, Iran
چکیده English

Psychotherapy has been demonstrated to be an efficacious intervention for the treatment of mental disorders. However, over the past decade, there has been a notable rise in client dissatisfaction with the psychotherapy process and an increase in the number of premature dropouts from treatment sessions. The objective of the present study was to examine the influence of demographic characteristics, self-esteem and anxiety on the phenomenon of premature termination of psychotherapy and counseling. The research method employed in the present study was that of a descriptive cross-sectional study. The study population comprised all clients attending psychology and psychiatry clinics in Mashhad. The intended sample comprised 87 references, selected by purposive sampling between September 2023 and April 2024. The Outcome Questionnaire-45 (OQ-45), the Beck Anxiety Inventory (BAI), the Rosenberg Self-Esteem Scale (RSES) and the Demographic Information Questionnaire for Patients (DIQFP) were employed as instruments for the measurement of the variables under investigation. The findings indicated that gender, age, anxiety, and self-esteem were associated with early discontinuation of psychotherapy and counseling (P < 0.05) and predicted 39% of the variance. No statistically significant correlation was identified between clinical diagnosis and premature dropout of psychotherapy and counseling (P > 0.05). The results of the study indicated that demographic characteristics, anxiety, and self-esteem are predictive premature dropout of psychotherapy and counseling. It is anticipated that the findings of the present study will provide a foundation for further investigation of the psychotherapy process and treatment sessions by clinical professionals.

کلیدواژه‌ها English

anxiety
demographic characteristics
premature dropout
psychotherapy
self-esteem
Allabadi, H., Alkaiyat, A., Alkhayyat, A., Hammoudi, A., Odeh, H., Shtayeh, J., Taha, M., Schindler, C., Zemp, E., Haj-Yahia, S., & Probst-Hensch, N. (2019). Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population. BMC public health, 19(1), 232. https://doi.org/10.1186/s12889-019-6561-3
Anderson, K. N. (2015). Premature termination of outpatient psychotherapy: Predictors, reasons, and outcomes (Doctoral dissertation. Available from ProQuest dissertations and Theses database.) University of Nebraska. URL: https://digitalcommons.unl.edu/psychdiss/74/
Arnow, B. A., Blasey, C., Manber, R., Constantino, M. J., Markowitz, J. C., Klein, D. N., Thase, M. E., Kocsis, J. H., & Rush, A. J. (2007). Dropouts versus completers among chronically depressed outpatients. Journal of Affective Disorders, 97(1-3), 197–202. https://doi.org/10.1016/j.jad.2006.06.017
Banyard, H., Behn, A. J., & Delgadillo, J. (2021). Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis. Cognitive Therapy and Research, 45, 561–576. https://doi.org/10.1007/s10608-021-10203-x
Barber, J. P., & Solomonov, N. (2019). Toward a personalized approach to psychotherapy outcome and the study of therapeutic change. World psychiatry: Official Journal of the World Psychiatric Association (WPA), 18(3), 291–292. https://doi.org/10.1002/wps.20666
Barkham, M., Lutz, W., & Castonguay, L. G. (Eds.). (2021). Bergin and Garfield's handbook of psychotherapy and behavior change. John Wiley & Sons. URL: https://psycnet.apa.org/record/2021-81510-000
Barrett, M. S., Chua, W.-J., Crits-Christoph, P., Gibbons, M. B., & Thompson, D. (2008). Early withdrawal from mental health treatment: Implications for psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45(2), 247–267. https://doi.org/10.1037/0033-3204.45.2.247
Beck, A. T., Epstein, N., Brown, G., & Steer, R. (1988). Beck Anxiety Inventory [Database record]. APA PsycTests. https://psycnet.apa.org/doi/10.1037/t02025-000
Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. (1996). Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. Journal of personality assessment, 67(3), 588–597. https://doi.org/10.1207/s15327752jpa6703_13
Borgogna, N. C., McDermott, R. C., Berry, A., Lathan, E. C., & Gonzales, J. (2020). A multicultural examination of experiential avoidance: AAQ – II measurement comparisons across Asian American, Black, Latinx, Middle Eastern, and White college students. Journal of Contextual Behavioral Science, 16, 1–8. https://doi.org/10.1016/j.jcbs.2020.01.011
Callahan, J. L., Aubuchon-Endsley, N., Borja, S. E., & Swift, J. K. (2009). Pretreatment expectancies and premature termination in a training clinic environment. Training and Education in Professional Psychology, 3(2), 111–119. https://doi.org/10.1037/a0012901
Chisholm, S. M., Crowther, J. H., & Ben-Porath, Y. S. (1997). Selected MMPI-2 scales' ability to predict premature termination and outcome from psychotherapy. Journal of Personality Assessment, 69(1), 127–144. https://doi.org/10.1207/s15327752jpa6901_7
Clarkin, J. F., & Levy, K. N. (2004). The influence of client variables on psychotherapy. Bergin and Garfield’s handbook of psychotherapy and behavior change, 5, 194-226. URL: https://levylab.la.psu.edu/wp-content/uploads/sites/9/2
Colak, M., Bingol, O. S., & Dayi, A. (2023). Self-esteem and social media addiction level in adolescents: The mediating role of body image. Indian Journal of Psychiatry, 65(5), 595–600. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_306_22
Connell, J., Grant, S., & Mullin, T. (2007). Client initiated termination of therapy at NHS primary care counseling services. Counseling and Psychotherapy Research, 6, 60–67. https://doi.org/10.1080/14733140600581507
Cottone, J. G., Drucker, P., & Javier, R. A. (2002). Gender differences in psychotherapy dyads: Changes in psychological symptoms and responsiveness to treatment during 3 months of therapy. Psythotherapy: Theory, Research, Practice, Training, 39(4), 297-308. https://doi.org/10.1037/0033-3204.39.4.297
Cramer, E. M., Song, H., Drent, A. M. (2016). Social comparison on Facebook: Motivation, affective consequences, self-esteem, and Facebook fatigue. Computers in Human Behavior, 64, 739-746. https://doi.org/10.1016/j.chb.2016.07.049
Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E., & Kessler, R. C. (2002). Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. The American Journal of Psychiatry, 159(5), 845–851. https://doi.org/10.1176/appi.ajp.159.5.845
Elbaky, G. B. A., Hay, P. J., le Grange, D., Lacey, H., Crosby, R. D., & Touyz, S. (2014). Pre-treatment predictors of attrition in a randomized controlled trial of psychological therapy for severe and enduring anorexia nervosa. BMC Psychiatry, 14(1), 69. https://doi.org/10.1186/1471-244X-14-69
Fenger, M., Mortensen, E. L., Poulsen, S., Lau, M. (2011). No-shows, drop-outs and completers in psychotherapeutic treatment: Demographic and clinical predictors in a large sample of non-psychotic patients. Nordic Journal of Psychiatry, 65(3),183–91. https://doi.org/10.3109/08039488.2010.515687
Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108–1122. https://doi.org/10.1037/ccp0000044
Flückiger, C., Meyer, A., Wampold, B. E., Gassmann, D., Messerli-Bürgy, N., & Munsch, S. (2011). Predicting premature termination within a randomized controlled trial for binge-eating patients. Behavior therapy, 42(4), 716–725. https://doi.org/10.1016/j.beth.2011.03.008
Fortuna, L. R., Alegria, M., & Gao, S. (2010). Retention in depression treatment among ethnic and racial minority groups in the United States. Depression and Anxiety, 27(5), 485–494. https://doi.org/10.1002/da.20685
Gamache, D., Savard, C., Lemelin, S., Côté, A., & Villeneuve, E. (2018). Premature psychotherapy termination in an outpatient treatment program for personality disorders: a survival analysis. Comprehensive psychiatry, 80, 14–23. https://doi.org/10.1016/j.comppsych.2017.08.001
García, J. A., Y Olmos, F. C., Matheu, M. L., & Carreño, T. P. (2019). Self esteem levels vs global scores on the Rosenberg self-esteem scale. Heliyon, 5(3), e01378. https://doi.org/10.1016/j.heliyon.2019.e01378
Goddard, E., Wingrove, J., & Moran, P. (2015). The impact of comorbid personality difficulties on response to IAPT treatment for depression and anxiety. Behaviour Research and Therapy, 73, 1-7. https://doi.org/10.1016/j.brat.2015.07.006
Greenspan, M., & Kulish, N. M. (1985). Factors in premature termination in long-term psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 22(1), 75–82. https://doi.org/10.1037/h0088529
Hanevik, E., Røvik, F. M. G., Bøe, T., Knapstad, M., & Smith, O. R. F. (2023). Client predictors of therapy dropout in a primary care setting: a prospective cohort study. BMC psychiatry, 23(1), 358. https://doi.org/10.1186/s12888-023-04878-7
Harpaz-Rotem, I., & Rosenheck, R. A. (2011). Serving those who served: retention of newly returning veterans from Iraq and Afghanistan in mental health treatment. Psychiatric services (Washington, D.C.), 62(1), 22–27. https://doi.org/10.1176/ps.62.1.pss6201_0022
Immel, N., Dagnino, P., & Hunger-Schoppe, C. (2022). Associations between patient personality, symptomatic change and therapy dropout. Clinical Psychology & Psychotherapy, 29(3), 922–932. https://doi.org/10.1002/cpp.2670
Kegel, A. F., & Flückiger, C. (2015). Predicting Psychotherapy Dropouts: A Multilevel Approach. Clinical Psychology & Psychotherapy, 22(5), 377–386. https://doi.org/10.1002/cpp.1899
Khazaie, H., Rezaie, L., Shahdipour, N., & Weaver, P. (2016). Exploration of the reasons for dropping out of psychotherapy: A qualitative study. Evaluation and Program Planning, 56, 23–30. https://doi.org/10.1016/j.evalprogplan.2016.03.002
Kullgard, N., Holmqvist, R., & Andersson, G. (2022). Premature Dropout From Psychotherapy: Prevalence, Perceived Reasons and Consequences as Rated by Clinicians. Clinical psychology in Europe, 4(2), e6695. https://doi.org/10.32872/cpe.6695
Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. (1996). The Reliability and Validity of the Outcome Questionnaire. Clinical Psychology & Psychotherapy, 3(4), 249-258. https://doi.org/10.1002/(SICI)1099-0879(199612)3:4%3C249::AID-CPP106%3E3.0.CO;2-S
Lu, Q., Lyu, Y., Jia, N., Dong, L., Zhang, M., Jin, M., Xie, M., Li, J., Xue, F., Li, W., Yang, Y., & Yu, Q. (2025). Socioeconomic status, individual behaviors and risk of anxiety disorders: A Mendelian randomization study. Journal of Affective Disorders, 368, 33–40. https://doi.org/10.1016/j.jad.2024.09.028
Poster, K., Bennemann, B., Hofmann, S. G., & Lutz, W. (2021). Therapist Interventions and Skills as Predictors of Dropout in Outpatient Psychotherapy. Behavior therapy, 52(6), 1489–1501. https://doi.org/10.1016/j.beth.2021.05.001
Ren, L., Fan, Y., Wu, W., Qian, Y., He, M., Li, X., Wang, Y., Yang, Y., Wen, X., Zhang, R., Li, C., Chen, X., & Hu, J. (2024). Anxiety disorders: Treatments, models, and circuitry mechanisms. European Journal of Pharmacology, 983, 176994. https://doi.org/10.1016/j.ejphar.2024.176994
Richard, A., & Dunkley, D. M. (2024). Self-Critical Perfectionism and Anxious and Depressive Symptoms Over 2 Years: Moderated Mediation Models of Anxiety Sensitivity and Experiential Avoidance. Behavior Therapy, 55(5), 974-989. https://doi.org/10.1016/j.beth.2024.02.001
Romans, J., White, J., Harrist, R., Boswell, D., Sims, W., & Murn, L. (2009). Predicting attrition from counseling in a university counseling center sample using the Outcome Questionnaire-45.2. The Internet Journal of Mental Health, 7(1). https://psycnet.apa.org/record/2012-06007-001
Rosenberg, M. (1979). Conceiving the Self. New York: Basic Books. URL: https://www.apa.org/obesity-guideline/rosenberg-self-esteem.pdf
Sisay, T., Mulate, M., Hailu, T., & Belete, T. M. (2024). The prevalence of depression and anxiety among cardiovascular patients at University of Gondar specialized hospital using beck's depression inventory II and beck anxiety inventory: A cross-sectional study. Heliyon, 10(2), e24079. https://doi.org/10.1016/j.heliyon.2024.e24079
Swift, J. K., Greenberg, R. P., Tompkins, K. A., & Parkin, S. R. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy (Chicago, Ill.), 54(1), 47–57. https://doi.org/10.1037/pst0000104
Syan, S. K., Minhas, M., Oshri, A., Costello, J., Sousa, S., Samokhvalov, A. V., Rush, B., & MacKillop, J. (2020). Predictors of premature treatment termination in a large residential addiction medicine program. Journal of substance abuse treatment, 117, 108077. https://doi.org/10.1016/j.jsat.2020.108077
Syropoulou, A., Vernadakis, N., Papastergiou, M., & Kourtessis, T. (2021). Psychometric evaluation of the Rosenberg Self-Esteem Scale in primary school students with mild intellectual disability: First evidence. Research in developmental disabilities, 114, 103964. https://doi.org/10.1016/j.ridd.2021.103964
Tang, N., Baker, A. (2016). Self-esteem, financial knowledge and financial behavior. Journal of Economic Psychology, 54, 164-176. https://doi.org/10.1016/j.joep.2016.04.005
Tarescavage, A. M., Finn, J. A., Marek, R. J., Ben-Porath, Y. S., & van Dulmen, M. H. (2015). Premature termination from psychotherapy and internalizing psychopathology: the role of demoralization. Journal of affective disorders, 174, 549–555. https://doi.org/10.1016/j.jad.2014.12.018
Thormählen, B., Weinryb, R. M., Norén, K., Vinnars, B., Bågedahl-Strindlund, M., & Barber, J. P. (2003). Patient Factors Predicting Dropout from Supportive-Expressive Psychotherapy for Patients with Personality Disorders. Psychotherapy Research, 13(4), 493–509. https://doi.org/10.1093/ptr/kpg039
Tulachan, P., Lama, P. Y., Upadhyaya, S., Pant, S. B., Chapagai, M., & Dhungana, S. (2022). Translation, adaptation and validation of Nepali version of Rosenberg Self Esteem Scale in adult Nepali population. SSM Mental Health, 2, 100150. https://doi.org/10.1016/j.ssmmh.2022.100150
Walters, G. D., Solomon, G. S., & Walden, V. R. (1982). Use of the MMPI in predicting psychotherapeutic persistence in groups of male and female outpatients. Journal of Clinical Psychology, 38(1), 80–83. https://doi.org/10.1002/1097-4679(198201)38:1<80::aid-jclp2270380110>3.0.co;2-d
Wang, J. (2007). Mental health treatment dropout and its correlates in a general population sample. Medical Care, 45(3), 224–229. https://doi.org/10.1097/01.mlr.0000244506.86885.a5
White, K. S., Allen, L. B., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2010). Attrition in a multicenter clinical trial for panic disorder. The Journal of nervous and mental disease, 198(9), 665–671. https://doi.org/10.1097/NMD.0b013e3181ef3627
Wongpakaran, N., Wongpakaran, T., & Kövi, Z. (2022). Development and validation of 21-item outcome inventory (OI-21). Heliyon, 8(6), e09682. https://doi.org/10.1016/j.heliyon.2022.e09682
Zieve, G. G., Persons, J. B., & Yu, L. A. D. (2019). The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy. Behavior Therapy, 50(1), 189–199. https://doi.org/10.1016/j.beth.2018.05.004

  • تاریخ دریافت 26 مهر 1403
  • تاریخ بازنگری 26 آبان 1403
  • تاریخ پذیرش 29 آبان 1403
  • تاریخ اولین انتشار 16 آذر 1403