اثربخشی پروتکل ترکیبی آموزش شناختی و خانواده‌درمانی ساختاری-سیستمی بر کاهش علائم افسردگی و بهبود انعطاف‌پذیری شناختی و کنترل بازداری

نویسندگان
پریسا پاکاری
زهرا کاووسیان
فائزه ضیایی
زینب حسنی اصل
پریسا حسین زاده یزدی
چکیده
پژوهش حاضر با هدف بررسی اثربخشی پروتکل ترکیبی آموزش شناختی تطبیقی و خانواده‌درمانی ساختاری-سیستمی بر کاهش علائم افسردگی و بهبود انعطاف‌پذیری شناختی و کنترل بازداری انجام شد. در یک کارآزمایی نیمه‌تجربی با طرح پیش‌آزمون-پس‌آزمون-پیگیری دو ماهه و گروه کنترل، ۳۲ نفر (۱۶ نفر در هر گروه) از مراجعان سه کلینیک معتبر خانواده‌درمانی تهران که تشخیص افسردگی خفیف تا متوسط داشتند، به‌صورت تصادفی در دو گروه آزمایش و کنترل گمارده شدند. گروه آزمایش علاوه بر دریافت ۱۲ جلسه خانواده‌درمانی ساختاری-سیستمی، ۱۲ جلسه آموزش شناختی تطبیقی (با تمرکز بر تمرین‌های تعویض تکلیف، تغییر مجموعه، مهار تکانه و استروپ) دریافت کرد؛ گروه کنترل تنها خانواده‌درمانی استاندارد را دریافت نمود. ابزارهای پژوهش شامل پرسشنامه افسردگی بک-ویرایش دوم، مقیاس انعطاف‌پذیری شناختی دنیس و وندروال و آزمون استروپ رنگی-کلمه (نسخه کامپیوتری) بود. تحلیل واریانس با اندازه‌گیری مکرر و آزمون‌های چندمتغیره نشان داد که مداخله ترکیبی منجر به کاهش بسیار معنادار علائم افسردگی و بهبود قوی انعطاف‌پذیری شناختی و کنترل بازداری در پس‌آزمون و پیگیری دو ماهه گردید ؛ اندازه اثرهای به‌دست‌آمده بسیار بزرگ بود (η² از 0/586٫ تا 0/923) و بهبود کنترل بازداری تا پیگیری کاملاً پایدار ماند. افزودن آموزش شناختی تطبیقی به خانواده‌درمانی ساختاری-سیستمی یک پروتکل ترکیبی نسل سوم، بسیار مؤثر و بالینی معنادار برای درمان افسردگی خفیف تا متوسط است که نه تنها علائم عاطفی را کاهش می‌دهد، بلکه نقایص شناختی پایدار را به‌طور مستقیم اصلاح کرده و پتانسیل پیشگیری از عود را افزایش می‌دهد. این رویکرد به‌ویژه در فرهنگ‌های جمع‌گرا و درمان‌های سیستمی پیشنهاد می‌شود.
کلیدواژه‌ها
افسردگی
آموزش شناختی تطبیقی
خانواده‌درمانی ساختاری-سیستمی
انعطاف‌پذیری شناختی
کنترل بازداری

عنوان مقاله English

Efficacy of a Combined Cognitive Training and Structural-Systemic Family Therapy Protocol in Reducing Depressive Symptoms and Enhancing Cognitive Flexibility and Inhibitory Control

نویسندگان English

Parisa Pakari
Zahra Kavousian
Faezeh Ziaei
Zeinab Hassani Asl
parisa hosein zadeh yazdi
چکیده English

This study aimed to investigate the efficacy of a combined adaptive cognitive training and structural-systemic family therapy protocol in reducing depressive symptoms and improving cognitive flexibility and inhibitory control. In a quasi-experimental design with pre-test, post-test, and two-month follow-up assessments and a control group, 32 adults (16 per group) diagnosed with mild-to-moderate depression were randomly assigned to either the experimental or control condition from three reputable family therapy clinics in Tehran. The experimental group received 12 sessions of standard structural-systemic family therapy plus 12 sessions of adaptive cognitive training focused on task-switching, set-shifting, response inhibition, and Stroop exercises; the control group received family therapy alone. Measures included the Beck Depression Inventory-II, Cognitive Flexibility Inventory, and computerized Stroop Color-Word Test. Repeated-measures multivariate analysis of variance revealed that the combined intervention produced highly significant reductions in depressive symptoms and substantial improvements in cognitive flexibility and inhibitory control at post-test and two-month follow-up (p < .001), with very large effect sizes (η² ranging from 0.586 to 0.923). Improvement in inhibitory control remained fully stable at follow-up. Adding adaptive cognitive training to structural-systemic family therapy constitutes a highly effective, clinically meaningful third-generation combined protocol for treating mild-to-moderate depression that not only alleviates emotional symptoms but also directly remediates persistent cognitive deficits, thereby enhancing relapse-prevention potential. This approach is particularly recommended for collectivist cultures and systemic treatment contexts.

کلیدواژه‌ها English

depression
Adaptive cognitive training
Structural-systemic family therapy
Cognitive Flexibility
inhibitory control
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