Investigating the effectiveness of teaching emotional distress tolerance skills based on dialectical behavior therapy on depression and sleep problems of women with hypothyroidism referring to Khatam-Nabiya Polyclinic in Yazd.

Master's Thesis in Psychology (M. Sc.)

Trend: Clinical

Abstract

Hypothyroidism is a chronic disease that can cause depression and sleep problems in people, therefore, the purpose of this research is to investigate the effectiveness of teaching emotional distress tolerance skills based on dialectical behavior therapy on depression and sleep problems in women with hypothyroidism. Thyroid dysfunction was referred to Khatam al-Nabiya polyclinic. In this semi-experimental (quasi-experimental) research, which was of pre-test, post-test and follow-up type with a control group, 30 patients with hypothyroidism who visited Khatam Albia polyclinic in Yazdam city in 2013 were randomly selected and participated in this research. All the subjects completed and signed the consent form to participate in the research and the subjects were randomly divided into two experimental (15 people) and control (15 people) groups. The experimental group was trained in emotional distress tolerance skills in 8 sessions of 45 minutes, and the control group did not receive any intervention. Both groups of subjects completed the Beck depression questionnaire and sleep problems before and after the educational program and the data were analyzed using one-way analysis of variance test at the p<0.05 level. The results showed that the training of emotional distress tolerance skills based on dialectical behavior therapy on depression, sleep onset, sleep continuation and wakefulness of women with hypothyroidism referring to Khatam Anbia Shahr polyclinic. Yazd has an effect (p?/05).

According to the research results, it can be stated that the training of emotional distress tolerance skills based on dialectical behavior therapy has been effective in reducing depression and sleep problems of women with hypothyroidism.

Key words: depression, dialytic behavior therapy, hypothyroidism, sleep problems, emotional distress tolerance skills

-1- Introduction

The thyroid gland[1] is one It is one of the most important endocrine glands in the body, which is responsible for the main control of the body's metabolism (Taqvi, 2008). Any problems in thyroid function cause diseases such as hypothyroidism. The prevalence of hypothyroidism and thyroid disorders is different according to different authorities. In some studies, the prevalence of hypothyroidism [2] has been reported as 2.5% and in others as 7.5% (Nadri, 2013). For unknown reasons, thyroid disorders in women are about ten times more than men, and because in most cases, thyroid disease is autoimmune in nature, and women are more susceptible to autoimmune diseases. Due to the female hormonal environment, this can be one of the prominent factors in this field (Nadri, 2011). The most common cause of hypothyroidism in areas with normal iodine consumption is autoimmune thyroid disease (Nadri, 2011).

Researches show that the role of environmental factors is important in the development of thyroid disorders. Also, psychological factors and annoying events are also factors that are important in both creating and aggravating these disorders. In fact, stress and psychological problems can be effective in the occurrence of hypothyroidism by reducing the strength of the immune system (Ahmadi, 2013).

The clinical spectrum of this disease is wide and its onset varies from an asymptomatic disease to a severe disease with myxodynia coma. And its signs and symptoms depend on the age of the patient, the cause of the disease, the duration of the disease and the geographical region, the duration of the disease and the geographical region. In fact, stress and annoying events can cause physical problems and mental problems for a person. Today, physical problems (such as hypothyroidism) and mental problems (such as depression and sleep problems) overlap a lot. so that both can be the cause and effect of each other. The signs and symptoms of hypothyroidism are depressed mood, sleepiness, fatigue and boredom. Or depression disorder can be a manifestation of thyroid disorder in the form of hypothyroidism (Sha'bani, 2017).

Depression is one of the most common diagnoses of mental disorders. Reports show that about a third of the world's population suffers from a mild period of depression at some point in their lives. Statistics show that around 20% of adults suffer from a mood disorder that needs treatment during their lifetime, and 8% of them also suffer from a major depressive disorder (Alavi, 2010).

Sleep is one of the basic human needs, so any disturbance in it causes a decrease in the person's ability and psychological and behavioral problems for the person. About 70% of people who refer to psychiatric clinics complain of sleep disorder, and this disorder and irregularity in the pattern of sleep and wakefulness can lead to disorders in social and occupational activities. Sleep disturbance is caused both by depression disorder and hypothyroidism.

There are many therapeutic ways to treat depression disorders and sleep problems, one of the therapeutic approaches is the new dialectical behavior therapy, whose effectiveness on depression and sleep problems is very promising.  Dialectical behavior therapy is a cognitive behavioral approach that was originally developed to treat borderline personality disorder. This approach combines interventions related to cognitive behavioral therapies that are based on the principle of change with tests and techniques of Eastern Zen philosophy that are based on the principle of acceptance, and based on this, it proposes four intervention components in its group therapy method:

Tolerance of emotional disturbance, mindfulness, emotional regulation and interpersonal effectiveness (Alavi, 2013).

In dialectical behavior therapy, the treatment orientation is in First, controlling Joe's treatment activities, teaching behavioral skills (heart therapy) and then helping him to feel better and solve problems in life, and finally helping Joe to seek pleasure and a sense of superiority. To achieve these goals, special treatment strategies that are specific to this treatment are used (Miller, 2006). Dialytic behavior therapy is more complicated than other methods. Based on a research conducted by Niksoo and Linhan (2010) under the title of Dialytic Behavioral Therapy in the treatment of patients with borderline personality disorder, it showed that Dialytic Behavioral Therapy skills were effective in reducing depression. Suller (2009) in a study conducted on women showed that emotional distress tolerance training based on behavioral therapy is effective in improving the intensity of moods and emotions such as depression, anxiety and emotional instability. be Also, in this study, the treatment caused a high clinical improvement and the rate of dropout and withdrawal from the treatment was low.

According to the mentioned cases and since the expression of efficient and effective methods is one of the necessities of research in the field of treatment and considering that diacetic behavior therapy is considered as one of the new treatments, in the present study, an attempt was made to study emotional distress tolerance skills based on behavioral therapy in the treatment of depression and sleep problems of women with hypothyroidism.

1-2- Statement of the problem

Hypothyroidism is a clinical syndrome that occurs as a result of a defect in the production of thyroid hormones (Naghizadeh, 2019). Its prevalence is about 4 cases out of every 1000 women and 1 case out of every 1000 men. This disease is more prevalent in some populations, which can be caused by genetic factors and chronic consumption of iodine-rich diet (Nakhjovani, 2019). This disease, which sometimes remains hidden from view, can be the cause of many physical complaints and psychological manifestations. Physical complaints primarily occur due to decreased levels of metabolism secondary to deficiency or absence of thyroid hormone. The onset of symptoms of hypothyroidism is usually silent and progresses gradually. Some of the physical symptoms include fatigue, cold intolerance, dry skin, irregular menstruation and constipation, slow heart rate, edema, puffy face, and delayed tendon reflexes. Mental disorder caused by this disease includes cognitive disorders, mood and psychosis. Hypothyroidism can affect cognitive function and mood, and in severe cases, it can mimic melancholic depression and insanity. Hypothyroidism is a condition that changes the patient's perception of his health due to the symptoms it causes. Symptoms such as fatigue, excessive sleepiness, depression, mood changes, and decreased cognitive function can affect the patient's daily activities and overshadow various aspects of the affected person's life (Mahlahsini, 2008).

Among the common disorders in psychiatry are mood disorders, which can be seen secondarily in other psychiatric syndromes and also in association with physical illness. Depression can be a manifestation of thyroid disorder in the form of hypothyroidism (Shaabani et al., 2017).