Comparison of the Effectiveness of Gestalt Group Therapy and Psychodrama Therapy on Cognitive Flexibility of Female Para-Medical Students with Social Anxiety Disorder

Document Type : Original Article

Authors

1 Department of Psychology, Semnan Branch, Islamic Azad University, Semnan, Iran

2 Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran ‎

Abstract

Background: Social anxiety has long been related to reduced cognitive flexibility, and this feature is seen as a factor of social anxiety disorder.
 
Objectives: The present study aimed to compare cognitive flexibility among patients with social anxiety disorder with two methods of Gestalt therapy and psychodrama among female para-medical students at Tehran University of Medical Sciences, Tehran, Iran, in 2020-2021.
 
Methods: This quasi-experimental study uses a before-and-after design that includes two experimental groups, one control group, and a follow-up period. The statistical population of this study consisted of female para-medical students from the Iranian Medical University, Tehran, Iran, in the second semester of the 2020-2021 academic year. A total of 75 individuals were selected through purposive sampling and were randomly assigned into two test groups and one control group (n=25 per group). An acceptance and behavioral questionnaire (AAQ-2) was administered. Group 1 received Gestalt group therapy, Group 2 was treated with the psychodrama therapy group, and the control group received no treatment. Eight sessions lasting 1.5 h were planned for each intervention. Multivariate analysis of covariance was performed to analyze the collected data using SPSS software (version 24).
 
Results: The obtained results revealed a varying average scores for the cognitive flexibility component before, immediately after, and later after the test in the pre-test, post-test, and follow-up periods (P<0.05). Moreover, the mean scores of emotional experience avoidance and life control were not significantly different between the two groups in the pre-test, post-test, and follow-up stages.
 
Conclusion: Based on the results of the present study, it can be concluded that psychodrama therapy is a multidimensional therapy that affects not only individuals and their emotions but also the environment and the relationship between them. Therefore, these aspects significantly improve the overall health level of the population.

Keywords


Copyright © 2024, Razavi International Journal of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Langer JK, Tonge NA, Piccirillo M, Rodebaugh TL, Thompson RJ, Gotlib IH. Symptoms of social anxiety disorder and major depressive disorder: A network perspective. JAD. 2019;243:531-8. doi: doi: 10.1016/j.jad.2018.09.078. 30292147.[PubMed: 30292147].
https://doi.org/10.1016/j.jad.2018.09.078
PMid:30292147 PMCid:PMC6202058
 
2. Wang Y, Chen J, Zhang X, Lin X, Sun Y, Wang N, et al. The relationship between perfectionism and social anxiety: A moderated mediation model. IJERPH. 2022;19(19):12934. doi: 10.3390/ijerph191912934. [PubMed: 36232234].
https://doi.org/10.3390/ijerph191912934
PMid:36232234 PMCid:PMC9566146
 
3. Filiou MD, Sandi C. Anxiety and brain mitochondria: a bidirectional crosstalk. TINS. 2019;42(9):573-88. doi: 10.1016/j.tins.2019.07.002. [PubMed: 31362874].
https://doi.org/10.1016/j.tins.2019.07.002
PMid:31362874
 
4. Stein MB, Craske MG. Treating anxiety in 2017: optimizing care to improve outcomes. Jama. 2017;318(3):235-6. doi: 10.1001/jama.2017.6996. [PubMed:28679009].
https://doi.org/10.1001/jama.2017.6996
PMid:28679009
 
5. Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Psychiatry J. 2020;177(9):868-72. doi: 10.1176/appi.ajp.2020.177901. [PubMed:32867516].
https://doi.org/10.1176/appi.ajp.2020.177901
PMid:32867516
 
6. Felsman P, Seifert CM, Himle JA. The use of improvisational theater training to reduce social anxiety in adolescents. Arts Psychother. 2019;63:111-7. doi:10.30486/jsrp.2020.1880492.2099.
https://doi.org/10.1016/j.aip.2018.12.001
 
7. Felsch CL, Kuypers KP. Don't be afraid, try to meditate-potential effects on neural activity and connectivity of psilocybin-assisted mindfulness-based intervention for social anxiety disorder: A systematic review. Neurosci. Biobehav. Rev. 2022;139:104724. doi: 10.1016/j.neubiorev.2022.104724.[PubMed: 35679988].
https://doi.org/10.1016/j.neubiorev.2022.104724
PMid:35679988
 
8. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues in clinical neuroscience. 2022. doi: 10.31887/DCNS.2017.19.2/bbandelow. [PubMed:28867934].
https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
PMid:28867934 PMCid:PMC5573566
 
9. Yu M, Zhou H, Wang M, Tang X. The heterogeneity of social anxiety symptoms among Chinese adolescents: Results of latent profile analysis. J. Affect. Disord. 2020;274:935-42. doi: 10.1016/j.jad.2020.06.003.[PubMed: 32664035].
https://doi.org/10.1016/j.jad.2020.06.003
PMid:32664035
 
10. Yu Y, Yu Y, Lin Y. Anxiety and depression aggravate impulsiveness: the mediating and moderating role of cognitive flexibility. Psychol Health Med . 2020;25(1):25-36. doi: 10.1080/13548506.2019.1601748. .[PubMed: 30947527].
https://doi.org/10.1080/13548506.2019.1601748
PMid:30947527
 
11. Rosa-Alcázar Á, Olivares-Olivares PJ, Martínez-Esparza IC, Parada-Navas JL, Rosa-Alcázar AI, Olivares-Rodríguez J. Cognitive flexibility and response inhibition in patients with Obsessive-Compulsive Disorder and Generalized Anxiety Disorder. IJCHP. 2020;20(1):20-8. doi: 10.1016/j.ijchp.2019.07.006.[PubMed:32021615].
https://doi.org/10.1016/j.ijchp.2019.07.006
PMid:32021615 PMCid:PMC6994753
 
12. Park J, Moghaddam B. Impact of anxiety on prefrontal cortex encoding of cognitive flexibility. Neurosci. 2017;345:193-202. doi: 10.1016/j.neuroscience.2016.06.013 .[PubMed:27316551].
https://doi.org/10.1016/j.neuroscience.2016.06.013
PMid:27316551 PMCid:PMC5159328
 
13. Uddin LQ. Cognitive and behavioural flexibility: neural mechanisms and clinical considerations. Nat. Rev. Neurosci. 2021;22(3):167-79. doi: 10.1038/s41583-021-00428-w .[PubMed:33536614].
https://doi.org/10.1038/s41583-021-00428-w
PMid:33536614 PMCid:PMC7856857
 
14. Kraft D, Rademacher L, Eckart C, Fiebach CJ. Cognitive, affective, and feedback-based flexibility-disentangling shared and different aspects of three facets of psychological flexibility. J. Cogn. 2020;3(1). doi: 10.5334/joc.120 .[PubMed:32984758].
https://doi.org/10.5334/joc.120
PMid:32984758 PMCid:PMC7500224
 
15. Gabrys RL, Tabri N, Anisman H, Matheson K. Cognitive control and flexibility in the context of stress and depressive symptoms: The cognitive control and flexibility questionnaire. Front. Psychol 2018;9:2219. doi:10.3389/fpsyg.2018.02219 [PubMed: 30510530].
https://doi.org/10.3389/fpsyg.2018.02219
PMid:30510530 PMCid:PMC6252356
 
16. Ben-Itzhak S, Bluvstein I, Maor M. The psychological flexibility questionnaire (PFQ): Development, reliability and validity. 2014.
 
17. Kercood S, Lineweaver TT, Frank CC, Fromm ED. Cognitive flexibility and its relationship to academic achievement and career choice of college students with and without attention deficit hyperactivity disorder. JPED. 2017;30(4):329-44
 
18. Hou Z, Sui Y, Song X, Yuan Y. Disrupted interhemispheric synchrony in default mode network underlying the impairment of cognitive flexibility in late-onset depression. Front. Aging Neurosci. 2016;8:230. doi: doi: 10.3389/fnagi.2016.00230. [PubMed: 27729858].
https://doi.org/10.3389/fnagi.2016.00230
 
19. Liu H, Li X, Han B, Liu X. Effects of cognitive bias modification on social anxiety: A meta-analysis. PloS one. 2017;12(4):e0175107. doi:10.1371/journal.pone.0175107. [PubMed: 28384301 ].
https://doi.org/10.1371/journal.pone.0175107
PMid:28384301 PMCid:PMC5383070
 
20. Pourrezaian M. The clinical evaluation of psychodrama's effectiveness in treatment of social anxiety: A case study. Clin. Psychol. Sci. 2016;6(24):29-46. doi:10.22054/jcps.2016.6513.
 
21. Holmes P. The inner world outside: Object relations theory and psychodrama: Routledge; 2015. doi:10.4324/9781315729490.
https://doi.org/10.4324/9781315729490
 
22. Samadi H, Mahdiyan H, Ghasemi M. Comparison of the Effectiveness of Psychodrama and Group Therapy Based on Acceptance and Commitment on Students' Depression with Social Anxiety Disorder. mjms. 2021;64(1). doi:10.22038/MJMS.2021.19397.
 
23. Gstrein D. Anna: A single-case efficacy study on the use of psychodrama group therapy with a student who has Mathematics Anxiety. ZPS. 2019;18:123-38. doi: 10.1007/s11620-015-0299-4.
https://doi.org/10.1007/s11620-015-0299-4
 
24. Adam Rita CS. The Effects Of Gestalt And Cognitive-Behavioral Therapy Group Interventions On The Assertiveness And Self-Esteem Of Women With Physical Disabilities Facing Abuse. 2010.
 
25. Öztürk AG. Gestalt Group Practice for Increasing Awareness of University Students. Int. J. Educ. Psychol. 2019;6(3):1-8. doi: 0.17220/ijpes.2019.03.001.
https://doi.org/10.17220/ijpes.2019.03.001
 
26. Herrera P, Mstibovskyi I, Roubal J, Brownell P. Researching Gestalt Therapy for Anxiety in Practice-Based Settings. Psychotherapie-Wissenschaft. 2019 :27(II):321. doi: 10.30820/1664-9583-2019-2-53b.
https://doi.org/10.30820/1664-9583-2019-2-53b
 
27. Perls F, Hefferline G, Goodman P. Gestalt therapy. New York. 1951;64(7):19-313.
 
28. Moreno JL. The essential Moreno: Writings on psychodrama, group method, and spontaneity: Springer Publishing Company; 1987.
 
29. Baker SL, Heinrichs N, Kim H-J, Hofmann SG. The Liebowitz social anxiety scale as a self-report instrument: a preliminary psychometric analysis. Behav Res Ther. 2002;40(6):701-15. doi: 10.1016/s0005-7967(01)00060-2. [PubMed: 12051488].
https://doi.org/10.1016/S0005-7967(01)00060-2
PMid:12051488
 
30. Zare M, Makvand Hosseini S, Sabahi P. Comparison of the Effectiveness of Gestalt Group Therapy and Psychodrama Therapy on the Perception of Social Interaction in Female Para-Medical Students with Social Anxiety Disorder. WHB. 2023;10(2):133-42. doi: 10.30476/whb.2023.97743.1220.
 
31. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behav. Ther. 2011;42(4):676-88. doi: 10.1016/j.beth.2011.03.007. [PubMed: 22035996].
https://doi.org/10.1016/j.beth.2011.03.007
PMid:22035996
 
32. Abasi E, Fti L, Molodi R, Zarabi H. Psychometric properties of Persian version of acceptance and action questionnaire-II. Psychol. Methods. 2012;3(10):65-80.
 
33. Stripling T. Gestalt Interventions Benefitting Children and Adolescents: A Literature Review. Gestalt Review. 2021;25(2):197-220. doi:10.5325/gestaltreview.25.2.0197.
https://doi.org/10.5325/gestaltreview.25.2.0197
 
34. Mokrivala M, Farahbakhsh K, Salimi Bajestani H, Yunesi Burujeni J. Effectiveness of Gestalt Therapy alone and in Combination with Cognitive-behavioral Therapy on Hope and Pain Intensity in Women with Breast Cancer. Journal of Client-Centered Nursing Care. 2022;8(3):199-208. doi:10.32598/JCCNC.8.3.408.2.
https://doi.org/10.32598/JCCNC.8.3.408.2
 
35. Haensel JX, Danvers M, Ishikawa M, Itakura S, Tucciarelli R, Smith TJ, et al. Culture modulates face scanning during dyadic social interactions. Scientific Reports. 2020;10(1):1958. doi: 10.1038/s41598-020-58802-0. [PubMed:32029826].
https://doi.org/10.1038/s41598-020-58802-0
PMid:32029826 PMCid:PMC7005015
 
36. Ghazanfari F, Nadri M. Developing of the etiology model of adolescent social anxiety disorder based on anxiety sensitivity, negative emotional regulation and anxiety and ambivalent attachment style with mediating role of emotional-focused coping strategy. Clinical Psychology Studies. 2019;9(35):97-130. doi:10.22054/jcps.2019.41584.2124.
 
37. Chen J, van den Bos E, Karch JD, Westenberg PM. Social anxiety is related to reduced face gaze during a naturalistic social interaction. Anxiety, Stress, & Coping. 2023;36(4):460-74. doi: 10.1080/10615806.2022.2125961. [PubMed: 3615375].
https://doi.org/10.1080/10615806.2022.2125961
PMid:36153759
 
38. Hamidi F, Hasanpour Khademi F. The effect of psychodrama on social anxiety and interpersonal sensitivity of secondary school teenage girls. Knowledge & Research in Applied Psychology. 2022;23(1):125-36. doi: 10.30486/jsrp.2020.1880492.2099.
 
39. Abeditehrani H, Dijk C, Toghchi MS, Arntz A. Integrating cognitive behavioral group therapy and psychodrama for social anxiety disorder: An intervention description and an uncontrolled pilot trial. Clinical Psychology in Europe. 2020;2(1). doi: 10.32872/cpe.v2i1.2693. [PubMed: 36397983].
https://doi.org/10.32872/cpe.v2i1.2693
PMid:36397983 PMCid:PMC9645483