اثربخشی درمان مبتنی بر شفقت بر نارسایی هیجانی و باورهای فراشناختی سالمندان

نوع مقاله : مقاله پژوهشی

نویسندگان

گروه روان‌شناسی، واحد دزفول، دانشگاه آزاد اسلامی، دزفول، ایران

10.22126/jap.2021.6282.1513

چکیده

سالمندی فرایند زیستی است که تمام موجودات زنده از جمله انسان‌ها آن را تجربه می‌کنند، از این رو توجه خاص و پیشگیری از اختلالاتی نظیر باورهای فراشناختی و نارسایی هیجانی در سالمندی بسیار مهم است. بنابراین این مطالعه با هدف تعیین اثربخشی درمان مبتنی بر شفقت بر باورهای فراشناختی و نارسایی هیجانی سالمندان انجام شد. روش پژوهش نیمه آزمایشی با طرح پیش‌آزمون پس‌آزمون با گروه کنترل بود. جامعه آماری پژوهش تمام سالمندان با نارسایی هیجانی شهر اهواز در سال 1399 بودند. نمونه پژوهش شامل 30 نفر مرد سالمند (60 تا 70 سال) بود که با روش نمونه‌گیری در دسترس و با توجه به ملاک‌های ورود و خروج مطالعه انتخاب شدند. گروه آزمایش هشت جلسه هفتگی 90 دقیقه‌ای درمان مبتنی بر شفقت دریافت نمودند. پرسش‌نامه‌های مورد استفاده در این پژوهش شامل باورهای فراشناختی ولز و کارترایت هاتون و نارسایی هیجانی تورنتو بود. داده‌ها با  استفاده از تحلیل کوواریانس تک‌متغیره (آنکوا) در سطح 05/0 مورد تجزیه و تحلیل قرار گرفتند. یافته‌ها نشان در مرحله پس‌آزمون بین گروه‌های آزمایش و کنترل از نظر باورهای فراشناختی و نارسایی هیجانی تفاوت معنی‌داری وجود داشت (001/0>P). به عبارت دیگر مداخله مبتنی بر شفقت باعث کاهش باورهای فراشناختی و نارسایی هیجانی سالمندان شد. منطبق با یافته‌های پژوهش حاضر می‌توان مداخله مبتنی بر شفقت را به عنوان یک روش کارا جهت کاهش باورهای فراشناختی و نارسایی هیجانی سالمندان پیشنهاد داد.

کلیدواژه‌ها


عنوان مقاله [English]

The Effectiveness of Compassion-Based Therapy on Meta-Cognitive Beliefs and Alexithymia in the Elderly

نویسندگان [English]

  • Farnaz Shesh Boloki
  • Homayoon Haroon Rashidi
Department of Psychology, Dezful Branch, Islamic Azad University, Dezful, Iran
چکیده [English]

Aging seems to be a biological process all living beings, including humans, experience. Hence, it is important to pay careful attention to the elderly and to prevent disorders such as meta-cognitive beliefs and alexithymia among the elderly. Therefore, the current study was to consider the effectiveness of compassion-based therapy on meta-cognitive beliefs and alexithymia in the elderly. It was a quasi-experimental study with pretest-posttest and control group design. The statistical population of the study consisted of all the elderly men with alexithymia living in Ahvaz, Iran in 2020. The sample consisted of 30 elderly men (60 to 70 years old) selected by convenience sampling method and according to the inclusion and exclusion criteria. The experimental group received eight weekly 90-minute sessions of compassion-based therapy. The questionnaires applied in the current study included Toronto Alexithymia Scale and Wells and Cartwright-Hatton’s Meta-Cognitions Scale. Data were analyzed using analysis of covariance (ANCOVA) at the confidence level of 0.05. The results showed that there was a significant difference between experimental and control groups in terms of meta-cognitive beliefs and alexithymia in the elderly (p<0.001). Put in other words, compassion-based therapy resulted in a decrease of meta-cognitive beliefs and alexithymia in the elderly. According to the findings of the present study, compassion-based therapy can be suggested as an efficient method in order to reduce meta-cognitive beliefs and alexithymia in the elderly.
References
Abolghasemi, A., & Kiamarsi, A. (2009). Relationship between metacognition and cognitive failures in the elderly. Advances in Cognitive Sciences, 11 (1), 8-15. [Persian]
Adibizadeh, N., & Sajjadian, I. (2019). The Effectiveness of compassion-focused therapy on depression, anxiety and emotion regulation in patients with coronary heart disease. Medical Journal of Mashhad University of Mmedical Sciences, 61(supplment1), 103-115. [Persian]
Aghajani, S., & Samadifard, H.R. (2019). The role of cognitive failures, alexithymia and cognitive flexibility in predicting the social health of elderly. Advances in Cognitive Sciences, 20 (4), 62-69. [Persian]
Andersen B., & Rasmussen P.H. (2017). Trans diagnostic group therapy for people with self- critic and low self-esteem, based on compassion focused therapy principles. Journal of Compassionate Health Care, 4(14), 1-11.
Bagby, R., Parker, J.D., Taylor, G.J. (1994). The Twenty-Item Toronto Alexithymia Scale: Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23-32.
Baharvandi, B., Kazemianmoghadam, K., & Haroon Rashidi, H. (2020). Effectiveness of compassion-focused therapy on ambiguity tolerance and death anxiety in the elderly. Aging Psychology, 6(1), 13-26. [Persian]
Bell, T., Montague, J., Elander, J., & Gilbert, P. (2020). A definite feel‐it moment: Embodiment, externalisation and emotion during chair‐work in compassion‐focused therapy. Counselling and Psychotherapy Research, 20(1), 143-153.
Besharat, M.A. (2008). Relation of alexithymia with ego defense styles. Journal of Fundamentals of Mental Health, 10(39), 181-190. [Persian]
Cook, R., Brewer, R., Shah, P., Bird, G. (2013). Alexithymia, not autism, predicts poor recognition of emotional facial expressions. Psychology Science Journal, 24(5), 723-732.
Dana, A., Pozesh Jadidi, R., & Falah, Z. (2018). The Effect of aerobic exercise on cognitive and metacognitive abilities among inactive elder men. Journal of Research in Behavioural Sciences, 16 (1), 84-92. [Persian]
Dinarvand, N., & Barghi Irani, Z. (2021). The Comparison of the effectiveness of metacognitive therapy and spiritual therapy on cognitive dissonance and feeling loneliness in the elderly Aging Psychology, 7(2), 181-197. [Persian]
Fisher, P.L., & Noble, A.J. (2017). Anxiety and depression in people with epilepsy: The contribution of metacognitive beliefs. Seizure, 50, 153-159.
Gavric, D., Moscovitch, D.A., Rowa, K., & McCabe, R.E. (2017). Post-eventprocessing in social anxiety disorder: Examining the mediating roles of positive metacognitive beliefs and perceptions of performance. Behaviour Research and Therapy, 91, 1-12.
Ghadampour, E., Roshannia, S., & Rezaeifar, N. (2019). Effectiveness of spirituality therapy on the metacognitive beliefs and dysfunctional Attitude in elderly people of Khorramabad city. Journal of Gerontology, 3 (3), 1-8. [Persian]
Gheitanchi, S., & Ebrahimi Moghadam, H. (2016). Prediction of happiness based on five factors model of personality and meta-cognitive beliefs in elderly. Aging Psychology, 2(1), 13-22. [Persian]
Golparvar, M., & Safari, H. (2016). The association between meta-cognitive beliefs and dysfunctional attitudes among middle and aged patients with cardiovascular disease. Salmand: Iranian Journal of Ageing, 11 (1), 52-63. [Persian]
Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 15(3), 199-208.‏
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53, 6-14.
Hajatpour, R., & Haroon Rashidi, H. (2021). The Effectiveness of acceptance and commitment therapy on irrational beliefs and death attitude in the elderly. Aging Psychology, 7(1), 43-54. [Persian]
Haroon Rashidi, H., & Bahiraei, M.R. (2020). The Effectiveness of positivism training on the life satisfaction and character strengths in the elderly men. Journal of Aging Psychology6(2), 179-189. [Persian]
Harper, S. (2014). Economic and social implications of aging societies. Science, 346(6209), 587-591.
Irons, C., & Lad, S. (2017). Using compassion focused therapy to work with shame and self-criticism in complex trauma. Australian Clinical Psychologist, 3(1), 123-140.
Klimecki, O. M., Leiberg, S., Ricard, M., & Singer, T. (2014). Differential pattern of functional brain plasticity after compassion and empathy training. Social Cognitive and Affective Neuroscience, 9(6), 873-879.
Mak, W. W. S. Wong, C. C. Y. Chan, A. T. Y. & Lau, J. T. F. (2019). Mobile self-compassion programmer for promotion of public mental health: a randomized controlled trial. Hong Kong Medical Journal, 25(2), 17-15.
Martin, R.D., Kennett, D.J., & Hopewell, N.M. (2019). Examining the importance of academic-specific self-compassion in the academic self-control model. The Journal of Social Psychology, 159(6), 691- 676.
Naghipoor, M., Kazemian Moghadam, K., & Haroon Rashidi, H. (2021). The Effectiveness of positivism training on suicide ideation and death anxiety in the elderly. Journal of Aging Psychology, 6(4), 357-367. [Persian]
Neff, K.D. (2013). Pommier E. The relationship between self-compassion and other-focused concern among college undergraduates, community adults, and practicing mediators. Self and Identity, 12, 160-176.
Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of clinical psychology, 69(1), 28-44.
Neff, K.D., & Mcgehee, P. (2010). Self-compassion and psychological resilience among adolescents and young adults. Self and Identity, 9, 3, 225-40.
Nejati, Sh. (2019). The relationship between dark personality traits and differentiation with marital adjustment: The mediating role of emotional failure. (Unpublished doctoral dissertation). Islamic Azad University, Dezful Branch, M.A. [Persian]
Pollatos, O., Werner, N. S., Duschek, S., Schandry, R., Matthias, E., Traut-Mattausch, E., & Herbert, B. M. (2011). Differential effects of alexithymia subscales on autonomic reactivity and anxiety during social stress. Journal of Psychosomatic Research, 1(6), 525-33.
Rahmati, A., Mousavi Nasab, S., Moradi, F. (2020). Cognitive ability in the elderly: The Role of self-transcendence, self-compassion and positive affect. Aging Psychology, 6(2), 107-117. [Persian]
Sadidi, M., Yamini, M. (2018). Prediction of psychological well-being based on coping strategies and alexithymia. Journal of Psychological Studies, 14(2), 125-141. [Persian]
Samadifard, H., & Narimani, M. (2017). The Role of metacognitive belief and cognitive avoidance in the prediction of general health in the elderly. Journal Geriatric Nursing, 3 (3), 68-77. [Persian]
Shirinzadeh Dastgiri, S., Goodarzi, M.A, Rahimi, C.H, & Naziri, G.h. (2009). Study of factor structure, validity and reliability of metacognition questionnaire-30. Journal of Psychology, 12, 445-461. [Persian]
Wells A. (2005). Detached mindfulness in cognitive therapy: A metacognitive analysis and ten techniques. Journal Ration Emotive Cognitive Behavior Therapy, 23 (4), 337-355.
Wells, A., & Cart Wright-Hatton, S. (2004). A short form of metacognitions questionnaire: Properties of the MCQ-30. Behaviors Research and Therapy, 42, 385-396.
Wells, A., & Fisher, P. (Eds.). (2015). Treating Depression: MCT, CBT, and Third Wave Therapies. John Wiley & Sons.
Wells, A. (2008). Meta-cognitive therapy: A practical guide. (Ch.9: Major depressive disorder). New York: Guilford Press.

کلیدواژه‌ها [English]

  • Alexithymia
  • compassion-based therapy
  • elderly
  • meta-cognitive beliefs
ابوالقاسمی، ع.، و کیامرثی، آ. (1388). بررسی رابطه بین فراشناخت و نارسایی‌های شناختی در سالمندان. تازه‌های علوم شناختی، 11(1)، 15-8.
ادیبی‌زاده، ن.، و سجادیان، ا. (1397). اثربخشی درمان مبتنی بر شفقت بر افسردگی، اضطراب و تنظیم هیجان در بیماران مبتلا به کرونر قلبی. مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد، 61(ویژه‌نامه 1)، 103-115.
آقاجانی، س.، و صمدی‌فرد، ح.ر. (1397). نقش نارسایی شناختی، نارسایی هیجانی و انعطاف‌پذیری شناختی در پیش بینی سلامت اجتماعی سالمندان. فصلنامه تازه‌های علوم شناختی، 20(4)، 90-75.
بشارت، م.ع. (1387). نارسایی هیجانی و سبک‌های دفاعی. مجله علمی پژوهشی اصول بهداشت روانی، 10(39)، 190-181.
بهاروندی، ب.، کاظمیان‌مقدم، ک.، و هارون رشیدی، ه. (1399). اثربخشی درمان مبتنی بر شفقت بر توانایی تحمل ابهام و اضطراب مرگ سالمندان. روان‌شناسی پیری، 6(1)، 26-13.
دانا، ا.، پوزش جدیدی، ر.، و فلاح، ز. (1397). تأثیر تمرینات هوازی بر توانایی‌های شناختی و فراشناختی مردان سالمند غیرفعال. تحقیقات علوم رفتاری، ۱۶(۱)، 92-84.
حاجت‌پور، ر.، و و هارون‌رشیدی، ه. (1400). اثربخشی درمان مبتنی بر تعهد و پذیرش بر باورهای غیرمنطقی و نگرش به مرگ در سالمندان. روانشناسی پیری، 7(1)، 54-43.
رحمتی، ع.، موسوی نسب، س.م.ح.، و مرادی، ف. (1399). توانمندی شناختی سالمندان: نقش خودفراروی، خود شفقت ورزی و عاطفه مثبت. روان‌شناسی پیری، 6(2)، 117-107.
دیناروند، ن.، و برقی ایرانی، ز. (1400). مقایسه اثربخشی فراشناخت درمانی و معنویت درمانی بر ناهماهنگی شناختی و احساس تنهایی سالمندان مقیم سرای سالمندان. روانشناسی پیری، ۷(2)، 197-181.
سدیدی، م.، و یمینی، م. (1397). پیش‌بینی بهزیستی روان‌شناختی بر  اساس  راهبردهای  مقابله‌ای  و  ناگویی هیجانی. مطالعات روانشناختی، 14(2)، 141-125.
شیرین‌زاده دستگیری، ص.، گودرزی، م.ع.، رحیمی، چ.، و نظیری، ق. (1387). بررسی ساختار عاملی، روایی و اعتبار پرسشنامه فراشناخت 30. مجله روانشناسی، 12، (4)، 461-445.
صمدی‌فرد، ح.ر.، و نریمانی، م. (1396). نقش باورهای فراشناختی و اجتناب شناختی در پیش‌بینی سلامت عمومی سالمندان. فصلنامه پرستاری سالمندان، ۳(۳)، 77-68.
قدم‌پور، ع.، روشن‌نیا، س.، و رضایی‌فر، ن. (1397). اثربخشی معنویت درمانی بر باورهای فراشناختی و نگرش‌های ناکارآمد سالمندان شهر خرم آباد در سال ۱۳۹۶. سالمندشناسی، ۳(۳)، 8-1.
قیطانچی، ص.، و ابراهیمی مقدم، ح. (1395). پیش‌بینی شادکامی بر اساس الگوی پنج عاملی شخصیت و باورهای فراشناخت در سالمندان. روان‌شناسی پیری، 2(1)، 22-13.
گل‌پرور، م.، و صفری، ح. (1395). بررسی قدرت باورهای فراشناختی معیوب برای پیش‌­بینی نگرش‌­های ناکارآمد در بیماران قلبی-عروقی سالمند و غیر­سالمند. سالمند: مجله سالمندی ایران، 11(۱)، 63-52.
نجاتی، ش. (1397). رابطه صفات تاریک شخصیت و تمایزیافتگی با سازگاری زناشویی: نقش واسطه‌ای نارسایی هیجانی )پایان‌نامه کارشناسی ارشد چاپ نشده). دانشگاه آزاد اسلامی واحد دزفول.
نقی‌پور، م.، کاظمیان‌مقدم، ک.، و هارون‌رشیدی، ه. (1399). اثربخشی روانشناسی مثبت‌نگر بر ایده‌پردازی خودکشی و اضطراب مرگ سالمندان. مجله روانشناسی پیری، 6(4)، 367-357.
هارون‌رشیدی، ه.، و بحیرایی، م.ر. (1399). اثربخشی مداخله مثبت‌نگر بر رضایت از زندگی و توانمندی منش در مردان سالمند. روان‌شناسی پیری، 6(2)، 189-179.
References
Abolghasemi, A., & Kiamarsi, A. (2009). Relationship between metacognition and cognitive failures in the elderly. Advances in Cognitive Sciences, 11 (1), 8-15. [Persian]
Adibizadeh, N., & Sajjadian, I. (2019). The Effectiveness of compassion-focused therapy on depression, anxiety and emotion regulation in patients with coronary heart disease. Medical Journal of Mashhad University of Mmedical Sciences, 61(supplment1), 103-115. [Persian]
Aghajani, S., & Samadifard, H.R. (2019). The role of cognitive failures, alexithymia and cognitive flexibility in predicting the social health of elderly. Advances in Cognitive Sciences, 20 (4), 62-69. [Persian]
Andersen B., & Rasmussen P.H. (2017). Trans diagnostic group therapy for people with self- critic and low self-esteem, based on compassion focused therapy principles. Journal of Compassionate Health Care, 4(14), 1-11.
Bagby, R., Parker, J.D., Taylor, G.J. (1994). The Twenty-Item Toronto Alexithymia Scale: Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23-32.
Baharvandi, B., Kazemianmoghadam, K., & Haroon Rashidi, H. (2020). Effectiveness of compassion-focused therapy on ambiguity tolerance and death anxiety in the elderly. Aging Psychology, 6(1), 13-26. [Persian]
Bell, T., Montague, J., Elander, J., & Gilbert, P. (2020). A definite feel‐it moment: Embodiment, externalisation and emotion during chair‐work in compassion‐focused therapy. Counselling and Psychotherapy Research, 20(1), 143-153.
Besharat, M.A. (2008). Relation of alexithymia with ego defense styles. Journal of Fundamentals of Mental Health, 10(39), 181-190. [Persian]
Cook, R., Brewer, R., Shah, P., Bird, G. (2013). Alexithymia, not autism, predicts poor recognition of emotional facial expressions. Psychology Science Journal, 24(5), 723-732.
Dana, A., Pozesh Jadidi, R., & Falah, Z. (2018). The Effect of aerobic exercise on cognitive and metacognitive abilities among inactive elder men. Journal of Research in Behavioural Sciences, 16 (1), 84-92. [Persian]
Dinarvand, N., & Barghi Irani, Z. (2021). The Comparison of the effectiveness of metacognitive therapy and spiritual therapy on cognitive dissonance and feeling loneliness in the elderly Aging Psychology, 7(2), 181-197. [Persian]
Fisher, P.L., & Noble, A.J. (2017). Anxiety and depression in people with epilepsy: The contribution of metacognitive beliefs. Seizure, 50, 153-159.
Gavric, D., Moscovitch, D.A., Rowa, K., & McCabe, R.E. (2017). Post-eventprocessing in social anxiety disorder: Examining the mediating roles of positive metacognitive beliefs and perceptions of performance. Behaviour Research and Therapy, 91, 1-12.
Ghadampour, E., Roshannia, S., & Rezaeifar, N. (2019). Effectiveness of spirituality therapy on the metacognitive beliefs and dysfunctional Attitude in elderly people of Khorramabad city. Journal of Gerontology, 3 (3), 1-8. [Persian]
Gheitanchi, S., & Ebrahimi Moghadam, H. (2016). Prediction of happiness based on five factors model of personality and meta-cognitive beliefs in elderly. Aging Psychology, 2(1), 13-22. [Persian]
Golparvar, M., & Safari, H. (2016). The association between meta-cognitive beliefs and dysfunctional attitudes among middle and aged patients with cardiovascular disease. Salmand: Iranian Journal of Ageing, 11 (1), 52-63. [Persian]
Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 15(3), 199-208.‏
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53, 6-14.
Hajatpour, R., & Haroon Rashidi, H. (2021). The Effectiveness of acceptance and commitment therapy on irrational beliefs and death attitude in the elderly. Aging Psychology, 7(1), 43-54. [Persian]
Haroon Rashidi, H., & Bahiraei, M.R. (2020). The Effectiveness of positivism training on the life satisfaction and character strengths in the elderly men. Journal of Aging Psychology6(2), 179-189. [Persian]
Harper, S. (2014). Economic and social implications of aging societies. Science, 346(6209), 587-591.
Irons, C., & Lad, S. (2017). Using compassion focused therapy to work with shame and self-criticism in complex trauma. Australian Clinical Psychologist, 3(1), 123-140.
Klimecki, O. M., Leiberg, S., Ricard, M., & Singer, T. (2014). Differential pattern of functional brain plasticity after compassion and empathy training. Social Cognitive and Affective Neuroscience, 9(6), 873-879.
Mak, W. W. S. Wong, C. C. Y. Chan, A. T. Y. & Lau, J. T. F. (2019). Mobile self-compassion programmer for promotion of public mental health: a randomized controlled trial. Hong Kong Medical Journal, 25(2), 17-15.
Martin, R.D., Kennett, D.J., & Hopewell, N.M. (2019). Examining the importance of academic-specific self-compassion in the academic self-control model. The Journal of Social Psychology, 159(6), 691- 676.
Naghipoor, M., Kazemian Moghadam, K., & Haroon Rashidi, H. (2021). The Effectiveness of positivism training on suicide ideation and death anxiety in the elderly. Journal of Aging Psychology, 6(4), 357-367. [Persian]
Neff, K.D. (2013). Pommier E. The relationship between self-compassion and other-focused concern among college undergraduates, community adults, and practicing mediators. Self and Identity, 12, 160-176.
Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of clinical psychology, 69(1), 28-44.
Neff, K.D., & Mcgehee, P. (2010). Self-compassion and psychological resilience among adolescents and young adults. Self and Identity, 9, 3, 225-40.
Nejati, Sh. (2019). The relationship between dark personality traits and differentiation with marital adjustment: The mediating role of emotional failure. (Unpublished doctoral dissertation). Islamic Azad University, Dezful Branch, M.A. [Persian]
Pollatos, O., Werner, N. S., Duschek, S., Schandry, R., Matthias, E., Traut-Mattausch, E., & Herbert, B. M. (2011). Differential effects of alexithymia subscales on autonomic reactivity and anxiety during social stress. Journal of Psychosomatic Research, 1(6), 525-33.
Rahmati, A., Mousavi Nasab, S., Moradi, F. (2020). Cognitive ability in the elderly: The Role of self-transcendence, self-compassion and positive affect. Aging Psychology, 6(2), 107-117. [Persian]
Sadidi, M., Yamini, M. (2018). Prediction of psychological well-being based on coping strategies and alexithymia. Journal of Psychological Studies, 14(2), 125-141. [Persian]
Samadifard, H., & Narimani, M. (2017). The Role of metacognitive belief and cognitive avoidance in the prediction of general health in the elderly. Journal Geriatric Nursing, 3 (3), 68-77. [Persian]
Shirinzadeh Dastgiri, S., Goodarzi, M.A, Rahimi, C.H, & Naziri, G.h. (2009). Study of factor structure, validity and reliability of metacognition questionnaire-30. Journal of Psychology, 12, 445-461. [Persian]
Wells A. (2005). Detached mindfulness in cognitive therapy: A metacognitive analysis and ten techniques. Journal Ration Emotive Cognitive Behavior Therapy, 23 (4), 337-355.
Wells, A., & Cart Wright-Hatton, S. (2004). A short form of metacognitions questionnaire: Properties of the MCQ-30. Behaviors Research and Therapy, 42, 385-396.
Wells, A., & Fisher, P. (Eds.). (2015). Treating Depression: MCT, CBT, and Third Wave Therapies. John Wiley & Sons.
Wells, A. (2008). Meta-cognitive therapy: A practical guide. (Ch.9: Major depressive disorder). New York: Guilford Press.