هدف مطالعه حاضر تعیین اثربخشی آموزش برنامه پذیرش و تعهد بر اضطراب اجتماعی و تابآوری تحصیلی دانش آموزان دارای اختلال لکنت زبان بود. طرح پژوهش از نوع شبه آزمایشی بود. جامعه آماری پژوهش شامل دانش آموزان پسر مقطع دوم متوسطه دارای اختلال لکنت زبان شهرستان خوی بودند. در این راستا 32 نفر از آنان به شیوةنمونهگیری در دسترس انتخاب شدند و بهصورت تصادفی در دو گروه 16 نفره آزمایش و کنترل برای شرکت در آموزش برنامه تجربه زیسته محور پذیرش و تعهد (باردل و همکاران، 2022) گمارده شدند. از مقیاسهای تابآوری تحصیلی (ساموئلز، 2004) و پرسشنامه اضطراب اجتماعی (کانر و همکاران، 2000) در پیش و پسآزمون برای جمعآوری دادهها استفاده شد. برنامه آموزش پذیرش و تعهد در 8 جلسه مداخلهای برای گروه آزمایش اجرا گردید. تحلیل کوواریانس نشان داد که برنامه آموزش پذیرش و تعهد تابآوری تحصیلی و اضطراب اجتماعی دانش آموزان دارای اختلال لکنت زبان را بهصورت معنیداری ارتقا داده است. درمان مبتنی بر پذیرش و تعهد با آموزش و بهبود راهبردها و تکنیکهای مؤثر باعث میشود دانشآموزان نگرش واقعبینانه نسبت به مشکل خود پیدا کنند و بر پیامدهای سخت اختلالشان فائق آیند؛ بنابراین اجرای این برنامه برای افراد دارای اختلال لکنت زبان و سایر نارساییهای تحولی پیشنهاد میشود.
عنوان مقاله [English]
The Effectiveness of Acceptance and Commitment Program on Social Anxiety and Academic Resilience of Students with Stuttering Disorder
This study aimed to determine the effectiveness of acceptance and commitment program training on social anxiety and academic resilience of students with stuttering disorder. The research design was quasi-experimental with two experimental and control groups. The statistical population of the study included high school students with stuttering disorder in Khoy city. In this regard, a sample of 32 students were selected by available sampling method and divided into two groups of 16, experimental and control, to participate in the training of life-based experience program of acceptance and commitment (Bardel et al., 2022) were assigned. Academic resilience scales (Samuels, 2004) and social anxiety questionnaire (Conner et al., 2000) were used before and after the test to collect data. Acceptance and commitment training program was implemented in 8 intervention sessions for the experimental group. Analysis of covariance showed that the training program has significantly improved the acceptance and commitment of academic resilience and social anxiety of students with stuttering disorder. Acceptance and commitment-based therapy by teaching and improving effective strategies and techniques allows students to take a realistic view of their problem and overcome the severe consequences of their disorder. Therefore, the implementation of this program is recommended for individuals with stuttering disorders and other developmental disabilities.
"Stuttering" is a communication disorder that disrupts the melodious and smooth flow of speech with repetition, involuntary stretching, pauses, or involuntary stuttering in sounds, syllables, and words (American Psychiatric Association, 2013). People with stuttering disorders often experience psychological problems such as social anxiety (Berchiati et al., 2023), low resilience (Bilby et al., 2022), low cognitive flexibility (Gillader et al., 2021) and perceptive speech problems (Bahrini and Thanagovi, 2022).
Children who stutter experience social anxiety, which can be a severe fear of situations in which one is in the company of others or has to do something in front of them (Berchiati et al., 2023). This fear may be a result of social anxiety disorder, a profound and pervasive fear of social situations (Gillader, Filksman, and Hooper, 2021). It's important to note that social anxiety disorder is different from shyness, which is a normal feeling of feeling uncomfortable in new or social situations (Gillader et al., 2021).
One of the main challenges faced by children with stuttering is having low resilience, which can make it difficult for them to overcome obstacles and challenges in both academic and social settings (Soluk, 2023). This issue seems to be particularly prevalent in the academic environment, where children with speech impairments tend to have lower academic resilience compared to their peers without speech impairments. Academic resilience is the capacity for one to achieve success in the face of various obstacles and challenges, and the concept has been researched extensively in the field of education (Sesher and Olash, 2023).
According to a review of the research related to speech disorders, multiple intervention methods such as drug therapy, cognitive-behavioral approach, speech therapy, and yoga can be effective in managing the psychological consequences of this disorder. One approach that appears promising is the acceptance and commitment approach, which encourages individuals to accept and embrace uncomfortable and anxiety-provoking feelings and thoughts. This approach can help individuals move away from trying to avoid these emotions and instead learn to accept and commit to their values despite their difficulties (Ising et al., 2022).
One treatment approach that has been proposed for children with stuttering disorder is the acceptance and commitment approach. This approach has become an area of interest for experts and is based on the principles of acceptance and commitment therapy (ACT), a cognitive-behavioral approach that centers on fostering awareness and acceptance of difficult experiences and developing commitment to personal values and behaviors (Bergman & Keitel, 2023). Acceptance and commitment therapy is based on relational frame theory (Löhm et al., 2018) and functional contextualism (Hayes et al., 2017), which aim to help individuals learn to engage with their thoughts and emotions in ways that align with their personal values and goals. This approach can be especially useful for individuals who struggle with stuttering, as it can help them develop greater acceptance of their stuttering and develop skills to pursue their goals and values regardless of the challenges they face (Bourgi et al., 2022).
The proposed research aims to evaluate the effectiveness of the Acceptance and Commitment Training program on reducing social anxiety and increasing academic resilience in students with stuttering. The study is guided by evidence-based practices and seeks to explore the theoretical and practical implications of the Acceptance and Commitment Approach in the field of communication disorders. The main research question is: Is the Acceptance and Commitment Training effective in reducing social anxiety and improving academic resilience in students with stuttering?
The Studies have shown that individuals with stuttering disorders often have psychological problems such as social anxiety, low resilience, low cognitive flexibility, and challenges with perception of speech, which can impact their quality of life and overall well-being (Berchiati et al., 2023; Bilby et al., 2022; Gillader et al., 2021; Bahrini and Thanagovi, 2022).
In people with social anxiety disorder, their feelings of anxiety and worry are especially pronounced in social situations where they fear that they may behave in an embarrassing or socially unacceptable way. Furthermore, these symptoms can be so severe that they can lead to other debilitating conditions such as depression and addiction to drugs or alcohol (Yashar et al., 2023; Atelose et al., 2020).
Previous research has shown that people with stuttering often exhibit low flexibility and resilience. This can manifest in difficulty in adapting to new situations or dealing with challenges (Malich and Kauert, 2019; Martin and Marsh, 2017). In a recent study, Balkent and colleagues have explored the role of resilience in the experiences of persons with stuttering (Balkent et al., 2015). Therapy based on Acceptance and Commitment (ACT) encourages individuals to practice mindfulness and develop a non-judgmental awareness of their experiences, which ultimately enables them to act in the direction of their goals and values. Commitment to values is the key element of this approach.
The current research employed a quasi-experimental design with a pre-test and a post-test. Participants were divided into an Experimental Group that received the Acceptance and Commitment Training program and a Control Group that received no intervention. The study took place in Shahr Khoi among male students with stuttering disorder. A sample of 32 participants was selected using available sampling techniques, and researchers verified the inclusion and exclusion criteria during a briefing meeting with relevant officials. Participants included only second-year male students with stuttering disorder who did not receive other psychological interventions and were willing to participate in the study. Exclusion criteria were the presence of other physical or neurodevelopmental problems, or the absence of more than two sessions. Interventions were executed in the counseling center of the education management. After the study, pre-test and post-test measures were administered to both groups.
Analyses aimed at investigating the effectiveness of acceptance and commitment (A&C) education in increasing academic resilience showed significant results. When separating the components of academic resilience, the A&C program proved significantly effective in improving future orientation and communication skills, but had no significant effect on the central problem.
When considering the "why" of the findings, it is worth noting that resilience is a stable coping style and a dynamic process in which people show successful and positive adaptation despite the experience of trauma or distress (Dan Head and Fisher, 2023). Research studies suggest that Resilience is related to the level of acceptance and commitment demonstrated by a person. Resilient people are able to maintain commitment to their goals, which can increase motivational behavior and ultimately lead to achieve high levels of success (Berchitti et al., 2023).
The results of the analysis showed that the acceptance and commitment training program is effective in reducing the social anxiety of the studied groups. In separating the components of social anxiety, teaching acceptance and commitment is significantly effective on avoidance and physiological symptoms; but it has no significant effect on fear; therefore, the results of the current research indicate that the acceptance and commitment training program is effective in reducing social anxiety.
In explaining the finding that acceptance and commitment training did not have a significant effect on the fear component of students with stuttering disorder, it is important to consider that social anxiety in this group of students is not solely due to the fear of speaking. In fact, the lifelong condition of speech impairments despite the interventions made has created a belief in those with speech impairments that these conditions always exist and must simply be tolerated and adapted to. This adaptation in children has been associated with anxiety, which can lead to difficulties responding in different social situations (Hayes et al., 2013).