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Advances in Cognitive Sciences 2024, 26(2): 16-30 |
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Senobar L, Atadokht A, Narimani M, Hajloo N. Comparison of the effect of transcranial direct current stimulation of the brain from the skull and psychodrama on psychological distress in adolescents with mild traumatic brain injury. Advances in Cognitive Sciences 2024; 26 (2) :16-30
URL: http://icssjournal.ir/article-1-1664-en.html
URL: http://icssjournal.ir/article-1-1664-en.html
1- PhD Student in Psychology, Faculty of Psychology and Educational Sciences, Mohaghegh Ardebili University, Ardabil, Iran
2- Professor of Psychology, Faculty of Psychology and Educational Sciences, Mohaghegh Ardebili University, Ardabil, Iran
2- Professor of Psychology, Faculty of Psychology and Educational Sciences, Mohaghegh Ardebili University, Ardabil, Iran
Abstract: (738 Views)
Introduction
Traumatic concussion is one of the most essential causes of long-term disability worldwide. Studies show the prevalence of concussions in Iran and the world to be about 200 and 500 per 100,000 people, respectively. Surveys show that the majority of hospital visits for children aged 1 to 17 are classified as mild traumatic concussions, and with diagnostic estimates of 97%, it is one of the most common causes of damage to the central nervous system. The physical, cognitive, and emotional problems of these patients are known as post-traumatic syndrome. Studies have pointed to the risk of high prevalence of psychiatric problems in patients after concussions. Psychological disturbances such as anxiety and depression, with high prevalence, are the most widespread psychiatric disorders in patients after concussions. Today, the use of neuropsychological treatments, including the use of direct electrical stimulation of the brain from the skull (tDCS) for the recovery of patients with brain damage, has become prevalent. Moreover, studies have pointed out the role of psychotherapy in reducing the problems of children with mild concussions, including symptoms of depression and emotional regulation. The review of the conducted research shows that no study has been conducted to investigate the therapeutic interventions regarding mood complications caused by mild concussions in teenagers. As a result, this study aimed to compare the effectiveness of transcranial direct current stimulation (tDCS) and psychodrama therapy in treating psychological issues in adolescents with mild traumatic brain injuries (mTBI).
Methods
This study was semi-experimental with a pre-test-post-test design with a control group. The statistical population consisted of all teenagers with brain damage in Ardabil province, Iran, who visited Fatemi Hospital in Ardabil city during the years 2021-2022. These individuals had received a score of 13-15 on the Glasgow Coma Scale. Among the statistical population, 45 people were selected using the available sampling method (because the list of all people was unavailable). Then, they were randomly divided into three groups of 15 people (two experimental groups and one control group). The criteria for subjects to enter the study were informed consent, the age range of 12 to 17 years, and diagnosis of mild brain damage before participating in the study with a Glasgow score. Exclusion criteria for neurocognitive disorders such as epilepsy and seizures, multiple arteriosclerosis, specific impairment in verbal comprehension and expression, and intracranial implants such as shunts, stimulators, electrodes, and any other metal object near the head (such as the mouth and or the heart) that cannot be separated, were considered. After the briefing session, the researcher explained the research's purpose and the importance of honest participation from the subjects. They also provided details on how to answer the questionnaires. This was all done according to the specific schedule for visits to the psychotherapy office. The researcher referred, and then a pre-test was conducted for all three groups (two experimental groups and one control group). Psychodrama therapy in the form of 13-90-minute sessions (2 sessions per week) was performed, which is designed based on Moreno et al. (2000) (25) psychodrama techniques and methods. Additionally, transcranial electrical therapy consisted of ten sessions that were performed twice a week. The intervention of direct electrical stimulation was in such a way that points on the subject's head were determined, and the anode electrode was placed on the dorsolateral area of the left prefrontal cortex. Besides, the cathode electrode was placed on the dorsolateral area of the right prefrontal cortex for 20 minutes, and stimulation with 5/mA 1 was implemented. After completing the therapeutic intervention sessions, a post-test was conducted to gather data. This study utilized the active dose tDCS device from Active Tek, America, and the Depression, Anxiety, and Stress Scale (DASS-21) developed by Lovibond and Lovibond (1995) (23) to collect the necessary data.
Results
Forty-five teenagers with mild brain injuries (mTBI) in three groups (two experimental groups and one control group) participated in this study. The age of people in the transcranial brain stimulation (tDCS), psychovisual, and control groups was 53.3, 53.3, and 60%, respectively. Most people in the tDCS and psychovisual test groups were boys 80% and 60%, and in the control group, 53.3% were girls. The results of Table 1 show the F ratio of univariate covariance analysis for depression (7.101 and P<0.01), anxiety (11.067 and P<0.01), and stress (19.502 and 0.01). These findings show that the dependent variable of depression, anxiety, and stress is different between the groups. The results listed in table 2 indicate that there is a significant difference between the scores of depression, anxiety, and stress of the tDCS test group and the control group. The tDCS group shows a clear advantage. This method has successfully improved depression, anxiety, and stress scores in adolescents with mild brain trauma. A significant difference was observed between the depression, anxiety, and stress scores of the psychographic test group and the control group. This difference is in favor of the psychological group. Specifically, psychoanalysis has been able to improve the depression, anxiety, and stress scores of adolescents with mild brain trauma. No significant difference was found between the depression, anxiety, and stress scores of the tDCS group and the psychovisual group.
Conclusion
Cathodal stimulation (inhibition) of the right DLPFC decreases the processing of negative emotions, and anodal stimulation (increases the activity) of the left DLPFC increases the processing of positive emotions. Because the right hemisphere is more responsible for processing negative emotions, and the left hemisphere is more responsible for processing positive emotions. In group psychotherapy, children re-enact past traumatic experiences in their roles and get a chance to understand those painful events more correctly and, in this way, gain more control over the future. The emotional refinement that takes place in group psychotherapy helps them to overcome their fears and negative emotions. In the psychic display, the events of the past with its stresses and the future with its hopes are transferred to the present and resolved. However, these two methods of treatment can be used in drug and non-drug treatment centers to improve the psychological problems of adolescents with mild concussions.
Ethical Considerations
Compliance with ethical guidelines
In order to comply with ethical considerations in this research, all participants had the right to freely choose to participate and could withdraw from the study at any stage. They were also assured that their information would not be given to another person. This research has been approved by the ethical code of IR.UMA.REC.1402.084 in the Research Ethics Committee of Mohaghegh Ardabili University.
Authors’ contributions
Akbar Atadekht: As the first supervisor, he was responsible for guiding the implementation of the research and editing the article. Mohammad Narimani: The second supervisor was responsible for expert and research advice and active supervision in the implementation of the research. Nader Hajloo: He was a consultant professor and specialized consultant in statistics and data analysis. Lili Senobar, Lili Senobar, PhD student, presented the initial design, conducted the research, collected and analyzed information and data, and wrote the initial article. All authors reviewed the results of the study and participated in editing and preparing the final version of the article.
Funding
This study was carried out with the financial support of the Research and Technology Vice-Chancellor of Mohaghegh Ardabili University.
Acknowledgments
The authors are extremely grateful for the cooperation of Fatemi Hospital in Ardabil and Vahid Abbasi, the participants in the study, and the families of these loved ones for their sincere cooperation in implementing this study and for the financial support of Mohaghegh Ardabili University for this study.
Conflicts of interest
The authors of this article have not reported any conflict of interest.
Traumatic concussion is one of the most essential causes of long-term disability worldwide. Studies show the prevalence of concussions in Iran and the world to be about 200 and 500 per 100,000 people, respectively. Surveys show that the majority of hospital visits for children aged 1 to 17 are classified as mild traumatic concussions, and with diagnostic estimates of 97%, it is one of the most common causes of damage to the central nervous system. The physical, cognitive, and emotional problems of these patients are known as post-traumatic syndrome. Studies have pointed to the risk of high prevalence of psychiatric problems in patients after concussions. Psychological disturbances such as anxiety and depression, with high prevalence, are the most widespread psychiatric disorders in patients after concussions. Today, the use of neuropsychological treatments, including the use of direct electrical stimulation of the brain from the skull (tDCS) for the recovery of patients with brain damage, has become prevalent. Moreover, studies have pointed out the role of psychotherapy in reducing the problems of children with mild concussions, including symptoms of depression and emotional regulation. The review of the conducted research shows that no study has been conducted to investigate the therapeutic interventions regarding mood complications caused by mild concussions in teenagers. As a result, this study aimed to compare the effectiveness of transcranial direct current stimulation (tDCS) and psychodrama therapy in treating psychological issues in adolescents with mild traumatic brain injuries (mTBI).
Methods
This study was semi-experimental with a pre-test-post-test design with a control group. The statistical population consisted of all teenagers with brain damage in Ardabil province, Iran, who visited Fatemi Hospital in Ardabil city during the years 2021-2022. These individuals had received a score of 13-15 on the Glasgow Coma Scale. Among the statistical population, 45 people were selected using the available sampling method (because the list of all people was unavailable). Then, they were randomly divided into three groups of 15 people (two experimental groups and one control group). The criteria for subjects to enter the study were informed consent, the age range of 12 to 17 years, and diagnosis of mild brain damage before participating in the study with a Glasgow score. Exclusion criteria for neurocognitive disorders such as epilepsy and seizures, multiple arteriosclerosis, specific impairment in verbal comprehension and expression, and intracranial implants such as shunts, stimulators, electrodes, and any other metal object near the head (such as the mouth and or the heart) that cannot be separated, were considered. After the briefing session, the researcher explained the research's purpose and the importance of honest participation from the subjects. They also provided details on how to answer the questionnaires. This was all done according to the specific schedule for visits to the psychotherapy office. The researcher referred, and then a pre-test was conducted for all three groups (two experimental groups and one control group). Psychodrama therapy in the form of 13-90-minute sessions (2 sessions per week) was performed, which is designed based on Moreno et al. (2000) (25) psychodrama techniques and methods. Additionally, transcranial electrical therapy consisted of ten sessions that were performed twice a week. The intervention of direct electrical stimulation was in such a way that points on the subject's head were determined, and the anode electrode was placed on the dorsolateral area of the left prefrontal cortex. Besides, the cathode electrode was placed on the dorsolateral area of the right prefrontal cortex for 20 minutes, and stimulation with 5/mA 1 was implemented. After completing the therapeutic intervention sessions, a post-test was conducted to gather data. This study utilized the active dose tDCS device from Active Tek, America, and the Depression, Anxiety, and Stress Scale (DASS-21) developed by Lovibond and Lovibond (1995) (23) to collect the necessary data.
Results
Forty-five teenagers with mild brain injuries (mTBI) in three groups (two experimental groups and one control group) participated in this study. The age of people in the transcranial brain stimulation (tDCS), psychovisual, and control groups was 53.3, 53.3, and 60%, respectively. Most people in the tDCS and psychovisual test groups were boys 80% and 60%, and in the control group, 53.3% were girls. The results of Table 1 show the F ratio of univariate covariance analysis for depression (7.101 and P<0.01), anxiety (11.067 and P<0.01), and stress (19.502 and 0.01). These findings show that the dependent variable of depression, anxiety, and stress is different between the groups. The results listed in table 2 indicate that there is a significant difference between the scores of depression, anxiety, and stress of the tDCS test group and the control group. The tDCS group shows a clear advantage. This method has successfully improved depression, anxiety, and stress scores in adolescents with mild brain trauma. A significant difference was observed between the depression, anxiety, and stress scores of the psychographic test group and the control group. This difference is in favor of the psychological group. Specifically, psychoanalysis has been able to improve the depression, anxiety, and stress scores of adolescents with mild brain trauma. No significant difference was found between the depression, anxiety, and stress scores of the tDCS group and the psychovisual group.
Conclusion
Cathodal stimulation (inhibition) of the right DLPFC decreases the processing of negative emotions, and anodal stimulation (increases the activity) of the left DLPFC increases the processing of positive emotions. Because the right hemisphere is more responsible for processing negative emotions, and the left hemisphere is more responsible for processing positive emotions. In group psychotherapy, children re-enact past traumatic experiences in their roles and get a chance to understand those painful events more correctly and, in this way, gain more control over the future. The emotional refinement that takes place in group psychotherapy helps them to overcome their fears and negative emotions. In the psychic display, the events of the past with its stresses and the future with its hopes are transferred to the present and resolved. However, these two methods of treatment can be used in drug and non-drug treatment centers to improve the psychological problems of adolescents with mild concussions.
Ethical Considerations
Compliance with ethical guidelines
In order to comply with ethical considerations in this research, all participants had the right to freely choose to participate and could withdraw from the study at any stage. They were also assured that their information would not be given to another person. This research has been approved by the ethical code of IR.UMA.REC.1402.084 in the Research Ethics Committee of Mohaghegh Ardabili University.
Authors’ contributions
Akbar Atadekht: As the first supervisor, he was responsible for guiding the implementation of the research and editing the article. Mohammad Narimani: The second supervisor was responsible for expert and research advice and active supervision in the implementation of the research. Nader Hajloo: He was a consultant professor and specialized consultant in statistics and data analysis. Lili Senobar, Lili Senobar, PhD student, presented the initial design, conducted the research, collected and analyzed information and data, and wrote the initial article. All authors reviewed the results of the study and participated in editing and preparing the final version of the article.
Funding
This study was carried out with the financial support of the Research and Technology Vice-Chancellor of Mohaghegh Ardabili University.
Acknowledgments
The authors are extremely grateful for the cooperation of Fatemi Hospital in Ardabil and Vahid Abbasi, the participants in the study, and the families of these loved ones for their sincere cooperation in implementing this study and for the financial support of Mohaghegh Ardabili University for this study.
Conflicts of interest
The authors of this article have not reported any conflict of interest.
Type of Study: Research |
Received: 2024/02/15 | Accepted: 2024/08/21 | Published: 2024/11/3
Received: 2024/02/15 | Accepted: 2024/08/21 | Published: 2024/11/3
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