Objectives The present study aims to explore the lived experiences of the caregivers of patients with bipolar disorder (BD) in Iran. Methods This is a qualitative study using Strauss and Corbin’s grounded theory approach. The sampling was done purposefully until reaching theoretical saturation. During data collection, 18 unstructured interviews with caregivers and 3 semi-structured interviews with experts were conducted. The process of coding and data analysis was done simultaneously based on the theoretical model. Results Role entanglement (core theme) and eight categories were extracted: Harmful family context, inhibiting cognitions (contextual factors), initial confronting, incongruent feedback, positive/negative attitudes toward treatment (causal factors), loneliness, adversity, dissociation/coherence (consequences). Conclusion The caregivers’ encountering with BD is a dynamic process influenced by personal, social, economic, and cultural variables. Over time, it can make it challenging for caregivers, which is associated with positive and negative consequences.
Objectives This study aimed to evaluate the reliability and validity of the Persian version of the brief emotion dysregulation scale (BEDS) for the general population of Iran. Methods The study included 814 participants with a mean age of 35.83±12.8 years. They completed the Persian versions of BEDS, the borderline personality questionnaire (BPQ), 16-item difficulties in emotion regulation scale (DERS-16), and the Rosenberg self-esteem scale (RSES) online. For construct validity assessment, the participants were randomly divided into two groups: Exploratory factor analysis was performed on the first group, and confirmatory factor analysis was conducted on the second group. Results The factor loadings of all items exceeded 0.32, indicating that the observed variables were appropriate for measuring the latent underlying variable. The internal consistency (Cronbach’s α) was 0.75 for the overall scale, 0.77 for the consequences, 0.68 for the sensitivity, and 0.51 for the instability domains. The Persian BEDS’s total scores had significant positive relationships with the DERS-16 (r=0.754) and BPQ (r=0.628) scores, and a significant negative relationships with the RSES score (r=0.534). Conclusion The Persian BEDS with three subscales (emotional sensitivity, emotional instability, and emotional consequences) has acceptable construct validity, convergent validity, and discriminant validity. Therefore, as a psychometrically valid and efficient screening instrument, it can be used for both clinical and research purposes in Iran.
Objectives Transcranial direct current stimulation (tDCS) has been proposed as a promising treatment for the rehabilitation of patients with neurodevelopmental disorders. The present study was aimed to review the impact of tDCS on the executive functions of Iranian children and adolescents with neurodevelopmental disorders. Methods This is a systematic review and meta-analysis. The related studies from 2014 to 2024 were searched in Web of Science, Scopus, PubMed, Scientific Information Database (SID), and the comprehensive humanities portal. The qualitative assessment of studies was performed using the Jadad scale. The standardized mean difference (SMD) was calculated with a 95% confidence interval (CI) in CMA software, version 2 to measure the effect size. Duval and Tweedie’s trim-and-fill method and funnel plots were used to analyze sensitivity and publication bias. After careful screening, 23 studies were finally included in the systematic review and meta-analysis. Results The meta-analysis results showed a significant effect of tDCS on the executive functions of Iranian children and adolescents with neurodevelopmental disorders (SDM=1.04; 95% CI, 0.83%, 1.25%; P<0.001). The subgroup analysis showed that tDCS had the greatest effect on the attention component compared to other components of executive function. Also, tDCS had a greater effect on children and adolescents with specific learning disorders than on those with attention deficit/hyperactivity disorder (ADHD). Conclusion Although there are promising findings for the effectiveness of tDCS in improving attention deficit/hyperactivity disorder and specific learning disorder, there is a lack of randomized controlled clinical trials with long-term follow-up in Iran, especially for autism spectrum disorder.
Objectives Several studies have examined perfectionism as a factor affecting exam anxiety and have reported different and inconsistent results. Therefore, the present research aimed to review the results of studies on the relationship between perfectionism and exam anxiety in Iranian students. Methods This is a systematic review and meta-analysis. The relevant studies published from 2011 to 2024 were searched in international and national databases, including Google Scholar, Web of Science (ISI), Science Direct, PubMed, SID, Irandoc, Noormags, and MagIran. The heterogeneity between studies was investigated using the Q-test and I2 statistics, and the random effects model was chosen to present the results. CMA software, version 2 was used to analyze the data. Results Finally, 17 studies with 25 effect sizes were selected for the review and analysis. The results showed that the correlation coefficient between perfectionism and exam anxiety was 0.18 (95% CI; 0.008%, 0.357%). The adaptive perfectionism (Effect size:-0.465) had the highest relationship with exam anxiety among antecedent variables. The analysis of subgroups based on participants’ gender showed that the combined effect size for girls was larger (r=0.50, 95% CI; 0.44%, 0.55%) than for boys (r=0.21, 95% CI; 0.12%, 0.30%). Also, there was an inverse and significant relationship between Fisher’s Z effect sizes and participants’ age, such that for every one unit increase in participants’ age, the Fisher’s Z effect sizes were reduced by 0.04 units. Conclusion Perfectionism has a significant relationship with exam anxiety among Iranian students. Experts can reduce the students’ exam anxiety by improving their perfectionism using effective interventions.
Objectives This study aimed to examine the relationship between negative perfectionism and early maladaptive schemas in the hypervigilance/inhibition domain, mediated by rumination in Iranian college students. Methods This is a descriptive-correlational study using structural equation modeling (SEM). The study population consists of students from universities in Tehran in the 2023–2024 academic year. Based on the inclusion and exclusion criteria, 379 participants were selected via convenience sampling. Those who scored ≥69 on the negative perfectionism subscale of Terry-Short’s positive and negative perfectionism scale (PANPS) were included. The used instruments included the Young schema questionnaire-3rd edition (YSQ-S3), PANPS, and Nolen-Hoeksema & Morrow’s ruminative response scale. Data was analyzed using SPSS software, version 26 and AMOS software, version 24. Results The findings showed that the direct effect of hypervigilance/inhibition on negative perfectionism was significant (β=0.30, P=0.001). The indirect effect of these schemas on negative perfectionism through rumination was also significant (β=-0.08, P<0.05), indicating that reducing the levels of these schemas and rumination may lead to a decrease in negative perfectionism. Conclusion Negative perfectionism is related to hypervigilance/inhibition domain of early maladaptive schemas, both directly and indirectly (through rumination) in Iranian college students. These findings highlight the importance of cognitive-behavioral and schema therapies for improving students’ mental health.
The World Health Organization (WHO)declared the COVID-19 outbreak a public health emergency in January 2020 and identified it as a pandemic in March 2020 [1]. Following the official announcement of COVID cases in Iran and in response to a request from the Ministry of Health, the 4030 Call System was launched on February 27, 2020, to provide medical services addressing COVID-19-related needs.
The prevalence of suicide among people with substance use disorders (SUDs) remains a significant public health issue worldwide. A review of the medical literature suggests that both substance addiction and behavioral addictions are closely associated with increased suicidal thoughts and attempts. A systematic review by Armon et al. found that 35% of individuals with SUDs reported suicidal ideation, while 20% had attempted suicide in the past year [1]. Among behavioral addictions, individuals with gambling disorder (22.9%) and sexual addiction (18.2%) reported the highest rates of suicidal ideation [2].
Objectives Suicide is one of the important psychosocial concerns. This study aimed to explore the process of suicide attempts among Iranian youth to identify the related factors. Methods This is a qualitative study based on the grounded theory approach. Semi-structured interviews were used for data collection. Participants were 23 young people (9 males and 14 females) aged 18-35 years with a history of suicide attempt from Shiraz, Iran, in 2024. They were selected via purposive and theoretical sampling. The data were analyzed using Strauss and Corbin's approach. Results We extracted 10 themes and 20 sub-themes. The core phenomenon was "mental breakdown". The causal factors included perceived discrimination and psychological shock. Social pressure and individual vulnerability were facilitating factors. The intervening factors included character armor, spiritual factors, and social support. The strategy adopted by participants was " pain avoidance". The consequence was "attempt to get free". Conclusion Emotional, cognitive, and social factors play a role in the occurrence of suicide attempts among Iranian youth. More attention should be paid to these factors for suicide prevention.
Objectives This study aimed to compare the effects of transference-focused psychotherapy (TFP) and acceptance and commitment therapy (ACT) on personality organization and defense styles of individuals with borderline personality disorder (BPD). Methods This is a randomized clinical trial with a pre-test/post-test/follow-up design. The participants were 11 patients with BPD referred to Zare Psychiatric Hospital and Khaney-e Ma'na Clinic in Sari, north of Iran, in 2020. They were selected using a convenience sampling method and randomly assigned to TFP (n=4), ACT (n=4), and control (n=3) groups. The interventions were provided for one year, two sessions per week. Data were collected before the interventions, at the first session, during the 40th session, during the 80th session, at the 100th session, and six months after the interventions. Kernberg's Inventory of Personality Organization (IPO) and Defense Styles Questionnaire were used for assessment. Statistical analysis was done using repeated measurement ANOVA and the Kruskal-Wallis test. Results There were significant differences in both treatment groups compared to the control group in total IPO score (P=0.023), mature defense styles (P=0.041), and neurotic defense style (P=0.366). TFP was more effective than ACT. Conclusion Both TFP and ACT can improve personality organization and defensive styles of patients with BPD, where TFP is more effective.
Objectives For exceptional children, a diverse range of interventions is needed to effectively address their needs. This study aimed to develop and validate a sensory-motor play therapy program grounded in Deleuze and Guattari's philosophy for children with autism spectrum disorder (ASD). Methods This is a qualitative study using the inductive content analysis approach. A search in online databases for articles and books related to Deleuze and Guattari's philosophy published from 1953 to 2023 was first conducted to extract the philosophical components and synthesize them with therapeutic and educational principles related to ASD and sensory-motor playtherapy. It led to designing a structured play therapy program. The program was reviewed by 16 experts. To ensure its validity, the content validity index (CVI) and content validity ratio (CVR) were calculated. Results The play therapy program had 14 core components categorized into three domains: format, content, and method. The components included: Immanence, Life, Assemblage, Vertical View, Body Without Organs, Becoming, Rhizome, Strata, Preference of Action Over Expression, Perception of the Other, Smoothing, Deterioration & Reterioration, Spaces of Encounter, and Repetition. The CVI values >0.79 and CVR values >0.62 confirmed the program's validity. Conclusion The developed play therapy program offers a structured yet flexible approach to fostering interaction and expression in autisticchildren. Future research shouldfocuson theclinical implementation of this valid program and its impact on the social and emotional development of children.
Objectives Establishing mental health first aid (MHFA) programs is a strategy employed by developed countries worldwide to empower students in terms of mental health literacy; these programs have not received the support for implementation in Iranian schools. The present study aimed to explore the challenges in the implementation of teen MHFA (tMHFA) programs in Iranian schools and provide solutions. Methods This is a qualitative study, conducted in 2021. The participants were purposively selected from adolescents, their parents, and the experts in the field of mental health aid for adolescents (n=34) in Tehran. Data collection was conducted using semi-structured, in-depth individual interviews. The collected data were analyzed using thematic analysis based on an inductive approach in MAXQDA software, version 2020. Results Three main themes as challenges were extracted, including characteristics/tendencies of students (independence in decision-making, influence from media and virtual social networks, willingness to attend the classes, and personality and behavioral characteristics), infrastructure/resources (readiness and competence of teaching and specialized staff, financial resources, physical resources, relevant educational content and related guides, and service delivery network), and the course implementation process (governance and stewardship, managers' willingness and perspective, planning, practicality and skill-based, and effectiveness evaluation). Conclusion The tMHFA program's successful implementation in Iranian schools requires the involvement of students and their families, empowering the school staff, localizing educational content based on needs assessment, providing resources from multiple sources; using media and distance education, integrating the program into the routine school activities and including in school textbooks, using incentives such as a certificate of course completion, informing by influencers, governmental support via appropriate legislation, employing qualified and trusted teachers, coordination with the health network, and designing and establishing a robust monitoring framework.
Objectives With the expansion of communication technologies and widespread internet accessibility, the use of virtual social media (VSM) has become popular. This study aimed to examine the relationships between VSM usage patterns and psychosocial outcomes. Methods This is a descriptive-correlational study conducted on 413 residents of Tehran, Iran, who were selected via multi-stage cluster sampling. Data collection was done using Social Media Sites Addiction Scale-Iranian version (SMSAS-IR), which assesses eight domains (Online social interaction, mood swings, compulsion, extensive interactions, educational/instructional impact, relapse, harmful leisure activities). Canonical correlation analysis was used to examine the relationships between study variables. Results Most people used VSM for 2-4 hours a day (41.6%). Additionally, 56.7% used VSM every night for 15 minutes before going to bed, and 39.2% used VSM every morning for 15 minutes after waking up. Only 7.7% reported that they used VSM during eating food for 15 minutes on all days. The VSM usage patterns demonstrated a significant correlation with psychological outcomes (r=0.72, P<0.001). This canonical set accounted for 47% of the variance shared by two-variable sets. Among usage patterns, those with the highest canonical loadings included: Daily usage (0.85), usage before bedtime (0.75), and usage immediately after waking up in the morning (0.73). Among the psychosocial outcomes, the variables with the highest canonical loadings included compulsion (0.46) and mood swings (0.4). Conclusion Maladaptive VSM use is correlated with adverse psychological outcomes. These findings underscore the need to improve VSM usage management through educational programs and interventions.
Objectives Climate change can affect individuals' physical and mental health. The present study aims to evaluate the mediating role of resilience and adaptation in the relationship between climate change anxiety and mental health. Methods This is a correlational study utilizing structural equation modeling (SEM). The study population included all members of the Iranian Red Crescent Society in six provinces of Iran exposed to climate change (Khuzestan, Hormozgan, Ilam, Kerman, Sistan & Baluchestan, and South Khorasan) in 2024. A total of 1196 people were selected using cluster random sampling and convenience sampling methods. Data were collected using the 25-item symptom checklist, the eco-anxiety scale, the Connor-Davidson resilience scale, and the adaptation questionnaire. Data analysis was conducted using Pearson's correlation test and path analysis in SPSS software, version 24 and AMOS software, version 24. Results There was a significant positive relationship between climate change anxiety and mental health (P<0.01, r=0.41) and between adaptation and mental health (P<0.01, r=0.57), while a significant negative relationship was observed between resilience and mental health (P<0.01, r=-0.39). The indirect effect of climate change anxiety on mental health was significant through adaptation and resilience (P<0.001). Conclusion Climate change anxiety has an indirect relationship with the mental health of people through resilience and adaptation.
Objectives: Negative symptoms of schizophrenia respond poorly to conventional pharmacological treatments despite their profound impact on functioning and quality of life. This study aimed to investigate the the efficacy of transcranial direct current stimulation (tDCS) over dorsolateral prefrontal cortex (DLPFC) in improving positive, negative, and depressive symptoms in patients with schizophrenia exhibiting predominant negative symptoms. Methods: In this double-blind, sham-controlled randomized clinical trial, 40 patients (aged 18-65) with schizophrenia and predominant negative symptoms were randomly assigned to active tDCS (n=20) or sham (n=20) groups. The active group received 15 daily sessions of tDCS (2mA, 20 min) with the anode over left DLPFC (F3) and cathode over right orbitofrontal region (Fp3). Assessments using the positive and negative syndrome scale (PANSS), scale for the assessment of negative symptoms (SANS), and the calgary depression Scale for Schizophrenia (CDSS) were conducted at baseline, post-intervention, and one-month follow-up. Results: The active tDCS group showed significant reductions in positive (F=6.59, P=0.004, eta(2)=0.207), negative (F=5.22, P=0.028, eta(2)=0.124), and depressive symptoms (F=17.71, P<0.001, eta(2)=0.324) at post-intervention compared to sham. Effects for positive (F=7.85, P=0.008, eta(2)=0.175) and negative symptoms (F=16.80, P<0.001, eta(2)=0.312) persisted at one-month follow-up, but no significant difference in depression was observed (F=0.15, P=0.700, eta 2=0.004). Conclusion: The tDCS is an effective method for improving positive, and negative, and depressive symptoms in schizophrenia patients with predominant negative symptoms. The therapeutic effects on positive and negative symptoms persisted for one month, suggesting that tDCS has potential as an adjunctive treatment along with antipsychotic medications.
Objectives Chronic pain is a pervasive condition that affects millions worldwide, with significant impacts on individuals' quality of life. This study aimed to explore the role of pain acceptance and health literacy in predicting pain intensity among individuals with chronic pain, providing insights into non-pharmacological factors that may influence pain experiences. Methods A cross-sectional design was employed, involving 350 participants from Richmond Hill, Ontario, Canada. Pain intensity was measured using the numeric pain rating scale (NPRS), while pain acceptance and health literacywere assessed using the chronic pain acceptance questionnaire (CPAQ) and the health literacy questionnaire (HLQ), respectively. Pearson correlation and linear regression analyses were conducted to examine the relationships between the study variables. Results Pain acceptance and health literacy were both significantly negatively correlated with pain intensity (r=-0.45, P<0.01 and r=-0.38, P<0.01, respectively). In the regression model, both variables significantly predicted pain intensity, accounting for 26% of the variance (R-2=0.26, adjusted R-2=0.24, F=19.56, P<0.001). Pain acceptance (B=-0.15, (beta=-0.25, t=-5.00, P<0.001) and health literacy (B=-0.10, (beta=-0.20, t=-4.00, P<0.001) emerged as significant predictors. Conclusion The study findings highlight the significant roles of pain acceptance and health literacy in managing pain intensity among individuals with chronic pain. These findings suggest that interventions aimed at enhancing pain acceptance and health literacy could be beneficial in reducing pain intensity and improving the quality of life for chronic pain sufferers.
Objectives Incompatibility in young couples and its resolution failure are among the main causes of emotional separation and divorce, which have several personal and social consequences. The present study aimed to examine the impact of acceptance and commitment therapy (ACT) on emotional empathy, adaptability, alexithymia, and couple functioning in incompatible young couples. Methods This randomized controlled clinical trial utilized a two-group research design with a pretest-posttest and a 6-month follow-up. The research sample consisted of incompatible young couples from Yazd County, Iran, who had been referred to this city's counseling and divorce centers in 2023. Based on the inclusion criteria and using simple random sampling, 52 couples (104 individuals) were selected and randomly assigned to the experimental group (ACT) and the control group. Participants were assessed before and after the intervention using the following tools: Mehrabian and Epstein's empathy questionnaire, Olson's adaptability and cohesion questionnaire, Toronto alexithymia scale, and the ENRICH couples' satisfaction questionnaire. The experimental group received a specified ACT protocol consisting of 8 sessions lasting 60 to 90 minutes each week. The project executor monitored the control group weekly, but no specific therapeutic protocol was implemented for them. After the follow-up phase, the treatment protocol was also applied to them. Finally, the data were analyzed using SPSS software, version 29. Results The analysis of covariance indicated significant differences in the pretest and posttest stages in the mean scores of the experimental and control groups in the variables of emotional empathy, adaptability, alexithymia, and couple functioning (P>0.01). Conclusion We found that the ACT intervention led to increased emotional empathy, decreased alexithymia, and a modulation of adaptability and couple functioning in incompatible young couples. Therefore, ACT can be utilized for incompatible couples seeking assistance at counseling and divorce centers. Conclusion We found that the ACT intervention led to increased emotional empathy, decreased alexithymia, and a modulation of adaptability and couple functioning in incompatible young couples. Therefore, ACT can be utilized for incompatible couples seeking assistance at counseling and divorce centers.
Objectives Sluggish cognitive tempo (SCT) or cognitive disengagement syndrome (CDS) is often identified by symptoms such as lethargy and frequent daydreaming. It has been mainly investigated in the general population and in children with attention deficit/hyperactivity disorder (ADHD). There is scant research on the presence of SCT in individuals with autism spectrum disorder (ASD). The current study aimed to examine the symptoms of ADHD, sleep problems, and executive dysfunction as predictors of SCT in Iranian children with high-functioning ASD. Methods This is a descriptive-correlational study. The participants were the parents of 116 children aged 6-12 with high-functioning ASD, who were selected from among 145 children in exceptional schools for children with autism in Tehran, Iran, in 2024, using convenience sampling. The parents who scored 55-70 in the Gilliam autism rating scale-third edition and had a score above the cut-off point on the SCT scale were included. They completed the online forms of the Swanson, Nolan, and Pelham rating scale (SNAP-IV), the children's sleep habits questionnaire (CSHQ), and the coolidge personality and neuropsychological inventory for children (CPNI). Data were analyzed using the Shapiro-Wilk test, Pearson's correlation test, and multiple regression analysis in SPSS software, version 27. Results The correlation test results revealed a positive and significant relationship between SCT and inattention (r=0.489, P<0.01), but the SCT had no significant association with hyperactivity. Additionally, SCT was significantly correlated with decision-making/planning (r=0.414, P<0.01) and organizing (r=0.392, P< 0.01), as executive functions. However, it had no significant relationship with the response inhibition skill. The SCT had no significant association with sleep problems. The multiple regression analysis further indicated that the attention deficit was the only moderate predictor of SCT (beta=0.489, P=0.001). Conclusion The SCT has a relationship with attention deficit and the problems in decision-making/planning and organizing abilities of children with ASD. These findings can be valuable for clinical evaluation and treatment of ASD.
Objectives The present study aimed to investigate the effectiveness of a dialectical behavioral therapy (DBT)-based parenting intervention on the primary caregivers of adolescents with self-harm behavior, living in Tehran Province, Iran. Methods This is a randomized clinical trial with a pre-test-post-test design. A total of 32 eligible dyads (parent and adolescent) were selected via a convenience sampling method and were randomly assigned to either a DBT-based parenting intervention or a control (waiting list) group. Adolescents did not receive any treatment as part of the study. The scales included the difficulty in emotion regulation scale (DERS); parenting style and dimensions questionnaire (PSDQ); depression, anxiety, and stress scale-21 (DASS-21); five-facet mindfulness questionnaire; conflict behavior questionnaire; and caregiver strain questionnaire-short form 11. Quade nonparametric analysis of covariance (ANCOVA) was used to analyze data. Results The results of the quade nonparametric ANCOVA showed a significant difference in authoritative parenting style, depression and anxiety symptoms, caregiver strain for the caregivers' group, as well as a statistically significant reduction in risk of suicide, conflict behavior with parent, depression and anxiety symptoms for adolescents' group between the experimental and control groups (P<0.05). Conclusion Therefore, we conclude that the DBT-based parenting intervention can be used as an independent or complementary treatment along with dialectical behavior therapy for adolescents with self-harm behaviors.
Objectives The current study aimed to examine whether anxiety sensitivity (AS) and repetitive negative thinking (RNT) can mediate the relationship of self-compassion and cognitive fusion with cyberchondria. Methods This is a descriptive-correlational study that utilizes structural equation modeling (SEM). Participants were 630 students from universities in Tehran and Mazandaran provinces of Iran in 2024, who voluntarily participated in the study. They completed the Cyberchondria severity scale, the cognitive fusion questionnaire, the self-compassion scale, the AS inventory, and the repetitive Thinking questionnaire. Data analysis was conducted using SEM in Amos software, version 29. Results The correlation test results revealed significant relationships between cognitive fusion, selfcompassion, AS, RNT, and cyberchondria (P<0.01). The SEM model indicated that AS significantly mediated the relationship between cognitive fusion and cyberchondria (b=0.157, P=0.001), and between self-compassion and cyberchondria (b=-0.197, P=0.001). However, no significant mediating effect was found for RNT (P>0.05). Conclusion Self-compassion and cognitive fusion are related to cyberchondria among Iranian college students. The AS can mediate this relationship, but RNT has no significant mediating role.
Objectives The present study aimed to determine the impact of self-compassion training on symptom severity, anxiety sensitivity, and distress tolerance (DT) in women with dermatillomania and trichotillomania. Methods This is a quasi-experimental study with a pre-test/post-test/follow-up design. Participants were 30 women with dermatillomania and trichotillomania referred to clinics in Tehran, Iran, in 2024. They were randomly assigned to intervention and control groups. Data collection tools included anxiety sensitivity index (ASI), DT scale (DTS), the Massachusetts general hospital hairpulling scale (MGH-HPS), and skin picking scale (SPS). The intervention group received self-compassion training based on Gilbert's protocol at eight sessions. The control group received no intervention. Data were analyzed using univariate and multivariate analysis of variance. Results The intervention group showed a significant reduction in the mean scores of MGH-HPS, SPS, and ASI, and a significant increase in the mean score of DTS in the post-test and follow-up phases compared to the control group (P<0.05). Conclusion The self-compassion training is effective in reducing symptom severity, anxiety sensitivity, and improving DT in women with dermatillomania and trichotillomania.
