استرس ادراک شده

Nursing critically ill patients can lead to death anxiety. Some factors can predict death anxiety in nurses, one of which is the meaning of life. There are factors that can strengthen or weaken the relationship between death anxiety and the meaning of life in nurses, one of which is perceived stress. This study aims to assess the mediating role of perceived stress in the relationship between the meaning of life and death anxiety in nurses. 

This is a correlational study using structural equation modeling (SEM). The participants were 240 nurses working in public hospitals in Isfahan, Iran, in 2023. They were selected using a convenience sampling method from two hospitals. The data collection tools included a demographic form, the Meaning in Life Questionnaire (MLQ), the Death Anxiety Scale (DAS), and the Perceived Stress Scale (PSS). Pearson’s correlation test and SEM were used for data analysis in SPSS software, version 23 and Amos software.

Out of 240 participants, 230 answered the questionnaires completely. Most of them were female (71%) and married (70%). The mean MLQ score was 50.14±9.92, the mean PSS score was 21.28±4.49, and the mean DAS score was 7.67±2.45. The analyses showed that meaning in life was negatively related to death anxiety (β=-0.160, P=0.009), while perceived stress was positively related to death anxiety (β=0.216, P=0.002). Also, the indirect relationship between the meaning of life and death anxiety through perceived stress was negative and significant (β=-0.702, P=0.006). 

There is a negative relationship between the meaning of life and death anxiety in Iranian nurses. Perceived stress can exacerbate death anxiety in Iranian nurses. In this regard, it is recommended to hold stress management and death awareness courses for nurses to control their death anxiety and stress.

 Cyber harassment of students is a significant stressor in today's society. Medical students are responsible for the physical health of people in the future, so paying attention to their mental health is of enormous importance. Therefore, the purpose of the present study was to investigate the effect of teaching emotion-oriented processing strategies on the perceived stress of cyberbullied medical students.

The present research was a quasi-experimental study that was conducted on medical students of Mashhad University of Medical Sciences in the academic year of 2022-2023. Thirty cyber-damaged medical students who had been cyberbullied and perceived stress were selected by the purposive sampling method and randomly divided into experimental and control groups. The educational intervention included 9 sessions, an hour for each session, virtually through the Skyroom platform. Before and after the intervention, participants filled out demographic and Perceived Stress Scale (PSS) data collection forms. The statistical test consisted of the ANOVA, which was analyzed by SPSS V.25, and the level of significance was considered less than 0.05.

The mean and standard deviation of the perceived stress scores among medical students who suffered from cyberbullying in the post-test of the experimental groups decreased compared to the control group (P=0.003). Based on the covariance analysis, there was a significant difference in the perceived stress scores of the experimental group compared to the control group (P<0.038).

The use of emotion-oriented processing by the cyberbullied medical students can improve their perceived stress.

Pregnancy and childbirth are natural events in the life cycle of women, but at the same time, they are considered stressful experiences that are associated with extensive psychological and physical changes in pregnant mothers. Since spirituality as a hidden source of love, pleasure, and connection with divinity, helps to strengthen and protect human beings against confusion, distress, and the stresses of daily life, it seems that spiritual intelligence can be effective in reducing stress during pregnancy. This study aimed to investigate the relationship between spiritual intelligence and stress in pregnant mothers referred to Alzahra Medical Education Center in Tabriz.

This study was descriptive and correlational. The statistical population of the current study consisted of 190 pregnant women who referred to Alzahra Medical Education Center in Tabriz in 2022. They were included in the study using the availability sampling method. Questionnaires on spiritual intelligence (with subscales of understanding and connection with the source of existence and spiritual life with reliance on the inner core) and perceived stress (with subscales of negative perceived stress and positive perceived stress) were utilized for data collection. Data were analyzed using descriptive and inferential statistics, including an independent t-test, an analysis of variance (ANOVA), and Pearson's correlation coefficient.

This study showed that there was no significant difference between the mean of total perceived stress and the positive dimension of perceived stress with the demographic characteristics of the participants. However, there was a significant difference between the mean score of the negative dimension of perceived stress and the history of abortion. A significant correlation was found between the negative and positive dimensions of perceived stress and the source of existence (a small scale of spiritual intelligence), with correlation coefficients of 0.154 (P= 0.04) and 0.224 (P<0.001), respectively. Also, the correlation between the score of spiritual life with reliance on the inner core (from the subscale of spiritual intelligence) and the negative dimension of perceived stress was significant, with a correlation coefficient of 0.234 (P< 0.001).

Given the results of this study with respect to the correlation between understanding the connection with the source of existence and perceived stress in the negative and positive dimensions, it seems that women's possession of spiritual intelligence and connection with the source of existence can reduce their stress during pregnancy and ultimately improve the health status of mothers and babies.

 Stress is a psychological pressure that affects an individual's physical health, including skin health. Skin disorders can also exacerbate stress, creating a vicious cycle in which stress and skin diseases reinforce each other. The aim of this study was to determine the level of stress in patients with fungal skin infections and compare it with healthy individuals.

 This descriptive-analytical study was conducted with the participation of 152 patients with fungal skin infections referred to Ardabil medical centers and 148 of their companions as a healthy group in 2023. The sampling method was available sample. A total of 300 individuals were selected through convenience sampling. The Perceived Stress Scale by Cohen was used to assess stress levels. After completing the questionnaires by both groups, perceived positive and negative stress levels were evaluated. Data were analyzed using the independent t-test and SPSS Statistics for Windows, version 26.0 (SPSS Inc., Chicago, Ill., USA).

 A total of 152 volunteers with fungal infections, including 108 women and 44 men, aged 18 to 48, and 148 healthy volunteers, including 76 women and 72 men, participated in the study. The mean (SD) age of the patient group was 31.5 (5.0) and the healthy group was 31.2 (6.6) years. In the patient group, the mean (SD) of perceived negative stress was 23.6 (0.3) higher than in the healthy group 22.8 (0.2) (P=0.01). There was no difference in the level of perceived positive stress between the healthy 17.0 (3.8) and the patient 16.7 (5.4) groups.

 The level of negative perceived stress was higher in patients with fungal skin infections compared to healthy individuals. Psychological interventions aimed at training patients in perceived stress management appear to be necessary.

This study aims to determine the effectiveness of yoga exercises in reducing perceived stress and improving the organizational resilience of nurses during the COVID-19 pandemic.

This is a controlled randomized controlled trial. The study population consists of all nurses from the corona ward at Shahid Mohammadi Hospital in Bandar Abbas, southern Iran. Participants were 22 eligible nurses with the highest perceived stress scale (PSS) score who were randomly assigned to two groups of intervention (n=11) and control (n=11). The Connor-Davidson resilience scale was used to measure their organizational resilience before and after the intervention. Statistical analyses, including one-way analysis of variance and chi-square test, were conducted in SPSS software, version 20. The significance level was set at 0.05.

In the intervention group, the mean PSS score decreased and organizational resilience improved compared to the control group after yoga exercises. The difference between pre-test and post-test scores were significant (P<0.05). 

A four-week yoga intervention can significantly reduce perceived stress and improve the resilience in nurses. As an accessible and low-cost intervention, yoga can help improve the mental health of nurses and potentially increase the overall quality of health care.

Sexual relationship between couples is an important aspect, with one of its most crucial functions being the creation of intimacy and strengthening emotional relationships between spouses. The present study aimed to determine the moderating role of marital intimacy in the relationship between perceived stress and sexual function of men.

This is a descriptive-correlation study in which structural equation modeling method is used. The statistical population included Iranian married men aged 25 to 45 residing in Tehran and Isfahan Provinces in 2023 who had been living together for at least one year. Among them, a total of 204 individuals were selected using convenience sampling method. In this study, tools such as the Cohen’s Perceived Stress Scale, Rosen’s Male Sexual Function Questionnaire, and Walker & Thompson’s Intimacy Questionnaire were used. The data was analyzed using Spearman’s correlation test and path analysis, and with the use of a moderation model.

The findings indicated a significant negative relationship between perceived stress and sexual function of men (β=-0.45, p<0.001). Additionally, marital intimacy showed a significant positive relationship with sexual function of men (β=0.53, p<0.001). Ultimately, marital intimacy played a moderating role in the relationship between perceived stress and sexual function of men (β=0.31, p<0.001).

Based on the findings of the current research, it can be concluded that perceived stresses have undesirable effects such as reducing sexual function in the relationship between spouses, and considering psychological variables such as marital intimacy can be effective in education and therapy.

One of the significant factors related to cognitive functions is a health-promoting lifestyle, alongside perceived stress. The consideration of the relationship between these factors, especially among older adults with hypertension, is of great importance. Therefore, this study aimed to model the structural relationships between a health-promoting lifestyle and cognitive functions, through the mediating role of perceived stress in older adults with hypertension. This descriptive research employed a correlational method using structural equation modeling (SEM). The statistical population consisted of older adults with hypertension from health centers in Urmia during the first six months of 2023, among whom a sample of 250 individuals (135 men and 115 women) were selected through convenience sampling. Data were collected using Wilson et al.’s cognitive functions questionnaire, Walker et al.’s health-promoting lifestyle profile and the Cohen’s perceived stress scale. Data were analyzed using Pearson’s correlation coefficients and SEM in SPSS-22 and AMOS software. The findings indicated a direct relationship between a health-promoting lifestyle and cognitive functions. Additionally, the bootstrap test showed that perceived stress mediates the relationship between a health-promoting lifestyle and cognitive functions. Specifically, 6% of the variance in cognitive functions was predicted by perceived stress, and 18% by a health-promoting lifestyle. Hence, it can be concluded that perceived stress mediates the relationship between a health-promoting lifestyle and cognitive functions. Therefore, psychologists and therapists in health centers, nursing homes, and psychological service clinics can focus on a health-promoting lifestyle and perceived stress to improve cognitive functions in older adults.

With the spread of COVID-19 around the world, governments were forced to close scientific institutions and universities to control the spread of the disease, so these factors required them to use virtual education in an unprecedented way. Increasing the use of this type of education caused an increase in stress among students and somehow affected their academic motivation. Therefore, the present study was conducted with the aim of the comparison of perceived stress and academic motivation of students under virtual education in different fields of Baqiyatallah University of Medical Sciences.

The present study is a descriptive cross-sectional study that was conducted from 2020 to 2021 at Baqiyatallah University of Medical Sciences among 300 students. To collect information, three demographic questionnaires, Cohen's perceived stress and, Harter's academic motivation were used, which were collected virtually and analyzed with the help of SPSS 22 software.

(70.2%) of students had a high level of academic motivation and (83.4%) reported a high level of perceived stress. Pharmacy students had the highest medical students had the lowest level of perceived stress, and dental and medical students had the highest and lowest levels of academic motivation, respectively.

According to the results of this study, most of the students under virtual education had experienced severe perceived stress, and high academic motivation.Therefore, by making appropriate decisions and planning, it is possible to prevent the occurrence of psychological disorders caused by high stress as well as the educational pressure of students and increase the quality of their learning.

The outbreak of Covid-19 is a major health crisis that has changed the lifestyles of many people around the world. There is widespread concern about the impact of Covid-19 and its associated limitations on mental health. The aim of this study was to investigate the effect of online yoga and mindfulness training on perceived stress and resilience of young females during the Covid-19 pandemic.

The research method was quasi-experimental with a pretest-posttest design with a control group. The sample consisted of 70 young women (27.64 ± 6.45 years) who were selected by convenience sampling and randomly divided into experimental and control groups (35 subjects in each group). The experimental group performed 21 sessions of yoga practice and mindfulness for 21 consecutive days. Both groups were assessed using the Cohen et al. (1983) Perceived Stress and Connor & Davidson (2003) Resilience Scales in both pre-test and post-test. Data were analyzed using SPSS25 with multivariate analysis of covariance at the significant level of P ≥ 0.05.

The results of multivariate analysis of variance showed a significant difference between the post-test scores of the two groups with a decrease in perceived stress and an increase in resilience in the experimental group. However, in the control group, a slight increase and decrease in stress and resilience were observed in the post-test, respectively, which was not significant (P =0.001).

Developing online yoga and mindfulness -based intervention programs seems to help reduce stress and increase resilience in young females in stressful situations.

 Breast cancer is the third most common cancer in the world, the most common cancer among women, and the second cause of cancer-related death among them.The present study aimed to predict the meaning of life based on the sense of coherence and defense mechanisms with the mediation of perceived stress in women with breast cancer in Qazvin.

The present research was conducted based on a descriptive-analytical design. The statistical population included all women with breast cancer in Qazvin in 2023 (n=200). From this population, 126 cases were selected using Morgan's table and available sampling. Data were analyzed in SPSS (version 26) and SmartPLS (version 3.0.1) software packages using structural equation modeling.

An inverse and significant relationship was detected between sense of coherence and  perceived stress (P=0.006; r= -0.478), defense mechanisms and perceived stress (P=0.015; r= -0.458), and perceived stress and the meaning of life (P=0.044; r= -0.414. Moreover,  defense mechanisms had a direct and significant correlation with the meaning of life (P=0.005; r=  0.608). Perceived stress had a significant mediating role with (P=0.032; r=0.198) on the relationship between the sense of coherence and the meaning of life. Furthermore, perceived stress palyed a mediating role in the relationship between defense mechanisms and the meaning of life (P=0.040; r= 0.190).

As evidenced by the results of this research, an increase in perceived stress causes a decrease in the sense of coherence, an increase in incompatible defense mechanisms, and a decrease in the meaning of life. According to the proposed model, it is possible to improve the meaning of life in patients by controlling their level of perceived stress by increasing the sense of coherence and defense mechanisms. It is suggested to provide psychological services to control perceived stress and inconsistent defense mechanisms.

The increase in the elderly population in the country, along with various problems that threaten their physical and mental health, has led to inappropriate emotional reactions and stress-causing factors such as reducing resilience and intensifying stress in the elderly community. The present study was conducted with the aim of determining the effectiveness of mindfulness-based stress reduction therapy on resilience and perceived stress in elderly residents in nursing homes. The present research method was a semi-experimental type with a pre-test-post-test design with a control group. The statistical population of the research included all the elderly living in Kermanshah nursing home in 1402, among which 30 people were randomly selected into two alternatives experimental and control groups with the available sampling method and according to the criteria for entering and exiting the study. Became the content of the therapy sessions was taken from the perspective of Segal et al. (2016). The research participants responded to the Connor and Davidson (2003) resilience questionnaire and the Cohen et al. (1983) perceived stress questionnaire. The data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS-26 software. The results showed that the experimental group was significantly different from the control group in terms of both resilience and perceived stress variables. In other words, stress reduction treatment based on mindfulness improved resilience and reduced perceived stress in the elderly (P<0.05). According to the results of the present study, therapists can use mindfulness-based stress reduction therapy for health-related interventions, especially to improve resilience and reduce perceived stress.

The present study was conducted to investigate the efficacy of self-compassion training on the perceived stress and psychological coherence in elderly caregivers.

 Materials and Methods:

 It was a quasi-experimental study with pretest-posttest and control group design and Two-month follow-up period. The statistical population of the present study was made up of elderly caregivers of centers under the supervision of the Ministry of Health in Tehran in 2022. 36 elderly caregiver were selected through available sampling method and randomly accommodated into experimental and control groups. The experimental group received ten sessions of self-compassion training during two-and-a-half-months. The applied questionnaires in this study included Perceived Stress Scale (Cohen, Kamarck, Mermelstein, 1983) and Psychological Sense of Coherence Questionnaire (Flensborg, Ventegodt, Merrick, 2006). The collected data were analyzed through mixed ANOVA via SPSS23 software.

Results:

 The results showed that self-compassion training has significant effect on the perceived stress and psychological coherence in elderly caregivers.

According to the findings of the study it can be concluded that self-compassion training can be used as an efficient method to decrease the perceived stress and increase psychological coherence in elderly caregivers through focusing on the method of Visualizing compassion for self and others, using creative helplessness, articulating worthwhile goals, fostering compassionate behaviors, and developing intelligent behaviors.

Psoriasis is one of the physical and mental diseases that psychological factors have a significant impact on its severity. Modifying behavioral and psychological patterns can be an important step in controlling and reducing this disease. Therefore, the aim of this study was to compare the effectiveness of Mindfulness-Based Stress Reduction Therapy and emotional therapy schematics on perceived stress and distress tolerance of women undergoing drug therapy with psoriasis in Ahvaz.

The field semi-experimental study method of the pre-test type-then the multi-group test. The statistical community of this study includes all female patients with psoriasis in Ahvaz, who were targeted sampling methods to choose a sample, in the form of religion, which was first obtained and contacted during a call with the Psoriasis Association of Iran, the list of female patients with psoriasis who live in Ahvaz, along with their contact number. Of the 127 female patients nominated, only 100 announced their readiness to select a research sample, and all 100 patients were sent online questionnaires on perceived stress and distress tolerance. Finally, 70 qualified female patients (patients who scored a high score of 28 on perceived stress questionnaires and a low score of 29 to endure distress) were selected, 10 of whom were later reluctant to participate. Eventually 60 women with psoriasis are considered as samples, with 20 in the first experimental group, 20 in the second experimental group and 20 in the witness group being randomly simplified. Research tools included Cohen et al. ' s perceived stress questionnaire (1983 and Simmons & Gahr's distress tolerance scale (2005). The data were examined using multivariate covariance analysis (MANCOVA) and one-variable covariance analysis (ANCOVA).

Results showed that both treatments had an effect on perceived stress and distress tolerance of women undergoing drug therapy with psoriasis (P<0.05). On the other hand, Mindfulness-Based Stress Reduction Therapy based on perceived stress and distress tolerance of women undergoing drug therapy with psoriasis has been more effective than emotional therapy schematics (P<0.05).

According to the results of the present study, mindfulness-based stress reduction intervention can be more efficient to improve perceived stress and tolerate distress in women with psoriasis. Therefore, it is recommended that psychotherapists use this treatment to improve perceived stress and tolerate distress in psoriasis patients alongside other therapeutic interventions.

Experiencing high levels of stress in cardiovascular patients is a common phenomenon that can endanger their health. The aim of this study was to investigate the moderating role of social support in the relationship between psychological hardiness and perceived stress in cardiovascular patients.

The method of this study was descriptive and correlational. The statistical population of the study included cardiovascular patients referred to cardiac hospitals and cardiac rehabilitation centers in Tehran in 1398, of which 151 people were selected as the sample group by purposive sampling. Data collection tools included a perceived stress questionnaire, a multidimensional perceived social support questionnaire, and psychological hardiness questionnaire. Pearson correlation coefficient and regression methods were used to analyze the data using SPSS software version 22.

According to the results, social support and psychological hardiness had a significant negative correlation coefficient with perceived stress at the level of 0.01. The results of regression analysis showed that social support had a moderating role in the relationship between psychological hardiness and perceived stress and the interaction effect of psychological hardiness and social support was able to explain 30% of the variance of perceived stress.

In cardiovascular patients, they can be helped to reduce perceived stress by strengthening social support and psychological hardiness.

Nursing students are one of the groups at risk of suicide, and suicidal thoughts are an important predictive factor for committing suicide and completing it. Therefore, the present study was conducted with the aim of investigating the role of perceived stress, alexithymia and mindfulness in predicting suicidal thoughts of nursing students.

The current research is descriptive and correlational. The number of 180 nursing students studying at the Islamic Azad University of Tehran, Faculty of Medical Sciences, in the second half of 2020, was selected using the available sampling method and responded to the Perceived Stress Scale of Cohen et al (1983). Toronto Alexithymia Scale Bagby et al (1994), Mindfulness Attention Awareness Scale Brown and Ryan (2003), and Beck Scale for  Suicidal Ideation (1991). The collected data were analyzed using Pearson's correlation coefficient and multivariate regression analysis in SPSS-24 software.

The results showed that there is a positive and significant relationship between perceived stress and alexithymia with suicidal thoughts (P<0.01). There is a negative and significant relationship between mindfulness and suicidal thoughts (P<0.01).  Also, the results of multivariate regression analysis also revealed that 49.9% of the variance of nursing students' suicidal thoughts is explained by perceived stress, alexithymia and mindfulness.

The findings of the present study showed that perceived stress and emotional ataxia as a risk factor and mindfulness as a protective factor play a role in the occurrence of suicidal thoughts. Therefore, in order to prevent suicide attempts among nursing students, it is recommended to pay special attention to treatments based on emotion regulation, cognitive therapy based on mindfulness, dialectical behavior therapy, and treatment based on mentalization.

The COVID-19 pandemic led to mental health problems in people, including nursing students. People use different coping strategies when faced with unprecedented stress. This study aims to determine the relationship between perceived stress and psychological capital components (hope, optimism, resilience, self-efficacy) in nursing and Midwifery students in Ahvaz, Iran, during the COVID-19 pandemic.

This is a descriptive-correlational study that was conducted on 178 third- and fourth-year undergraduate nursing and Midwifery students of Ahvaz Jundishapur University of Medical Sciences, who were selected using a census method. The data were collected from May to July 2022 online using a demographic checklist, Cohen’s Perceived Stress Scale 14-item, and Luthans’s Psychological Capital Questionnaire. Data were analyzed using independent t-test, one-way ANOVA, Pearson’s correlation test, and multiple linear regression analysis in SPSS software, version 22.

A significant and negative correlation was found between perceived stress and psychological capital components (r=-0.5, P<0.001). Regression models showed that optimism (β=-0.36, P<0.001), self-efficacy (β=-0.30, P=0.001), visiting a psychologist (β=-0.17, P=0.005), and resilience (P=0.043, β=0.16) were the predictors of perceived stress in nursing students. These factors were able to predict 32% of the changes in the perceived stress variable.

There is a negative relationship between psychological capital and perceived stress in nursing students. It is recommended to make appropriate plans to improve the psychological capital of these students to prevent and control their stress during the pandemic.

The diagnosis and treatment of cancer is stressful and perceived stress and concerns during the treatment period can add to this stress and affect the recovery of patients with gastrointestinal cancer. The aim of this study was to investigate the relationship between illness perception and coping styles, and perceived stress in patients with gastrointestinal cancer.

The present cross-sectional correlational study was conducted in 110 patients with gastrointestinal cancer in Sari Imam Khomeini Hospital, Iran 2022, selected by convenience sampling. Data were collected using a demographic questionnaire, The Brief Illness Perception Questionnaire (Brief IPQ), Billings and Moos Coping Styles Questionnaire, and Perceived Stress Scale (PSS). Finally, the data were analyzed applying descriptive statistics and Chi-square, independent t-test, Pearson's coefficient correlation, and ANOVA.

Most of the participants were females (50.9%), with a medium income level (59.1%), living in the city (91.8%), suffering from colon cancer (40.9%), and undergoing treatment (90.0%). Findings showed that most of the patients had a high level of perceived stress (57.3%), moderate levels of illness perception (71.8%), and moderate coping styles (71.8%). We observed an inverse relationship between perceived stress and illness perception (P<0.001, r=-0.604), but there were no significant relationships between perceived stress and coping styles (P=0.064, r=-0.177) and other demographic variables.

Considering the inverse relationship between illness perception and perceived stress, healthcare managers are suggested to take measures to improve the illness perception of patients with gastrointestinal cancer.

The nursing profession is associated with difficult and stressful conditions and some psychological consequences. Also, one of the most important health potentials described in theoretical and research bases is the sense of coherence. Therefore, the present study was conducted with the aim of investigating the effect of perceived stress on psychological distress and psychological well-being with the mediating role of sense of coherence in nurses.

The present study was a cross-sectional correlational study. The research community included all nurses working in hospitals and medical centers in Tehran. In this study, 200 people were selected by convenience sampling method. The research tools are: Cohen Perceived Stress Scale (1983), Kessler's psychological distress questionnaire (2003), Ryff Psychological well-being scale (1989), Antonovsky’s Sence of Coherence Scale (1993). Pearson correlation, structural equation modeling and SPSS and AMOS version 23 software were used for data analysis.

The results of the findings show the fit of the desired model. In addition, the obtained results indicate a direct, positive and significant effect between perceived stress and psychological distress (T=5.556; P<0.001; β=0.385). Also, there is a direct, negative and significant effect between perceived stress and psychological well-being (T=3.407; P<0.001; β=0.173). In addition, the sense of coherence played a mediating role in the relationship between perceived stress and psychological distress and psychological well-being.

The results of this study show the importance of the mediating role of sense of coherence in the relationship between perceived stress and psychological distress and psychological well-being. In other words, the sense of coherence acts as a health potential in a stressful work environment; therefore, it is necessary to design interventions based on this component, because it can probably significantly change a person's physical and psychological functions in a stressful work environment.

Diabetic elderly people face with many problems including increased perceived stress and chronic pain and reduced treatment adherence. Therefore, the aim of this study was to determine the effectiveness of acceptance and commitment therapy on perceived stress, chronic pain and treatment adherence in diabetic elderly.

This study was quasi-experimental with a pretest and posttest design with a control group. The research population was consisted of elderly diabetics who referred to the health centers of Rafsanjan, which 30 people of whom were selected as a sample after reviewing the inclusion criteria and randomly were replaced into two equal groups. The experimental group received 8 sessions of 90 minutes the acceptance and commitment therapy based on the protocol of Vowles et al (2007) and the control group remained on the waiting list for training. The research tools were included Cohen et al.'s perceived stress questionnaire (1983), Melzak's pain questionnaire (1975), and Toobert and Glasgow's diabetes self-care activities questionnaire (1994). Data were analyzed by multivariate analysis of covariance test in SPSS version 25 software.

The findings showed that there was a significant difference between the experimental and control groups in terms of all three variables of perceived stress, chronic pain and treatment adherence in diabetic elderly. In the other words, acceptance and commitment therapy reduced perceived stress and chronic pain and increased treatment adherence in diabetic elderly (P<0.001).

Based on the findings of this study, health professionals and therapists can use acceptance and commitment therapy along with other treatment methods to reduce perceived stress and chronic pain and increase treatment adherence in vulnerable groups including the diabetic elderly.