نشریه روان پرستاری
سال یازدهم شماره 6 (پیاپی 60، بهمن و اسفند 1402)

 Nowadays, in the Post-COVID-19 period, paying attention to related psychological issues, such as loneliness and subsequent death anxiety among the elderly, is of particular importance. This study was conducted to determine the relationship of loneliness with death anxiety in the Post-COVID-19 era among the Older People in Ilam Province in 2023.

 In this cross-sectional descriptive-analytical study, 384 elderly men and women in Ilam province were included in the study after checking the inclusion criteria by cluster and simple random sampling methods. To collect data, demographic information questionnaires, the UCLA Loneliness Scale (Version 3), and Templer's Death Anxiety (DAS) were used. The obtained data were analyzed using descriptive statistics and Kolmogorov-Smirnov, Mann-Whitney, Kruskal-Wallis, and Spearman's correlation coefficient tests in SPSS version 22 software with a significance level of P< 0.05.

 The mean and standard deviation of loneliness and death anxiety scores were 51.88 ± 14.17 and 10.93 ± 4.55, respectively. A significant direct relationship was found between loneliness and death anxiety. Also, there was a significant direct correlation between age with loneliness (r = 0.29) and death anxiety (r = 0.88) and a significant inverse correlation between the number of children with death anxiety (r = -0.1). There was a statistically significant difference between loneliness and death anxiety with gender, insurance status, residence, and housemate segregation, and there was also a statistically significant difference between death anxiety with marital status, education level, underlying disease, and experiencing a stressful event.

 Considering the positive relationship between loneliness and death anxiety and the influencing factors in this study, health policymakers must plan to reduce loneliness and subsequent death anxiety in the elderly while paying attention to these factors.

Old age is considered a critical phase in human life, and attention to the challenges and needs of this stage is essential from physical, psychological, and social perspectives. Loneliness during this period arises due to a reduction in social interactions, and poor sleep quality can lead to disruptions in individuals' emotions, thoughts, and motivation. The present study was conducted in 2023 with the aim of determining the relationship between loneliness and the sleep quality of the elderly visiting comprehensive health centers in the urban and rural areas of Varamin County.

The present study was conducted on 120 elderly individuals who sought care at the comprehensive health centers in the urban and rural areas of Varamin County in the year 2023. A multistage sampling method was employed for participant selection. Initially, Varamin County was divided into four clusters based on a map, and then four comprehensive health centers in urban/rural areas were randomly chosen. Subsequently, considering the total number of elderly individuals in Varamin County and the specific count for each center (information obtained from Varamin Health Center), the allocation of each center was determined based on the covered population. Continuing with the research, a continuous sampling method was utilized to select elderly participants. Data collection instruments included the UCLA Loneliness Scale for assessing loneliness and the Pittsburgh Sleep Quality Index (PSQI) for evaluating sleep quality. Data analysis was performed using SPSS version 26, employing descriptive and inferential statistics

The research findings revealed a significant and strong direct correlation between loneliness and sleep quality (r = 0.611, p < 0.001). Furthermore, 37% of the variance in loneliness can be explained by sleep quality. Sleep quality, with a positive beta coefficient of 0.611, predicts loneliness significantly (p = 0.015).

The findings of this study indicate the impact and correlation between loneliness and the sleep of the elderly. The results of this research can serve as a clear picture to better understand how the feeling of loneliness affects the sleep of the elderly. These findings can be utilized in providing practical strategies to increase awareness among families and even the elderly themselves, aiming to reduce loneliness and its detrimental effects on the quality of life and sleep. Furthermore, these results can be instrumental at the organizational level for officials in relevant institutions dealing with the elderly, helping in formulating appropriate policies and measures to manage loneliness and enhance the sleep quality of the elderly

Many factors, such as the economic and social status of mothers, can affect the adjustment of adolescents. Therefore, it is necessary to understand the effective components of these consequences; Therefore, the present study was conducted with the aim of comparing the adjustment of adolescents in monogamous and polygamous families based on the economic and social status of mothers.

The research method is causal-comparative.The statistical population of the research was made up of all adolescents aged 14 to 18, members of monogamous and polygamous families in Saravan city in the academic year of 2020-2021, accompanied by their mothers. 240 people, including 120 adolescents from polygamous and monogamous families and 120 mothers from polygamous and monogamous families, were selected through accessible and purposeful sampling, and were answered the Sinha and Singh's student Adjustment Scale and the Adjustment questionnaire and social and economic status of Gudrat Nama. After collecting the questionnaires, the data were analyzed using (SPSS-26) and through independent t-groups and multivariate variance analysis.

The results showed that there is a significant difference between adolescents in monogamous and polygamous families in terms of emotional adjustment (P<0.05). There is no significant difference in terms of social adjustment, academic adjustment and general adjustment (P<0.05). Also there is a significant difference between the adjustment of adolescents whose mothers have a low economic and social status (P<0.05).

According to the results, polygamous families can be informed that the economic and social status of mothers affects the adjustment of adolescents, so it is necessary for the family to pay special attention to the economic and social status of mothers for better adjustment of their children.

This study investigated the effectiveness of mindfulness-integrated cognitive behavior therapy (MiCBT), to decrease intolerance of uncertaint and psychological distress in patients with COVID-19.

This research was conducted in the form of an experimental design with pre-test-post-test and follow-up with a control group. thirty patients with covid-19 in Amol city were randomly allocated to either to the experimental group (n = 15) and control group (n = 15). Outcomes were assessed at pre-, postintervention and at 2-month follow-up with the Kessler psychological distress scale-10 (K10) and the short version of the intolerance of uncertainty scale. The data were analyzed using SPSS.26 software and mixed covariance analysis with repeated measures and Bonferroni post hoc test.

The MiCBT intervention significantly reduced intolerance of uncertainty and psychological distress scores at posttreatment and the gains were maintained at 2-month follow-up (p < 0.001).

The results support the effectiveness of MiCBT in creating rapid and sustainable reduction of intolerance of uncertainty and psychological distress in patients with COVID-19. Therefore, experts, researchers and therapists in this field can use this intervention as an effective treatment option to improve the psychological functions of patients with COVID-19 in Iran.

A significant portion of the population suffers from maladaptive perfectionism, which, without appropriate psychological treatment, can lead to various psychological disorders and impairments in occupational, social, and educational functioning. Therefore, the present study aimed to examine the effectiveness of cognitive-behavioral therapy in reducing perfectionism.

This study utilized a quasi-experimental design with a pretest-posttest and follow-up period, including a control group. The target population consisted of all students of Zanjan University of Medical Sciences in 2020. The sample was selected in two stages: first, 350 individuals were selected from the target population using convenience sampling, and the Frost Multidimensional Perfectionism Scale (FMPS) was administered to them. In the second stage, individuals who scored above the diagnostic cutoff point (score equal to or higher than 90) on the FMPS were selected (n = 314). Finally, based on entry and exit criteria and the progression of subsequent stages, a sample of 40 individuals was randomly assigned to the experimental group (n = 20) and the control group (n = 20). The inclusion criteria included residence in Zanjan at the time of the study, willingness to participate in the research, and scoring above the diagnostic cutoff on the FMPS. The exclusion criteria included the onset of psychiatric illnesses during the intervention, previous experience of cognitive-behavioral interventions, particularly more than 5 sessions of cognitive-behavioral therapy, more than two consecutive absences in the group protocol, failure to participate in one of the three assessment stages, and obtaining a score of 140 or higher on the FMPS. The experimental group received group cognitive-behavioral therapy based on perfectionism once a week for 90 minutes. The participants were assessed at three-time points: pretest, posttest, and two-month follow-up. The data were analyzed using SPSS-25 software and repeated measures analysis of variance.

The results of the analysis indicated that group cognitive-behavioral therapy led to a significant improvement in overall perfectionism scores, particularly in the subscales of concerns over mistakes and parental criticism (p < 0.05). The mean pretest score for overall perfectionism in the experimental group was 83.110, which decreased to 39.98 in the posttest. For the subscale of concerns over mistakes, the mean scores at the pretest and posttest were 72.10 and 22.9, respectively. Finally, for parental criticism, the mean scores at pretest and posttest were 28.8 and 61.7, respectively. These improvements were significant compared to the control group.

The findings of this study support the effectiveness of group cognitive-behavioral therapy as an intervention that can reduce maladaptive perfectionism in individuals with perfectionistic traits. Therefore, therapists can utilize this treatment to improve perfectionism in their clients.

Self-harm is one of the strongest predictors of suicide. Students are known as one of the populations that have the highest rate of self-harm. Therefore, it is vital to understand why and the mechanisms that are important in this context. The present study was also conducted with the aim of investigating the mediating role of mentalization and negative emotional dysregulation in the relationship between traumatic life events and self-injurious behaviors in college students.

The present research is a descriptive-correlation type of structural equations. The statistical population of this research was all undergraduate students of Karaj University, of which 290 people were selected by simple random sampling. The research tools are: Life Events Scale, Reflective Functioning Questionnaire, Diffiiculties in Emotion Regulation Scale- Short Form and Self-Harm Inventory. The research data were analyzed using SPSS and LISREL software and with the help of structural equation modeling method.

The results of the findings show the fit of the assumed model. Also, the direct path coefficients of traumatic life events on negative emotional dysregulation (T = 14.169, β = 0.683) and Uncertainty mentalization component (T = 21.61, β = 0.782) were positively significant. The coefficient of the direct path of traumatic life events on confidence (T = -24.650, β = -0.823) were negatively significant. The direct path of traumatic life events on self-injurious behaviors was not significant. Also, the analysis of research findings indicated the mediating role of mentalization and negative emotional dysregulation in the relationship between traumatic life events and self-injurious behaviors.

Based on the findings of the research, it can be concluded that targeted interventions that are used to increase mentalizing capacity and reduce negative emotional dysregulation, can probably be effective in preventing and reducing self-harming behaviors of people.

Premature ejaculation is the most common sexual problem that has many psychological effects on the relationship between spouses. Therefore, the present study aimed the effectiveness of mindfulness therapy, biofeedback and combined method on sexual self-efficacy in men with premature ejaculation.

The research method was semi-experimental, pre-test, post-test with a control group. The studied population included all men 30 to 50 years with premature ejaculation who referred to the sexual health clinics in Tehran city in 2022. Among them, 32 men with premature ejaculation were selected based on the inclusion criteria and by purposive sampling method. Then they randomly assigned to experimental and control groups (groups of 8 people each). The Sexual Self-Efficacy Scale - Erectile Functioning (SSES-E) was used to pre-test and post-test. The first experimental group received mindfulness intervention in eight 90-minute sessions, the second experimental group received biofeedback intervention in eight 20-minute sessions, and the third experimental group received the combined method (The combination of mindfulness and biofeedback) in eight 90-minute sessions; While the control group was on the waiting list. The data were analyzed using covariance analysis (MANCOVA) and LSD post hoc test.     

No statistically significant differences were observed in the demographic variables of the groups. The results showed that there was a significant difference between the mean sexual self- efficacy in the experimental and control groups. Also, the findings indicated that the effectiveness of the combined method on sexual self- efficacy was more than mindfulness and biofeedback intervention.

According to the results of the present study, the of mindfulness therapy, biofeedback and combined method intervention can increase the sexual self- efficacy of men with premature ejaculation. It is suggested that therapists and counselors use these treatments in order to improve the sexual self- efficacy of men with premature ejaculation along with other therapeutic interventions.

Mental retardation in children is a source of stress for the family and caregivers, which can lead to significant impairment in social-occupational functioning and damage to the caregivers' quality of life. This study aimed to compare the effectiveness of positive resilience training and metalization-based training in improving emotional self-regulation and parent-child interactions in mothers of children with intellectual disabilities.

The study population included all mothers of children with intellectual disabilities in Tabriz in 2022. Out of the study population, 45 individuals were selected using purposive sampling method and randomly assigned to three groups (15 individuals per group). The data collection tools included the the Emotion Self-Regulation Questionnaire by Hofmann and Kashdan (2010), and the Parent-Child Interaction Questionnaire by Pianta (1994). Positive resilience training and metalization-based training were implemented in 8 sessions, each lasting 90 minutes. Data analysis was done using SPSS.v21 software and multivariate covariance analysis and post hoc test of least significant difference.

The results showed that positive resilience training has an effect on emotional self-regulation (MD=2.391; P=0.014) and parent-child interaction (MD=4.683; P=0.026). Also, metalization-based training was effective on emotional self-regulation (MD=4.257; P=0.001) and parent-child interaction (MD=9.955; P=0.001). The comparison of the effectiveness of the interventions also showed that, apart from emotional self-regulation (P<0.05), metalization-based training in the parent-child interaction was more effective compared to positive resilience training (P<0.05).

Based on the results of this study, it is recommended to prioritize metalization-based training in intervention programs aimed at improving the mental health of mothers of children with intellectual disabilities.

The treatment processes and complications of heart failure are associated with tension, mood problems, anxiety and feeling of hopelessness. Due to the importance of psychological health and hope in dealing with the consequences of the disease and the effect of mindfulness-based interventions on them, the aim of this study was to compare the effect of mindfulness-based cognitive therapy with acceptance and commitment therapy on psychological distress and hope in males with heart failure.

This research was semi-experimental with a pretest-posttest design with a control group on three-month follow-up. 45 males aged 35 to 55 with stage B heart failure in Isfahan city, were purposefully selected and placed in three groups of 15 (two experiment groups and one control group) by simple random method. Data were collected with depression, anxiety and stress scale, Loybond & Loybond's (1995) and Hope scale Snyder et al. (1991), in the three stages of pre-test, post-test and follow-up. The interventions performed for test groups. The control group did not receive any intervention. Data analysis was done with mixed analysis of variance and Bonferroni's post hoc test.

Findings showed a significant difference for depression, anxiety, stress and hope in both interventions compared to the control group in the post-test and follow-up (P˂0.05). Comarsion of mindfulness-based cognitive therapy with acceptance and commitment therapy showed a significant difference in the treatment of depression (P=0.005), anxiety (P=0.034) and hope (P=0.007). However no significant difference was observed for Stress (P=0.451).

Both interventions reduced depression, anxiety, stress, and increased hope in males with heart failure. Therefore the suggested treatments should be used in medical centers along with common medical treatments as complementary interventions. For anxiety problems, the preferred method is mindfulness-based cognitive therapy and for hope, mood and depression problems, acceptance and commitment therapy.

Bipolar disorder is one of the common and debilitating psychiatric disorders, which includes different aspects of a person's personal, family and social life.The purpose of this research was to investigate the effect of object relations psychotherapy on insecure attachment Styles of 25-30-year-old women with bipolar disorder.

This research was a semi-experimental type with a pre-test-post-test design and a 2-month follow-up, along with a control group. The statistical population consisted of all women with bipolar disorder hospitalized in Isfahan psychiatric hospitals in 1402-1401. Among the patients referred to Modares Psychiatric Hospital, Isfahan, 40 women with bipolar disorder were selected using a random method and based on inclusion and exclusion criteria, and were randomly assigned to two experimental and control groups (n=20). The research tool was Hazen and Shaver (1987) attachment style questionnaire. The experimental group was exposed to 16 sessions of 45-minute object relations psychotherapy based on a master protocol, while the control group was on the waiting list. Data were analyzed using SPSS 23 statistical software and variance analysis with repeated measurements.
 

The results of the data analysis showed that there was a significant difference between the adjusted averages of attachment variables, avoidant insecure attachment and ambivalent insecure attachment in the experimental group after the implementation of the intervention, and this difference continued until the follow-up stage (P<0.01).

Considering the effectiveness of object relations psychotherapy on insecure attachment patterns, this treatment method can be used to improve patients with bipolar disorder.

 The present study was conducted to predict health anxiety based on health literacy and the mediating role of cyberchondria and cognitive flexibility in patients with a history of breast cancer.

The present study is descriptive and correlational. The statistical population of this study was patients with breast cancer in Tehran in 1401.  196 patients the Convenience sampling method. Participants completed the Health Literacy Questionnaire by Montazeri et al. (2015), Salkovskis and Warwick 's Health Anxiety Inventory (1989), Dennis and Vander Wal's Cognitive Flexibility Inventory (2010), and McElroy and Shevlin's Cyberchondria Severity Scale (2014). We used SEM method to analyze the data.

The results showed that the study model was optimally fit. There was a significant negative correlation between health literacy, cognitive flexibility, and health anxiety (P<0.001), and a significant positive correlation between cyberchondria and health anxiety (P<0.001). Regarding indirect paths, the model representing cognitive flexibility and cyberchondria mediating the relationship between health literacy and health anxiety was significant.

Conclusively, research findings have shown that it is important to increase health literacy through psychological flexibility by intervening and empowering people to overcome health barriers.  Accordingly, they are encouraged to use health literacy and awareness, and choose adaptive alternative strategies toward healthy actions and behaviors, and use less unusual patterns of anxiety reduction.