@2024 Afarand., IRAN

---

ISSN: 2008-2630    Iranian Journal of War & Public Health 2020;12(3):149-155

Background
… [1]. Undoubtedly, the veteran's spouse is one of the closest people to the veteran with the most and the widest relationships in terms of emotional and cognitive, verbal and non-verbal, as well as face-to-face, and reciprocal communication with the veteran. If the emotional needs and appropriate communication in the family are not met, this person is expected to suffer the most problems and discomforts [2].
Previous Studies
... [3, 4]. One of the vulnerable psycho-emotional processes in veterans' spouses is their emotional processes and cognitive regulation of emotion [1, 5]. ... [6-11]. Their resilience is also another process in these people [1, 12]. ... [13-15]. Resilience includes maintaining calm in stressful situations, flexibility in the face of obstacles, avoiding erosive strategies, maintaining optimism and positive emotions while facing difficulty [16]. ... [17-19]. Various therapeutic and educational methods have been used to solve the psychological, emotional, and marital problems of the veterans' spouses. ... [20-34]. The main goal of integrated transdiagnostic therapy is to acquire skills that can effectively manage negative emotions [29]. Transdiagnostic therapy teaches people how to deal with their inappropriate emotions and respond more appropriately to environmental stimuli.
Aim(s)
The aim of this study was to investigate the effectiveness of integrated transdiagnostic treatment on cognitive emotion regulation and psychological resilience of veterans' spouses.
Research type
The present research was a quasi-experimental study.
Research society, place and time
The present research had a pre-test post-test design with a control group that was done on the wives of psychiatric veterans in Tehran between June and September 2020.
Sampling method and number
Using the voluntary sampling method, 30 spouses of the veterans were selected from June to September 2020 by referring to the district 4 veterans’ medical center and distributing voluntary forms (to participate in the study). The sample size was calculated using Cohen's table and based on the effect size considering a = 0.05, α = 0.005, 1-β = -0.8, and according to the effect size of the previous studies [36]. Thirty subjects were considered for both groups and assigned to the experimental and control groups (n=15 per group). Inclusion criteria were having a psychiatric veteran spouse (according to a specialist doctor), no acute or chronic psychological and physical illness (according to the subjects’ report), and having at least a diploma. Those receiving psychological training simultaneously or cases who were absent for more than two sessions and did not do their homework were excluded.
Used devices&materials
Data were collected using the following questionnaires: Cognitive Emotion Regulation Questionnaire (CERQ): CERQ was developed by Gross and John [37] and has 10 questions and two subscales of emotional inhibition and cognitive reassessment. Soleimani and Habibi [38] reported Cronbach's alpha of 0.71 for cognitive reassessment and 0.81 for emotional inhibition. Asli Azad et al. [39] using Cronbach's alpha coefficient, reported the reliability of the questionnaire for the two subscales of emotional inhibition and cognitive reassessment and the total score of the questionnaire to be 0.72, 0.74, and 0.76, respectively. In the present study, the reliability of the questionnaire was calculated to be 0.73 using Cronbach's alpha coefficient. Resilience Scale (RS): DS was designed by Connor and Davidson [40] to measure resilience. Mozaffari reported the reliability of this scale to be 0.88 using Cronbach's alpha coefficient [1]. In the present study, the reliability of the questionnaire was calculated to be 0.86 using Cronbach's alpha coefficient After obtaining the necessary permission from the Foundation of Martyrs and Veterans, the experimental group received integrated transdiagnostic treatment for two and a half months in 10 90-minute sessions, one session per week. However, the control group did not receive the interventions and after collecting the data, they were provided with training as a brochure. Therapeutic sessions were conducted by the first author of the study. In order to observe ethics in the research, participants' consent to participate in the intervention program was obtained and they were informed about all stages of the intervention. After starting the intervention, 2 cases in the experimental group and one case in the control group were excluded from the study. Shapiro-Wilk test was used to check the normality of data distribution, Levene's test was used to check the homogeneity of variances, regression analysis was used to check the slope of the regression line, and analysis of covariance was used to compare post-test results between the two groups using SPSS 23 statistical software.
Findings by Text
Twenty-seven subjects participated in the study (13 cases in the experimental group and 14 cases in the control group). The age range of participants was 35 to 50 years; the age range of 40 to 45 years (4, 30.77%) in the experimental group and 35 to 40 years (5, 35.71%) in the control had the highest frequency. The participants had a diploma to master's degree and in both the experimental (5, 38.46%) and control (6, 42.85%) groups, those with a bachelor's degree showed the highest frequency. In the post-test stage, the homogeneity of variance was established for cognitive regulation of emotion and psychological resilience (p <0.05). In the post-test stage, the assumption of variance-covariance matrices was also established (p <0.05). In addition, the assumption of normal distribution of data for cognitive emotion regulation and psychological resilience in the experimental and control groups was established in the pre-test and post-test stages (p <0.05). Finally, the interaction of the pre-test with the grouping variable in the post-test stage was not significant for cognitive emotion regulation and psychological resilience (p <0.05), and the assumption of homogeneity of the regression line slope was established for cognitive emotion regulation and psychological resilience. The mean scores of cognitive regulation of emotion and its dimensions and psychological resilience of veterans' spouses increased in the experimental group (Table 2).Also, 57% of changes in cognitive emotion regulation (F=31.62; p=0.0001) and 52% of changes in psychological resilience (F = 26.05; p=0.0001) of veterans' spouses were explained after adjusting for the effect of pre-test by implementing integrated transdiagnostic treatment. In addition, 37% of changes in emotional inhibition (F=13.21; p=0.001) and 49% of changes in cognitive reassessment (F=21.45; p=0.0001) of veterans' spouses were explained after adjusting for the effect of pre-test by implementing transdiagnostic treatment.
Main comparison to the similar studies
We investigated the significant effect of integrated transdiagnostic treatment on cognitive emotion regulation and psychological resilience of veterans' spouses. Integrated transdiagnostic treatment had a significant effect on the cognitive regulation of emotion of veterans' spouses and was able to improve their cognitive regulation of emotion. The present result was consistent with the findings of Hassanpour et al. [25], Firoozi & Biranvandi [26], and Azimi et al. [27]. Also, Grossman & Ernrich-Mai [30], Saciris & Berl [31], Steele et al. [32], and Orlenas Maya et al. [34] have also shown that integrated transdiagnostic therapy can improve emotional processing and performance. Integrative transdiagnostic treatment had a significant effect on the psychological resilience of veterans' spouses and was able to improve their psychological resilience. The present finding was consistent with the results of studies by Kamrani et al. [24] and Nargesi et al. [23]. Also, Shur-Zavala et al. [29] and Talkowski et al. [33] have shown that integrated transdiagnostic therapy improved mental strength and coping.
Suggestions
To increase the generalizability of the results, it is suggested that this research be conducted in other provinces, regions, and communities with different cultures and also other groups, such as spouses of people with MS, Parkinson's disease, migraine, etc., by the control of the mentioned factors and using random sampling method and follow-up stage.
Limitations
Limiting the sample to the spouses of veterans in Tehran, no control on variables affecting cognitive emotion regulation and psychological resilience of veterans' spouses, the lack of using random sampling method, and the lack of follow-up to evaluate the stability of treatment were the limitations of the present study.
Conclusions
Integrated transdiagnostic therapy can use techniques such as emotion recognition, emotional awareness training, cognitive reassessment, identification of emotion avoidance patterns, and the study of emotion-induced behaviors. It can be used as an effective treatment to improve the cognitive emotion regulation and psychological resilience of veterans' spouses.
Acknowledgments
We would like to thank all the women who participated in the study and the officials of the District 4 medical center for veterans of Tehran who fully cooperated in conducting the research.
Conflict of interest
The present article is taken from the Ph.D. dissertation of Valieh Mozaffari, Islamic Azad University, Tehran-North Branch.
Ethical Permissions
None declared.
Funding Sources
The research was not financially supported.

TABLES and CHARTS

Show attach file