@2024 Afarand., IRAN
ISSN: 2008-2630 Iranian Journal of War & Public Health 2017;9(3):111-117
ISSN: 2008-2630 Iranian Journal of War & Public Health 2017;9(3):111-117
Effectiveness of Emotion-Focused Therapy on Emotional Dysregulation, Hopelessness and Suicidal Ideation in Post-Traumatic Stress Disorder Veterans
ARTICLE INFO
Article Type
Original ResearchAuthors
Mikaeili N. (1)Molavi P. (2)
Einy S. (*)
Tagavy R. (3)
(*) Psychology, Educational Sciences & Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
(1) Psychology, Educational Sciences & Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
(2) Psychiatry, Medical, Ardabil University of Medical Sciences, Ardabil, Iran
(3) Psychology, Psychology, Ardabil Branch, Islamic Azad University, Ardabil, Iran
Correspondence
Address: Psychology and Educational Sciences Faculty, End of Daneshgah Street, University of Mohaghegh Ardabili, Ardabil, IranPhone: +98 (45) 33262678
Fax: +98 (45) 33511508
sanaz.einy@yahoo.com
Article History
Received: January 29, 2017Accepted: March 11, 2017
ePublished: July 27, 2017
BRIEF TEXT
PTSD is a collection of symptoms of a kind of syndrome that is found in the face of life-threatening accidents. The person responds to this experience in form of fear and frustration. This person constantly imagines the event and at the same time wants to avoid its reminder. The clinical features of this disorder, the painful event of a reoccurrence of the event, a pattern of avoidance, emotional numbness and relatively permanent arousal [1].
… [2-33]. According to researches, it has been shown that emotion-focused therapy is a good and effective treatment, including reducing symptoms of depression, and emotional regulation of disturbed couples [34], reducing symptoms of anxiety, depression, and stress of students [35], improving the quality of life in depressed students [36], and generally leads to improved quality of life and psychological well-being of individuals.
The aim of this study was to investigate the efficacy of emotion-focused therapy on emotional dysregulation, suicidal ideation, and hopelessness in veterans with PTSD.
This is a semi-experimental research with pretest-posttest design with control group.
This study was performed among all veterans with PTSD who had referred to an Ardabil Psychiatric Hospital called Isar in 2016.
50 participants were selected through convenience sampling method that randomly assigned into two groups of control and experimental.
1- PTSD Checklist – Military Version (PCL-M): This tool is made up 17 five-option items that have been prepared based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM_IV), as a diagnostic tool by Wenders et al. for the National Center of Post-Traumatic Disorder in the United States [37]. 5, 7, and 5 items are respectively related to re-experiencing signs of injury, the symptoms of emotional numbness and avoidance, and symptoms of severe arousal. The cutting score for the post-traumatic disorder is considered to be 50. … [38, 39]. 2- Beck Desperate Inventory (BHS): This questionnaire was created by Aaron T Beck in 1979 to assess and measure the individual's expectations of future incidents. This test has 20 sentences that express the individual's mindset. The sentences are answered in form of correct or incorrect. The questionnaire measures three dimensions of disappointment, including a person's feelings about the future, lack of motivation or loss of motivation, and expectations. The questionnaire has been designed for people ages 17 to 80, and the obtained score in it is between zero and 20 that a higher score indicates more disappointment [40]. … [41, 42]. 3- Beck Suicidal Thinking Scale (BSSI): to measure suicidal thoughts, Beck et al Suicidal Thinking Scale (BSSI) was used. This scale was designed by Beck et al. in 1974 and contains 19 three-option questions to detect, measure of attitude, and planning for suicide and its constituent elements. Questions have three options: “no”, “to some extent”, and “a lot” [43]. 4- Difficulties in Emotion Regulation Scale (DERS): this scale was developed by Gratz and Roemer [44] with the goal of examining emotional regulation problem, with 36 items. This instrument which is a self-reporting scale, has six subscales of: lack of acceptance of emotional responses (6 items), limited access to emotional regulation strategies by pressure (8 items), difficulty in performing purposeful behaviors during stress (5 items), lack of emotional awareness (6 items), lack of emotional clarity (5 items) and difficulty in controlling impulsive pressure (6 items). This tool is scored on a five-degree scale from “almost never” to “almost always”. The high score indicates the problems of emotional setting. … [44, 45]. At first, pretest was carried out. Then weekly EFL training sessions were hold for the experimental group for 8 sessions of 1.5 hours. Based on emotion-focused therapy, change is created by helping people with creating emotion and through the development, adjustment, feedback, transfer, and modified emotional experience of the communication context that facilitates these processes (Table 1) [46]. Eventually, after the completion of the training sessions, both groups participated in the posttest. Statistical analysis Data were analyzed using SPSS 23 software using multivariate analysis of covariance analysis in SPSS 23 software. For the implementation of the covariance analysis test, its assumption (Levin test and Box test) were first examined. The results of the Box test confirmed the general assumption of homogeneity of variance-covariance. Levin's test results also showed that the variances of the two groups are equal in the variables studied at the community level. Therefore, to investigate the effectiveness of emotion-focused therapy (independent variable) on suicidal thoughts, disappointment, and emotional dysregulation in veterans with PTSD (dependent variables), multivariate analysis of covariance analysis was used.
The mean age in the experimental group and control group was 51.20±8.20 and 50.70±7.40 years in the experimental and control group respectively. Also, in the experimental group 16, and 9 respectively had under diploma and diploma and higher education respectively, and in the control group 12, and 13 had under diploma and diploma and higher education respectively. Mean scores of emotional maladaptive, suicidal ideation, and disappointment variables were significantly different between the experimental group and control groups in posttest with the control of pretest effect and the treatment intervention significantly decreased the mean scores of these variables (Table 2).
The results of this study showed that emotion-focused therapy was effective in reducing the suicidal ideation of veterans with PTSD in the experimental group. This finding is fairly consistent with earlier studies [31-33, 47]. … [48, 49].
It is suggested that in future studies, the extent and type of interpersonal and family problems of veterans be studied in order to investigate the relationship between these interactions and the interpersonal conditions with improvement or emergence of emotional problems of veterans with PTSD.
This research was conducted on veterans with PTSD in Ardabil Psychiatric Hospital, called Isar that causes the problems in generalization of the data other cities.
Emotion-focused therapy can reduce emotional dysregulation, suicidal thoughts, and disappointment of veterans with PTSD.
In the end, the authors of this article are grateful to the dear veterans of Ardabil Isar Psychiatric Hospital, as well as the support of the officials of the Foundation of Martyrs and Veterans Affairs in Ardabil city.
Non-declared
Prior to the implementation of the research, coordination with Foundation of Martyrs and Veterans Affairs in Ardabil Province was carried out and the consent of the participation in this study was taken from the participants.
This study is based on research work and no financial support was obtained from any institution or organization.
TABLES and CHARTS
Show attach fileCITIATION LINKS
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[3]Leahy R, Napolitano LA, Tirch D. Emotion regulation in psychotherapy: A practitioners guide. New York: Guilford Press; 2011.
[4]Foa EB, Kozak MJ. Emotional processing of fear: Exposure to corrective information. Psychol Bull. 2008;99(1):20-35.
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[6]Bardeen JR, Kumpula MJ, Orcutt HK. Emotion regulation difficulties as a prospective predictor of posttraumatic stress symptoms following as mass shooting. J Anxiety Dis. 2013;27(2):188-96.
[7]Ozdamir O, Boysan M, Ozdamir PG, Yilmaz E. Relationships between posttraumatic stress disorder (PTSD), dissociation, quality of life, hopelessness, and suicidal ideation among earthquake survivors. Psychiatry Res. 2015;228(2):598-605.
[8]Azad Marzabadi E, Moqtadaee K, Aria Pooran S. The effectiveness of mindfulness training on psychological symptoms in veterans with post- traumatic stress disorder. J Behav Sci. 2013;7(1):67-74. [Persian]
[9]Sheykhan R, Ghazanfari F, Jadidi F, Adineh M, Sadrmohamadi R. Attachment styles and cognitive emotion regulation strategies as predictor of post-traumatic stress disorder in veterans. J Mazand Univ Med Sci. 2016;26(137):95-104. [Persian]
[10]krysinska k, Lester D. Post-traumatic stress disorder and suicide risk: A systematic review. Arch Suicide Res. 2010;14(1):1-23.
[11]Panagioti M, Gooding PA, Tarrier N. A meta-analysis of the association between posttraumatic stress disorder and suicidality: The role of comorbid depression. Compr Psychiatry. 2012;53(7):915-30.
[12]Coohey C, Dirks- Bihun A, M.Renner L, Baller R. Strain, depressed mood and suicidal thoughts among maltreated adolescents in the United States. Child Abuse Negl. 2014;38(7):1171-9.
[13]Leiner AS, Compton MT, Houry D, Nadine J, Kaslow J. Intimate partner violence, psychological distress, and suicidality: A path model using data from African American women seeking care in an urban emergency department. J Fam Violence. 2008;23(6):473-81.
[14]Pompili M, Sher L, Serafini G, Forte A, Innamorati M, Dominici G, et al. Posttraumatic stress disorder and suicide risk among veterans: A literature review. J Nerv Ment Dis. 2013;201(9):802-12.
[15]Ghamari-Givi H, Hosseini Kiasari ST. The effectiveness of cognitive- existential group therapy on hopelessness in patients with multiple sclerosis. Daneshvar. 2014;21(112):1-11. [Persian]
[16]Snyder CR. Hope theory: rainbows in the mind. Psychol Inq. 2002;13(4):249-75.
[17]Hasson-Ohayon I, Kravetz S, Meir T, Rozencwaig S. Insight into severe mental illness, hope, and quality of life on persons with schizophrenia and schizoaffective disorders. Psychiatry Res. 2009;167(3):231-8.
[18]Johnson KL. The relationship of hope and quality of life in combat veterans seeking treatment for posttraumatic stress disorder. Kansas: University of Kansas, Psychology and Research in Education Publisher; 2001. pp. 29-58.
[19]Leahy RL. Cognitive therapy techniques: A practitioner s guide. 2rd edition. Fata L, Shakiba Sh, Tahmasbi Moradi Sh, Naseri H, Ziaei K, translators. New York City: Guilford Press; 2001. [Persian]
[20]Paunović N. Exposure inhibition therapy as a treatment for chronic posttraumatic stress disorder: A controlled pilot study. Psychology. 2011;2(6):605-14.
[21]Talbot NL, Gamble SA. IPT for women with trauma histories in community mental health care. J Contemp Psychother. 2008;38(1):35-44.
[22]McCarthy KS, Connolly-Gibbons MB, Barber JP. The relation of rigidity across relationship with symptoms and functioning: An investigation with the revised central relationship questionnaire. J Couns Psychol 2008;55(3):346-58.
[23]Fridja NH. The emotions. Cambridge, MA: Cambridge University Press; 1986. pp. 9-41.
[24]Greenberg LJ, Warwar SH, Malcolm WM. differential effects of emotion-focused therapy and psychoeducation in facilitating forgiveness and letting go of emotional injuries. J Counsel Psychol. 2008;55(2):185-96.
[25]Pos AE, Greenberg LS. Emotion-focused therapy: The trans- forming power of affect. J Contemp Psychother. 2007;37(1):25-31.
[26]Greenberg LS, Angus L. The contribution of emotion processes to narrative change: A dialectical-constructivist approach. In: Angus L, McLeod J, editors. Handbook of narrative and psychotherapy: Practice, theory, and research. Thousand Oaks, CA, US: Sage Publications; 2004. pp. 331-50.
[27]Greenberg LS. Emotion focused therapy for depression. Pers Exp Psychother. 2017;16(2):106-17.
[28]Prochaska JO, Norcross JC. Systems of psychotherapy. Seyyed Mohammadi Y, translator. Pacific Grove: Brooks Cole; 2009.
[29]Greenberg LS, Foerster F. Task analysis exemplified: The process of resolving unfinished business. J Cons Clin Psychol. 1996;64(3):439-46.
[30]Greenberg LS, Paivio SC. Working with the emotions in psychotherapy. New York City: Guilford Press; 1997. pp. 14-290.
[31]Church D. The treatment of combat trauma in veterans using EFT (Emotional Freedom Techniques): A pilot protocol. J Traumatology. 2010:16(1):55-65.
[32]Church D, Hawk C, Brooks AJ, Toukolehto O, Wren M, Dinter I, et al. Psychological trauma symptom improvement in veterans using emotional freedom techniques: A randomized controlled trial. J Nerv Ment Dis.. 2013;201(2):153-60.
[33]Akbari E, Poursharifi H, Fahimi S, Azimi Z, Alilou MM, Amiri Pichakolaei A, et al. Effectiveness of emotion focused therapy on sexual victims of romantic relationships: A single case study. J Fundam Ment Health. 2016;18(1):10-21. [Persian]
[34]Khojasteh Mehr R, Shiralinia KH, Rajabi GH, Beshlideh K. The effects of emotion-focused couple therapy on depression symptoms reduction and enhancing emotional regulation in distressed couples. Appl Couns. 2012;3(1):1-18. [Persian]
[35]Sobhi-Gharamaleki N, Porzoor P, Aghajani S, Narimani M. Effectiveness of emotion regulation training on reduction of anxiety, stress and depression symptoms among university students. Health Educ Health Promot. 2015;3(1):5-13. [Persian]
[36]Golpour R, Abolghasemi A, Ahadi B, Narimani M. The effectiveness of cognitive self-compassion training and emotion-focused therapy on quality of life with depression disorder. J Clin Psychol. 2014;1(21):53-64. [Persian]
[37]Weathers FW, Keane TM, Davidson JR. Clinician-administered PTSD scale: A review of the first ten years of research. Depress Anxiety. 2001;13(3):132-56.
[38]Mirzaee J, Karami GR, Ameli J, Hemmati MA. Investigation of clinical diagnosis by psychological tests in PTSD outpatients and inpatients. J Mil Med. 2004;6(3):201-8. [Persian]
[39]Goodarzi MA. Reliability and validity of post- traum atic stress disorder Mississippi scale. J Psychol. 2003;7(2):135-78. [Persian]
[40]Beck AT, Weissman A, Lester D. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;42(6):861-5.
[41]Dejhkam N, Sharifi HP, Human HA. Conformity and norm of the beck hopelessness scale among students of Tehran Islamic Azad University [Dissertation]. Tehran: Tehran University; 2003. [Persian]
[42]Yousefi N, Shirbigy N. The relationship between acceptation in ma exam with hopelessness and self–handicapping. Iran High Educ. 2012;4(4):159-81. [Persian]
[43]Kaviani H. Interview and psychological inventories. 1st edition. Tehran: Besat Press; 2002. pp. 171-8. [Persian]
[44]Gratz KL, Roemer L. Multidimensional assessment of emotion regulation a dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2008;30(4):315-9.
[45]Asgari P, Pasha G, Aminian M. The relationship emotional regulation, life events and body image with eating disorder in women. Andisheh va Raftar. 2009;4(13):65-78. [Persian]
[46]Greenberg LS. Emotion-Focused The rapy: A Clinical Synthesis. J Lifelong Learn Psychiatry. 2010;8(1):32-42.
[47]Sabury M. The effectiveness of cognitive therapy in reducing suicidal thoughts and emotion-focused cognitive triangle patients with major depression [Dissertation]. Mashhad: Mashhad University; 2013. [Persian]
[48]Schotte DE, Clum GA. Problem- solving skills in suicidal psychiatric patients. J Consult Clin Psychol. 1987;55(1):49-54.
[49]Narimani M, Alisari Nasirlou K, Effat Parvar S. The effectiveness of emotion-focused training for cognitive emotional regulation strategies of emotionally abused students. Appl Couns. 2013;3(2):37-50. [Persian]
[2]Tull MT, Barrett HM, McMillan ES, Roemer L. A preliminary investigation of relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behav Ther. 2007;38(3):303-13.
[3]Leahy R, Napolitano LA, Tirch D. Emotion regulation in psychotherapy: A practitioners guide. New York: Guilford Press; 2011.
[4]Foa EB, Kozak MJ. Emotional processing of fear: Exposure to corrective information. Psychol Bull. 2008;99(1):20-35.
[5]Mazloom M, Yaghubi H, Mohammadkhani S. The relationship of metacognitive beliefs and emotion regulation difficulties with posttraumatic stress disorder. J Behav Sci. 2014;8(2):105-13. [Persian]
[6]Bardeen JR, Kumpula MJ, Orcutt HK. Emotion regulation difficulties as a prospective predictor of posttraumatic stress symptoms following as mass shooting. J Anxiety Dis. 2013;27(2):188-96.
[7]Ozdamir O, Boysan M, Ozdamir PG, Yilmaz E. Relationships between posttraumatic stress disorder (PTSD), dissociation, quality of life, hopelessness, and suicidal ideation among earthquake survivors. Psychiatry Res. 2015;228(2):598-605.
[8]Azad Marzabadi E, Moqtadaee K, Aria Pooran S. The effectiveness of mindfulness training on psychological symptoms in veterans with post- traumatic stress disorder. J Behav Sci. 2013;7(1):67-74. [Persian]
[9]Sheykhan R, Ghazanfari F, Jadidi F, Adineh M, Sadrmohamadi R. Attachment styles and cognitive emotion regulation strategies as predictor of post-traumatic stress disorder in veterans. J Mazand Univ Med Sci. 2016;26(137):95-104. [Persian]
[10]krysinska k, Lester D. Post-traumatic stress disorder and suicide risk: A systematic review. Arch Suicide Res. 2010;14(1):1-23.
[11]Panagioti M, Gooding PA, Tarrier N. A meta-analysis of the association between posttraumatic stress disorder and suicidality: The role of comorbid depression. Compr Psychiatry. 2012;53(7):915-30.
[12]Coohey C, Dirks- Bihun A, M.Renner L, Baller R. Strain, depressed mood and suicidal thoughts among maltreated adolescents in the United States. Child Abuse Negl. 2014;38(7):1171-9.
[13]Leiner AS, Compton MT, Houry D, Nadine J, Kaslow J. Intimate partner violence, psychological distress, and suicidality: A path model using data from African American women seeking care in an urban emergency department. J Fam Violence. 2008;23(6):473-81.
[14]Pompili M, Sher L, Serafini G, Forte A, Innamorati M, Dominici G, et al. Posttraumatic stress disorder and suicide risk among veterans: A literature review. J Nerv Ment Dis. 2013;201(9):802-12.
[15]Ghamari-Givi H, Hosseini Kiasari ST. The effectiveness of cognitive- existential group therapy on hopelessness in patients with multiple sclerosis. Daneshvar. 2014;21(112):1-11. [Persian]
[16]Snyder CR. Hope theory: rainbows in the mind. Psychol Inq. 2002;13(4):249-75.
[17]Hasson-Ohayon I, Kravetz S, Meir T, Rozencwaig S. Insight into severe mental illness, hope, and quality of life on persons with schizophrenia and schizoaffective disorders. Psychiatry Res. 2009;167(3):231-8.
[18]Johnson KL. The relationship of hope and quality of life in combat veterans seeking treatment for posttraumatic stress disorder. Kansas: University of Kansas, Psychology and Research in Education Publisher; 2001. pp. 29-58.
[19]Leahy RL. Cognitive therapy techniques: A practitioner s guide. 2rd edition. Fata L, Shakiba Sh, Tahmasbi Moradi Sh, Naseri H, Ziaei K, translators. New York City: Guilford Press; 2001. [Persian]
[20]Paunović N. Exposure inhibition therapy as a treatment for chronic posttraumatic stress disorder: A controlled pilot study. Psychology. 2011;2(6):605-14.
[21]Talbot NL, Gamble SA. IPT for women with trauma histories in community mental health care. J Contemp Psychother. 2008;38(1):35-44.
[22]McCarthy KS, Connolly-Gibbons MB, Barber JP. The relation of rigidity across relationship with symptoms and functioning: An investigation with the revised central relationship questionnaire. J Couns Psychol 2008;55(3):346-58.
[23]Fridja NH. The emotions. Cambridge, MA: Cambridge University Press; 1986. pp. 9-41.
[24]Greenberg LJ, Warwar SH, Malcolm WM. differential effects of emotion-focused therapy and psychoeducation in facilitating forgiveness and letting go of emotional injuries. J Counsel Psychol. 2008;55(2):185-96.
[25]Pos AE, Greenberg LS. Emotion-focused therapy: The trans- forming power of affect. J Contemp Psychother. 2007;37(1):25-31.
[26]Greenberg LS, Angus L. The contribution of emotion processes to narrative change: A dialectical-constructivist approach. In: Angus L, McLeod J, editors. Handbook of narrative and psychotherapy: Practice, theory, and research. Thousand Oaks, CA, US: Sage Publications; 2004. pp. 331-50.
[27]Greenberg LS. Emotion focused therapy for depression. Pers Exp Psychother. 2017;16(2):106-17.
[28]Prochaska JO, Norcross JC. Systems of psychotherapy. Seyyed Mohammadi Y, translator. Pacific Grove: Brooks Cole; 2009.
[29]Greenberg LS, Foerster F. Task analysis exemplified: The process of resolving unfinished business. J Cons Clin Psychol. 1996;64(3):439-46.
[30]Greenberg LS, Paivio SC. Working with the emotions in psychotherapy. New York City: Guilford Press; 1997. pp. 14-290.
[31]Church D. The treatment of combat trauma in veterans using EFT (Emotional Freedom Techniques): A pilot protocol. J Traumatology. 2010:16(1):55-65.
[32]Church D, Hawk C, Brooks AJ, Toukolehto O, Wren M, Dinter I, et al. Psychological trauma symptom improvement in veterans using emotional freedom techniques: A randomized controlled trial. J Nerv Ment Dis.. 2013;201(2):153-60.
[33]Akbari E, Poursharifi H, Fahimi S, Azimi Z, Alilou MM, Amiri Pichakolaei A, et al. Effectiveness of emotion focused therapy on sexual victims of romantic relationships: A single case study. J Fundam Ment Health. 2016;18(1):10-21. [Persian]
[34]Khojasteh Mehr R, Shiralinia KH, Rajabi GH, Beshlideh K. The effects of emotion-focused couple therapy on depression symptoms reduction and enhancing emotional regulation in distressed couples. Appl Couns. 2012;3(1):1-18. [Persian]
[35]Sobhi-Gharamaleki N, Porzoor P, Aghajani S, Narimani M. Effectiveness of emotion regulation training on reduction of anxiety, stress and depression symptoms among university students. Health Educ Health Promot. 2015;3(1):5-13. [Persian]
[36]Golpour R, Abolghasemi A, Ahadi B, Narimani M. The effectiveness of cognitive self-compassion training and emotion-focused therapy on quality of life with depression disorder. J Clin Psychol. 2014;1(21):53-64. [Persian]
[37]Weathers FW, Keane TM, Davidson JR. Clinician-administered PTSD scale: A review of the first ten years of research. Depress Anxiety. 2001;13(3):132-56.
[38]Mirzaee J, Karami GR, Ameli J, Hemmati MA. Investigation of clinical diagnosis by psychological tests in PTSD outpatients and inpatients. J Mil Med. 2004;6(3):201-8. [Persian]
[39]Goodarzi MA. Reliability and validity of post- traum atic stress disorder Mississippi scale. J Psychol. 2003;7(2):135-78. [Persian]
[40]Beck AT, Weissman A, Lester D. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;42(6):861-5.
[41]Dejhkam N, Sharifi HP, Human HA. Conformity and norm of the beck hopelessness scale among students of Tehran Islamic Azad University [Dissertation]. Tehran: Tehran University; 2003. [Persian]
[42]Yousefi N, Shirbigy N. The relationship between acceptation in ma exam with hopelessness and self–handicapping. Iran High Educ. 2012;4(4):159-81. [Persian]
[43]Kaviani H. Interview and psychological inventories. 1st edition. Tehran: Besat Press; 2002. pp. 171-8. [Persian]
[44]Gratz KL, Roemer L. Multidimensional assessment of emotion regulation a dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2008;30(4):315-9.
[45]Asgari P, Pasha G, Aminian M. The relationship emotional regulation, life events and body image with eating disorder in women. Andisheh va Raftar. 2009;4(13):65-78. [Persian]
[46]Greenberg LS. Emotion-Focused The rapy: A Clinical Synthesis. J Lifelong Learn Psychiatry. 2010;8(1):32-42.
[47]Sabury M. The effectiveness of cognitive therapy in reducing suicidal thoughts and emotion-focused cognitive triangle patients with major depression [Dissertation]. Mashhad: Mashhad University; 2013. [Persian]
[48]Schotte DE, Clum GA. Problem- solving skills in suicidal psychiatric patients. J Consult Clin Psychol. 1987;55(1):49-54.
[49]Narimani M, Alisari Nasirlou K, Effat Parvar S. The effectiveness of emotion-focused training for cognitive emotional regulation strategies of emotionally abused students. Appl Couns. 2013;3(2):37-50. [Persian]