@2024 Afarand., IRAN
ISSN: 2228-5468 Education Strategies in Medical Sciences 2015;8(5):301-308
ISSN: 2228-5468 Education Strategies in Medical Sciences 2015;8(5):301-308
Role of Mindfulness and Cognitive Emotion Regulation Strategies on Predicting the Psychological Symptoms of Medical Students
ARTICLE INFO
Article Type
Descriptive & Survey StudyAuthors
Sajjadi M.S. (*)Askarizadeh Gh. (1)
(*) Psychology Department, Literature & Human Sciences Faculty, Shahid Bahonar University, Kerman, Iran
(1) Psychology Department, Literature & Human Sciences Faculty, Shahid Bahonar University, Kerman, Iran
Correspondence
Address: Psychology Department, Faculty of Literature and Humanities, Shahid Bahonar University, Afzalipour Square, 22 Bahman Boulevard, Kerman, IranPhone: +9834313202431
Fax: +983433257347
mssajadi224@gmail.com
Article History
Received: September 26, 2015Accepted: November 16, 2015
ePublished: January 10, 2016
BRIEF TEXT
… [1-20] Emotion regulation is an attempt to maintain or prevent or enhance the experiences [21]. As a set of processes, emotion regulation is a way to determine what emotion should be perceived at what time and how [22]. … [23-27]
Favorable emotion regulation can reduce anxiety and depression [28, 29], which are psychological reactions to the stresses of student life [19, 20]. … [30, 31] The correlations between life meaning and stress, anxiety, and depression in the medical students are studied [32].
The aim of this study was to investigate the role of mindfulness and emotion regulation cognitive strategies in predicting the psychiatric symptoms (depression, anxiety, and stress) in the medical students.
This is a descriptive-correlational study.
General medicine, dentistry, pharmacology, nursing, midwifery, and professional courses students of Kerman University of Medical Sciences were studied in academic year 20115.
400 questionnaires were randomly distributed between the students. 15 uncompleted or non-returned questionnaires were excluded. 375 questionnaires (210 female and 165 male students) were finally analyzed.
Data was collected using the five facet mindfulness questionnaire (FFMQ) [33], cognitive emotion regulation strategies, and depression, anxiety, and stress scale. The scoring in FFMQ is based on 5-point Likert from “never or seldom true” to “often or always true”. Alpha coefficient is acceptable and between 0.55 (non-reactive) and 0.83 (descriptive) [34]. The cognitive emotion regulation questionnaire (CERQ) includes 36 items [23]. Cronbach’s alpha coefficients of its sub-scales were between 0.64 and 0.82 [35]. Reliability of the sub-scales of depression, anxiety, and stress scale (DASS) was confirmed via internal consistency and retest coefficients [36]. Mindfulness level and the utilization of positive and negative emotion regulation cognitive strategies in the students were measured based on 5-point scale as very high, high, moderate, low, and very low. In addition, depression, anxiety, and stress intensity in the samples was measured based on 5-point scale as normal, mild, moderate, severe, and too severe. Data was analyzed by SPSS 20 software. Pearson correlation matrix was used to determine any preliminary correlation between the predictive and the criterion variables. Step-wise regression was used to separate the roles of positive and negative emotion regulation cognitive strategies and mindfulness in predicting the criterion variables. … [37-43]
Mean age of the students was 23.11±3.75 years, and they aged between 18 and 50 years old. 210 (56%) and 165 (44%) students were female and male. 73 (19.5%), 67 (18.1%), 61 (16.3%), 79 (21.1%), 69 (15.7%), and 26 (6.9%) persons were general medicine, pharmacology, dentistry, nursing, midwifery, and professional medical courses students, respectively. The mean level of mindfulness of the students (112.84±10.94, between 76.52 and 155) was moderate. The mean levels of utilization of negative emotion regulation cognitive strategies (67.97±11.44, between 16 and 72) and positive emotion regulation cognitive strategies (48.41±8.34, between 35 and 97) were low. Mean depression (14.10±4.77, between 7 and 28), anxiety (13.80±4.51, between 7 and 26), and stress (15.90±4.65, between 7 and 27) levels were moderate. There was a significant correlation between mindfulness and emotion regulation strategies and depression, anxiety, and stress (p<0.01; Table 1). Totally, 25% of variance changes of the students’ depression were explained by the positive and negative emotion regulation strategies and mindfulness, including 12% of the negative emotion regulation cognitive strategies, 9% of the positive emotion regulation cognitive strategies, and 4% of mindfulness (p<0.05). On this basis, the higher the negative emotion regulation cognitive strategies were (β=0.42), the higher the depression was; and the higher the positive emotion regulation cognitive strategies (β=-0.24) and the mindfulness (β=-0.11) were, the lower the depression was. In addition, 17% of the variance changes of anxiety were explained by the positive and the negative emotion regulation cognitive strategies, including 12% of the negative cognitive strategies and 5% of the positive cognitive strategies (p<0.05). The higher the negative emotion regulation cognitive strategies were (β=0.40), the higher the students’ anxiety was; and the higher the positive emotion regulation cognitive strategies were (β=-0.23), the lower the students’ anxiety was. In stress, 19.3% of the variance changes of the criterion variable were predicted by the positive and the negative emotion regulation cognitive strategies, including 17% of the negative cognitive strategies and 2.3% of the positive cognitive strategies (p<0.05). The higher the negative emotion regulation cognitive strategies were (β=0.44), the higher the stress level was; and the higher the positive emotion regulation cognitive strategies were (β=-0.15), the lower the stress level was. The mindfulness variable could not predict anxiety and stress.
Mindfulness could only reversely predict the depression level. The higher the mindfulness, the lower the depression level is [8]. The result is consistent with the present results. Cognitive therapy based on mindfulness is highly used as a mindfulness-based treatment [44]. The reverse correlation between mindfulness and depression is explainable [45, 46]. The mindfulness-based treatments can reduce mental rumination [47], as well as inefficient attitudes and negative automatic thoughts [48], in the students. … [49] Compared to emotion regulation cognitive strategies, mindfulness could predict anxiety and stress. The negative emotion regulation cognitive strategies affect depression [50] and the strategies are used by the depressed people more than other people [51]. Compared to mindfulness and the positive strategies, the negative strategies considerably affect prediction of depression directly. There are 4 occurrences of anxiety in the persons, which are cognitive, behavioral, physical, and emotional [52]. In addition, there is a considerable clinical correlation between anxiety and depression [53]. The correlation was shown in the present study. The effectiveness of the positive cognitive strategies was less than the negative strategies in the reverse prediction of depression, anxiety, and stress factors. The effectiveness of the positive emotion regulation strategies is low in depression [49], which is a result consistent with the present results. There is a positive correlation between the negative emotion regulation cognitive strategies and physical symptoms, anxiety, and depression in the medical students. In addition, there is a negative correlation between the positive strategies and defects in the social functioning of mental health [54].
Other mindfulness tools should be used to investigate such factors. Based on the results of the study, a new approach in training the medical students can be formed.
No access to accurate statistical information about the sample size and conducting the study through self-report method were the limitations for the study.
The emotion regulation cognitive strategies and especially, the negative emotion regulation cognitive strategies can better explain the psychiatric symptoms as depression, anxiety, and stress in the medical students.
All the participating students and researchers are appreciated.
There is no conflict with the interests of any organization.
The participants were assured on the confidentiality of information and group analysis. They were also informed in the goal of data collection as contribution in a study plan.
The study was funded by the correspondence author.
TABLES and CHARTS
Show attach fileCITIATION LINKS
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[3]Baer RA, Smith GT, Allen KB. Assessment of mindfulness by self-reports: The Kentucky inventory of mindfulness skills. Assessment. 2004;11(3):191-206.
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[8]Zeidan F, Gordon NS, Merchant J, Goolkasian P. The effect of brief mindfulness meditation training on experimentally induced Pain. J Pain. 2010;11(3):199-209.
[9]Bohlmeijer E, Prenger R, Taal E Cuijpers, P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis. J Psychosom Res. 2010;68(6):539-44.
[10]Carmody J, Bear RA. Relationship between mindfulness practice and level of mindfulness, medical and psychological symptoms and well-being in a mindfulness stress reduction program. Beh Med. 2007;31(1):23-33.
[11]Howell AJ, Digdon N, Buro K. Mindfulness predicts sleep-related self- regulation and well-being. Personal Individ Differ. 2010;48(4):419-24.
[12]Boyce M, Sawang S. Unpacking the role of mindfulness on conscientiousness and spirituality. Interdiscip J Res Relig. 2014;10(6):1-21.
[13]Teixeira RJ, Pereira MG. Examining mindfulness and its relation to self-differentiation and alexithymia. Mindfulness. 2015;6(1):79-87.
[14]Fisak B, Von Lehe AC. The Relation between the five facets of mindfulness and worry in a non-clinical sample. Mindfulness. 2012;3(1):15-21.
[15]Pidgeon A, Grainger A. Mindfulness as a factor in the relationship between insecure attachment style, neurotic personality and disordered eating behavior. J Med Psychol. 2013;2(4B):25-33.
[16]de Vibe M, lda Solhaug O, Tyssen R, Sorial T, Halland E, Bjorndal A. Dose personality moderate the effects of mindfulness training for medical and psychology students?. Mindfulness. 2015;6(2):281-9.
[17]Golpour-chamarkohi R, Mohammadamini Z. The efficacy of mindfulness based stress reduction on mindfulness and assertiveness of students with test anxiety. J Sch Psychol. 2012;1(3):82-100. [Persian]
[18]Basaknejad S, Aghajani A, Zargar Y. The efficacy of mindfulness based cognitive therapy on quality of Life and quality of slip in girl students. J Psychol Achiev. 2011;4(2):181-98. [Persian]
[19]Rezaei Adryani M, Azadi A, Ahmadi F, Azimi AV. Comparison level of stress, anxiety, depression and quality of life in dormitory resident students. Iran J Nurs Res. 2007;2(5):31-8. [Persian]
[20]Gammon J, Morgan-Samuel H. A study to ascertain the effect of structured student tutorial support on student stress self-esteem and coping. Nurs Educ Pract. 2005;5(3):161-71.
[21]Roberton T, Daffern M, Bucks RS. Emotion regulation and aggression. Aggress Violent Behav. 2012;17(1):72-82.
[22]Szczygieł D, Buczny J, Bazinska R. Emotion regulation and emotional information processing: The moderating effect of emotional awareness. Personal Individ Differ. 2012;52(3):433-7.
[23]Garnefski N, Van den Kommer T, Kraaij V, Teerds J, Legerstee J, Onstein E. The relationship between cognitive emotion regulation strategies and emotional problems: Comparison between clinical and a nonclinical sample. Euro J Personal. 2002;16(5):403-20.
[24]Jazaieri H, Morrison AS, Goldin PR. Gross JJ. The role of emotion and emotion regulation in social anxiety disorder. Curr Psychiatry Rep. 2015;17(1):5-31.
[25]Garnefski N, Baan S, Kraaij V. Relationships between cognitive strategies of adolescents and depressive symptomatology across different typeof life event. J Youth adolesc. 2003;32(6):401-8.
[26]Eisenberg N, Cumberlan A, Spinrad TL, Fabes RA, Shepard SA, Reiser M, et al. The relations of regulation and emotionality to Children's externalizing an internalizing problem behavior. Child Dev. 2001;72(4):11-34.
[27]Gresham D, Gullone E. Emotion regulation strategy use in children and adolescents: The explanatory roles of personality and attachment. Personal Individ Differ, 2012;52(5):616-62.
[28]Desrosiers A, Joshua Curtiss VV, Klemanski DH. Observing nonreactively: A conditional process model linking mindfulness facets, cognitive emotion regulation strategies, and depression and anxiety symptoms. J Affect Disord. 2014;165:31-7.
[29]Feliu T, Balle M, Sese A. Relationships between negative affectivity, emotion regulation, anxiety, and depressive symptoms in adolescents as examined through structural equation modeling. J Anxiety Disord. 2010;24(7):686-93.
[30]Marroquin, B. Interpersonal emotion regulation as a mechanism of social support in depression. Clin Psycho Rev. 2011;31(8):1276-90.
[31]Najafi kalyani M, Porjam E, Jamshidi N, Karimi, SH, Najafi kalyani V. Survey of Stress, Anxiety, Depression and Self-Concept of Students of Fasa University of Medical Sciences. J Fasa Univ Med Sci. 2013;3(3):235-40. [Persian]
[32]Dehdari T, Yarahmadi R, Taghdisi M, Daneshvar R, Ahmad Poor J. The relationship between meaning in life and depression, anxiety and stress status among college students of iran university of medical sciences in 2013. Health Educ Health Promot. 2013;1(3):83-92. [Persian]
[33]Baer RA, Smith GT, Hopkins J, Krietemeyer, J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assess. 2006;13(1):27-45.
[34]Ahmadvand Z, Heydarinasab L, Shaeri M. Validity and reliability of five facet mindfulness questionnaire in non-clinical Iranian samples. Sci Behav. 2013;7(3):229-37. [Persian]
[35]Abdi S, Taban S, Ghaemian A. Cognitive emotion regulation questionnaire: Validity and reliability of Persian translation of CERQ-36 item. Proced Soc Behav Sci. 2012;32:2-7.
[36]Asghari-moghadam MA, Saed F, Dibajniya, P, Zangene J. Validity and reliability depression, anxiety and Stress (DAAS) questionnaire in non-clinical sample. Daneshvar Raftar. 2008;15(31):23-38. [Persian]
[37]Brown K, Goodman RJ, Inzlicht M. Dispositional mindfulness and the attenuation of neural responses to emotional stimuli. Soc Cogn Affect Neurosci. 2013;8(1):93-9.
[38]John OP, Gross JJ. Healthy and unhealthy emotion regulation: Personality processes, individual differences, and lifespan development. J Pers. 2004;72(6):1301-33.
[39]Jermann F, Van der Linden MD, D’Acremont M, Zermatten A. Cognitive emotion regulation questionnaire (CERQ): Confirmatory factor analysis and psychometric properties of the French translation. Euro J Psycol Assess. 2006;22(2):126-30.
[40]Rude SS, McCarthy CT. Emotional functioning in depressed and depression-vulnerable college students. Cognit Emot. 2003;17(5):799-806.
[41]Hayes SC, Strosahl K, Wilson KG, Bissett RC, Pistorello J, Toarmino D, et al. Measuring experiential avoidance: A preliminary test of a working middle. Psychol Rec. 2004;54(4):553-78.
[42]Catanzaro SJ, Mearns J. Measuring generalized expectancies for negative mood regulation: initial scale development and implications. J Pers Assess. 1990;54(3-4):546-63.
[43]Brown KW, Ryan RM, Creswell D. Addressing fundamental questions about mindfulness. Psychol Inq. 2007;18(4):272-81.
[44]Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78(2):169-83.
[45]McLaughlin KA, Nolen-Hoeksema S. Rumination as a transdiagnostic factor in depression and anxiety. Behav Res Ther. 2011;49(3):186-93.
[46]Desrosiers A, Vine V, Klemanski DH, Nolen-Hoeksema S. Mindfulness and emotion regulation in depression and anxiety: Common and distinct mechanisms of action. Depress Anxiety. 2013;30(7):654-61.
[47]Azargoon H, Kajbaf MB, Molavi H, Abedi MR. The effect of mindfulness training on the decreasing rumination and depression students of Isfahan University. Daneshvar Raftar. 2009;16(34):13-20. [Persian]
[48]Azargoon H, Kajbaf MB. The effect of mindfulness training on the dysfunctional attitude and automatic thinking of depressed students of Isfahan University. J Psychol. 2010;14(1):79-94. [Persian]
[49]Aldao A, Nolen-Hoeksema S. Specificity of cognitive emotion regulation strategies: A tran's diagnostic examination. Behav Res Ther. 2010;48:974-83.
[50]Garnefski N, Kraaij V. Cognitive emotion regulation questionnaire – development of a short 18-item version (CERQ-short). Personal Individ Differ. 2006;41(6):1045-53.
[51]Ehring T, Tuschen Caffier B, Schnulle J, Fischer S, Gross JJ. Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emot. 2010;10(4):563-72.
[52]Koksal F. Power K. Four systems anxiety questionnaire (FSAQ): A self-report measure of somatic, cognitive, behavioral and feeling components. J Personal Assess.1990;54(3-4):534-45.
[53]Asghri-moghadam MA, Saed F, Dibajniya P, Zangene J. Investigating validity and reliability of depression, anxity and stress (DASS) in nun-clinical sampales. Daneshvar Raftar. 2008;15(31):23-38. [Persian]
[54]Sayyah M, Olapour A, Ardame A, Shahidi Sh, Yaghoobi Askarabad E. Prediction of mental health and academic performance of students within cognitive emotional regulation strategies in Medical Sciences University of Jundishapur in Ahvaz. Educ Dev Jundishapur. 2014;5(1):37-44. [Persian]
[2]Brown KW, Ryan RM. The benefit of being present: mindfulness and its role in psychological well- being. J Pers Soc Psychol. 2003;84(4):822-48.
[3]Baer RA, Smith GT, Allen KB. Assessment of mindfulness by self-reports: The Kentucky inventory of mindfulness skills. Assessment. 2004;11(3):191-206.
[4]Barnhofer T, Duggan D, Crane C, Hopburn, S, Fennell MJV, Williams J, et al. Effects of meditation on frontal (alpha) asymmetry in previously suicidal individuals. Neuroreport. 2007;18(7):709-12.
[5]Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125-43.
[6]Schroevers MJ. Brandsma R. Is learning mindfulness associated with improved affect after mindfulness-based cognitive therapy?. Br J Psychol. 2010;101(Pt 1):95-107.
[7]Brown KW, Ryan RM. Perils and promise in defining and measuring mindfulness observation from experience. Clin psychol Sci pract. 2004;11(3):242-8.
[8]Zeidan F, Gordon NS, Merchant J, Goolkasian P. The effect of brief mindfulness meditation training on experimentally induced Pain. J Pain. 2010;11(3):199-209.
[9]Bohlmeijer E, Prenger R, Taal E Cuijpers, P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis. J Psychosom Res. 2010;68(6):539-44.
[10]Carmody J, Bear RA. Relationship between mindfulness practice and level of mindfulness, medical and psychological symptoms and well-being in a mindfulness stress reduction program. Beh Med. 2007;31(1):23-33.
[11]Howell AJ, Digdon N, Buro K. Mindfulness predicts sleep-related self- regulation and well-being. Personal Individ Differ. 2010;48(4):419-24.
[12]Boyce M, Sawang S. Unpacking the role of mindfulness on conscientiousness and spirituality. Interdiscip J Res Relig. 2014;10(6):1-21.
[13]Teixeira RJ, Pereira MG. Examining mindfulness and its relation to self-differentiation and alexithymia. Mindfulness. 2015;6(1):79-87.
[14]Fisak B, Von Lehe AC. The Relation between the five facets of mindfulness and worry in a non-clinical sample. Mindfulness. 2012;3(1):15-21.
[15]Pidgeon A, Grainger A. Mindfulness as a factor in the relationship between insecure attachment style, neurotic personality and disordered eating behavior. J Med Psychol. 2013;2(4B):25-33.
[16]de Vibe M, lda Solhaug O, Tyssen R, Sorial T, Halland E, Bjorndal A. Dose personality moderate the effects of mindfulness training for medical and psychology students?. Mindfulness. 2015;6(2):281-9.
[17]Golpour-chamarkohi R, Mohammadamini Z. The efficacy of mindfulness based stress reduction on mindfulness and assertiveness of students with test anxiety. J Sch Psychol. 2012;1(3):82-100. [Persian]
[18]Basaknejad S, Aghajani A, Zargar Y. The efficacy of mindfulness based cognitive therapy on quality of Life and quality of slip in girl students. J Psychol Achiev. 2011;4(2):181-98. [Persian]
[19]Rezaei Adryani M, Azadi A, Ahmadi F, Azimi AV. Comparison level of stress, anxiety, depression and quality of life in dormitory resident students. Iran J Nurs Res. 2007;2(5):31-8. [Persian]
[20]Gammon J, Morgan-Samuel H. A study to ascertain the effect of structured student tutorial support on student stress self-esteem and coping. Nurs Educ Pract. 2005;5(3):161-71.
[21]Roberton T, Daffern M, Bucks RS. Emotion regulation and aggression. Aggress Violent Behav. 2012;17(1):72-82.
[22]Szczygieł D, Buczny J, Bazinska R. Emotion regulation and emotional information processing: The moderating effect of emotional awareness. Personal Individ Differ. 2012;52(3):433-7.
[23]Garnefski N, Van den Kommer T, Kraaij V, Teerds J, Legerstee J, Onstein E. The relationship between cognitive emotion regulation strategies and emotional problems: Comparison between clinical and a nonclinical sample. Euro J Personal. 2002;16(5):403-20.
[24]Jazaieri H, Morrison AS, Goldin PR. Gross JJ. The role of emotion and emotion regulation in social anxiety disorder. Curr Psychiatry Rep. 2015;17(1):5-31.
[25]Garnefski N, Baan S, Kraaij V. Relationships between cognitive strategies of adolescents and depressive symptomatology across different typeof life event. J Youth adolesc. 2003;32(6):401-8.
[26]Eisenberg N, Cumberlan A, Spinrad TL, Fabes RA, Shepard SA, Reiser M, et al. The relations of regulation and emotionality to Children's externalizing an internalizing problem behavior. Child Dev. 2001;72(4):11-34.
[27]Gresham D, Gullone E. Emotion regulation strategy use in children and adolescents: The explanatory roles of personality and attachment. Personal Individ Differ, 2012;52(5):616-62.
[28]Desrosiers A, Joshua Curtiss VV, Klemanski DH. Observing nonreactively: A conditional process model linking mindfulness facets, cognitive emotion regulation strategies, and depression and anxiety symptoms. J Affect Disord. 2014;165:31-7.
[29]Feliu T, Balle M, Sese A. Relationships between negative affectivity, emotion regulation, anxiety, and depressive symptoms in adolescents as examined through structural equation modeling. J Anxiety Disord. 2010;24(7):686-93.
[30]Marroquin, B. Interpersonal emotion regulation as a mechanism of social support in depression. Clin Psycho Rev. 2011;31(8):1276-90.
[31]Najafi kalyani M, Porjam E, Jamshidi N, Karimi, SH, Najafi kalyani V. Survey of Stress, Anxiety, Depression and Self-Concept of Students of Fasa University of Medical Sciences. J Fasa Univ Med Sci. 2013;3(3):235-40. [Persian]
[32]Dehdari T, Yarahmadi R, Taghdisi M, Daneshvar R, Ahmad Poor J. The relationship between meaning in life and depression, anxiety and stress status among college students of iran university of medical sciences in 2013. Health Educ Health Promot. 2013;1(3):83-92. [Persian]
[33]Baer RA, Smith GT, Hopkins J, Krietemeyer, J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assess. 2006;13(1):27-45.
[34]Ahmadvand Z, Heydarinasab L, Shaeri M. Validity and reliability of five facet mindfulness questionnaire in non-clinical Iranian samples. Sci Behav. 2013;7(3):229-37. [Persian]
[35]Abdi S, Taban S, Ghaemian A. Cognitive emotion regulation questionnaire: Validity and reliability of Persian translation of CERQ-36 item. Proced Soc Behav Sci. 2012;32:2-7.
[36]Asghari-moghadam MA, Saed F, Dibajniya, P, Zangene J. Validity and reliability depression, anxiety and Stress (DAAS) questionnaire in non-clinical sample. Daneshvar Raftar. 2008;15(31):23-38. [Persian]
[37]Brown K, Goodman RJ, Inzlicht M. Dispositional mindfulness and the attenuation of neural responses to emotional stimuli. Soc Cogn Affect Neurosci. 2013;8(1):93-9.
[38]John OP, Gross JJ. Healthy and unhealthy emotion regulation: Personality processes, individual differences, and lifespan development. J Pers. 2004;72(6):1301-33.
[39]Jermann F, Van der Linden MD, D’Acremont M, Zermatten A. Cognitive emotion regulation questionnaire (CERQ): Confirmatory factor analysis and psychometric properties of the French translation. Euro J Psycol Assess. 2006;22(2):126-30.
[40]Rude SS, McCarthy CT. Emotional functioning in depressed and depression-vulnerable college students. Cognit Emot. 2003;17(5):799-806.
[41]Hayes SC, Strosahl K, Wilson KG, Bissett RC, Pistorello J, Toarmino D, et al. Measuring experiential avoidance: A preliminary test of a working middle. Psychol Rec. 2004;54(4):553-78.
[42]Catanzaro SJ, Mearns J. Measuring generalized expectancies for negative mood regulation: initial scale development and implications. J Pers Assess. 1990;54(3-4):546-63.
[43]Brown KW, Ryan RM, Creswell D. Addressing fundamental questions about mindfulness. Psychol Inq. 2007;18(4):272-81.
[44]Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78(2):169-83.
[45]McLaughlin KA, Nolen-Hoeksema S. Rumination as a transdiagnostic factor in depression and anxiety. Behav Res Ther. 2011;49(3):186-93.
[46]Desrosiers A, Vine V, Klemanski DH, Nolen-Hoeksema S. Mindfulness and emotion regulation in depression and anxiety: Common and distinct mechanisms of action. Depress Anxiety. 2013;30(7):654-61.
[47]Azargoon H, Kajbaf MB, Molavi H, Abedi MR. The effect of mindfulness training on the decreasing rumination and depression students of Isfahan University. Daneshvar Raftar. 2009;16(34):13-20. [Persian]
[48]Azargoon H, Kajbaf MB. The effect of mindfulness training on the dysfunctional attitude and automatic thinking of depressed students of Isfahan University. J Psychol. 2010;14(1):79-94. [Persian]
[49]Aldao A, Nolen-Hoeksema S. Specificity of cognitive emotion regulation strategies: A tran's diagnostic examination. Behav Res Ther. 2010;48:974-83.
[50]Garnefski N, Kraaij V. Cognitive emotion regulation questionnaire – development of a short 18-item version (CERQ-short). Personal Individ Differ. 2006;41(6):1045-53.
[51]Ehring T, Tuschen Caffier B, Schnulle J, Fischer S, Gross JJ. Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emot. 2010;10(4):563-72.
[52]Koksal F. Power K. Four systems anxiety questionnaire (FSAQ): A self-report measure of somatic, cognitive, behavioral and feeling components. J Personal Assess.1990;54(3-4):534-45.
[53]Asghri-moghadam MA, Saed F, Dibajniya P, Zangene J. Investigating validity and reliability of depression, anxity and stress (DASS) in nun-clinical sampales. Daneshvar Raftar. 2008;15(31):23-38. [Persian]
[54]Sayyah M, Olapour A, Ardame A, Shahidi Sh, Yaghoobi Askarabad E. Prediction of mental health and academic performance of students within cognitive emotional regulation strategies in Medical Sciences University of Jundishapur in Ahvaz. Educ Dev Jundishapur. 2014;5(1):37-44. [Persian]