@2024 Afarand., IRAN
ISSN: 2008-2630 Iranian Journal of War & Public Health 2020;12(1):43-51
ISSN: 2008-2630 Iranian Journal of War & Public Health 2020;12(1):43-51
Effectiveness of Acceptance and Commitment Therapy and Logotherapy on Happiness of Veterans' Spouses
ARTICLE INFO
Article Type
Original ResearchAuthors
Falahati M. (1)Shafiabady A. (*2)
Jajarmi M. (1)
Mohamadipoor M. (3)
(*2) Counseling Department, Education & Psychology Faculty, Allameh Tabatabaei University, Tehran, Iran
(1) Psychology Department, Humanities Faculty, Bojnord Branch, Islamic Azad University, Bojnord, Iran
(3) Psychology Department, Humanities Faculty, Quchan Branch, Islamic Azad University, Quchan, Iran
Correspondence
Address: Counseling Department, Education & Psychology Faculty, Allameh Tabatabaei University, Dehkade-ye Olampik, West Hemmat Highway, Tehran, Iran. Postal code: 1489684511Phone: -
Fax: -
ashafiabady@yahoo.com
Article History
Received: July 30, 2019Accepted: January 11, 2020
ePublished: March 17, 2020
BRIEF TEXT
Happiness is one of the most important mental needs of mankind which has a major impact on personality and mental health.
… [1-8]. One of the most important goals of psychological research is to increase the mental health of families, especially the families of injured or vulnerable veterans. Women play a key role in ensuring the mental health of the family and society as the most important element of the family, and veterans are more likely to develop most of the injuries [9]. … [10-31]. Considering the impact of the quality of life of caregivers on the quality of life of veterans, addressing various aspects of the lives of veteran spouses, examining their physical and mental condition, solving the problems caused by taking care of the veteran, necessary training in veteran care, life skills training, participating in social and sports activities, and providing social support can enhance the quality of life and marital relationships of veterans’ spouses [32].
The aim of this study was to investigate the effectiveness of acceptance and commitment therapy and Logotherapy on the happiness of veterans' spouses.
This research was a semi-experimental study with a pretest-posttest design.
In this study, 60 spouses of veterans of Tehran were studied in 2017.
The subjects were selected from the spouses of the psychiatric veterans covered by the Foundation of Martyrs and Veterans Affairs of Tehran by the Poisson simple random sampling. The sample size was estimated 19 individuals for each group based on Cohen's table (at the error level of 0.05, confidence interval of 0.95 and maximum variance) [33]. The total number of samples was 57 cases, which increased to 60 people (20 people per group) due to possible attrition.
The demographic information questionnaire assessing information, such as age, education, number of children, occupation, etc., as well as the Oxford Happiness Questionnaire were used as research tools. In the pre-test phase, the Oxford Happiness Questionnaire was given to the subjects and they were asked to read the questions carefully, to select the answers that were appropriate to their characteristics, and not to leave the question as unanswered as possible. The spouses of the veterans were then randomly assigned to two case groups and a control group (20 cases per group). Accordingly, the samples were randomly assigned to two groups of acceptance and commitment therapy (ACT) and logotherapy, as well as one control group. … [34-38]. Each case group received group therapy by the researcher in nine 120-min sessions. One group received ACT, and the other group logotherapy, whereas the control group did not receive any treatment. After the treatment, the treated groups and the control group were subjected to the post-test. The overall structure of the treatment sessions was based on the ACT according to Hayes' guidelines [39] and logotherapy based on Frankel's guidelines [40]. Data were analyzed using SPSS 18 statistical software using a one-way analysis of covariance and Tukey’s post-hoc test. Also, the normal distribution of data was tested by the Kolmogorov-Smirnov test.
The mean age of the ACT, logotherapy, and control groups was 42.94 ±4.90, 44.3±3.98, and 44.80. 4.58 years, respectively. The average age of the spouses in the ACT, logotherapy, and control groups was 50.2 ± 50.2, 50.2 ±2.83, and 51.5 ±3.31 years, respectively. The mean percentage of injury in the ACT, logotherapy, and control groups was 39.25 ±16.49, 36.75 ±13.79, and 41.50 ±17.32, respectively.Also, 8.3% of the participants had got married between the years 1984-88, 40.0% between the years 1989-91, 31.7% between the years 1992-95, and 20.0% between the years 1996-2000. The highest level of education in the ACT group was diploma and in the logotherapy and control groups was secondary school. The highest educational level of the spouses in the ACT group was secondary school and in the logotherapy and control groups was a diploma. Regarding occupation, most respondents in all three groups were housewives and their spouses were retired. Considering the number of children, the ACT group had one child and the logotherapy and control groups had two children. The average happiness scores of all groups in the pretest stage were lower than the cutoff point (the case mean); however, the mean happiness scores of the logotherapy and control groups in the post-test phase increased from the cutoff point (the case mean). After adjustment for the effect of pre-test scores, there was a significant difference between the mean happiness scores of the studied groups in the post-test stage (F = 102.82; p <0.001; Table 1). In paired comparing, the ACT (p <0.001) and logotherapy (p = 0.008) groups were significantly different from the control group and the interventions caused a significant increase in the mean scores of happiness in these groups compared with the control group, but there was no significant difference between the two (ACT and logotherapy) groups (p <0.05) and the effectiveness of the two treatments was almost the same (Table 2).
The obtained findings were consistent with the findings of Falahati et al. [24], Honarparvaran et al. [25], Walser et al. [26], Ruiz [27], Grafami et al. [28], Ghanbari Zarandi et al. [29], Kang et al. [30] Jarsma et al. [31] and confirmed them. … [41-48].
It is suggested that more studies be conducted on this subject and its different dimensions using larger sample sizes and comparing the results with the results of the present study. It is also recommended to conduct a meta-analysis of the studies.
One of the main limitations of this research was the lack of follow-up due to the time limit.
Both ACT and logotherapy are effective in increasing the happiness of veterans' spouses.
The authors are grateful to the officials and staff of the Danesh Pajoohan Center and Martyr and Veteran Associations of the Foundation of Martyrs and Veterans Affairs, Cultural Commission of the Martyr and Veteran Associations, Shahid Bahonar High School, Tehran, and the spouses of the veterans who participated in this research.
None declared.
This research received the ethics Committee of the Islamic Azad University, Bojnourd Branch (IR.IAU.BOJNOURD.REC.1398.006).
This research was extracted from a Ph.D. thesis.
TABLES and CHARTS
Show attach fileCITIATION LINKS
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[2]Saleh S, Zahedi Asl M. Correlation of social support with social health of psychiatry veterans wives. Iran J War Public Health. 2014;6(5):201-6. [Persian]
[3]Saban KL, Mathews HL, Janusek LW. The relationship among depression and caregiver burden with salivary cortisol awakening level in female caregivers of stroke survivors. Brain Behav Immun. 2010;24(Suppl 1):S21.
[4]Renshaw KD, Rodebaugh TL, Rodrigues CS. Psychological and marital distress in spouses of Vietnam veterans: Importance of spouses' perceptions. J Anxiety Disord. 2010;24(7):743-50.
[5]Manteghi A. Level of expressed emotion, depression and caregiver burden in wives of veterans admitted in psychiatric ward and their relationship with readmissions. J Fundam Ment Health. 2010;12(45):410-9. [Persian]
[6]Khaghanizadeh M, Sirati M. Influence of individual, familial and socioeconomic factors on severity of psychiatric symptoms in veterans with mental disorders. J Mil Med. 2004;6(1):33-7. [Persian]
[7]Najafi M, Mohammadifar MA, Dabiri S, Erfani N, Kamari AA. The comparison of the quality of life of the war veterans families with/without post traumatic stress disorder. Iran J War Public Health. 2011;3(3):27-35. [Persian]
[8]Hojjat SK, Talebi M, Zamirinejad S, Shakeri M. The effectiveness of training coping styles on combat veterans with PTSD’s wives. J North Khorasan Univ Med Sci. 2012;4(2):185-90. [Persian]
[9]Khoshakhlagh H, Narimani A. Effectiveness of solution-focused brief couple therapy on happiness and marital conflict in veterans' spouses. Iran J War Public Health. 2019;11(1):7-13. [Persian]
[10]D’raven LL, Pasha-Zaidi N. Happiness strategies among Arab university students in the United Arab Emirates. J Happiness Well-Being. 2014;2(1),131-44.
[11]Diener E, Suh EM, Lucas RE, Smith HL. Subjective well-being: three decades of progress. Psychol Bull. 1999;125(2):276-302.
[12]Luhmann M, Necka EA, Schönbrodt FD, Hawkley LC. Is valuing happiness associated with lower well-being? A factor-level analysis using the Valuing Happiness Scale. J Res Pers. 2016;60:46-50.
[13]Nazari A, Goli M. The effects of solution- focused psychotherapy on the marital satisfaction of dual career couples. J Knowledge Health. 2008;2(4):36-40. [Persian]
[14]Hayes SC. Climbing our hills: a beginning conversation on the comparison of acceptance and commitment therapy and traditional cognitive behavioral therapy. Clin Psychol. 2008;15(4):286-95.
[15]Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011;4:41-9.
[16]Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013; 44(2):180-98.
[17]Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25.
[18]Hayes-Skelton SA, Orsillo SM, Roemer L. An acceptance-based behavioral therapy for individuals with generalized anxiety disorder. Cogn Behav Pract. 2013;20(3):264-81.
[19]Hayes SC, Strosahl KD, Bunting K, Twohig M, Wilson KG. What is acceptance and commitment therapy? In: Hayes SC, Strosahl KD, editors. A practical guide to acceptance and commitment therapy. New York: Springer; 2004. p. 3-29.
[20]Smit TB, Bartz J, Richards PS. Outcomes of religious and spiritual adaptations to psychotherapy: a metaanalytic review. Psychother Res, 2007;17(6):64355.
[21]Corey G. Theory and practice in group counseling. 4th Edition. Bostson: Brooks/Cole Publishing Company; 1995.
[22]Kim TH, Lee SM, Yu K, Lee S, Puig A. Hope and the meaning of life as influences on Korean adolescents’ resilience: Implications for counselors. Asia Pacific Educ Rev. 2005;6(2);143-52.
[23]Barnes RC. Victor Frankl's logotherapy: spirituality and meaning in the new millennium. TCA J. 2000;28(1):24-31.
[24]Falahati M, Shafiabadi A, Jajromi M, Mohammadipour M. Effectiveness of acceptance and commitment therapy and logotherapy on marital satisfaction of veterans' spouses. Iran J War Public Health. 2019;11(3):139-45. [Persian]
[25]Honarparvaran N. The Efficacy of acceptance and commitment therapy (ACT) on forgiveness and marital adjustment among women damaged by martial infidelity. J Soc Women. 2014;5(3):135-50. [Persian]
[26]Walser RD, Garvert DW, Karlin BE, Trockel M, Ryu DM, Taylor CB. Effectiveness of acceptance and commitment therapy in treating depression and suicidal ideation in veterans. Behav Res Ther. 2015;74:25-31.
[27]Ruiz FJ. A review of acceptance and commitment therapy (ACT) empirical evidence: correlational, experimental psychopathology, component and outcome studies. Int J Psychol Psychol Ther. 2010;10(1):125-62.
[28]Gerfami H, Shafiabadi A, Sanai Zaker B. The effectiveness of group-based logotherapy on reducing mental disorders symptoms in women with breast cancer. Andiseh Va Raftar. 2009;4(13):35-42. [Persian]
[29]Ghanbari Zarandi Z, Goudarzi M. The impact of group counseling in logo therapy method the improvement of general health of female victims of earthquake. J Women Stud. 2009;2(4):57-66. [Persian]
[30]Kang KA, Im JI, Kim HS, Kim SJ, Song MK, Sim S. The effect of logotherapy on the suffering, finding meaning, and spiritual well-being of adolescents with terminal cancer. J Korean Acad Child Health Nurs. 2009;15(2):136-44.
[31]Jaarsma TA, Pool G, Ranchor AV, Sanderman R. The concept and measurement of meaning in life in Dutch cancer patient. Psychooncology. 2007;16(3):241-8.
[32]Han B, Haley WE. Family caregiving for patients with stroke: Review and analysis. Stroke. 1999;30(7):1478-85.
[33]Cristofolini L, Testoni M. The importance of sample size and statistical power in experimental research: a comparative study. Acta Bioeng Biomech. 2000;2(1):3-16.
[34]Argyle M, Martin M, Crossland J. Happiness as a function of personality and social encounters. In: Forgas JP, Innes JM, editors. Recent advances in social psychology: an international perspective. New York: North Holland: Elsevier Science Publishers; 1989. p. 189-247.
[35]Gong M. Does status in consistency matter for marital quality? J Fam Issues. 2007;28(12):1582-610.
[36]Alipour A, Noorbala A. A preliminary evaluation of the validity and reliability of the Oxford happiness questionnaire in students in the universities of Tehran. Iran J Psychiatry Clin Psychol. 1999;5(1 and 2):55-66. [Persian]
[37]Alipour A, Agah Heris M. Reliability and validity of the Oxford happiness inventory among Iranians. J Dev Psychol. 2007;3(12):287-98. [Persian]
[38]Khoshakhlagh H, Narimani A. Effectiveness of solution-focused brief couple therapy on happiness and marital conflict in veterans' spouses. Iran J War Public Health. 2019;11(1):7-13. [Persian]
[39]Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther. 2004;35(4):639-65.
[40]Frankle VE. Man’s search for meaning: an introduction to logotheraphy. NewYork: Pocket Books; 1963.
[41]Azizi A, Ghasemi S. Comparison the effectiveness of solution-focused therapy, cognitive-behavior therapy and acceptance and commitment therapy on depression and quality of life in divorced women. Cult Couns Psycother. 2017;8(29):207-36. [Persian]
[42]Masuda A, Hayes SC, Sackett CF, Twohig MP. Cognitive defusion and self-relevant negative thoughts: examining the impact of a ninety year old technique. Behav Res Ther. 2004;42(4):477-85.
[43]Bernier M, Thienot E, Codron R, Fournier JF. Mindfulness and acceptance approaches in sport performance. J Clin Sports Psychol. 2009;4(4):320-33.
[44]Moghtadayi M, Khoshakhlagh H. Effectiveness of acceptance- and commitment-based therapy on psychological flexibility of veterans’ spouses. Iran J War Public Health. 2015;7(4):183-8. [Persian]
[45]Wong PTP. Meaning of life and meaning of death in successful aging. In: Tomer A, editor. Death attitudes and the older adult. New York, NY: Brunner/Mazel Publishers; 2000. p. 23-35.
[46]Marco JH, Garcia-Alandete J, Pérez S, Guillen V, Jorquera M, Espallargas P, Botella C. Meaning in life and non-suicidal self-injury: A follow-up study with participants with borderline personality disorder. Psychiatry Res. 2015;15:230(2):561-6.
[47]Steger MF, Fitch-Martin AR, Donnelly J, Rickard KM. Meaning in Life and Health: Proactive health orientation links meaning in life to health variables among American undergraduates. J Happiness Stud. 2015;16:583-97.
[48]Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL. Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. J Health Psychol. 2006;25(6):753-61.
[2]Saleh S, Zahedi Asl M. Correlation of social support with social health of psychiatry veterans wives. Iran J War Public Health. 2014;6(5):201-6. [Persian]
[3]Saban KL, Mathews HL, Janusek LW. The relationship among depression and caregiver burden with salivary cortisol awakening level in female caregivers of stroke survivors. Brain Behav Immun. 2010;24(Suppl 1):S21.
[4]Renshaw KD, Rodebaugh TL, Rodrigues CS. Psychological and marital distress in spouses of Vietnam veterans: Importance of spouses' perceptions. J Anxiety Disord. 2010;24(7):743-50.
[5]Manteghi A. Level of expressed emotion, depression and caregiver burden in wives of veterans admitted in psychiatric ward and their relationship with readmissions. J Fundam Ment Health. 2010;12(45):410-9. [Persian]
[6]Khaghanizadeh M, Sirati M. Influence of individual, familial and socioeconomic factors on severity of psychiatric symptoms in veterans with mental disorders. J Mil Med. 2004;6(1):33-7. [Persian]
[7]Najafi M, Mohammadifar MA, Dabiri S, Erfani N, Kamari AA. The comparison of the quality of life of the war veterans families with/without post traumatic stress disorder. Iran J War Public Health. 2011;3(3):27-35. [Persian]
[8]Hojjat SK, Talebi M, Zamirinejad S, Shakeri M. The effectiveness of training coping styles on combat veterans with PTSD’s wives. J North Khorasan Univ Med Sci. 2012;4(2):185-90. [Persian]
[9]Khoshakhlagh H, Narimani A. Effectiveness of solution-focused brief couple therapy on happiness and marital conflict in veterans' spouses. Iran J War Public Health. 2019;11(1):7-13. [Persian]
[10]D’raven LL, Pasha-Zaidi N. Happiness strategies among Arab university students in the United Arab Emirates. J Happiness Well-Being. 2014;2(1),131-44.
[11]Diener E, Suh EM, Lucas RE, Smith HL. Subjective well-being: three decades of progress. Psychol Bull. 1999;125(2):276-302.
[12]Luhmann M, Necka EA, Schönbrodt FD, Hawkley LC. Is valuing happiness associated with lower well-being? A factor-level analysis using the Valuing Happiness Scale. J Res Pers. 2016;60:46-50.
[13]Nazari A, Goli M. The effects of solution- focused psychotherapy on the marital satisfaction of dual career couples. J Knowledge Health. 2008;2(4):36-40. [Persian]
[14]Hayes SC. Climbing our hills: a beginning conversation on the comparison of acceptance and commitment therapy and traditional cognitive behavioral therapy. Clin Psychol. 2008;15(4):286-95.
[15]Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011;4:41-9.
[16]Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013; 44(2):180-98.
[17]Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25.
[18]Hayes-Skelton SA, Orsillo SM, Roemer L. An acceptance-based behavioral therapy for individuals with generalized anxiety disorder. Cogn Behav Pract. 2013;20(3):264-81.
[19]Hayes SC, Strosahl KD, Bunting K, Twohig M, Wilson KG. What is acceptance and commitment therapy? In: Hayes SC, Strosahl KD, editors. A practical guide to acceptance and commitment therapy. New York: Springer; 2004. p. 3-29.
[20]Smit TB, Bartz J, Richards PS. Outcomes of religious and spiritual adaptations to psychotherapy: a metaanalytic review. Psychother Res, 2007;17(6):64355.
[21]Corey G. Theory and practice in group counseling. 4th Edition. Bostson: Brooks/Cole Publishing Company; 1995.
[22]Kim TH, Lee SM, Yu K, Lee S, Puig A. Hope and the meaning of life as influences on Korean adolescents’ resilience: Implications for counselors. Asia Pacific Educ Rev. 2005;6(2);143-52.
[23]Barnes RC. Victor Frankl's logotherapy: spirituality and meaning in the new millennium. TCA J. 2000;28(1):24-31.
[24]Falahati M, Shafiabadi A, Jajromi M, Mohammadipour M. Effectiveness of acceptance and commitment therapy and logotherapy on marital satisfaction of veterans' spouses. Iran J War Public Health. 2019;11(3):139-45. [Persian]
[25]Honarparvaran N. The Efficacy of acceptance and commitment therapy (ACT) on forgiveness and marital adjustment among women damaged by martial infidelity. J Soc Women. 2014;5(3):135-50. [Persian]
[26]Walser RD, Garvert DW, Karlin BE, Trockel M, Ryu DM, Taylor CB. Effectiveness of acceptance and commitment therapy in treating depression and suicidal ideation in veterans. Behav Res Ther. 2015;74:25-31.
[27]Ruiz FJ. A review of acceptance and commitment therapy (ACT) empirical evidence: correlational, experimental psychopathology, component and outcome studies. Int J Psychol Psychol Ther. 2010;10(1):125-62.
[28]Gerfami H, Shafiabadi A, Sanai Zaker B. The effectiveness of group-based logotherapy on reducing mental disorders symptoms in women with breast cancer. Andiseh Va Raftar. 2009;4(13):35-42. [Persian]
[29]Ghanbari Zarandi Z, Goudarzi M. The impact of group counseling in logo therapy method the improvement of general health of female victims of earthquake. J Women Stud. 2009;2(4):57-66. [Persian]
[30]Kang KA, Im JI, Kim HS, Kim SJ, Song MK, Sim S. The effect of logotherapy on the suffering, finding meaning, and spiritual well-being of adolescents with terminal cancer. J Korean Acad Child Health Nurs. 2009;15(2):136-44.
[31]Jaarsma TA, Pool G, Ranchor AV, Sanderman R. The concept and measurement of meaning in life in Dutch cancer patient. Psychooncology. 2007;16(3):241-8.
[32]Han B, Haley WE. Family caregiving for patients with stroke: Review and analysis. Stroke. 1999;30(7):1478-85.
[33]Cristofolini L, Testoni M. The importance of sample size and statistical power in experimental research: a comparative study. Acta Bioeng Biomech. 2000;2(1):3-16.
[34]Argyle M, Martin M, Crossland J. Happiness as a function of personality and social encounters. In: Forgas JP, Innes JM, editors. Recent advances in social psychology: an international perspective. New York: North Holland: Elsevier Science Publishers; 1989. p. 189-247.
[35]Gong M. Does status in consistency matter for marital quality? J Fam Issues. 2007;28(12):1582-610.
[36]Alipour A, Noorbala A. A preliminary evaluation of the validity and reliability of the Oxford happiness questionnaire in students in the universities of Tehran. Iran J Psychiatry Clin Psychol. 1999;5(1 and 2):55-66. [Persian]
[37]Alipour A, Agah Heris M. Reliability and validity of the Oxford happiness inventory among Iranians. J Dev Psychol. 2007;3(12):287-98. [Persian]
[38]Khoshakhlagh H, Narimani A. Effectiveness of solution-focused brief couple therapy on happiness and marital conflict in veterans' spouses. Iran J War Public Health. 2019;11(1):7-13. [Persian]
[39]Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther. 2004;35(4):639-65.
[40]Frankle VE. Man’s search for meaning: an introduction to logotheraphy. NewYork: Pocket Books; 1963.
[41]Azizi A, Ghasemi S. Comparison the effectiveness of solution-focused therapy, cognitive-behavior therapy and acceptance and commitment therapy on depression and quality of life in divorced women. Cult Couns Psycother. 2017;8(29):207-36. [Persian]
[42]Masuda A, Hayes SC, Sackett CF, Twohig MP. Cognitive defusion and self-relevant negative thoughts: examining the impact of a ninety year old technique. Behav Res Ther. 2004;42(4):477-85.
[43]Bernier M, Thienot E, Codron R, Fournier JF. Mindfulness and acceptance approaches in sport performance. J Clin Sports Psychol. 2009;4(4):320-33.
[44]Moghtadayi M, Khoshakhlagh H. Effectiveness of acceptance- and commitment-based therapy on psychological flexibility of veterans’ spouses. Iran J War Public Health. 2015;7(4):183-8. [Persian]
[45]Wong PTP. Meaning of life and meaning of death in successful aging. In: Tomer A, editor. Death attitudes and the older adult. New York, NY: Brunner/Mazel Publishers; 2000. p. 23-35.
[46]Marco JH, Garcia-Alandete J, Pérez S, Guillen V, Jorquera M, Espallargas P, Botella C. Meaning in life and non-suicidal self-injury: A follow-up study with participants with borderline personality disorder. Psychiatry Res. 2015;15:230(2):561-6.
[47]Steger MF, Fitch-Martin AR, Donnelly J, Rickard KM. Meaning in Life and Health: Proactive health orientation links meaning in life to health variables among American undergraduates. J Happiness Stud. 2015;16:583-97.
[48]Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL. Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. J Health Psychol. 2006;25(6):753-61.