@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2020;12(3):141-147

Background
Spinal cord injury (SCI) in veterans has been one of the complications of war that has profound and far-reaching effects on their physical and mental health and lifestyle [1, 2].
Previous Studies
... [3-5]. Lee & Green [6], Shrove & Sahota [7], and Martz et al. [8] believe that adaptation to SCI requires more psychological effort than those whose physical function returns to normal after a traumatic event. This damage can lead to negative emotions and anxiety because disability creates a sense of vulnerability and dependence in the individual [9]. ... [10-12]. Emotional self-regulation means how to control and direct behaviors and emotions in order to achieve the desired goals [13]. ... [14-22]. Increased emotion regulation leads to the ability to function properly in life and the ability to positively cope with the injuries and the flexible functioning of the injured person [23, 24]. ... [25-30].
Aim(s)
The aim of this study was to evaluate the effectiveness of Berking's Emotional Competence Intervention on emotional regulation in SCI veterans.
Research type
The present research was a quasi-experimental study.
Research society, place and time
This study was conducted in November and December 2019 on male veterans with SCI (n=264) in Isfahan (according to statistics received directly from the Deputy of Treatment of the Foundation of Martyrs and Veterans Affairs of Isfahan).
Sampling method and number
Initially, by purposive sampling and using the Emotional Regulation Skills Questionnaire [31] as a screening tool and also as a pre-test, 31 veterans with weakness in emotional regulation (according to Morgan table and inclusion and exclusion criteria) were identified and randomly divided into the experimental (n=16) and control (n=15) groups. Those who were willing to participate in the research and respond to the questionnaire had weaknesses in the emotional regulation according to the cut-off scores of the questionnaire, those with no mental disorders, adverse physical conditions, or chronic physical illnesses other than SCI that affected the physical condition, mood, and vision of the veterans (at the physician's discretion and based on the veterans' medical records), and had at least a secondary school education entered the study. Those who were absent for more than two sessions during the intervention or were unwilling to do their homework were excluded from the study.
Used devices&materials
The Emotional Regulation Skills Questionnaire developed by Berking & Znoj was used [31]. The pilot test and internal consistency of the Persian version of the questionnaire was performed by Zebardast et al. [32], and Cronbach's alpha and reliability coefficient of the questionnaire were 0.86 and 0.88, respectively. At the end of the intervention, a post-test was carried out and follow-up was performed one month after the post-test. It should be noted that after the follow-up, the control group also underwent emotional regulation intervention. To intervene in the emotional regulation in SCI veterans, the integrated emotional competency training method presented by Breaking et al. [33] was used. In order to evaluate the effectiveness of the intervention, using SPSS 23 software, the effect of pre-test and possible differences in that stage were first controlled using MANCOVA. Then repeated measures analysis of variance was used to examine the differences between pre-test, post-test and follow-up results. Prior to MANCOVA, the necessary assumptions, such as the normality of the data distribution, the homogeneity of the covariance matrix, and the homogeneity of the variance of the variables were examined.
Findings by Text
The age of the participants was 50-65 years and most of them (77.41%) aged 50-58 years. In addition, 11 participants (35.48%) had a bachelor's degree, 15 (48.38%) had a diploma, and 5 (16.12%) had a bachelor's degree. The mean scores of the components of the emotional regulation skills questionnaire of both groups in the pre-test, post-test, and follow-up stages are shown in Table 1. In the post-test and follow-up stages, the difference between the two groups compared with the pre-test increased and was significant (p=0.00) and there was a significant difference between the experimental and control groups in terms of at least one of the dependent variables (p=0.00). Considering the pre-test scores as covariate variables, the difference between the performance of the experimental and control groups in the pre-test and post-test stages and regarding all components of the Emotional Regulation Skills Questionnaire was positive and significant, and statistical power also indicated the adequacy of the sample size (Table 2). In order to evaluate the continuity and stability of the effect of the intervention on emotional regulation in veterans with SCI, the results of repeated measures analysis of variance on the pre-test, post-test, and follow-up scores of the experimental group showed that there was a significant difference in at least one of the variables (p=0.04). For all components of the Emotional Regulation Skills Questionnaire, the difference between pre-test and post-test scores was significant (p≤0.05). This finding indicated the effectiveness of the emotional regulation intervention on improving the emotional self-regulation skills of SCI veterans; while there was no significant difference between a post-test score and follow-up (p≥0.05) and this result indicated the continuity and stability of the intervention until the follow-up stage (Table 3).
Main comparison to the similar studies
Breaking’s emotional competence intervention was used for the first time for an Iranian population and SCI veterans. This intervention improved emotional self-regulation in male veterans with SCI in Isfahan. Baklo et al. [34] state that higher levels of anxiety in patients with SCI are due to vain thoughts, emotional expression, and self-blame; therefore, effective interventions on emotional self-regulation in these patients can lead to better management of these emotions. Although no other similar studies conducted on patients with SCI have been found, the findings of the present study are in line with those of Craig et al. [5], Pollard & Kennedy [21], Norse [26], Hu & Klingina [27], King & Kennedy [28], Dachnik et al. [29], and Kennedy et al. [30] in terms of addressing different dimensions of emotions in people with SCI.
Suggestions
It is suggested that this study be performed on veterans with SCIs in other provinces of Iran, as well as on women with SCIs and in other age groups.
Limitations
Only male participants were used in this research.
Conclusions
Breaking’s emotional competence intervention can be an effective intervention in improving the emotional self-regulation of veterans with SCI.
Acknowledgments
The authors express their gratitude to all the veterans who participated in the research and the research ethics committee of the Foundation of Martyrs and Veterans Affairs.
Conflict of interest
This research was taken from the doctoral dissertation of the first author of the article.
Ethical Permissions
The research ethics committee of the Foundation of Martyrs and Veterans Affairs approved the study (IR.ISAAR.REC.1398.007).
Funding Sources
This study was supported by the Foundation of Martyrs and Veterans Affairs of Isfahan.

TABLES and CHARTS

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