@2024 Afarand., IRAN
ISSN: 2008-2630 Iranian Journal of War & Public Health 2015;7(2):57-65
ISSN: 2008-2630 Iranian Journal of War & Public Health 2015;7(2):57-65
Effectiveness of Cognitive-Behavioral Training on Reducing the Secondary Trauma Symptoms of PTSD Veterans' Wives
ARTICLE INFO
Article Type
Original ResearchAuthors
Abolmaali Kh. (* )Aghaeepour Gavasaraee M. (1 )
(* ) Psychology Department, Psychology Faculty, Roudehen Branch, Islamic Azad University, Roudehen, Iran
(1 ) Psychology Department, Psychology Faculty, Roudehen Branch, Islamic Azad University, Roudehen, Iran
Correspondence
Address: Psychology Department, Imam Ali Building, Islamic Azad University, Roudehen, IranPhone: +982176505018
Fax: +982188577520
sama.abolmaali@gmail.com
Article History
Received: December 21, 2014Accepted: February 18, 2015
ePublished: April 20, 2015
ABSTRACT
Aims
Secondary trauma is a psychological consequence of direct and prolonged contact with a post-traumatic stress disorder person. The purpose of this study was to evaluate the efficacy of instruction of cognitive-behavioral techniques on reduction of secondary trauma symptoms in wives of post-traumatic stress disorder veterans, with controlling the effect of depression, anxiety and stress.
Materials & Methods In this quasi-experimental research with pretest-posttest with control group design, 22 spouses of post-traumatic stress disorder veterans referred to Sadr Psychiatric Hospital of Tehran, Iran in 2013 were studied. The people who have attained high score on the secondary trauma test were randomly assigned to two experimental and control groups. The research instruments were a demographic questionnaire, questionnaire of secondary post-traumatic stress, and questionnaire of depression, anxiety and stress. The experimental group was weekly taught cognitive-behavioral techniques in 13 sessions in 135 minutes. The analysis of data was performed by univariate and multivariate analysis of covariance.
Findings The mean of secondary trauma and components of intrusion, avoidance, and arousal in all cases in the experimental group were lower than the control group. Instruction of cognitive behavioral techniques with controlling the effect of depression, anxiety and stress was effective in reduction of secondary trauma symptoms in wives of post-traumatic stress disorder veterans (p<0.05).
Conclusion Teaching the cognitive-behavioral techniques is an effective strategy for reducing the symptoms of secondary traumatic stress.
Materials & Methods In this quasi-experimental research with pretest-posttest with control group design, 22 spouses of post-traumatic stress disorder veterans referred to Sadr Psychiatric Hospital of Tehran, Iran in 2013 were studied. The people who have attained high score on the secondary trauma test were randomly assigned to two experimental and control groups. The research instruments were a demographic questionnaire, questionnaire of secondary post-traumatic stress, and questionnaire of depression, anxiety and stress. The experimental group was weekly taught cognitive-behavioral techniques in 13 sessions in 135 minutes. The analysis of data was performed by univariate and multivariate analysis of covariance.
Findings The mean of secondary trauma and components of intrusion, avoidance, and arousal in all cases in the experimental group were lower than the control group. Instruction of cognitive behavioral techniques with controlling the effect of depression, anxiety and stress was effective in reduction of secondary trauma symptoms in wives of post-traumatic stress disorder veterans (p<0.05).
Conclusion Teaching the cognitive-behavioral techniques is an effective strategy for reducing the symptoms of secondary traumatic stress.
CITATION LINKS
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[2]Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298(18):2141-8.
[3]Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. The psychological risks of Vietnam for U.S. veterans: A revisit with new data and methods. Sci. 2006;313(5789):979-82.
[4]Kotler M, Cohen H, Aizenberg D, Matar M, Loewenthal U, Kaplan Z, et al. Sexual dysfunction in male posttraumatic stress disorder patients. Psychother Psychosom. 2000;69(6):309–15.
[5]Solomon Z, Shklar R, Mikulincer M. Frontline treatment of combat stress reaction: A 20-year longitudinal evaluation study. Am J Psychiatry. 2005;162(12):2309-14.
[6]Galovski T, Lyons JA. Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran’s family and possible interventions. Aggress Violent Behav. 2004;9:477-501.
[7]Boscarino JA, Figley CR, Adams RE. Compassion fatigue following the September 11 terrorist attacks: A study of secondary trauma among New York City social workers. Int J Emerg Ment Health. 2004;6(2):57-66.
[8]Zimering R, Gulliver SB, Knight J, Munroe J, Keane TM. Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to Ground Zero. J Trauma Stress. 2006;19(4):553-7.
[9]Sodeke-Gregson EA, Holttum S, & Billings J. Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients. Eur J Psychotraumatol. 2013;4:10.
[10]Pines A, Aronson E. Career burnout: Causes and cures. New York: Free Press; 1998.
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[12]Klarić M, Kvesić A, Mandić V, Petrov B, Frančišković T. Secondary traumatisation and systemic traumatic stress. Psychiatr Danub. 2013;25(Suppl1):29-36.
[13]Figley CR. The family as victim: Mental health implication. Psychiatry. 1985;6:283-91.
[14]Francisković T, Stevanović A, Jelusić I, Roganović B, Klarić M, Grković J. Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croat Med J. 2007;48(2):177–84.
[15]Collins J. Addressing secondary traumatic stress: Emerging approaches in child welfare. Children’s Voice. 2009;2:10-4.
[16]Adams RE, Boscarino JA, Figley CR. Compassion fatigue and psychological distress among social workers: A validation study. Am J Orthopsychiatry. 2006;76(1):103-8.
[17]Ben Arzi N, Solomon Z, Dekel R. Secondary traumatization among wives of PTSD and post-concussion casualties: Distress, caregiver burden and psychological separation. Brain Inj. 2000;14(8):725-36.
[18]Klarić M, Frančišković T, Obrdalj EC, Petrić D, Britvić D, Zovko N. Psychiatric and health impact of primary and secondary traumatization in wives of veterans with posttraumatic stress disorder. Psychiatr Danub. 2012;24(3), 280-6.
[19]Koić E, Frančišković T, Mužinić-Masle L, Đorđević V, Vondraček S, Prpić J. Chronic pain and secondary traumatization in wives of Croatian war veterans treated for post-traumatic stress disorder. Acta Clinica Croatica. 2002;41(4):295-306.
[20]Porafshar S, Ahmadi Noudeh Kh, Elias MH. Evaluation of secondary PTSD and marital satisfaction in spouses of veterans with PTSD. Milit Psychol Q. 2008;1(1):67-76. [Persian]
[21]Cockram DM, Drummond PD, Lee CW. Role and treatment of early maladaptive schemas in Vietnam Veterans with PTSD. Clin Psychol Psychother. 2010;17(3):165-82.
[22]Yousefi R, Abedin A, Tirgari A, Fathabadi J. The effect of schema-based instruction on improving marital satisfaction. J Clin Psychol. 2009;2(3):25-37. [Persian]
[23]Kazemi AS, Banijamali SS, Ahadi H, Farrokhi NA. Effectiveness of cognitive-behavioral strategies in reducing the symptoms of secondary traumatic stress disorder (STSD) spouses of veterans with chronic PTSD and psychological problems caused by the war. Islamic Azad Univ J Med Sci. 2012;22(2):122-9. [Persian]
[24]Ortlepp k, Friedman M. Prevalence and correlates of secondary traumatic stress in workplace lay trauma counselors. J Trauma Stress. 2002;15(3):213-22.
[25]Follette V, Palm KM, Pearson AN. Mindfulness and trauma: Implications for treatment. J Ration-Emot Cogn-Behav Ther. 2006:24(1):45-61.
[26]Kazemi AS. The effectiveness of mindfulness-based cognitive strategies to reduce the symptoms of secondary traumatic stress disorder and chronic psychological problems. J Think Behav. 2011;6(23):122-9. [Persian]
[27]Robertson CS, Valadka AB, Hannay HJ, Contant CF, Gopinath SP, Cormio M, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999; 27(10):2086-95.
[28]Pietrzak RH, Johnson DC, Goldstein MB, Malley JC, Southwick SM. Psychological resilience and post deployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom. Depress Anxiet. 2009;26(8):745-51.
[29]LaMontagne, LL, Hepworth JT, Cohen F, Salisbury MH. Cognitive-behavioral intervention effects on adolescents’ anxiety and pain following spinal fusion surgery. Nurs Res. 2003;52(3):183-90.
[30]Prochaska JO. Decision making in the trans-theoretical model of behavior change. Med Decis Making. 2008;17;11-9.
[31]Beck AT. The current state of cognitive therapy: A 40-year retrospective. Arch Gen Psychiatry. 2005;62(9):953-59.
[32]Roiser JP, Elliott R, Sahakian BJ. Mood disorders: Cognitive mechanisms of treatment in depression. Neuropsychopharmacol Rev. 2012;37:117-36.
[33]Burns DD, Spangler DL. Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to increased homework compliance? J Consult and Clin Psychol. 2000;68(1):46 –56.
[34]Gould RA, Buckminster S, Pollack MH, Otto MW, Yap L. Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis. Clin Psychol: Sci Pract. 1997;4(4):291-306.
[35]Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: A systematic review of interventions and outcomes s. Rheumatol. 2008;47(5):670-8.
[36]Hilbert A, Tuschen-Caffier B. Body image interventions in cognitive-behavioral therapy of binge-eating disorder: A component analysis . Behav Res Ther. 2004;42(11):1325–39.
[37]Narimani M, Rajabi S. Comparison of the effect of eye movement desensitization and reprocessing and cognitive-behavioral therapy in the treatment of posttraumatic stress disorder. Islamic Azad Univ J Med Sci. 2009; 19(4):236-45. [Persian]
[38]Zoellner, L A, Feeny NC, Fitzgibbons LA, Foa EB. Response of African American and Caucasian women to cognitive behavior therapy for PTSD. Behav Ther. 1999;30(4):581–95.
[39]Paunovic, N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behavior research and therapy. 2001;39(10):1183-97.
[40]Devilly GJ, Spence SH. The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder. J Anxiety Disord. 1999;13(1-2):131-57.
[41]Cristofolini L. The important of sample size and statistical power in experimental research: A comparative study. Acta Bioengin Biomechanics. 2000;2(1):3-16.
[42]Ahmadi Kh, Rezapour Y, Davoudi F, Saberi M. Investigate of validity and reliability of secondary trauma stress scale for evaluation of ptsd symptoms in samples of warfare victims’ wives. Iran J War Public Health. 2013;5(3):47-57. [Persian]
[43]Bride BE, Robinson MM, Yegidis B, Figley CR. Development and validation of the secondary traumatic stress scale. Res Soc Work Pract. 2004;14(1):27-35.
[44]Zoladz PR, Diamond DM. Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature. Neurosci Biobehav Rev. 2013;37(5):860-95.
[45]Abolmaali Kh, Kamal A. Effect of schema-based learning on reducing the symptoms of secondary traumatic stress in wives of post-traumatic stress disorder veterans. Iran J War Public Health. 2015;7(1):21-8. [Persian]
[46]Ahmadi Kh, Rezapour Mirsalah R. Standardization test of vicarious PTSD in veterans' families [Research Report]. Institute of Behavioral & Neuroscience and Behavioral Sciences Research Center: Baqiyatallah University of Medical Sciences, Tehran, Iran; 2011. [Persian]
[47]Samani S, Jokar B. A study on the reliability and validity of the short form of depression, anxiety and stress scale. J Soc Sci Humanities Shiraz Univ. 2007;26(3):65-77. [Persian]
[48]Ahmadzadeh Aghdam E, Ahmadi Kh, Nooranipoor R, Akhavi Z. The effect of stress inoculation on decrease of PTSD symptoms in veterans. Iran J War Public Health. 2013;5(3):32-40. [Persian]
[49]Zayfart C, DeViva JC. Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress. 2004;17(1):69-73.
[50]Moradi Manesh F, Ahadi H, Jomehri F, Rahgozar M. Relationship between psychological distress and quality of life in women with breast cancer. J Zabol Univ Med Sci Health Serv. 2012;4(2):51-9. [Persian]
[51]Leahy RL, Trich D, Napolintano LA. Emotion Regulation in Psychotherapy: A Practitioner guide. New York- London: The Guilford Press; 2011.
[52]Aslani M, Hashemian K, Lotfi Kashani F, Mirzaei J. The effectiveness of cognitive behavioral therapy (CBT) in patients with chronic posttraumatic stress disorder as a result of the war. J Appl Psychol. 2005;1(3):16-7. [Persian]
[53]Zoghi Paidar M, Sohrabi F, Borjali A, Delavar A. Effectiveness of instruction of coping skills based on cognitive-behavioral approach on post-traumatic stress disorder and depression caused by the war veterans. Milit Psychol. 2011;2(5):1-16. [Persian]
[54]Foa EB, Rothbaum BO, Riggs D, Murdock T. Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol. 1991;59(5):715-23.
[55]Monson CM, Fredman SJ, Macdonald A, Pukay-Martin ND, Resick PA, Schnurr PP. Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial. J Am Med Assoc. 2012;308(7):700-9.
[56]Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang, A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognit Ther Res. 2012;36(5):427–40.
[57]Otte C. Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues Clin Neurosci. 2011;13(4): 413-21.
[58]McGuire J. The think first program. In: McMurran M, McGuire J, editors. Social problem solving and offending: Evidence, evaluation and evolution. Hoboken: John Wiley & Sons; 2005. pp. 183-206.
[2]Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298(18):2141-8.
[3]Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. The psychological risks of Vietnam for U.S. veterans: A revisit with new data and methods. Sci. 2006;313(5789):979-82.
[4]Kotler M, Cohen H, Aizenberg D, Matar M, Loewenthal U, Kaplan Z, et al. Sexual dysfunction in male posttraumatic stress disorder patients. Psychother Psychosom. 2000;69(6):309–15.
[5]Solomon Z, Shklar R, Mikulincer M. Frontline treatment of combat stress reaction: A 20-year longitudinal evaluation study. Am J Psychiatry. 2005;162(12):2309-14.
[6]Galovski T, Lyons JA. Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran’s family and possible interventions. Aggress Violent Behav. 2004;9:477-501.
[7]Boscarino JA, Figley CR, Adams RE. Compassion fatigue following the September 11 terrorist attacks: A study of secondary trauma among New York City social workers. Int J Emerg Ment Health. 2004;6(2):57-66.
[8]Zimering R, Gulliver SB, Knight J, Munroe J, Keane TM. Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to Ground Zero. J Trauma Stress. 2006;19(4):553-7.
[9]Sodeke-Gregson EA, Holttum S, & Billings J. Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients. Eur J Psychotraumatol. 2013;4:10.
[10]Pines A, Aronson E. Career burnout: Causes and cures. New York: Free Press; 1998.
[11]Pearlman LA. Self-care for trauma therapists: Ameliorating vicarious traumatization. In: Stamm BH, editor. Secondary traumatic stress: Self-care issues for clinicians, researchers & educators. 2nd edition. Baltimore: Sidran Press; 1999. pp. 51-64.
[12]Klarić M, Kvesić A, Mandić V, Petrov B, Frančišković T. Secondary traumatisation and systemic traumatic stress. Psychiatr Danub. 2013;25(Suppl1):29-36.
[13]Figley CR. The family as victim: Mental health implication. Psychiatry. 1985;6:283-91.
[14]Francisković T, Stevanović A, Jelusić I, Roganović B, Klarić M, Grković J. Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croat Med J. 2007;48(2):177–84.
[15]Collins J. Addressing secondary traumatic stress: Emerging approaches in child welfare. Children’s Voice. 2009;2:10-4.
[16]Adams RE, Boscarino JA, Figley CR. Compassion fatigue and psychological distress among social workers: A validation study. Am J Orthopsychiatry. 2006;76(1):103-8.
[17]Ben Arzi N, Solomon Z, Dekel R. Secondary traumatization among wives of PTSD and post-concussion casualties: Distress, caregiver burden and psychological separation. Brain Inj. 2000;14(8):725-36.
[18]Klarić M, Frančišković T, Obrdalj EC, Petrić D, Britvić D, Zovko N. Psychiatric and health impact of primary and secondary traumatization in wives of veterans with posttraumatic stress disorder. Psychiatr Danub. 2012;24(3), 280-6.
[19]Koić E, Frančišković T, Mužinić-Masle L, Đorđević V, Vondraček S, Prpić J. Chronic pain and secondary traumatization in wives of Croatian war veterans treated for post-traumatic stress disorder. Acta Clinica Croatica. 2002;41(4):295-306.
[20]Porafshar S, Ahmadi Noudeh Kh, Elias MH. Evaluation of secondary PTSD and marital satisfaction in spouses of veterans with PTSD. Milit Psychol Q. 2008;1(1):67-76. [Persian]
[21]Cockram DM, Drummond PD, Lee CW. Role and treatment of early maladaptive schemas in Vietnam Veterans with PTSD. Clin Psychol Psychother. 2010;17(3):165-82.
[22]Yousefi R, Abedin A, Tirgari A, Fathabadi J. The effect of schema-based instruction on improving marital satisfaction. J Clin Psychol. 2009;2(3):25-37. [Persian]
[23]Kazemi AS, Banijamali SS, Ahadi H, Farrokhi NA. Effectiveness of cognitive-behavioral strategies in reducing the symptoms of secondary traumatic stress disorder (STSD) spouses of veterans with chronic PTSD and psychological problems caused by the war. Islamic Azad Univ J Med Sci. 2012;22(2):122-9. [Persian]
[24]Ortlepp k, Friedman M. Prevalence and correlates of secondary traumatic stress in workplace lay trauma counselors. J Trauma Stress. 2002;15(3):213-22.
[25]Follette V, Palm KM, Pearson AN. Mindfulness and trauma: Implications for treatment. J Ration-Emot Cogn-Behav Ther. 2006:24(1):45-61.
[26]Kazemi AS. The effectiveness of mindfulness-based cognitive strategies to reduce the symptoms of secondary traumatic stress disorder and chronic psychological problems. J Think Behav. 2011;6(23):122-9. [Persian]
[27]Robertson CS, Valadka AB, Hannay HJ, Contant CF, Gopinath SP, Cormio M, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999; 27(10):2086-95.
[28]Pietrzak RH, Johnson DC, Goldstein MB, Malley JC, Southwick SM. Psychological resilience and post deployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom. Depress Anxiet. 2009;26(8):745-51.
[29]LaMontagne, LL, Hepworth JT, Cohen F, Salisbury MH. Cognitive-behavioral intervention effects on adolescents’ anxiety and pain following spinal fusion surgery. Nurs Res. 2003;52(3):183-90.
[30]Prochaska JO. Decision making in the trans-theoretical model of behavior change. Med Decis Making. 2008;17;11-9.
[31]Beck AT. The current state of cognitive therapy: A 40-year retrospective. Arch Gen Psychiatry. 2005;62(9):953-59.
[32]Roiser JP, Elliott R, Sahakian BJ. Mood disorders: Cognitive mechanisms of treatment in depression. Neuropsychopharmacol Rev. 2012;37:117-36.
[33]Burns DD, Spangler DL. Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to increased homework compliance? J Consult and Clin Psychol. 2000;68(1):46 –56.
[34]Gould RA, Buckminster S, Pollack MH, Otto MW, Yap L. Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis. Clin Psychol: Sci Pract. 1997;4(4):291-306.
[35]Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: A systematic review of interventions and outcomes s. Rheumatol. 2008;47(5):670-8.
[36]Hilbert A, Tuschen-Caffier B. Body image interventions in cognitive-behavioral therapy of binge-eating disorder: A component analysis . Behav Res Ther. 2004;42(11):1325–39.
[37]Narimani M, Rajabi S. Comparison of the effect of eye movement desensitization and reprocessing and cognitive-behavioral therapy in the treatment of posttraumatic stress disorder. Islamic Azad Univ J Med Sci. 2009; 19(4):236-45. [Persian]
[38]Zoellner, L A, Feeny NC, Fitzgibbons LA, Foa EB. Response of African American and Caucasian women to cognitive behavior therapy for PTSD. Behav Ther. 1999;30(4):581–95.
[39]Paunovic, N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behavior research and therapy. 2001;39(10):1183-97.
[40]Devilly GJ, Spence SH. The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder. J Anxiety Disord. 1999;13(1-2):131-57.
[41]Cristofolini L. The important of sample size and statistical power in experimental research: A comparative study. Acta Bioengin Biomechanics. 2000;2(1):3-16.
[42]Ahmadi Kh, Rezapour Y, Davoudi F, Saberi M. Investigate of validity and reliability of secondary trauma stress scale for evaluation of ptsd symptoms in samples of warfare victims’ wives. Iran J War Public Health. 2013;5(3):47-57. [Persian]
[43]Bride BE, Robinson MM, Yegidis B, Figley CR. Development and validation of the secondary traumatic stress scale. Res Soc Work Pract. 2004;14(1):27-35.
[44]Zoladz PR, Diamond DM. Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature. Neurosci Biobehav Rev. 2013;37(5):860-95.
[45]Abolmaali Kh, Kamal A. Effect of schema-based learning on reducing the symptoms of secondary traumatic stress in wives of post-traumatic stress disorder veterans. Iran J War Public Health. 2015;7(1):21-8. [Persian]
[46]Ahmadi Kh, Rezapour Mirsalah R. Standardization test of vicarious PTSD in veterans' families [Research Report]. Institute of Behavioral & Neuroscience and Behavioral Sciences Research Center: Baqiyatallah University of Medical Sciences, Tehran, Iran; 2011. [Persian]
[47]Samani S, Jokar B. A study on the reliability and validity of the short form of depression, anxiety and stress scale. J Soc Sci Humanities Shiraz Univ. 2007;26(3):65-77. [Persian]
[48]Ahmadzadeh Aghdam E, Ahmadi Kh, Nooranipoor R, Akhavi Z. The effect of stress inoculation on decrease of PTSD symptoms in veterans. Iran J War Public Health. 2013;5(3):32-40. [Persian]
[49]Zayfart C, DeViva JC. Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress. 2004;17(1):69-73.
[50]Moradi Manesh F, Ahadi H, Jomehri F, Rahgozar M. Relationship between psychological distress and quality of life in women with breast cancer. J Zabol Univ Med Sci Health Serv. 2012;4(2):51-9. [Persian]
[51]Leahy RL, Trich D, Napolintano LA. Emotion Regulation in Psychotherapy: A Practitioner guide. New York- London: The Guilford Press; 2011.
[52]Aslani M, Hashemian K, Lotfi Kashani F, Mirzaei J. The effectiveness of cognitive behavioral therapy (CBT) in patients with chronic posttraumatic stress disorder as a result of the war. J Appl Psychol. 2005;1(3):16-7. [Persian]
[53]Zoghi Paidar M, Sohrabi F, Borjali A, Delavar A. Effectiveness of instruction of coping skills based on cognitive-behavioral approach on post-traumatic stress disorder and depression caused by the war veterans. Milit Psychol. 2011;2(5):1-16. [Persian]
[54]Foa EB, Rothbaum BO, Riggs D, Murdock T. Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol. 1991;59(5):715-23.
[55]Monson CM, Fredman SJ, Macdonald A, Pukay-Martin ND, Resick PA, Schnurr PP. Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial. J Am Med Assoc. 2012;308(7):700-9.
[56]Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang, A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognit Ther Res. 2012;36(5):427–40.
[57]Otte C. Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues Clin Neurosci. 2011;13(4): 413-21.
[58]McGuire J. The think first program. In: McMurran M, McGuire J, editors. Social problem solving and offending: Evidence, evaluation and evolution. Hoboken: John Wiley & Sons; 2005. pp. 183-206.