Volume 24, Issue 4 (Winter 2019)                   IJPCP 2019, 24(4): 370-383 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Razavizadeh Tabadkan B B Z, Jajarmi M, Vakili Y. The Effectiveness of Mindfulness-Based Cognitive Therapy on Ruminative Thoughts, Perceived Stress and Difficulties in Emotion Regulation of Women With Type 2 Diabetes. IJPCP. 2019; 24 (4) :370-383
URL: http://ijpcp.iums.ac.ir/article-1-2796-en.html
1- PhD. Candidate in General Psychology, Department of Psychology, Faculty of Humanities, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran.
2- PhD. in Consultation, Assistant Professor, Department of Psychology, Faculty of Humanities and Basic Sciences, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran. , jajarmimahmoud96@gmail.com
3- PhD. in Clinical Psychology, Assistant Professor, Golestan Research Center of Psychiatry, Golestan University of Medical Sciences, Gorgan, Iran.
Full-Text [PDF 2986 kb]   (1985 Downloads)     |   Abstract (HTML)  (3920 Views)
Full-Text:   (2118 Views)
Extended Abstract
1. Introduction

Diabetes mellitus is one of the most common non-communicable metabolic disorders around the world with a high mortality. Since the disease has many complications such as fluctuations in blood glucose, limb amputations, blindness, and so on, it becomes the source of depression, anxiety, stress and emotional disturbances in patients. These problems can lead to exacerbations of physical symptoms and injuries in self-care behaviors of patients. Therapists use multiple therapy methods to improve the mental condition of such patients, including Mindfulness-Based Cognitive Therapy (MBCT). 
In this treatment method, attention is focused on what is happening in the present and one understands the internal and external realities freely and without distortion. This causes the person to be free from the false chain of mental ruminations and to face a different way of emotion. This way of thinking leads to health joint outcomes such as the decrease in anxiety, depression and stress. MBCT is applicable on both individual and group patients. Thus, this research aims to investigate the effectiveness of MBCT on perceived stress, the rumination and difficulties in emotion regulation in women with type 2 diabetes.

2. Method
This quasi-experimental study was carried out using a pre-test and post-test design with a control group and a follow-up period of three months. Of all women with type 2 diabetes, who were member of the Public Sports Organization of North Khorasan Province in 2017, 30 people aged 30-67 years on the basis of written consent form, were recruited using convenience sampling method and randomly (using random numbers table) assigned in two groups of MBCT and control group. These patients were evaluated by clinical psychologist to measure the inclusion criteria based on Structured Clinical Interview for Diagnosis (SCID-I). After performing a pre-test, patients in the experimental group attended eight 120-minute sessions of MBCT once per week, based on cognitive therapy protocol of Mindfulness for Depression Disorder. The study data were obtained by perceived stress scale, ruminative responses scale, and difficulties in emotion regulation scale in three stages of pre-test, post-test and three-month follow-up. Analysis of results was done using 2-way repeated measures analysis and 2-way multivariate repeated measures analysis.

3. Results
Results of the mean scores of study variables in the post-test and follow-up stage were respectively as follows: 38.92 and 45.25 for rumination, 17.18 and 17.24 for the perceived stress scale, 9.89 and 13.83 for the subscale of non-acceptance of emotional response (non-accept), 8.83 and 11.83 for the subscale of the difficulty engaging in goal-directed behavior (goals), 9.83 and 12.25 for the subscale of the impulse control difficulties (impulse), 15 and 16 for the lack of emotional awareness (awareness) subscale, 12.5 and 16 for the subscale of the limited access to emotion regulation strategies (strategies), and 8.92 and 10.67 for the lack of emotional clarity (clarity) subscale. 
These changes, except for the awareness subscale, are significant compared to the pre-test. The values of interactive test effect and group membership on mental rumination are 0.46 and 0.55, respectively. The values of test interactive effect and group membership on perceived stress are 0.55 and 0.62, respectively and the values of interactive test effect and group membership for the difficulties in emotion regulation subscales (non-accept, goals, impulse, strategies and clarity) are 0.46, 0.52, 0.44, 0.51, and 0.28, respectively. The test power is also at the high level. The results of variance analysis with repeated measures also indicate that MBCT has decreased patients' scores in the post-test with regard to mental ruminants (P≤0.01) and the difficulties in emotion regulation except the awareness subscale (P≤0.01) in three months’ follow-up and perceived stress (P≤0.01); also the difference between the experimental and control groups is statistically significant.

4. Discussion
Diabetes occurs when the glucose regulation system is disrupted in the body. Failure to adhere to treatment can lead to undesirable metabolic control in diabetes. These complications, in addition to imposing high economic costs on families and society, lead to many psychological problems such as anxiety, depression and stress. Different research studies have shown the success of mindfulness-based cognitive therapy in improving the physical and psychological conditions of these patients. The higher prevalence of depression in diabetic patients than in the normal population is associated with physical symptoms in this disorder. One of the important characteristics of depression is rumination. This treatment focuses on instantaneous awareness of thoughts, feelings, and physical states, and will lead to the discontinuation of the mental rumination chain and prevent the individual's focus on the past or the future. In addition, the use of yoga exercises, meditation techniques, and muscle relaxation in this treatment can reduce stress in patients. 
In this study, the stress scores of patients in post-test and follow-up stages show the effects of this treatment. Based on the results of various research studies, MBCT makes people flexible in developing different emotions during difficult situations. In the present study, the significant reduction of scores in “the difficulties in emotion regulation” has confirmed the previous results in this area. Finally, MBCT is effective in reducing the ruminative thoughts, perceived stress and the difficulties in emotion regulation in women with type 2 diabetes.

Ethical Considerations
Compliance with ethical guidelines

After explaining the research objectives for the patients, their consent was taken to participate in the research, and they were assured of the confidentiality of the information and the eligibility to participate in the research. 
This study is a registered clinical trial (code: IRCT2017071515754N2), and has been approved by the Ethics Committee of Islamic University of Bojnurd branch (code: IR.IAU.BOJNOURD.REC.1396.1). Written consent was obtained from all patients and they were assured of the confidentiality of their information.

This paper was extracted from a PhD. thesis prepared by the first author and approved by Department of Psychology at Islamic University of Bojnurd branch. 

Authors contributions
The authors contributions is as follows: Conceptualization, methodology, editing, and project administration: all authors; Validation, formal analysis, investigation, resource, drafting and Funding: Bibi Zohreh Razavizadeh Tabadkan; and supervision by Mahmoud Jajarmi and Yaghoob Vakili.

Conflict of interest
The authors declared no conflict of interest.

We are grateful to the Public Sports Committee of North Khorasan and all the patients who participated in this study.
Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2017/12/10 | Accepted: 2018/08/14 | Published: 2020/03/10

1. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, ShawJE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research and Clinical Practice. 2014; 103(2):137-49. [DOI:10.1016/j.diabres.2013.11.002] [PMID] [DOI:10.1016/j.diabres.2013.11.002]
2. World Health Organization. Global health estimates summary tables:projection of deaths by cause, age and sex. Geneva: World Health Organization; 2014.
3. Willis T. Pharmaceutice rationalis sive diatriba de medicamentorum oper-ationibus in humano corpore. Oxford: Theatro Sheldoniano; 2013.
4. Menninger WC. Psychological factors in the etiology of diabetes. The Journal of Nervous and Mental Disease. 1935; 81:1-13. [DOI:10.1097/00005053-193501000-00001] [DOI:10.1097/00005053-193501000-00001]
5. Morrow A. Stress and the dying process [Internet]. 2018 [Updated 2018 March 09]. Available from: https://www.verywellhealth.com/defining-stress-1132264
6. Moon HJ, Seo JG, Park SP. Perceived stress in patients with migraine: A case-control study. The Journal of Headache and Pain. 2017, 18(1):73. [DOI:10.1186/s10194-017-0780-8] [PMID] [PMCID] [DOI:10.1186/s10194-017-0780-8]
7. Pibernik Okanovic M, Peros K, Szabo S, Begic D, Metelko Z. Depression in Croatian type 2 diabetic patients: A Croatian survey from the European Depression in Diabetes (EDID) research consortim. Diabetic Medicine. 2005; 22(7):942-5. [DOI:10.1111/j.1464-5491.2005.01528.x] [PMID] [DOI:10.1111/j.1464-5491.2005.01528.x]
8. Nolen Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination. Perspectives of Psychological Science. 2008; 3(5):400-24. [DOI:10.1111/j.1745-6924.2008.00088.x] [PMID] [DOI:10.1111/j.1745-6924.2008.00088.x]
9. Nolen hokesema S, Davis CG. Thanks for sharing that; Ruminations and their support networks. Journal of Personality and Social Psychology. 1999; 77(4):801-14. [DOI:10.1037/0022-3514.77.4.801] [DOI:10.1037/0022-3514.77.4.801]
10. Wenzolf RM, Wehner DM. Thought suppression. Annual Review of Psychology. 2000; 51:59-91. [DOI:10.1146/annurev.psych.51.1.59] [DOI:10.1146/annurev.psych.51.1.59]
11. Fisher L, Skaff MM, Mullan JT, Arean P, Glasgow R, Masharani U. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabetic Medicine. 2008; 25(9):1096-101. [DOI:10.1111/j.1464-5491.2008.02533.x] [PMID] [PMCID] [DOI:10.1111/j.1464-5491.2008.02533.x]
12. Schram MT, Baan CA, Pouwer F. Depression and quality of life in patients with diabetes: A systematic review from the European Depression in Diabetes (EDID) research consortium. Current Diabetes Reviews. 2009; 5(2):112-21. [DOI:10.2174/157339909788166828] [PMID] [PMCID] [DOI:10.2174/157339909788166828]
13. Makine C, Karsidag C, Kadioglu P, Ilkova H, Karsidag K, Skovlund SE, et al. Symptoms of depression and diabetes-specific emotional distress are associatedwith a negative appraisal of insulin therapy in insulin-naive patients with type 2 diabetesmellitus. A study from the European Depression in Diabetes [EDID] research consortium. Diabetic Medicine. 2009; 26(1):28-33. [DOI:10.1111/j.1464-5491.2008.02606.x] [PMID] [DOI:10.1111/j.1464-5491.2008.02606.x]
14. Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: A meta-analytic review of the literature. Diabetes Care. 2000; 23(7):934-42. [DOI:10.2337/diacare.23.7.934] [DOI:10.2337/diacare.23.7.934]
15. Egede LE, Nietert PJ, Zheng D. Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care. 2005; 28(6):1339-45. [DOI:10.2337/diacare.28.6.1339] [DOI:10.2337/diacare.28.6.1339]
16. Van Dooren FE, Nefs G, Schram MT, Verhey FR, Denollet J, Pouwer F. Depression and risk of mortality in people with diabetes mellitus: A systematic review and metaanalysis. PLOS One. 2013; 8(3):e57058. [DOI:10.1371/journal.pone.0057058] [PMID] [PMCID] [DOI:10.1371/journal.pone.0057058]
17. Gross JJ, John OP. Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology. 2003; 85(2):348-62. [DOI:10.1037/0022-3514.85.2.348] [DOI:10.1037/0022-3514.85.2.348]
18. Leahy R, Napolitano LA, Tirch D. Emotion regulation in psychotherapy: A practitioner's guide. New York: Guilford Press; 2011.
19. Pollock NC, McCabe GA, Southard AC, Zeigler Hill V. Pathological personality traits and emotion regulation difficulties. Personality and Individual Differences. 2016; 95:168-77. [DOI:10.1016/j.paid.2016.02.049] [DOI:10.1016/j.paid.2016.02.049]
20. Gross JJ. The emerging field of emotion regulation: An integrative review. Review of General Psychology. 1998; 2(3):271-99. [DOI:10.1037/1089-2680.2.3.271] [DOI:10.1037/1089-2680.2.3.271]
21. Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, et al. Mindfulnessbased therapy: A comprehensive meta-analysis. Clinical Psychology Review. 2013; 33(6):763-71. [DOI:10.1016/j.cpr.2013.05.005] [PMID] [DOI:10.1016/j.cpr.2013.05.005]
22. Shapiro SL, Carlson LE, Astin JA, Freedman B. Mechanisms of mindfulness. Journal of Clinical Psychology. 2006; 62(3):373-86.[DOI:10.1002/jclp.20237] [PMID] [DOI:10.1002/jclp.20237]
23. Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York. Guilford Press; 2002.
24. Godfrin KA, van Heeringen C. The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: A randomized controlled study. Behaviour Research and Therapy. 2010; 48(8): 746-38. [DOI:10.1016/j.brat.2010.04.006] [PMID] [DOI:10.1016/j.brat.2010.04.006]
25. Mace C. Mindfulness and mental health. Abingdon: Routledge Press; 2008.
26. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist. 2000; 55(1):68-78. [DOI:10.1037/0003-066X.55.1.68] [PMID] [DOI:10.1037/0003-066X.55.1.68]
27. Siegal ZV, Williams JM, Teasdale J. Mindfulness-based cognitive therapy for depression. New York: Guilford Press; 2013.
28. Jafari D, Salehi M, Mohmmadkhani P. [Comparison of the effectiveness of mindfulness-based cognitive therapy and behavioral activation treatment for depression in reducing symptoms, improving quality of life and decreasing suicidal thoughts in depressed individuals (Persian)]. International Journal for Psychotherapy, Counseling & Psychiatry. 2015; 20(4):297-308.
29. Son J, Nyklíček I, Victor JP, Blonk MC, Erdtsieck RJ, Pouwer F. Mindfulness-based cognitive therapy for people with diabetes and emotional problems: Long-term follow-up findings from the DiaMind randomized controlled trial. Journal of Psychosomatic Research. 2014; 77(1):81-4. [DOI:10.1016/j.jpsychores.2014.03.013] [PMID]
30. Haenen S, Nyklíček I, Son JV, Pop V, Pouwer F. Mindfulness facets as differential mediators of short and long-term effects of mindfulness-based cognitive therapy in diabetes outpatients: Findings from the diamind randomized trial. Journal of Psychosomatic Research. 2016; 85:50-44. [DOI:10.1016/j.jpsychores.2016.04.006] [PMID] [DOI:10.1016/j.jpsychores.2016.04.006]
31. Nyklíček I, van Son J, Pop VJ, Denollet J, Pouwer F. Does mindfulness-based cognitive therapy benefit all people with diabetes and comorbid emotional complaints equally? moderators in the DiaMind trial. Journal of Psychosomatic Research. 2016; 91:40-7.[DOI:10.1016/j.jpsychores.2016.10.009] [DOI:10.1016/j.jpsychores.2016.10.009]
32. Petrocchi N, Ottaviani C. Mindfulness facets distinctively predict depressive symptoms after two years: The mediating role of rumination. Personality and Individual Differences. 2016; 93:92-6.[DOI:10.1016/j.paid.2015.08.017] [DOI:10.1016/j.paid.2015.08.017]
33. Mohamadi J, Mir Drikvand F, Azizi A. [Efficacy of mindfulness on anxiety and depression in patients with irritable bowel syndrome (Persian)]. Journal of Mazandaran University of Medical Sciences. 2015; 25(130):52-61.
34. Melyani M, Alahyari AA, Azadfallah P, Fathi Ashtiani A, tavoli A. [Miulness based cognitive therapy versus cognitive behavioral therapy on predictors of relapse in recurent depression (Persian)]. Journal of Clinical Psychology. 2014; 2 (10), 86-75.
35. Paul NA, Stanton SJ, Greeson JM, Smoski MJ, Wang L. Psychological and neural mechanisms of trait mindfulness in reducing depression vulnerability. Social Cognitive and Affective Neuroscience. 2013; 8(1):56-64. [DOI:10.1093/scan/nss070] [PMID] [PMCID] [DOI:10.1093/scan/nss070]
36. Dimidjian S, Beck A, Felder JN, Boggs JM, Gallop R, Segal Z. Web-based mindfulness-based cognitive therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls.Behaviour Research and Therapy. 2014; 63:83-9. [DOI:10.1016/j.brat.2014.09.004] [PMID] [PMCID] [DOI:10.1016/j.brat.2014.09.004]
37. Feili AR, Borjali A, Sohrabi F, Farrokhi N. [The cognitive-behavior therapy and teasdale mindfulnessbased cognitive therapy of infertile depressed women's rumination (Persian)]. Yasuj University of Medical Sciences Journal. 2012; 17(1):14-21.
38. Sattarpour F, Ahmadi E, Sadegzadeh S. [Effect of mindfulness training on reduction of depressive symptoms among students (Persian)]. Journal of Gorgan University of Medical Sciences. 2015; 17(3):81-8.
39. Kharatzadeh H, Davazdah Emamy MH, Bakhtiary M, Kachuei A, Mahaki B. [Effectiveness of mindfulness based stress reduction on glycemic control, stress, anxiety and depression in patients with type 2 diabetes mellitus (Persian)]. The Journal of Urmia University Medical Sciences. 2017; 28(3):206-14.
40. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. Journal of Alternative and Complementary Medicine. 2009; 15(5):593-600. [DOI:10.1089/acm.2008.0495] [PMID] [DOI:10.1089/acm.2008.0495]
41. Khoury B, Sharma M, Rush S, Fournier C. Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research. 2015; 78(6):519-28. [DOI:10.1016/j.jpsychores.2015.03.009] [PMID] [DOI:10.1016/j.jpsychores.2015.03.009]
42. Praissman S. Mindfulness-based stress reduction: A literature review and clinician's guide. Journal of the American Academy of Nurse Practitioners. 2008; 20(4): 212-6. [DOI:10.1111/j.1745-7599.2008.00306.x] [PMID] [DOI:10.1111/j.1745-7599.2008.00306.x]
43. Young LA, Cappola AR, Baime MJ. Mindfulness based stress reduction: Effect on emotional distress in diabetes. Practical Diabetes International. 2009; 26(6):222-4 [DOI:10.1002/pdi.1380] [PMID] [PMCID] [DOI:10.1002/pdi.1380]
44. Vala M, Razmandeh R, Rambod K, Nasli Esfahani E, Ghodsi Ghasemabadi R. [Mindfulness-based stress reduction group training on depression, anxiety, stress, self-confidence and hemoglobin a1c in young women with type 2 diabetes (Persian)]. Iranian Journal of Endocrinology and Metabolism. 2015; 17(5):382-421.
45. Mauer CB, Johnson LA, Schrimsher GW, O'Bryant SE. Diabetes Diagnosis is related to anxiety among mexican americans but not non- hispanic adults: A project FRONTER study. Journal of Depression and Anxiety. 2012; 1:101-7. [DOI:10.4172/2167-1044.1000107] [DOI:10.4172/2167-1044.1000107]
46. Nyklíček I, Kuijpers KF. Effects of mindfulness-based stress reduction interventionon psychological well-being and quality of life: is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine. 2008; 35(3):331-40. [DOI:10.1007/s12160-008-9030-2] [PMID] [PMCID] [DOI:10.1007/s12160-008-9030-2]
47. Shapiro SL, Oman D, Thoresen CE, Plante TG, Flinders T. Cultivating mindfulness: Effects on well-being. Journal of Clinical Psychology. 2008; 64(7):840-62. [DOI:10.1002/jclp.20491] [PMID] [DOI:10.1002/jclp.20491]
48. Mimura C. Griffiths P. A Japanese version of the perceived stress scale: Translation and preliminary test. International Journal of Nursing Studies. 2004; 41(4):379-85. [DOI:10.1016/j.ijnurstu.2003.10.009] [PMID] [DOI:10.1016/j.ijnurstu.2003.10.009]
49. Hartmann M, Kopf S, Kircher C, Faude-Lang V, Djuric Z, Augstein F, et al. Sustained effects of a mindfulness-based stress-reduction intervention in type 2 diabetic patients: design and first results of a randomized controlled trial (the Heidelberger Diabetes and Stress-study). Diabetes Care. 2012; 35:945-947. [DOI:10.2337/dc11-1343] [DOI:10.2337/dc11-1343]
50. Hofmann S, Sawyer A, Witt A, Oh D. The effect of mindfulness- based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology. 2010; 78(10):169-83. [DOI:10.1037/a0018555] [PMID] [PMCID] [DOI:10.1037/a0018555]
51. Mehrinejad SA, Ramezan Saatchi L. [Impact of mindfulness-based cognitive therapy on depression, anger and emotion regulation of veterans' spouses (Persian)]. Iranian Journal of Public Health. 2016; 8(3):141-8.
52. Kiani B, Hadianfard H. [The impact of therapy based on mindfulness meditation training on emotion dysregulation in subclinical ADHD adolescents (Persian)]. Journal of School Psychology. 2016; 5(1):118-38.
53. Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice. 2003; 10(2):125-43. [DOI:10.1093/clipsy.bpg015] [DOI:10.1093/clipsy.bpg015]
54. Hofmann SG, Grossman P, Hinton DE. Loving-kindness and compassion meditation: Potential for psychological interventions. Clinical Psychology Review. 2011; 31(7):1126–32. [DOI:10.1016/j.cpr.2011.07.003] [PMID] [PMCID] [DOI:10.1016/j.cpr.2011.07.003]
55. Edenfield TM, Saeed SA. An update on mindfulness meditation as a self help treatment for anxiety and depression. Psychology Research and Behavior Management. 2012; 5:131-41. [DOI:10.2147/PRBM.S34937] [PMID] [PMCID] [DOI:10.2147/PRBM.S34937]
56. Raes F, Dewulf D, Van Heeringen C, Williams JM. Mindfulness and reduced cognitive reactivity to sad mood: Evidence from a correlational study and a non-randomized waiting list controlled study. Behaviour Research and Therapy. 2009; 47(7):623-7. [DOI:10.1016/j.brat.2009.03.007] [PMID] [DOI:10.1016/j.brat.2009.03.007]
57. Rosenzweig S, Reibel DK, Greeson JM, Edman JS, Jasser SA, McMearty KD, et al. Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: A pilot study. Alternative Therapies In Health And Medicine. 2007; 13(3):36-8. [PMID] [PMID]
58. Delavar A. [Theoretical & practical basics of research in human & social sciences (Persian)]. Tehran: Roshd Publication; 1996.
59. Bieling PJ, McCabe RE, Antony MM. Cognitive-behavioral therapy in groups. New York: Gilford Press; 2006.
60. Kabat Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice. 2003; 10(2):144-56. [DOI:10.1093/clipsy.bpg016] [DOI:10.1093/clipsy.bpg016]
61. Mohammad khani P, Jokar M, Jahanitabesh O, Tamanaefar Sh. [Clinical structured interview for DSMIV-TR disorders (Persian)]. Tehran: Welfare and Rehabilitation Sciences; 2011.
62. Nolen Hoeksema S, Marrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology. 1991; 61(1):115-21. [DOI:10.1037/0022-3514.61.1.115] [DOI:10.1037/0022-3514.61.1.115]
63. Papageorigiou C, Wells A. Meta-cognative beliefs about rumination in recurrent major depression. Cognitive and Behavioral Practice. 2001; 8(2):160-4. [DOI:10.1016/S1077-7229(01)80021-3]
64. Farnam A, Bakhshipour Roodsari A, Mazsouri A, Mahmood Aliloo M. [The Comparison of rumination in patients with major depression disorder, obsessive- compulsive disorder, generalized anxiety disorder and normal individuals (Persian)]. Journal of Sabzevar University of Medical Sciences. 2010; 17(3):189-95.
65. Chohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of Health and Social Behavior. 1983; 24(4):385-96. [DOI:10.2307/2136404] [DOI:10.2307/2136404]
66. Yazdi A, Salehi Fedri J. [A survey attributional style and perceived stress (Persian)]. Mashhad: Ferdowsi University of Mashhad; 2009.
67. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment. 2004; 26(1):41-54. [DOI:10.1023/B:JOBA.0000007455.08539.94] [DOI:10.1023/B:JOBA.0000007455.08539.94]
68. Alavi K, Modarres Gharavi M, Amin Yazdi SA, Salehi Fadardi J. [Effectiveness of group dialectical behavior therapy (based on core mindfulness, distress tolerance and emotion regulation components) on depressive symptoms in

Add your comments about this article : Your username or Email:

Send email to the article author

© 2020 All Rights Reserved | Iranian Journal of Psychiatry and Clinical Psychology

Designed & Developed by : Yektaweb