Introduction
Psychosomatic disorders are a set of disorders that are created due to mental pressure, tension, and chronic stress. These disorders occur in different forms in any person at any age and situation, but it is usually more common in people aged 20-45 years. The patients feel unpleasant pains in the body, which are called psychosomatic pains. Migraine, as the most common psychosomatic pain, occurs in the form of recurring, throbbing, and often one-sided headache attacks for 4-72 hours. According to the World Health Organization (WHO), this disorder is one of the 20 debilitating disorders; its one-year prevalence is more than 10%, about 15% for women and 6% for men. The causes of migraine can be psychological factors; the accurate identification of the effect of these factors on migraine can help improve the physical, mental and social health of affected people.  
Cognitive emotion regulation strategies is a set of mental and conscious methods that people use to maintain and control emotions and increase the experience or expression of their feelings in order to achieve goals.  Emotion-regulatory behavior manifests externally before the occurrence of emotion and plays an important role in the adaptation of individuals to stressful events.  According to Garnefski et al., nine cognitive emotion regulation strategies are divided into two groups of maladaptive strategies (self-blame, rumination, catastrophizing, and blaming others) and adaptive strategies (acceptance, positive refocusing, refocusing on planning, putting into perspective, and positive reappraisal). Due to the fact that people with migraines are often anxious and that the onset of headaches in them is often associated with the experience of negative emotional states such as anger, it seems that these people use less positive strategies for regulating their emotions.  Positive emotion regulation using effective strategies such as re-reappraisal can increase the positive perception of pain, reduce its severity, and subsequently improve the quality of life. Mindfulness-based cognitive therapy (MBCT) is a standard technique that combines mindfulness training, patient education, and group support. It is an eight-week evidence-based program that is used to help treat people with stress, anxiety, depression, and pain.  
Migraine can disrupt women’s performance in life and need to be addressed.  if left untreated, it can affect their efficiency and prevent them from fulfilling their duties and responsibilities which can cause problems for the family members and endanger the general health of the society. Therefore, this study aims to examine whether MBCT is effective in the cognitive emotion regulation, migraine severity, and the stress coping styles of women with migraine.

Methods
This is a quasi-experimental study. The study population consisted of all women suffering from migraine who referred to neurologists in Khorramabad city in 2022. Of these, 32 were selected by a convenience sampling method and randomly divided into two groups of intervention (n=16) and control (n=16). To collect data, the cognitive emotion regulation questionnaire, Najarian’s psychosomatic symptoms of migraine questionnaire, and the stress coping styles questionnaire of Billings and Moss (1981) were used.

Results
According to the results in Table 1, MBCT had a significant effect on at least one of the variables (F=14.406, P<0.01) in woman with migraine.


Therefore, the null hypothesis is rejected and the research hypothesis is confirmed. Based on the results, MBCT was effective in increasing the cognitive emotion regulation ability, reducing the severity of migraine symptoms, and improving stress coping styles of women with migraine.

Conclusion
The results of this study showed that the MBCT had a significant effect on cognitive emotion regulation, psychosomatic symptoms severity of migraine, and stress coping styles in women with migraine. MBCT had an effect in these women through two processes, avoiding unpleasant emotions and symptoms and accepting the experience of negative emotions. It prevents women to avoid unpleasant thoughts and feelings and help them tolerate them.  

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Lorestan University of Medical Sciences (Code: IR.LUMS.REC.1401.172), and was registered at Iranian Registry of Clinical Trials (Code: IRCT20221218056852N1).

Funding
This research financially supported by Nasser Khosrow Institute of Higher Education.

Authors contributions
Conceptualizatio, Research, review, Editing and Finalization: Ameneh Shahverdi; Supervision: Maboud Omidi and Maryam Mousavinik.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank the neurologists for referring the  women with migraine to participate in the study, and the participants for corporation in the study.

References

1. Satsangi AK, Brugnoli MP. Anxiety and psychosomatic symptoms in palliative care: From neuro-psychobiological response to stress, to symptoms’ management with clinical hypnosis and meditative states. Annals of Palliative Medicine. 2018; 7(1):75-111. [DOI:10.21037/apm.2017.07.01] [PMID]
2. Baldacci F, Lucchesi C, Cafalli M, Poletti M, Ulivi M, Vedovello M, et al. Migraine features in migraineurs with and without anxiety-depression symptoms: A hospital-based study. Clinical Neurology and Neurosurgery. 2015; 132:74-8. [DOI:10.1016/j.clineuro.2015.02.017] [PMID]
3. Lim AP, Loo JK, Lee PH. The impact of leadership on turnover intention: The mediating role of organizational commitment and job satisfaction. Journal of Applied Structural Equation Modeling. 2017 ; 1(1):27-41. [DOI:10.47263/JASEM.1(1)04]
4. Fortes LD, Cipriani F, Almeida SD, Ferreira ME. Eating disorder symptoms: Association with perfectionism traits in male adolescents. Archives of Clinical Psychiatry (São Paulo). 2014; 41(5):117-20. [DOI:10.1590/0101-60830000000024]
5. Ravat S, Olivier B, Gillion N, Lewis F. Laterality judgment performance between people with chronic pain and pain-free individuals. A systematic review and meta-analysis. Physiotherapy Theory and Practice. 2020; 36(12):1279-99. [DOI:10.1080/09593985.2019.1570575] [PMID]
6. Ilbeigy Ghale Nei R, Rostami M. [Role of honesty-humility, emotionality, extraversion, agreeableness, ‎conscientiousness and openness to experience personality ‎dimensions, emotion regulation and stress coping strategies in ‎predicting the quality of life in migraine peoples (Persian)]. Journal of Mazandaran University of Medical Sciences. 2014; 24 (112):67-76. [Link]
7. Extremera N, Quintana-Orts C, Sánchez-Álvarez N, Rey L. The role of cognitive emotion regulation strategies on problematic smartphone use: Comparison between problematic and non-problematic adolescent users. International Journal of Environmental Research and Public Health. 2019; 16(17):3142. [DOI:10.3390/ijerph16173142] [PMID] [PMCID]
8. Balzarotti S, Biassoni F, Villani D, Prunas A, Velotti P. Individual differences in cognitive emotion regulation: Implications for subjective and psychological well-being. Journal of Happiness Studies. 2016; 17:125-43. [Link]
9. Tamir M. Why do people regulate their emotions? A taxonomy of motives in emotion regulation. Personality and Social Psychology Review. 2016; 20(3):199-222. [DOI:10.1177/1088868315586325] [PMID]
10. Nakagawa T, Gondo Y, Ishioka Y, Masui Y. Age, emotion regulation, and affect in adulthood. The mediating role of cognitive reappraisal. Japanese Psychological Research. 2017; 59(4):301-8. [DOI:10.1111/jpr.12159]
11. Victor SE, Klonsky ED. Validation of a brief version of the difficulties in emotion regulation scale (DERS-18) in five samples. Journal of Psychopathology and Behavioral Assessment. 2016; 38:582-9. [Link]
12. Arabi E, Bagheri M. [The mediating role of emotion regulation strategies on the relationship between pain intensity and quality of life in patients with chronic pain disorder (Persian)]. Quarterly journal of health psychology. 2017; 6(22):72-87. [Link]

13. Svendsen JL, Osnes B, Binder PE, Dundas I, Visted E, Nordby H, et al. Trait self-compassion reflects emotional flexibility through an association with high vagally mediated heart rate variability. Mindfulness. 2016; 7(5):1103-13. [DOI:10.1007/s12671-016-0549-1] [PMID] [PMCID]
14. Gadzella BM, Baloglu M. Confirmatory factor analysis and internal consistency of the Student-life Stress Inventory. Journal of Instructional Psychology. 2001; 28(2):84-94. [Link]
15. Mason AE, Epel ES, Kristeller J, Moran PJ, Dallman M, Lustig RH, et al. Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: Data from the SHINE randomized controlled trial. Journal of Behavioral Medicine. 2016; 39(2):201-13. [DOI:10.1007/s10865-015-9692-8] [PMID] [PMCID]
16. Lazarus RS. Psychological stress and the coping process. New York: McGraw-Hill; 1966. [Link]
17. MacBeth A, Gumley A. Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review. 2012; 32(6):545-52. [DOI:10.1016/j.cpr.2012.06.003] [PMID]
18. Rezaei Dogaheh E, Yoosefi A, Kami M. Comparison of maladaptive coping styles in patients with migraine and tension headaches with normal group. Practice in Clinical Psychology. 2014; 2(3):211-9. [Link]
19. Kabat-Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice. 2003; 10(2):144–56. [Link]
20. Mohammadpour S, Shahi M, Tajikzadeh F. [The effect of mindfulness-based cognitive therapy on the psychological well- being, hope, core self evaluations among epileptic patients (Persian)]. Clinical Psychology and Personality. 2019; 15(2):37-50. [DOI:10.22070/CPAP.2020.2815]
21. Razavizadeh Tabadkan BB, 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 (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2019; 24(4):370-83. [DOI:10.32598/ijpcp.24.4.370]
22. Tickell A, Ball S, Bernard P, Kuyken W, Marx R, Pack S, et al. The effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in real-world healthcare services. Mindfulness. 2020; 11(2):279-90. [DOI:10.1007/s12671-018-1087-9] [PMID] [PMCID]
23. Mansouri koryani R , Bassak Nrjad S, Mehrabizadeh Honarmand M, Majdinasab N [Effectiveness of compassion focused acceptance and commitment therapy on psychological flexibility and psychological distress in patiants with multiple sclcrosis (persion)].Iranian Journal of Psychiatry and Clinical Psychology. 2023; 29(3):222-35. [DOI:10.32598/ijpcp.28.2.3747.1]
24. Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences. 2001; 30(8):1311-27. [DOI:10.1016/S0191-8869(00)00113-6]
25. Basharat MA, Bazazian S. [Examining the psychometric characteristics of the emotion regulation questionnaire in a sample of Iranian society (Persian)]. Journal of Nursing and Midwifery. 2013; 24(84):61-70. [Link]

26. Najarian B. [Construction and Validation of a Questionnaire for measuring symptoms of migraine headache in undergraduate students (Persian)]. Journal of Educational Sciences. 1997; 4(2):30-43. [Link]
27. Zonozian S, Gharaie B, Yekkeyazdandost R. [Efficacy of problem solving training in changing coping strategies of university students (Persian)]. The Quarterly Journal of Modern Psychological Researches . 2011; 5(20):83-101. [Link]
28. Bowen S, Chawla N, Marlatt GA. Mindfulness-based relapse prevention for addictive behaviors: A clinician›s guide. New York: Guilford Publications; 2021. [Link]
29. Erfan A, Aghaei A, Golparvar M. [Comparison of the effect of mindfulness based cognitive therapy and Iranian-Islamic positive therapy on pain catastrophizing and severity symptoms in women with irritable bowel syndrome (Persian)]. Daneshvar Medicine. 2021; 29(3):42-56. [Link]
30. Hosseini Z, Ahmadi T, Mami Sh. [The effectiveness of mindfulness-based cognitive therapy in improving happiness and cognitive emotion regulation strategies in male methamphetamine users (Persian)]. Applied Family Therapy. 2021; 2(1):177-99. [Link]
31. Sanagovi Mohrar G, Kehrazai F, Shirazi M, Maqsoodlou F, Mohammadi R. [The effectiveness of mindfulness-based cognitive therapy on stress coping styles and depression in patients with MS (Persian)] . Medical  Journal of Mashhad University of Medical Sciences. 2019; 62(3):1574-86. [DOI:10.22038/MJMS.2019.17406]
32. Pirkhafi A, Rozbahani M, Rastgoo SS. [Effectiveness of Mindfulness-Based Cognitive-Therapy on somatic symptoms in patients with irritable bowel syndrome (Persian)]. Health Psychology Quarterly. 2019; 7(28):52-66. [DOI:10.30473/hpj.2019.38550.3907]
33. Khosh Khati N, Amiri Majd M, Bazazian S, Yazdinejad A. [The effectiveness of mindfullness-based cognitive therapy on pain intensity of renal patients under hemodialysis (Persian)]. Anesthesia and Pain. 2020; 11(1):1-13. [Link]
34. Rocky S, Naderi F. [Effectiveness of mind-fullness based cognitive therapy on emotional cognitive regulation, resiliency and competitive anxiety in female athletes (Persian)]. Iranian Journal of Psychiatric Nursing. 2019; 6(6):18-26. [Link]
35. Jones DR, Lehman BJ, Noriega A, Dinnel DL. The effects of a short-term mindfulness meditation intervention on coping flexibility. Anxiety, Stress, & Coping. 2019; 32(4):347-61. [DOI:10.1080/10615806.2019.1596672] [PMID] [PMCID]
36. Guendelman S, Medeiros S, Rampes H. Mindfulness and emotion regulation: Insights from neurobiolog, psychological, and clinical studies. Frontiers in Psychology. 2017; 8:220. [DOI:10.3389/fpsyg.2017.00220] [PMID] [PMCID]