Introduction
Cerebral palsy is a chronic condition that occurs due to damage or disruption in the developing parts of the brain. This injury occurs more often from birth, during birth, or in the early years of childhood. This creates significant challenges for families, especially mothers. Constant caring for a child with cerebral palsy can lead to significant stress. Rumination, as a negative and persistent thought pattern, and resilience, as the ability to cope with difficulties and return to a state of mental balance, are two key factors in determining the mental health of the mothers of children with cerebral palsy. In recent years, increasing attention has been paid to the role of spirituality in promoting mental health and resilience. Spiritual therapy can help mothers find meaning in the experience and suffering of caring for a child with cerebral palsy. This study aims to determine the effect of spiritual therapy on rumination and resilience of mothers of children with cerebral palsy.

Methods
This is a quasi-experimental study with a pre-test/post-test design, which was conducted on 60 mothers of children with cerebral palsy referred to Imam Ali Hospital in Zahedan, south of Iran, in 2024. The inclusion criteria were having at least one child with cerebral palsy and at least one year of age, living with their parents since birth, and the willingness to cooperate (physically and mentally). Exclusion criteria were absence from more than one spiritual therapy session and death or illness of the child. The participants were randomly divided into intervention and control groups (30 people in each group). The intervention group participated in 8 one-hour sessions of spiritual therapy in the conference room of Imam Ali Hospital. The data collection tools were Nolen-Hoeksema and Morrow’s ruminative response scale (RRS) and the Connor-Davidson resilience scale (CD-RISC). Questionnaires were completed by mothers before and one month after the end of the intervention. Data were analyzed in SPSS software, version 27 using the chi-square test, paired t-test, and independent t-test.

Results 
The two groups were not significantly different in terms of age, child’s age, marital status, place of residence, ethnicity, and economic status (P>0.05). Most of the mothers were housewives living in urban areas. One month after the intervention, the mean RRS score was 43.73±8.25 in the intervention group and 54.23±6.86 in the control group (Table 1).


The independent t-test results showed that this difference was statistically significant (P<0.001). Also, the CD-RISC score one month after the intervention was 53.53±2.38 in the intervention group and 45.01±3.98 in the control group, which was significantly different (P<0.001). The difference between the pre-test and post-test scores of RRS and CD-RISC in the intervention group was statistically significant (P<0.001), but it was not significant in the control group (P>0.05). Also, after the intervention, there was a statistically significant difference between the two groups in all domains of RRS (depression, brooding, reflection) and CD-RISC; the mothers in the intervention group achieved higher scores in CD-RISC and its domains and lower scores in RRS and its dimensions compared to the control group.

Conclusion
The spiritual therapy can significantly affect rumination and resilience of mothers of children with cerebral palsy living in Zahedan, south of Iran. It can help increase their resilience and reduce their rumination. It is recommended to conduct similar research in other cities of Iran to increase the generalizability of the data.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Zahedan University of Medical Sciences (Ethics Code: IR.ZAUMS.REC.1403.265), and written informed consent was obtained from all participants prior to their inclusion in the study.

Funding
This article was extracted from a research project (Grand No. 11444) at Zahedan University of Medical Sciences. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors contributions
Conceptualization, Investigation, Visualization, Writing original draft: Samaneh Falah Karimi, Leila Mohammadi Fard; Methodology, resources, Review & Editing: Zahra Khalilzadeh Farsangi, Nasrin Mahmoudi; Validation: Leila Mohammadi Fard, Nasrin Mahmoudi; Data Analysis: Zahra Khalilzadeh Farsangi, Samaneh Falah Karimi; Supervision: Nasrin Mahmoudi; Project Administration: Zahra Khalilzadeh Farsangi.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all children and mothers who participated in this study for their cooperation.

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