Psychometric Properties of the Iranian Version of the Invalidating Childhood Environment Scale.

Objective: To understand the consequences of an invalidating environment, it is essential to have a measurement tool with appropriate statistical properties. Thus, the primary aim of this study was to render the ICES (Invalidating Childhood Environment Scale) into Persian and subsequently evaluate the psychometric attributes of this translated version. Method : Data were collected from 1221 nonclinical participants, including 1053 females and 168 males, who were students at medical universities in Tehran, Iran. Several questionnaires, such as the ICES, CTQ (Childhood Trauma Questionnaire), DTS (Distress Tolerance Scale), BIS-11 (Barratt Impulsiveness Scale), Self-Compassion Questionnaire, Dutch Eating Behavior Questionnaire, and EAT-26 (Eating AttitudesTest) were used in the study. The data sets were investigated through SPSS and R language to evaluate the ICES' reliability and construct validity. Additionally, Item Response Theory (IRT) was employed with the Graded Response Model (GRM) to measure the psychometric properties of each item in terms of difficulty and discrimination parameters. Results: Confirmatory factor analysis indicated that both single-factor and two-factor models fit well for both maternal and paternal versions of the ICES. The internal consistency, as assessed by Cronbach's alpha, was high and satisfactory for both maternal (0.87) and paternal (0.87) versions. Notably, the IRT analysis revealed that item 9 performed poorly in both maternal and paternal versions. Compared to the one-factor model, the two-factor model demonstrated a superior fit. Additionally, the test-retest reliability of the ICES over two months demonstrated good reliability for both maternal and paternal versions (0.98). Divergent and convergent validity analysis revealed a significant negative relationship between childhood invalidation environment and distress tolerance (r = 0.175, P < 0.01) as well as self-compassion (r = 0.142, P < 0.01), which were inversely related to the ICES. Furthermore, there was a considerably positive correlation between the invalidating environment experienced during childhood and impulsivity, as evidenced by r = 0.196 and P < 0.01. Conclusion: This study established the favorable psychometric properties of the Persian version of the ICES, indicating that this version is reliable and valid to assess the Invalidating Childhood Environment in the Iranian population. However, further investigations are warranted to reevaluate its validity and reliability.

Psychometric Evaluation of a Persian Version of Beliefs about Emotions Scale in Community and Clinical Samples.

Objective: This research is primarily conducted to determine the psychometric properties of the Beliefs about Emotions Scale (BES) in community and clinical samples. The BES is a scale measure used for evaluating individuals' beliefs in terms of how acceptable it is for them to experience and express their emotions. Method : This study was conducted on two separate samples. In the first part, 300 individuals were selected from a general sample in Tehran using the quota sampling method. For the second part of the study, we used purposive sampling to gather data from 119 patients suffering from Major Depressive Disorder (MDD) and 121 patients from Somatic Symptoms Disorder (SSD), whose disorders were diagnosed based on the DSM-5 diagnostic criteria. The BES structural validity was examined through Confirmatory Factor Analysis (CFA). Additionally, test-retest composite and internal consistency indices were explored to investigate the reliability of the BES score. Finally, the associations of the BES score with the Hospital Anxiety and Depression Scale (HADS), Young Schema Questionnaire (YSQ), Multidimensional Perfectionism Scale (MPS), Difficulties in Emotion Regulation Scale (DERS), and Emotion Regulation Questionnaire (ERQ) scores were highlighted to investigate the discriminant and convergent validity of the BES score. Results: According to CFAs, the one-factor model for the BES demonstrated a good fit with the data collected from both the clinical and community samples. The internal consistency (Cronbach's alpha) was satisfactory in the community sample (α = 0.84) and the clinical samples of SSD (α = 0.86) and MDD (α = 0.83). The community sample demonstrated high overall test-retest reliability (ICC = 0.93, P < 0.001; 95% CI: 0.89 - 0.95). In terms of convergent validity, the findings confirmed that in the MMD sample, there was a significant relationship between the BES and almost all measures (including Depression (r = 0.39, P < 0.01), Anxiety (r = 0.21, P < 0.05), Self-Sacrifice (r = 0.27, P < 0.01), MPS-total score (r = 0.22, P < 0.05), DERS total score (r = 0.50, P < 0.01), and Suppression (r = 0.38, P < 0.01). However, in the SSD group, this finding was not found. Conclusion: The results demonstrated that the Persian BES is a reliable and valid scale of maladaptive beliefs about emotions which could be implemented for both clinical and research aims.

Psychometric properties of the Persian version of the somatic symptom disorder-B Criteria Scale (SSD-12) in community and clinical samples.

OBJECTIVE: In the DSM-5's diagnostic criteria of somatic symptom disorders (SSD), the presence of psychological problems (i.e., excessive thoughts, feelings, or behaviors) is emphasized more than the absence of the medical causes of patients' bothersome symptoms. In this regard, the Somatic Symptom Disorder-B Criteria Scale (SSD-12) is a screening tool for assessing these psychological features in somatic symptom disorder. This study aimed to validate the Persian version of SSD-12 in the Iranian community (non-clinical) and clinical samples. METHODS: Data was gathered from 291 individuals in a community sample (aged 18 to 54, M-age = 36.62, SD = 10.56, 79.7% females) and from clinical setting, including 118 patients diagnosed with major depressive disorder (MDD, aged 18 to 60, M-age = 36.52, SD = 11.39, 75.8% females) and 120 patients diagnosed with somatic symptom disorders (aged 18 to 60, M-age = 35.17, SD = 8.77, 73.7% females). To assess the convergent validity of SSD-12 in the clinical samples, participants were asked to complete measures assessing anxiety, depression, somatic symptoms, health anxiety, and emotional regulation. RESULTS: Confirmatory Factor Analyses (CFAs) showed that the three-factor model of the SSD-12 reached acceptable fit in the community and clinical samples and yielded excellent internal consistency across the samples. Also, test-retest reliability analysis results were good in the community sample. Convergent validity could be shown in the clinical samples. A cut-off score greater than 14 was in the optimal state with a sensitivity of 70.83 and a specificity of 70.07. CONCLUSION: The current study provides evidence on the factor structure, reliability, and validity of the Persian SSD-12 in the Iranian community and clinical samples. A sum score of 14 can be recommended as the cut-off point. Further studies are needed to assess SSD-12 in different clinical populations and larger samples.

The Relation between Maternal Personality and Internalizing/ Externalizing Behaviors: Mediating Role of Maternal Alexithymia, Children's Alexithymia and Emotional Regulation.

Objective: Although many studies have investigated the effect of maternal personality on internalizing and externalizing behaviors of a child, the role of both mother and child's emotional mechanisms in these behaviors is little explored. The present study was focused on the relationship between the mother's personality, and internalizing and externalizing behaviors of children with the mediating role of children's alexithymia, mother's alexithymia, and children's emotion regulation (ER). Method: 162 mothers and elementary school-aged children were recruited regarding their demographics and completed the NEO personality inventory, Child behavior checklist, Toronto alexithymia scale, Children's alexithymia measure, and Children's emotion regulation checklist. Data were analyzed using SPSS (ver.23), and AMOS (ver.23). Results: Structural equations modeling demonstrated an acceptable model fit to data (CMIN/DF = 1.233, RSME = 0.038, GFI = 0.962). Mother's alexithymia predicted internalizing problems whereas it didn't predict externalizing problems in children. Also, the bootstrap results indicated that the mother and children's alexithymia and children's ER had mediating roles between mother's personality and externalizing and internalizing problems. Conclusion: The present results demonstrated that mother's personality can indirectly, through mother and children's alexithymia and children's ER act as an important factor in development of mental problems. In other words, findings indicated that children's emotional development is not a one-way road, but it is a mutual process that involves both the mother and the child.

Emotion regulation therapy for social anxiety disorder: a single case series study.

BACKGROUND: Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present. AIMS: It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap. METHOD: Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen's d) and percentage of improvement. RESULTS: SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables. CONCLUSION: These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.

Unified Protocol for Transdiagnostic Prevention of Depression and Anxiety in Iranian Adolescents: Protocol Development and Initial Outcome Data.

Objective: Cognitive-behavioral interventions have been used as effective approaches for the treatment and prevention of depression and anxiety. However, to date, no anxiety and depression prevention guidelines package has been developed for Iranian adolescents. Thus, the purpose of this study was to develop transdiagnostic prevention program of anxiety and depression for Iranian adolescents and to assess the effectiveness of this program in a sample of adolescents. Method : Based on evidence-based literatures on CBT interventions, transdiagnostic prevention program was developed and its content and face validity was assessed and established by three clinical psychologies (Ph.D.) and a psychiatrist (child and adolescent postdoctoral). Then, in a semi-experimental design, 62 students were recruited from a school in Tehran by purposive sampling method and were randomly assigned in to experimental (n = 40) and control (n = 22) groups. They participated in 8 sessions of intervention based on the developed program. Revised Child Anxiety and Depression Scale (RCADS)- Child Version and Parent Version- were used to gather the data before, after, and 3 months after intervention. Results: Results of ANCOVA, controlling for the effect of pretest score, showed no significant differences (P>0.05) between experimental and control groups in SAD, panic, MDD, separation anxiety, GAD, OCD, total anxiety, and total anxiety-depression for parent and child in pretest and posttest. Conclusion: Transdiagnostic prevention package for anxiety and depression had no significant effect on reducing anxiety and depression of adolescents. Using an inappropriate measure, difficulties with timing of assessment, and lower severity of pre-intervention anxiety and depression due to universal prevention and sample recruited, might have affected the present findings. Discussion would be clearer and more complete by analyzing follow-up results and education performance in the future.

Cultural Aspects of Social Anxiety Disorder: A Qualitative Analysis of Anxiety Experiences and Interpretation.

Objective: Anxiety is a complex phenomenon on which culture has a prominent influence. The present study aimed to investigate the cultural aspects of social anxiety disorder (SAD) in an Iranian population. Method : A qualitative content analysis research was done to answer the study question. A total of 16 individuals with social anxiety disorder (six men and 10 women) were selected using purposeful sampling method (M = 24.43, SD = 4.56). The study was conducted in Tehran, Urmia, and Sanandaj- Iran. Participants were from different ethnic backgrounds (LOR, FARS, TURK, and KURD). Data were analyzed by thematic analysis using an inductive method. Results: Analysis of participants' records yielded five distinct categories with some subcategories, which are as follow: (1) anxiety experiences; (2) core beliefs; (3) reasons of being anxious; (4) effects of SAD on life aspects; and (5) coping strategies. Conclusion: It seems that symptoms of social anxiety and its underlying beliefs, causes and effects and coping strategies are almost experienced and interpreted in a way that could be the same as DSM-5 clinical presentation of social anxiety, with the exception that somatic symptoms are experienced by almost all participants.

Emotion Regulation in Generalized Anxiety and Social Anxiety: Examining the Distinct and Shared Use of Emotion Regulation Strategies.

Objective: According to the transdiagnostic view, emotion regulation strategies are common among emotional disorders. Despite the vast majority of studies demonstrating the common role of emotion regulation strategies in emotional disorders including generalized anxiety disorder (GAD) and social anxiety disorder (SAD), distinct functions of these strategies are largely unknown. So, the aim of the present study was to assess the distinct and shared use of emotion regulation strategies in individuals with GAD and SAD symptoms. Method : Participants were recruited from a community sample of Tehran using purposive sampling method. The sample (N = 346) consisted of 269 nonclinical individuals, 47 individuals with generalized anxiety symptoms, and 30 individuals with social anxiety symptoms. Informed consent was obtained from all the participants and they were asked to fill in a series of self -report questionnaires including GAD-IV, SIAS, DERS, EQ, ACS, and RRS. Data were analyzed by discriminant function analysis using SPSS-23. Results: Findings revealed significant differences between the 3 groups in non-acceptance, focusing, shifting, brooding, and decentering (P<0.01). Results of discriminant function analysis showed 2 functions: the first accounted for 87.4% of the variance (Wilk`s Lambda = 0.81, df = 10, P<0.01, χ2 = 70.06), and the second for 12.6% of the variance (Wilk`s Lambda = 0.97, df = 4, P<0.05, χ2 = 9.43) of between group variability. Non-acceptance and focusing discriminated GAD and SAD the most. Conclusion: The findings of the present study support both splitter and lumper approaches as there were some emotion regulation strategies common between GAD and SAD, including shifting, decentering, and brooding. However, some of them were distinct, such as focusing and non-acceptance. Nevertheless, there are still inconsistencies in research about the findings, and thus examining the pathways may illuminate these findings.

The Psychometric Properties of Attentional Control Scale and Its Relationship with Symptoms of Anxiety and Depression: A Study on Iranian Population.

Objectives: The attentional control scale is a self- report questionnaire that assesses individual differences in attentional control. Despite its extensive use, the psychometric properties of the Persian version of the ACS are not well understood. Thus, the present study aimed at investigating the psychometric properties of the attentional control scale and its relationship with symptoms of anxiety and depression in Iranian population. Method: Using quota sampling, we asked a community sample of 524 to respond to Attentional Control Scale, mindfulness, emotion regulation, social anxiety, depression, generalized anxiety, worry, and rumination. SPSS (Version 23) was used for data analysis. Results: Exploratory factor analysis yielded 2 factors of focusing and shifting, which accounted for 30.93% of the total variance. The results of convergent validity revealed that reappraisal, as an emotion regulation strategy and mindfulness facets, had a positive relationship with focusing, shifting, and the total score of the attentional control scale. Furthermore, worry, rumination, depression, generalized anxiety, and social anxiety symptoms all had negative relationships with focusing, rumination, and the total score of the attentional control scale. In addition, the results of incremental validity revealed that focusing, not shifting, uniquely predicted depression and generalized anxiety symptoms. Furthermore, both focusing and shifting uniquely predicted social anxiety symptoms. Test- retest reliability of focusing and shifting was 0.80 and 0. 76, respectively. Conclusion: Attentional control scale has been demonstrated to have acceptable validity and reliability in Iranian population. However, further studies are needed to evaluate other aspects of the ACS like CFA.

Anxiety Sensitivity Dimensions and Generalized Anxiety Severity: The Mediating Role of Experiential Avoidance and Repetitive Negative Thinking .

Objective: Generalized anxiety disorder is one of the most common anxiety disorders in the general population. Several studies suggest that anxiety sensitivity is a vulnerability factor in generalized anxiety severity. However, some other studies suggest that negative repetitive thinking and experiential avoidance as response factors can explain this relationship. Therefore, this study aimed to investigate the mediating role of experiential avoidance and negative repetitive thinking in the relationship between anxiety sensitivity and generalized anxiety severity. Method: This was a cross-sectional and correlational study. A sample of 475 university students was selected through stratified sampling method. The participants completed Anxiety Sensitivity Inventory-3, Acceptance and Action Questionnaire-II, Perseverative Thinking Questionnaire, and Generalized Anxiety Disorder 7-item Scale. Data were analyzed by Pearson correlation, multiple regression analysis and path analysis. Results: The results revealed a positive relationship between anxiety sensitivity, particularly cognitive anxiety sensitivity, experiential avoidance, repetitive thinking and generalized anxiety severity. In addition, findings showed that repetitive thinking, but not experiential avoidance, fully mediated the relationship between cognitive anxiety sensitivity and generalized anxiety severity. α Level was p<0.005. Conclusion: Consistent with the trans-diagnostic hypothesis, anxiety sensitivity predicts generalized anxiety severity, but its effect is due to the generating repetitive negative thought. .

The Role of Neuroticism and Experiential Avoidance in Predicting Anxiety and Depression Symptoms: Mediating Effect of Emotion Regulation.

BACKGROUND: Preliminary evidence supports the role of neuroticism, experiential avoidance and emotion regulation in anxiety and depression; however, the mechanism of these relationships is not known well. OBJECTIVES: The present study mainly aimed to assess the mediating role of emotion regulation in the relationship between neuroticism and experiential avoidance and anxiety and depression symptoms. MATERIALS AND METHODS: By convenient sampling, 316 students from Tehran University of Medical Sciences, Iran University of Social Welfare and Rehabilitation Sciences and University of Tehran were selected and measures of experiential avoidance, neuroticism, emotion regulation, worry, anxiety and depression were administered among them, 2014-2015. Path analysis via regression according to Baron and Kenny evaluative criteria was used for data analysis. RESULTS: Experiential avoidance and neuroticism predicted anxiety, and depression symptoms and the predictions were mediated by emotion regulation and worry. CONCLUSIONS: Emotion regulation deficits have an outstanding role in the mechanism of anxiety and depression which are so comorbid and further studies are needed to evaluate emotion regulation with more advanced methods and along with other transdiagnostic components.

Family Risk Factors Among Women With Addiction-Related Problems: An Integrative Review.

CONTEXT: Recent years have produced many articles about women's addiction and its risk factors and the consequences of substance use and misuse in the emotional, social, psychological, and economic domains of life. Family vulnerabilities are one of the most important variables contributing to addiction among women. Thus, the purpose of this article is to investigate areas of family life that lead to women's taking up and maintaining drug and alcohol abuse. EVIDENCE ACQUISITION: A database search of PubMed, ScienceDirect, Springer, and Google Scholar was conducted using the following keywords: "women and addiction", "women addiction and family", "addiction", "substance abuse" and "family". For the first step, we chose studies that were conducted between 2000 and 2015, and for the second step, studies conducted before 2000. We categorized all search results into three main groups: processes related to family disturbances, factors related to parenting styles, and variables related to partners. RESULTS: Partners, parenting styles, and family disturbances are three main factors affecting children growing up in a family and their inclination toward addiction. Some of these pathways are complicated and indirect, and some are straightforward. CONCLUSIONS: Future research should pay more attention to the mechanisms and pathways mediating or moderating the relationship between family risk factors and addiction in women. Clinicians and researchers should keep in mind these vulnerabilities and take into consideration factors special to processes related to addiction in women.