A culturally adapted unified protocol for transdiagnostic treatment of anxiety disorders in adolescents (UP-A): a randomized waitlist-controlled trial.

BACKGROUND: Anxiety disorders are highly prevalent and debilitating conditions that show high comorbidity rates in adolescence. The present article illustrates how Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) was adapted for Iranian adolescents with anxiety disorders. METHODS: A total of 54 adolescents with comorbid anxiety disorders participated in a randomized, waitlist-controlled trial of group weekly sessions of either UP-A or waitlist control (WLC). Primary and process of change outcomes were assessed at baseline, posttreatment, and 1-month follow-up. RESULTS: Significant changes were observed over time on major DSM-5 anxiety disorder symptoms (F(2, 51) = 117.09, p < 0.001), phobia type symptoms (F(2, 51) = 100.67, p < 0.001), and overall anxiety symptoms (F(2, 51) = 196.29, p < 0.001), as well as on emotion regulation strategies of reappraisal (F(2, 51) = 17.03, p < 0.001), and suppression (F(2, 51) = 21.13, p < 0.001), as well as on intolerance of uncertainty dimensions including prospective (F(2, 51) = 74.49, p < 0.001), inhibitory (F(2, 51) = 45.94, p < 0.001), and total intolerance of uncertainty (F(2, 51) = 84.42, p < 0.001), in favor of UP-A over WLC. CONCLUSION: Overall, results provide a cultural application of the UP-A and support the protocol as useful for improving anxiety disorders as well as modifying of emotion regulation strategies and intolerance of uncertainty dimensions in Iranian adolescents. Future directions and study limitations are discussed.

Associations between Sleep Disturbance and Suicidal Ideation Severity in Iranian University Students: Evaluating Emotion Regulation Difficulties and Distress Tolerance.

AIM: Although sleep disturbance is associated with suicide ideation, underlying cognitive-affective mechanisms that may explain this association are not well understood. The aim of the present study was to concurrently evaluate whether emotion regulation difficulties and distress tolerance explain this association among Iranian university students. METHOD: A total of 679 Iranian university students (66.42% females; Mage = 24.34 years, SD = 4.86) completed a battery of online self-report questionnaire. Structural equation modeling was used to empirically explore the relations among variables. RESULTS: Sleep disturbance was positively associated with suicide ideation. Higher sleep disturbance symptoms were associated with higher levels of suicide ideation. Sleep disturbance was indirectly related to suicide ideation through both emotion regulation difficulties and distress tolerance. CONCLUSION: Findings expand knowledge of cognitive-emotional processes that may explain the sleep disturbance-suicide ideation association among Iranian university students. Iranian students experiencing sleep disturbance may benefit from intervention strategies targeting emotion regulation skills and distress tolerance to reduce suicide ideation.

The impact of prefrontal transcranial direct current stimulation (tDCS) on theory of mind, emotion regulation and emotional-behavioral functions in children with autism disorder: A randomized, sham-controlled, and parallel-group study.

Advances in our knowledge about the neuropsychological mechanisms underlying core deficits in autism spectrum disorder (ASD) have produced several novel treatment modalities. One of these approaches is modulation of activity of the brain regions involved in ASD symptoms. This study examined the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) on autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functions in children with ASD. Thirty-two children (Mage  = 10.16, SD = 1.93, range 7-12 years) diagnosed with ASD were randomly assigned to active (N = 17) or sham stimulation (N = 15) groups in a randomized, sham-controlled, parallel-group design. Participants underwent 10 sessions of active (1.5 mA, 15 min, bilateral left anodal/right cathodal DLPFC, 2 sessions per week) or sham tDCS. Autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functioning of the patients were assessed at baseline, immediately after the intervention, and 1 month after the intervention. A significant improvement of autism symptom severity (i.e., communication), theory of mind (i.e., ToM 3), and emotion regulation strategies was observed for the active as compared to the sham stimulation group at the end of the intervention, and these effects were maintained at the one-month follow-up. The results suggest that repeated tDCS with anodal stimulation of left and cathodal stimulation of right DLPFC improves autism symptom severity as well as social cognition and emotion regulation in ASD. LAY SUMMARY: Previous research has suggested that targeting core mechanisms underlying cognitive-emotional and behavioral deficits of autistic children might improve symptoms of ASD. Deficient social and behavioral functioning, impaired theory of mind, and emotional regulation deficits have been identified as core treatment targets for this group. Specific subregions of the prefrontal cortex are involved in these deficits, including hypoactivity of the dorsolateral prefrontal cortex (DLPFC). Upregulation of this area with non-invasive brain stimulation, namely anodal transcranial direct current stimulation (tDCS), results in improved social and behavioral functioning in children with ASD. Very few studies have however examined the effects of this intervention on theory of mind, emotional regulation, and emotional-behavioral problems. We examined the effects of anodal tDCS over the left DLPFC (F3), combined with cathodal tDCS over the right DLPFC (F4) on autism symptom severity as well as theory of mind, emotional regulation, and emotional-behavioral problems of children with ASD. This intervention improved autism symptom severity, specific domains of theory of mind, and emotion regulation. These findings have clinical implications for the treatment of ASD and suggest that targeting core mechanisms underlying socio-cognitive-emotional deficits of autistic children using tDCS might improve symptoms of ASD.

A Pilot Randomized Clinical Trial of a Novel, Culturally Adapted, Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women.

Trauma-focused cognitive-behavioral therapy (TF-CBT), broadly, is one of the leading evidence-based treatments for youth with posttraumatic stress disorder (PTSD). Generally, few culturally adapted TF-CBT interventions have been examined among war trauma-affected populations in low- and middle-income countries. Using a randomized clinical trial design, a total of 48 war trauma-exposed women in Iraq, Mage (SD) = 32.91 (5.33), with PTSD were randomly assigned to either TF-CBT or wait-list control (WLC) conditions. The intervention group received 12 individual weekly sessions of a culturally adapted TF-CBT intervention. Significant reductions in PTSD symptom severity were reported by women in the TF-CBT condition from pre- to posttreatment. Women in the TF-CBT condition reported significantly greater reductions in PTSD symptoms compared to WLC at 1-month follow-up. Additionally, levels of depression, anxiety, stress, and use of maladaptive emotion regulation strategies were significantly lower in the TF-CBT condition at posttreatment and 1-month follow-up, compared to the WLC condition. Women in the TF-CBT condition also reported significant improvements in various domains of quality of life at posttreatment and 1-month follow-up. This clinical trial provides preliminary cross-cultural support for the feasibility and efficacy of TF-CBT for the treatment of PTSD symptoms among women in non-Western cultures. Future directions and study limitations are discussed.

A preliminary examination of unified protocol for transdiagnostic treatment of emotional disorders in patients with panic disorder: a single-case experimental design in Iran.

BACKGROUND AND OBJECTIVES: The majority of patients suffering from anxiety disorders in low- and middle-income countries do not receive evidence-based treatments. The Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders is an evidence-based cognitive-behavioral intervention designed to treat the range of emotional disorders. DESIGN AND METHODS: Using a single-case experimental design five patients with panic disorder were assigned to a 3-week baselines assessment phase followed by eight sessions of UP treatment and 4-week follow-up phases. Multiple outcome measures of panic severity, anxiety sensitivity, affectivity, and overall anxiety severity and impairment were administered weekly during the baseline, intervention, and follow-up phases. RESULTS: At post treatment, all participants showed significant reductions in outcome measures, with changes functionally related to treatment and most improvements maintained at 4-week follow-up. CONCLUSION: Findings provide preliminary cross-cultural support for UP and add to the growing body of literature showing UP can be useful for patients with anxiety disorders in low- and middle-income countries with non-Western cultures.

Psychometric Properties of the Obsessive Compulsive Inventory-Child Version in Iranian Clinical and Community Samples.

This study evaluated the psychometric properties of the Persian version of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) in clinical and community samples. Factor structure (confirmatory factor analysis), validity (convergent/discriminant, and predictive), and reliability (internal consistency, and 4-week retest) of the Persian version of the OCI-CV were investigated in a sample of 391 children and adolescents 7-17 years comprised of two groups: a clinical sample of youth with OCD (n = 62), and a community sample (n = 329). Participants completed the OCI-CV, Multidimensional Anxiety Scale for Children (MASC), Children's Depression Inventory (CDI), and Child Behavior Checklist (CBCL). Similar to the English version of the OCI-CV, the Persian version of the scale demonstrated a stable six-factor structure, good convergent and discriminant validity through its correlations with other specific measures of pediatric psychopathology, acceptable sensitivity and specificity for the detection of OCD, and good reliability in terms of internal consistency and temporal stability. These findings suggest that the OCI-CV is a valid and reliable measure to assess obsessive-compulsive symptom dimensions in Iranian youth. Findings provide cross cultural support on the utility of OCI-CV as a self-report measure of obsessive-compulsive symptomology.

Associations of Childhood Maltreatment and Attachment Styles with Romantic Breakup Grief Severity: The Role of Emotional Suppression.

Childhood maltreatment (CM) and insecure attachment styles may partly explain grief severity following romantic breakup. Empirical studies examining the factors that could possibly explain this association, however, remain sparse. The present study tested whether the relations among CM, attachment styles, and romantic breakup grief severity could be explained by emotional suppression in Iranian college students. In a cross-sectional study, 239 Iranian college students (ages 18-45; M = 24.11, SD = 15.29; 50.6% women) with a recent romantic breakup experience were recruited from University of Tabriz. Participants completed a diagnostic interview and self-report battery, including the Persian version of the Child Abuse Self-Reported Scale, Revised Adult Attachment Scale, Romantic Breakup Grief Inventory, and Weinberger Adjustment Inventory. Structural equation modeling was used to empirically explore the relations among variables. Results indicated that those who reported higher levels of CM also reported higher levels of romantic breakup grief. Attachment closeness showed a significant negative and direct effect on romantic breakup grief severity. However, attachment anxiety was positively associated with greater levels of romantic breakup grief. Bootstrapping results showed that CM might affect romantic breakup grief severity via emotional suppression. Furthermore, attachment closeness and attachment anxiety exerted indirect effects on romantic breakup grief severity through emotional suppression. Clinical and empirical implications are discussed.

Changes in neuroticism-related constructs over the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in patients on an optimal dose of SSRI.

Recent advances in clinical practice emphasize the utility of Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) as an effective intervention for targeting core processes underlying comorbid disorders. This study aimed to evaluate changes in psychopathological risk factors associated with the construct of neuroticism (i.e., negative affect, anxiety sensitivity, experiential avoidance, intolerance of uncertainty) within the UP to adults already on an optimal and stable dose of SSRIs. In a randomized controlled trial, a total of 39 adults (Mage = 27.51 [±8.43]; 56.4% female) on SSRIs with a diagnosis of comorbid anxiety and depressive disorder were randomly assigned to either UP + SSRI (n = 18) or continued SSRI-only (n = 21). Neuroticism dimensions were assessed at baseline, posttreatment, and 1-month follow-up. UP + SSRI condition demonstrated medium to large effect sizes for changes over time on facets of neuroticism including negative affect (Cohen's d = 1.12, 95% confidence interval [CI; 0.44, 1.80]), anxiety sensitivity (Cohen's d = 1.21, 95% CI [0.53, 1.90]), experiential avoidance (Cohen's d = 0.74, 95% CI [0.09, 1.04]), and intolerance of uncertainty (Cohen's d = 1.66, 95% CI [0.93, 2.39]). Post hoc analyses showed reductions in variables that were maintained at follow-up. Results adds to the growing body of literature and provide cross-cultural support for the utility of UP in targeting pathological risk factors as adjuncts to SSRI. Implications for future studies and limitations are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Preliminary Examination of Acceptance and Commitment Therapy Versus Exposure and Response Prevention for Patients with Obsessive-Compulsive Disorder on an Optimal Dose of SSRIs: A Randomized Controlled Trial in Iran.

This study compared the effects of adding acceptance and commitment therapy (ACT) or exposure and response prevention (ERP) to adults diagnosed with obsessive compulsive disorder (OCD) already on an optimal and stable dose of selective serotonin reuptake inhibitors (SSRIs). Forty adults on SSRIs who were diagnosed with OCD participated in a randomized controlled trial in Iran of 12 individual weekly sessions of either ACT+SSRI, ERP+SSRI, or continued SSRI only. The results showed significant reductions in OCD symptom severity in ACT+SSRI and ERP+SSRI conditions at posttreatment with significantly greater reductions in both conditions compared to SSRI-only at follow-up. Additionally, psychological inflexibility and use of thought control strategies significantly decreased in the ACT+SSRI condition at posttreatment and follow-up compared to the ERP+SSRI and SSRI conditions. Both conditions led to decreases in perceived importance of stop signals. Results provide cross-cultural support for the treatment of OCD using ACT and ERP as adjuncts to SSRI and modest process of change differences between ACT and ERP. Future directions and study limitations are discussed.

Psychometric Evaluation of the Intolerance of Uncertainty Scale for Children (IUSC): Findings From Clinical and Community Samples in Iran.

OBJECTIVE: The present study examined the psychometric properties of a Persian version of the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al, 2009). METHOD: Participating youth (n = 346) 8 to 18 years of age were nonreferred community youth (n = 279) or youth who met diagnostic criteria for an anxiety disorder (n = 67) and their parents. RESULTS: Across child- and parent-report data, confirmatory factor analysis supported a shortened 12-item version of the IUSC, and the confirmatory factor analysis also confirmed a theory-driven correlated two-factor structure of the IUSC-12. (i.e., prospective/inhibitory IU). Results further supported reliability and validity of parent- and child-reports of the Persian IUSC-12 via evidence of internal consistency, 4-week retest, significant associations with established measures of internalizing problems, and the ability of the measure to reliably distinguish the clinical sample from the community sample. CONCLUSION: Findings demonstrate sound psychometric properties of the Persian version of the IUSC-12 and provide additional support for the reliability and validity of the measure and its use in non-Western cultures. Findings are discussed in terms of implications for assessment, treatment, and study of anxiety and related internalizing problems in Iranian youth.

DSM-5 pathological personality domains as vulnerability factors in predicting COVID-19-related anxiety symptoms.

Since the beginning of the coronavirus disease-2019 (COVID-19) outbreak, individuals worldwide have shown different anxiety-related reactions. Several vulnerability factors may play a role in individuals' psychological reactions to the COVID-19 pandemic. Such factors include pathological personality traits which have been shown to contribute to the development of anxiety-related conditions. Consequently, the present study investigated the relationships between DSM-5 pathological personality domains and COVID-19-related anxiety symptoms. Using an online data portal, the relationships between DSM-5 pathological personality domains and COVID-19-related anxiety symptoms among a mixed university student and community sample (N = 612) were studied. The results showed that there was a positive and significant relationship between all DSM-5 pathological personality domains and COVID-19-related anxiety. The results of multiple linear regression analysis showed that DSM-5 pathological personality domains explained 21% of COVID-19-related anxiety variance. Based on standardized coefficients, the Personality Inventory for DSM-5 (PID-5) negative affect domain had the main role in COVID-19-related anxiety. The findings suggest that pathological personality domains can be predictors in the symptoms of anxiety in a viral outbreak. The novel findings add to the literature on individual differences in domains of personality in response to pandemic situations. Implications for future clinical applications and research investigations are discussed.

Factor structure, validity, and reliability of a Persian version of the Body and Appearance Self-conscious Emotions Scale.

This study examined the psychometric properties of a Persian translation of the Body and Appearance Self-conscious Emotions Scale. A total of 393 university students from Iran completed the Body and Appearance Self-conscious Emotions Scale, along with measures of depression, self-esteem, affect, body appreciation, physical self-perceptions, personality, obsessive-compulsive disorder, and body dysmorphic disorder. Confirmatory factor analysis indicated that the four-factor structure had adequate fit. Further analyses indicated that the Body and Appearance Self-conscious Emotions Scale scores evidenced internal consistency, convergent validity, and test-retest reliability. These results suggest that scores on the Persian version of the Body and Appearance Self-conscious Emotions Scale show evidence of reliability and validity in the Iranian population and can be used in the field of research and treatment.

Acceptance and commitment therapy for the treatment of depression in persons with physical disability: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of acceptance and commitment therapy (ACT) on depressive symptoms in physically disabled persons. DESIGN: Randomized controlled trial. SETTING: State welfare organization in Kamyaran, Kurdistan, Iran. PARTICIPANTS: Fifty-two physically disabled participants with a primary diagnosis of depression were randomly assigned to either ACT or control groups. INTERVENTIONS: Participants in the ACT group (n = 23) received eight weekly 90-minute group sessions based on standard ACT protocol for depression. Participants in the control group (n = 29) received psychoeducation regarding depression. MAIN MEASURES: Measures were recorded at baseline, eight weeks (end of treatment), and 16 weeks (follow-up). The outcomes were the change in the depressive symptoms, measured by Beck Depression Inventory-II (BDI-II), psychological flexibility, emotion regulation, and psychological well-being measured by Acceptance and Action Questionnaire-II (AAQ-II), Emotion Regulation Questionnaire (ERQ), and Scales of Psychological Well-Being (SPWB), respectively. RESULTS: After eight weeks, significant changes in depressive symptoms was observed in the experimental group (ACT -10.39 ± 0.79 vs control 0.66 ± 0.68, P < 0.001). Compared to the control group, the experimental group also showed significant improvement in psychological flexibility (ACT 8.13 ± 0.52 vs control -0.03 ± 0.51, P < 0.001), adaptive emotion regulation strategies (ACT 10.74 ± 0.62 vs control 0.03 ± 1.03, P < 0.001), and psychological well-being (ACT 66.95 ± 4.01 vs control -1.90 ± 1.04, P < 0.001). CONCLUSION: Compared with control group, ACT significantly reduced the participants' depression, and changed psychological flexibility, emotion regulation, and psychological well-being in persons with physical disability.

Effectiveness of mindfulness-based cognitive therapy for comorbid depression and anxiety in pregnancy: a randomized controlled trial.

Pregnant women are at high risk of mood and anxiety disorders, and options for non-pharmacological treatment are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among people with mood and anxiety disorders, but limited studies reported the effectiveness of MBCT on perinatal comorbid conditions. This study aimed to examine the effects of an 8-week MBCT intervention on pregnant women with comorbid depression and anxiety. In this randomized controlled study, 38 pregnant women with a diagnosis of depression and varying levels of comorbid anxiety disorders were randomly assigned to either MBCT or a control group. Scores on the Beck Depression Inventory-II, Beck Anxiety Inventory, Emotion Regulation Questionnaire, and Scales of Psychological Wellbeing were used as outcome measures at baseline, after MBCT, and through 1-month follow-up. Intent to treat analyses provided preliminary evidence that MBCT can be effective in reducing depressive and anxiety symptoms and in enhancing the use of adaptive emotion regulation strategies and psychological well-being. Improvements in outcomes were maintained 1 month. Results provide cross-cultural support for MBCT as a treatment for depression and anxiety in pregnant women. This brief and non-pharmacological treatment can be used to improve maternal psychological health.

A Comparative Study on the Effectiveness of Individual and Group Play Therapy on Symptoms of Oppositional Defiant Disorder among Children.

BACKGROUND: This research compared the effectiveness of play therapy provided individually or in groups for oppositional defiant disorder (ODD) symptoms among children. METHODS: This was a randomized controlled trial that used a multi-stage random sampling method. Participants included 45 children aged 6 to 10 years old with ODD, all of whom had been referred to medical consultation centers in Ahvaz, Iran in 2012. Experimental groups consisted of 15 children receiving individual play therapy and 15 receiving group play therapy, while the control group consisted of 15 randomly selected children. Data were collected using the child behavior checklist parent report form and teacher report form, along with clinical interviews with the parents. Play therapy took place weekly for eight total sessions; individual sessions lasted 45 minutes each, while group sessions were each 60 minutes in duration. Participants were assessed in three stages, including preintervention, post-intervention, and at 2-month follow-up. PASW SPSS ver. 18.0 software (SPSS Inc., Chicago, IL, USA) and analysis of covariance analysis methods were used to analyze data. RESULTS: Results showed meaningful decreases in ODD symptoms in the experimental groups in comparison with the control group, based on parent reporting (P≤0.001 and F=129.40) and the teacher reports additionally showed meaningful decreases in ODD symptoms in the experimental groups compared to the control group, (P≤0.001 and F=93.14). Furthermore, the effects were maintained after 2 months. CONCLUSION: This research supports the efficacy of individual and group play therapy for the treatment of ODD in children, as well as the consistency of the effects at 2-month follow-up.

The Factorial Structure and Psychometric Properties of the Persian Effort-Reward Imbalance Questionnaire.

BACKGROUND: With global changes in the current state of work and employment, the role of health-adverse psychosocial work environments has received increasing attention in developed as well as in rapidly developing countries. Thus, there is a need to apply valid measurement tools for monitoring and preventive purposes. This study aims to examine the factorial structure and psychometric properties of the Persian version of the effort-reward imbalance (ERI) questionnaire, assessing one of the internationally leading concepts of stressful work. METHODS: This descriptive cross-sectional study of a random sample of 202 white collar employees in an industrial company in Iran analyzes the ERI scales by exploratory and confirmatory factor analysis. Moreover, aspects of construct and criterion validity are tested. To this end, correlations of ERI scales with subscales of organizational injustice, a complementary work stress model, and also the correlations of ERI scales with a questionnaire assessing psychosomatic symptoms are performed. RESULTS: Internal consistency of the three ERI scales was satisfactory (Cronbach α effort: 0.76, reward: 0.79, overcommitment: 0.75). Fit indices of confirmatory factor analysis pointed to an adequate representation of the theoretical construct (e.g., adjusted goodness of fit index (AGFI): 0.73, goodness of fit index (GFI): 0.78). Negative correlations with subscales of organizational injustice supported the notion of construct validity of the ERI scales, and positive correlations of ERI scales with psychosomatic symptoms indicated preliminary criterion validity. CONCLUSION: The Persian version of the ERI questionnaire has acceptable psychometric properties and can be used as a valid instrument in research on this topic.

Comparative effects of group metacognitive therapy versus behavioural activation in moderately depressed students.

BACKGROUND: The high incidence and prevalence rates of depression among students identify them as a vulnerable population and make the case for the development of cost-effective treatments. AIMS: We aimed to examine the comparative effects of brief group metacognitive therapy (MCT) versus behavioural activation (BA) treatments for depression, anxiety, and emotion regulation in university students. METHOD: All participants (25 women, 16 men; age range: 18-30 years) fulfilled criteria for major depression and were randomly assigned to MCT (n = 15), BA (n = 15), or a wait-list control group (n = 15). The treatment groups received 8 weekly MCT or BA sessions. Scores on the Beck Depression Inventory, Beck Anxiety Inventory, and Cognitive Emotion Regulation Questionnaire were used as outcome measures. RESULTS: This pilot study showed that both treatments were equally effective for depressive and anxiety symptoms. However, therapeutic techniques differed with regards to their effects on specific facets of emotion regulation, such as Positive Reappraisal and Catastrophizing, with MCT being more effective compared to BA. BA also showed a stronger relapse at follow-up with regards to Acceptance and Refocus on Planning. CONCLUSIONS: Results suggest that groups MCT and BA may be implemented as cost-effective treatments for students with moderate depression.