Sleep Disorders and Fatigue among Patients with MS: The Role of Depression, Stress, and Anxiety.

Sleep disorders and fatigue represent prominent symptoms frequently experienced by individuals with multiple sclerosis (MS). Some psychological factors such as depression, stress, and anxiety seem to have a relationship with such problems. This study aimed to examine the role of depression, stress, and anxiety in predicting sleep disorders and fatigue among patients with MS. Employing a cross-sectional descriptive-correlational design, the study involved a sample size of 252 participants selected through purposive sampling based on inclusion and exclusion criteria. We utilized a demographic information questionnaire along with the Mini-Sleep Questionnaire (MSQ), Fatigue Severity Scale (FSS), and Depression, Anxiety, and Stress Scale (DASS-21) to collect data and analyzed them applying SPSS22, incorporating statistical measures including Pearson correlation and regression. The results of the Pearson correlation coefficient showed that sleep disorders had a positive and significant relationship with depression (r = 0.56; P < 0.001), stress (r = 0.40; P < 0.001), and anxiety (r = 0.52; P < 0.001). There was no significant relationship between age and the development of sleep disorders in total score (r = -0.001; P < 0.985), but age had a relationship with insomnia (r = -0.146; P < 0.021) and oversleeping (r = 0.153; P < 0.015). Age and fatigue did not have a significant relationship as well (r = -0.044; P < 0.941). In addition, fatigue had a positive and significant relationship with depression (r = 0.52; P < 0.001), stress (r = 0.48; P < 0.001), and anxiety (r = 0.54; P < 0.001). The results of the regression analysis also showed that depression, stress, and anxiety predict 0.37% of the total variance of sleep disorders (F = 48.34; P < 0.001) and 0.35% of the total variance of fatigue (F = 44.64; P < 0.001). Our findings suggest that depression, stress, and anxiety play a significant role in predicting sleep disorders and fatigue among patients with MS. This study has been reported in accordance with the TREND checklist for nonrandomized trials.

Effectiveness of Acceptance Commitment Therapy in Social Anxiety Disorder: Application of a Longitudinal Method to Evaluate the Mediating Role of Acceptance, Cognitive Fusion, and Values.

Introduction: The aim of the present study was to examine the effectiveness of acceptance and commitment therapy (ACT) on symptom severity, fear of negative evaluation, quality of life (QoL), and the mediating role of acceptance, cognitive fusion, and value among patients with social anxiety disorder (SAD). Methods: Thirty patients diagnosed with SAD were randomized in the intervention (n=15) or waiting list groups (n=15). The social phobia and Anxiety inventory (SPAI), brief fear of negative evaluation scale (BFNE), World Health Organization quality of life (WHOQoL) scale, social anxiety-acceptance and action questionnaire (SA-AAQ), cognitive fusion questionnaire (CFQ), and valued living questionnaire (VLQ) were administered before, immediately after, and at a one-month follow-up. Repeated measurement design was used in the intervention group to investigate the changes of mediation and outcomes variables in the pre-test, during treatment, and post-test. Twenty-four patients completed the study. Data were analyzed using one-way analysis of covariance (ANCOVA), multivariate analysis of covariance (MANCOVA), and repeated measurements. Results: There were significant differences between the intervention and waiting list groups in the severity of symptoms (P=0.001), fear of negative evaluation (P=0.002), and QoL (P=0.03), as well as in terms of specific measures of SA-AAQ (P=0.001), cognitive fusion (P=0.001), an important section of VLQ (P=0.001). Repeated measurement results showed that acceptance and action of social anxiety and cognitive fusion had a mediating role in the severity of social anxiety, fear of negative evaluation, and QoL. Conclusion: The results indicated the effectiveness of ACT for SAD and highlighted the mediator role of social anxiety, acceptance and action, and cognitive fusion in the severity of SAD. Highlights: This study evaluated effectiveness of acceptance commitment therapy(ACT) on social anxiety disorders (SAD).This study evaluated mechanisms of change of ACT in SAD.ACT has effectiveness for SAD.Acceptance and action and cognitive fusion have mediator role in SAD. Plain Language Summary: Social anxiety disorder (SAD) is one of the most psychiatric disorders. Although CBT has been effective for SAD, most patients continue to demonstrate residual symptoms and impairment after treatment. Over the past several years, a third-wave behavioral therapy has been developed within behavioral and cognitive approaches. Some researchers suggest a new generation of psychotherapists termed acceptance and commitment therapy (ACT) that has many evidence in SAD. However, studies have not examined the mechanism of change of ACT in SAD using methods and proper instruments.in the present study ACT have effectiveness for SAD. In addition to, acceptance and action and cognitive fusion have mediator role in SAD.

Patient safety improvement in the gastroenterology department: An action research.

BACKGROUND: Patient safety is a global concern. Safe and effective care can shorten hospital stays and prevent or minimize unintentional harm to patients. Therefore, it is necessary to continuously monitor and improve patient safety in all medical environments. This study is aimed at improving patient safety in gastroenterology departments. METHODS: The study was carried out as action research. The participants were patients, nurses and doctors of the gastroenterology department of Ayatollah Taleghani Hospital in Tehran in 2021-2022. Data were collected using questionnaires (medication adherence tool, patient education effectiveness evaluation checklist, and medication evidence-based checklist), individual interviews and focus groups. The quantitative data analysis was done using SPSS (v.20) and qualitative data analysis was done through content analysis method using MAXQDA analytic pro 2022 software. RESULTS: The majority of errors were related to medication and the patient's fault due to their lack of education and prevention strategy were active supervision, modification of clinical processes, improvement of patient education, and promotion of error reporting culture. The findings of the research showed that the presence of an active supervisor led to the identification and prevention of more errors (P<0.01). Regarding the improvement of clinical processes, elimination of reworks can increase satisfaction in nurses (P<0.01). In terms of patient education, the difference was not statistically significant (P>0.01); however, the mean medication adherence score was significantly different (P<0.01). CONCLUSION: The improvement strategies of patient safety in Gastroenterology department included the modification of ward monitoring processes, improving/modification clinical processes, improvement of patient education, and development of error reporting culture. Identifying inappropriate processes and adjusting them based on the opinion of the stakeholders, proper patient education regarding self-care, careful monitoring using appropriate checklists, and presence of a supervisor in the departments can be effective in reducing the incidence rate. A comprehensive error reporting program provides an opportunity for employees to report errors.

Comparison of the potency of nortriptyline and mirtazapine on gastrointestinal symptoms, the level of anxiety and depression in patients with functional dyspepsia.

Aim: In the current clinical trial study, the potency of mirtazapine and nortriptyline was compared in patients with Functional Dyspepsia (FD) who had anxiety or depression. Background: FD usually accompanies other psychosocial disorders. According to previous studies, among these disorders, anxiety and depression have the most correlation. Methods: This randomized clinical trial was organized in Taleghani hospital (Tehran, Iran). In two parallel groups, 42 patients were treated for 12 weeks, with 22 patients receiving 7.5 mg of mirtazapine and 20 patients receiving 25 mg of nortriptyline per day. To gain robust results, the patients with a positive history of antidepressant therapy, organic diseases, alcohol abuse, pregnancy, and major psychiatric disorders were excluded from the study. The subjects were examined by three questionnaires, including Nepean and Hamilton questionnaires. The patients were asked to answer the questions three times during the study: once before the onset of the treatment, second during the treatment, and third at the end of the treatment. Results: Based on Gastrointestinal (GI) manifestations, mirtazapine, in comparison to nortriptyline could significantly suppress the signs and symptoms of FD, including epigastric pains (P=0.02), belching (P=0.004), and bloating (P=0.01). Although the results from the use of mirtazapine compared to the use of nortriptyline (P=0.002) showed a lower mean depression score on the Hamilton questionnaire, no significant differences were found between the effects of these drugs on the anxiety scale of patients (P=0.091). Conclusion: Mirtazapine is more effective for GI symptoms related to gastric emptying. Considering the level of anxiety, mirtazapine, compared to nortriptyline, revealed better outcomes in FD patients suffering from depression.

Efficacy of emotion regulation training on pain intensity and life quality in patients with peptic ulcer disease (PUD).

Aim: Because gastric ulcer is a psychosomatic disease involving many psychological factors like assertiveness and cognitive beliefs, this study aimed to investigate the effectiveness of emotion regulation training on pain intensity and quality of life in patients with peptic ulcer disease. Background: Gastric ulcer, a recurrent and common disease worldwide, is associated with gastrointestinal symptoms and lower health-related quality of life. Psychological factors and stress have been recognized as important contributors to the onset and duration of gastric ulcer, highlighting the need for effective psychological interventions to improve pain intensity and quality of life in patients. Methods: The research method was semi-experimental and based on the pretest-posttest control group design, with follow-up after three months. The sample included 46 participants selected by a Purposive Sampling method and placed randomly in the experimental and control groups. At first, simultaneously, and under the same conditions, all the participants responded to the Chronic Pain Grade Questionnaire (CPG) and Quality of Life Questionnaire (SF-12). The emotion regulation training was performed on the experimental group. In the end, both groups were evaluated by posttests, and then they were tracked after three months. To analyze data, the ANCOVA test was applied through SPSS 22. Results: Findings showed that emotion regulation training was meaningfully effective in decreasing pain intensity and increasing life quality (p<0.01), but after three months interval, no significant changes were found in the results. Conclusion: Due to the results about emotion regulation training protocol that has successfully reduced pain intensity symptoms in PUD patients and increased life quality, it is suggested that this protocol can be added to other treatments for PUD patients.

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.

The comparison between CBT focused on perfectionism and CBT focused on emotion regulation for individuals with depression and anxiety disorders and dysfunctional perfectionism: a randomized controlled trial.

BACKGROUND: There is considerable evidence indicating that similar aetiological and maintenance processes underlie depressive and anxious psychopathology. According to the literature, perfectionism and emotion regulation are two transdiagnostic constructs associated with symptoms of emotional disorders. AIMS: This study is the first randomized controlled trial comparing the efficacy of cognitive behavioural therapy for perfectionism (CBT-P) and the unified protocol for the transdiagnostic treatment of emotional disorders (UP). METHOD: Seventy-five participants with a range of depressive and anxiety disorders and elevated perfectionism were randomized to three conditions: CBT-P, UP or a waitlist control (WL). RESULTS: Repeated measures ANOVA indicated that the treatment groups reported a significantly greater pre-post reduction in the severity of symptoms of disorders, as well as a significantly greater pre-post increase in quality of life, all with moderate to large effect sizes compared with the WL group. Treatment gains were maintained at 6-month follow-up. The CBT-P group reported a significantly greater pre-post reduction in perfectionism compared with UP, and the UP group reported a significantly greater pre-post improvement in emotion regulation compared with CBT-P. CONCLUSIONS: Findings support CBT for perfectionism and regard UP as efficacious treatments for individuals with depression and anxiety disorders who also have dysfunctional perfectionism. It appears that perfectionism cannot be a serious obstacle to UP. As this is a preliminary study and has some limitations, it is recommended that further research be conducted.

A randomized clinical trial of metacognitive therapy and nortriptyline for anxiety, depression, and difficulties in emotion regulation of patients with functional dyspepsia.

Functional Dyspepsia (FD) as a psychosomatic disorder is an upper gastrointestinal tract disease without organic pathogenesis causes. The psychopathological nature of this disease and its high correlation with anxiety and depression implies the need for psychological interventions. The purpose of the present study is to compare the efficacy of Metacognitive Therapy (MCT) and medication for the symptoms of anxiety, depression, and difficulties in emotion regulation in patients with FD. In a randomized clinical trial, 65 patients with FD were recruited during their visit to gastroenterology clinics. These patients were randomly assigned to three groups to receive MCT, nortriptyline treatment, and controls. They were treated for 10 weeks and followed up three months later. The instruments used in this study were Hamilton anxiety and Depression Rating Scale (HAM-A and HDRS) and difficulties in emotion regulation scale. The results were analyzed using repeated measure analysis by SPSS (19- IBM). Data analysis showed statistically significant differences in the variables of depression, anxiety among MCT, nortriptyline treatment, and controls at pre-test, post-test and follow-up phases. Moreover, MCT had a better and more persistent effect on anxiety compared to nortriptyline treatment, as well as a better efficacy in treating anxiety and depression symptoms compared to the controls. MCT demonstrated better efficacy in treating anxiety symptoms compared to nortriptyline treatment and controls.

Rumination-Focused Cognitive-Behavioral Therapy for Chronic Low Back Pain: A Randomized Controlled Trial.

BACKGROUND: Chronic pain remains or reappears for more than 3 to 6 months, and it is influencing 20% of the global population. The pain catastrophizing affects pain intensity and psychological conditions of patients with chronic pain. Rumination-focused cognitive-behavioral therapy (RFCBT) targets rumination as the key component of pain catastrophizing. The aim of this study was to determine the effectiveness of RFCBT on depression, anxiety, and pain severity of individuals with chronic low back pain (LBP). MATERIALS AND METHODS: In a randomized controlled trial, 30 patients aged between 20-55 years with diagnosed chronic LBP were chosen by convenience sampling and randomly allocated into intervention and control groups. All patients used their prescribed medications for pain management, but the intervention group received 12 weekly sessions of RFCBT, which was manualized psychotherapy to change unconstructive rumination to constructive rumination. Depression Anxiety and Stress scale-21 and chronic pain grade questionnaire were administered as pre-tests and re-administered after 3 and 6 months as post-test and follow-up assessments, respectively. RESULTS: RFCBT significantly reduced depression (F1=23.01, P=0.001), anxiety (F1=25.7, P=0.001) and pain severity (F1=7.17, P=0.012) in patients with chronic LBP. CONCLUSION: RFCBT may offer benefits for treating patients with chronic low back pain when added to their usual pharmacological treatment. This benefit may be the result of targeting rumination as the key element of pain catastrophizing.

Protective factors of marital stability in long-term marriage globally: a systematic review.

OBJECTIVES: In recent decades, due to the high prevalence of divorce in numerous countries and the detrimental aftermath thereof, it has become increasingly important to study the components of marital stability. The current study explored fundamental protective factors in long-term marriage through a systematic review. METHODS: Searches for relevant publications were conducted in Embase, Web of Science, PubMed, Scopus, Science Direct, Magiran, and Scientific Information Database from their inception through January 30, 2019. Through the keyword search, 1,706 articles were found, of which 25 articles remained after screening based on the eligibility criteria. RESULTS: The extracted protective factors associated with marital stability in long-term marriage were classified as interpersonal and intrapersonal. Notable extracted factors included spirituality and religion, commitment, sexual relationship, communication, children, love and attachment, intimacy, and conflict resolution approach. These findings show that some aspects of relationships, such as commitment, act to preserve the pillars of marriage in critical situations, while other aspects, such as intimacy, help to construct marital identity and satisfaction. CONCLUSIONS: The identified components of marital stability are structures that enhance a couple's identity and sense of togetherness. Identifying the specific aspects of marital relationships that contribute to marital stability may help specialists and researchers to target specific types of marital interaction that may enhance the happiness and longevity of relationships, thereby preventing avoidable divorces.

Validity and Reliability of the Persian Version of Leeds Dyspepsia Questionnaire.

BACKGROUND: It is essential in clinical care services to measure the symptoms of functional dyspepsia both in the primary examination and treatment outcomes. No valid assessment tool is already available for functional dyspepsia in Iran. The present study aimed at evaluating the reliability, validity, and responsiveness of the Leeds dyspepsia questionnaire (LDQ). MATERIALS AND METHODS: The LDQ was completed by 67 subjects with no dyspepsia symptoms and 93 subjects with certain functional dyspepsia diagnosed via endoscopy by a gastroenterologist and other clinical assessments. After definite diagnosis of functional dyspepsia, the participants were assessed by the LDQ. The psychometric characteristics of the questionnaire were then documented to investigate its reliability, validity, and responsiveness. RESULTS: The internal consistency of the LDQ ranged from 0.80 to 0.89 and its test-retest reproducibility was 0.96. The LDQ was significantly correlated with all domains of dyspepsia symptom severity index (DSSI) and also with some of the domains of gastrointestinal symptom rating scale (GSRS). The LDQ had a sensitivity of 90.3% with a great specificity and a very good predictive validity. Moreover, a significant responsiveness to changes was observed (P<0.05). CONCLUSION: The LDQ is a valid, reliable, reproducible, and self-rated instrument responsive to change, which can be used to measure the frequency and severity of functional dyspepsia symptoms in clinical trials.

Psychometric Properties of the Persian Version of the Social Anxiety - Acceptance and Action Questionnaire.

BACKGROUND: Social anxiety disorder is often related to specific impairment or distress in different areas of life, including occupational, social and family settings. OBJECTIVE: The purpose of the present study was to examine the psychometric properties of the persian version of the social anxiety-acceptance and action questionnaire (SA-AAQ) in university students. MATERIALS AND METHODS: In this descriptive cross-sectional study, 324 students from Shahid Beheshti University of Medical Sciences participated via the cluster sampling method during year 2015. Factor analysis by the principle component analysis method, internal consistency analysis, and convergent and divergent validity were conducted to examine the validity of the SA-AAQ. To calculate the reliability of the SA-AAQ, Cronbach's alpha and test-retest reliability were used. RESULTS: The results from factor analysis by principle component analysis method yielded three factors that were named acceptance, action and non-judging of experience. The three-factor solution explained 51.82% of the variance. Evidence for the internal consistency of SA-AAQ was obtained via calculating correlations between SA-AAQ and its subscales. Support for convergent and discriminant validity of the SA-AAQ via its correlations with the acceptance and action questionnaire - II, social interaction anxiety scale, cognitive fusion questionnaire, believability of anxious feelings and thoughts questionnaire, valued living questionnaire and WHOQOL- BREF was obtained. The reliability of the SA-AAQ via calculating Cronbach's alpha and test-retest coefficients yielded values of 0.84 and 0.84, respectively. CONCLUSIONS: The Iranian version of the SA-AAQ has acceptable levels of psychometric properties in university students. The SA-AAQ is a valid and reliable measure to be utilized in research investigations and therapeutic interventions.