Mourning in the time of coronavirus: Examining how grief differs in those who lost loved ones to COVID-19 vs. natural causes in Iran

OBJECTIVES

Our study aimed to analyze and compare the grief experiences of individuals in Iran who lost family members to COVID-19 and those who lost loved ones to other natural causes.

METHODS

In this study, telephone interviews were conducted with 640 first-degree relatives, and finally, a total of 395 people remained in the research. Participants answered the Prolonged Grief Questionnaire (PG-13-R) and Grief Experience Questionnaire.

RESULTS

The results showed that the most common symptoms and features of grief were feeling guilt, searching for an explanation, somatic reactions, and rejection, with no significant difference observed between the 2 death groups. However, the average scores for these symptoms were higher in the COVID-19 death group. Moreover, the majority of bereaved reported signs and symptoms of prolonged grief, with a higher percentage in the COVID-19 death group, although there was no significant difference between the 2 death groups in terms of the distribution of symptoms and signs of prolonged grief. These findings suggest that the bereavement process can be challenging, and losing a loved one to COVID-19 may lead to more intense experiences of grief.

SIGNIFICANCE OF RESULTS

The study reveals high levels of guilt, searching for meaning, somatic reactions, and rejection among COVID-19 grievers. Losing loved ones to the pandemic appears linked to more intense, prolonged grief symptoms.

A comparison of Barkley's behavioral inhibition model (1997) with Barkley's updated executive functioning model in predicting adult ADHD symptoms: A preliminary report using structural equation modeling

One of the most comprehensive approaches to explaining attention-deficit/hyperactivity disorder (ADHD) symptoms is Barkley's behavioral inhibition model (BBIM) (1997), in which behavioral inhibition (BI) plays a primary role. Due to the substantial role of working memory (WM) in explaining ADHD symptoms, Barkley recently updated his model and elevated WM from a mediator variable (in BBIM) to a primary position as an exogenous variable alongside BI, and titled his new model as Barkley's updated executive functioning model (BUEFM). However, since the information about the explanatory power of the new model is sparse, this study aims to investigate the impact of this change in WM role by comparing these two models to explain ADHD symptoms. The study involved a sample of 184 (96 females and 88 males) undergraduate students with high ADHD symptoms who were selected using the purposive sampling method. For assessing models, we have utilized four tools that include: CNS-Vital Sign Test Battery; Barkley Deficit in Executive Functioning Scale; self-verbalization questionnaire (SVQ); and trail making test. We analyzed the data by running structural equation modeling (SEM) analysis using IBM AMOS software version 22. The results show that Model Comparison Measurement (e.g. AIC was 197.583 and 144.614 for BBIM and BUEFM, respectively) and Model Fit Indices (e.g. root mean square error of approximation (RMSEA) obtained 0.076 and 0.067 for BBIM and BUEFM, respectively) representing that BUEFM had a better value than BBIM, which means that the BUEFM was considered better fitting to the data. The findings of this study show that BUEFM has more Predictive power than BBIM to predict symptoms of ADHD through the motor control fluency (MOT) variable.

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.

Gender role conflict: Is it a predictor of marital dissatisfaction? A cross sectional study in Tehran

Background: Gender role, sex-oriented attitudes, behaviors, cognitions, and emotions play an essential role in interpersonal relationships. Along with other factors, marital relationships and satisfaction can also be affected by a person’s gender role. The increased rate of divorce is related to a decrease in marital satisfaction. The aim of this study was to evaluate the predictor power of gender role conflict on marital satisfaction considering the role of demographic variables (age, income, number of children, and number of family members), marriage-related factors (duration of the marriage, family functioning), and mental health disorder.

Methods: This was a cross sectional study. Participants were selected from couples who were attending West of Tehran health center. A total of 123 married couples aged 18 to 60 years who did not have mental or other medical disorders were recruited. Data gathering tools were McMaster Family Assessment Device (FAD), ENRICH Marital Satisfaction Scale, Bem Sex-Role Inventory (BSRI), a sociodemographic questionnaire, and Brief Symptom Inventory (BSI). Pearson correlation, chi-square, t test, ANOVA, Scheffe post hoc, and linear regression tests were used to analyze the data. Data were analyzed using SPSS 16, and in all statistical tests, significance level was set at p<0.05.

Results: No significant correlations were observed between marital satisfaction and age, number of family members, duration of the marriage, number of children, and income (p>0.05). The presence of gender role conflict was correlated with lower marital satisfaction. Family functioning, gender role conflict, and presence of psychotic problems were predictors of marital satisfaction (p<0.001, R2=0.419).

Conclusion: Screening couples who applied for divorce due to psychiatric problems and gender role conflict and evaluating their family functioning may have a positive effect on reduction of divorce rate.

Modeling the relationship between attachment styles and somatic symptoms with the mediating role of emotional processing

INTRODUCTION

In spite of our general knowledge about psychological roots and defects of developmental processes in the formation of somatic symptoms, the effect of the interaction of developmental components with cognitive-emotional variables is unclear. Previous researches suggest that individuals with insecure attachment may have a higher risk to experience of somatic symptoms. The main aim of this study is "Modeling the Relationship between Attachment Styles and Somatic Symptoms with the Mediating Role of Emotional Processing."

MATERIALS AND METHODS

This study was a descriptive-correlational study. Two hundred and twenty individuals aged 18-59 years living in Tehran were selected by available sampling from the general population. Collins and Reed's Adult Attachment Scale, Baker's Emotional Processing Scale, and Patient Health Questionnaire were used to collecting data. Data analysis was performed by Pearson correlation and independent t-test. The conceptual model presented in this study was tested with a path analysis approach.

RESULTS

Given the Chi-squared size (χ²= 1.214; P > 0.05), it can be said that the proposed conceptual model fits well with the observed model. Besides, checking the other absolute and relative indices also shows a very good fit of the model.

CONCLUSION

Our results showed that when the reciprocal effects of attachment styles were controlled, secure attachment could be considered as a protective factor against deficits in emotional processing and somatization of negative emotions. On the other hand, we found that when the dominant attachment style in individuals was anxiety based, it could be possible that they experience deficiency in the processing of emotion and more severe somatic symptoms.

The changes of social performance with transcranial magnetic stimulation (TMS) in depressed patients

Objectives

The purpose of this study was investigating the effectiveness of rTMS (repetitive transcranial of magnetic stimulation) on increase social performance in patients with recurrent major depression.

Method

It was used a quasi-experimental, pretest–posttest design with control group, a sample consisting of 32 patients who had depression on the basis of DSM-IV diagnostic criteria, SCID and BDI-II scales and were randomly assigned to two groups.

The experimental group underwent 20 sessions of rTMS as the independent factor and both groups (control & experimental) had 12-session psychotherapy and drugs treatment. Upon the intervention, both groups were tested with two tests (BDI-II & SASS). To determine the effect of the independent factor on the dependent factor of rTMS.

Data were analyzed by t-test.

Results

The comparison between pre- & posttest of all the tests showed the reduction of signs & symptoms of depression, (a = 0/05) (Beck scale P ≤ 0/001 & F = 30) and increase social performance in participants (P ≤ 0/001 & F = 83).

Conclusion

The rTMS is effect in the reduction of signs & symptoms of depression and increase social functioning in recurrent major depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Application of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: A randomized controlled trial

BACKGROUND

Body dysmorphic disorder (BDD) is a common disorder which is associated with a high rate of comorbidity and functional impairment. Although research shows that cognitive-behavioral therapy can be an efficacious treatment for BDD, there is growing evidence that dysregulated emotion is a core deficit. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic, emotion focused cognitive-behavioral therapy protocol that has been developed to target emotion regulation processes that play an important role in the development and maintenance of many emotional disorders METHODS: : In the present study, 128 patients meeting criteria for BDD were randomized to either the UP (n = 64) or waitlist/treatment-as-usual (WL/TAU) condition. Diagnoses were determined using semi-structural interviews and patients also completed the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI), the Difficulties in Emotion Regulation Scale (DERS), the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI).

RESULTS

Repeated measure ANOVA indicated that the UP significantly decreased depression, BDD symptoms and body-related anxiety, as well as significantly improving emotional regulation all with large effect sizes compared to the TAU/WL condition. Treatment gains as well as remission of comorbid conditions were maintained at the three-month follow-up.

LIMITATIONS

Our study limitations include restricted follow-up periods and excluding participants who were actively suicidal.

CONCLUSIONS

To our knowledge, this is the first examination of the UP for BDD, and results suggest that this disorder shares common mechanisms with other disorders of emotion, and that the UP may be an additional efficacious treatment for this condition.

Sexual problems in Tehran: Prevalence and associated factors

INTRODUCTION

Sexual dysfunctions are considered as the most prevalent problems in the general population and their prevalence is so dispersed depending on different cultures and living conditions. This research investigates the prevalence of sexual dysfunctions and their relevant factors in Tehran.

MATERIALS AND METHODS

In this cross-sectional questionnaire-based study, 1129 women and men referring to health centers in 22 Districts of Tehran were selected using quota, stratified and cluster sampling. Demographic questionnaire, female sexual function index (FSFI), and Brief Sexual Function Inventory (BSFI) were used to collecting data.

DATA ANALYSIS

The data were analyzed using descriptive methods, and the findings were compared using the Chi-square, analysis of variance, and independent t-tests.

RESULTS

Totally 561 women and 568 men with the average ages of 33/06 and 34/98 participated in this study. In general, 77/6% of women and 35/6% of men complained about sexual problems. The most prevalent problems in women were sexual desire dysfunction (45/3%) and arousal dysfunction (38/85%), and the most prevalent problems in men were erection dysfunction (40/4%) and then ejaculation dysfunction (32/5%). Prevalence rates of dysfunctions of orgasm, dyspareunia, and vaginal dryness were, respectively, 9/2%, 9/0%, and 7/0%, and prevalence of sexual drive dysfunction in men was 10/6%.

CONCLUSION

The prevalence of sexual problems in Iranian women is so much higher than the global findings, and in men, this rate is somewhat higher than global prevalence. This difference can be due to the culture and the chosen silence about sexuality and specially women's sexuality in the Iranian culture that requires extra attention to this area.

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.

Determining the effectiveness of the third person interview in the level of insight psychotic patients

The goal of this study was to determine the effectiveness of the third person interview in increasing the level of insight and cooperation in psychotic patients. We used a quasi-experimental posttest design with an alternative method group. A number of 40 individuals with a definite diagnosis of psychosis were selected using a simple random sampling, and were put randomly in an experimental group (third person interview) and an alternative control group (clinical interview). The results indicated that using the third person interview, the insight level of the psychotic patients increased in all dimensions of insight, except awareness of flat or blunted affect and awareness of unsociability. The results of the independent t-test samples showed no significant difference in cooperation between the two groups of psychotic patients. It seems that the ability to consider one's mental viewpoint from other's, is dependent on the relative ability of psychotic patients to represent other's mental states (theory of mind). But, psychotic patients have severe impairment in the ability to represent their own mental states, resulting in an impairment in the recognition of their mental disorder, psychotic symptoms, the need for therapy, and social consequences of their mental disorder.

A Qualitative Study of the Relationship Between Methamphetamine Abuse and Sexual Dysfunction in Male Substance Abusers

Background

Increased prevalent use of methamphetamine is a global public challenge. Information on drug use can be helpful in preventing high-risk behavior related to drug abuse.

Objectives

This study aims to investigate the sexual function changes related to methamphetamine use in the male clients of public and private addiction treatment centers.

Patients and Methods

In this qualitative study, 45 men (35 methamphetamine users, 5 family members of the users, and 5 psychiatrists or physicians who were famous for treating or researching addiction) are involved. An in-depth interview was done with therapists and key individuals.

Results

The results show that the effects of methamphetamine on sexual function are not identical. The first usage is concomitant with the increased duration of sex, an increase in the quality and quantity of sexual pleasure, a delighted orgasm, and feeling more control of the sex act. These effects gradually decrease. A decreased libido and various sexual dysfunctions such as erectile dysfunction, premature ejaculation, and losing control during the sex act will appear over time.

Conclusions

There are differences in the libido and sexual functions of methamphetamine users. Personal perceptions of one’s sexual function may be affected by cognitive changes resultant from the drug. Drug-use prevention, addiction treatments, appropriate sexual behavior education, and harm reduction are priorities.

A Randomized Double-Blind Controlled Trial Comparing Davanloo Intensive Short-Term Dynamic Psychotherapy as Internet-Delivered Vs Treatment as Usual for Medically Unexplained Pain: A 6-Month Pilot Study

BACKGROUND

Research has shown that Intensive Short-Term Dynamic Psychotherapy (ISTDP) can effectively decrease pain intensity and improve quality of life in patients with medically unexplained pain.

OBJECTIVE

Understanding that not all patients with medically unexplained pain have access to in-person ISTDP, this study aims to investigate the efficacy of an Internet-delivered ISTDP for individuals with medically unexplained pain using Skype in comparison with treatment as usual.

METHOD

In this randomized controlled trial, 100 patients were randomly allocated into Internet-delivered ISTDP (n = 50) and treatment-as- usual (n = 50) groups. Treatment intervention consisted of 16 weekly, hour-long therapy sessions. The primary outcome was perceived pain assessed using the Numeric Pain Rating Scale. The secondary outcome included Depression Anxiety Stress Scale-21, Emotion Regulation Questionnaire, Mindful Attention Awareness Scale, and Quality-of-Life Inventory. Blind assessments were conducted at the baseline, posttreatment, and at a 6-month follow-up.

RESULTS

In the intention-to-treat analysis, pain symptoms in the intervention group were significantly reduced (p < 0.001), whereas a reduction was not observed in the treatment as usual group (p = 0.651). Moreover, there were significant decreases in depression, anxiety, and stress, as well as a greater increase in emotion regulation functioning, mindfulness, and quality of life observed in the intervention group 6 months after the treatment compared with the treatment as usual condition.

CONCLUSION

The results of this pilot trial demonstrate that 16 weeks of ISTDP delivered by Skype can significantly improve pain intensity and clinical symptoms of medically unexplained pain.

Differences between expressive suppression and cognitive reappraisal in opioids and stimulant dependent patients

Background

Substance use and affective disorders frequently co-occur, but the role of affective dysregulation in addiction is often overlooked. There is evidence shows that substance – dependent individuals have more problems in regulating their emotions.

Objectives

This study compared two commonly used emotional regulation strategies, cognitive reappraisal and suppression, in opioids and methamphetamine dependents.

Materials and Methods

One hundred forty men with substance dependence (70 Opioids, 70 Methamphetamine) were selected by accessible sampling, and they responded to Emotion Regulation Questionnaire (Gross & John) and Clinical drug addiction profile (CDAP) questionnaire. SPSS software was used to analyze the results, and descriptive statistics such as frequency tables and inferential statistics including independent t-test were used.

Results

Opioids and methamphetamine dependent patients differ in reappraisal strategy (P < 0.01). These groups differ not only in reappraisal strategy, but also in the suppression (P < 0.001).

Conclusion

Opioids and methamphetamine dependent individuals used different strategies for regulating their emotions. The key finding was that opioids dependents prefer suppression, and methamphetamine dependents usually use reappraisal for this purpose.

The efficacy of metacognitive therapy on patients suffering from pure obsession

OBJECTIVE

The present study aimed to examine the efficacy of metacognitive therapy in treatment of patients with pure obsession.

METHOD

Six patients suffering from pure obsession were selected using purposeful sampling method and were included after meeting the inclusion criteria of the study. Patients were assessed using the structured clinical interview for DSM- IV Axis I disorder - patient edition (SCID- I/P). The patients' main obsessions were present including sexual, aggressive and blasphemous thoughts. In response to these obsessions, all patients used covert rituals and compulsive behaviors. In this study, multiple baseline, a major type of single- subject empirical design, was employed. During the baseline (3-7 weeks) and treatment (14 weekly sessions) and follow-up (3 months) patients filled out the Obsessive Compulsive Inventory (Revised form) (OCI-R), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Metacognitive Questionnaire (MCQ), Thought Fusion Inventory (TFI) and Beck Depression Inventory- II (BDI-II). To implement metacognitive therapy, Well's theraputicimstruction for OCD was used.

RESULTS

The results indicated that Metacognitive Therapy (MCT) is effective in reducing obsessive - compulsive symptoms and in modifying metacognitive beliefs and thought-fusion beliefs.

CONCLUSION

Metacognitive therapy is effective in treatment of pure obsession.