stress
mohsen jalali; elnaz pourahmadi
Abstract
Objectives: During the pandemic COVID-19, numerous studies displayed an increase in anxiety and depression in pregnant women. This present study aimed to investigate the effect of neurofeedback therapy on pregnancy anxiety and prenatal depression in pregnant women. Methods: The study was a single-case ...
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Objectives: During the pandemic COVID-19, numerous studies displayed an increase in anxiety and depression in pregnant women. This present study aimed to investigate the effect of neurofeedback therapy on pregnancy anxiety and prenatal depression in pregnant women. Methods: The study was a single-case experimental study with multiple baseline design with a follow-up period. Three pregnant women were selected according to purposive sampling method and entered the study gradually in fixed intervals. The research tools included the neurofeedback therapy, Pregnancy Related Anxiety Questionnaire (PRAQ) and Beck Depression Inventory Second Edition (BDI-II). Results: The findings showed that the neurofeedback reduced the severity of pregnancy anxiety and prenatal depression symptoms in both post-treatment and follow-up stages, so that the percentage of improvement for the first, second and third participants in the symptoms of pregnancy anxiety was 72%, 74% and 71% in post-treatment and 75%, 80% and 73% in follow-up stage, respectively. The percentages of improvement for the first, second and third participants in the symptoms of prenatal depression were also 72%, 77% and 77% in post-treatment and 79%, 77% and 83% in follow-up stages, respectively. Moreover, the overall percentages of improvement in post-treatment and follow-up stage in the symptoms of pregnancy anxiety were 72% and 79% and in the symptoms of prenatal depression was 75% and 80%, respectively. In addition, at the end of the intervention sessions and at the 1-month follow-up, all the three patients scored less than 14 on BDI-II, which indicated the clinical significance of the reduction of their depression symptoms on this scale. The visual analyses and the results of inter-positional and intra-positional analyses showed a significant difference between baseline and intervention stage for all subjects (PND>70, PAND>50). The percentages of non-overlapping data (PND) as a measure of effect size for the first, second and third participants in the symptoms of pregnancy anxiety were 83%, 100% and 83% respectively. The percentages of all non-overlapping data (PAND) as the second effect size criterion for the subjects were also 87.5%, 100% and 90%, respectively, which shows the effectiveness of the intervention for all the three subjects in the symptoms of pregnancy anxiety. The percentages of non-overlapping data (PND) for the first, second and third participants in the symptoms of prenatal depression were 83%, 83% and 67% respectively. The percentages of all non-overlapping data (PAND) for the subjects were 87.5%, 89% and 800% respectively, which shows the effectiveness of the intervention for all the three subjects in the symptoms of prenatal depression.
stress
Maede Asadollah Najafi; Batool Aminjafari; Mehdi Marvi
Abstract
Objectives: Cancer has experienced alarming growth in the last two decades and is considered as an urgent health problem of modern life. Meanwhile, breast cancer is one of the most common types of cancer, and its annual incidence is increasing at a rate of 1.8 to 2% in the world, and it ranks first among ...
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Objectives: Cancer has experienced alarming growth in the last two decades and is considered as an urgent health problem of modern life. Meanwhile, breast cancer is one of the most common types of cancer, and its annual incidence is increasing at a rate of 1.8 to 2% in the world, and it ranks first among all women's cancers. However it has a major difference from other chronic diseases. In addition to requiring long-term care and treatment, it cannot be completely cured. This study aimed to investigate the effectiveness of group self-healing training on distress tolerance, emotional reactivity and anxiety in women with breast cancer in Isfahan. Methods: It was semi-experimental in the form of pre-test-post-test with a control group. The statistical population included all women with breast cancer in Isfahan who had referred to support center for cancer patients in the first quarter of 2011, and their number was 93 people in this period of time based on the statistics received from the counseling center. 30 people were selected as the sample through available sampling and were placed in two experimental (15 people) and control (15 people) groups. The used tools were Simons & Gaher's distress tolerance (2005), Matuo & Nock's emotional reactivity (2008) and Reese and Patterson anxiety (1985) questionnaires. Self-healing group training sessions based on the protocol of Latifi and Meravi (2017) adapted from Loyd and Johnson (2010) were conducted during 14 sessions. The data were analyzed using SPSS-24 software in two descriptive and inferential (normalization and MANCOVA) according to the investigated hypotheses. Results: The results showed that group self-healing training on distress tolerance and its dimensions (tolerance, evaluation and regulation), emotional reactivity (sensitivity, intensity and stability) and anxiety (fear of physical symptoms, fear of cognitive control distortion, fear of observing anxiety reactions) is effective in women with cancer in Isfahan (P<0.05). Conclusion: Therefore, it seems that this method can be used for breast cancer patients. The reason for the effectivness of self-healing training on reducing cancer patients’ anxiety and stress in physical and psychological dimensions can be attributed to the effects of direct training in the field of fear and anxiety in this intervention. In this treatment method for treating anxiety, strategies include self-education and communication management (keeping calm, avoiding haste, avoiding useless discussions, speaking in a soft tone, not reacting quickly and not judging quickly), trusting others (patience, calmness, happiness and entrusting the solution of the problem to a higher power), adjustment of idealism (reducing the desire to be perfect and accepting mistakes as an inseparable part of every human being), order and time management (having discipline, planning and prioritization and doing necessary daily tasks), correct connection with the mind (living in the present moment), and using physical and muscle relaxation techniques (muscle relaxation, breathing, hydrotherapy, swimming, walking, religious behaviors, watching the sky, listening to the sound of water, meditation and yoga, the use of relaxing audio files at least once a day) were used and the patients were helped to reduce their anxiety to a great. Considering the confirmation of the effectiveness of self-healing training on reducing emotional reactivity and anxiety in people with cancer, it is suggested that doctors and nurses pay attention to their psychological condition in addition to physical treatments for these patients and if they observe psychological problems caused by the disease, refer them to psychologists and counsellors. It is also suggested to set up counseling and psychological centers for cancer patients in hospitals.
stress
Mohammad Reza Tamannaifar; Azam Mansourinik; Shiva Ahmadpoursamani
Abstract
Objectives: Quality of life in patients with heart failure can be affected by several factors. The present study aimed to examine the relationship between personality traits and quality of life in heart failure patients mediated by self-care behaviors. Method: This study is a structural equation modeling. ...
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Objectives: Quality of life in patients with heart failure can be affected by several factors. The present study aimed to examine the relationship between personality traits and quality of life in heart failure patients mediated by self-care behaviors. Method: This study is a structural equation modeling. Among the heart failure patients referred to Tehran Heart Hospitals, 300 patients referred to Jam Hospital and Bustan Cardiovascular Clinic were recruited through convenient sampling. In order to collect information, NEO-FFI (Costa & McCrae, 1992), MOS (Ware & Sherbourne, 1992) and EHFSCB (Jarsma et al., 2003) were used. Data were analyzed using SPSS and AMOS 24 software. Results: The results of correlation coefficients showed that there are significant negative correlation between the personality traits of neuroticism and agreeableness with quality of life, while there are significant positive correlation between extroversion and quality of life (P<0.01). Also, there are significant negative correlation between self-care behaviors and quality of life (P<0.01). According to the results the proposed model has a good fit (x2/df=2.786, p<0.001, CFI= 0.92, RMSEA=0.07). In addition, the direct effect of neuroticism, extroversion and agreeableness on quality of life is significant (P<0.01). When self-care behaviors are included as mediators in the relationship between personality traits and quality of life, the indirect effect of neuroticism and conscientiousness on quality of life is 0.09 and 0.049 respectively, and these indirect effects are significant (P<0.01). Therefore, self-care behaviors mediate the relationship between personality traits of neuroticism and conscientiousness with quality of life.Conclusion: These results have important implications for clinical practice and research in the field of cardiac health psychology and indicate the need to develop approaches and better management of these patients in self- care behaviors. Considering the widespread prevalence of heart diseases as a chronic disease and the high costs of treatment, the results of this research have many practical implications for health psychologists, doctors and nurses. Interventions aimed at changing personality characteristics (especially reducing neuroticism and increasing conscientiousness) in order to improve the quality of life of heart patients is a complex and time-consuming task. Therefore, one of the effective interventions to increase these patients’ quality of life can be focusing on increasing self-care behaviors. Hence, educating patients about the importance of this issue can play an important role in improving these patients’ quality of life.
stress
mina nikoravesk; hamid alizadeh; saeed rezaei; mehdi dastjerdi kazemi
Abstract
Objectives: Cancer has extensive effects on children’s mental health and well-being. One of the problems of children with cancer is social interest. Due to the constant reduction of social interests and their association with quality of life, effective intervention programs are very important. ...
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Objectives: Cancer has extensive effects on children’s mental health and well-being. One of the problems of children with cancer is social interest. Due to the constant reduction of social interests and their association with quality of life, effective intervention programs are very important. On the other hand, helping childhood cancer survivors and children with cancer to maintain physical, mental and social well-being is one of the most important responsibilities of health professionals and psychologists. It should be noted that the intervention was tailored to the condition of children with cancer. This study aimed to evaluate the effectiveness of an Adlerian play therapy on enhancing social interest in children with cancer.Methods: It was a quasi-experimental study with pretest–posttest with control group. The statistical population consisted of all children with cancer of Yazd City, Iran. Using the convenience sampling method, 30 children were selected as a sample based on the inclusion and exclusion criteria. They were randomly divided into experimental and control groups (n=15/group). The inclusion criteria for children included age 8-12, definitive diagnosis of cancer, at least one course of chemotherapy, not being treated with psychotropic drugs, the child living with both parents, not having any disease other than cancer, not having neuropsychological problems such as mental retardation, hyperactivity, moderate socio-family status and hospitalized for at least one month. The inclusion criteria included reluctance to continue cooperation, not cooperating in completing questionnaire at each of stages or more than two absences in training sessions. In pretest and posttest stage, participants completed the Social Interest Scale for Iranian Children (Alizadeh, 2015(, which included responsibility-task doing, relationship with people-empathy, confidence -assertive, equality vs inferiority-superiority. The weekly sessions of play therapy program included eighteen 45–minute for children. To describe the obtained data, central and dispersion indices, including mean and standard deviation and multivariate and univariate analysis of covariance were used in SPSS 24 at the significance level of 0.05. Results: The results of the multivariate covariance analysis for the subscales of the social interest scale show that the experimental group shows a significant positive change in the subscales after participating in the training program compared to the control group (p <0.05).Conclusion: Adlerian play therapy is effective on social interest in children with cancer and should be offered as a complementary treatment along with other medical and psychological therapies to these children.
stress
Fatemeh Kazemi; Sahar Safarzadeh
Abstract
Objective: This study aimed to investigate the burnout model based on physical health status and brain-behavioral system by mediation of job stress in employees of Abadan Oil Company. Method: The type of research is structural equation and the statistical population was all the employees working in Abadan ...
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Objective: This study aimed to investigate the burnout model based on physical health status and brain-behavioral system by mediation of job stress in employees of Abadan Oil Company. Method: The type of research is structural equation and the statistical population was all the employees working in Abadan Oil Company of which 255 people were selected by purposive sampling. The participants responded to Moslesh and Jackson’s job burnout scale (1981), Spence et al.’s physical health status (1987), Carver and White’s brain-behavioral systems 1994) and Parker and Dekutis’s occupational psychological pressure (1983) questionnaires. Data analysis was done using structural equation modeling. Results: Findings showed that physical health and behavioral activating brain system have a direct and inverse effect on burnout and behavioral inhibition system and job stress have a direct and positive effect on burnout. By increasing the activity of the behavioral activator system, the feeling of job burnout and fatigue decreases and with the increase in the activity of the behavioral inhibitory system and the perceived stress in the job, the level of job burnout increases. Also physical condition and two behavioral activation / inhibitory systems can play a role in the formation of burnout by affecting job stress. It was also found that the proposed model is suitable for data. Based on this, it has been determined that the increase in job burnout can be caused by several factors, such as weak physical health or underlying diseases that are not suitable for the chosen job, as well as the increasing activity of the inhibitory behavioral brain system and impaired behavioral activation system and job stress can be one of the characteristics of any job, can mediate this relationship. Conclusion: According to the present findings, we can conclude that physical health, improvement of the behavioral activation system, and job stress reduction decrease the rate of job burnout. Since employment in industrial organizations is associated with risks and traumatic conditions, no matter how hard the organization tries, their mental and physical health is facing risks, and can lead to job burnout. So the factors such as lack of physical health disruption of the activator system and increased activity of the inhibitory-behavioral system can increase job burnout by increasing stressful conditions in the work environment.
stress
sepideh Tamrchi; Mona Farkhondehfal; Mohadese Kheradmand; Mahtab Rabiee; Fariba Zarani
Abstract
Objective: Breaking bad news to the patients and their family is an important and difficult stage in disease process requiring both verbal and non-verbal skills. Thus, studies in the field of health psychology have provided protocols to explain step by step how to break bad news. These protocols have ...
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Objective: Breaking bad news to the patients and their family is an important and difficult stage in disease process requiring both verbal and non-verbal skills. Thus, studies in the field of health psychology have provided protocols to explain step by step how to break bad news. These protocols have focused on how to break bad news in various therapeutic fields and different approaches. The diversity of these models can make health professionals hesitate in choosing the right model. The purpose of this review study was to identify the most widely used protocols for breaking bad news, their similarities and differences, and to provide a structure to compare these protocols.
Methods: The search for breaking bad news protocols was conducted in Google Scholar and Science Direct databases. Then, the most widely used protocols that were mostly referred to by other studies were identified. Finally, 13 protocols were selected for detailed investigation. Results: As a result of comparing these protocols, 9 common concepts were find, including: 1- preparation before the session, 2- setting up the proper communicational space, 3- personal evaluation of the patient, 4- evaluation of the patient's environment, 5- approaching the news, 6- exploring the emotions and providing empathic response, 7-talking about treatment plans, 8- investigating support systems, 9- summarizing and concluding the session. Along with these common steps, 47 sub-steps were identified. All these findings were classified altogether in both summarized and extended model. In summarized model the one look table consisting of 9 common concepts and 47 sub-steps was provided. While in an extended table, the contribution of each of 13 investigated protocols in each of the concepts and sub-steps was clarified by detail. Conclusion: The extended table also highlights the unique features of each protocol, allowing health professionals to choose the most appropriate approach based on the specific needs of the patients and their families. In general, this study reviews and compares the most important protocols of breaking bad news to patients to provide a relatively comprehensive picture of what has been considered in different studies for breaking bad news. Therefore, it provided the summarized and extended models of breaking bad news to health professionals as a practical tool containing common concepts and different sub-steps of the most important protocols. This study emphasizes the importance of a structured and empathetic approach to breaking bad news, which can improve patient satisfaction, trust, and coping strategies.
stress
samira torkian valashani; zohreh latifi; niloofar bagheri; Mohammad Soltanizadeh
Abstract
Objective: The aim of the present study was to investigate the effect of self-healing education on the spiritual well-being and positive and negative emotions in multiple sclerosis (MS) patients in Isfahan, Iran. Methods: This research was a semi-experimental study with two experimental and control groups ...
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Objective: The aim of the present study was to investigate the effect of self-healing education on the spiritual well-being and positive and negative emotions in multiple sclerosis (MS) patients in Isfahan, Iran. Methods: This research was a semi-experimental study with two experimental and control groups by using pre-test-post-test and 2-month follow-up. The statistical population included all MS patients reffering to the treatment center in 2020, and the sample size consisted of 31 volunteers willing to participate in educational sessions who were randomly assigned to the experimental and control groups. The range of participants’ age was between 18 and 54 years. All participants completed positive and negative emotions questionnaires (Watson, 1988) and spiritual well-being (Dehshiri, 2010) as pre-tests under similar conditions. Subsequently, self-healing education consisting of 14 weekly sessions in 60 minutes, was considered for the experimental group. To examine the effectiveness of self-healing education on positive and negative emotions, repeated measures analysis of variance (ANOVA) and to dtudy the effect of self-healing education on spiritual well-being, the Friedman and Wilcoxon tests were used due to non-establishment of the assumption of normal distribution of data. Results: The LSD pairwise comparisons test results showed no significant difference in positive emotion scores in the experimental group between the pre-test and post-test stages. However, significant differences were noted between the pre-test and follow-up, as well as between the post-test and follow-up stages. In examining the significance of the self-connection subscale in both the experimental and control groups, no significant difference was observed at all three stages in the control group. However, in the experimental group, a significant difference was evident at all three stages following the intervention. Also, the difference in overall spiritual well-being scores in the experimental group was significant between the pre-test and follow-up, with an increase in the follow-up period. Similarly, the difference in the connection to nature subscale in the experimental group was significant between the pre-test and follow-up, as well as between the post-test and follow-up stages, indicating a positive impact of the education. But no significant effect was observed on the individual's relationship with others, the individual's relationship with God, and the reduction of negative emotions. Conclusion: The findings indicate that self-healing education improves spiritual well-being and positive emotions in MS patients. Participants likely improved their spiritual well-being in the area of self-connection by learning techniques such as spiritual elevation and inner richness, and accurately recognizing negative memories and their detrimental actions resulted in an improvement in their relationship with nature. It also appears that reducing inhibitory traits such as resentment and false beliefs leads to a change in attitude, strengthening willpower, and finding a better way to solve the problems. Additionally, tasks related to strengthening the 9 healing code may increase positive emotions.
stress
azade Fathi Dooki; Elahe Fathi Dooki; leila Hassannia; hadi Hassannia
Abstract
Objective: Covid-19 pandemic as an acute respiratory disease that emerged in Wuhan, China on 30 January 2020 was declared a public health emergency of international concern. The World Health Organization has introduced this disease as a great threat to physical and mental health because of changing in ...
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Objective: Covid-19 pandemic as an acute respiratory disease that emerged in Wuhan, China on 30 January 2020 was declared a public health emergency of international concern. The World Health Organization has introduced this disease as a great threat to physical and mental health because of changing in families’ normal lifestyle. It has seriously damaged people's mental health due to fear, uncertainty, quarantine measures, staying at home, social isolation, inappropriate information or pouring out news from various media, including social media, etc. With the spread of the Covid-19 disease, various centers including schools and universities were closed, social relations were severely limited, and leisure activities outside the home were canceled or greatly reduced. Virtual training, the suspension of end-of-semester final exams, and the unavailability of books, computers, and low-speed internet at home, affected students' mental health. The students were exposed to a significant risk of adverse consequences of quarantine, such as hopelessness and boredom, and financial loss to the family. Also the change in the daily schedule, including the lack of outdoor activities, disruption of sleep patterns and social distance, has affected the students’ mental health. The aim of the present study was to investigate the psychological consequences of Covid 19 virus on students. Methods: The research findings from the outbreak of Covid 19 during 2019 to 2023 in the PupMed, Science direct, Google Scholar and ProQuest databases were searched through the keywords quarantine, mental health, psychological problems and students. Finally among 70 articles, 34 articles entered the research and the results were summarized and reported. Results: The results showed that post-traumatic stress, depression, anxiety, fear, practical obsession, social isolation, suicidal ideation, poor sleep quality, mood disorder, social dysfunction, wrong and risky diet, alcohol abuse, interpersonal conflicts, limitations of social communication, lack of concentration and loneliness are among the psychological consequences of Covid 19 virus in students. Conclusion: So it was concluded that due to the negative psychological effects of the corona pandemic on students, it is necessary to plan and implement effective intterventions in order to improve thid future generation of society’s health physical and mentale.
stress
sara zarieh; Farah Naderi; Saeid Bakhtiarpoor; parviz askari
Abstract
Objective: The present research was aimed to study the effectiveness of emotion-focused therapy in cognitive emotion regulation and ego strength among cardiovascular patients with obesity.
Method: The method was semi-experimental with pretest, posttest and 3-month follow-up with control group design. ...
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Objective: The present research was aimed to study the effectiveness of emotion-focused therapy in cognitive emotion regulation and ego strength among cardiovascular patients with obesity.
Method: The method was semi-experimental with pretest, posttest and 3-month follow-up with control group design. The statistical population included all cardiovascular patients with obesity in Tehran who referred to Shariati and Rajaei hospitals in 2019-2020. The sampling method was purposive method. Thirty patients were assigned in two groups randomly (15 patients in each group). The experimental group received emotion-focused intevention in 90-minute weekly sessions for eight weeks. The control group were in waitting list. To gather the data, the cognitive emotion regulation (Garnefsk and Kraaij., 2007) and the psychosocial inventory of ego strengths (Markstrom, et al., 1997) questionairs were implemented. The data were analyzed by SPSS-24 via analysis of variance with repeated measures.
Results: Results showed that emotion-focused therapy was effective in increasing positive emotional cognitive regulation (p<0.001) and ego strength (p<0.001). The effectiveness of this treatment in negative emotional cognitive regulation was not significant (p>0.05). The interactive effect of time group for the components of hope (P = 0.170, h2 = 0.018), desire (h2=0.182, P = 0.012), goal (h2 = 0.207, P = 0.005), competence (h2=0.141, P=0.042), loyalty h2=0.296, P = 0.001, F = 6.95), love (h2=0.317, P=0.001), care (h2=0.274, P=0.001) and wisdom (h2=0.190, P=0.011) are significant. The results of the Ben Feroni test comparing the effect of time showed that the difference in the average scores of the eight components of my strength in the pre-test-post-test and pre-test-follow-up stages is statistically significant, but the difference in the average scores in the post-test-follow-up stages is not significant.
Conclusion: According to the findings, it could be said that emotion-focused therapy was a reliable and a stable method in order to improving the psychological conditions of cardiovascular patients, especially ego strength and positive emotional cognitive regulation. In explaining the effectiveness of emotion-oriented therapy in increasing the strength of cardiovascular patients with obesity, it can be said that emotion-oriented therapy is by processing emotional experiences to cardiovascular patients in regulating their emotional functions and in this way achieve more consistent emotional responses that increase resilience and strength. Achieving adaptive emotional responses by modulating emotional responses and coping with disempowering maladaptive emotions increases my resilience in these individuals.
stress
Hossein Zare; Azadeh Sabeti
Abstract
Objective: The aim of the present study was to predict complicated grief based on cognitive flexibility with the mediating role of cognitive regulation of emotion in survivors of the COVID-19.Method: This descriptive study was fundamental-applicative and correlation type with path analysis in terms of ...
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Objective: The aim of the present study was to predict complicated grief based on cognitive flexibility with the mediating role of cognitive regulation of emotion in survivors of the COVID-19.Method: This descriptive study was fundamental-applicative and correlation type with path analysis in terms of method. The statistical population included all the bereaved people who lost one of their close relatives or family members due to the corona virus since 2018 to 1400. Therefore 200 survivors and mourners formed the research sample.Three questionnaires included cognitive-emotional regulation by Garnevsky et al. (2009), cognitive flexibility by Dennis Vonderwall (2010), and grief experience by Barrett and Scott (1998) were used and completed online by the participants. SPSS-26 software was used to analyze statistical correlation relationships and Imus software version 24 was used to evaluate the achievement of the fitted model.Results: The results showed that the direct effect of cognitive flexibility with beta coefficient on compromised strategies is positive (Beta=0.655), and on uncompromised strategies (Beta=-0.628) and the experience of bereavement (Beta=-0.387) is negative and significant (P<01.1). Also, the direct effect of emotion-cognitive compromise strategies with the standard coefficient on bereavement experience (Beta=0.254) is positively significant and the adaptive cognitive strategies of emotion are negatively significant on the experience of bereavement (Beta=-0.327).The correlation coefficient between the variables showed that cognitive flexibility has a positive correlation with emotional cognitive strategies (r=0.66) and a negative correlation with bereavement experience (r=-0.75) and a negative correlation with non-compromised emotional cognitive strategies (P<0.1). In other words, as survivors' cognitive flexibility increases, their mourning decreases. Also, the experience of bereavement is more in the survivors who use non-compromised strategies of emotional cognition (r=0/66) and less in those who use compromised cognitive strategies of emotion (r=-0.71).The results of the Bootstrap test for indirect ways showed that the indirect way of cognitive flexibility to the experience of bereavement with the mediating role of cognitive regulation of uncompromising emotion has an effect size -0.14, as well as the indirect way of cognitive flexibility to the experience of bereavement with the mediating role of cognitive regulation of compromising emotion has an effect size-0.18, that is significant at the level of less than 0.05.Conclusion: Cognitive regulation of emotion has a mediating role between cognitive flexibility and bereavement experience of survivors. In general, the use of cognitive regulation of uncompromised emotion enhances the experience of bereavement and the use of cognitive regulation of compromised emotion reduces it. There is a significant negative relationship between cognitive flexibility and bereavement experience of corona survivors. There is a significant negative relationship between the dimensions of cognitive flexibility and the dimensions of uncompromising cognitive emotion regulation strategies of corona survivors. Also, cognitive flexibility has a significant effect on the complex grief of corona survivors through the mediating role of cognitive emotion regulation. In complicated grief caused by events such as Covid-19, various psychological and cognitive factors such as cognitive flexibility, cognitive regulation of emotion are involved, and psychotherapists, especially cognitive-behavioral therapists, should pay attention to these issues and focus on the positive factors influencing the reduction of complex bereavement and the treatment process.Due to the lack of funeral rituals and traditional mourning interactions which play an important role in facilitating the mourning process, the levels of resolving the painful emotions become more difficult. Greater flexibility will allow individuals to focus more on alternative ways of cognitive changes, therefore, in traumatic situations and psychological distress, they will have better control over their emotions.
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