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Roghayeh Asgarnejad; Atefeh Hojjati
Abstract
Objective: Breast cancer is the most prevalent malignancy among women worldwide, and its experience significantly elevates the likelihood of developing somatization symptoms, thereby imposing substantial healthcare costs (Arnold et al., 2022; Moran et al., 2023). Identifying factors influencing these ...
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Objective: Breast cancer is the most prevalent malignancy among women worldwide, and its experience significantly elevates the likelihood of developing somatization symptoms, thereby imposing substantial healthcare costs (Arnold et al., 2022; Moran et al., 2023). Identifying factors influencing these symptoms is therefore imperative. Personality organization, as a foundational psychological construct, plays a pivotal role in psychosomatic responses to stress, with specific personality traits demonstrably linked to mental health outcomes and adaptation processes in cancer patients (Kovács et al., 2021; Cerezo et al., 2020). Conversely, somatization frequently stems from an inability to directly express negative emotions, a process exacerbated by "entrapment", a psychological state commonly observed in cancer populations and associated with particular personality dimensions such as neuroticism (Çetin & Varma, 2021; Chen et al., 2022). Despite existing evidence, prior research has predominantly focused on direct relationships between Five-Factor Model personality traits and psychosomatic outcomes, exhibiting two critical limitations: first, neglecting the comprehensive theoretical framework of "personality organization," and second, failing to examine the mediating role of entrapment as a key mechanism in chronic cancer-related stress responses. This research gap is particularly pronounced among Iranian women with breast cancer, who face unique cultural challenges (Hosseini et al., 2023). Consequently, the present study employs structural equation modeling to investigate the relationship between personality organization and somatization symptoms, incorporating entrapment as a mediating variable. The primary objective is to determine whether these variables collectively predict somatization symptoms in this population. Method: This fundamental research utilized a descriptive-correlational design. The statistical population comprised all women diagnosed with breast cancer attending Shahid Tajrish Hospital in Tehran during the Iranian calendar years 1402–1403 (2023–2024). Adhering to structural equation modeling principles (Kline, 2012), a sample size of 200 participants was determined and selected via purposive sampling based on predefined inclusion and exclusion criteria. Assessment instruments included the Stress Symptom Checklist (Cheng & Hamid, 1996) for measuring somatization, the Personality Organization Questionnaire (Kernberg, 2002), and the Entrapment Questionnaire (Gilbert & Allan, 1998). The validity and reliability of these tools have been established in both international and Persian-language studies (Shaker, 2018; Ghamarani et al., 2013; Cheng & Hamid, 1995). Following informed consent acquisition, data were collected through self-report questionnaires. Data analysis employed descriptive and inferential statistical methods, specifically path analysis within a structural equation modeling framework using SPSS and AMOS software. This analytical approach enabled examination of direct and indirect relationships among personality organization, entrapment, and somatization symptoms within a cohesive theoretical model. Results: Personality organization demonstrated a significant positive direct effect on entrapment (standardized coefficient β = 0.593, p <.001). Both entrapment (β=0.264, p=.005) and personality organization (β=0.473, p<.001) exhibited significant direct effects on somatization symptoms. Bootstrap testing (Table 1) revealed a significant indirect effect of personality organization on somatization symptoms through entrapment (β=0.156, p=.014), confirming that diminished personality organization intensifies entrapment, subsequently amplifying somatization symptoms at the 5 percent significance level.Conclusion: This study demonstrates that deficits in personality organization predict somatization symptoms in women with breast cancer both directly and indirectly through the mediating role of entrapment. These findings suggest that individuals with maladaptive personality structures lack effective emotion regulation and stress-processing mechanisms, leading them to suppress psychological distress related to their illness and unconsciously manifest it as physical pain or fatigue (Lipowski, 1988). Within this pathway, entrapment functions as a critical missing link: personality disorganization fosters perceptions of helplessness and being trapped by the disease (O'Connor & Portzky, 2018), thereby intensifying the conversion of psychological suffering into physical symptoms. Consistent with prior research (Hosseini et al., 2023; Kang et al., 2023), these results underscore the necessity of transcending purely biological perspectives on cancer. Practically, therapeutic interventions should extend beyond physical symptom management to address personality structure reconstruction and reduction of entrapment feelings. Approaches such as Emotion-Focused Therapy or Cognitive-Behavioral Therapy may disrupt the vicious cycle of somatization by facilitating direct emotional expression and restoring perceived control (Çetin & Varma, 2021). Although limitations exist, including the cross-sectional design and uncontrolled clinical variables, this model provides a valuable framework for developing integrated psychosomatic care protocols tailored to the Iranian cultural context, where direct expression of psychological distress often encounters social barriers.
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Hossein Haji Ali Akbari; Abbas Mokhtari
Abstract
Objective: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with the mediating roles of pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility ...
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Objective: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with the mediating roles of pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility in patients with IBS. Irritable bowel syndrome is considered one of the most prevalent functional gastrointestinal disorders and is characterized by persistent alterations in bowel habits, such as diarrhea, constipation, or a combination of both, accompanied by abdominal pain and discomfort. A defining feature of this disorder is the absence of identifiable structural or biochemical abnormalities in routine clinical examinations and laboratory tests. In other words, despite the substantial impact of these symptoms on patients’ quality of life, no clear organic cause has been established. In recent years, numerous studies have examined the influence of psychological factors on the experience and exacerbation of IBS symptoms. Findings from this body of research indicate a close association between IBS and variables such as perceived stress, pain catastrophizing, anxiety sensitivity, cognitive flexibility, and emotion regulation. Patients with IBS commonly experience high levels of psychological distress, anxiety, and mood disturbances in addition to physical pain, which can substantially diminish their overall life satisfaction. Method: The present study adopted a descriptive–correlational design and was conducted using structural equation modeling (SEM) with a path analysis framework. The target population included all individuals who were diagnosed with irritable bowel syndrome (IBS) by a gastroenterologist, based on endoscopic and colonoscopic examinations, and who referred to gastroenterology clinics and medical centers in Isfahan, Iran, during 2025. Participants were recruited using a convenience sampling method. Although there is no universally accepted guideline for determining sample size in SEM studies, methodological recommendations generally suggest a minimum of 200 participants to ensure adequate statistical power and model stability. Accordingly, an initial sample of 225 patients with IBS, aged 20 to 75 years, was recruited. After screening the data, 25 cases were excluded due to incomplete questionnaire responses. Consequently, data from 200 participants were retained for the final analyses. Data were collected using a battery of standardized self-report instruments, including the IBS Symptom Severity Questionnaire (Solati, 2008), the Perceived Stress Scale (Cohen et al., 1983), the Satisfaction with Life Scale (Diener et al., 1985), the Pain Catastrophizing Questionnaire (Rahmati et al., 2017), the Anxiety Sensitivity Index (Reiss & Peterson, 1986), the Emotion Regulation Questionnaire (Gross & John, 2003), and the Cognitive Flexibility Inventory (Dennis & Vander Wal, 2010). Data analyses were conducted using Pearson’s correlation coefficients and structural equation modeling with path analysis. All statistical analyses were performed using SPSS (Version 26) and AMOS (Version 24). Results: The results of the path analysis indicated that IBS symptom severity had a significant positive direct effect on pain catastrophizing (β=.25, p<.01) and anxiety sensitivity (β=.49, p<.01). However, the direct effect of IBS symptom severity on life satisfaction was not statistically significant (β = .03, p = .555). In addition, perceived stress demonstrated a significant positive direct effect on anxiety sensitivity (β= .18, p<.01), pain catastrophizing (β=.18, p<.01), and ife satisfaction (β = .21, p <.01). Thedirct effect of pain catastrophizing on emotion regulation was not significant (β=.02, p=.727). I contrast, emotion regulation had a significant positive direct effect on life satisfaction (β=.24, p<.01). Furthermore, anxiety sensitivity did not have a significant direct effect on cognitive flexibility (β=−.11, p=.106). However, cognitive flexibility showed a significant positive direct effect on life satisfaction (β=.23, p<.01). Overall, the findings supported the hypothesized structural model, confirming the proposed relationships among the study variables.Conclusion: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility as mediating variables. The results indicated that the proposed model demonstrated good fit. Findings showed that the severity of IBS symptoms directly increased pain catastrophizing and anxiety sensitivity but had no direct effect on life satisfaction. This suggests that the mere presence of physical symptoms does not necessarily reduce patients’ life satisfaction; rather, such reductions occur through intermediary psychological processes. According to cognitive pain processing and emotion regulation theories, individuals who focus on the negative aspects of physical symptoms and appraise them as threatening experience more intense pain and lower quality of life. Similar results have been reported by Carter et al. (2017), indicating that individuals with functional gastrointestinal disorders who experience high levels of stress and anxiety report lower quality of life. Considering the study’s findings and the significant role of mediating variables, it is essential to develop workshops and programs aimed at enhancing adaptive coping skills, such as problem-solving, mindfulness, and acceptance, for this population.
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Ainollah Sakinepoor; Saadollah Hashmi
Abstract
Objective: Proper posture reflects the coordinated alignment of body segments, minimizing muscle effort, reducing pain, and optimizing functional efficiency (Haji Hosseini et al., 2015). In contrast, postural deviations disrupt muscular function, impair appearance, increase energy expenditure, and raise ...
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Objective: Proper posture reflects the coordinated alignment of body segments, minimizing muscle effort, reducing pain, and optimizing functional efficiency (Haji Hosseini et al., 2015). In contrast, postural deviations disrupt muscular function, impair appearance, increase energy expenditure, and raise the risk of musculoskeletal disorders (Beheiraei et al., 2016). These abnormalities are particularly common among students aged 11–15 years, with high rates of forward head posture, kyphosis, and rounded shoulders reported (Moghadid et al., 2022; Akbari et al., 2008). Sedentary behaviors, inappropriate furniture, and prolonged screen time significantly contribute to postural deviations, including Upper Crossed Syndrome (UCS) (Seddars et al., 2015). Janda (Chang et al., 2023) described UCS as an imbalance involving tight upper trapezius, levator scapulae, and pectoral muscles alongside weak deep cervical flexors and lower trapezius. This imbalance alters thoracic curvature, disrupts shoulder mechanics, and often causes neck and shoulder pain, headaches, and temporomandibular joint discomfort (Wirnata et al., 2024; Ghamkhar & Khallaii, 2018). Chronic musculoskeletal pain is linked to psychological consequences such as social anxiety, emotional distress, and increased stress responses (Heikinnen et al., 2019), which may promote impulsive, rapid, and unplanned behaviors in individuals with poor emotional regulation (Cashagrande et al., 2020). Pain can also interfere with emotion regulation, foster maladaptive coping strategies, and perpetuate a cycle between pain and distress (Kuyckelin et al., 2018). Corrective exercise programs targeting UCS have been shown to improve posture, functional movement, and reduce pain (Kim et al., 2015). They may also enhance psychological functioning by decreasing fear, improving mood, and increasing perceived physical competence (Wieland & Linton, 2012). Based on these findings, this study aimed to investigate the effects of corrective exercises on social–physical anxiety, impulsive behaviors, and emotional self-regulation in students with UCS. Method: The research method of the present study was semi-experimental. The statistical population consisted of students diagnosed with Upper Crossed Syndrome (UCS) in Eslamabad-e-Gharb. Sixty students who met the inclusion and exclusion criteria were convenience selected and randomly assigned to either a corrective exercise group (n = 30) or a control group (n = 30).During the pre-test phase, all participants completed validated questionnaires, and postural variables related to UCS were measured. The corrective exercises were performed for the experimental group over eight weeks, with three sessions per week, each lasting one hour.The control group received no intervention and continued routine daily activities. Post-tests were conducted simultaneously under identical conditions to assess the program’s effectiveness, and corrective sessions were later offered to the control group for ethical reasons. Inclusion criteria were age 11–18 years, signed consent, daily computer use over four hours, forward head angle >46°, rounded shoulder angle >52°, and thoracic kyphosis >42°. Exclusion criteria included psychological disorders, prior corrective training, incomplete questionnaires, psychotic or severe physical illnesses, and absence from more than two consecutive sessions. Results: Considering that the main assumptions of the test were met, a Multivariate Analysis of Covariance (MANCOVA) was initially performed on the data to examine the effect of the corrective exercise intervention on the dependent variables in the students. Table 4 presents the results of the Multivariate Analysis of Covariance test.As observed in Table 4, the results of Wilks' Lambda test indicated a significant difference between the corrective exercise group and the control group in at least one of the measured dimensions (P < 0.001). The F statistic was 37.36, and the effect size was 0.91 (91%). In other words, 91% of the variance in the scores of social physique anxiety, impulsive behaviors, and emotional self-regulation in the students was attributed to group membership or the effect of the corrective exercise intervention. Therefore, to examine the effect of corrective exercises on each variable individually, the results of the univariate analysis of covariance (ANCOVA) within the MANCOVA framework are presented next (Table 5). According to Table 5, the results show that the F ratio for the Forward Head Angle variable in the corrective exercise and control groups is 11830.35, which is significant at the 0.05 level. These results indicate a significant difference between the corrective exercise and control groups, and the corrective exercise intervention led to a reduction in the forward head angle and an improvement in posture, with an effect size of 0.91. The F ratio for the Rounded Shoulder Angle variable is 10256.84, which is significant at the 0.05 level. These results indicate a significant difference between the corrective exercise and control groups, and the corrective exercise intervention led to a reduction in the rounded shoulder angle and an improvement in posture, with an effect size of 0.90. The F ratio for the Kyphosis Angle variable is 7623.79, which is significant at the 0.05 level. These results indicate a significant difference between the corrective exercise and control groups, and the corrective exercise intervention led to a reduction in the kyphosis angle and an improvement in posture, with an effect size of 0.89. The F ratio for the pain variable is 4420.27, which is significant at the 0.05 level. These results indicate a significant difference between the corrective exercise and control groups, and the corrective exercise intervention led to a reduction in pain and improvement in pain levels, with an effect size of 0.90. The F ratio for the Social Physique Anxiety variable is 7012.03, which is significant at the 0.05 level. These results indicate a significant difference between the corrective exercise and control groups, and the corrective exercise intervention led to an improvement in social physique anxiety, with an effect size of 0.88. The F ratio for the impulsive behaviors variable is 7204.94, which is significant at the 0.05 level. These results indicate a significant difference between the corrective exercise and control groups, and the corrective exercise intervention led to an improvement in impulsive behaviors, with an effect size of 0.89. The F ratio for the emotional self-regulation variable is 11253.93, which is significant at the 0.05 level. These results indicate a significant difference between the corrective exercise and control groups, and the corrective exercise intervention led to an improvement in emotional self-regulation, with an effect size of 0.91.Conclusion: This study examined the effectiveness of corrective exercises on social-physical anxiety, impulsive behaviors, and emotional self-regulation in individuals with Upper Crossed Syndrome (UCS). The findings demonstrated significant reductions in these psychological variables following the intervention. The observed reductions in social-physical anxiety align with existing literature. Multiple studies suggest physical activity enhances body image, perceived competence, and social acceptance, thereby reducing anxiety. Improvements in posture and physical appearance from corrective exercises likely contribute to this effect by boosting confidence in social settings. The decrease in impulsive behaviors can be explained through cognitive and physiological pathways. Chronic musculoskeletal pain consumes attentional resources, impairing self-regulation and increasing impulsivity. Corrective exercises, by alleviating pain and improving neuromuscular function, may free cognitive capacity and enhance self-control. Furthermore, pain reduction can improve mood and self-efficacy, reducing the reliance on impulsive coping strategies. Improvements in emotional self-regulation are consistent with a biopsychosocial framework. Corrective exercises may modulate physiological arousal, increase parasympathetic activity, and stimulate brain regions involved in executive control. The foundational improvements in physical condition and pain reduction likely lower emotional burden and increase perceived control, creating the psychological resources necessary for better emotional management. Important Caveats: Despite a controlled design, a purely causal interpretation is limited. The improvements may stem from the comprehensive intervention package (including regular interaction, positive expectations, and lifestyle changes) rather than the physical exercises alone. The complex interplay of physical, psychological, and contextual factors must be acknowledged. Generalizability is constrained by the specific population (UCS), and direct comparisons are hampered by a lack of identical prior studies, necessitating cautious extrapolation from research on other chronic pain conditions or different age groups. In conclusion, a structured corrective exercise program appears to be a beneficial component of intervention for individuals with UCS, associated with meaningful psychological improvements. Future research should aim to isolate the specific mechanisms of change and investigate these effects in larger, homogeneous samples.
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amir hamzeh sabzi; farnaz torabi; Aliyeh Amini Khanavandi
Abstract
Objective: Aging is an inevitable biological process accompanied by extensive physiological and structural changes across multiple body systems (Ahmadi et al., 2017; Migliore et al., 2024). With the growing population of individuals aged 60 years and older worldwide and in Iran, maintaining functional ...
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Objective: Aging is an inevitable biological process accompanied by extensive physiological and structural changes across multiple body systems (Ahmadi et al., 2017; Migliore et al., 2024). With the growing population of individuals aged 60 years and older worldwide and in Iran, maintaining functional independence and enhancing quality of life among older adults has become a major public health priority (Ahmadi et al., 2017). One of the principal barriers to preserving physical independence in this population is the age-related decline in sensory integration systems, including the somatosensory, visual, and vestibular systems, which contributes to progressive deterioration in functional capacity, reduced physical activity, and an increased risk of falls (Zhang et al., 2022). Motor performance is a multidimensional construct that reflects the integrity of the musculoskeletal and neuromuscular systems and encompasses four primary components: flexibility, static balance, dynamic balance, and muscular strength (Holland et al., 2002). Age-related reductions in flexibility can impair the efficient performance of activities of daily living (Holland et al., 2002), whereas deficits in dynamic balance are strongly associated with accidental falls, the leading cause of injury-related mortality among adults aged over 65 years (World Health Organization, 2007). Likewise, the gradual loss of lower-limb muscle strength, known as dynapenia, compromises the ability to generate rapid corrective contractions required to restore balance following slips or perturbations (Mitchell et al., 2012). Lower-extremity weakness is recognized as one of the most important modifiable risk factors for falls (CDC, 2023). The vestibular system serves as a central regulator of postural stability by activating vestibulospinal pathways responsible for maintaining antigravity muscle tone (Han, 2021). According to the sensory reweighting theory, systematic vestibular stimulation can enhance the efficiency of the central nervous system in dynamically processing sensory inputs and generating more effective neuromuscular responses (Peterka, 2002). Despite well-established evidence supporting the beneficial effects of physical exercise on balance (McDonnell & Hillier, 2015; Kanyılmaz et al., 2022), the effectiveness of targeted vestibular interventions on all dimensions of motor performance in sedentary older adults without clinical vestibular pathology remains unclear. Previous studies have primarily focused on multicomponent exercise programs, making it difficult to isolate the specific contribution of sensory-based training (Sabzi et al., 2022; Labata-Lezaun et al., 2023). Therefore, the present study aimed to investigate the effects of a vestibular stimulation training program on motor performance components in older women. Method: This study employed a quasi-experimental pretest–posttest design with a control group. The study population consisted of sedentary women aged 60–75 years residing in Qom, Iran. Thirty eligible volunteers (mean age = 66 ± 5.4 years) provided written informed consent and were randomly assigned to either an experimental group (n = 15) or a control group (n = 15). The experimental group participated in a four-week vestibular stimulation training program consisting of three sessions per week (12 sessions, 60 minutes each). The intervention was structured into three phases: gaze stabilization, postural stability, and dynamic balance. Training complexity was progressively increased according to individual advancement by gradually modifying support surfaces (from firm ground to foam and trampoline surfaces) and manipulating visual input (eyes closed). The control group continued their usual daily activities. Data were analyzed using analysis of covariance (ANCOVA) with the significance level set at p<0.05. Results: Descriptive findings indicated improvements in all motor performance variables in the experimental group at posttest.After adjustment for baseline scores, the between-group difference in static balance was statistically significant (F1,27 = 14.27, p < 0.001), with the vestibular training program accounting for 24% of the variance in static balance performance. A significant between-group difference was also observed in dynamic balance (F1,27 = 8.75, p < 0.05), with vestibular stimulation explaining 21% of the observed improvement. The effect of group on muscular strength remained significant after controlling for baseline values (F1,27 = 5.74, p < 0.05), with 23% of the variance in strength gains attributable to the intervention. Similarly, a significant difference was found between groups in posttest flexibility scores (F1,27 = 4.21, p < 0.05), and vestibular stimulation training explained 17% of the variance in flexibility. Conclusion: The significant improvements in balance outcomes are consistent with the findings of McDonnell and Hillier (2015) and Hall et al. (2022), who identified vestibular rehabilitation as an effective approach for enhancing postural stability. Furthermore, Meng et al. (2023) reported that vestibular training improves dynamic balance through the enhancement of vestibulo-ocular and vestibulospinal reflexes. The physiological mechanism underlying these adaptations can be attributed to central compensation and reflex retraining processes, whereby head and trunk movements combined with visual challenges promote sensory reweighting and more efficient utilization of vestibulospinal pathways (Peterka, 2002; van der Scheer-Horst et al., 2014). The observed improvements in muscular strength are consistent with the findings of Karimzadeh Ardakani et al. (2020) and Concha-Cisternas et al. (2023). Although Granacher et al. (2012) and Wolfson (1996) suggested that static balance exercises exert minimal effects on maximal strength because of their low mechanical loading, the strength gains observed in the present study may be attributed to the dynamic nature of the protocol and the repeated eccentric contractions of antigravity muscles involved in postural adjustments. Improvements in flexibility were also in agreement with the findings of Emilio et al. (2014), as vestibular stimulation enhances trunk muscle stability (Takakusaki, 2017) and increases movement confidence by reducing fear of falling, thereby enabling older adults to achieve greater ranges of motion without excessive muscular guarding (Hall et al., 2022).Overall, a vestibular stimulation training program appears to be an effective and multifaceted intervention for improving functional physical fitness in sedentary older women through mechanisms of neuroplasticity and sensory reweighting. The program simultaneously enhances postural stability, lower-limb strength, and flexibility. From a practical perspective, this low-cost and scalable protocol requires no sophisticated equipment and can be implemented in residential care facilities or as a home-based exercise program to promote functional independence and reduce the economic burden associated with falls among older adults (Hall et al., 2022).
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