In collaboration with Payame Noor University and Iranian Health Psychology Association

Document Type : Scientific Research

Authors

1 Faculty of Education Sciences and Psychology, Ferdowsi University, Mashhad, Iran

2 Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University, Mashhad, Iran

10.30473/hpj.2025.72689.6136

Abstract

Objective: Infertility is a medical condition that can cause psychological, physical, psychological, spiritual and medical harm to the patient. Psychosomatic symptoms are prevalent among infertile women and can significantly impair their quality of life and daily activities. Psychosomatic symptoms are created as physiological symptoms associated with emotional situations .Infertile women experience psychosomatic symptoms such as headache, lack of concentration, nausea and mental distress. Considering the critical need for improving and addressing these symptoms, it is essential to examine the psychological factors that affect psychosomatic symptoms. The purpose of this study is to explore the association between early maladaptive schemas and psychosomatic symptoms, with a focus on the mediating role of cognitive emotion regulation strategies in infertile women to help identify the variables affecting psychosomatic symptoms and also to reduce these symptoms and psychological injuries of these people. Method: This research uses a descriptive, correlational approach and has a structural equation modeling. The statistical population consisted of infertile women who visited an infertility clinic in Mashhad. To this end, 360 individuals volunteered to participate. Data were collected using the Young Early Maladaptive Schema Questioner Short Form (1994), Takata and Sakata Psychosomatic Symptoms Questioner (2004), and the Cognitive Emotion Regulation Questionnaire Short Form (2007). The analysis of the data was carried out using the Pearson correlation test, structural equation modeling, and path analysis by SPSS 22 and AMOS 24 software. Results:  According to the results, early maladaptive schemas and maladaptive cognitive emotion regulation strategies have a positive relationship with psychosomatic symptoms and adaptive cognitive emotion regulation strategies have a significant negative relationship with psychosomatic symptoms (P<0.001). The relationship between early maladaptive schemas and adaptive cognitive emotion regulation strategies in infertile women (P < 0.001 and β = -0.41) was statistically significant. The relationship between early maladaptive schemas and maladaptive cognitive emotion regulation strategies in infertile women (P < 0.001 and β = 0.43) was statistically significant. The relationship between adaptive cognitive emotion regulation strategies and psychosomatic symptoms in infertile women (P < 0.001 and β = -0.18) was statistically significant. The relationship between maladaptive cognitive emotion regulation strategies and psychosomatic symptoms in infertile women (P < 0.001 and β = 0.21) was statistically significant. The indirect relationship of early maladaptive schemas through adaptive cognitive emotion regulation strategies with psychosomatic symptoms (P = 0.001 and β = 0.130) and the indirect relationship of early maladaptive schemas through maladaptive cognitive emotion regulation strategies with psychosomatic symptoms (P = 0.001 and β = 0.140) were statistically significant. Furthermore, the structural equation modeling results showed that cognitive emotion regulation strategies play a mediating role in the relationship between early maladaptive schemas and psychosomatic symptoms, and all fit indices indicated a good model fit. Conclusion: This research can be used as a basis for conducting interventional research, including cognitive emotion regulation strategies and schema therapy. The results demonstrate the importance of teaching cognitive emotion regulation skills to infertile women. Given the emergence of psychosomatic symptoms in these individuals, adaptive cognitive emotion regulation strategies may help alleviate the frequency and intensity of psychosomatic symptoms in this group.

Keywords

Main Subjects

Agarwal, A., & Said, T. M. (2004). Carnitines and male infertility. Reproductive biomedicine online, 8(4), 376-384. https://doi.org/10.1016/S1472-6483 (10)60920-0                                                                
Ahmadi, S. C. (2015). Narcissism and late adolescent friendships: Perceived closeness, cooperation, competitiveness, and friendship quality.  Honors Theses. 335.  https://aquila.usm.edu/honors_theses/335.                                                   
Aldao, A., & Nolen-Hoeksema, S. (2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour research and therapy, 48(10), 974-983.  https://doi.org/10.1016/j.brat.2010.06.002
Alipour, F., Hasani, J., Bodaghi, E., Mohtashmirad, F., & Saeidpour, S. (2016). Cognitive Emotion Regulation Strategies, Metacognition, and Early Maladaptive Schemas in Students with Stuttering and Normal Students. Quarterly Journal of Child Mental Health, 3(2), 41-54. (in persian) 
Al-Marib, M. M. (2021). Some common psychosomatic disorder among women exposed to domestic violence in the Saudi society in light of some demographic variables. PalArch's Journal of Archaeology of Egypt/Egyptology, 18(18), 225-255.                                                  
Anayurt, A., & Yalçın, İ. (2021). Investigation of relations between emotion regulation, early maladaptive schemas, cognitive flexibility, and rumination. Kastamonu Education Journal, 29(4), 194-204.https://doi.org/10.24106/kefdergi.818048  
Aruna, P., Puviarasan, N., & Palaniappan, B. (2005). An investigation of neuro-fuzzy systems in psychosomatic disorders. Expert Systems with applications, 28(4), 673-679. https://doi.org/10.1016/j.eswa.2004.12.024   
Bär, A., Bär, H. E., Rijkeboer, M. M., & Lobbestael, J. (2023). Early Maladaptive Schemas and Schema Modes in clinical disorders: A systematic review. Psychology and Psychotherapy: Theory, Research and Practice, 96(3),716-47.
Cámara, M., & Calvete, E. (2012). Early maladaptive schemas as moderators of the impact of stressful events on anxiety and depression in university students. Journal of Psychopathology and Behavioral Assessment, 34, 58-68. https://doi.org/10.1007/s10862-011-9261-6                                    
Davoodi, E., Wen, A., Dobson, K. S., Noorbala, A. A., Mohammadi, A., & Farahmand, Z. (2019). Emotion regulation strategies in depression and somatization disorder. Psychological reports, 122(6), 2119-2136.https://doi.org/10.1177/0033294118799731                                                                                       
Etamadi, S. Poursharifi, H. businessman, b. Kalantari, M. Vahasi Somar, N. (2020). The moderating role of cognitive emotion regulation strategies in the relationship between the intensity of sexual trauma experience and physical symptoms. Research Journal of Behavioral Sciences 2019; 18(1):121-112. (in persian).http://rbs.mui.ac.ir/article-1-534-en.html                                                                                                  
Farahi, S., Naziri, G., Davodi, A., & Fath, N. (2023). The Mediating Role of Cognitive Emotion Regulation Strategies in the Relationship between Early Maladaptive Schemas, Alexithymia, and Emotional Intelligence with Somatic Symptoms in People with Somatic Symptoms Disorder. Practice in Clinical Psychology, 11(3), 187-200 .https://doi.org/10.32598/jpcp.11.3.887.1 
Garnefski, N., Hossain, S., & Kraaij, V. (2017). Relationships between maladaptive cognitive emotion regulation strategies and psychopathology in adolescents from Bangladesh. Archives of Depression and Anxiety, 3(2), 23-29.
 Garnefski, N., & Kraaij, V. (2007). The cognitive emotion regulation questionnaire. European journal of psychological assessment, 23(3), 141-149. https://doi.org/10.1027/1015-5759.23.3.141
Ghahari, Sh. Visi, F. Kavand, H. Yeke Fallah, M. Zandi Fari, H. Farrokhi, N. and Davodi, R. (2020). Psychometric characteristics of the primary maladaptive schema questionnaire short form-75 questions (YSQ-SF) Nurse and Doctor in Razm, 8(27), 31-40. https://doi.org/10.29252/npwjm.8.27.31 (in persian).                          
Ghamkharfard, Z. (2012). Examining the predictors of childhood anxiety based on early maladaptive schemas of children and parenting styles of mothers. International Journal of Behavioral Sciences, 6(3), 253-262.
Gibson, M., & Francis, A. J. (2019). Intergenerational transfer of early maladaptive schemas in mother–daughter dyads, and the role of parenting. Cognitive Therapy and Research, 43, 737-747.  (in persian).
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and wellbeing. Journal of personality and social psychology,85(2), 348.https://doi.org/10.1037/0022-3514.85.2.348  
Hajloo, N. (2011). Psychometric properties of Takata and Sakata psychosomatic complaints scale among students of Mohaghegh Ardabili University. Journal of Behavioral Sciences Research, 10(3), 0 0. https://doi:10.1016/j.sbspro.2011.10.058. (in persian)                                                                                      
Henker, J., Keller, A., Reiss, N., Siepmann, M., Croy, I., & Weidner, K. (2019). Early maladaptive schemas in patients with somatoform disorders and somatization. Clinical Psychology & Psychotherapy, 26(4), 418-429. https://doi.org/10.1002/cpp.2363
Heydari, A. Aghaei, A. and Afshar, H. (2017). Comparison of problem solving skills and cognitive emotion regulation strategies in people with symptoms of psychosomatic diseases and control population in Isfahan city. Journal of Isfahan Medical School, 35(456), 1660. https://doi.org/10.22122/JIMS.V35I456.8714. (in persian)                                                                                                                                                    
Khabbaz Sabet, S., Keykhosrovani, M., Poladi Rishehri, A., & Bahrani, M. R. (2023). The relationship between tendency towards cosmetic surgery with negative body image and irrational beliefs of women applying for cosmetic surgery: the mediating role of cognitive emotion regulation. Health Psychology, 11(44), 31 50. https://doi.org/10.30473/hpj.2022.60727.5327. (in persian)                                                                                                                                                                                       
Kwon, J.-H., Park, J.-I., Sakong, J.-K., & Yang, J.-C. (2021). Characteristics of the perception of the somatic symptoms and the cognitive emotion regulation strategies in patients with posttraumatic stress disorder. Korean Journal of Psychosomatic Medicine, 29(2), 102-110. https://doi.org/10.22722/KJPM.2021.29.2.102     
Lin, J. L., Lin, Y. H., & Chueh, K. H. (2014). Somatic symptoms, psychological distress and sleep disturbance among infertile women with intrauterine insemination treatment. Journal of clinical nursing, 23(11-12), 1677-1684.    https://doi.org/10.1111/jocn.12306                                              
Matsubayashi, H., Hosaka, T., Izumi, S.-i., Suzuki, T., Kondo, A., & Makino, T. (2004). Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress. General hospital psychiatry, 26(5), 398-404. https://doi.org/10.1016/j.genhosppsych.2004.05.002
Meyers, L. S., Gamst, G., & Guarino, A. J. (2016). Applied multivariate research: Design and interpretation. Sage publications.
Mizani, S., Rezaei, A., Khayyer, M., & Shegefti, N. S. (2021). The Mediating Role of Cognitive Emotion Regulation for Maladaptive Schemas and Negative Affects AmongYouth. Quarterly Journal of Psychological Methods and Models Spring, 12(43). https://doi.org/10.30495/jpmm.2021.4712
Mohammadi, Sh. And Neshat Dost, etc. (2018). The relationship between emotion regulation dimensions and primary maladaptive schemas with social anxiety in married women of Isfahan city, 2013. Salamat Jamia, 11(1), 59 68. (in persian).                      
Naseri, A. and Hayatpour, A. (2023). The mediating role of emotion regulation strategies in the relationship between early maladaptive schemas and internalizing and externalizing behavioral disorders in adolescents. New strategies in psychology and educational sciences, 18(5), 38-56.  (in persian)
Nicol, A., Kavanagh, P. S., Murray, K., & Mak, A. S. (2022). Emotion regulation as a mediator between early maladaptive schemas and non-suicidal self-injury in youth. Journal of Behavioral and Cognitive Therapy, 32(3), 161-170. https://doi.org/10.1016/j.jbct.2022.05.001
Nordahl, H. M., Holthe, H., & Haugum, J. A. (2005). Early maladaptive schemas in patients with or without personality disorders: Does schema modification predict symptomatic relief? Clinical Psychology & Psychotherapy, 12(2), 142-149.   https://doi.org/10.1002/cpp.430
Oei, T. P., & Baranoff, J. (2007). Young Schema Questionnaire: Review of psychometric and measurement issues. Australian Journal of Psychology, 59(2), 78-86. https://doi.org/10.1080/00049530601148397
Okur Güney, Z. E., Sattel, H., Witthöft, M., & Henningsen, P. (2019). Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PloS one, 14(6), e0217277. https://doi.org/10.1371/journal.pone.0217277 
Patel, A., Sharma, P., Kumar, P., & Binu, V. (2018). Sociocultural determinants of infertility stress in patients undergoing fertility treatments. Journal of human reproductive sciences, 11(2), 172.  https://doi.org/10.4103/jhrs.JHRS_134_17 
Petzke, T. M., & Witthöft, M. (2024). The Association of Emotion Regulation and Somatic Symptoms. Psychosomatic Medicine, 86(6), 561-568.https://doi.org/10.1097/PSY.0000000000001310
Pozza, A., Albert, U., & Dèttore, D. (2020). Early maladaptive schemas as common and specific predictors of skin picking subtypes. BMC psychology, 8, 1-11.  https://doi.org/10.1186/s40359-020-0392-y
Schnabel, K., Schulz, S. M., & Witthöft, M. (2022). Emotional reactivity, emotion regulation, and regulatory choice in somatic symptom disorder. Psychosomatic Medicine, 84(9), 1077-1086. https://doi.org/10.1097/PSY.0000000000001118
Schultz, L. T., & Heimberg, R. G. (2008). Attentional focus in social anxiety disorder: Potential for interactive processes. Clinical psychology review, 28(7), 1206-1221. https://doi.org/10.1016/j.cpr.2008.04.003
Shafierizi, S., Basirat, Z., Nasiri-Amiri, F., Kheirkhah, F., Chehrazi, M., Pasha, H., & Faramarzi, M. (2023). The prevalence of adjustment disorder and predisposing factors in infertile women. BMC psychology, 11(1), 142. https://doi.org/10.1186/s40359-023-01193-4 
Sharma, S., Khinchi, M. P., Sharma, N., Agrawal, D., & Gupta, M. (2011). Female infertility: an overview. International Journal of Pharmaceutical Sciences and Research, 2(1), 1.                                                                    
Shirvani, M. Y., & Peyvastegar, M. (2011). The relationship between life satisfaction and early maladaptive schemas in university students. Knowledge & Research in Applied Psychology, 12(2), 55-65. (in persian).                                                                                                                                                                                                                                                                                                                            
Soltani, M., Shairi, M. R., Roshan, R., & Rahimi, C. R. (2014). The impact of emotionally focused therapy on emotional distress in infertile couples. International journal of fertility & sterility, 7(4), 337.                                                                                                                                                             
Tahmasabi Ashtiani, A. Qalich Khan, N. Yousefi, N. and Shams, S. (2021). The role of mentalization, insecure attachment and emotional dysregulation in predicting symptoms of somatization and corona anxiety in nurses during the covid 19 epidemic. Nursing Management Quarterly. (in persian)                                             
Tale Bektash, S. Yaghoobii, Hassan. and Yousefi, R. (2012). Comparison of primary maladaptive schemas and cognitive emotion regulation strategies in patients with obsessive compulsive disorder and normal people. Faiz Journal of Medical Sciences, 17(5), 471 481. (in persian)                                                 
Turkmani, H. Ghasemi Mutlaq, Mehdi. Ismaili Shad, Behrang. and Mohammadipour, Mohammad. (1401). Predicting students' addiction tendencies: the role of early maladaptive schemas and cognitive regulation of emotion. Journal of Health Faculty and Health Research Institute, 20 (1), 69 80. http://sjsph.tums.ac.ir/article-1-6110-fa.html. (in persian).                                                                                                                                                                                  
Vilan, R., & DC, D. (2004). The role of chiropractic care in the resolution of migraine headaches and infertility. Journal of Clinical Chiropractic Pediatrics, 6(1), 338-341.                                                                         
Yanartaş, Ö. (2019). Psychosomatic signs and symptoms in organic gastrointestinal diseases. Psychiatry and Clinical Psychopharmacology, 29, 426-427.                                                                                                      
Yıldız, M. A., & Duy, B. (2019). The predictive role of emotion regulation strategies on depressive and psychosomatic symptoms in adolescents. Current Psychology, 38, 387-396. https://doi.org/10.1007/s12144-017-9616-6
Young, J. (2012). Cognitive therapy of personality disorders based on the schema-based approach. Translation: Hassan Hamidpour (1401). Tehran: Arjmand Publications. (in persian)                                                                 
Young, J., & Kloskoo, M. (2008). Schema Therapy: Translated by H. In: Hamid Pour, A. Zarandoz. Iran, Tehran: Arjmand Press. (in persian)                                                                                                                    
Yousefi, R., Asghari, H., & Toghyani, E. (2016). Comparison of early maladaptive schemas and cognitive emotion regulation in cardiac patients and normal individuals. Journal of Advances in Medical and Biomedical Research, 24(107), 130-143.  http://journal.zums.ac.ir/article-1-3781-en.html                                                                                  
Zade-Mohammadi, A., & Kordestanchi Aslani, H. (2021). The mediating role of cognitive emotion regulation in the relationship of early maladaptive schemas with spouse abuse. Iranian Journal of Psychiatry and Clinical Psychology, 26(4), 502-523. 
Zarieh, S., Naderi, F., Bakhtiarpoor, S., & Askari, P. (2023). The effectiveness of Emotion-Focused Therapy in Cognitive Emotion Regulation and Ego Strength among Cardiovascular Patients with Obesity. Health Psychology, 12(47), 119-132.  https://doi.org/10.30473/hpj.2024.66573.5712. (in persian).                                                                                                                                                                                                                                                                                                          
Zohra Vandi, Z. Babakhani, N. and Taheri, A. (2022). The effectiveness of treatment based on acceptance and commitment on perceived stress, psychosomatic symptoms and emotional distress in women undergoing IVF infertility treatment. Applied Family Therapy Quarterly, 3(2), 496-516.https://doi.org/10.61838/kman.aftj.3.2.26.(in persian).                                                                                                                                 
Zuraida, A. (2010). Psychological distress among infertile women: Exploring biopsychosocial response to infertility. Malaysian Journal of Psychiatry, 19(2), 82-92