Health Nexus

Comparison of the Effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) and The present study aimed to compare the effectiveness of short-term psychodynamic therapy and integrated acceptance and commitment therapy with schema therapy on sleep quality and disability due to tension headaches in insecurely attached nurses with anxiety symptoms. This study was a quasi-experimental study with a pre-test-post-test design and a one-month follow-up. The statistical population of this study consisted of all nurses working in the intensive care units (ICU, CCU), emergency and cancer departments of Imam Reza Hospital (AS) in Mashhad in the second half of 1403 (N=420). To determine the sample size based on Cohen's table, 10 people were considered for each group. Accordingly, 30 of the aforementioned nurses were selected using the convenience sampling method and randomly assigned to three groups; (10 people in each group). The research instruments included the headache-induced disability Jacobson et al. (1994), Bayes et al. (1989) sleep quality. Short-term psychodynamic therapy based on the Duvanlo protocol (1400) and integrated therapy based on the McKay and Avigil protocol models (1397) were implemented in 8 70-minute sessions (two sessions per week). To test the hypotheses, univariate and multivariate analysis of covariance and Bonferroni post hoc test were used using SPSS 22 software package. The results showed that both treatments had significant effectiveness compared to the control group on sleep quality (P<0.001, F=10.23) and disability due to tension headache (P<0.001, F=13.89). However, regarding sleep quality and disability due to headache, short-term psychodynamic therapy showed greater effectiveness than integrated therapy at post-test (P<0.05), but at one-month follow-up, the difference between the two groups was not significant. In addition, in the follow-up period, both interventions showed significant effectiveness compared to the control group, indicating the stability of the effectiveness of both interventions. Therefore, according to the results obtained, although both interventions showed appropriate effectiveness, short-term psychodynamic therapy can be used to improve sleep quality and disability caused by headaches in the vulnerable group of anxious nurses with insecure relationships.

Background: Critical care settings such as intensive care units, emergency departments, anesthesia units, and crisis-response hospital wards expose healthcare staff to high task density, moral pressure, unpredictable clinical events, and emotionally demanding encounters with patients and families. These conditions can affect staff mental health, quality of life, professional functioning, and patient safety. Objective: This systematic review synthesizes evidence on the relationship between the work environment, workload, and mental health outcomes among healthcare staff working in critical care settings. Methods: The review was structured according to the main reporting principles of PRISMA 2020. English and Persian literature was searched and verified through PubMed, Google Scholar, journal websites, SID, Magiran, and related databases. Eligible studies examined healthcare workers in critical care or comparable crisis settings and reported work-environment factors, workload, job stress, burnout, depression, anxiety, sleep problems, quality of life, coping, or patient-safety-related outcomes. Given the heterogeneity of study designs, settings, instruments, and outcomes, findings were synthesized narratively rather than statistically. Results: The evidence consistently shows that high workload, insufficient staffing, rotating or night shifts, limited decision latitude, poor team communication, inadequate physical environments, and repeated exposure to death or ethical dilemmas are associated with poorer mental health. Burnout, emotional exhaustion, depressive symptoms, anxiety, sleep disturbance, moral distress, reduced quality of life, and lower perceived patient-safety culture were the most commonly reported outcomes. Protective factors included supportive leadership, meaningful teamwork, supervisor and peer support, resilience, fair scheduling, structured reflection, access to psychological support, and organizational attention to rest, staffing, and safety culture. Conclusion: Mental health in critical care staff is not merely an individual vulnerability; it is a system-level outcome shaped by the interaction between job demands, job resources, organizational culture, and personal coping capacity. Sustainable interventions should therefore combine workload redesign, staffing adequacy, shift planning, supportive supervision, psychological services, team communication, and staff participation in decision-making.

Self-harming thoughts are among the most important psychological warning signs associated with emotional dysregulation, maladaptive coping, and vulnerability to self-injurious behaviors. The present study aimed to examine the predictive role of mindfulness and early maladaptive schemas in self-harming thoughts among adults referring to psychological clinics in Tehran. This applied study used a descriptive-correlational cross-sectional design. The statistical population consisted of individuals over 18 years of age who referred to private or public psychological clinics in Tehran during the third quarter of 2025 due to anxiety, depression, or other psychological difficulties. Using simple random sampling and based on the Krejcie and Morgan table, 300 participants were selected. Data were collected using the Kentucky Inventory of Mindfulness Skills, Young Schema Questionnaire–Short Form, and Beck Scale for Suicide Ideation. Data were analyzed using Pearson correlation coefficients and simultaneous multiple regression analysis in SPSS version 22. The results showed that total mindfulness was negatively and significantly associated with self-harming thoughts (r = −0.556, p = 0.001), whereas the total maladaptive schema score was positively and significantly associated with self-harming thoughts (r = 0.455, p = 0.002). In the regression analyses, the mindfulness model and schema model significantly predicted self-harming thoughts. Among mindfulness components, only describing without labeling remained a significant predictor (β = 0.244, p = 0.004). Among schema domains, only impaired autonomy and performance significantly predicted self-harming thoughts (β = 0.307, p = 0.002). In the simultaneous model, mindfulness and early maladaptive schemas together explained approximately 40% of the variance in self-harming thoughts (R² = 0.402). These findings suggest that self-harming thoughts are shaped by the combined effects of reduced mindfulness skills and dysfunctional cognitive-emotional schemas. Interventions that strengthen nonjudgmental description of internal experiences and modify autonomy-related maladaptive schemas may help reduce self-harming thoughts.

Background: Chronic pain is a persistent biopsychosocial condition in which pain-related thoughts, behavioral avoidance, emotional distress, and perceived coping ability can interact to maintain disability and suffering. Acceptance and Commitment Therapy (ACT) is designed to increase psychological flexibility and help individuals engage in valued action even when pain and distress are present. Objective: This study examined the effectiveness of ACT on pain catastrophizing, pain self-efficacy, and psychological flexibility in adults with chronic pain. Methods: A quasi-experimental pretest-posttest control group design with a two-month follow-up was used. Thirty adults with chronic pain were recruited through online platforms and purposively selected according to eligibility criteria. Participants were randomly assigned to an ACT group (n = 15) or a control group (n = 15). The ACT group received eight weekly 90-minute online group sessions, whereas the control group received no intervention during the active study period. Measures included the Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, and Acceptance and Action Questionnaire-II. Data were analyzed using repeated-measures ANOVA and Bonferroni comparisons. Results: The ACT group showed marked improvement from pretest to posttest and follow-up. Pain catastrophizing decreased from 37.80 to 26.07 at posttest and 26.80 at follow-up. Pain self-efficacy increased from 30.40 to 42.27 at posttest and 43.47 at follow-up. Psychological flexibility improved as AAQ-II scores decreased from 31.33 to 19.80 at posttest and 19.20 at follow-up. Significant time, group, and time by group effects were reported for all outcomes. Conclusion: ACT was associated with sustained reductions in pain catastrophizing and improvements in pain self-efficacy and psychological flexibility among individuals with chronic pain. Larger randomized trials with active controls and longer follow-up periods are recommended.

Emotion regulation is a central developmental capacity during childhood and is closely related to children’s psychological adjustment, interpersonal functioning, and behavioral adaptation. Parents play a major role in children’s emotional development through modeling, emotional communication, parenting responses, and the emotional climate of the family. Parental emotional intelligence may therefore be associated with children’s ability to understand, manage, and regulate emotional experiences. This study examined the relationship between parental emotional intelligence and emotion regulation in children aged 6–12 years. Specifically, it investigated whether the main components of parental emotional intelligence—self-awareness, self-regulation, self-motivation, empathy, and social skills—were positively associated with children’s emotion regulation. This applied, descriptive, cross-sectional survey study was conducted among parents of children aged 6–12 years in Tehran, Iran. Based on Cochran’s formula for an unlimited population, 384 parents were included. Data were collected using the Schering Emotional Intelligence Questionnaire and the Cognitive Emotion Regulation Questionnaire developed by Garnefski and Kraaij. Internal consistency coefficients for the parental emotional intelligence components ranged from .76 to .80 in the present sample. Data were analyzed in SPSS using descriptive statistics, bivariate correlation coefficients, and multiple regression model summary statistics. The findings showed positive and statistically significant associations between all parental emotional intelligence components and child emotion regulation. The strongest reported correlation was observed for parental self-awareness (r = .50), followed by parental social skills (r = .45), self-motivation (r = .41), self-regulation (r = .38), and empathy (r = .37). The combined model showed a multiple correlation of R = .470. Because the originally reported R² value was not mathematically compatible with the reported R value, R² was corrected to .221, indicating that the parental emotional intelligence components jointly explained approximately 22.1% of the variance in children’s emotion regulation. The results suggest that higher parental emotional intelligence is associated with better emotion regulation in children aged 6–12 years. The findings support the importance of strengthening parents’ emotional skills as part of family-based educational and preventive mental health programs.

Depression is frequently maintained by repetitive negative thinking, particularly rumination, and by deeper maladaptive cognitive structures that shape how individuals interpret themselves, their emotions, and life events. This quasi-experimental study examined the effectiveness of schema-reconstruction-based cognitive behavioral therapy (CBT) in reducing depressive symptoms and rumination components among patients with depression. Thirty patients with depression who attended treatment clinics in Isfahan, Iran, in 2025 were selected from eligible volunteers and allocated to an experimental group (n = 15) and a control group (n = 15). Participants completed the Beck Depression Inventory and the Ruminative Response Scale before and after the intervention. The experimental group received eight 45-minute group sessions of schema-reconstruction-based CBT, while the control group received no psychological intervention during the active study period. The intervention focused on psychoeducation, identification of automatic thoughts, recognition of early maladaptive schemas, links between schemas and developmental experiences, cognitive restructuring, emotional and cognitive exposure to schemas, behavioral practice, and relapse prevention. Data were analyzed using one-way analysis of covariance in SPSS version 22. Compared with the control group, the experimental group showed lower posttest scores for depression, distraction, reflection, and brooding/absorption in thought. Group effects were significant for depression, F = 52.74, p <= .01; distraction, F = 10.73, p <= .01; reflection, F = 15.75, p <= .01; and brooding/absorption in thought, F = 16.89, p <= .01. Schema-reconstruction-based CBT was associated with meaningful reductions in depressive symptoms and all measured components of rumination. The findings support the value of targeting deeper cognitive schemas when treating depression characterized by repetitive negative thinking. Larger trials with follow-up assessments are recommended.

Background: Extramarital relationships can produce a severe relational rupture that weakens trust, emotional accessibility, marital commitment, intimacy, and the capacity to forgive. Emotionally Focused Couple Therapy (EFT) is an attachment-oriented intervention designed to restructure negative interaction cycles and restore emotional responsiveness between partners. Objective: This study examined the effectiveness of EFT on marital commitment, marital intimacy, and marital forgiveness among couples affected by extramarital relationships. Methods: A quasi-experimental pretest-posttest design with an experimental group and a control group was used. Thirty-two participants who had attended family counseling clinics in Tehran because of distress related to a spouse's extramarital relationship were selected through purposive sampling and assigned equally to an EFT intervention group or a control group. The intervention group received eight 90-minute EFT sessions, whereas the control group received no EFT intervention during the study period. Data were collected using the Marital Commitment Questionnaire, the Walker-Thompson Marital Intimacy Scale, and the Rye Forgiveness Scale. Descriptive statistics, assumption testing, multivariate analysis of covariance, and follow-up univariate analyses of covariance were applied. Results: After controlling for pretest scores, a significant multivariate difference was observed between groups at posttest, Wilks' Lambda = .489, F = 37.49, p = .008, partial eta squared = .56. Follow-up analyses indicated significant posttest improvements in marital commitment, marital intimacy, and marital forgiveness in the EFT group compared with the control group. Conclusion: EFT appears to be a useful intervention for couples experiencing injury after extramarital relationships, particularly when clinical work targets attachment needs, emotional disclosure, responsiveness, and reconstruction of safe interaction cycles.

Parental death during childhood is a major developmental adversity that may disrupt emotion regulation, executive functioning, autonomic regulation, and grief adaptation. Because children depend heavily on surviving caregivers for co-regulation, family-based interventions may be especially important for reducing prolonged grief symptoms and supporting recovery of cognitive and physiological functioning. This quasi-experimental pretest-posttest study evaluated an eight-session Emotion Regulation and Parental Support (ERPS) program among 60 bereaved children aged 8-12 years. Participants were allocated to an intervention group (n = 30) or waitlist control group (n = 30). Outcomes included executive functioning (Stroop interference), working memory (Digit Span Backward), physiological arousal (systolic and diastolic blood pressure and resting heart rate), emotion regulation (Emotion Regulation Checklist), and prolonged grief symptoms (PG-13-C total score). Analysis of covariance (ANCOVA) was used to compare posttest outcomes between groups while controlling for baseline scores. The intervention group showed substantially greater improvement than the control group across all outcome domains. Significant adjusted between-group effects were found for Stroop interference, F(1, 57) = 68.42, p < .001, η² = .55; Digit Span Backward, F(1, 57) = 32.18, p < .001, η² = .36; systolic blood pressure, F(1, 57) = 14.55, p < .001, η² = .20; diastolic blood pressure, F(1, 57) = 11.20, p = .001, η² = .16; resting heart rate, F(1, 57) = 19.85, p < .001, η² = .26; ERC emotion regulation, F(1, 57) = 95.40, p < .001, η² = .63; ERC lability/negativity, F(1, 57) = 58.30, p < .001, η² = .51; and prolonged grief symptoms, F(1, 57) = 82.10, p < .001, η² = .59. Reductions in Stroop interference were correlated with reductions in resting heart rate (r = .48, p < .01), and improvements in Digit Span Backward were correlated with reductions in grief symptoms (r = -.52, p < .01). The findings suggest that a structured parental support and emotion regulation program can improve neurocognitive, physiological, and psychological outcomes in bereaved children. The results support the clinical value of caregiver-inclusive interventions that target co-regulation and adaptive grief processing.