Mothers' Experiences of Husband’s Involvement in Maternal Fetal Attachment: A Qualitative Study

Background: The involvement of husbands during pregnancy within the Iranian culture is one of the challenging topics. In this context, efforts to encourage male involvement in the maternal health issues can strengthen family bonds and consequently improve the relationships between men and women in societies. Objectives: This qualitative study aimed to elucidate the involvement of husbands in maternal-fetal attachment (MFA). Methods: Using a qualitative approach and conventional content analysis, 11 pregnant women referring to the health care centers in Sari, Iran were interviewed from March 2020 to February 2021. The participants met the maximum diversity criteria in terms of age, level of education, occupation, and socioeconomic status. Deep and unstructured interviews were utilized to obtain the research data. All the interviews were then transcribed verbatim and analyzed using the qualitative content analysis method developed by Graneheim and Lundman in MAXQDA Software. Results: A total of 350 codes emerged from the data. We identified a main theme entitled ‘husband support’, which included four categories and 11 sub-categories. The main categories were: (1) empathic response, (2) emotional support, (3) continued support, and (4) attention to fetus. Conclusions: Interventions to enhance husband support could increase MFA. Planning to promote male participation in pregnancy process is essential to promote maternal and child health.

Effectiveness of Acceptance and Commitment Therapy in Depression and Anxiety in People with Substance Use Disorder

Background: The comorbidity of substance use, mood disorders, and anxiety has been proven in various studies, leading to many clinical implications. Objectives: This study aimed to evaluate the effectiveness of acceptance and commitment therapy (ACT) in depression and anxiety in individuals with substance use disorder. Methods: This quasi-experimental study utilized a pretest-posttest design with a control group. The statistical population consisted of all people with substance abuse in Urmia in 2019, including 220 subjects. The sample consisted of 50 individuals with substance use disorders selected by purposive sampling and randomly assigned to experimental and control groups. The experimental group was trained in eight sessions, each lasting 90 min, based on the ACT protocol by Hayes et al. (2004), while the control group did not receive any intervention. The data were obtained using the Beck Depression Inventory and Beck Anxiety Inventory. Pretest and posttest were performed in both groups. The collected data were analyzed by multivariate analysis of covariance (MANCOVA) using SPSS23 software. Results: The results showed that after controlling for the pretest effects, a significant difference was observed between the mean posttest scores of the two groups in both depression and anxiety (P < 0.05). Conclusions: Acceptance and commitment therapy is an appropriate strategy to effectively improve depression and anxiety in people with substance use disorder.

The Effectiveness of Acceptance and Commitment Therapy and Cognitive-Behavioral ‎Therapy in Enhancing Resiliency and Quality of Life Among Multiple Sclerosis Patients: A Randomized Clinical Trial Study

Background: Multiple sclerosis (MS) is a chronic, common, and progressive disease of the nervous system, and the affected individuals suffer from its complications throughout their lives and experience different physical and emotional disorders. Objectives: The present study aimed to compare the effectiveness of acceptance and commitment therapy (ACT) and cognitive-behavioral ‎therapy (CBT) in enhancing resiliency and quality of life among MS patients. Methods: This randomized clinical trial was carried out on 30 MS patients referred to the Department of Neurology in Baqiyatallah Hospital (Tehran, Iran) during February 19 to September 1, 2017. The patients were randomly assigned to three groups: (1) ACT (n = 10, 8 sessions, 90-minute weekly‎ sessions), (2) CBT (n = 10, 10 sessions, 90-minute weekly‎ sessions), and (3) control group (n = 10, no sessions). The resilience and quality of life were measured in pre-test and post-test phases and 1.5 months after treatment using the Connor-Davidson Resilience and Multiple Sclerosis Impact Scales, respectively. Repeated measurement ANOVA and SPSS Software (version 24) were used in this study to analyze the collected data. Results: The study sample consisted of 30 MS patients (mean age = 31.7 ± 5.7, 60% female and 57% married). The three groups were homogeneous in terms of demographic and baseline variables. The results demonstrated that both ACT and CBT had the same effectiveness in increasing resiliency (mean difference in CBT = 0.9 vs ACT = 0.8 (P = 0.882); CBT = 0.9 vs. Control = -1.4 (P = 0.004); ACT = 0.8 vs. Control = -1.4 (P = 0.0041)) and quality of life (mean difference in CBT = 2.9 vs ACT = 3.1 (P = 0.051); CBT = 2.9 vs. Control = 0.6 (P = 0.002); ACT = 3.1 vs. Control = 0.6 (P = 0.014)) among the MS patients so that the participants’ post-test and follow-up scores increased significantly compared to the pretest scores. Conclusions: The present study results indicate that ACT and CBT can equally enhance resiliency and quality of life among MS patients.

The Effect of Group Acceptance and Commitment Therapy on the Management of Asthma: A Randomized Clinical Trial

Background: Asthma is a common respiratory disorder that negatively affects quality of life (QOL) and mood status. Objectives: The purpose of this study was to investigate the efficacy of group acceptance and commitment therapy (ACT) on the symptom control, QOL, and mood status of asthmatic patients. Methods: This randomized clinical trial study was conducted on 32 asthmatic patients randomly allocated to the case group (underwent group ACT plus medical therapy; n = 15) and the control group (who were medically treated only in 2019; n = 17). The case group participated in 8 sessions of 90-minute group ACT. Spirometry was performed for both groups at baseline and at the end of the intervention. The Asthma Control Questionnaire (ACQ) to assess symptom control status, Hospital Anxiety and Depression Scale (HADS) to assess mood status, and Asthma Quality of Life Questionnaire (AQLQ) to assess QOL were filled out by the patients at baseline and at the end of the intervention. Results: The measurements regarding the trend of changes in the case group over the time were significant in all of the evaluated entities, including ACQ, depression and anxiety subscales of HADS, and AQLQ scores (P < 0.05), while nonsignificant alterations were observed in the controls (P > 0.05). The comparison of the 2 groups revealed significant differences in all the assessed entities (P > 0.05). The spirometry variables were statistically significant in the control group at baseline (P < 0.05), while the post-intervention assessments revealed a nonsignificant difference (P > 0.05). Conclusions: Group ACT can efficiently reduce the asthma symptoms in asthmatic patients, along with the remarkable improvement in mood and QOL. Further evaluations with a longer period of intervention are strongly recommended.

The Frequency and Factors Related to Aggressive Behavior in Psychiatric Patients Controlled by a Variety of Restraint Methods

Background: Aggressive behavior of patients in psychiatric wards is one of the main challenges faced by healthcare workers. Despite the abundance of research on the frequency of aggressive behavior, not enough attention has been paid to its severity. Furthermore, limited studies have evaluated the restraint methods used to manage aggressive behaviors. Objectives: The current descriptive study aimed to compare the relationship between demographic characteristics, diagnosis of psychiatric illness, medical illness, and hospitalization characteristics with features of aggressive behavior in patients experiencing different types of restraint during hospitalization. Methods: We evaluated subjects admitted to the adult psychiatric wards of Imam Hossein and Taleghani hospitals in Tehran, Iran, in 2018. The patients were controlled by various restraint methods during hospitalization. All the patients were evaluated for the severity of aggression, which was determined utilizing the Persian version of the Modified Overt Aggression Scale (MOAS). All the data along with demographic and clinical characteristics obtained from medical records were analyzed using the Mann-Whitney and Kruskal-Wallis nonparametric test (P-value = 0.05) and Spearman correlation coefficient to describe the factors affecting the aggressive behavior of patients. Results: In this study, the prevalence of aggressive behavior was 11.7%. Among the demographic variables, gender (P-value = 0.003), education level (P-value = 0.05), and the history of aggressive behavior (P-value = 0.001) were significantly associated with the MOAS. Furthermore, as the hospitalization duration increased, the frequency of aggressive behavior decreased, and its severity intensified. Moreover, there was a significant relationship between aggression severity with admission type (P-value = 0.00), concurrent medical illness (P-value = 0.026), and substance abuse (P-value = 0.025). Conclusions: According to the obtained results, the factors affecting the aggression and early identification of patients with the potential of aggressive behavior is an effective management strategy for controlling these patients.

Temperament and Personality Traits in Patients with Chronic Spontaneous Urticaria: A Cross-Sectional Study

Background: Considering the psychobiological aspects of various dermatological diseases and the role of personality traits in the development of chronic skin diseases, the present study aimed to assess the personality traits of patients with chronic spontaneous urticaria compared to healthy individuals. Methods: In this cross-sectional study conducted during 2016 - 2018, 100 patients with chronic spontaneous urticaria were selected using the convenience sampling method. Moreover, 100 healthy participants were selected as the control group. Research instruments were Temperament and Character Inventory (TCI) and a demographic checklist. Data were analyzed using descriptive statistics, t-test, and chi-square test using SPSS Software version 23. Results: The patients had higher scores in novelty-seeking (P = 0.041) and harm avoidance (P = 0.015), while the healthy individuals had higher scores in self-directedness (P = 0.003) and cooperativeness (P = 0.001). Moreover, male patients had higher scores in novelty-seeking (P = 0.006) and rewarded dependence (P = 0.013); however, female patients had higher scores in self-transcendence (P = 0.001) and cooperativeness (P = 0.019). Furthermore, there was a correlation between the disease duration of with reward dependence, self-directedness, and self-transcendence. Conclusions: Personality traits seem to be associated with chronic spontaneous urticaria. In this regard, patients with chronic spontaneous urticaria had higher scores in novelty-seeking and harm avoidance and lower scores in self-directedness and cooperativeness than healthy individuals.

Individual Factors Underlying Suicidal Behaviors in Patients with Borderline Personality Disorder: A Qualitative Study

Background: Borderline personality disorder (BPD) is associated with a high risk of suicide. Limited information is available on the individual factors underlying suicidal behaviors, especially suicide attempts (SAs), in Iranian patients with BPD. Objectives: This study aimed to analyze the individual factors underlying suicidal behaviors in patients with BPD. Methods: This was a qualitative descriptive study that was conducted from May 2020 to February 2021 in Tehran and Karaj, Iran, on 23 participants, including 14 patients with BPD and seven mental health professionals, as well as two members of their families. The research environment included psychiatric inpatient wards, psychiatric emergencies, and psychiatric clinics. Participants were selected through purposive sampling. Data were collected using semi-structured interviews and were analyzed using conventional content analysis. Results: Data analysis revealed five main themes and 15 sub-themes related to the individual factors underlying the identification and prediction of the risk for suicidal behaviors and SAs. The extracted themes included “psychological pain and loneliness”, “defects in the distinction and integration of emotions”, “unconventional behavior and emotion”, “pervasive incompatibility”, and “breakdown of the self-integrity”. Conclusions: The BPD is a complex and challenging disorder in which patients with BPD usually tend to engage in suicidal behaviors, and with the emergence of individual factors underlying the occurrence of such behaviors, appropriate preventive measures and interventions can be taken to reduce suicide-related behaviors such as suicidal thoughts and planning, as well as SAs.

Relationship Between Domestic Violence in Pregnancy and Maternal Fetus Attachment

Background: Attachment between mother and fetus plays an important role in maternal identity, birth outcomes, growth, and development of a newborn. In addition, domestic violence, especially in pregnancy, has been regarded as a health priority in many societies. Objectives: The study aimed to assess the relationship between domestic violence in pregnancy and maternal fetus attachment. Methods: This descriptive correlational study was conducted on 200 pregnant mothers visiting the selected Healthcare Centers of Mashhad. The questionnaires were demographic information, Straus Violence Questionnaire and Cranley’s Mother-Fetus Attachment Questionnaire. Data were analyzed using descriptive and correlation coefficient and linear regression tests as well as SPSS v.21 software. Results: Here, 54% of members had experienced domestic violence. In general, there was a reversed and significant correlation between all aspects of domestic violence and mother-fetus attachment. Moreover, 89% of research centers reported fetal attachment as good, 10% as average, and 1% as weak. Based on the linear regression test, physical violence was able to predict the variance of maternal attachment score of 4.14% in mothers. Conclusions: As a result of this article, regarding lower maternal-fetal attachment in violated women in pregnancy, much more sensitive screening should be considered for domestic violence so that adverse outcomes are prohibited.

Effectiveness of Social Skills Training on Social Anxiety Disorder in Students with Learning Disabilities

Background: Children with learning disabilities (LDs) may be at risk of social anxiety because they are less socially accepted and more anxious than their peers. Approximately 70% of students with LDs experience a high level of anxiety symptoms, and they have clinical symptoms of anxiety more than their peers. Objectives: This study aimed to determine the effectiveness of social skills training on social anxiety disorder in students with LDs. Methods: This randomized controlled trial study included a pretest-posttest control group. Data were collected using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (SCID-5), Spence Children’s Anxiety Scale (SCAS), and Matson Evaluation of Social Skills with Youngsters (MESSY). In total, 30 participants with diagnosed LDs and high social anxiety were randomly assigned to intervention and control groups. The intervention group received a social skills treatment over 12 sessions of 90 minutes. After collecting the data, SPSS version 24 was used with 95% CI for data analysis. The Levene test was used to assess the equality of variances, and analysis of covariance (ANCOVA) employed to assess the main effect of social skills intervention. Results: The results of the ANCOVA test showed that social skills training reduced social anxiety in the intervention group (P < 0.01). The covariate (pretest of anxiety) was also significant (P < 0.01). Conclusions: This study showed that social skills training could reduce social anxiety in children with LDs. This result can be a guideline for clinicians to provide the appropriate intervention for the emotional problems of students with LDs.

The Relationship Between Childhood Traumas with Social Appearance Anxiety and Symptoms of Body Dysmorphic Disorder: The Mediating Role of Sociocultural Attitudes Toward Appearance

Background: Body dysmorphic disorder (BDD) and social anxiety are two concepts related to body dissatisfaction. These concepts have been linked to sociocultural attitudes to appearances and painful experiences in interpersonal relationships. Objectives: The present study examines the relationship between childhood traumas with social appearance anxiety (SAA) and BDD through the mediating role of sociocultural attitudes toward appearance (SATA). Methods: This cross-sectional study was conducted on 415 university students in Tehran, Iran using the convenience sampling method in 2019 - 2020. Data were analyzed using SPSS version 24 and Amos version 21 software. Results: According to our results, while childhood traumas were not directly related to BDD (β = 0.059; SE = 0.31), SAA seemed to play a statistically significant mediating role (β = 0.17; SE = 0.005). Moreover, childhood trauma was related to SAA both directly (β = 0.24; SE = 0.001) and through the mediating role of SATA. In addition, SATA (β = 0.17; SE = 0.005) significantly predicted BDD (β = 0.27, P < 0.001). The assumed model was in good fit with the acquired data (CFI = 0.97, GFI = 0.95, NFI = 0.94, RMSEA = 0.046). Conclusions: Children who have had traumatic experiences may experience anxiety and self-doubt. Thus, childhood traumas are ostensibly related to signs of BDD and SAA through the mediation of sociocultural attitudes. Childhood traumas can also predict susceptibility to rejection in interpersonal relationships. However, no results have been found to mediate rejection sensitivity concerning trauma with BDD and SAA.