Razi Journal of Medical Sciences

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Background & Aims: Depression is one of the leading causes of disability worldwide and can have a profound effect on an individual's ability to function and lead a productive life. It is also estimated by the WHO (2023) that 5% of the adult population worldwide suffers from this disorder (2). Therefore, the high prevalence of depression has led researchers to look at other related factors, including childhood trauma (3). Childhood is a very important time for our physical, mental, and social development. What we experience and what happens to us during this very sensitive time will be the foundation and root of our physical and mental health as we grow up and enter adulthood. Therefore, through childhood experiences we are building a path with very long term effects (4). Therefore, a trauma during this period can have negative consequences in life. It can cause a person to develop a negative or depressive cognitive style (5). Research shows that people who have experienced childhood trauma are twice as likely to develop depression in adulthood than those who have not been traumatized (6). There are several types of childhood trauma, the most important of which are emotional abuse, sexual abuse, and physical abuse, as well as emotional neglect and physical neglect. While the presence of traumatic events in childhood increases the risk of depression in adulthood, not all people who have such experiences show the same symptoms in adulthood (7). Other factors have also been found to play a mediating role between these two variables; for example, research shows that childhood trauma leads to a decrease in a person's level of mindfulness (8,9). In fact, traumatized people are very sensitive to the threat of danger. They feel that danger can occur at any time. As a result, they become dissociated from their current situation, their mindfulness is disturbed, and they experience negative psychological experiences, including depression (10). Several studies indicate a negative relationship between mindfulness and depression (11 - 14). Based on the definition of Ryan & Brown (2003), mindfulness is defined as a state of aroused attention and awareness of what is happening in the present moment, which allows a person to respond with thought and reflection, rather than reacting to events involuntarily and without reflection (15). Mindfulness skills also include the ability to observe, describe, and fully participate in one's actions in a nonjudgmental, mindful, and effective manner (16).Therefore, it is very important to have a better understanding of depression and the factors that influence this disorder. In this study, we examined mindfulness as a mediator between childhood trauma and depression.
Methods: The current research was descriptive and correlational. The statistical population of this research was undergraduate and graduate students of Psychology and Law of Valiasr Complex of South Tehran Azad University studying in 1402-1401. For this purpose, 266 individuals were selected as the research sample group using a multistage random sampling method. The Beck Depression Inventory II (BDI-II; Beck et al., 1996), the Mindfulness Scale (MAAS; Brown and Ryan, 2003), and the Childhood Trauma Questionnaire (CTQ; Bernstein and Fink, 1998) were used for data collection were used.
Results: The results of this research showed that childhood trauma have a significant positive relationship with depression (P<0.01). Also, childhood trauma are negatively significant with mindfulness and depression (P<0.01). The model fit indices also confirmed the path from childhood trauma to depression with the mediating role of mindfulness.
Conclusion: This research was conducted to determine the mediating role of mindfulness in the relationship between childhood trauma and depression. The results of this research showed that childhood trauma had a significant negative relationship with mindfulness. This finding was consistent with previous research (8,9). In explaining this finding, it can be said that mindful people have a great ability to face a wide range of thoughts, emotions, and experiences (both pleasant and unpleasant) (15). Mindfulness is also a state in which people pay attention to the present and what is happening without judgment and without adding or subtracting any aspect of the experience, and they are aware of this attention and do not react to the experience (15), while childhood trauma can make a person very sensitive to possible future threats (27). In this situation, mindfulness allows a person to keep their focus on the present, and when they are aware of the present, they are no longer involved in the past or the future (28). The results of this study also showed that there was a significant positive relationship between childhood trauma and depression. This finding was consistent with previous studies (5, 29, 30). In explaining this finding, it can be said that childhood maltreatment causes the emergence of negative internal messages about oneself and events (31). Thus, in the future, the person feels that he deserves to be mistreated and concludes that his experiences are inevitable and caused by something negative in him. Over time, the person generalizes these negative conclusions to other events and incidents, eventually leading to the belief that negative events are inevitable; ultimately, this style of negative, general, and generalized attributions leads to people's vulnerability to depression (32).  Another aspect of this research was the existence of a significant relationship between depression and mindfulness. This finding was consistent with previous studies (11, 12, 13, 14, 15). The possible explanation is that people who are more mindful are in a better psychological and quality of life state and experience less psychological and emotional turmoil (33). People with depressive disorders have cognitive biases and ineffective attitudes, and these attitudes and thoughts play an important role in the perpetuating of this disorder. Research shows that depression is associated with a tendency to selectively attend to negative information and cognitive biases with negative judgments and documents (34). Since mindfulness means receptive and nonjudgmental awareness of what is happening in the present moment (15), what makes a person psychologically vulnerable to depression is the mental conflict with past memories and possible future events. And since mindfulness is one of the skills that allows us to keep our focus in the present, when we are aware of the present, our attention is no longer involved with the past or the future (28). Finally, the results of this study showed that mindfulness plays a mediating role in the relationship between childhood trauma and depression, which is consistent with the findings of previous studies (8, 9).It seems that childhood trauma can make a person more sensitive to possible future threats (27). and cause a wide range of adverse physical and psychological consequences, including depression (29). Depression is associated with a tendency to selectively attend to negative information, as well as cognitive biases with negative judgments and documents (34). While mindfulness is a state in which people pay attention to the present and what is happening without judging and without adding or subtracting any aspect of that experience (15), depressed people also exaggerate their failures and ignore their successes (34).Therefore, what makes a person psychologically vulnerable to depression is the mental conflict with past memories and possible future events. And since mindfulness is one of the skills that keeps people focused on the present, when a person is aware of the present, he is no longer involved in the past or the future (28). Of course, it is necessary to interpret the results of this research in light of its limitations: this research was cross-sectional in nature, which makes it difficult to draw conclusions about cause. The statistical population of this research consisted of students, so its generalization to other population groups has some limitations. The present research is more of correlational type and requires the use of self-report tests, so the causal explanation of the results is not possible. Therefore, it is suggested to conduct this research with a longitudinal method. This study investigated the symptoms of depression in non-clinical population. Therefore, it is suggested that future research should be conducted in the clinical population suffering from depression. It is also suggested to conduct qualitative research in this area. In addition to these cases, holding workshops for training and prevention of childhood trauma and also teaching mindfulness skills, especially in groups with high levels of depression, is one of the suggestions of this research. The results of this study showed that mindfulness plays a mediating role in the relationship between childhood trauma and depression, and these findings support the research hypothesis. Based on the results, increasing people's level of mindfulness can reduce the effect of childhood trauma on depression to some extent. Holding mindfulness workshops to train mindfulness skills, especially in groups with high levels of depression, as well as holding workshops to teach and prevent childhood trauma can reduce and prevent it from playing a role in depression.
Keywords: depression, childhood trauma, mindfulness

Ethical approval: The Ethics Committee of Azad Islamic University, Tehran-Central Branch, approved the study (IR.IAU.CTB.REC.1402.001).

Funding: This study did not have any funds.

Conflict of interest: None declared.

 

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Background : The growth of any society depends on its students in the future; accordingly, countries spend significant amounts of their income on their education systems. However, depression reduces the quality of students’ mental health (1). Existing research, such as Mortier et al. (2) and Pillay et al. (3), show that depression is prevalent among students (4). Some students manage to cope with it, while the subjective well-being has troubled others. Therefore, it is crucial to know the effective strategies for alleviating the depression symptoms of students (5).
Mental well-being denotes individuals’ evaluation of life and comprises both reflective cognitive judgments (such as life satisfaction) and emotional responses to life when experiencing positive and pleasant emotions versus unpleasant and negative emotions (7). It includes emotional (Emotional well-being), social (Social Well-being), and psychological (Mental Well-being) categories. The psychological category can be defined as an individual’s ability to express his satisfaction without allowing others to influence the experience of positive feelings (8). The emotional category refers to the presence of positive emotions, the absence of negative emotions, and satisfaction (9). Social category is the evaluation and recognition of an individual on how he functions in society and the quality of his relationships with individuals and social groups (10).
Mindfulness-based interventions are among the efforts aimed at effectively and efficiently reducing depression symptoms in students (12). It enables clients to understand their experiences non-judgmentally and alter their relationships with others by challenging and accepting their beliefs and feelings (15).
Behavioral activation is one of the effective treatment methods (17), which assumes that the life problems of vulnerable individuals take away their ability to receive positive reinforcement from the environment. This is based on emphasizing the major and real factors causing depression, i.e., the reduction of rewarding activities and the increase of avoidance behaviors and ruminative thoughts (19).
Shahsavari (2022) found that mindfulness improved well-being scores (24). Ghamari (2021) reported that mindfulness increased psychological well-being (25). Bahreini (2021) indicated that mindfulness influenced the well-being level (26). Yosep (2023) concluded that mindfulness could help improve psychological well-being (27). Ghodrati and Vaziri Neku (2018) found that behavioral activation therapy affected psychological well-being (28). Mazzucchelli (2010) realized that the effectiveness of behavioral activation intervention was comparable to the integrated effect of positive psychology interventions on well-being (29). A meta-analysis conducted by Stiles-Shields (2014) showed that behavioral activation positively impacted depression. (30).
The review of the literature revealed that no systematic study has yet been conducted on this topic in Iran. Therefore, the purpose of the current research is to answer the question of whether there was a significant difference between the effectiveness of behavioral activation training and mindfulness training on the mental well-being of students with depressive syndrome.
Methods: The research was semi-experimental with a pre-test, post-test, control group, and 60-day follow-up design. The statistical population included all female students studying for both bachelor’s and master’s degrees who were referred to the counseling center of the University of Isfahan, among whom 45 were selected and randomly assigned to two experimental groups and a control group, each comprising 15 students.
The experimental group participants of behavioral activation received this intervention during nine two-hour sessions; the participants of the mindfulness training group underwent eight two-hour sessions, while the control group received no intervention. The participants were retested after 60 days as a follow-up. Finally, they completed the questionnaires in three stages, and the data were analyzed using the mixed analysis of variance and the Bonferroni post-hoc test by SPSS26.
Beck depression scale: This test was developed by Beck (1961) and has 21 items that measure the severity of depression symptoms using a four-point Likert scale, with scores ranging between 0 and 63. Dobson and Mohammad Khani (2006) reported Cronbach’s alpha of 0.93 for students (34).
The mental well-being questionnaire: it was developed by Keyes and Magyarmo (2003). The items are rated on a 5-point Likert scale, ranging from not at all (1) to all the time (5). The internal consistency coefficient of the questionnaire, estimated by Cronbach’s alpha, was 0.80 (36). The description of mindfulness training sessions was taken from Kabat-Zinn (2013) (36), and the description of behavioral activation sessions was provided by Lejuez et al. (2011) (37).
Results: Demographic characteristics were investigated in the descriptive statistics section, and the variables were described using mean and standard deviation. In both experimental groups, the mean score of total well-being increased compared to the pre-test. Levene’s test was used to perform a mixed analysis of variance, which indicates the confirmation of the assumption of homogeneity of variance (P<0.05). Covariance analysis was used to investigate the between-groups effect (F=0.745, p=0.32). Therefore, there was a significant difference between the mean scores of the between subjects’ group in the post-test and the follow-up of the total well-being (P<0.05). Bonferroni post-hoc test was used to examine the difference between the mean of the experimental and control groups in pairs and to determine the effectiveness. The results indicated a significant difference between the mean of the post-test and follow-up well-being of the control group and the experimental group of behavioral activation (P< 0.01), while a significant difference was observed in the mindfulness intervention group only in the follow-up phase (P<0.05); therefore, both methods effectively and equally increased well-being. It is noteworthy that only the behavioral activation treatment effect remained constant over time.
Conclusion: The results showed that both methods effectively and equally increased the mental well-being of students, but only the behavioral activation treatment effect remained constant over time. Although no similar study was found, the findings of Dominguez Rodrigues et al. (23), Shahsavari et al. (24), Ghamari et al. et al. (27), Ghodrati and Vaziri Neku (28), Mazzuchelli (29) and Shields et al. (30) are consistent with those of the present study.
In explaining the findings, it can be stated that behavioral activation is assumed to help individuals engage in different behaviors to feel pleasure and be useful (28). At the same time, mindfulness helps students become more self-aware and allows them to identify negative thought patterns and feelings associated with depression. Therefore, it can be concluded that these two approaches can improve the mental well-being of students.
One of the limitations of the study was that the results were related to female students, and the generalization of the results to the male ones should be done with caution. It is suggested that this research be conducted on other age groups as well. Therefore, it is possible to enhance the mental well-being and reduce mood disorders of students by holding training courses in university counseling centers.

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Abstract
Parents of children with attention deficit-hyperactivity disorder experience more stress compared to parents of normal children. This can lead to mental health problems for parents, such as depression, parental stress, and increased parental problems. This psychological pressure is caused by Having a child with a disorder has a significant impact on parenting styles. Therefore, the purpose of this research was to compare the effectiveness of positive parenting intervention program and cognitive therapy based on mindfulness on psychological fatigue in mothers of children with attention deficit/hyperactivity disorder in 2014. This research is a semi-experimental project with a pre-test-post-test in the experimental group (positive parenting intervention program) and the comparison group (cognitive therapy based on mindfulness) with the control and follow-up group, the statistical population of all mothers of children with attention deficit disorder. The research sample includes 60 mothers of children with attention deficit/hyperactivity disorder in the 6 months of spring and summer of 1402 and has the criteria to enter the intervention by selection and sampling. Purposeful and simple random assignment of 20 participants to each group and implementation of interventions. The experimental group underwent positive parenting intervention and cognitive therapy based on mindfulness for a period of 12 sessions of 75 minutes, and the control group did not receive the intervention. The research tool was Smets (1996) Multidimensional Fatigue Questionnaire (MFI). The results of the covariance analysis showed that the averages of the psychological fatigue scores in the positive parenting intervention program group, the cognitive therapy group based on mindfulness, and the control group showed a significant difference. Therefore, it can be said that the positive parenting intervention program had a greater effect on psychological fatigue in mothers of children with attention deficit/hyperactivity disorder than cognitive therapy based on mindfulness.
Conclusion: The positive parenting intervention program can be used to reduce the psychological fatigue of mothers of children with attention deficit/hyperactivity disorder.
 

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  Background: Mindfulness is a mind-body medicine technique which is used in stress reduction and promotion in many patients quality of life, with chronic diabetes. The purpose of this study was evaluating the effectiveness of mindfulness based on stress reduction on glycemic control of patients with diabetes.

  Methods : in the case-control experimental research60 diabetic patients (30 control group, 30 experimental groups) in Shahriyar city were invited to participate in this study. Mindfulness presents in 8 weekly sessions. Glycolysis hemoglobin as indicator of glycemic control was assessed, before and after this intervention. T-test for dependant groups and independent groups and one-way ANOVA was used for data analysis.

  Results: Results indicate a significant difference between pre test and post test of experimental group.

  Conclusions: So it is concluded that mindfulness has significant effects on glycemic control.

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Background: In this research effectiveness of mindfulness based cognitive therapy (MBCT) on depression, anxiety and somatic symptoms in asthma patients was studied. Asthma is a psychosomatic disorder that depression and anxiety were considered as a trigger or exacerbation factor for it.

Methods: According to this matter MBCT was used for reducing depression and anxiety and somatic symptoms in asthma patients. For this purpose 26 female patients that were under medical treatment for 1 year at least in Isfahan were selected and assigned in two groups randomly (experimental group and control group). Two groups were tested (pre-test) by Beck Depression Inventory (BDI_II), Beck Anxiety Inventory (BAI) and Asthma Quality of Life Questionnaire (AQLQ). Experimental group received MBCT intervention for 8 sessions weekly for two hours and control group was registered in waiting list. After finishing the therapy the two groups were tested again (post-test). Data was analyzed by ANCOVA in spss21 program.

Results: Results show that after MBCT intervention significantly depression, anxiety and somatic symptoms scores decreased in experimental group in comparison with control group (p<0/05).

Conclusion: So it shows that MBCT can reduce level of anxiety and depression in asthma patient and then reduces somatic symptom in this patients.

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Abstract

Background: Many biological and psychological processes could be effective in irritable bowel syndrome (IBS). The aim of the present research was to determine the relationship of metacognitive beliefs and mindfulness skills with symptoms severity of IBS.

Methods: In a cross-sectional study, 61 consecutive IBS patients, referred to one of the gastrointestinal tract and liver specialty clinics belonging to the city of Boroujerd, were selected. The patients completed Metacognitive Beliefs Questionnaire, Mindful Attention Awareness Scale and the IBS Symptom Severity Scoring System. Data was analyzed by Pearson correlation and Enter regression model.

Results: A relationship between metacognitive beliefs and mindfulness skills with symptom severity in patients with IBS was observed (P < 0.01). More reviews using with regression coefficient test showed that regression coefficients of all factors of metacognitive beliefs and mindfulness is significant in prediction of symptoms severity of IBS                 (P < 0.05).

Conclusion: This study showed that there is a relationship between metacognitive beliefs and mindfulness with symptom severity in IBS. So the interventions based on metacognitive beliefs and mindfulness skills is proposed for managing symptom severity in IBS.

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Background: Psychological well-being is considered as one of the important factors in the development of personal and social development in research literature, and is influenced by various factors such as the personality characteristics and mindfulness. The purpose of this study was to investigate the relationship between psychological well-being students and personality characteristics considering the mediating role of mindfulness in the form of a causal model.
Methods: This is a descriptive correlational research. Statistical population of this research is the Mohaghegh Ardebil University students, among whom 440 were selected by multistage cluster sampling. For data collection, questionnaire of Ryff’s psychological well-being scale (1989), Neo's personality questionnaires (1985) and Braun and Ryan's mindfulness (2003) were used. Data were analyzed through SPSS v. 24 and Amose v. 20 using Pearson correlation and path analysis.
Results: The results showed that the indirect path coefficients among the extroversion personality characteristics (p =011, β= 0.31), conscientiousness (p =047, β= 0.22), openness (p =028, β= 0.11) and neuroticism (p =000, β= -0.19), with psychological well-being are significant. The proposed model also had a good fit (GFI= 0.92, AGFI= 0.91, CFI = 0.94, RMSEA = 0.07, X2/df = 2/61) and the results supported the mediating role of mindfulness in the relationship between the personality traits and psychological well-being of the students.
Conclusion: The findings indicated that the personality traits are directly related with the intermediary of the mindfulness with psychological well-being. Therefore, in order to increase psychological well-being in students, intervention in the personality traits and mindfulness can be important.

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Background: Body dysmorphic disorder is one of the most common adolescent disorders, which is defined as preoccupation with imaginary defect or exaggerated distortion of a minor physical defect. The purpose of the present study is to investigate the relationship of body image-related cognitive fusion, body image psychological inflexibility, meaning of life and mindfulness with body dysmorphic disorder in a group of female students in Khoramabad city.
Methods: This is a correlation study and the population comprised of all second-grade female students in Khoramabad city in 2016-17 academic year. Of these, n=364 were selected using random cluster sampling. The data collection instruments were the modified Yale-Brown Obsessive-Compulsive Scale for Body Dysmorphic Disorder, Cognitive Fusion Questionnaire- Body Image (CFQ-BI), Body Image Psychological Inflexibility Scale (BIPIS), Engaged Living Scale (ELS) and Mindfulness Attention Awareness Scale (MAAS). The collected data were analyzed using SPSS-v22.0, Pearson correlation coefficient and multivariate regression analysis using a step-wise method.
Results: The results showed that body image-related cognitive fusion, body image psychological inflexibility, meaning of life and mindfulness were significantly correlated with body dysmorphic disorder in female students (p<0.05). Body image-related cognitive fusion, body image psychological inflexibility, meaning of life and mindfulness played a significant role in anticipating the body dysmorphic disorder in female students. These four variables predicted 85.7% of variation in body dysmorphic disorder.
Conclusion: According to the results, body image-related cognitive fusion, body image psychological inflexibility, meaning of life and mindfulness can predict body dysmorphic disorder. Hence, they need to be considered in the treatment of body dysmorphic disorder.
 

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Background: Substance abuse is one of the most widespread and costly health problems in modern societies. Customary medical treatments are often ineffective and relapse is prevalent. The aim of this study was to investigate the effects of transcranial direct current stimulation (tDCS) and mindfulness-based substance abuse treatment (MBSAT) to improve executive functions in adolescents with substance abuse.
Methods: The research design was experimental with pretest-posttest and control group. Sixty adolescents (aged 18-21) with substance abuse disorders were selected according to including and excluding criteria and randomly assigned into the tDCS group (n=20), MBSAT group (n=20) and control group (n=20). To collect data, we used of the neurosciences tasks including N-Back Test, Wisconsin card sorting test, Go/ No Go Task and Balloon Analogue Risk Taking Task (BART). Data analysis was performed using mixed analysis of variance with repeated measures in SPSS 22.
Results: The results showed that both transcranial direct current stimulation (tDCS) and mindfulness-based substance abuse treatment (MBSAT) therapy improved the executive functions of adolescents with substance abuse disorder. Analysis showed no significant difference between two treatments.
Conclusion: Transcranial Direct Current Stimulation (tDCS) and Mindfulness-Based Substance Abuse Treatment can be used as an effective intervention to improve executive functions in adolescents in adolescents with SUD.

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Background: Diabetes is one of the most prevalent chronic illnesses that is closely associated with some psychological problems, particularly stress. In this case, psychological interventions can be useful. The aim of this study was to investigate effectiveness of Mindfulness Based Stress Reduction (MBSR) on self-care activities and life expectancy in patient with type 2 diabetes.
Methods: In this study, semi-experimental design (pretest-post-test) and a one year follow up period with control group was used. Population of the study included patients with type 2 diabetes that were members of Iranian Diabetes Society of Tehran. For sampling, 60 patients were selected by available sampling method. Finally, 15 patients were randomly assigned to either experimental and control groups. Summary of Diabetes Self-care Activities Questionnaire (SDSCA) and Snyder’s life expectancy Questionnaire were used. The obtained data were analyzed using repeated measures ANOVA.
Results: The results showed that MBSR significantly affected on self-care activities and this effect was stable after one year follow up period (p=0.037). Also, the results showed that MBSR only with regard to pretest, post-test and follow up periods and its interaction with the group could have a significant effect on life expectancy and this effect was stable after one year follow up period (p=0.004).
Conclusion: Findings revealed that MBSR can be effective on increasing self-care activities and life expectancy in patients with type 2 diabetes. Therefore, it is recommended to integrate such interventions into comprehensive treatment of diabetes.
 

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Background & Aims: Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the leading causes of referral to hepatology clinics in adults. It occurs in people who have accumulation triglyceride levels in liver cells without a history of drinking alcohol or consuming very little. Behavioral therapies include psychological therapies that commonly used to improve the health of chronic patients. Today, various treatment methods have been introduced and used in this field. Recently, however, third-wave behavioral therapies such as Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) over existing therapies have been shown to have a lasting effect which are gaining more acceptance. Instead of focusing on changing beliefs, these therapies try to increase a person's psychological connection to his or her thoughts and emotions. Today, MBCT and ACT are widely used to modify behavior and reduce stress and psychological distress in people with chronic diseases. Therefore, psychological intervention in NAFLD should be considered by clinicians to prevent the severe consequences of this disease. The purpose of this study was to compare the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) on perceived stress in people with Non-Alcoholic Fatty Liver Disease (NAFLD).
Methods: This study was a quasi-experimental design with two experimental groups and one control group with pre-test, post-test and two-month follow-up. This study was conducted in 2019 in the statistical population of individuals with NAFLD in Tehran. The statistical population of this study included all people with NAFLD who referred to liver and gastrointestinal clinics in Tehran who had referred to these centers between July 1 and the end of September 2018. For this purpose, four specialized gastrointestinal and liver clinics (Massoud, Behbood, Ibn Sina and Ayatollah Taleghani hospitals) were selected with cluster random sampling and the invitation to participate in a psychological training course was distributed among the people who referred to these centers. 70 people with NAFLD announced their readiness to participate in the study. Considering the inclusion and exclusion criteria, 60 patients were eligible to participate in the study. After explaining the goals of the study and the content of the treatment sessions, 15 people withdrew from the study and finally the number of applicants was reduced to 45. Finally, in this study, 45 patients with NAFLD were selected by purposive sampling and were randomly assigned to three groups, and the pre-test was received from them. Then, each of experimental group underwent group intervention during two months of ten sessions, and the control group received the typical routine interventions from medical centers. Perceived Stress Scale (Cohen et al., 1986) was conducted in the all of three stages of measurement In this study, SPSS-25 software was used to analyze the data. In the descriptive part, mean scattering and standard deviation indices were used and in the inferential part, repeated measures analysis of variance test was used. Also, the level of error in this study was considered 0.05.
Results: A total of 45 people with NAFLD participated in the study, which included three groups of 15 people. The mean age (in terms of year) for each MBCT, ACT and control groups was 49.73, 48.73 and 48.46, respectively. The results showed that MBCT and ACT interventions significantly reduced the perceived stress in the participants over time, but in the control group, no significant difference was observed over time (P <0.001) and in participant’s psychological interventions reduced stress up to 37%. Bonferroni post hoc test was used for pairwise comparison of assessment steps. The results showed that there was a significant difference between the experimental groups and the control group in the pre-test-post-test stage of the perceived stress variable. This means that therapeutic interventions have a significant effect on the perceived stress of people with NAFLD and this treatment has remained stable over time, ie in the follow-up phase. Tukey post hoc test was used to compare the pairs of ACT and MBCT experimental groups and the control group. As shown, there is a significant difference in stress reduction between ACT and control groups and between MBCT and control groups.
Conclusion: Finally, the results of the present study indicate that MBCT and ACT interventions with appropriate capacities in changing attitudes and creating appropriate behaviors, can play an effective role in reducing stress. Overall, third-wave behavioral therapies encourage people to treat their self-assessments as simple, transient thoughts, rather than trying to avoid or change them. These therapies seek to weaken empirical avoidance and increase one's actual exposure to all experiences and emotions, and encourage individuals to accept fully their illnesses, thoughts, feelings, emotions, and impulses and set valuable goals for themselves. Cognitive integration is also impaired in people with chronic diseases through the process of cognitive defusion and acceptance and cognitive dysfunctions and rationalizations are reduced and pursuing valuable goals in life and committed action to achieve those goals will reduce unpleasant emotions and create a productive life. Absence of some participants and lack of timely attendance of some of them in treatment sessions, non-random selection of individuals and implementation of a randomized clinical trial plan, lack of nutrition control and sports activities which in turn play an important role in stress, also, the lack of investigation of stressful events during the study period from pre-test to follow-up is one of the limitations of this study. It can be concluded that psychological interventions with proper capacities and presenting favorable changes have an effective role in reducing stress in people with NAFLD. In the practical field, it is suggested that psychological interventions be considered to improve the quality of life of people with NAFLD and to facilitate the medical treatment process. It is recommended that the NAFLD treatment process be presented to patients in a group setting, consisting of a set of specialists.

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Background: The purpose of the present study was to determine the effectiveness of mindfulness-based cognitive therapy on interleukin-6 (IL-6) and the health status of women with breast cancer in Tehran.
Methods: The present study was a quasi-experimental study with pre-test and post-test design and two measurement stages (three months and six months after the first measurement). For this purpose, among women with breast cancer referred to Tehran Medical Sciences Medical Centers and under study conditions, 20 volunteers were randomly selected and divided into experimental (n = 10) and control (n = 10) groups. The experimental group then participated in eight sessions of 1.5-hour sessions of mindfulness-based cognitive therapy sessions and the control group performed their usual treatment plan. The data were analyzed by repeated measure ANOVA.
Results: The results of the data analysis showed that the treatment program was unable to have a significant effect on interleukin 6 (P>0.05) but was able to decrease biological age (P<0.01). The results of the two follow-up stages show that the intervention was able to maintain its effects throughout time.
Conclusion: According to the research findings mindfulness based cognitive therapy is able to improve the biological age of breast cancer patients. But further research is needed on the effect of psychotherapy on biomarkers such as interleukin-6.

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Background & Aims: Cardiovascular disease is considered one of the most important causes of mortality in many countries of the world. Cardiovascular disease causes physical and psychological complications for these patients. Their quality of life is usually reduced under the influence of simultaneous feelings of depression, anxiety, anger and stress (12). Stress has been shown to affect a wide range of cognitive and non-cognitive skills. It has been shown to impair memory, cognitive and executive functions, and to affect risk-taking behavior, which in turn impacts important day-to-day decisions. Prolonged stress can lead to both physical health problems (e.g., heart disease, high blood pressure, diabetes) and mental health problems (e.g., depression or anxiety), although the effects are not always clear (34). There is a lot of evidence associated with the psychological, physical and emotional implications associated with heart failure in patients. In addition, the family of cardiovascular patients who have the responsibility to take care of them also have many problems (13). Positive psychology is a new advent approach in psychology that addresses the happiness and well-being of individuals. This approach tries to use people's abilities and capacities to increase people's lives in the face of events and disadvantages, and increase their satisfaction with life (31). In recent years, the fields of preventive cardiology and positive psychology have both set ambitious goals that go beyond simply reducing risk of disease to include increasing healthy longevity, improving quality of life, preserving good mental health (32). The relationship of mindfulness with the pathological variables such as stress and health variables like adjustment ability  and  emotional  functioning,psychological  well-being, and   emotional, psychological  and social  wellbeing  have been  well illustrated. Other variables that are significant in the field of health and positive psychology are the concept of happiness tha  is  composed  of  cognitive  and  emotional  components (31). Happiness promotes activity and initiative, but no indication for negative effects on creativity. Last but not least, happiness is positive for health; happy people live longer (33). and Hope increases the ability to cope with problems. Hope is an important adaptation mechanism in chronic diseases including cardiovascular disease (10). Mindfulness reduces negative thoughts and increases mental and physical health (16). Mindfulness means maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment, through a gentle, nurturing lens (14). Mindfulness training, which are more concerned with the development of focus attention., could be associated with significant improvements in selective and executive attention. This mental state allows one to experience thoughts and feelings in a way that emphasizes their subjectivity and transient nature. Mindfulness has been associated with increased health outcomes. Mindfulness therapy and medical care together are effective methods for treating cardiovascular patients. According to recent research, mindfulness, reduces physical problems and psychological disorders and increases happiness, hope and quality of life (12, 10). Recently, due  to  the  development  of  chronic  physical  and psychological  disorders  the  mindfulness  and  lifestyle  have been  drawn  into  attention.  But there are few  empirical research  on  these  subjects  and  most  research  has  been performed on recognition of the therapeutic effects of mind-consciousness. Therefore, The purpose of this study was to determine the effectiveness of mindfulness on stress, happiness and Hope in cardiovascular patients. 
Methods: According to the purpose, this study is applied. In this study which was a Quasi-Experimental with per-test, post-test with the control group, the sample group was selected by available sampling method from all cardiovascular patients referred to Shahid Rajaei Heart Hospital and Shariati Hospital in Karaj. Therefore, 40 cardiovascular patients were chosen and assigned to Experimental and control groups. To assess the severity of Stress, Dass-21 test was used, happiness Oxford OHI and Hope was measured by Snyder Hope Questionnaire. The experimental group received 10 90-minute mindfulness training sessions. After training, Dass-21, Oxford OHI and Snyder Hope were used again for both experimental and control groups.
Results: Data were analyzed by SPSS 22 and the results of ANCOVA showed that There was a significant difference between groups regarding stress, happiness and Hope. Mindfulness has been able to reduce stress, and increase happiness and Hope of participants in the experimental group. According to the results, 72.2% of stress changes, 72% of happiness changes and 86% of Hope changes in the experimental group were related to the impact of mindfulness The results showed that mindfulness training has been effective in reducing stress mindfulness, improving happiness and Hope in cardiovascular patients.
Conclusion: The results showed that mindfulness training has been effective in reducing stress, improving happiness and Hope in cardiovascular patients. mindfulness meditation techniques as they are empowering and teach skills individuals can use on their own to control depression and other health problems. It has been associated with enhanced emotional regulation It can be defined as bringing non-evaluative awareness to one’s inner and outer environment and then focusing attention on a limited range of experience (29). Mindfulness training focuses on attention to moment-by-moment experience and consists of routine exercises such as bringing the mind’s attention to the present (for example, by focusing attention on one’s breathing or on what one is eating). These techniques are seen as ideal training to improve self-control, perhaps because most of the exercises focus on training the ability to inhibit one’s impulses (34). mindfulness may decrease stress and mood dysfunction-related psycho physiologic activation by strengthening positive reappraisal and emotion regulation skills. Mindfulness has helped patients to understand the events without distortion and judgment. Mindfulness, in    general, through    ultra-consciousness, delaying conceptual processing and separating a  person from cognitive events can be effective in improving lifestyle (22).  Happiness through better assessment of individual skills and  more  positive  life  events  than  negative  events, interpersonal  skills,  Optimism,  hope  and  a  positive  look  at life  can  motivate  and  empower  people  to  lead  a  healthier lifestyle,  better  manage  stress  and  a  sense  of  responsibility for health (31). Joyful people usually evaluate their skills better than others and remind positive events more than negative ones and make better decisions in their life In   other words,  mind-consciousness  can  create  positive  changes  in happiness and psychological well-being. Therefore, Mindfulness can improve cardiovascular Patients stress, happiness and Hope.
 

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Background & Aims: Sports psychology means the scientific study of psychological factors related to participation and performance in exercise, sports and other physical activities. Although sports psychology is very young, a lot of research has been done on it and one of its most important issues is psychological issues. One of the most important psychological concepts in sports psychology is the competitive anxiety of athletes. The competitive and stressful nature of exercise creates competitive anxiety. Competitive anxiety is competition anxiety. Competitive anxiety has three aspects: cognitive anxiety, physical anxiety and self-confidence. Professional athletes with high anxiety are more likely to have increased physiological arousal and decreased performance than athletes with low anxiety. The results of various studies have shown that competitive anxiety can affect the performance of athletes in different ways. Therefore, identifying the effective factors in athletes' competitive anxiety is doubly important due to its direct and threatening effect on various aspects of athletic performance. According to the results of various studies, there is a significant relationship between mindfulness and competitive anxiety. Mindfulness is the awareness that emerges when we pay attention to our experience in certain ways. Psychological toughness has been considered as a resilient personality trait in the face of stress. Hardiness is a set of personality traits that acts as a source of resistance to the pressures of life. Research on the competitive anxiety of athletes, especially national team athletes, is very important and failure to pay attention to it can lead to persistent fractures and withdrawal from the sport. Also, examining which of the variables of mindfulness and psychological toughness has a more effective role in predicting competitive anxiety in athletes, can be effective in providing solutions to prevent the adverse consequences associated with sports anxiety. Therefore, the present study seeks to answer the question that the model of predicting the competitive anxiety of national team athletes based on mindfulness mediated by psychological hardiness has a good fit?
Methods: The research method is descriptive and of correlation designs and structural equation modeling method. The statistical population in this study included all athletes of national individual and team teams in 2019. To select the sample, the purposeful sampling method was used, so that among the athletes of national teams based on the criteria for entry and exit of the research (criteria for entry into the study, including being in the age category (18- 35) Year, having at least a diploma, membership in a national team with a minimum of 6 months of national experience and criteria for leaving the research are a history or suffering from acute psychiatric disorders such as psychotic disorders, bipolar disorder and major depression , Neurocognitive disorders, over the past year) and were available as a sample. According to the type of study and the number of predictor variables in the analysis of structural equations, according to the researchers, the sample size should be at least 10 times the number of variables plus 50. In the present study, there are a total of 21 subscales observed; Therefore at least 280 samples are required. In this study, up to 300 subjects were increased to reduce sampling error and prevent drop in subjects. Three standard questionnaires were used to assess the research variables. The Competitive Anxiety Scale (SCAL-2) was developed by Martens et al. (1990) and has 27 items that measure three independent factors including cognitive anxiety, physical anxiety, and self-esteem. Five-dimensional mindfulness questionnaire (FFMQ) based on factor analysis study on five mindfulness questionnaires, including Attention Awareness (MAAM), Freiburg Mindfulness Questionnaire (FMI), Emotional and Cognitive Mindfulness Scale (CMAS) and A Mindfulness Questionnaire (MQ) has been developed. Psychological Toughness Questionnaire developed by Kubasa (1979). The Personal Perspectives Test is a self-report questionnaire that measures the degree of psychological toughness of individuals and has 50 items and three subscales of control, commitment and struggle. Amos computer software and SPSS version 22 and structural equation modeling were used to analyze the research data.
Results: The results showed that mindfulness has a direct effect on competitive anxiety, the relationship between mindfulness and competitive anxiety is directly equal (t= -3.39 and β=  -0.28). Therefore, the direct effect of mindfulness on the competitive anxiety of national team athletes has been confirmed with 95% confidence. Also, what results from the above table is that the relationship with the indirect effect of mindfulness on the competitive anxiety of national team athletes has been confirmed by stubbornness with 95% confidence (p<0.05). The results also showed that toughness factors had a direct effect on competitive anxiety, the relationship between toughness and competitive anxiety is directly equal (t= -7.35 and β= -0.68). Therefore, the direct effect of stubbornness on competitive anxiety of national team athletes has been confirmed with 95% confidence.
Conclusion: The aim of this study was to develop a model for predicting the competitive anxiety of athletes in national teams based on mindfulness mediated by psychological toughness. The results of statistical tests showed that mindfulness affects competitive anxiety directly and also through psychological toughness. In explaining this finding, it should be noted that mindfulness can predict the presence or absence of a decrease in the sense of success, as one of the underlying components of competitive anxiety. High awareness can indicate an athlete's correct understanding of himself and the situation in which he is present, and prevent the creation of destructive and incorrect thoughts and feelings, including the reduction of feelings of success. Among the limitations of the present study include: Structural relationships of variables were tested by modeling structural equations which is a non-experimental method. Non-experimental methods have limitations such as the lack of control of some interveners, such as the level of education in the sport, which should be considered. The sample of the present study was the athletes of Iranian national teams. Therefore, caution should be exercised in generalizing the results to other groups and other athletes. At the practical level, the findings of the present study suggested the importance and necessity of paying attention to the mediating variables of mindfulness as influential factors with competitive anxiety in athletes. By identifying these psychological structures as mediating variables in athletes, an effective step can be taken to prevent adverse outcomes in sports competitions. Developing training and intervention programs to improve the level of mindfulness, especially in national and international competitions, is another practical action that can be taken to moderate the levels of negative emotions and improve the athletic performance of athletes.
 

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Background & Aims: Anxiety or inquietude, and or turmoil mean a widespread, unpleasant, and vague feeling of fear and concern with an unknown origin that includes uncertainty, helplessness, and physiological arousal. Performance anxiety is a group of disorders that affect individuals in a range of endeavors, from test-taking, mathematics performance, public speaking, and sport, to the performing arts of dance, acting, and music (1).
Music performance anxiety (MPA) is a complex phenomenon caused by many factors, including genetics, environmental stimuli, and an individual's experience, emotions, cognitions, and behaviors. MPA manifests via three elements, independent of varying types: cognitions, autonomic arousal, and behaviors. While a certain degree of performance anxiety is facilitative and normal, it can sometimes become debilitating and even be taken as a mental disorder (2). defines MPA as the experience of marked and persistent anxious apprehension related to musical performance, which is manifested through combinations of affective, cognitive, somatic, and behavioral symptoms MPA is also known as stage fight, musician stress syndrome, and music syndrome. (3)
Coping strategies are factors affecting MPA. Coping style means mastering, reducing, or enduring those harms that cause stress. Endler and Parker divide coping strategies into three categories: emotion-oriented, avoidance-oriented, and problem-oriented.
Emotional self-regulation, the reappraisal of negative affections, and overexpression of emotions can be named as other factors seen in MPA, which are observed in individuals with negative feelings, thoughts, and emotional disturbances that cause negative social implications and negative inner reactions. Hence, MPA is considered as maladaptive behavior. The dual function of emotions refers to the emotional regulation process in which, individuals regulate and modify their emotions under different situations.
Various factors determine the effect of a psychological intervention on a specific problem, so MPA is not an exception. Mindfulness of unintentional meditation occurs on the current events. Mindfulness can be defined as attention self-regulation ability and directing attention towards an experience. Accordingly, thoughtful attention regulation is a core component of mindfulness. Mindfulness is a kind of relaxation with attention control that affects sensory processes by influencing attention span, beliefs, expectations, mood, and emotional regulation.
Therefore, the extant study aimed to find whether the program extracted from the conceptual model (MPA self-regulation) of coping strategies, emotional self-regulation, and mindfulness can affect performance anxiety.
Methods: This was a quasi-experimental study. The statistical population comprised all musicians (N=30) living in Kermanshah County, Iran. The members of the statistical sample were selected using convenience sampling then were assigned to two experimental (n=15) and control (n=15) groups. Voluntary participation, more than 2-year experience in musicianship, 15-55 age range, and at least one experience of playing music at the stage in front of people were taken as inclusion criteria. Exclusion criteria included more than two absenteeism sessions, an incomplete questionnaire in the first section of the study, and suffering from acute or chronic psychiatric diseases, such as anxiety, depression, bipolar disorder, schizophrenia, ADHD, suspicion, autism, and learning disorders, which caused performance loss and anxiety when they were playing music. The Kenny et al. Music Performance Anxiety Inventory (2004) was used to collect data. The training protocol was designed based on the model and performed in 12 sessions, including the effect of coping strategies, emotional self-regulation, and mindfulness on the MPA. Data analysis was done through univariate and multivariate ANCOVA.
Results: There was a significant difference (P<0.01) between the two studied groups in terms of self-assessment (F(1,23)=13.64), negative affect, and situational symptoms (F(1,23)=4.82), and fear of negative evaluation (F(1,23)=5.81) at 0.001 level. Therefore, the training program of the model had a significant effect on MPA dimensions, e.g., self-assessment, negative affection and situational symptoms, and fear of negative evaluation, while this program had no significant impact (P≥0.01) on the uncontrollability (F(1,23)=3.71) and unpredictability (F(1,23)=1.83) dimensions of MPA at 0.001 level. Therefore, the training program of the model had no significant effect on MPA dimensions, including uncontrollability and unpredictability.
The results indicated a significant difference between two experimental and control groups in terms of the effect of the training intervention extracted from the model on reduction of MPA, considering its dimensions (e.g., self-assessment, negative affection and situational symptoms, and fear of negative evaluation), while its effect on uncontrollability and unpredictability was not significant.
Conclusion: The extant study was conducted to examine the effectiveness of a protocol based on the coping strategies, emotional self-regulation, and mindfulness model on musicians' music performance anxiety. The obtained results indicated the effectiveness of the teaching protocol adopted from the cognitive self-regulation and coping strategies model with mediating role of mindfulness on MPA. This finding was consistent with the results of studies conducted by Worth-Grad(14), Hribar (15), Kazajowski, Grisley, and Alice (19), and Worth & Escher (13).
The impact of the training program extracted from the model on the reduction of MPA dimensions indicated a significant difference between two studied experimental and control groups in terms of self-assessment, negative affection, situational symptoms, and fear of negative evaluation. Therefore, the training protocol of the model had a significant effect on MPA dimensions (e.g., self-assessment, negative affection, situational symptoms, and fear of negative evaluation). However, the training protocol of the model was not significant in terms of uncontrollability and unpredictability dimensions. Therefore, the training program of the model had no significant effect on the uncontrollability and unpredictability dimensions of MPA.
It is recommended to apply the results of this study widely in educational packages for individuals who play music in music classes and academic music fields, particularly those who experience low music performance, perform slowly in music sessions, and suffer from learning disorders.
The protocol of mindfulness, coping strategies, and emotion regulation can be attended by musicians to prevent and control performance anxiety. It also is suggested to prevent and control performance anxiety by employing psychologists who are aware of and interested in performance anxiety issues. Lack of follow-up among studied subjects was one of the constraints in this research, so consideration of follow-up courses within several months is recommended to assess intervention's effects.

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Background & Aims: Because of competitive and stressful nature of sports, competitive anxiety occurs that leads to emotional and fleeting reactions that assess the threat of some situations and therefore influences on the athlete's performance negatively. Early studies of anxiety assumed that anxiety was one-dimensional, but researchers in multidimensional theory of anxiety have recently proposed a set of two-dimensional connections between cognitive anxiety, physical anxiety, self- confidence and performance. Cognitive anxiety is a psychological component of anxiety and is recognized by negative expectations and cognitive concerns about oneself, situations and possible consequences, while physical anxiety is a physiological and emotional component of the anxiety and is associated with arousal of the autonomic nervous system. In addition, sports self-confidence is defined as the degree of confidence of individuals about their abilities and the challenges they face in order to succeed in sports. Many researchers have considered the study of competitive anxiety in the field of sports psychology due to its direct and threatening effects on the sports performance and success.
In the past years, the science of sports psychology has used cognitive-behavioral methods to improve athletes' competitive performances. Recently, psychologists have stated that avoiding and suppression of negative thoughts has increased unwanted cognitive activity and therefore impaired their optimal execution.
In this regard, the mindfulness approach has recently been used as an alternative strategy for practicing traditional mental skills.
This approach is clearly different from the traditional practice approaches of mental skills, both in terms of theoretical assumptions and also intervention strategies. Although in many studies, the effectiveness of mindfulness trainings has been shown on many variables including exercise performance, flow, worry, thoughts unrelated to the tasks and physiological factors, but the results of the studies are contradictory.
According to the current weakness of existing interventions and the inconsistencies associated with the role of traditional mental skills training and also the role of new interventions on the levels of competitive anxiety and self-confidence in the professional athletes, the aim of this study was to evaluate the effectiveness of six weeks of mindfulness-based cognitive intervention on the competitive anxiety levels and self-confidence of adolescent shooting athletes.
Methods: The present study is a quasi-experimental using a pretest and posttest design with a control group. The statistical population of this study who were voluntarily invited to take part in the study included all male shooters (guns and pistols) in Yazd province. All athletes had at least two years of regular shooting activity and experience in provincial and national competitions. After selecting the eligible individuals based on the questionnaire and explaining the purpose of the present study, 16 subjects were randomly divided into two groups, mindfulness intervention group and the control group. The subjects in the experimental group took part in six specified training sessions during six weeks (one session of 75-90 minutes per week).
The Competitive Sports Anxiety Inventory-2 (Martens et al, 1990) was used to evaluate the research variables. The physical anxiety, cognitive anxiety and self-confidence subscales with Cronbach's alpha coefficients of 0.85, 0.75 and 0.83, respectively, show the high reliability of mentioned questionnaire. In this study, Shapiro-Wilk test was used to determine the normality of the data. Also independent t-test was used to compare self-confidence, physical and cognitive anxiety in the control and experimental groups. In all tests, the confidence level was considered 0.05.
Results: First, the assumption of normality of measured variables was checked using the Shapiro-Wilk test. The results of the test showed that the distribution of data in the study groups is normal (P≤0.05). Also, the comparison of pre-test scores between two groups did not show a significant difference (P≤0.05), which indicated that the groups were homogeneous. To evaluate the effectiveness of the intervention, the data of CSAI-2 questionnaire of two groups, in the post-test, were compared using independent t-test. The results showed that there was a significant difference between two groups in the variables of cognitive anxiety and self-confidence (P≤0.05). However, there was no significant difference between two groups in the physical anxiety variable (P≥0.05).
Conclusion: The results showed that there is a significant difference between two groups in the variables of cognitive anxiety and self-confidence. Due to an increase in the negative emotions caused by anxiety and stress in the sports situations, these factors can increase the negative interpretations in athletes. Based on the assumption that unwanted thoughts are the core of anxiety and excitement, mindfulness actually makes the person less focused on repetitive thought patterns. Therefore, athletes can control their anxiety. The findings of the present study on the positive effectiveness of mindfulness approach on the reducing cognitive anxiety in athletes are in line with the findings of previous studies that showed that mindfulness reduces anxiety symptoms, pessimism and negative thoughts before competition. The finding showed that physical anxiety did not differ significantly before and after the intervention. There is a possibility that subjects couldn’t reflect emotions through a questionnaire. Also, in explaining on the distinction between the reducing physical and cognitive anxiety, (Martens, 1990) has demonstrated that physical and cognitive anxiety are affected in different ways. Cognitive anxiety has a direct and negative relationship with performance and should be minimal, while physical anxiety has an inverted U-shape relationship with performance and should be moderate. The posttest results showed a significant difference of self-confidence between two groups. Self-confidence means the ability to promote positive thoughts and self-efficacy in competition. As regards cognitive anxiety has decreased, therefore self-confidence has increased. In general, the differences between the present study and others may be due to the nature of their intervention, the location, duration and the type of programs, and so on. Since the research sample was limited to young male shooters, so the generalization of the results of this study should be followed with caution. According to the innovation and importance of this topic, the researchers should evaluate the effectiveness of mindfulness interventions on the competitive anxiety levels and Self-confidence of athletes in the other sports as well.

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