academic journalism

Persian Validation of the Mindful Attention Awareness Scale (MAAS) in Iranian Substance Abusers: Validity and Reliability

AUTHORS

avatar Nikzad Ghanbari 1 , avatar Roghieh Nooripour ORCID 2 , * , avatar Fatemeh Heydari 3 , avatar Hossein Ilanloo ORCID 4 , avatar Telmo Mota Ronzani 5 , avatar Carl Chip Lavie 6 , avatar Keyvan Kakabraee 7

1 Clinical Psychology (Prevention and Treatment of Addiction), Faculty of Education and Psychology, Shahid Beheshti University (SBU), Tehran, Iran

2 Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran

3 Faculty of Education and Psychology, Shahid Beheshti University (SBU), Tehran, Iran

4 Kharazmi University, Tehran, Iran

5 Center for Research, Intervention and Evaluation for Alcohol & Drugs – CREPEIA, Department of Psychology, Federal University of Juiz de Fora, Brazil

6 John Ochsner Heart and Vascular Institute, Ochsner Clinical School, the University of Queensland School of Medicine, New Orleans, LA 70121, USA

7 Department of Psychology and Counseling, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran

How to Cite: Ghanbari N , Nooripour R, Heydari F , Ilanloo H, Ronzani T M, et al. Persian Validation of the Mindful Attention Awareness Scale (MAAS) in Iranian Substance Abusers: Validity and Reliability. J Kermanshah Univ Med Sci. 2022;26(1):e121711.
doi: 10.5812/jkums.121711.

ARTICLE INFORMATION

Journal of Kermanshah University of Medical Sciences: 26 (1); e121711
Published Online: March 26, 2022
Article Type: Research Article
Received: December 7, 2021
Revised: January 29, 2022
Accepted: February 1, 2022
Crossmark
Crossmark
CHECKING
READ FULL TEXT

Abstract

Background:

The Mindful Attention Awareness Scale (MAAS) is widely used as an evaluation tool for mindfulness.

Objectives:

The present study aimed to validate the Persian version of the MAAS in Iranian substance abusers.

Methods:

This descriptive-analytical, cross-sectional study was conducted in Tehran during April 2017-December 2018 on 753 male Iranian substance abusers. Data were collected using a demographic questionnaire, the Persian version of the MAAS, the Depression, Anxiety, and Stress Scale-21 (DASS-21), the General Self-efficacy Scale, the Aggression Scale, and the Quality of Mindfulness Scale. The study had two stages of exploratory factor analysis and confirmatory factor analysis (CFA). Data analysis was performed in SPSS version 22, and a single-factor structure was employed to analyze the internal consistency of the MAAS in LISREL version 8.8.

Results:

The CFA results indicated that the single-factor model had a good fit to the data. In addition, negative correlations were observed between the MAAS, DASS-21, and aggression, while a positive correlation was denoted with self-efficacy (P < 0.01).

Conclusions:

According to the results, the Persian version of the MAAS is a valid and reliable instrument for assessing the mindfulness of Iranian substance abusers. Our findings shed light on a new direction for future focus and exploration in this regard.

1. Background

Today's world is grappling with drug abuse and dependence as one of its most pressing and costly health problems (1). Drug abuse and addiction have debilitative effects on individuals, the community, and culture. Therefore, these factors motivate patients and medical professionals to prevent, stop, and avoid relapse. One of the emerging areas in this field is mindfulness, which is known to play a key role in most psychiatric disorders (2).

Regarding substance abuse and mindfulness, it has been theorized that individuals with high levels of mindfulness are better able to perceive treatment experiences as transient and are less likely to engage in addictive behaviors (3). However, a negative correlation has been denoted between mindfulness and substance use behaviors. Acting with awareness, non-judgment, and non-reactivity has a negative and significant association with substance use behaviors. Mindfulness could be considered a significant ability to understand, evaluate, and accept the emotions that may be involved in therapeutic behaviors in addiction (4).

Previous findings have shown significant associations between mindfulness practices and various psychological outcomes, such as lower impulsivity and addiction symptoms (5). Addictive behaviors are also associated with low levels of mindfulness. The rapid growth of substance abuse requires various tools to measure the mindfulness level of addicts consistent with ethnocultural and structural factors.

The Mindful Attention Awareness Scale (MAAS) is the most widely used questionnaire in this regard, which was also used in the present study to measure mindfulness in terms of attention (6). Another important tool is the five facet mindfulness questionnaire (7), which measures five factors associated with the construct of mindfulness. In addition, the Freiburg mindfulness inventory (8) has been designed to measure the state of mindfulness after a meditation retreat. Finally, the Toronto Mindfulness Scale (9) measures the state of the mindful self-regulation of attention and approach to experience.

Out of several psychometric tests that have been developed to measure mindfulness, the MAAS is probably the most widely researched and used approach, which assesses individual differences in the frequency of mindful states over time (6). The MAAS is a 15-item self-report measure (6) developed to evaluate mindfulness. It has been validated and translated to several languages, including Swedish (10), French (11), and Spanish (12). Nevertheless, the scale has not been used explicitly for a population of substance abusers.

It is essential to guarantee culturally relevant questionnaire items for the Iranian population to address external validity and avoid misinterpretations regarding the meaning of specific items. As such, it is critical to adapt and validate the MAAS to sample Iranian substance abusers and further the advancement of mindfulness research in a culturally appropriate manner and investigate different aspects of mindfulness in samples of Iranian substance abusers.

2. Objectives

The present study aimed to validate the Persian version of the MAAS in a sample of Iranian substance abusers.

3. Methods

3.1. Participants

This descriptive-analytical, cross-sectional study was conducted on all the male substance abusers receiving treatment in Tehran, Iran. The samples had been referred to public or private medical centers during April 2017-December 2018.

The sample population included 753 men with substance abuse disorders who were studied in five groups, including methadone-treated, buprenorphine-treated, opium tincture-treated (tenturapium), out-of-treatment, and patients who were members of the narcotics anonymous (N.A.). The subjects were selected via convenience sampling from among the patients referred to addiction treatment clinics, compulsory treatment camps, and N.A. in Tehran.

3.1.1. Inclusion Criteria

The inclusion criteria of the study were as follows: (1) age of 18 - 71 years; (2) basic literacy; (3) no history of specific psychiatric disorders and (4) willingness to participate. In case of difficulty in reading/understanding the questionnaires, the items would be read out and explained by calling. Absence of psychiatric disorders was considered based on participants' self-report and not on psychiatric interviews.

3.2. Measures

A demographic checklist was used to collect data on age, marital status, education level, history of substance use in the family, and onset of substance abuse.

3.2.1. Mindful Attention Awareness Scale

The mindful attention awareness scale (MAAS) has been developed by (6) to assess awareness and attention to current events and experiences in daily life. It is a 15-item scale based on a six-point Likert Scale (almost always = 1, almost never = 6). The total score of mindfulness in the MAAS is within the range of 15 - 90, with the higher scores indicating high levels of mindfulness. In Iran, the Cronbach's alpha coefficient has been estimated at 0.90 for the general population (13).

3.2.2. Depression, Anxiety, and Stress Scale-21

In 1995, Lovibond and Lovibond developed a 21-item scale to assess stress, anxiety, and depression, known as the Depression, Anxiety, and Stress Scale-21 (DASS-21). The validity of the scale is estimated at 0.77 by (14). In Iran, the internal consistency of the DASS-21 has been confirmed at the Cronbach's alpha of 0.82 (15).

3.2.3. General Self-efficacy Scale

The General Self-efficacy (GSE) scale was developed by Schwarzer and Jerusalem in 1979 and revised in 1981 into 10 items, which measure general self-efficacy. The items are scored based on a four-point Likert scale within the range of 1 - 4. In Iran, the Cronbach's alpha coefficient of the scale has been estimated at 0.81, and its reliability was also confirmed for substance abusers using the test-retest method (16).

3.2.4. The Aggression Scale

The aggression scale measures 11 indicators of aggressive behaviors/responses, which range from zero times to six or more times. The Cronbach’s alpha coefficient, as a measure of internal consistency, has been estimated at 0.78 (17). The Persian version of the aggression scale has been validated in Iran, and the reliability of the scale has also been confirmed at the Cronbach's alpha of 0.87 (18).

3.2.5. Quality of Mindfulness Scale

The Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) (19) is a 12-item scale to measure everyday mindfulness. The items are scored based on a four-point Likert Scale (not at all = 1, almost always = 4) (20). In Iran, the Cronbach's alpha of the scale has been reported to be 0.80, and the test-retest reliability has also been confirmed.

3.3. Ethical Considerations

All the procedures and objectives of the current research regarding human research complied with the ethical standards of the National Research Committee, the Declaration of Helsinki (1964), subsequent revisions, and equivalent ethical norms. The participants provided implied consent, and written informed consent elements were incorporated into the internet invitation.

3.4. Procedure

The study was conducted in two stages; the first stage involved the translation and cultural adaptation of the instrument, and the second stage involved the analysis of its psychometric properties and evaluating validity and reliability. The MAAS was translated into Persian in the first stage via back-translation. The technique was implemented by a translation team who translated the scale into the target language, and a second team back-translated the scale to the original language. Moreover, three translators were asked to assist this process. The translators served independently so that there would be no significant differences in the interpretation and presentation of the applied methods. Finally, a professor of English studies modified some of the items so that they could be comprehensible to the general population. Measures were also taken to ensure that the length of the items was similar to the original scale.

3.5. Statistical Analysis

The research was divided into two stages, and the cross-validation technique was used to assess validity. Exploratory factor analysis EFA was performed on half of the samples in the first stage using principal component analysis (PCA) and the VARIMAX rotation method. Since the obtained results in the Iranian population were similar to the original samples, confirmatory factor analysis (CFA) was performed on the other half of the subjects to confirm the factor structure of the questionnaire. Demographic characteristics and Pearson’s correlation-coefficient between the Persian version of MAAS, DASS-21, the aggression scale, the GSE scale, and the quality of mindfulness scale were analyzed in SPSS version 22.0 (IBM SPSS Statistics, Inc., Armonk, USA). In addition, a single-factor structure was used to analyze the internal structure of the MAAS in LISREL version 8.8.

4. Results

4.1. Descriptive Statistics

In total, 753 Iranian substance abusers completed the survey. The mean score of the Persian version of the MAAS for the Iranian substance abusers was within the range of 3.04 ± 1.48 - 4.61 ± 1.53 (Table 1). As mentioned earlier, the present study was conducted in two stages of EFA and CFA.

Table 1. Associations Between Persian Version of MAAS with Sociodemographic and Clinical Characteristic (n = 753)
No. (%)Mean ± SD
Marital status
Married255 (66.13)56.24 ± 14.45
Single/widow, divorce498 (33.86)51.67 ± 14.01
Education level
Elementary 169 (22.24)51.02 ± 9.02
Cycle/middle certificate268 (35.59)51.53 ± 10.21
Diploma219 (29.08)54.92 ± 11.56
Associate degree14 (1.85)55.74 ± 80.36
Bachelor’s degree62 (8.23)57.62 ± 9.42
Master’s degree (or higher)21 (2.78)60.07 ± 7.91
Substance abuse (illegal drugs) in family
Yes324 (40.02)52.42 ± 14.47
No429 (56.98)53.82 ± 13.27
Onset of substance use (y)
≥ 18278 (36.91)51.97 ± 10.23
< 18475 (63.08)53.95 ± 14.73

Table 2 shows the calculated inter-item and item-total correlation matrix.

Table 2. Inter-item and Item-total Correlation Matrix a
Items12345678910111213141516
m11
m20.352**1
m30.374**0.442**1
m40.249**0.327**0.337**1
m50.365**0.379**0.318**0.443**1
m60.274**0.386**0.277**0.342**0.372**1
m70.372**0.437**0.386**0.452**0.450**0.419**1
m80.277**0.415**0.402**0.414**0.365**0.397**0.558**1
m90.273**0.347**0.374**0.419**0.449**0.289**0.431**0.476**1
m100.290**0.358**0.354**0.388**0.449**0.304**0.586**0.567**0.547**1.
m110.152**0.169**0.0530.133**0.129**0.0600.216**0.222**0.141**0.247**1
m120.304**0.404**0.323**0.360**0.304**0.427**0.356**0.456**0.333**0.353**0.118**1
m130.244**0.289**0.284**0.224**0.175**0.224**0.348**0.351**0.262**0.257**0.326**0.311**1
m140.267**0.472**0.439**0.426**0.394**0.351**0.512**0.670**0.517**0.508**0.206**0.521**0.403**1
m150.283**0.332**0.305**0.325**0.404**0.301**0.369**0.399**0.379**0.441**0.134**0.376**0.129**0.475**1.
Total0.534**0.651**0.604**0.628**0.646**0.583**0.736**0.744**0.669**0.711**0.348**0.634**0.511**0.765**0.604**1

a**Correlation significant at 0.01 (2-tailed)

The internal structure of the Persian MAAS in the Iranian substance users was calculated to be -15 by the EFA using the PCA and VARIMAX rotation. In addition, the Kaiser-Meyer-Olkin index was estimated at 0.89, exceeding the recommended value (0.6). Bartlett's test of sphericity also reached statistical significance (x2 = 1512.74; P < 0.001), indicating that the data were suitable for factor analysis. On the other hand, the results of the initial analysis revealed three factors with an Eigenvalue of > 1, explaining 52.77% of the variance. The PCA also indicated that the total factor loading on a single factor exceeded 0.40, except for item 11 (Table 3 and Figure 1)

Table 3. EFA of 15-item Persian MAAS
Factor LoadingCronbach's Alpha (If Item Deleted)Corrected Item-total CorrelationEigenvalueTotal Alpha
TotalVariance (%)Cumulative (%)
Item 10.4910.8700.4285.60637.37637.370.874
Item 20.6140.8650.5391.2348.22745.60
Item 30.5670.8680.4831.0757.16952.77
Item 40.6200.8650.5400.9636.42359.19
Item 50.6120.8650.5320.8395.59664.79
Item 60.5260.8690.4440.7735.15469.94
Item 70.7460.8580.6760.6854.56974.51
Item 80.7360.8590.6570.6634.42378.93
Item 90.6530.8640.5670.5833.88582.82
Item 100.7090.8610.6300.5463.64386.46
Item 110.2570.8800.2120.5243.49289.95
Item 120.6130.8650.5350.4603.06493.02
Item 130.4640.8710.4040.4322.88095.90
Item 140.7870.8560.7170.3532.35498.25
Item 150.5730.8670.4870.2621.746100.00

According to the CFA, 446 drug abusers with the mean age of 35.9 ± 7.11 years were studied. As for marital status, 281 subjects (63%) were single, and 165 (36.9%) were married. In terms of employment status, the participants were divided into different categories; 216 cases (48.4%) were unemployed, 123 (27.5%) were part-time workers, and 107 subjects (23.9%) were employed. (Figure 2 and Table 4)

Table 4 . CFA of 15-item Persian MAAS
ItemsFactor LoadingEigenvalueTotal Alpha
TotalVariance (%)Cumulative (%)
Item 10.486.27941.85941.8590.897
Item 20.630.9897.43749.296
Item 30.590.9526.34755.642
Item 40.590.8565.70961.351
Item 50.610.7885.25466.605
Item 60.560.7374.91671.521
Item 70.720.6314.20475.725
Item 80.770.5963.97079.696
Item 90.670.5423.61283.307
Item 100.710.5283.51986.826
Item 110.290.4803.20190.027
Item 120.640.4462.97393.000
Item 130.460.4252.83695.835
Item 140.770.3352.23298.067
Item 150.590.2901.933100.000
Table 5. CFA and Fit Indices
ModelRMSEA (CI 90%)sbX2SRMRCFINFIIFIRFIAGFIGFI
15 items0.074 (0.065 - 0.083)308.80.0470.970.960.970.950.890.92

Abbreviations: RMSEA, root mean square error of approximation; SRMR, standardized RMR; CFI, comparative fit index; NFI, normed fit index; IFI, incremental fit index; RFI, relative fit index; AGFI, adjusted goodness of fit index; GFI, goodness of fit index.

Table 5 shows the CFA results of the single-factor structure. These findings were considered acceptable as the factor loading of all the items was significant (> 0.45), except for item 11. In the present study, the fit indices of the model included RMSEA (0.074), SRMR (0.047), CFI (0.97), NFI (0.96), IFI (0.97), RFI (0.95), GFI (0.92), and AGFI (0.89). According to the information in Table 5, the factor loading of all the items were significant.

Table 6. Pearson’s Correlation-Coefficient Between Persian MAAS and DASS-21, Aggression Scale, GSE, and CAMS-R in Participants (CFA Samples = 447)
12345678
Persian MAAS1
DASS-21 (depression)-0.44 a1
DASS-21 (stress)-0.49a0.52 a1
DASS-21 (anxiety)-0.54 a0.61 a0.69 b1
DASS-21 (total)-0.58 a0.84 a0.76 a0.73 a1
Aggression scale-0.43 a0.26 a0.38 b0.30 a0.37 a1
GSE0.41 a-0.31 a-0.34 a-0.34 a-0.35 a-0.36 a1
CAMS-R0.68 a-0.41 a-0.44 b-0.43a-0.47 a-0.33 a0.27 a1

aP < 0.01

bP < 0.05

4.2. Reliability

The internal consistency and reliability of the Persian MAAS were evaluated for Iranian substance abusers based on Cronbach's alpha for all the participants, and the value was estimated at 0.89. The corrected item-total correlation coefficient was above 0.40 (except for item 11) and remained constant at 0.26 (Table 6). Furthermore, temporal stability was assessed using the test-retest method in a small sub-sample of 91 participants over two weeks and calculated to be 0.81 (95% CI = 0.79 - 0.83).

4.3. Validity

According to the information in Table 6, the negative correlation between the Persian MAAS and the three DASS-21 subscales ranged from -0.44 to -0.58, while it was -0.43 for the aggression scale. The convergent validity of the MAAS was also determined by correlating the GSE and quality of mindfulness scores. The positive correlations between the MAAS, GSE (r = 0.41), and CAMS-R (r = 0.68) also indicated good convergent validity (Table 6).

5. Discussion

The present study aimed to validate the Persian version of the MAAS among Iranian substance abusers, and the obtained results were consistent with the previous findings in this regard (21). Accordingly, the MAAS could be used as a valid, reliable tool for measuring mindfulness. Today, mindfulness in addiction could be used to resist temptation. Therefore, mindfulness plays a unique role in preventing relapse (22).

According to the literature (23), the Persian version of the MAAS has a negative correlation with the DASS-21 (total and subscales), signifying that mindful individuals experience less anxiety. This is in line with the studies indicating a negative correlation between mindfulness and neuroticism in various sample populations (7). Consequently, mindfulness could contribute to alleviating anxiety. Similarly, (24), a study showed a negative correlation between mindfulness and anxiety as insufficient attention is the main sign of anxiety and depression. Mindfulness reduces rumination, thereby decreasing the expression of aggression (25). In another research, the MAAS was observed to be correlated with aggression and general self-efficacy. Based on (26), it could be inferred that nonjudgmental attention and awareness of the moment are associated with general self-efficacy.

One of the main limitations of the present study was the lack of predictive validity measurements, and it is suggested that further research address this particular issue. Another suggestion for further research in this regard is to assess the psychometric properties of the Persian MAAS in clinical samples and investigate the application of the scale for behavioral outcomes in the Iranian population with an emphasis on the mindfulness dimension. It is also recommended that more studies be focused on this scale in different addictions (e.g., alcohol and methamphetamine abuse). The intensity of substance abuse and a history of drug abuse should be considered in further investigations as well. The discrepancy in the education level and ethnicity of the participants should also be considered in subsequent studies. Longitudinal and longitudinal-comparative studies could be highly informative in this regard.

5.1. Conclusions

According to the results, the MAAS could be applied as a supplementary tool to assess mindful attention awareness in substance abusers. The validation and adaptation of the MAAS for Iranian substance abusers might be an important step toward identifying specific outcomes of mindfulness, thereby allowing researchers to have a more precise conception of the abilities developed through this modality. In general, the analysis of the behaviors associated with mindfulness among substance abusers is incomplete regardless of the sociocultural context. Therefore, addressing these issues could help these patients promote their health and mindful attention awareness. The MASS could properly assess awareness and attention in Iranian substance abusers.

Acknowledgements

References

  • 1.

    Ditre JW, Zale EL, LaRowe LR. A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions. Annu Rev Clin Psychol. 2019;15:503-28. doi: 10.1146/annurev-clinpsy-050718-095440. [PubMed: 30566371].

  • 2.

    Carroll H, Lustyk MKB. Mindfulness-Based Relapse Prevention for Substance Use Disorders: Effects on Cardiac Vagal Control and Craving Under Stress. Mindfulness (N Y). 2018;9(2):488-99. doi: 10.1007/s12671-017-0791-1. [PubMed: 34025815]. [PubMed Central: PMC8139128].

  • 3.

    Black DS, Sussman S, Johnson CA, Milam J. Trait mindfulness helps shield decision-making from translating into health-risk behavior. J Adolesc Health. 2012;51(6):588-92. doi: 10.1016/j.jadohealth.2012.03.011. [PubMed: 23174469]. [PubMed Central: PMC3505281].

  • 4.

    Tang YY, Tang R, Posner MI. Mindfulness meditation improves emotion regulation and reduces drug abuse. Drug Alcohol Depend. 2016;163 Suppl 1:S13-8. doi: 10.1016/j.drugalcdep.2015.11.041. [PubMed: 27306725].

  • 5.

    Schonert-Reichl KA, Lawlor MS. The Effects of a Mindfulness-Based Education Program on Pre- and Early Adolescents’ Well-Being and Social and Emotional Competence. Mindfulness. 2010;1(3):137-51. doi: 10.1007/s12671-010-0011-8.

  • 6.

    Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822-48. doi: 10.1037/0022-3514.84.4.822. [PubMed: 12703651].

  • 7.

    Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13(1):27-45. doi: 10.1177/1073191105283504. [PubMed: 16443717].

  • 8.

    Walach H, Buchheld N, Buttenmüller V, Kleinknecht N, Schmidt S. Measuring mindfulness-the Freiburg Mindfulness Inventory (FMI). Pers Individ Differ. 2006;40(8):1543-55. doi: 10.1016/j.paid.2005.11.025.

  • 9.

    Maltby J, Macaskill A, Gillett R. The cognitive nature of forgiveness: using cognitive strategies of primary appraisal and coping to describe the process of forgiving. J Clin Psychol. 2007;63(6):555-66. doi: 10.1002/jclp.20367. [PubMed: 17457850].

  • 10.

    Hansen E, Lundh LG, Homman A, Wangby-Lundh M. Measuring mindfulness: pilot studies with the Swedish versions of the Mindful Attention Awareness Scale and the Kentucky Inventory of Mindfulness Skills. Cogn Behav Ther. 2009;38(1):2-15. doi: 10.1080/16506070802383230. [PubMed: 19125361].

  • 11.

    Jermann F, Billieux J, Laroi F, d'Argembeau A, Bondolfi G, Zermatten A, et al. Mindful Attention Awareness Scale (MAAS): Psychometric properties of the French translation and exploration of its relations with emotion regulation strategies. Psychol Assess. 2009;21(4):506-14. doi: 10.1037/a0017032. [PubMed: 19947785].

  • 12.

    Johnson CJ, Wiebe JS, Morera OF. The Spanish Version of the Mindful Attention Awareness Scale (MAAS): Measurement Invariance and Psychometric Properties. Mindfulness. 2013;5(5):552-65. doi: 10.1007/s12671-013-0210-1.

  • 13.

    Ghorbani N, Watson PJ, Weathington BL. Mindfulness in Iran and the United States: Cross-Cultural Structural Complexity and Parallel Relationships with Psychological Adjustment. Curr Psychol. 2009;28(4):211-24. doi: 10.1007/s12144-009-9060-3.

  • 14.

    Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther. 1997;35(1):79-89. doi: 10.1016/s0005-7967(96)00068-x.

  • 15.

    Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. Int J Psychol. 2008;2(2):82-102.

  • 16.

    Farnia V, Asadi R, Abdoli N, Radmehr F, Alikhani M, Khodamoradi M, et al. Psychometric properties of the Persian version of General Self-Efficacy Scale (GSES) among substance abusers the year 2019–2020 in Kermanshah city. Clin Epidemiol Glob Health. 2020;8(3):949-53. doi: 10.1016/j.cegh.2020.03.002.

  • 17.

    Orpinas P, Frankowski R. The Aggression Scale. J Early Adolesc. 2016;21(1):50-67. doi: 10.1177/0272431601021001003.

  • 18.

    Samadifard HR, Sadri Damirchi E. The relationship between perception of social interaction, perceived social support and social acceptance with aggression among adolescents. J Res Health. 2018;8(1):38-46. doi: 10.29252/acadpub.jrh.8.1.38.

  • 19.

    Feldman G, Hayes A, Kumar S, Greeson J, Laurenceau J. Mindfulness and Emotion Regulation: The Development and Initial Validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). J Psychopathol Behav Assess. 2006;29(3):177-90. doi: 10.1007/s10862-006-9035-8.

  • 20.

    Mohsenabadi H, Shabani MJ, Zanjani Z. Factor Structure and Reliability of the Mindfulness Attention Awareness Scale for Adolescents and the Relationship Between Mindfulness and Anxiety in Adolescents. Iran J Psychiatry Behav Sci. 2018;In Press(In Press). doi: 10.5812/ijpbs.64097.

  • 21.

    Phang C, Mukhtar F, Ibrahim N, Mohd. Sidik S. Mindful Attention Awareness Scale (MAAS): factorial validity and psychometric properties in a sample of medical students in Malaysia. J Ment Health Train Educ Pract. 2016;11(5):305-16. doi: 10.1108/jmhtep-02-2015-0011.

  • 22.

    Amaro H, Black DS. Mindfulness-Based Intervention Effects on Substance Use and Relapse Among Women in Residential Treatment: A Randomized Controlled Trial With 8.5-Month Follow-Up Period From the Moment-by-Moment in Women's Recovery Project. Psychosom Med. 2021;83(6):528-38. doi: 10.1097/PSY.0000000000000907. [PubMed: 34213858]. [PubMed Central: PMC8257470].

  • 23.

    Gaspar I, Martinho A, Lima M. Exploring the benefits of a mindfulness program for Portuguese public healthcare workers. Curr Psychol. 2018;40(2):772-81. doi: 10.1007/s12144-018-9987-3.

  • 24.

    Gathright EC, Salmoirago-Blotcher E, DeCosta J, Balletto BL, Donahue ML, Feulner MM, et al. The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: A systematic review and meta-analysis. Complement Ther Med. 2019;46:172-9. doi: 10.1016/j.ctim.2019.08.009. [PubMed: 31519275]. [PubMed Central: PMC7046170].

  • 25.

    Borders A, Earleywine M, Jajodia A. Could mindfulness decrease anger, hostility, and aggression by decreasing rumination? Aggress Behav. 2010;36(1):28-44. doi: 10.1002/ab.20327. [PubMed: 19851983].

  • 26.

    Taylor SB, Kennedy LA, Lee CE, Waller EK. Common humanity in the classroom: Increasing self-compassion and coping self-efficacy through a mindfulness-based intervention. J Am Coll Health. 2022;70(1):142-9. doi: 10.1080/07448481.2020.1728278. [PubMed: 32150524].

Copyright © 2022, Journal of Kermanshah University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
COMMENTS

LEAVE A COMMENT HERE: