1 Associations Between Fear of Intimacy and Divorce Proneness in Married Women: The Mediating Roles of Sexual and Emotional Satisfaction https://brieflands.com/journals/zjrms/articles/170047 10.5812/zjrms-170047 1 Background :Marital instability and rising separation rates remain significant concerns in contemporary psychology, particularly in transitional societies such as Iran, where women navigate conflicting traditional and modern roles. Objectives :This study examined the structural relationship between fear of intimacy and divorce proneness, with emphasis on the parallel mediating effects of sexual satisfaction and emotional satisfaction among married women. Methods :This descriptive-correlational study recruited 359 married women in Hamadan, Iran, in 2024 using convenience sampling. Data were collected using the Divorce Proneness Scale, Fear of Intimacy Scale, Sexual Satisfaction Questionnaire, and Emotional Satisfaction Scale. Structural equation modeling (SEM) with maximum likelihood estimation was conducted using AMOS version 26 to test direct and indirect effects, using bootstrapping with 5000 resamples. Results :The proposed model demonstrated excellent fit (χ2/df = 2.00, CFI = 0.98, RMSEA = 0.053 [90% CI, 0.042 - 0.064], SRMR = 0.041). Fear of intimacy had a significant positive direct effect on divorce proneness (β = 0.17, P = 0.024). Higher fear of intimacy was significantly associated with lower sexual satisfaction (β = -0.48, P < 0.001) and lower emotional satisfaction (β = -0.23, P < 0.001). Bootstrapped mediation analyses confirmed significant indirect effects through both mediators: fear of intimacy → sexual satisfaction → divorce proneness (β = -0.10, P = 0.002; 95% CI, -0.16 to -0.05) and fear of intimacy → emotional satisfaction → divorce proneness (β = -0.14, P = 0.001; 95% CI, -0.19 to -0.09). Conclusions :Fear of intimacy is a key underlying factor in the risk of marital dissolution, both directly and indirectly, through reduced sexual and emotional satisfaction. Interventions that target intimacy-related anxiety and enhance sexual and emotional fulfillment are recommended to mitigate proneness to divorce in married women. 1 8 Maryam Movahedi Rad Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran Iran masoudnianm@gmail.com Marjan Hosseinzadeh Taghvaei Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran Iran marjan.taghvai@iau.ac.ir Sheida Sodagar Department of Health and Clinical Psychology, Ka.C., Islamic Azad University, Karaj, Iran Iran sodagarsheida@gmail.com Mohammad Esmail Ebrahimi Department of Psychology, Ha.C., Islamic Azad University, Hamedan, Iran Iran ebrahimimhes@gmail.com Alireza Poursaeed Department of Agricultural Extension and Education, Il.C., Islamic Azad University, Ilam, Iran Iran poursaeedar@gmail.com No Keyword 1.pdf [0]Sadeghian E, Ghasemi SA, Maddineshat M.Exploring marriage beliefs from the perspectives of married students. Front Psychol. 2025;16. 1481905. [PubMed ID: 40051405]. [PubMed Central ID: PMC11882564]. doi: 10.3389/fpsyg.2025.1481905.##[1]Eftekhari Moghaddam N, Shahbazi M, Moghaddam KK.Marital Commitment Mediates the Effects of Forgiveness and Alexithymia on Marriage Quality in Nursing Students. Journal of Client-centered Nursing Care. 2024;10(4):287-296. doi: 10.32598/JCCNC.10.4.658.1.##[2]Salar A, Nezamdoost R, Rezvaniamin M, Keikha H.The Role of Premarital Counseling in Marital Commitment, Intimacy, and Positive Interactions Among Couples: A Cross-sectional Correlational Study in Zahedan. Zahedan J Res Med Sci. 2025;28(2). e168745. doi: 10.5812/zjrms-168745.##[3]Zare Shahabadi A, Montazeri M.A Survey of Factors Related to Marital Satisfaction among Married Women in Taft City, Iran. Journal of Social Behavior and Community Health. 2019;3(1):309. doi: 10.18502/sbrh.v3i1.1035.##[4]Manbeck KE, Kanter JW, Kuczynski AM, Maitland DWM, Corey M.Fear-of-intimacy in the interpersonal process model: An investigation in two parts. Journal of Social and Personal Relationships. 2020;37(4):1317-39. doi: 10.1177/0265407519898267.##[5]Finzi-Dottan R, Abadi H.From Emotional Abuse to a Fear of Intimacy: A Preliminary Study of the Mediating Role of Attachment Styles and Rejection Sensitivity. Int J Environ Res Public Health. 2024;21(12):1679. [PubMed ID: 39767518]. [PubMed Central ID: PMC11675676]. doi: 10.3390/ijerph21121679.##[6]Azimi S, Hashemiparast M, Alizadeh Mizani M, Javadivala Z, Bagherzadeh B, Allahverdipour H.A qualitative exploration of declining sexual intimacy among married men and women. Health Promot Perspect. 2025;15(3):286-94. [PubMed ID: 41356736]. [PubMed Central ID: PMC12680515]. doi: 10.34172/hpp.025.44424.##[7]Jafarian Dehkordi S, Amiri M.Divorce: An International Multi-dimensional Challenge. Int J Epidemiol Res. 2018;5(2):64-6. doi: 10.15171/ijer.2018.14.##[8]Ghelichkhan N, Bakhtiarpour S, Makvandi B, Ehteshamzadeh P.Predicting Forgiveness in the Context of Divorce Based on Mindfulness and Emotion Regulation Among Divorced Women. Zahedan J Res Med Sci. 2025;28(2). e167269. doi: 10.5812/zjrms-167269.##[9]Butkutė L, Mortelmans D, Sondaitė J.Restricted Self-Transition: A Journey of Divorcees Through Lasting Marital Dissolution in Eastern European Society. Eur J Psychol. 2023;19(3):273-84. [PubMed ID: 37731751]. [PubMed Central ID: PMC10508201]. doi: 10.5964/ejop.9619.##[10]Bafrani MA, Nourizadeh R, Hakimi S, Mortazavi SA, Mehrabi E, Vahed N.The Effect of Psychological Interventions on Sexual and Marital Satisfaction: A Systematic Review and Meta-Analysis. Iranian Journal of Public Health. 2023;52(1). doi: 10.18502/ijph.v52i1.11666.##[11]Ghanbarian M, Hooman F, Hafezi F, Mashalpourfard M.Marital Commitment as a Mediator Between Intolerance of Uncertainty, Sexual Satisfaction, and Attitudes Toward Infidelity Among Married Students. Zahedan J Res Med Sci. 2025;28(1). e166228. doi: 10.5812/zjrms-166228.##[12]Regan A, Walsh LC, Horton C, Rodriguez A, Kaufman VA.Contextualizing marital dissatisfaction: examining profiles of discordant spouses across life domains. Front Psychol. 2025;16. 1458129. [PubMed ID: 40177037]. [PubMed Central ID: PMC11961942]. doi: 10.3389/fpsyg.2025.1458129.##[13]Bloch L, Haase CM, Levenson RW.Emotion regulation predicts marital satisfaction: more than a wives' tale. Emotion. 2014;14(1):130-44. [PubMed ID: 24188061]. [PubMed Central ID: PMC4041870]. doi: 10.1037/a0034272.##[14]Bedrov A, Gable SL.Thriving together: the benefits of women's social ties for physical, psychological and relationship health. Philos Trans R Soc Lond B Biol Sci. 2023;378(1868). 20210441. [PubMed ID: 36440568]. [PubMed Central ID: PMC9703221]. doi: 10.1098/rstb.2021.0441.##[15]Roghani R, Jafari S, Shakibania FS, Hatami B, Hajiyousefi E.Effectiveness Acceptance and Commitment Treatment on Marital Dissatisfaction and Sexual Performance in Couples with Emotional Divorce. Iranian Evolutionary Educational Psychology Journal. 2024;6(4):369.##[16]Rusbult CE, Johnson DJ, Morrow GD.Predicting Satisfaction and Commitment in Adult Romantic Involvements: An Assessment of the Generalizability of the Investment Model. Social Psychology Quarterly. 1986;49(1):81. doi: 10.2307/2786859.##[17]Amirahmadi T, Jayervand H, Hooman F, Homaei R.Predicting the Probability of Divorce Based on Triangulation and Mindfulness in Married Female University Students. Adv Nurs Midwifery. 2024;33(3):15-20.##[18]Descutner CJ, Thelen MH.Development and validation of a Fear-of-Intimacy Scale. Psychol Assess. 1991;3(2):218-25. doi: 10.1037/1040-3590.3.2.218.##[19]Falahzadeh H, Farzad V, Falahzadeh M.A study of the psychometric characteristics of fear of intimacy scale (FIS). J Res Psychol Health. 2011;5:70-9.##[20]Hudson WW, Harrison DF, Crosscup PC.A short-form scale to measure sexual discord in dyadic relationships. J Sex Res. 1981;17(2):157-174. doi: 10.1080/00224498109551110.##[21]Bahrami N, Yaghoobzadeh A, Sharif Nia H, Soliemani M, Haghdoost A.Psychometric Properties of the Persian Version of Larsons Sexual Satisfaction Questionnaire in a Sample of Iranian Infertile Couples. Iranian Journal of Epidemiology. 2016;12(2):18-31.##[22]Lam SY, Shankar V, Erramilli MK, Murthy B.Customer value, satisfaction, loyalty, and switching costs: An illustration from a business-to-business service context. Journal of the Academy of Marketing Science. 2004;32(3):293-311. doi: 10.1177/0092070304263330.##[23]Finzi-Dottan R.The role of fear of intimacy as mediator between self-differentiation and marital relationship satisfaction: a dyadic model. Fam J. 2023;31(3):392-8. doi: 10.1177/10664807231163254.##[24]Seyfizadeh H, Zareei Mahmodabadi H, Bakhshayesh A.The relationship between early maladaptive schemas and marital adjustment with mediation fear of intimacy in married people. J Fam Res. 2020;15(4):467-84.##[25]Dosch A, Rochat L, Ghisletta P, Favez N, Van der Linden M.Psychological Factors Involved in Sexual Desire, Sexual Activity, and Sexual Satisfaction: A Multi-factorial Perspective. Arch Sex Behav. 2016;45(8):2029-45. [PubMed ID: 25787208]. doi: 10.1007/s10508-014-0467-z.##[26]Mirzazade Z, Molazade J, Hadianfard H, Taghavi M.The effect of emotionally focused couple therapy (EFCT) on shame and intimacy in couples: a randomized controlled trial (RCT). BMC Psychol. 2025;13(1). 1111. [PubMed ID: 41057959]. [PubMed Central ID: PMC12506414]. doi: 10.1186/s40359-025-03415-3.##[27]Dehghanidowlatabadi S, Pallathadka H, Ismail SM, Abdullaev D, Ibrahim FM, Prasad KDV.Moderating Effect of Interpersonal Mindfulness Between Marital Conflict and Marital Intimacy Among Iranian Married Individuals. Brain Behav. 2025;15(3). e70392. [PubMed ID: 40022278]. [PubMed Central ID: PMC11870819]. doi: 10.1002/brb3.70392.##

1 Hepatoprotective Effects of a Combination of Three Medicinal Plants on Carbamazepine-Induced Liver Injury: A Case Report https://brieflands.com/journals/zjrms/articles/170006 10.5812/zjrms-170006 1 Introduction :The global incidence of liver disease has increased, and some drugs can cause adverse effects, underscoring the need for alternative medicine approaches. This report evaluated the hepatoprotective effects of a combination of three medicinal plants, Silybum marianum, Cichorium intybus, and Ziziphus vulgaris, in a patient with elevated levels of liver injury marker enzymes. Case Presentation :The patient was a 27-year-old man with tonic-clonic seizures who had been receiving chronic carbamazepine treatment and had elevated liver injury marker enzyme levels. The results showed that the combination of Silybum marianum, Cichorium intybus, and Ziziphus vulgaris significantly reduced the elevated serum levels of aspartate transaminase, alanine aminotransferase, and alkaline phosphatase in the patient (P < 0.05), decreasing to 34.0 ± 3.16, 40.5 ± 3.83, and 370.5 ± 4.76 U/L, respectively. These findings suggest that total flavonoid and phenol doses of 200.84 and 149.00 mg/day, respectively, could alleviate carbamazepine-associated side effects. Conclusions :Based on this case report, the combination of Cichorium intybus, Silybum marianum, and Ziziphus vulgaris may exert hepatoprotective effects, as reflected by improved liver enzyme levels following herbal therapy. 1 6 Alireza Ebadollahi-Natanzi Department of Medicinal Plants, Imam Khomeini Higher Education Center, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran Iran a.ebadollahi@areeo.ac.ir Gholamreza Arab-Rahmatipour Department of Biochemistry, Farabi Hospital Laboratory, Tehran University of Medical Sciences, Tehran, Iran Iran arab.mplants@gmail.com No Keyword 2.pdf [0]Barouki R, Samson M, Blanc EB, Colombo M, Zucman-Rossi J, Lazaridis KN, et al.The exposome and liver disease - how environmental factors affect liver health. Journal of Hepatology. 2023;79(2):492-505. [PubMed ID: 36889360]. [PubMed Central ID: PMC10448911]. doi: 10.1016/j.jhep.2023.02.034.##[1]Rendic S, Guengerich FP.Survey of human oxidoreductases and cytochrome P450 enzymes involved in the metabolism of xenobiotic and natural chemicals. Chem. Res. Toxicol. 2015;28(1):38-42. [PubMed ID: 25485457]. [PubMed Central ID: PMC4303333]. doi: 10.1021/tx500444e.##[2]Ebadollahi-Natanz A, Arab-Rahmatipour G.An overview on toxicity, adverse effects and therapeutic properties of some medicinal plants. Razi J. Med. Sci. 2023;30(7):1-20. doi: 10.47176/rjms.30.156.##[3]Armani S, Geier A, Forst T, Merle U, Alpers DH, Lunnon MW.Effect of changes in metabolic enzymes and transporters on drug metabolism in the context of liver disease: Impact on pharmacokinetics and drug-drug interactions. Br. J. Clin. Pharmacol. 2024;90(4):942-958. [PubMed ID: 38148609]. doi: 10.1111/bcp.15990.##[4]Kaplan YC, Demir O.Use of phenytoin, phenobarbital carbamazepine, levetiracetam lamotrigine and valproate in pregnancy and breastfeeding: risk of major malformations, dose-dependency, monotherapy vs polytherapy, pharmacokinetics and clinical implications. Curr. Neuropharmacol. 2021;19(11):1805-1824. [PubMed ID: 33573557]. [PubMed Central ID: PMC9185784]. doi: 10.2174/1570159x19666210211150856.##[5]French JA, Gazzola DM.New generation antiepileptic drugs: what do they offer in terms of improved tolerability and safety? Ther. Adv. Drug. Saf. 2011;2(4):141-158. [PubMed ID: 25083209]. [PubMed Central ID: PMC4110862]. doi: 10.1177/2042098611411127.##[6]Üstün Özek S, Gurses C.Carbamazepine: There are still unknowns. Turk. J. Neurol. 2024;30(4):272-275. doi: 10.4274/tnd.2023.04484.##[7]Koliqi R, Polidori C, Islami H.Prevalence of side effects treatment with carbamazepine and other antiepileptics in patients with epilepsy. Mater. Sociomed. 2015;27(3):167-171. [PubMed ID: 26236162]. [PubMed Central ID: PMC4499297]. doi: 10.5455/msm.2015.27.167-171.##[8]Wang B, Liu Q, Zhao W, Zhang T, Zhang D, Sutcharitchan C, et al.Revolutionizing drug discovery from natural products: The roles of artificial intelligence and multi-omics in accelerating innovation. Acta Pharmaceutica Sinica B. 2025. doi: 10.1016/j.apsb.2025.12.030.##[9]Ghanbari AU, Jalili CU, Shahveisi KU, Raissi FU, Mazini FU, Akhshi NU.Antioxidant, anti-apoptotic and anti-inflammatory effects of acacetin against deltamethrin-induced hepatotoxicity in mice: a biochemical and histopathological study. koomesh. 2023;25(4). e152847. doi: 10.5812/jjnpp-152847.##[10]Hadadian S, Moradzadegan A.Investigating the Toxicity caused by photodynamic therapy with a Low-power Diode Laser with a wavelength of 810 nm compared to a combination of Curcumin in breast cancer cells. Gene Cell Tissue. 2023;11(1). e138519. doi: 10.5812/gct-138519.##[11]Arshad A, Pervaiz S, Errum A, Mahmood A, Asghar H, Maqsood S, et al.Evaluation of antidiabetic effect of Silybum marianum and Cichorium intybus extracts. Pakistan Journal of Medical & Health Sciences. 2022;16(1):820-823. doi: 10.53350/pjmhs22161820.##[12]Anushiravani A, Ghajarieh Sepanlou S.Burden of liver diseases: A review from Iran. Middle East journal of digestive diseases. 2019;11(4):189-1891. [PubMed ID: 31824620]. [PubMed Central ID: PMC6895850]. doi: 10.15171/mejdd.2019.147.##[13]Madani H, Talebolhosseini M, Asgary S, Naderi GH.Hepatoprotective activity of Silybum marianum and Cichorium intybus against thioacetamide in rat. Pakistan. J. Nut. 2008;7(1):172-176. doi: 10.3923/pjn.2008.172.176.##[14]Mohammadi SM, kianbakht S, Rezazadeh S, Ziaee M, Fallah Huseini H.Clinical efficacy of Silybum marianum seed extract in treatment of type 2 diabetes mellitus and non-alcoholic fatty liver disease: a narrative review. J. Med. Plants. 2020;19(73):12-26. doi: 10.29252/jmp.1.73.12.##[15]Maddahi SZ, Jokar A, Kamalinejad M, Behnampur N.The efficacy of Jujube syrup on the prevention of drug-induced hepatotoxicity in pulmonary tuberculosis patients: A pilot randomized double-blind placebo-controlled clinical trial. Pharmacol Res Perspect. 2022;10(1). e00902. [PubMed ID: 34939363]. [PubMed Central ID: PMC8929366]. doi: 10.1002/prp2.902.##[16]World Medical Association Declaration of Helsinki.Ethical principles for medical research involving human subjects. Bull. World. Health. Organ. 2001;79(4):373-374.##[17]Balouchzad A, Rahimi HR, Ebadollahi AR, Minaei-Zan B, Sabzevari O.Aqueous extract of Iranian green tea prevents lipid peroxidation and chronic ethanol liver toxicity in rats. J. Pharmacol. Toxicol. 2011;6(8):691-700. doi: 10.3923/jpt.2011.691.700.##[18]Nazıroğlu M, Yürekli VA.Effects of antiepileptic drugs on antioxidant and oxidant molecular pathways: focus on trace elements. Cell. Mol. Neurobiol. 2013;33(5):589-599. [PubMed ID: 23584684]. [PubMed Central ID: PMC11497999]. doi: 10.1007/s10571-013-9936-5.##[19]Santhrani T, Maheswari E, Saraswathy G.Carbamazepine provoked hepatotoxicity: Attenuation by vitamin C. Oxidants and Antioxidants in Medical Science. 2013;2(1):1. doi: 10.5455/oams.270113.or.026.##[20]Wu JW, Lin LC, Hung SC, Chi CW, Tsai TH.Analysis of silibinin in rat plasma and bile for hepatobiliary excretion and oral bioavailability application. J. Pharm. Biomed. Anal. 2007;45(4):635-641. [PubMed ID: 17692492]. doi: 10.1016/j.jpba.2007.06.026.##[21]Zhuang H, Jing N, Wang L, Jiang G, Liu Z.Jujube powder enhances cyclophosphamide efficiency against murine colon cancer by enriching CD8(+) T cells while inhibiting eosinophilia. Nutrients. 2021;13(8):2700. [PubMed ID: 34444860]. [PubMed Central ID: PMC8401958]. doi: 10.3390/nu13082700.##[22]Li L, Qin Y, Xin X, Wang S, Liu Z, Feng X.The great potential of flavonoids as candidate drugs for NAFLD. Biomed. Pharmacother. 2023;164. 114991. [PubMed ID: 37302319]. doi: 10.1016/j.biopha.2023.114991.##

1 Effect of Spiritual Skills Training on Stress, Anxiety, and Depression Among Nurses Working in Baharan Psychiatric Hospital, Zahedan: A Quasi-Experimental Study https://brieflands.com/journals/zjrms/articles/168825 10.5812/zjrms-168825 1 Background :Nurses, especially those working in psychiatric settings, are exposed to high job demands, frequent contact with high-risk patients, and emotional burden, all of which increase the risk of stress, anxiety, and depression. In recent years, spiritually oriented interventions and spiritual skills training have been introduced as complementary approaches to promote nurses’ mental health. Objectives :This study aimed to determine the effect of spiritual skills training on stress, anxiety, and depression among nurses working in Baharan Psychiatric Hospital in Zahedan, Iran. Methods :This quasi-experimental study with a pretest–posttest design and control group was conducted in 2024 among 70 nurses working in Baharan Psychiatric Hospital. Sampling was carried out by census from all eligible nurses, who were then randomly allocated into an intervention group (n = 35) and a control group (n = 35). Data were collected using a demographic questionnaire and the 21-item Depression Anxiety Stress Scales (DASS-21). The intervention group participated in eight 30-minute group sessions of spiritual skills training, while the control group received only routine educational and clinical programs. The DASS-21 was completed by both groups before and immediately after the intervention. Data were analyzed using descriptive statistics, independent t-test, and chi-square test at a significance level of 0.05. Results :The two groups did not differ significantly at baseline in demographic characteristics or in mean scores of stress, anxiety, depression, and total DASS-21 (P > 0.05). After the intervention, the mean total DASS-21 score in the intervention group was significantly lower than in the control group (31.02 ± 5.08 vs. 41.96 ± 5.17; P < 0.001). Post-intervention mean scores of stress (10.57 ± 2.60 vs. 14.11 ± 1.02; P < 0.001), anxiety (9.80 ± 2.25 vs. 14.40 ± 2.77; P < 0.001), and depression (10.65 ± 2.68 vs. 13.45 ± 3.14; P = 0.004) were also significantly lower in the intervention group compared with the control group. Conclusions :Spiritual skills training significantly reduced stress, anxiety, and depression among nurses working in a psychiatric hospital. Incorporating structured spiritual skills training into in-service education programs may represent a low-cost, culturally congruent strategy for improving nurses’ mental health and care quality. 1 8 Mehdi Rezvaniamin Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran Iran mehdi.rezvaniamin@gmail.com Mohammad Pourkahkhai Department of Clinical Psychology, Health Clinical Sciences Research Center, Zahedan Medical Sciences Branch, Islamic Azad University, Zahedan, Iran Iran mr.pourkahkhai90@gmail.com Azizollah Mojahed Zahedan University of Medical Sciences, Zahedan, Iran Iran mojahed@zaums.ac.ir Hossein Keikha Zabol University of Medical Sciences, Zahedan, Iran Iran hsrm.k114@gmail.com Farinaz Fouladi Department of Teaching English and Translation, Islamic Azad University, Karaj , Iran Iran f.fouladi1387@yahoo.com Alireza Salar Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran Iran salar293@gmail.com No Keyword 3.pdf [0]Sovold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, et al.Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front Public Health. 2021;9:679397. [PubMed ID: 34026720]. [PubMed Central ID: PMC8137852]. doi: 10.3389/fpubh.2021.679397.##[1]Hofmeyer A, Taylor R.Strategies and resources for nurse leaders to use to lead with empathy and prudence so they understand and address sources of anxiety among nurses practising in the era of COVID-19. J Clin Nurs. 2021;30(1-2):298-305. [PubMed ID: 33006794]. [PubMed Central ID: PMC7537231]. doi: 10.1111/jocn.15520.##[2]Farmahini Farahani M, Jaberi K, Purfarzad Z, Ramos-Pichardo JD.Workplace Spirituality, Compassion Satisfaction, Burnout, and Secondary Traumatic Stress: A Cross‐Sectional Study in Iranian Nurses. Perspect Psychiatr Care. 2023;2023(1). doi: 10.1155/2023/7685791.##[3]Esfahani P, Khammer MA, Aghaee H, Shahnavazi Y, Khorramrouz M.[Spiritual health in Iranian nurses: a meta-analysis]. Interdiscip Quaran Stud. 2021;12(1):35-50.FA.##[4]Najafi K, Khoshab H, Rahimi N, Jahanara A.Relationship between spiritual health with stress, anxiety and depression in patients with chronic diseases. Int J Afr Nurs Sci. 2022;17. doi: 10.1016/j.ijans.2022.100463.##[5]Khorami MA, Mokhtari L, Habibpour Z, Ghafari S, Zeinali E, Sakhaei S, et al.[The role of spiritual health on health system staffs’ job satisfaction]. Nurs Midwifery J. 2017;15(5 (94)):329-38.FA.##[6]Ghaempanah Z, Shamsaee M, Baratian R.[Common Concepts in Spiritual Skills: A Review Study]. Cult Psychol. 2022;6(1):24-45.FA. doi: 10.30487/jcp.2022.130762.##[7]Bolhari J, Mohsenikabir M.Compiling and Evaluating Educational Package of Spiritual Skills for University Students. Iran J Psychiatry Clin Psychol. 2019:210-21. doi: 10.32598/ijpcp.25.2.210.##[8]Sharifnia AM, Fernandez R, Green H, Alananzeh I.The effectiveness of spiritual intelligence educational interventions for nurses and nursing students: A systematic review and meta-analysis. Nurse Educ Pract. 2022;63:103380. [PubMed ID: 35714561]. doi: 10.1016/j.nepr.2022.103380.##[9]Arad M, Alilu L, Habibzadeh H, Khalkhali H, Goli R.Effect of spiritual intelligence training on nurses' skills for communicating with patients - an experimental study. J Educ Health Promot. 2022;11:127. [PubMed ID: 35677273]. [PubMed Central ID: PMC9170219]. doi: 10.4103/jehp.jehp_1483_20.##[10]Mahmoudirad G, Bagherian F.[Effects of spiritual intelligence training on nurses' job stress]. Q J Nurs Manag. 2015;4(1):69-79.FA.##[11]Heydari A, Meshkinyazd A, Soudmand P.The Effect of Spiritual Intelligence Training on Job Satisfaction of Psychiatric Nurses. Iran J Psychiatry. 2017;12(2):128-33. [PubMed ID: 28659985]. [PubMed Central ID: PMC5483238].##[12]Soleimanpour Manzari R, Moradi M, Sadeghmoghadam L.[Effect of Psychological/Spiritual Self-care Education Through Telenursing on Death Anxiety of the Elderly During the COVID-19 Pandemic in Gonabad, Iran: A Randomized Controlled Clinical Trial]. Salmand. 2024;19(1):40-53.FA. doi: 10.32598/sija.2023.3542.1.##[13]Pakdaman M, Shamsi F, Malekpour N.The Relationship Between Spiritual Health and Job Stress of Nurses in Selected Teaching Hospitals in Yazd in 2020. Evid Based Health Policy Manag Econ. 2022;6(3). doi: 10.18502/jebhpme.v6i3.10862.##[14]Avarsin FM, Pirkhaefi A, Golkar MK.[The Effectiveness of Spiritual Group Therapy on Psychological Well-Being and Self-Efficacy of Patients with Type 2 Diabetes in Tehran in 2023]. J Toloo E Behdasht. 2024;23(3).FA. doi: 10.18502/tbj.v23i3.16484.##[15]Mirzaee S, Bekmaz K, Rasooli A, Shamsi A.Effect of spiritual self-care education on the resilience of nurses working in the intensive care units dedicated to COVID-19 patients in Iran. Complement Med J. 2022;12(2):188-201.##[16]Mirzaian S, Madadkar Dehkordi S, Karimiankakolaki Z, Mohammadi P.The Effect of Spiritual Self-Care virtual Training on Anxiety Caused by Corona in Final Year Nursing Students. complement Med J. 2023;12(4):40-9. doi: 10.61186/cmja.12.4.40.##[17]Folkman S.Stress: Appraisal and Coping. In: Gellman MD, Turner J, editors. Encyclopedia of Behavioral Medicine. New York, USA: Springer; 2013. p. 1913-5. doi: 10.1007/978-1-4419-1005-9_215.##[18]Suhifatullah MI, Sutarman S, Thoyib M.Character education strategies in improving students' spiritual intelligence. Int Res J Manag IT Soc Sci. 2021;8(2). doi: 10.21744/irjmis.v8n2.1350.##[19]Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP.Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176-81. doi: 10.1037/1040-3590.10.2.176.##[20]Ibrahim MA, Isa KQ, Haji-Idris HA, Nawi SH, Teo YC, Abdul Rahman H, et al.Spiritual Coping with Stress Among Emergency and Critical Care Nurses: A Cross-Sectional Study. Community Ment Health J. 2020;56(2):287-93. [PubMed ID: 31583621]. doi: 10.1007/s10597-019-00486-6.##[21]Perera CK, Pandey R, Srivastava AK.Role of Religion and Spirituality in Stress Management Among Nurses. Psychol Stud. 2018;63(2):187-99. doi: 10.1007/s12646-018-0454-x.##[22]Abdelrazek EM, Higazy OA.Burnout among nurses in Jazan General Hospital, Saudi Arabia: its prevalence and associated factors. Afr J Reprod Health. 2023;27(4):43-53. [PubMed ID: 37584907]. doi: 10.29063/ajrh2023/v27i4.5.##[23]Ramezanzade Tabriz E, Orooji A, Bikverdi M, Alizade taghi abad B.Investigation Clinical Competence and Its Relationship with Professional Ethics and Spiritual Health in Nurses. Health Spiritual Med Ethics. 2017;4(1):2-9.##

1 The Effectiveness of Play Therapy Based on Cognitive Behavioral Therapy and Rational Emotive Behavior Therapy on the Adjustment of Students with Attention-Deficit/Hyperactivity Disorder https://brieflands.com/journals/zjrms/articles/168734 10.5812/zjrms-168734 1 Background :Attention deficit hyperactivity disorder (ADHD) significantly impairs the social and emotional functioning of children. Objectives :The present study aimed to compare the effectiveness of cognitive-behavioral play therapy (CBPT) and rational emotive behavior therapy (REBT) on the adjustment of students with ADHD. Methods :This quasi-experimental study utilized a pre-test, post-test, and follow-up design with a control group. The population comprised elementary students with ADHD in Behbahan, Iran, during the 2023 - 2024 academic year. Forty-five students were selected via convenience sampling and randomly assigned to three groups of CBPT, REBT, and a control group (n = 15 each). The experimental groups received eight structured therapy sessions plus two parental training sessions, while the control group received no intervention. Data were collected using the Emotional Adjustment Measure (EAM) and analyzed using repeated measures ANOVA. Results :Findings indicated that both CBPT and REBT significantly increased overall adjustment scores and their components — including regulation of emotional/physiological arousal and reduction of hopelessness — compared to the control group (P < 0.001). However, no significant difference was observed between the efficacy of the two experimental interventions. Conclusions :Both CBPT and REBT are effective, viable clinical interventions for enhancing adjustment levels in students with ADHD and can be utilized as complementary treatments in educational and clinical settings. 1 8 Kobra Raoufi Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran Iran rahmatzadehab@gmail.com Nahid Havasi Soomar Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran Iran havasin2020@gmail.com Marjan Hosseinzadeh Taghvaei Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran Iran msjantaghvai@gmail.com Maryam Bahrami Hidaji Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran Iran bahramihidajimr@gmail.com Arezoo Tarimoradi Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran Iran tarimoradiarzo@gmail.com No Keyword 4.pdf [0]Musullulu H.Evaluating attention deficit and hyperactivity disorder (ADHD): a review of current methods and issues. Front Psychol. 2025;16:1466088. [PubMed ID: 40066184]. [PubMed Central ID: PMC11891363]. doi: 10.3389/fpsyg.2025.1466088.##[1]Hashemi A, Siavashi E, Saadatian A.Improving Physical Fitness in Children with ADHD Through Virtual Physical Activity: A Randomized Controlled Trial. Zahedan J Res Med Sci. 2025;28(1). e164115. doi: 10.5812/zjrms-164115.##[2]Stern A, Agnew-Blais JC, Danese A, Fisher HL, Matthews T, Polanczyk GV, et al.Associations between ADHD and emotional problems from childhood to young adulthood: a longitudinal genetically sensitive study. J Child Psychol Psychiatry. 2020;61(11):1234-42. [PubMed ID: 32112575]. [PubMed Central ID: PMC7483180]. doi: 10.1111/jcpp.13217.##[3]Saliminia N, Danesh E, Hakimi Z, Shamshiri M.Efficacy of Management Skills Group Training for Mothers on Self-Esteem and Anxiety of Their Children With Attention Deficit and Hyperactivity Disorder. Zahedan J Res Med Sci. 2016;18(7). e7550. doi: 10.17795/zjrms-7550.##[4]Yadegari N, Sayehmiri K, Zamanian Azodi M, Sayehmiri F, Modara F.The Prevalence of Attention Deficient Hyperactivity Disorder Among Iranian Children: A Meta-Analysis. Iran J Psychiatry Behav Sci. 2018;In Press(In Press). doi: 10.5812/ijpbs.8990.##[5]Riahi F, Mohammadi MR, Izadi Mazidi M, Khaleghi A, Hooshyari Z.Prevalence of Psychiatric Disorders among Children and Adolescents: A Study from Khuzestan. Iran J Child Neurol. 2022;16(3):95-107. [PubMed ID: 36204445]. [PubMed Central ID: PMC9531189]. doi: 10.22037/ijcn.v15i4.27319.##[6]Ginapp CM, Greenberg NR, Macdonald-Gagnon G, Angarita GA, Bold KW, Potenza MN.The experiences of adults with ADHD in interpersonal relationships and online communities: A qualitative study. SSM Qual Res Health. 2023;3. [PubMed ID: 37539360]. [PubMed Central ID: PMC10399076]. doi: 10.1016/j.ssmqr.2023.100223.##[7]Carpenter Rich E, Loo SK, Yang M, Dang J, Smalley SL.Social functioning difficulties in ADHD: association with PDD risk. Clin Child Psychol Psychiatry. 2009;14(3):329-44. [PubMed ID: 19515751]. [PubMed Central ID: PMC2827258]. doi: 10.1177/1359104508100890.##[8]Ferretti NM, King SL, Hilton DC, Rondon AT, Jarrett MA.Social Functioning in Youth with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo. Yale J Biol Med. 2019;92(1):29-35. [PubMed ID: 30923471]. [PubMed Central ID: PMC6430168].##[9]Rubio VJ, Aguado D, Hontangas PM, Hernández JM.Psychometric Properties of an Emotional Adjustment Measure. Eur J Psychol Assess. 2007;23(1):39-46. doi: 10.1027/1015-5759.23.1.39.##[10]Lambez B, Harwood-Gross A, Golumbic EZ, Rassovsky Y.Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis. J Psychiatr Res. 2020;120:40-55. [PubMed ID: 31629998]. doi: 10.1016/j.jpsychires.2019.10.007.##[11]William S, Horrocks M, Richmond J, Hall CL, French B.Experience of CBT in adults with ADHD: a mixed methods study. Front Psychiatry. 2024;15:1341624. [PubMed ID: 38962060]. [PubMed Central ID: PMC11221408]. doi: 10.3389/fpsyt.2024.1341624.##[12]Taghizadeh Hir S, Aghajani S, Khoshsorour S.[Effectiveness of Cognitive-Behavioral Play Therapy (CBPT) on improving attention and planning in children with attention-deficit/hyperactivity disorder]. J Sch Psychol. 2023;11(4):16-29.FA.##[13]Khatoon A, Iqbal N, Masroor U.Efficacy of Cognitive Behavioral Play Therapy (CBPT) For Children with Attention Deficit Hyperactivity Disorder (ADHD). Clin Counsel Psychol Rev. 2021;2(2). doi: 10.32350/ccpr.22.02.##[14]Knell SM.Cognitive‐Behavioral Play Therapy. In: O'Connor KJ, Schaefer CE, Braverman LD, editors. Handbook of Play Therapy. Hoboken, USA: John Wiley & Sons; 2015. p. 119-33. doi: 10.1002/9781119140467.ch6.##[15]Fattahi Andebil A, Saberi H, Kazemi Kavaki A.[Effectiveness of Cognitive behavioral group Play therapy and Transcranial Direct Current Stimulation on Executive Function of Working Memory And Response Inhibition of Children with Attention Deficit-Hyperactivity Disorder]. Neuropsychol. 2018;4(14):73-90.FA.##[16]Dryden W.Rational emotive behavior therapy. In: Freeman A, Felgoise SH, Nezu CM, Nezu AM, Reinecke MA, editors. Encyclopedia of cognitive behavior therapy. New York, USA: Springer; 2005. p. 321-4.##[17]Turner MJ.Rational Emotive Behavior Therapy (REBT), Irrational and Rational Beliefs, and the Mental Health of Athletes. Front Psychol. 2016;7:1423. [PubMed ID: 27703441]. [PubMed Central ID: PMC5028385]. doi: 10.3389/fpsyg.2016.01423.##[18]Nafisi F, Fattahiandabil A.The effectiveness of group counseling with rational, emotive and behavior therapy (REBT) on self-concept and social adjustment of male adolescents. J Adolesc Youth Psychol Stud. 2020;1(1):106-19. doi: 10.61838/kman.jayps.1.1.10.##[19]Doyle KA, Terjesen MD.Rational-emotive behavior therapy and attention deficit hyperactivity disorder. In: Ellis A, Bernard ME, editors. Rational emotive behavioral approaches to childhood disorders: Theory, practice and research. New York, USA: Springer; 2006. p. 281-309.##[20]Champ RE, Adamou M, Tolchard B.The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review. PLoS One. 2021;16(12). e0261247. [PubMed ID: 34932573]. [PubMed Central ID: PMC8691636]. doi: 10.1371/journal.pone.0261247.##[21]Sanaeipour MH, Royaei Z, Gharetapeei Z.[Psychometric Properties of the Emotional Adjustment Measure among Iranian Students]. Educ Measure. 2016;6(23):77–97.FA.##[22]Sheykholeslami A, Seyedesmaili Ghomi N, Mohammadi N.Investigating the Effectiveness of Cognitive Rehabilitation on the Executive Functions of Students with Specific Learning Disorder. Iran J Learn Memory. 2023;6(23):43-51. doi: 10.22034/iepa.2023.421809.1452.##[23]Dai L, Su B, Liu Q.Effect of the Intervention Dominated by Rational-Emotive Therapy on Obese Children’s Mental Health. Iran J Public Health. 2025;54(3):589.##[24]Hamidi F, Paidar F, Mohammadi F.The Role of Rational Emotive Behavioral Therapy on Students Adjustment. Int J Sch Health. 2017;4(2):1-6. doi: 10.17795/intjsh-40020.##