Volume 10, Issue 1 (Winter 2022)                   PCP 2022, 10(1): 55-68 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Minoosepehr S, Karbalaei Mohammad Meyguni A, Nikoogoftar M, Gholamali Lavasani M. A Structural Equation Modeling to Explain Marital Burnout: Pornography Consumption and Perfectionism With the Mediating Role of Sexual Self-concept. PCP 2022; 10 (1) :55-68
URL: http://jpcp.uswr.ac.ir/article-1-791-en.html
1- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran.
2- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran. , dr.karbalae1335@gmail.com
3- Department of Psychology, Payame Noor University, Tehran, Iran.
4- Department of Psychology, University of Tehran, Tehran, Iran.
Full-Text [PDF 724 kb]   (1255 Downloads)     |   Abstract (HTML)  (2783 Views)
Full-Text:   (1117 Views)
1. Introduction 
Despite the importance of family, couples’ relationships are damaged for various reasons, and the families collapse. Marriage is based on the couple’s mutual support in the physical, social, and psychological areas. A successful and sustainable marriage is associated with achievement in these three areas (Candemir Karaburc, & Tunc, 2020). For this reason, considering these three areas is one of the principles of research in family and marital relations and investigating the factors affecting the quality of everyday life. Marital burnout is one of the factors affecting the separation of couples and the failure of emotional relationships (Pines, 2002; Nazari et al., 2015). Marital burnout is a state of extreme physical, mental, and emotional fatigue characterized by a gradual decrease in emotional attachment to the spouse, along with feelings of alienation, apathy, and indifference between couples and the replacement of positive emotions with negative emotions (Pines, 1996).
Marital burnout is caused by a discrepancy between a person’s expectations of an emotional relationship and reality. When couples realize that despite all efforts, their expectations of the marital relationship have not been met and the relationship has not given the meaning and concept they wanted in their lives, they become frustrated, and the relationship becomes boring over time. Also, people who internalize their ideals expect that the emotional relationship will solve their problems, meet their needs, and give meaning to their lives. When these needs and expectations are unmet, they become frustrated with their emotional partner, and their worlds lose their meaning (Pines, 2002; Zarei et al., 2013). The discrepancy between people’s perceived real self and what they see as an ideal for themselves has unpleasant consequences for marital relationships and life satisfaction (Robins & Boldero, 2003). Kennis et al. (2021) reported that sexual self-concept discrepancy mediated the relationship between gender dysphoria, sexual esteem, and sexual attitudes. “Self” is a fundamental element of human personality and the agent of personal compromise. It is a social product that grows from the interaction of the individual and the environment and gradually becomes stable. Although self-concept is almost complete by the end of adolescence, it can change under the influence of interpersonal experiences (Higgins, 1987). Based on research, marital relationship and marital satisfaction are affected by the role of “self” (Calaxton et al., 2012).
Sexual self-concept is people’s perception of their sexual desires and is formed during emotional-social development along with sexual attitudes. This emotional phenomenon helps people become aware of their sexual issues and shape their sexual identities (O’sullivan, Meyer‐Bahlburg, & McKeague, 2006). Studies have indicated that women with positive sexual self-esteem have higher levels of sexual responses, sexual self-concept, sexual satisfaction, marital satisfaction, sexual optimism, marital adjustment, sexual self-efficacy, sexual consciousness, and sexual-problem management. They also have lower sexual self-blame, while negative sexual self-concept in women leads to sexual problems, feelings of sexual anxiety, sexual fear, sexual repression, and poor sexual performance. These women try less to adjust to their sexual problems and experience less sexual activity. Thus, it is essential to investigate various factors affecting sexual self-concept because its consequences affect the quality of emotional relationships and mental health (Hamidi, Hamzehgardeshi, & Shahhosseini, 2020; Rostosky et al., 2008; Salehi et al., 2015). In the sexual media practice model (Steele & Brown, 1995), people’s use of pornography shapes their sexual identity, which leads to selecting a particular type of media and developing certain attitudes and behaviors in practical life.
In this model, the content of pornography in adolescents, such as sex messages they receive through music videos, magazines, and television programs, mediates the relationship between their sexual self-concept and the sexual intensity of the image they present (Bobkowski, Shafer, & Ortiz, 2016). This model states that sexual relationships and gender are an essential part of a person’s identity, so people are interested in sexual topics and search for them in the media. People may or may not be affected in the face of sexual topics. People may be physically or emotionally aroused by the images they see. Using such media can lead to pre-behavioral sexual outcomes, such as perceived sexual norms, attitudes, beliefs, the expectation of results, and sexual scripts that ultimately affect sexual behavior (Shafer, Bobkowski, & Brown, 2013). Thus, investigating the use of pornography (images, animations, videos) in cyberspace has been the concern of many researchers in various societies. From 1969 onwards, many studies have been conducted on pornography (Carroll et al., 2008).
Pornography has been considered an equivalent term for harmful media use with immoral topics in this study. The term pornography is originally a Greek word used in the 19th century and means writing about prostitution. Because of the negative semantic burden of this word in societies, some researchers use relatively neutral words and terms such as “sexually explicit media or material,” “erotica,” or “online sexual activity” to refer to this topic (Carroll et al., 2008). Regardless of the word used for this topic, this word is defined in two ways in the research literature: topics that create sexual thoughts, feelings, or behaviors, and topics that contain explicit images or represent sexual behavior in which sexual organs have been used (Reid et al., 2011; Kor et al., 2014; Hald & Malmuth, 2015). Pornography refers to visible topics (images or descriptions) of sexual actions that arouse sexual feelings or thoughts in the audience (Perry, 2017).
Owing to sexual instinct power, people have shown this behavior in different ways from the beginning of history. Sexual images of women, men, and animals, some of which have been discovered on the walls of caves in France and Spain before 13000 BC, ceramics painted with erotic images buried in the city of Pompeii, and stone carvings depicting naked women 18000 years ago to the Kama Sutra book, which is one of the most famous and comprehensive works recorded in depicting sexual behavior in India, dating back to more than 2000 years ago indicate this sexual intrinsic power (Kohut & Fisher, 2017). The modern history of the distribution and reproduction of sexually explicit topics is closely associated with the development of technological innovations. For example, it is stated that a collection of sexually explicit satires of Poggio Bracciolini’s Facetiae in 1474 was published only 19 years after the Gutenberg Bible. Several hundreds of years later, the low cost of printing technology allowed novels and the printing of pornographic images to flourish, both as a form of political satire and sexual entertainment. The invention of photography in the 1820s and later the creation of motion pictures in the next century introduced new technologies that later became the main method of producing sexually explicit topics. This trend culminated in the late 1970s with the invention of the video device, which allowed people to sit and watch sexually explicit movies at home. In the mid-1990s, the Internet emerged as a new and widely available method of distributing sexually explicit texts and images. Following the emergence of the Internet, access to sexually explicit topics reached its highest level worldwide (Kohut & Fisher, 2017).
Over the previous decades, the use of pornography in the Western media has increased so much that it has raised many concerns about the moral, social, and psychological effects. These effects consist of the promotion and normalization of violence against women (Hald & Malamuth, 2015), hypersexuality (Grubbs, et al., 2015), creating behavioral scripts (Davis, et al., 2018), unwillingness to marry and increasing the age of marriage (Perry, & Longest, 2019; Malcolm, & Naufal, 2016), reducing the quality of emotional and marital relationship (Perry, 2017; Poulsen, Busby, & Galovan, 2013; Gwinn, et al., 2013; Maddox, Rhoades, & Markman, 2011), and creation of unrealistic beliefs about sex (Wright, et al., 2017). Although studies have shown a relationship between pornography and emotional failure (Daines, & Shumway, 2011; Doran & Price, 2014; Perry & Schleifer, 2018; Willoughby, et al., 2016), they have provided conflicting and contrasting results (Perry, 2020; Campbell, & Kohut, 2017; Leibel, 2021), which shows the complexity of pornography use on couple’s relationship indicating needs for further investigation in this area.
Regarding this complexity, Campbell and Kohut (2017) reviewed studies conducted on the relationship between pornography and the emotional relationship, and their results showed the positive and negative effects of pornography in a committed relationship. They stated that limitations in data collection and hypotheses make it challenging to conclude clearly about the relationship between pornography and the emotional relationship. Other studies have shown that the quality of couples’ relationships affects the association between pornography and sexual satisfaction, satisfaction with emotional relationships, and commitment. Thus, pornography can affect the quality of emotional relationships (Wright et al., 2017; Newstorm & Harris, 2016). Perry (2020) reviewed 57 studies to examine the relationship between pornography and the emotional relationship among American married couples and 29 studies among non-married people. He concluded that the use of pornography had no relationship or negative relationship with the emotional relationship. Except for one study, pornography showed no positive relationship with the quality of the couple’s relationship for unknown reasons, indicating the ambiguity in the relationship between pornography and the emotional relationship. This result implies the necessity of more extensive research in this area.
One of the factors that can affect the evaluation of relationship quality is the individual’s beliefs. The irrational beliefs underline the distance between the current situation and expectations (Stoeber & Stoeber, 2009). People with perfectionism show the signs of irrational beliefs, too. Perfectionism is a personality trait associated with irrational and unrealistic beliefs and expectations. These beliefs are associated with burnout because couples’ burnout depends on their adaptation to their beliefs (Adib Rad & Adib Rad, 2005). The conducted studies have focused more on negative or maladaptive perfectionism and have shown its relationship with various psychological disorders and interpersonal problems, such as hypersexuality (Reid et al., 2011), sexual satisfaction (Habke, Hewitt, & Flett, 1999), emotional relationship (Stober & Stober, 2009), and marital burnout (Najafi, 2016). Although the outcomes of perfectionism and irrational beliefs in the area of sexual problems and disorders have been investigated (Stoeber & Harvey, 2016; Reid et al., 2012; Kluck, Zhuzha, & Hughes, 2018), little attention has been paid to sexual perfectionism. 
Eidelson and Epstein (1982) consider sexual perfectionism as a cognitive distortion in which people believe they should act as sexual partners in the best possible way. Only one dimension has been considered for it. Combining the dimensions of the Hewitt and Flett (1991) and couple perfectionism, Snell (2011) presented a multidimensional model of sexual perfectionism in which four forms of sexual perfectionism have been distinguished: self-oriented, partner-oriented, partner-prescribed, and socially-prescribed. Self-oriented sexual perfectionism reflects the expectations and standards of perfectionism that people consider for themselves.
Partner-oriented sexual perfectionism is a perfectionist’s expectations and standards that focus on one’s emotional partner. Partner-prescribed perfectionism reflects beliefs that are the perfectionist’s expectations and standards that a person’s emotional partner has. Socially-prescribed sexual perfectionism depicts the beliefs that society and the public have about the person in the form of perfectionist expectations and standards.
Studies show that negative perfectionism and various dimensions of self-concept are directly associated (DeDonno, & Rivera-Torres, 2018; Eusanio, Thomson, & Jaque, 2014). Totonchi, Samani, and Ghashghaei (2012) showed that positive and negative perfectionism mediates the effect of self-concept on mental health. Perfectionists need information so that they can compare and measure, and evaluate their positions by setting unrealistic standards and expectations for themselves in various areas of life (Saadat et al., 2017). In other words, by strictly comparing themselves with external standards and criteria, the perfectionist forms a self-assessment scale that should be transformed into an image with much pressure to feel valued. Stoeber (2012) showed that self-oriented and partner-oriented sexual perfectionism has a positive relationship with sexual self-esteem (positive dimension of self) and with the sexual problem of self-blame (negative dimension of self). Moreover, partner-oriented perfectionism and partner-prescribed perfectionism are positively associated with sexual self-efficiency. Socially-prescribed sexual perfectionism also has a positive relationship with sexual problems, self-blame, and sexual anxiety (negative dimensions) and a negative relationship with sexual optimism (one positive dimension). In a longitudinal study on women, Stoeber and Harvey (2016) found that a partner-prescribed sexual perfectionism (thinking that my partner expects me to be a perfect sexual partner) reduces sexual self-esteem and increases sexual anxiety over time so sexual function decreases. 
Although researchers have studied pornography consumption, sexual perfectionism, sexual self-concept, and their effect on couples’ relationships separately but the ambivalent outcomes in previous studies and scarcity of literature on this subject demand deeper insight into this matter. Furthermore, to our knowledge, no study has examined these variables in a structural modeling, and to date, no research has examined the potential mediating role of sexual self-concept on relations between pornography consumption, sexual perfectionism, and marital burnout. The present study aimed to evaluate the role of pornography consumption, sexual perfectionism, and the potential mediating role of sexual self-concept on marital burnout.

2. Materials and Methods
The present study seeks a model of structural relationships of marital burnout with pornography and sexual perfectionism mediated by sexual self-concept in married students. Thus, in terms of the data collection method, it is a descriptive-correlational study conducted through path analysis modeling. The study sample was recruited from married students of Islamic Azad University. Because of the outbreak of COVID-19 disease and the shutdown of university classes, the students completed the questionnaires online in the second half of 2020. After obtaining permission from the Research Council, obtaining the code of ethics, and preparing the questionnaires on a website, the site link was sent to different virtual groups related to the students of the Azad University living in Tehran City, Iran, while explaining the content of the research. 
It was necessary to provide explanations about the study objectives, voluntary participation, confidentiality, non-registration of identification details, the right to withdraw from all stages of data collection in the study, and their consent to participate in the study. Thus, all study participants read this information and confirmed it. In the path analysis, the sample size can be between 5 and 15 observations for each measured variable: 5q<=n<=15q; where q is the number of variables observed or the number of items (questions) of the questionnaire and n is the sample size (Hooman, 2005). For this purpose, according to the inclusion and exclusion criteria, 210 people were included in this study. The inclusion criteria were being an Azad University student and married. The exclusion criteria were not answering more than 10% of the questions in the study questionnaires and unwillingness to continue the study.
Data collection tools consisted of general (demographic) questions, including gender, age, the field of study, degree, marriage duration, use or non-use of pornography, and, if used, its duration during the week; and specialized questions, including 131 questions from the following questionnaires.

Couple Burnout Measurement (CBM)
The couple burnout measurement (CBM) questionnaire is a self-assessment tool adapted from the burnout questionnaire by (Hooman, 2005). The questionnaire has 21 items that include three parts of physical exhaustion (fatigue, weakness, and sleep disorders), emotional exhaustion (depression, disappointment, and falling into the trap), and mental exhaustion (worthlessness, frustration, anger toward the spouse). Items are answered based on a 7-point Likert-type scale. Level 1 indicates the inexperience (never) of the item, and level 7 indicates the high experience (always) of the item (Hooman, 2005). This questionnaire has an internal consistency value between 0.84 and 0.90. The validity of CBM has been indicated through negative correlation with positive dimensions of interpersonal relationships, such as positive opinion about relationship, feeling of security, quality of conversation, self-fulfillment, purposefulness, attraction and emotional attraction towards the spouse, and quality of sex (Karimi & Khalatbari, 2017). This questionnaire has been used in different languages ​​in various cultures such as Finland, Norway, Hungary, Mexico, Spain, and Portugal (Pines & Nunes, 2003), as cited by Karimi & Khalatbari (2017)compared this questionnaire with an enriched marital satisfaction questionnaire, and the correlation coefficient between these two questionnaires was obtained at -0.40, which is significant at the level of P<0.001.

The Pornography Consumption Inventory (PCI)
The Pornography Consumption Inventory (PCI) is a 15-item tool that is scored on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” Reid et al. (2011) designed this questionnaire based on the hypothesis that pornography consumption adapts or avoids unpleasant emotions and stressful experiences; pornography consumption satisfies sexual curiosities; pornography consumption facilitates sexual pleasure; and pornography consumption satisfies emotional desires, dreaming, novelty, and diversity. Based on these hypotheses, 38 items were initially considered, but after researching 105 people who sought to solve the problem of online pornography consumption, the factor structure of items number reached 15. The Cronbach α of the whole questionnaire was reported at 0.83. The α values were reported at 0.85, 0.87, 0.73, and 0.71 for the subscales of emotional avoidance, sexual curiosity, sensation-seeking, and sexual pleasure, respectively. Its internal validity was obtained at r=0.87 after 4 weeks. Then, Reid et al. (2011) re-examined the questionnaire on another 107 people seeking treatment for hypersexuality. Factor analysis showed a good correlation between the subscales, and in this study, the Cronbach alpha values were reported at 0.95, 0.89, 0.85, and 0.90, respectively, for the subscales of emotional avoidance, sexual curiosity, sensation-seeking, and sexual pleasure and 0.93 for the whole questionnaire. 
To assess its validity, the questionnaire was implemented on 211 male and female Spanish students who consumed pornography subjects. The factor structure showed that 13 items in 3 subscales had a good fit. The subscale of sensation-seeking and sexual pleasure together formed a subscale. All three subscales had high reliability (<0.91) (Leon-Larios, et al., 2019). This questionnaire has not been examined in Persian so far. So its English version was translated to Persian and back-translated to English for this research by language experts. To evaluate its face validity, the questionnaire was reviewed by 10 professors of psychology, and the desired changes and corrections were made. 
To evaluate the reliability of the questionnaire, in a pilot study, 30 samples of Islamic Azad University students answered the questionnaire, and each was asked to clarify the concept and wording of the questions. Exploratory and confirmatory factors were used to evaluate the construct validity. Three acceptable latent factors were obtained in the questionnaire, which was named according to the shared area in each factor, using the opinions of experts and the components of the original version. Thus, factor 1 was named emotional avoidance (α=0.81), factor 2 sexual curiosity (α=0.78), and factor 3 sexual pleasure (α=0.77); the Cronbach α of the whole questionnaire was obtained at 0.79.

Multidimensional Sexual Perfectionism Questionnaire (MSPQ)
The multidimensional sexual perfectionism questionnaire (MSPQ) was developed by Snell, Rigdon (1995) Snell, (2011) based on a multidimensional model of sexual perfectionism. This questionnaire is presented by combining the dimensions of the model of perfectionism of Hewitt and Flett (1991) and has 24 items in which four forms of sexual perfectionism are distinguished: self-oriented, partner-oriented, partner-prescribed, and socially-prescribed. Self-oriented sexual perfectionism reflects the expectations and standards of perfectionism that people consider for themselves. Partner-oriented sexual perfectionism is a perfectionist’s expectations and standards that focus on one’s emotional partner. Partner-prescribed perfectionism reflects beliefs that are the perfectionist’s expectations and standards that a person’s emotional partner has. 
Socially-prescribed sexual perfectionism depicts the beliefs that society and the public have about the person in the form of the perfectionist’s expectations and standards. The Cronbach α in the original version of Snell and Rigdon (1995) was below the acceptable value (socially-prescribed perfectionism was about α=0.37). So Snell (2011) presented a revised version of the questionnaire to solve this low value. In the research by Stoeber et al. (2013) to evaluate the dimensions of sexual perfectionism, the reliability of all subscales of the questionnaire was found acceptable (α>0.8). Also, it showed that self-oriented and other-oriented (partner or society) sexual perfectionism has both positive and negative dimensions of perfectionism and are related to the negative dimensions of sexual self-concept and problematic sexual behaviors that can be positive or negative. However, partner-prescribed or socially-prescribed sexual perfectionism indicates the negative dimensions of perfectionism that are directly related to negative sexual self-concept and problematic sexual behaviors. 
In the research by Kluck et al. (2018) in examining the relationship between the dimensions of sexual perfectionism and sexual assertiveness in women, the subscales of the questionnaire had high reliability (α>0.87). This questionnaire has not been used in the Persian language so far. So, its English version was translated to Persian and then back-translated to English by language experts. To evaluate its face validity, the questionnaire was reviewed by 10 professors of Psychology, and their commented changes and corrections were implemented. To evaluate the reliability of the questionnaire, in a pilot study, 30 samples of Islamic Azad University students answered the questionnaire, and each was asked about the clarity and wording of the questions. The original questionnaire was developed in 4 subscales, and each subscale consisted of 6 items (Snell, 2011). In the Persian version, because of cultural differences and incongruity of the concept of the socially-prescribed sexual perfectionism subscale with the cultural value of sex in the context of marriage and family formation, this subscale was removed from the Persian version. Because of duplicated questions, the number of questions reached 17 items in 3 subscales. They are scored on a 5-point Likert scale from never=1 to always=4. The total α value for the whole questionnaire was obtained at 0.83, which is an acceptable value. 
Exploratory and confirmatory factors were used to evaluate the construct validity of the MSPQ. Each extracted factor was examined in exploratory factor analysis and labeled according to the shared area in each factor, using the opinions of experts and the components of the original version. Accordingly, factor 1 is self-oriented perfectionism, factor 2 is partner-oriented perfectionism, and factor 3 is partner-prescribed perfectionism. It should be noted that question 3 took more than two factors, and due to non-meeting the required criteria, it was removed from the questionnaire, and the final number of questionnaire items reached 16.
Multidimensional Sexual Self-concept Questionnaire (Snell, 1998)
The Snell multidimensional Sexual Self-concept Questionnaire (MSSCQ) was developed in 1995 and is one of the most commonly used tools in both sexes to measure the feelings, perceptions, and beliefs about sex. Snell prepared 100 questions for this questionnaire, which includes 20 subscales, and each subscale is measured with 5 items. This questionnaire covers cognitive (sexual self-schemata), emotional (sexual depression), and motivational (sexual motivation) dimensions. Its Cronbach α is between 0.72 and 0.94. MSSCQ includes 20 subscales classified into two dimensions of positive sexual self-concept and negative sexual self-concept. These 20 subscales comprise sexual anxiety, sexual self-efficacy, sexual consciousness, motivation to avoid risky sex, chance/luck sexual control, sexual assertiveness, sexual optimism, sexual problem self-blame, sexual preoccupation, sexual monitoring, sexual motivation, sexual problem management, sexual esteem, power- other sexual control, sexual self-schemata, fear of sex, sexual problem prevention, sexual depression, internal sexual control (Ziaei et al., 2013).
Ziaei et al. (2013) evaluated the validity and reliability of the Persian version of this questionnaire in an Iranian community. The Cronbach α ranged from 0.88 for the whole questionnaire and 0.41 to 0.87 for the subscales, while its minimum value in the Snell study was 0.72. Given the cultural and educational differences in sexual issues, this difference is expected. Rostosky et al. (2008) classified the subscales into two general groups of positive and negative because of this difference in the Cronbach α coefficient values. In a study by Ziaei et al. (2013), 78 items in 18 subscales obtained sufficient validity to measure sexual self-concept. The internal validation between subscales and explanatory factor analysis showed that subscales could be positively measured with the subscales of sexual self-efficacy, sexual optimism, sexual-consciousness, motivation to avoid risky sex, sexual preoccupation, sexual monitoring, sexual assertiveness, sexual motivation, sexual esteem, sexual problem management, sexual satisfaction in the positive dimension and sexual anxiety, fear of sex, sexual depression, sexual problem self-blame, internal control of sexual issues, and sexual self-schemata in the negative dimension. The minimum score in the positive and negative self-concepts is 0, and the maximum score is 275 in the positive self-concept and 115 in the negative self-concept (Jaafarpour Maroufi & Molaeinezhad , 2016). In this study, two general dimensions of positive and negative sexual self-concept are considered and scored on a 5-point Likert-type scale from 1 (never) to 5 (always).

Statistical analysis
Based on the multivariate normal distribution of the indicator variables, no missing data, an adequate sample size (210 individuals), and a linear relationship between the observed variables, we used correlation coefficient (using SPSS software version 26) and path analysis (using LISREL statistical software) to assess hypothesis and model goodness of fit.

3. Results 
A total of 210 samples were included in the study (female=129, male=81). The youngest was 19 years old, and the oldest was 58 (mean age=36.81 years); the minimum period of marriage was 2 months, and the maximum was 28 years (mean duration=11.20 years). The duration of pornography consumption is shown in Table 1 which shows the sample distribution based on the duration of pornography consumption during one week.

About 45.7% of the samples do not spend any time on pornography consumption, and 33.3% consume pornography for less than one hour per week. Also, 15.2% consume pornography between one and three hours per week, and 5.8% consume pornography for more than three hours.
The descriptive indices of the research are presented in Table 2.

The correlation matrix of research variables is presented in Table 3.

Investigating the relationships between variables shows that the relationship between all independent variables and marital burnout is significant (P≤0.01). The relationship between independent variables and the mediating variable of negative and positive sexual self-concept (except for the relationship between pornography and positive self-concept) is significant. Negative self-concept has a significant relationship with marital burnout, and positive self-concept has no significant relationship with marital burnout.
Thus, all variables were entered into the path analysis. To examine the variables of the marital burnout prediction model, which include independent variables of pornography consumption, perfectionism, and the mediating variable of sexual self-concept, LISREL software and the path analysis method were used. In the first stage of path analysis, all variables were entered into the analysis, but in the obtained model, path coefficients related to positive sexual self-concept were insignificant and caused a decrease in fit indices. In the next step, the positive sex self-concept variable was removed from the model. Removing this variable increased the model’s usefulness and improved some path coefficients and t values. The values obtained in the following tables are based on the second model (after removing the above cases).
Based on the values reported in the above Table 4, the direct effect of pornography consumption on marital burnout (β=0.04) is not significant. However, the direct effect of sexual perfectionism on marital burnout (β=0.20) is significant (P≤0.01).

Investigating the direct effects of independent variables on negative sexual self-concept shows that the direct effect of using pornography consumption (β=0.24) and sexual perfectionism (β=0.35) on negative sexual self-concept is significant (P≤0.01). The direct effect of negative sexual self-concept on marital burnout is 0.23, which is significant (P≤0.01).
Table 5 presents the coefficients of the indirect effect of independent variables on marital burnout mediated by negative sexual self-concept. According to the results, the indirect effect of pornography consumption (β=0.06) and sexual perfectionism (β=0.08) on marital burnout mediated by negative sexual self-concept is significant at the level of P≤0.05. Table 6 presents the fit indices of the final model. The results indicate that the model has a good fit.


4. Discussion
The results revealed a relationship between pornography consumption, sexual perfectionism, and marital burnout mediated by sexual self-concept among married students, and the model has a good fit. Studies have indicated that pornography consumption lacks a direct effect on marital burnout. This result is inconsistent with previous studies (Daines, & Shumway, 2011; Doran & Price, 2014; Perry & Schleifer, 2018; Willoughby, et al., 2016). Based on research literature, past studies have also presented conflicting results on the relationship between pornography consumption and the emotional relationship (Perry, 2020; Campbell & Kohut, 2017; Leibel, 2021). Most studies suggest no relationship or a negative relationship between pornography consumption and a committed emotional relationship (Campbell and Kohut, 2017).
Various factors seem influential, making the clear and specific conclusion distorted. First, it is unclear whether the low quality of the relationship between couples leads to pornography consumption or vice versa (Wright et al., 2017; Perry, 2020; Newstorm & Harris, 2016), indicating that other variables such as gender, couples’ watch together or alone, the rate of consumption and addiction to pornography, the duration of consumption, and the age of onset of consumption are influential in this regard. This result was confirmed in the following hypotheses of this study and showed that other factors are influential in the relationship between the mentioned variables. It is also notable that most individuals in this study spent less than 30 minutes per week consuming pornography. 
Campbell and Kohut (2017) stated that most studies conducted in this area have measured the couples’ relationship with a negative bias and considered the harmful effects of pornography. In other words, the aim is to prove the harmfulness and or the non-harmfulness of pornography consumption. In this study, we investigated individual burnout, while previous studies focused on the couple’s relationship, influenced by the opinion of both partners. The porn user does not necessarily experience burnout in this relationship, but it might be unpleasant and harmful for the other partner. Reviewing past studies in this area, Leibel (2021) stated that a person’s attitude to consuming pornography, content, transparency in the use of such media between couples, and the level of commitment of couples to each other are among the influential factors of pornography on the emotional relationship. As the results show, pornography is associated with marital burnout through the mediating role of negative sexual self-concept. The relationship between sexual self-concept and marital burnout through the mediating role of negative sexual self-concept is in line with similar areas such as the quality of the emotional relationship (Hamidi et al., 2020; Mohammadi Nik et al., 2018).
The positive dimension of sexual self-concept includes self-efficacy, self-esteem, assertiveness, consciousness, avoidance of risky behaviors, management, and sexual satisfaction. Using these characteristics significantly impacts sexual health, high sexual responses, and the quality of emotional relationships. Thus, it seems that the dimension of sexual self-concept has no role in the relationship between pornography consumption and marital burnout. This result is in line with previous studies that stated that negative self-concept compared to positive self-concept affects the quality of marital relationships (Hamidi et al., 2020; Rostosky et al., 2008; Salehi et al., 2015; Calaxton et al., 2012).
As suggested in the theories of sexual scripts (Simon and Gagnon, 1986), sexual behavior as part of the behavioral scripts of the environment and society induces the person to what behavior is permissible or forbidden. People with a negative sexual self-concept are more likely to seek information about sexual behavior because they do not believe in themselves and are more likely to be influenced by false and misleading information about pornography. Also, sexual self-concept is influenced by environmental factors, such as behavioral scripts induced as a norm in pornography (Davis et al., 2018). This finding shows a direct association with a negative dimension of sexual self-concept, which is consistent with the result of research by Bobkowski et al. (2016) and Schafer et al. (2013).
The results also show that sexual perfectionism is directly and indirectly associated with marital burnout through negative sexual self-concept. In line with the results of previous studies, these results suggest that people with perfectionist attitudes toward emotional relationships believe that the condition for a satisfying relationship with their emotional partner is perfection. Since true perfection is unachievable, people with perfectionist concerns will fail to achieve the impossible standards they feel imposed on them. As a result, they will feel that they have lost the love, trust, and respect of their partner and will experience disappointment and anger due to dissatisfaction with the emotional relationship, which finally results in marital burnout (Stoeber and Stoeber, 2009; Stoeber and Harvey, 2016; Najafi, 2016). Moreover, in line with the results of previous studies, perfectionism had a positive relationship with the negative dimension of sexual self-concept and a negative relationship with the positive dimension of sexual self-concept (Stoeber et al.,2013; Snell, 2001; Snell and Rigdon, 2001).
In this regard, Wright et al. (2017) reported that pornography could create unrealistic beliefs about sex in people and the perfectionist people perceive a difference that is distant from their ideals by internalizing the criteria and standards that they receive through the environment, including pornography and strictly and unrealistically evaluation of self and comparing the real self with the ideal self. The more negative this self-perception and the self-image and self-belief, the more this distance and mismatch between what is in the form of reality in the present moment in the relationship and what idealistic standards and criteria dictate to them about the quality of the relationship. This mismatch between the current situation and the expected situation of the relationship, on the one hand, and lack of positive sexual self-concept, on the other hand, leads to conflicts both within the person and in the interpersonal relationship. These stresses gradually lead to mental exhaustion, frustration, disappointment, and finally, marital burnout. 
Finally, the results suggest that although there is no direct association between pornography consumption and marital burnout, negative sexual self-concept mediates between pornography consumption and sexual perfectionism and marital burnout. It means that people with a positive sexual self-concept are not influenced by the environment and pornography and have a realistic image of themselves and the expectations of their relationship and partner, which helps them have a better emotional relationship. 
The present study has several limitations that should be noted. Because of the COVID-19 epidemic, the convenience sampling method was used to collect data, and the results are limited to married students living in Tehran. Effects of pornography consumption, sexual perfectionism, and sexual self-concept on marital burnout might vary socially and culturally. It is suggested to conduct further research on a rather varied and multifaceted sample in different cultures. Data also were collected using self-report questionnaires that may be associated with bias in answers. Another limitation is that the study was based on one of the couples, and it is recommended that both partners be considered in future studies.

5. Conclusion
According to the results, pornography consumption has no relationship with marital burnout, but individuals with negative sexual self-concept are prone to marital burnout by using pornography. Positive sexual self-concept has no relationship with pornography consumption which indicate that positive beliefs people have about themselves are more important than the kind of media people use. Sexual perfectionism can directly and indirectly, via negative sexual self-concept, lead to marital burnout. These results can help couple therapists and professionals to have a more extensive understanding of relationship issues and marital distress regarding the impact of pornography consumption and personality traits.

Ethical Considerations
Compliance with ethical guidelines

The present study was approved by the Iranian National Committee for Ethics in Biomedical Research (IR.IAU.K.REC.1398.023).

Funding
This article was extracted from the PhD dissertation of the first author at the Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran.

Authors' contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declared no conflict of interest. 

Acknowledgments
The authors would like to thank all the participants who collaborated with this research.

References
Adib Rad, N., & Adib Rad, M. (2005). Investigating the relationship between communication beliefs and marital burnout and its comparison in divorced women and women seeking to live together. News and Consulting Research, 13(4), 99-110. 
Bobkowski, P. S., Shafer, A., & Ortiz, R. R. (2016). Sexual intensity of adolescents’ online self-presentations: Joint contribution of identity, media consumption, and extraversion. Computers in Human Behavior, 58, 64-74. [DOI:10.1016/j.chb.2015.12.009]
Calaxton, A., O’Rurke, N., Smith, J., & DeLongis, A. (2012). Personality traits and marital satisfaction within enduring relationships: An intra-couple discrepancy approach. Journal of Social and Personal Relationship, 29(3), 375-96. [DOI:10.1177/0265407511431183]
Campbell, L., & Kohut, T. (2017). The use and effects of pornography in romantic relationships. Current Opinion in Psychology, 13, 6-10. [DOI:10.1016/j.copsyc.2016.03.004] [PMID]
Candemir Karaburç, G., & Tunç, E. (2020). Problematic İnternet use, marital adjustment, couple burnout and basic psychological need satisfaction levels of married individuals. Journal of Social and Humanities Sciences Research, 7(55), 1695-721. [DOI:10.26450/jshsr.1925]
Carroll, J. S., Padilla-Walker, L. M., Nelson, L. J., Olson, C. D., McNamara Barry, C., & Madsen, S. D. (2008). Generation XXX: Pornography acceptance and use among emerging adults. Journal of Adolescent Research, 23(1), 6-30. [DOI:10.1177/0743558407306348]
Daines, R. M., & Shumway, T. (2011). Pornography and divorce. Paper presented at the 7th Annual Conference on Empirical Legal Studies Paper, Stanford, USA, June 2011. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2112435
Davis, A. C., Carrotte, E. R., Hellard, M. E., & Lim, M. S. (2018). What behaviors do young heterosexual australians see in pornography? A cross-sectional study. The Journal of Sex Research, 55(3), 310-9. [DOI:10.1080/00224499.2017.1417350] [PMID]
DeDonno, M. A., & Rivera-Torres, K. (2018). The influence of perfectionism on academic self-concept. International Journal of Education and Practice, 6(4), 192-9. [DOI:10.18488/journal.61.2018.64.192.199]
Doran, K., & Price, J. (2014). Pornography and marriage. Journal of Family and Economic Issues, 35(4), 489-98. [DOI:10.1007/s10834-014-9391-6]
Eidelson, R. J., & Epstein, N. (1982). Cognition and relationship maladjustment: Development of a measure of dysfunctional relationship beliefs. Journal of Consulting and Clinical Psychology, 50(5), 715-20. [DOI:10.1037/0022-006X.50.5.715] [PMID]
Eusanio, J., Thomson, P., & Jaque, S. (2014). Perfectionism, shame, and self-concept in dancers: A mediation analysis. Journal of Dance Medicine & Science, 18(3), 106-14. [DOI:10.12678/1089-313X.18.3.106] [PMID]
Grubbs, J. B., Volk, F., Exline, J. J., & Pargament, K. I. (2015). Internet pornography use: Perceived addiction, psychological distress, and the validation of a brief measure. Journal of Sex & Marital Therapy, 41(1), 83-106. [DOI:10.1080/0092623X.2013.842192] [PMID]
Gwinn, A. M., Lambert, N. M., Fincham, F. D., & Maner, J. K. (2013). Pornography, relationship alternatives, and intimate extradyadic behavior. Social Psychological and Personality Science, 4(6), 699-704. [DOI:10.1177/1948550613480821]
Habke, A. M., Hewitt, P. L., & Flett, G. L. (1999). Perfectionism and sexual satisfaction in intimate relationships. Journal of Psychopathology and Behavioral Assessment, 21(4), 307-22. [DOI:10.1023/A:1022168715349]
Hald, G. M., & Malamuth, N. N. (2015). Experimental effects of exposure to pornography: The moderating effect of personality and mediating effect of sexual arousal. Archives of Sexual Behavior, 44(1), 99-109. [DOI:10.1007/s10508-014-0291-5] [PMID]
Hamidi, F., Hamzehgardeshi, Z., & Shahhosseini, Z. (2020). Bio-psycho-social factors related to female sexual self-concept: A scoping review. Clinical Excellence, 9(3), 23-34. http://ce.mazums.ac.ir/article-1-486-en.html
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456-70. [DOI:10.1037/0022-3514.60.3.456] [PMID]
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94(3), 319-39. [DOI:10.1037/0033-295X.94.3.319] [PMID]
Hooman, H. A. (2005). [Structural equation modeling with lisrel application (Persian)]. Tehran: SAMT. file:///C:/Users/E.hasanpour/Desktop/64813906006.pdf.
Jaafarpour M, Maroufi M, & Molaeinezhad M. (2016). [Relationship between sexual self-concept and sexual performance in married women referring to Mobarakeh health centers, Iran (Persian)]. Journal of Research Development in Nursing and Midwifery, 12(53), 40-7. http://nmj.goums.ac.ir/article-1-814-en.html
Karimi, B., & Khalatbari, J. (2017). The effectiveness of cognitive-behavioral therapy on couple’s burnout, marital adjustment and intimacy. Journal of Educational Psychology, 8(1), 65-74. http://psyedu.toniau.ac.ir/article_595337.html?lang=en
Kennis, M., Duecker, F., T’Sjoen, G., Sack, A. T., & Dewitte, M. (2021). Sexual self-concept discrepancies mediate the relation between gender dysphoria sexual esteem and sexual attitudes in binary transgender individuals. The Journal of Sex Research, 1-13. [DOI:10.1080/00224499.2021.1951643] [PMID]
Kluck, A. S., Zhuzha, K., & Hughes, K. (2016). Sexual perfectionism in women: Not as simple as adaptive or maladaptive. Archives of Sexual Behavior, 45(8), 2015-27. [DOI:10.1007/s10508-016-0805-4] [PMID]
Kluck, A. S., Hughes, K., & Zhuzha, K. (2018). Sexual Perfectionism and Women’s Sexual Assertiveness: Understanding the Unique Effects of Perfectionistic Expectations about Sex Originating from and Directed toward the Sexual Partner. Sex Roles, 79(11), 715-725. [DOI:10.1007/s11199-018-0901-0]
Kohut, T., & Fisher, W. A. (2017). Pornography, effects on attitudes and behaviors In V. S. Ramachandran (Ed.), Encyclopedia of Human Behavior (pp. 132-9). Amsterdam: Elsevier. [DOI:10.1016/B978-0-12-375000-6.00283-4]
Kor, A., Zilcha-Mano, S., Fogel, Y. A., Mikulincer, M., Reid, R. C., & Potenza, M. N. (2014). Psychometric development of the problematic pornography use scale. Addictive Behaviors, 39(5), 861-8. [DOI:10.1016/j.addbeh.2014.01.027] [PMID]
Leibel, I. (2021). Potential and hypothesized determinants of the positive and negative effects as a result of pornography use in dyadic relationships. Canadian Journal of Family and Youth, 13(3), 11-21. [DOI:10.29173/cjfy29618]
Leon-Larios, F., Saavedra-Macias, F. J., Albar-Marin, M. J., & Gomez-Baya, D. (2019). Pornography influence among young students: Adaptation and validation of pornography consumption inventory into Spanish. Journal of Sex & Marital Therapy, 45(7), 652-61. [DOI:10.1080/0092623X.2019.1610124] [PMID]
Maddox, A. M., Rhoades, G. K., & Markman, H. J. (2011). Viewing sexually-explicit materials alone or together: Associations with relationship quality. Archives of Sexual Behavior, 40(2), 441-8. [DOI:10.1007/s10508-009-9585-4] [PMID] [PMCID]
Malakh-Pines, A. (1996). Couple burnout: Causes and cures. New York: Routledge. https://www.google.com/books/edition/_/3p41UVU1RxsC?hl=en&sa=X&ved=2ahUKEwjT
Malcolm, M., & Naufal, G. (2016). Are pornography and marriage substitutes for young men? Eastern Economic Journal, 42(3), 317-34. [DOI:10.1057/eej.2015.7]
Mohammadi Nik, M., Modarres, M., & Ziaei, T. (2018). The relation between sexual self-concepts and attachment styles in married women: A cross-sectional study. Nursing Practice Today, 5(1), 235-42. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=810178
Najafi, A. (2016). The relationship between personality traits, irrational beliefs and couple burnout. International Academic Journal of Social Sciences, 3(1), 1-7. https://www.iaiest.com/abstract.php?id=3&archiveid=317
Nazari, A., Rasouli, M., Davarniya, R., Hosseini, A., & Babaei Gharmkhani, M. (2015). [Effectiveness of Solution- Focused Brief Therapy (SFBT) on couple burnout and divorce tendency in married women (Persian)]. Iranian Journal of Psychiatric Nursing, 3(3), 41-52. http://ijpn.ir/article-1-616-en.html
Newstrom, N. P., & Harris, S. M. (2016). Pornography and couples: What does the research tell us? Contemporary Family Therapy, 38(4), 412-23. [DOI:10.1007/s10591-016-9396-4]
Perry, S. L. (2017). Does viewing pornography reduce marital quality over time? Evidence from longitudinal data. Archives of Sexual Behavior, 46(2), 549-59. [DOI:10.1007/s10508-016-0770-y] [PMID]
Perry, S. L. (2020). Pornography and relationship quality: Establishing the dominant pattern by examining pornography use and 31 measures of relationship quality in 30 national surveys. Archives of Sexual Behavior, 49(4), 1199-213. [DOI:10.1007/s10508-019-01616-7] [PMID]
Perry, S. L., & Longest, K. C. (2019). Does pornography use reduce marriage entry during early adulthood? Findings from a panel study of young Americans. Sexuality & Culture, 23(2), 394-414. [DOI:10.1007/s12119-018-09581-4]
Perry, S. L., & Schleifer, C. (2018). Till porn do us part? A longitudinal examination of pornography use and divorce. The Journal of Sex Research, 55(3), 284-96. [DOI:10.1080/00224499.2017.1317709] [PMID]
Pines, A. M. (2002). The female entrepreneur: Burnout treated using a psychodynamic existential approach. Clinical Case Studies, 1(2), 170-80. [DOI:10.1177/1534650102001002005]
Pines, A. M., & Nunes, R. (2003). The relationship between career and couple burnout: Implications for career and couple counseling. Journal of Employment Counseling, 40(2), 50-64. https://psycnet.apa.org/record/2003-06844-002 
Poulsen, F. O., Busby, D. M., & Galovan, A. M. (2013). Pornography use: Who uses it and how it is associated with couple outcomes. Journal of Sex Research, 50(1), 72-83 [DOI:10.1080/00224499.2011.648027] [PMID]
O’sullivan, L. F., Meyer‐Bahlburg, H. F., & McKeague, I. W. (2006). The development of the sexual self‐concept inventory for early adolescent girls. Psychology of Women Quarterly, 30(2), 139-49. [DOI:10.1111/j.1471-6402.2006.00277.x]
Reid, R. C., Li, D. S., Gilliland, R., Stein, J. A., & Fong, T. (2011). Reliability, validity, and psychometric development of the Pornography Consumption Inventory in a sample of hypersexual men. Journal of Sex & Marital Therapy, 37(5), 359-85. [DOI:10.1080/0092623X.2011.607047] [PMID]
Robins, G., & Boldero, J. (2003). Relational discrepancy theory: The implications of self discrepancy theory for dyadic relationships and for the emergence of social structure. Personality and Social Psychology Review, 7(1), 56-74. [DOI:10.1207/S15327957PSPR0701_4] [PMID]
Rostosky, S. S., Dekhtyar, O., Cupp, P. K., & Anderman, E. M. (2008). Sexual self-concept and sexual self-efficacy in adolescents: A possible clue to promoting sexual health? Journal of Sex Research, 45(3), 277-286. [DOI:10.1080/00224490802204480] [PMID]
Saadat, S. H., Shahyad, S., Pakdaman, S., & Shokri, O. (2017). Prediction of social comparison based on perfectionism, self-concept clarity, and self-esteem. Iranian Red Crescent Medical Journal, 19(4), e43648. [DOI:10.5812/ircmj.43648]
Salehi, M., Tavakol, H. K., Shabani, M., & Ziaei, T. (2015). The relationship between self-esteem and sexual self-concept in people with physical-motor disabilities. Iranian Red Crescent Medical Journal, 17(1), e25359. [DOI:10.5812/ircmj.25359] [PMID] [PMCID]
Shafer, A., Bobkowski, P., & Brown, J. D. (2013). Sexual media practice: How adolescents select, engage with, and are affected by sexual media. In K. E. Dill (Ed.), The Oxford Handbook of Media Psychology (pp. 223–51). Oxford: Oxford University Press. [DOI:10.1093/oxfordhb/9780195398809.013.0013]
Simon, W., & Gagnon, J. H. (1986). Sexual scripts: Permanence and change. Archives of sexual behavior, 15(2), 97-120. [DOI: 10.1007/BF01542219] [PMID]
Snell Jr, W. E. (1998). The multidimensional sexual self-concept questionnaire. In C. M. Davis, W. L. Yarber, R Bauserman, G Schreer, & S. L. Davis (Eds.), Handbook of Sexuality-Related Measures, pp. (521-4). Thousand Oaks: SAGE Publications. https://www.google.com/books/edition/Handbook_of_Sexuality_Related_Measures/EFPs55zfAKcC?hl=en&gbpv=r
Snell Jr, W. E. (2011). Multidimensional sexual perfectionism scale. In C. M. Davis, W. L. Yarber, R Bauserman, G Schreer, & S. L. Davis (Eds.), Handbook of Sexuality-Related Measures, (pp. 586-8). Thousand Oaks: SAGE Publications. https://www.google.com/books/edition/_/h8hbPgAACAAJ?hl=en&sa=X&ved=2ahUKEwij6PDhne31AhWPR_EDHUmND
Snell Jr, W. E., & Rigdon, K. L. (1995). The sexual perfectionism questionnaire: Preliminary evidence for reliability and validity. In Meeting of the Southwestern Psychological Association. San Antonio, TX. http://cstl-cla.semo.edu/wesnell/books/sexuality/chap15.htm
Steele, J. R., & Brown, J. D. (1995). Adolescent room culture: Studying media in the context of everyday life. Journal of Youth and Adolescence, 24(5), 551-76. [DOI:10.1007/BF01537056]
Stoeber, J. (2012). Dyadic perfectionism in romantic relationships: Predicting relationship satisfaction and long-term commitment. Personality and Individual Differences, 53, 300–305. [10.1016/j.paid.2012.04.002]
Stoeber, J., & Harvey, L. N. (2016). Multidimensional sexual perfectionism and female sexual function: A longitudinal investigation. Archives of Sexual Behavior, 45(8), 2003-14. [DOI:10.1007/s10508-016-0721-7] [PMID] [PMCID]
Stoeber, J., Harvey, L. N., Almeida, I., & Lyons, E. (2013). Multidimensional sexual perfectionism. Archives of Sexual Behavior, 42(8), 1593-604. [DOI:10.1007/s10508-013-0135-8] [PMID]
Stoeber, J., & Stoeber, F. S. (2009). Domains of perfectionism: Prevalence and relationships with perfectionism, gender, age, and satisfaction with life. Personality and Individual Differences, 46(4), 530-5. [DOI:10.1016/j.paid.2008.12.006]
Totonchi, M., Samani, S., & Zandi Ghashghaei, K. (2012). [Mediating role of self-concept in perfectionism and mental health of adolescents in the City of Shiraz in 2012 (Persian)]. Journal of Fasa University of Medical Sciences, 2(3), 210-7. [DOR:20.1001.1.22285105.2012.2.3.13.1]
Willoughby, B. J., Carroll, J. S., Busby, D. M., & Brown, C. C. (2016). Differences in pornography use among couples: Associations with satisfaction, stability, and relationship processes. Archives of Sexual Behavior, 45(1), 145-58. [DOI:10.1007/s10508-015-0562-9] [PMID]
Wright, P. J., Tokunaga, R. S., Kraus, A., & Klann, E. (2017). Pornography consumption and satisfaction: A meta-analysis. Human Communication Research, 43(3), 315-43. [DOI:10.1111/hcre.12108]
Zarei, E., Sadeghifard, M., Adli, M., & Tayebi Soogh, M. (2013). The Effectiveness of Ellis couple therapy training (The rational-emotional-behavioral approach) on reducing the marital burnout. Journal of Life Science and Biomedicine, 3(3), 229-32. http://jlsb.science-line.com/attachments/article/22/J.%20Life%20Sci.%20Biomed.%203(3)%20229-232,%202013.pdf
Ziaei, T., Khoei, E. M., Salehi, M., & Farajzadegan, Z. (2013). Psychometric properties of the Farsi version of modified multidimensional sexual self-concept questionnaire. Iranian Journal of Nursing and Midwifery Research, 18(6), 439-45. [PMID] [PMCID]
Type of Study: Research | Subject: Family and group therapy
Received: 2021/11/6 | Accepted: 2022/01/25 | Published: 2022/01/1

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb