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Evaluation of COVID-19 Stress in University Students According to Their Socio-demographic Characteristics Based on Machine Learning Algorithms 2 2 Objective: The coronavirus pandemic has presented a significant challenge and brought about dramatic changes for universities and their students. This study evaluated machine learning algorithms for estimating COVID-19 stress levels among Iranian university students. Methods: We conducted an online survey from May 10th to November 20th, 2021, to determine how Iranian university students responded to the COVID-19 outbreak in Iran. The survey invitations were sent to Iranian university students via e-mail, forums, and social media platforms, such as internet advertisements. We collected data from 3490 university students, using sociodemographic characteristics and the COVID-19 Stress Scale (CSS; Nooripour et al. [2022]). The adaptive neuro-fuzzy inference system (ANFIS) network for prediction and fuzzy logic-based rules were used for analyzing the data. For classification, eight machine learning algorithms were employed: support vector machine (SVM), K-nearest neighbors (KNN), random forest, multilayer perceptron, decision tree, and passive-aggressive algorithm. These algorithms were selected based on their principles and suitability for stress detection in the desired category. Results: Among the algorithms, the decision tree algorithm showed the best performance in accurately classifying the data into the correct stress intensity categories. Moreover, analyses revealed that gender, age group, and education significantly influenced stress intensity levels, with men experiencing less stress; stress intensity decreased with age, and higher education was associated with lower stress levels. The results indicated that education and marital status were the most influential parameters for all three top-performing algorithms (random forest, multi-layer perceptron, and decision tree). Conclusion: Our research suggests that innovative methods such as machine learning algorithms can be used to evaluate psychological distress caused by the COVID-19 outbreak, such as stress. Evaluating stress levels can help prevent mental health problems and enhance students’ coping capabilities. 1 12 2023/06/2 1402/3/12 2023/08/13 1402/5/22 Roghieh Nooripour Roghieh Nooripour Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran. Iran nooripour.r@gmail.com Hossein Ilanloo Hossein Ilanloo Department of Counseling, Faculty of Education and Psychology, Kharazmi University, Tehran, Iran. Iran Std_hoseinelanloo@khu.ac.ir Mohammad Naveshki Mohammad Naveshki Department of Petroleum, Faculty of Reservoir Engineering Oil and Gas, Sahand University of Technology, Tabriz, Iran. Iran sblue.nasim@gmail.com Saeid Naveshki Saeid Naveshki Department of Remote Sensing and Geographic Information Systems (GIS), Faculty of Remote Sensing and Geographic Information System Geographic, Kharazmi University, Tehran, Iran. Iran kousari.m2023@gmail.com Mojtaba Amiri Majd Mojtaba Amiri Majd Department of Psychology, Faculty of Humanities, Abhar Branch, Islamic Azad University, Abhar, Iran. Iran amirimajd@yahoo.com Sverker  Sikström Sverker  Sikström Chair of the Cognitive Division, Department of Psychology, Faculty of Education and Psychology, Lund University, Lund, Sweden. Sweden sverker.sikstrom@psy.lu.se Farnaz Jafari Farnaz Jafari Department Of Educational Sciences, Faculty of Education and Psychology, Farhangian University, Shiraz, Iran. Iran nimsada.2020@gmail.com COVID-19 Machine learning Psychological distress Student Stress ## ##

Getting Rid of Substance Abuse: A Look at Experiences, Opinions, and Facilitators of Psychological Well-being After Addiction Recovery in Females 2 2 Objective: Addiction is one of the main obstacles to achieving psychological well-being in a person. This study analyzed the experiences, opinions, and facilitators of psychological well-being in women after addiction recovery.  Methods: This study was conducted using a qualitative and grounded theory approach. The participants were selected through purposive sampling. The data were saturated through semi-structured and open-ended interviews with 14 women who had given up addiction and had follow-up visits to addiction rehabilitation centers in Districts 18 to 20 from April to September 2022 in Tehran. The collected data were analyzed using open, axial, and selective coding proposed by Strauss and Corbin (2008).  Results: Analysis of the lived experiences of the women who recovered from addiction revealed five main factors including causal conditions (physical condition, mental/psychological distress, and economic condition), contextual conditions (receiving social support and environmental restrictions), facilitators (social support and influence, individual determination and effort, and religious beliefs), consequences (cognitive, psychological, and behavioral consequences), and strategies (individual and social strategies).  Conclusion: Participants pointed out that the strong facilitators to getting rid of addiction were social support, individual determination and effort, and religious beliefs. The insights from this study add to the knowledge about recovery from addiction among addicted women who are about to quit and can contribute to a better understanding of facilitating factors and treatment and rehabilitation strategies in the process of psychological therapies. 13 26 2023/06/22023/06/27 1402/4/6 2023/08/132023/08/30 1402/6/8 Zeinab Dehghani Zeinab Dehghani Department of Counseling, Faculty of Humanities and Social Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran. Iran anna_khodabakhshi@yahoo.com Anahita Khodabakhshi-Koolaee Anahita Khodabakhshi-Koolaee Department of Psychology & Educational Sciences, Faculty of Humanities, Khatam University, Tehran, Iran. Iran a.khodabakhshid@khatam.ac.ir Mohammad Reza Falsafinejad Mohammad Reza Falsafinejad Department of Assessment and Measurement, Faculty of Psychology & Educational Sciences, Allameh Tabataba’i University, Tehran, Iran. Iran falsafinejad@atu.ac.ir Narration Psychological well-being Psychological Adaptation Women Addiction Qualitative research Ali, S. F., Onaivi, E. S., Dodd, P. R., Cadet, J. L., Schenk, S., & Kuhar, M. J., et al. (2011). Understanding the global problem of drug addiction is a challenge for IDARS scientists. Current Neuropharmacology, 9(1), 2–7. [DOI:10.2174/157015911795017245] [PMID] ##American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington: American Psychiatric Association. [DOI:10.1176/appi.books.9780890425596]##Brown, S., Jun, M. K., Min, M. O., & Tracy, E. M. (2013). Impact of dual disorders, trauma, and social support on quality of life among women in treatment for substance dependence. Journal of Dual Diagnosis, 9(1), 61–71. [DOI:10.1080/15504263.2012.750147] [PMID] ##Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches. Newbury Park: Sage Publications. [Link]##Dehghan, M., Malakoutikhah, A., Kazemy, H., Fattahi Toqroljerdi, M. H., Mokhtarabadi, S., & Zakeri, M. A. (2023). The relationship between beliefs in substance craving and quality of life among narcotics anonymous: a cross-sectional study in southeastern Iran. BMC Psychology, 11(1), 126. [DOI:10.1186/s40359-023-01164-9] [PMID] [PMCID]##Dehghani, Z., & Khodabakhshi-Koolaee, A. (2017). Effectiveness of group hope therapy on quality of life and resilience in addicted women. Journal of Education and Community Health, 4(1), 28-34. [DOI:10.21859/jech.4.1.28]##Frew J. R. (2023). Reducing the stigma of perinatal substance use disorders: The time is now. Archives of Women's Mental Health, 26(3), 411–413. [DOI:10.1007/s00737-023-01322-3] [PMID]##Graham, M., & Bitten, C. (2014). Counseling intentional addiction recovery grounded in relationships and social meaning. In RA. Young, JF. Domene, & L. Valach (Eds.) Counseling and action: Toward life-enhancing work, relationships, and identity (pp. 211-222). New York: Springer. [DOI:10.1007/978-1-4939-0773-1_12]##Heitmann, J., van Hemel-Ruiter, M. E., Vermeulen, K. M., Ostafin, B. D., MacLeod, C., & Wiers, R. W., et al. (2017). Internet-based attentional bias modification training as add-on to regular treatment in alcohol and cannabis dependent outpatients: A study protocol of a randomized control trial. BMC Psychiatry, 17(1), 193. [DOI:10.1186/s12888-017-1359-2] [PMID] ##Jia, D., Zhang, K., & Xu, Y. (2023). The relationship between social support and relapse tendency among those who struggle with drug addiction: Multiple mediators of exercise self-efficacy and health-related quality of life. Journal of Drug Issues, 54(1), 120-133. [DOI:10.1177/00220426231152912]##Khadivi-Zand, A., Khodabakhshi-Koolaee, A., & Falsafinejad, M. R. (2020). Role of psychological and social security in predicting depression among women living in the homeless shelters of Tehran. Journal of Client-Centered Nursing Care, 6(4), 213-222. [DOI:10.32598/JCCNC.6.4.33.13]##Khodabakhshi Koolaee, A., & Damirchi, F. (2016). Comparing the quality of life among female sex workers with and without addiction. Journal of Client-Centered Nursing Care, 2(4), 201-206. [DOI:10.32598/jccnc.2.4.201]##Noorbala, A. A., Saljoughian, A., Bagheri Yazdi, S. A., Faghihzadeh, E., Farahzadi, M. H., & Kamali, K., et al. (2020). Evaluation of drug and alcohol abuse in people aged 15 years and older in Iran. Iranian Journal of Public Health, 49(10), 1940–1946. [DOI:10.18502/ijph.v49i10.4697] [PMID] ##Martin, R. A., Cassidy, R. N., Murphy, C. M., & Rohsenow, D. J. (2016). Barriers to quitting smoking among substance dependent patients predict smoking cessation treatment outcome. Journal of Substance Abuse Treatment, 64, 7–12.[DOI:10.1016/j.jsat.2016.02.007] [PMID] ##McHugh, R. K., Votaw, V. R., Sugarman, D. E., & Greenfield, S. F. (2018). Sex and gender differences in substance use disorders. Clinical Psychology Review, 66, 12–23. [DOI:10.1016/j.cpr.2017.10.012] [PMID] ##Myers, B., Carney, T., & Wechsberg, W. M. (2016). Not on the agenda: A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa. The International Journal on Drug Policy, 30, 52–58. [DOI:10.1016/j.drugpo.2015.12.019] [PMID] ##National Institute on Drug Abuse (NIDA). (2018). Substance use in women. Rockville: National Institute on Drug Abuse. [Link]##Pagano, A., Tajima, B., & Guydish, J. (2016). Barriers and facilitators to tobacco cessation in a nationwide sample of addiction treatment programs. Journal of Substance Abuse Treatment, 67, 22–29. [DOI:10.1016/j.jsat.2016.04.004] [PMID] ##Richardson, L., Wood, E., Montaner, J., & Kerr, T. (2012). Addiction treatment-related employment barriers: the impact of methadone maintenance. Journal of Substance Abuse Treatment, 43(3), 276–284. [DOI:10.1016/j.jsat.2011.12.008] [PMID] [PMCID]##Sayar, S., Poryosefi, H., & Mirzaei, K. (2018). Qualitative study on the consequences of women’s addiction to drug abuse in Tehran. International Transaction Journal of Engineering Management & Applied Sciences & Technologies, 9(5), 401-408. [DOI:10.14456/ITJEMAST.2018.36]##Sellman D. (2010). The 10 most important things known about addiction. Addiction, 105(1), 6–13. [DOI:10.1111/j.1360-0443.2009.02673.x] [PMID]##Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks: SAGE Publications. [Link]##United Nations Office Drugs and Crime (UNODC). (2018). Women and Drugs: Drug use, drug supply, and their consequences. Vienna: United Nations Office Drugs and Crime. [Link]## ##

Gender Identity Disorder and Improvement of Life Satisfaction and Psychological Well-being Indices After Sex Reassignment Surgery: A Multicenter Prospective Cohort Study 2 2 Objective: Sex reassignment surgery (SRS) is a surgery performed to reassign the physical gender identity of transgender people. Despite the physical consequences of this surgery, research has indicated its significant effects on patients’ mental health; however, the findings are contradictory. This study determined the effects of sexual reassignment surgery on life satisfaction and psychological well-being in transgender people.  Methods: In a multicenter prospective cohort study, from January to March 2019, a total of 40 patients with sexual dysphoria of both sexes were selected using the purposive sampling method and after meeting the necessary criteria, they were entered into the research process. Patients were placed in one of two groups of gender reassignment surgery and the surgery waiting list. Life satisfaction and psychological well-being indices were evaluated in the surgery group, before and after surgery (one week to one month and more than six months). Data were analyzed using multivariate analysis of variance test in SPSS software, version 21, and the significance criterion was considered as 0.05.  Results: Data analysis showed that the life satisfaction index in patients undergoing gender reassignment surgery had a significant difference as compared to the waiting list (P<0.001). Also, the six components of psychological well-being, including self-acceptance, positive relationship with others, personal growth, independence, purposeful life, and mastery of the environment in patients undergoing sexual reassignment surgery showed a significant improvement compared to the waiting list (P<0.001).  Conclusion: Sexual reassignment surgery has significant psychological effects on patients’ psychological characteristics. These findings may be associated with clinical applications in designing complementary psychological interventions in transgender individuals. 27 32 2023/06/22023/06/272023/02/26 1401/12/7 2023/08/132023/08/302023/09/19 1402/6/28 Atefeh Charkhgard Atefeh Charkhgard Department of Personality Psychology, Faculty of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran. Iran A.charkhgard@gmail.com Alireza Kakavand Alireza Kakavand Department of Psychology, Faculty of Social Sciences, Imam Khomeini International University, Qazvin, Iran. Iran A.charkhgard@gmail.com Transgender health Sex reassignment surgery Gender dysphoria Babu, R., & Shah, U. (2021). Gender identity disorder (GID) in adolescents and adults with differences of sex development (DSD): A systematic review and meta-analysis. Journal of Pediatric Urology, 17(1), 39-47. [PMID]##Cerezo, A., Cummings, M., Holmes, M., & Williams, C. (2020). Identity as resistance: Identity formation at the intersection of race, gender identity, and sexual orientation. Psychology of Women Quarterly, 44(1), 67–83. [DOI:10.1177/0361684319875977] [PMID] ##Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75. [DOI:10.1207/s15327752jpa4901_13] [PMID]##Hess, J., Rossi Neto, R., Panic, L., Rübben, H., & Senf, W. (2014). Satisfaction with male-to-female gender reassignment surgery. Deutsches Arzteblatt International, 111(47), 795–801. [DOI:10.3238/arztebl.2014.0795] [PMID] ##Heß, J., Sohn, M., Küntscher, M., & Bohr, J. (2020). [Gender reassignment surgery from male to female (German)]. Der Urologe. Ausg. A, 59(11), 1348–1355. [DOI:10.1007/s00120-020-01337-z] [PMID]##Hinz, A., Conrad, I., Schroeter, M. L., Glaesmer, H., Brähler, E., & Zenger, M., et al. (2018). Psychometric properties of the satisfaction with life scale (SWLS), derived from a large German community sample. Quality of Life Research, 27(6), 1661–1670. [DOI:10.1007/s11136-018-1844-1] [PMID]##Holmberg, M., Arver, S., & Dhejne, C. (2019). Supporting sexuality and improving sexual function in transgender persons. Nature reviews. Urology, 16(2), 121–139. [DOI:10.1038/s41585-018-0108-8] [PMID]##Krempasky, C., Harris, M., Abern, L., & Grimstad, F. (2020). Contraception across the transmasculine spectrum. American Journal of Obstetrics and Gynecology, 222(2), 134–143. [DOI:10.1016/j.ajog.2019.07.043] [PMID]##Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., & Erwin, P. J., et al. (2010). Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology, 72(2), 214–231. [DOI:10.1111/j.1365-2265.2009.03625.x] [PMID]##Pirnia, B., Mansour, S., Rahmani, S., & Soleimani, A. A. (2015). Sexual behavior and age differences in methamphetamine dependent and non-dependent men who have sex with men (MSM). Practice in Clinical Psychology, 3(4), 273-282. [Link]##Pirnia, B., & Pirnia, K. (2022). Sex reassignment surgery in iran, re-birth or human rights violations against transgender people?. Iranian Journal of Public Health, 51(11), 2632–2633. [DOI:10.18502/ijph.v51i11.11183] [PMID] [PMCID]##Pirnia, B., Givi, F., Roshan, R., Pirnia, K., & Soleimani, A. A. (2015). The cortisol level and its relationship with depression, stress and anxiety indices in chronic methamphetamine-dependent patients and normal individuals undergoing inguinal hernia surgery. Medical Journal of the Islamic Republic of Iran, 30, 395. [PMID] [PMCID]##Pirnia, B., Khosravani, V., Maleki, F., Kalbasi, R., Pirnia, K., & Malekanmehr, P., et al. (2020). The role of childhood maltreatment in cortisol in the hypothalamic-pituitary-adrenal (HPA) axis in methamphetamine-dependent individuals with and without depression comorbidity and suicide attempts. Journal of Affective Disorders, 263, 274–281. [DOI:10.1016/j.jad.2019.11.168] [PMID]##Pirnia, B., Maleki, F., Kazemi, M., & Malekanmehr, P. (2020). [Effectiveness of well-being therapy on psychological well-being index, optimist and life expectancy in Iranian methamphetamine-dependent men in abstinence phase, a randomized clinical trial (Persian)]. Razi Journal of Medical Sciences, 27(5), 131-140. [Link]##Pirnia, B., Pirnia, K., Bazyari, K., Aslani, F., & Malekanmehr, P. (2019). Physical or psychological therapy? Cognitive behavioral therapy or acupuncture for subsyndromal depression among methamphetamine users. Iranian Journal of Public Health, 48(3), 561–563. [DOI:10.18502/ijph.v48i3.905] [PMID] ##Pirnia, B., Pirnia, K., Haghighat, S., Malekanmehr, P., & Zahiroddin, A. (2020). The effectiveness of acupuncture on cortisol levels in a prostate-carcinoma patient under androgen deprivation therapy with dysthymic syndrome: A single-case experimental design. Middle East Journal of Cancer, 11(2), 237-242. [DOI:10.30476/mejc.2019.81258.0]##Pirnia, B., Pirnia, K., Sarabi, R. E., Malekanmehr, P., Soltani, L., Zahiroddin, A., & Sadeghi, P. (2019). A double-blind randomized controlled trial in effectiveness of parent-child interaction therapy on psychological Indicator and cortisol level in children of caregiver with Cancer. International Journal of Cancer Management, 12(7), e85572. [DOI:10.5812/ijcm.85572]##Pirnia, B., Soleimani, A., Farhoudian, A., Zahiroddin, A., Majidi, K., & Pirnia, F. (2022). Research considerations: Cannabis consumption and the role of quantification of its secondary metabolite in the study of biopsychosocial effects. Asian Journal of Psychiatry, 74, 103195. [DOI:10.1016/j.ajp.2022.103195] [PMID]##Ring, A., & Malone, W. J. (2020). Confounding effects on mental health observations after sex reassignment surgery. The American Journal of Psychiatry, 177(8), 768–769. [DOI:10.1176/appi.ajp.2020.19111169] [PMID]##Ristori, J., Cocchetti, C., Castellini, G., Pierdominici, M., Cipriani, A., & Testi, D., et al. (2020). Hormonal treatment effect on sexual distress in transgender persons: 2-Year follow-up data. The Journal of Sexual Medicine, 17(1), 142–151. [DOI:10.1016/j.jsxm.2019.10.008] [PMID]##Russo, N., Deitch, J., Schor, J., Saha, S., Lachhar, G., & Singh, K. (2020). Peripheral vascular complication of transgender reassignment surgery. Annals of Vascular Surgery, 69, 448.e15–448.e18. [DOI:10.1016/j.avsg.2020.05.015] [PMID]##Ryff, C. D., & Keyes, C. L. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), 719–727. [DOI:10.1037//0022-3514.69.4.719] [PMID]##Schönauer, L. M., Dellino, M., Loverro, M., Carriero, C., Capursi, T., & Leoni, C., et al. (2021). Hormone therapy in female-to-male transgender patients: Searching for a lifelong balance. Hormones, 20(1), 151–159. [DOI:10.1007/s42000-020-00238-2] [PMID]##Shabani, A., Masoumian, S., Zamirinejad, S., Hejri, M., Pirmorad, T., & Yaghmaeezadeh, H. (2021). Psychometric properties of structured clinical interview for DSM-5 disorders-clinician version (SCID-5-CV). Brain and Behavior, 11(5), e01894. [DOI:10.1002/brb3.1894] [PMID] [PMCID]##Sohn, M., Rieger, U., & Morgenstern, S. (2020). [Gender reassignment from female to male : Phalloplasty (German)]. Der Urologe. Ausg. A, 59(11), 1340–1347. [DOI:10.1007/s00120-020-01328-0] [PMID]##Specht, A. A., Gesing, J., Pfaeffle, R., Koerner, A., & Kiess, W. (2020). [Symptoms, comorbidities and therapy of children and adolescents with gender dysphoria (German)]. Klinische Padiatrie, 232(1), 5–12. [DOI:10.1055/a-1066-4625] [PMID]##Tagharrobi, Z., Sharifi, K., Sooky, Z., & Tagharrobi, L. (2012). [Psychometric evaluation of the Iranian version of quality of life enjoyment and satisfaction questionnaire short form (Q-LES-QSF) (Persian)]. Payesh, 11(2), 235-244. [Link]##Tolstrup, A., Holmgaard, R., Thomsen, M. V., Hilden, M., Zetner, D., & Rosenberg, J. (2020). [Sex reassignment surgery in Denmark (Danish)]. Ugeskrift for laeger, 182(6), V05190270. [PMID]## ##

Metacognitions About Health and COVID-19 Preventive Behaviors: Experiential Avoidance and Coronavirus Anxiety as Mediators 2 2 Objective: People can easily be infected by the coronavirus disease 2019 (COVID-19) virus unless they adhere to the globally suggested preventive behaviors. Metacognition about health is a crucial factor that may affect health behaviors. Our study investigated the relationship between metacognition and COVID-19 preventive behaviors mediated by experiential avoidance and COVID-19 anxiety.  Methods: After distributing online participation advertisements, 702 participants, 430 female (61%) and 272 male (39%) were recruited from the general population in Iran. They answered four questionnaires, including the preventive COVID-19 behaviors scale (PCBS; Toussaint et al., 2020), acceptance and action questionnaire II (AAQ-2; Bond et al., 2011), coronavirus anxiety scale (CAS; Lee, 2020d), and metacognition questionnaire-health anxiety (MCQ-HA; Bailey & Wells, 2015). SPSS software, version 22, LISREL software, version 8.85, and MPlus software, version 7.4 were used to analyze the data and investigate the research hypotheses. Model fit for the modified hypothetical model was tested using structural equation modeling (SEM).  Results: The results showed that COVID-19 anxiety and experiential avoidance could significantly predict preventive behaviors (P<0.01). However, metacognition could indirectly predict these behaviors by changing COVID-19 anxiety (P<0.01) and experiential avoidance (P<0.01).  Conclusion: Identifying and modifying dysfunctional metacognitive beliefs that lead to experiential avoidance and COVID-19 anxiety can help us modify COVID-19 preventive behaviors and, as a result, reduce the spread of COVID-19 and behavioral problems. 33 42 2023/06/22023/06/272023/02/262023/01/22 1401/11/2 2023/08/132023/08/302023/09/192023/08/30 1402/6/8 Shahram Mohammadkhani Shahram Mohammadkhani Department of Clinical Psychology, Faculty of Psychology, Kharazmi University, Tehran, Iran. Iran mohammadkhani@khu.ac.ir Mahsa Akbarian Firoozabadi Mahsa Akbarian Firoozabadi Department of Clinical Psychology, Faculty of Psychology, Kharazmi University, Tehran, Iran. Iran akbarianmahsa84@gmail.com Mehdi Akbari Mehdi Akbari Department of Clinical Psychology, Faculty of Psychology, Kharazmi University, Tehran, Iran. Iran m.akbari@khu.ac.ir Mohammad Nasiri Mohammad Nasiri Department of Clinical Psychology, Faculty of Psychology, Kharazmi University, Tehran, Iran. Iran mohammad.nasiritb@gmail.com Metacognition Behavior Avoidance Anxiety Abasi, E., Fti, L., Molodi, R., & Zarabi, H. (2013). Psychometric properties of the Persian version of acceptance and action questionnaire-II. Psychological Methods and Models, 3(10), 65-80. [Link]##Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411. [DOI:10.1037/0033-2909.103.3.411]##Asmundson, G. J. G., & Taylor, S. (2020). How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of Anxiety Disorders, 71, 102211.[DOI:10.1016/j.janxdis.2020.102211] [PMID] ##Bailey, R., & Wells, A. (2013). Does metacognition make a unique contribution to health anxiety when controlling for neuroticism, illness cognition, and somatosensory amplification?. Journal of Cognitive Psychotherapy, 27(4), 327–337.[DOI:10.1891/0889-8391.27.4.327] [PMID]##Bailey, R., & Wells, A. (2015). Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA. Psychiatry Research, 230(3), 871–877.[DOI:10.1016/j.psychres.2015.11.035] [PMID]##Bailey, R., & Wells, A. (2016). The contribution of metacognitive beliefs and dysfunctional illness beliefs in predicting health anxiety: An evaluation of the metacognitive versus the cognitive models. Clinical Psychologist, 20(3), 129-137. [DOI:10.1111/cp.12078]##Barsky, A. J., Ettner, S. L., Horsky, J., & Bates, D. W. (2001). Resource utilization of patients with hypochondriacal health anxiety and somatization. Medical Care, 39(7), 705–715.[DOI:10.1097/00005650-200107000-00007] [PMID]##Bond, F. W., Hayes, S. C., Baer, R. 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W., et al. (2020). Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: An observational study. The Lancet Public Health, 5(5), e279-e288. [DOI:10.1016/S2468-2667(20)30090-6]##Fink, P., Ørnbøl, E., & Christensen, K. S. (2010). The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. Plos One, 5(3), e9873. [DOI:10.1371/journal.pone.0009873] [PMID] ##Fledderus, M., Bohlmeijer, E. T., & Pieterse, M. E. (2010). Does experiential avoidance mediate the effects of maladaptive coping styles on psychopathology and mental health?. Behavior Modification, 34(6), 503–519. [DOI:10.1177/0145445510378379] [PMID]##González-Castro, J. L., Ubillos-Landa, S., Puente-Martínez, A., & Gracia-Leiva, M. (2021). Perceived vulnerability and severity predict adherence to COVID-19 protection measures: The mediating role of instrumental coping. Frontiers in Psychology, 12, 674032. 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Comparison of the effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) and Drug Therapy on Obsessive-Compulsive Disorder (OCD) 2 2 Background: The use of rTMS, a form of brain stimulation, has shown to be successful and authorized for treating individuals with OCD. The study aimed to comparison of the effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) and drug therapy on obsessive-compulsive disorder (OCD). Methods: The study adopted a quasi-experimental method and a pre-post control group design. The statistical population of the present study included all patients referred to specialized clinics in regions 2, 3, and 7 of Tehran from July to September 2022. Study participants included 45 obsessive-compulsive disorder who were selected purposefully and were assigned to two experimental groups (rTMS: 15 participants, Drug therapy: 15 participants), and a control group: 15 participants. The rTMS treatment sessions was three sessions a week for four weeks. Therefore, rTMS treatment was performed with the parameters specified below regarding the variables of the present study. For obsessive-compulsive disorder (OCD), the supplementary motor area with a frequency of 1 Hz (HZ) for 20 minutes, 1200 pulses and the F3 and F4 areas were worked with the tablets. The MCMI-III or Checklist-90-Revision pre and post interventions measured. Data analysis was conducted using the SPSS software version 26 with an analysis of covariance test. Results: findings showed that the differentiation between the treatment technique of repetitive transcranial magnetic stimulation (rTMS) and drug administration is significant in obsessive-compulsive disorder (P=0.0001). The decrease in obsessive-compulsive disorder based on considered repetitive transcranial magnetic stimulation (rTMS) was more than the drug therapy group(P=0.0017). Conclusions: This study revealed that rTMS is an effective neurostimulation therapy for OCD. Therefore, rTMS provides better results in terms of treatment effectiveness and clinical response rate.  Furthermore, drug treatment appears to have a significant therapeutic effect.  In subgroup analysis, it was found that DLPFC stimulation and inhibition produced better treatment effects. 43 52 2023/06/22023/06/272023/02/262023/01/222023/04/8 1402/1/19 2023/08/132023/08/302023/09/192023/08/302023/08/30 1402/6/8 Hooshang Esmaili Hooshang Esmaili Department of Psychology, Faculty of Humanity, Semnan Branch, Islamic Azad University, Semnan, Iran. Iran esmaili.hooshang@gmail.com Nemat Sotoudehasl Nemat Sotoudehasl Department of Psychology, Faculty of Humanity, Semnan Branch, Islamic Azad University, Semnan, Iran. Iran sotodeh1 yahoo.com Raheb Ghorbani Raheb Ghorbani Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran. 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Comparing the Effectiveness of Guided Imagery and Lazarus Multimodal Therapy on COVID-19 Anxiety and Life Expectancy in People Recovered From COVID-19 2 2 Objective: Given the well-established and irreversible psychological consequences associated with the COVID-19 disease, it becomes imperative to develop interventions tailored to address these effects and comprehensively evaluate their efficacy in promoting the mental well-being of individuals who have successfully recuperated from COVID-19. The current investigation primarily ascertained and juxtaposed the efficacy of guided imagery and Lazarus multimodal therapy in alleviating COVID-19-induced anxiety and enhancing life expectancy among post-COVID-19 patients Methods: The present study employed a semi-experimental design, encompassing the objectives, application, and research methodology. Specifically, a pre-test-post-test design with a control group was utilized, incorporating a three-month follow-up period. The statistical population comprised individuals who had recovered from COVID-19 and were residing in Tehran City, Iran, in 2021. Participants were selected from various government hospitals in Tehran who received treatment for COVID-19. A total of 45 participants were randomly assigned into three groups: the guided imagery group (15 participants), the Lazarus multimodal therapy group (15 participants), and the control group (15 participants), using the lottery method. The experimental groups underwent 10 sessions of 90 minutes each, wherein guided imagery and Lazarus multimodal therapy interventions were respectively administered. The control group did not receive any form of training or intervention. The research instruments employed in this study were the COVID-19 Anxiety Questionnaire (CDAS, 2020) developed by Alipour, Gadami, Alipour, and Abdulzadeh, and Miller’s Life Expectancy Questionnaire (MLEQ, 1998). Data were analyzed using covariance analysis in SPSS software, version 26. Inferential analysis was performed with alpha 0.05 Results: The findings of the study revealed that both guided imagery and Lazarus multimodal therapy demonstrated effectiveness in mitigating COVID-19 anxiety (F=11.16, P=0.000) and enhancing life expectancy (F=5.49, P=0.008) among individuals who had recovered from COVID-19 (P<0.05). Furthermore, no significant difference was observed between the effects of these interventions on the aforementioned variables. Conclusion: Based on the research findings, the educational packages developed in this study hold the potential for utilization in reducing COVID-19 anxiety and enhancing life expectancy among individuals amidst the ongoing pandemic outbreak. These packages offer valuable resources for addressing and managing anxiety related to COVID-19, thereby contributing to improved psychological well-being and overall life expectancy during this challenging period. 53 66 2023/06/22023/06/272023/02/262023/01/222023/04/82023/06/28 1402/4/7 2023/08/132023/08/302023/09/192023/08/302023/08/302023/09/13 1402/6/22 Maziar Farzin Maziar Farzin Department of Counseling, Faculty of Humanity, Abhar Branch, Islamic Azad University, Abhar, Iran. Iran Mfarzin983@gmail.com Mojtaba Amiri Majd Mojtaba Amiri Majd Department of Counseling, Faculty of Humanity, Abhar Branch, Islamic Azad University, Abhar, Iran. Iran mo.Amiri@iau.ac.ir Mohammad Ghamari Mohammad Ghamari Department of Counseling, Faculty of Humanity, Abhar Branch, Islamic Azad University, Abhar, Iran. Iran counselor_ghamari@yahoo.com Guided imagery Lazarus multimodal therapy COVID-19 anxiety syndrome Life expectancy People recovered from COVID-19 Ali Far, E., & Nokani, M. (2013). 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A., & Olver, I. N. (2009). Hope, life, and death: A qualitative analysis of dying cancer patients' talk about hope. Death Studies, 33(7), 609–638. [DOI:10.1080/07481180903011982] [PMID]##Fekri, C, & Shafiabadi, A. (2006). [Criticism of Simonton’s guided mental imagery method (Persian)]. Educational Psychology Quarterly, 2(5), 59-74. [DOI:10.22054/jep.2006.5988]##Hosseini, S. M. (2006). [Relationship of life expectancy and psychological hardiness in male and female students (Persian)]. Gachsaran: Islamic Azad University.##Javier-Aliaga, D. J., Quispe, G., Quinteros-Zuñiga, D., Adriano-Rengifo, C. E., & White, M. (2022). Hope and resilience related to fear of COVID-19 in young people. International Journal of Environmental Research and Public Health, 19(9), 5004. [DOI:10.3390/ijerph19095004] [PMID] ##Jenkins, C. S. (2010). Concepts, experience and modal knowledge. Philosophical Perspectives, 24, 255-279. [Link]##Khodabakhshy, N., & Foroozandeh, E. (2022). [Comparison of the effectiveness of lazarus multifaceted treatment and matrix treatment on indications for treatment of drug abuse (Persian)]. Scientific Quarterly Research on Addiction, 16(63), 199-222. [DOI:10.52547/etiadpajohi.16.63.199]##Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., & Wei, N., et al. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open, 3(3), e203976. [DOI:10.1001/jamanetworkopen.2020.3976] [PMID] ##Lakhan, R., Agrawal, A., & Sharma, M. (2020). Prevalence of depression, anxiety, and stress during COVID-19 pandemic. Journal of Neurosciences in Rural Practice, 11(4), 519–525. [DOI:10.1055/s-0040-1716442] [PMID] ##Lazarus, A.A ( 2006 ). Multimodal therapy. In J. C. Norcross, & M. R. Goldfried (eds.), Handbook of psychotherapy integration (2 edn) (pp. 105–120). Oxford: Oxford Academic. [DOI:10.1093/med:psych/9780195165791.003.0005]##Lazarus, A. A. (2005). Multimodal therapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 337–371). Pacific Grove: Thomson Brooks/Cole Publishing Co. [Link]##Lazarus, A. A. (2008). Multimodal behavior therapy. In W. T. O'Donohue & J. E. Fisher (Eds.), Cognitive behavior therapy: Applying empirically supported techniques in your practice (pp. 342–346). Hoboken: John Wiley & Sons, Inc. [Link]##Lazarus, C. N., & Lazarus, A. A. (2019). Multimodal therapy. In J. C. Norcross, M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 125–143). Oxford: Oxford Academic. [DOI:10.1093/med-psych/9780190690465.003.0006]##Li, W., Yang, Y., Liu, Z. H., Zhao, Y. J., Zhang, Q., Zhang, L., & Cheung, T., et al. (2020). Progression of mental health services during the COVID-19 outbreak in China. International Journal of Biological Sciences, 16(10), 1732–1738. [DOI:10.7150/ijbs.45120] [PMID] ##Liu, C-Y., Yang, Y-z., Zhang, X-M., Xu, X., Dou, QL, & Zhang, W-W. (2020). The prevalence and influencing factors for anxiety in medical workers fighting COVID-19 in China: A cross-sectional survey. Journal of Clinical Medicine, 10, 11-23. [DOI:10.1101/2020.03.05.20032003]##Mahfud, I., & Gumantan, A. (2020). Survey of student anxiety levels during the COVID-19 pandemic. Jp. Jok (Jurnal Pendidikan Jasmani, Olahraga Dan Kesehatan), 4(1), 86-97. [DOI:10.33503/jp.jok.v4i1.1103]##Hojatkhah, S. M, Mesbah, I., & parvaneh, A. (2021). [Effectiveness of group counseling based on Lazarus multimodal approach on psychographic well-being of male students (Persian)]. Journal of Counseling Research, 20(78), 108-128. [DOI:10.18502/qjcr.v20i78.6786]##Miller, J. F., & Powers, M. J. (1988). Development of an instrument to measure hope. Nursing Research, 37(1), 6–10. [PMID]##Naami, A., & Rezayatizadeh, A. (2022). [The effectiveness of lazarus multimodal therapy on cognitive dissonance and sexual satisfaction in women with ambivalent attachment style (Persian)]. Community Health Journal, 16(1), 76-86. [DOI:10.22123/chj.2022.275253.1690]##Rahmatinejad, P., Yazdi, M., Khosravi, Z., & Shahisadrabadi, F. (2020). [The lived experience of patients with COVID-19 virus (COVID-19): A phenomenological study (Persian)]. Journal of Research in Psychological Health, 14(1), 71-86. [DOI:10.22123/chj.2022.275253.1690]##Roffe, L., Schmidt, K., & Ernst, E. (2005). A systematic review of guided imagery as an adjuvant cancer therapy. Psycho-Oncology, 14(8), 607–617. [DOI:10.1002/pon.889] [PMID]##Roy, D., Tripathy, S., Kar, S. K., Sharma, N., Verma, S. K., & Kaushal, V. (2020). Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian Journal of Psychiatry, 51, 102083. [DOI:10.1016/j.ajp.2020.102083] [PMID] ##Sarker, P. C., Sugawara, D., & Nishad, M. F. R. (2022). 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Explaining the Relationship Between Perfectionism and Binge Eating Disorder in Female College Students: The Mediating Role of Cognitive Emotion Regulation 2 2 Objective: Binge eating disorder is a type of eating behavior disorder that occurs with voluntary limitations in eating food. It has a psychological and social origin and is one of the concerns of the World Health Organization. The present study explains the relationship between perfectionism and binge eating disorder in female college students and the mediating role of cognitive emotion regulation. Methods: In this descriptive-correlation study, data were analyzed using the structural equation modeling (SEM) method. The statistical population of this research consisted of all the female college students of Isfahan City, Iran, in October and November 2022. A total of 214 students were selected by the available sampling method. The participants answered the perfectionism inventory (PI, 2004), the cognitive emotion regulation questionnaire (CERQ, 2001), and the binge eating severity (BES, 1982). The data were analyzed using EMOS 22 software and SEM. Results: The results showed that adaptive cognitive regulation strategies could negatively mediate the relationship between adaptive perfectionism and eating disorder (P<0.01, β= -0.113) while positively and significantly mediating the relationship between maladaptive perfectionism and eating disorder (P<0.01, β=0.124). Conclusion: Based on the results, physicians and therapists can incorporate cognitive regulation techniques into eating disorder treatments and help individuals manage perfectionism and negative thoughts. Additionally, educational programs can be developed in counseling centers, schools, and universities to empower individuals to recognize signs and seek help promptly. 67 80 2023/06/22023/06/272023/02/262023/01/222023/04/82023/06/282023/07/1 1402/4/10 2023/08/132023/08/302023/09/192023/08/302023/08/302023/09/132023/09/19 1402/6/28 Mina Soltani Mina Soltani Department of Counseling, Faculty of Literature, Humanities and Social Sciences, Science and Research Branch. Islamic Azad University, Tehran, Iran. Iran Soltani.cou93@yahoo.com Batol Salehi Batol Salehi Deputy of Education, Isfahan University of Medical Sciences, Isfahan, Iran. Iran salehib_moshaver@yahoo.com Gholamreza Kheirabadi Gholamreza Kheirabadi Behavioral Sciences Research Center, Department of Psychiatry, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Iran kheirabadi@bsrc.mui.ac.ir Perfectionism Feeding and eating disorders Emotion regulation Alfalahi, M., Mahadevan, S., Balushi, R. A., Chan, M. F., Saadon, M. A., & Al-Adawi, S., et al. (2022). Prevalence of eating disorders and disordered eating in Western Asia: A systematic review and meta-Analysis. Eating Disorders, 30(5), 556–585. [DOI:10.1080/10640266.2021.1969495] [PMID]##Araujo, A. P. d. C., Gadelha, M. J. N., & Melo, R. L. P. d. (2020). Evidence of validity, reliability, and psychometric parameters of the items of the Cognitive Emotion Regulation Questionnaire-Short (CERQ-Short). Psico-USF, 25(3), 547-559. [DOI:10.1590/1413-82712020250312]##Bailly, N., Pothier, K., Ouhmad, N., Deperrois, R., Cojean, S., & Combalbert, N. (2022). Effects of gender and age on cognitive emotional regulation. Current Psychology, 42, 1-4. [DOI:10.1007/s12144-022-03557-2]##Baranauskas, M., Kupčiūnaitė, I., & Stukas, R. (2022). Potential triggers for risking the development of eating disorders in non-clinical higher-education students in emerging adulthood. Nutrients, 14(11), 2293. [DOI:10.3390/nu14112293] [PMID] ##Brewerton, T. D. (2019). 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Comparison of the Effectiveness of Cognitive-behavioral Therapy and Acceptance and Commitment Therapy on Cognitive Distortions and Rumination in Adolescents With Social Anxiety Disorder 2 2 Objective: Social anxiety disorder is a prevalent and persistent psychological disorder that is characterized by an intense fear of negative judgment from others, leading to avoidance of social interactions. This study compared the effectiveness of cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) in reducing social anxiety disorder (SAD) symptoms, including cognitive distortions, rumination, and anxiety sensitivity, in adolescents diagnosed with SAD. Methods: The study was semi-experimental, with a pre-test and post-test design featuring a control group. The research sample comprised 45 adolescents diagnosed with SAD, who were recruited from psychological service offices in Bukan City, Iran, between April 4th, 2022, and September 6th, 2022. Fifteen adolescents were assigned to the first experimental group, 15 to the second experimental group, and 15 to the control group. The subjects were selected using the purposive sampling method and were randomly assigned to the experimental and control groups. CBT (12 sessions) and ACT (8 sessions) were implemented in two sessions per week for the experimental groups. Each session lasted for an hour. The control group did not receive any intervention. The participants completed the social phobia inventory (SPIN) (2000), the ruminative response scale (RRS) (2003), and the dysfunctional attitude scale (DAS) (1978). The data of the research were analyzed using the analysis of variance test using SPSS software, version 23 and a significance level of 0.05.  Results: The results of the analysis of variance showed that CBT and ACT have a significant effect on cognitive distortions and rumination in adolescents (P<0.001). Also, there is no significant difference between the effectiveness of CBT and ACT on cognitive distortions and rumination in adolescents (P>0.05). The Mean±SD difference before (54.76±13.88) and after (49.51±13.42) the rumination in the CBT group was significant (P<0.001). The Mean±SD difference before (98.32±7.44) and after (83.90±7.77) the cognitive distortions in the CBT group was significant (P<0.001). The Mean±SD difference before (52.33±14.78) and after (47.73±14.23) the rumination in the ACT group was significant (P<0.001). Also, the Mean±SD difference before (98.70±7.02) and after (85.13±6.83) the cognitive distortion in the ACT group was significant (P<0.001).  Conclusion: Based on the results of the analysis, it can be concluded that CBT and ACT can be considered in cognitive distortions and rumination in adolescents with SAD.  81 94 2023/06/22023/06/272023/02/262023/01/222023/04/82023/06/282023/07/12023/07/19 1402/4/28 2023/08/132023/08/302023/09/192023/08/302023/08/302023/09/132023/09/192023/09/13 1402/6/22 Shirin Ebrahimi Shirin Ebrahimi Department of Psychology, Faculty of Education and Humanities, Tabriz Branch, Islamic Azad University, Tabriz, Iran. Iran Shirinebrahimi64@yahoo.com Naeimeh Moheb Naeimeh Moheb Department of Clinical Psychology, Faculty of Medical Sciences, Tabriz Branch, Islamic Azad University, Tabriz, Iran. Iran nmoheb36@gmail.com Marziyeh Alivani Vafa Marziyeh Alivani Vafa Department of Psychology, Faculty of Education and Humanities, Tabriz Branch, Islamic Azad University, Tabriz, Iran. Iran a.feelfull92@gmail.com Cognitive behavioral therapy Acceptance and commitment therapy Cognitive distortion Rumination Social anxiety disorder ## ##