Volume 7, Issue 2 (May 2020)                   Avicenna J Neuro Psycho Physiology 2020, 7(2): 77-84 | Back to browse issues page


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Mohammadi S, Moradi O, Shafiabady A, Ahmadian H. The Comparison of the Effectiveness of Structural Couple Therapy and Redecision Couple Therapy Method on the Reduction of Marital Conflicts in Infertile Couples. Avicenna J Neuro Psycho Physiology. 2020; 7 (2) :77-84
URL: http://ajnpp.umsha.ac.ir/article-1-314-en.html
1- 1. Department of Psychology, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran.
2- Department of Psychology, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran , o.moradi@iausdj.ac.ir
3- Department of Counseling, Allameh Tabataba'i University, Tehran, Iran
4- Department of psychology, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
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Background
As marital life begins, couples expect to have children because with the birth of a child life will move on to another path. In contrast, in the case
of infertility, the partners may face serious psychological problems [1]. For most people, children are the meaning of life and an important part of their identity. Multiple studies on infertile couples who yearn for biological neonates have shown that these couples experience tension in a deep distressed way [2]. Infertility causes harmful psychological effects [3], including reduced self-confidence, impaired self-image, and impaired male and female identities [4]. Some researchers believe that infertility is a challenging experience leading to problems in marital life [4].
Marital conflicts result from the disharmony of husband and wife needs and the way to meet
them, egocentrism, difference in requests, and irresponsible behavioral schemas for marital relationship and marriage [5]. The process of conflict starts when one side of the relationship feels that the other side is suppressing some of his/her favorite issues. Conflict occurs when something satisfied a side but leading to a kind of deprivation for the other side [6].
Therapists describe the conflict system as a kind of struggle to take over bases and sources of power which is revealed towards taking other points and increasing advantages. It is clear that both sides of the conflict aim to hurt the other side thwarted his tactics and finally put him/her out of the scene. Therefore, conflict is an indication of reaction to personal differences, and it can be sometimes so severe leading to anger, violence, hatred, disgust,   jealousy, physical and verbal misbehavior in couples, and reaction in a destructive and devastating way [7].
Recent studies showed that family therapy is very effective in various problems, including emotional, psychosomatic, and behavioral disorders [8]. According to the system theory, every member of the family communicates with others in order to maintain balance. Family therapy helps to reveal hidden patterns in the family and recognize them. All the therapists believe that not only the member of the family who has been labeled as patient and all problems of the family attributed to him/her need to be treated in the treatment process but also other members of the family should be taken into account in this process [9].
One of the systematic family approaches is structural therapy. The main idea of family therapy is that individual features can be best recognized when they are assessed in the interactive patterns of the family. From the family therapy point of view, before starting treatment and resolving the symptoms of the disease some changes should be made in the organization or structure of the family. Family structure is an invisible collection of special roles connecting members of the family. In this procedure, the emphasis is on the family as the whole and interactions among its subsystems. The most important criterion is the proper and effective performance of subsystems and clear borders based on roles, regulations, and power [10].
In structural couple therapy, the focus is generally on marital subsystem, border between them, sharing the tasks between couples, and relationship of other subsystems inside and outside the family, which if there is a specific disorder in any of these cases it is tried to assess, measure, and resolve the cases in order for couples to reconstruct their proper functions. Studies in this domain have demonstrated that structural family therapy significantly affects the decrease in marital conflicts and improvement of family performance [11].
However, another approach that can be effective in decreasing marital conflicts is the redecision approach. The reason for choosing this approach to be compared with structural family therapy is that this redecision emphasized that it is different from structural family therapy in decreasing marital conflicts. Redecision therapy is established based on Transactional Analysis Theory. Many of the interactive analysts also provide individual, marital, and family therapies and integrate other systems with transactional analysis for the treatment of couples and families [12].
Currently, transactional analysis has considerably changed, including Mary and Robert Goulding as the leaders of redecision therapy school who made basic changes in Berne’s classic transactional analysis approach. In order to function more effectively and efficiently, they blended the transactional analysis theory with the principles and techniques of Gestalt therapy, family therapy, psychodrama, and behavioral therapy. The aim of redecision therapy is to help people in the challenge with themselves in order to know their pseudovictim role, be aware of accountability and conduct their life, and impose necessary changes in life’s process [13].
In this type of treatment, clients are helped to fight with their previous beliefs regarding themselves, and clients are taught that they are free in their options in order to decide again about who they are and who they want to be [14]. Then, by adopting this approach in treatment, couples can decide to show new behaviors. Redecision therapy is based on the view that when people feel involved in a conflicting situation or they arrive at a point that becomes insoluble as the root of this conflict is in their childhood and it was insoluble at that time now they return to it. This return is usually beyond conscious awareness and with the answers which the individual gives to interview conditions usually will have an improper and ineffective state [15]. Studies have shown that the redecision approach has been effective in working with conflicting couples [16].
 
Objectives
The current study aimed to compare the effectiveness of structural couple therapy and redecision couple therapy in the reduction of marital conflicts among infertile couples. 
 
Materials and Methods
The present empirical semi-experimental study was carried out on two experimental groups receiving Minuchin’s structural and redecision therapies and a control group from a psychological point of view using a pretest and posttest design. The dependant variable was marital conflicts and associated dimensions. The statistical population of the study were all the infertile couples referring to Besat hospital of Sanandaj, Iran. A total of 36 study participants who met inclusion criteria were selected using convenient sampling and assigned to three groups. Semi-structured interviews and marital conflicts questionnaire were used for the selection of the subjects. Each of the experimental groups underwent 10 sessions of couple therapy.
The inclusion criteria were infertile couples with at least 3 years of marriage, living with each other and not leaving the home after an argument, having marital conflict scores of at least 150 and at most 186, no participation in any type of therapeutic intervention parallel with the interventions provided in this study, completing informed consent form for participation in the study, having at least diploma, and no addiction of spouses. The exclusion criteria were no participation in the treatment sessions for two successive sessions or three nonconsecutive sessions without any acceptable reason, failure to cooperate with the therapist, not doing the main assignments proposed by the therapist, and awareness that the subject did not meet the inclusion criteria of the experiment.
 
Marital conflicts questionnaire
This questionnaire is a reporting tool, includes 54 items which is developed by Boostanipoor and Sanai Zaker [17] in Iran and basically used for the identification of the nature and the number
of conflicts in the marital relationship. This questionnaire studies seven dimensions of marital conflicts, namely decreased cooperation, decreased sexual relationship, increasing emotional reactions, increasing children support, increasing personal relationships with one’s relatives, decreasing family relationships with spouse’s friends and relatives, separating financial affairs from each other, and decreasing effective relationship and marital conflicts. The scaling of the options is based on 1) Never, 2) Rarely, 3) Sometimes, and 5) Always. The items 3, 11, 14, 26, 30, 33, 45, 47, and 45 are numbered in reverse. Cronbach’s alpha for the whole questionnaire was reported as 0.71. This questionnaire has good and acceptable validity. The reliability of this tool was reported as 0.90 for the whole scale using the internal consistency method [18]. The reliability of this questionnaire in the present study was calculated at 0.93.
Descriptive statistic indices and multivariate analysis of covariance (MANCOVA) were used to analyze the data. In addition, the data were analyzed using SPSS software (version 22).
 
Table 1. Protocol of structural couple therapy
 
Session Objective Assignment
First session Introducing and making a friendly relationship, expressing the objectives of the sessions, method therapy, and concept of marital conflicts and affliction People are asked to write down their main conflict on a paper and state what they expect from the sessions.
Second session The assignment of the previous session is checked. Communication and family subsystems are defined. Finally, the dominant status of the family is revised. Members are asked to practice communication skills and write down the results of their practice.
Third session By receiving feedback from previous sessions, the third session will be started. Then, the techniques of family therapy, such as adhesion, imitation, and restatement, were taught. The assignment is to record the effects of family therapy techniques on the improvement of daily lives.
Fourth Session By reviewing previous session assignments and giving feedback by group members, the fourth session will be started. Then, common interactional patterns and an available triangle around family problems are discussed.

Members are instructed to write their expectations from their spouses and put forward in the session and state cases which they think can lead to more cooperation of each spouse as a strategy.

Fifth session This session is started with checking the assignments of the previous session. Moreover, reconstruction and family changing strategies are studied. Participants are given the assignment to write two cases that cause reactions and state in the session.
Sixth session The assignment of the previous session is checked. The manner and amount of communication of each member with his/her spouse are checked. The comparison of their relationships with their own family members is studied and taught. Participants are asked to write some of their experiences that have brought them closer to their main family and caused them to stay away from their spouses and state in the session.
Seventh session The assignment of the previous session is checked. Family relations with relatives and friends are discussed and studied. Participants are instructed to write about strategies that balance the family relationship with spouse relatives and cause healthy relationships with friends.
Eighth session The assignment of the previous session is checked. Considering that marital conflicts over sexual matters are more frequently about women and quality of the relationship, these cases are taught. Participants are given the assignment to discuss the time and quality of having a sexual relationship with their spouses and follow what they agreed on.
Ninth session The assignment of the previous session is checked. How to maintain coupled subsystems with the boarders of children subsystem will be discussed. Participants are asked to write two cases that have led to attracting children support and state in the session.
Tenth session The assignment of the previous session is checked. Proper financial management regarding concerns and turbulences are discussed. Members discuss their experiences in this regard and reach an agreement with their spouses.


Table 2. Protocol of redecision therapy
 
Session Objective Assignment
First session Introduction and creating a friendly relationship; executing pretest; stating principles and regulations Completing questionnaire; stating problems by the couples
Second session Becoming familiar with marital conflict concepts and dimensions, its disadvantages and negative effects on the couples; discussing marital affliction Studying pamphlet provided by the counselor for the next sessions
Third session Familiarizing with the individual's personality structure or moods (i.e., parent, adult, and child); informing members of the process of character formation from Berne’s point of view Studying pamphlet provided by the counselor
Fourth session Explaining the redecision approach and naming its components, inhibitors, and propellants; learning about decisions made as the result of inhibitors and propellants Writing inhibitors and propellants which parents remind of their spouses
Fifth session Teaching to discover the drama of life; familiarizing with the concept and types of caress Studying the pamphlet and making a list of caresses received in childhood
Sixth session Explaining who to arrange an agreement; talking about personal responsibility with each member; assign responsibilities Exchanging opinions about the agreement; writing cases which they expect to change during marital life
Seventh Session Identifying family regulations and do’s and don’ts using cognitive techniques (i.e., cognitive controversy, conversation, and extreme questions) to understand initial decisions Identifying defective beliefs and proposing realistic ones
Eighth session Working on initial decisions using Gestalt therapy techniques (i.e., roleplaying, role inversion, and empty chair) in order to reconstruct the scenes coming to mind of the members from the past Applying initial decisions using Gestalt therapy techniques; confronting with unfinished works through empty chair technique
Ninth Session Discussing questions to review decisions (e.g., Do you want to review your initial decisions? Are these decisions useful for you and what new decisions do you want to make?) Members are asked to specify weeks or days and act at least in an environment similar to home or workplace as if they are that person
Tenth decision Holding a posttest; interviewing with participated couples; providing a plan based on their decisions regarding continuation of life Talking about changes that are made during the treatment
 
Results
The mean scores of participants’ age in the structural couple therapy, redecision couple therapy, and control groups were reported as 28.8±7.9, 28.9±8.1, and 33.5±7 years, respectively. The duration averages of infertility in the structural couple therapy, redecision couple therapy, and control groups were 3.58, 4.25, and 5.08 years, respectively.
The results of Box’s M and Levene’s tests were evaluated in order to follow the defaults which are shown in the following tables. The results of Box’s M test are presented in Table 6 to study the assumption of the equality of covariance matrices of dependent variables. F gained for the variable of marital conflict components with (3034.31,72) degrees of freedom was not significant at 0.05 level, and the assumption of the equality of covariance matrices in  Box’s M test was rejected when the amount of F obtained for variables to be significant at 0.01 level; therefore, it was confirmed in the present study. Since Box’s M test was not significant, the term of homogeneity of variance-covariance matrices was properly observed. F amounts gained for the dimensions of the marital conflict components were not significant (P<0.05) in the posttest with degrees of freedom (df-33,2).
Lack of significance at Levene’s test indicated that the term of variance equality between the groups was observed, and the amount of error variance of dependent variables was equal at all groups; consequently, there was no significant difference between the error variances of the groups. Therefore, the assumption of homogeneity of error variances was observed, and MANCOVA can be used. Considering that the defaults using the MANCOVA were observed, Table 4 tabulates the results of Wilks’ Lambda to study the group effect.
As it can be observed in Table 4, the effect of the group is significant in the dimensions of marital conflict components at 0.001; consequently, the results indicated that it is significant at least among one of the components of the marital conflicts. The results of the MANCOVA are shown in Table 5.
As it can be observed in Table 5, in cooperation (F[2,25]=14.17), decreased sexual relationship (F[2,25]=28.53), increasing emotional reactions (F[2,25]=16.99), increasing personal relationships with one’s relatives (F[2,25]=24.02), decreasing family relationships with spouse’s friends and relatives (F[2,25]=21.81), separating financial affairs from each other (F[2,25]=18.70), and decreasing effective relationship (F[2,25]=28.53), there is a significant difference at 0.001 level. Furthermore, in increasing children support (F[2,25]=0.091), there was no significant difference between the two experimental groups and control group (P<0.05). There was a significant difference between the effectiveness of the Minuchin’s structural couple therapy, redecision couple therapy, and control groups in decreasing marital conflicts.
When Bonferroni adjustment was performed for a number of comparisons, the obtained results showed that there was a significant difference between the three groups regarding marital conflict components. A review of the means in Table 7 indicated that there was a significant difference between cooperation dimension in Minuchin’s structural therapy and redecision therapy groups with the control group at the significance level of < 0.01; however, there was not a significant difference between the two Minuchin’s structural therapy and redecision therapy groups (P0.05). A significant difference was observed regarding decreased sexual
 

Table 3. Descriptive statistics (i.e., mean and standard deviation) of variables
 
Posttest Pretest Group Variable
Mean Standard deviation Mean Standard deviation
1.72 7.08 3.14 18.67 Minuchin’ structural therapy Decreased cooperation
1.56 6.08 0.99 16.92 Redecision therapy
1.8 13.17 1.72 13.91 Control
2.28 10.17 3.01 17.75 Minuchin’ structural therapy Decreased sexual relationship
1.08 6.08 1.90 18.17 Redecision therapy
1.11 14.17 1.77 14.67 Control
3.70 13.33 5.40 27.83 Minuchin’ structural therapy Increasing emotional reactions
2.42 10.67 3.83 28.83 Redecision therapy
1.61 22.67 1.31 22.50 Control
0.99 5.41 1.72 5.58 Minuchin’ structural therapy Increasing children support
0.58 5.16 0.99 5.41 Redecision therapy
1.15 5.56 1.08 5.91 Control
2.35 8.50 3.42 18.80 Minuchin’ structural therapy Increasing personal relationships with one’s relatives
1.50 7.58 2.97 20.58 Redecision therapy
1.28 16.75 1.57 17.50 Control
2.14 8.67 3.98 18.33 Minuchin’ structural therapy Decreasing family relationships with the spouse’s friends and relatives
2.12 7.83 2.60 20.08 Redecision therapy
1.24 15.58 1.29 15.75 Control
2.09 13.25 4.45 20.75 Minuchin’ structural therapy Separating financial affairs from each other
2.02 8.50 3.08 23.42 Redecision therapy
1.52 19.17 1.35 18.75 Control
3.78 24.83 3.78 46.50 Minuchin’ structural therapy Decreasing effective relationship
4.42 21.67 4.25 51.58 Redecision therapy
2.10 37.17 3.34 39.42 Control
11.61 91.25 13.05 173.92 Minuchin’ structural therapy Marital conflicts
11.16 73.58 13.30 185 Redecision therapy
3.96 144.33 7 148.42 Control
 

Table 4. Study the group effect using Wilks’ Lambda
 
Variable Value F Question df. Error df. Sig. Eta2
Marital conflict components 0.051 7.694 16 34 0.001 0.774
 


Table 5. Results of multivariate analysis of covariance to compare pretest and posttest in three groups
 
Eta squared Sig. F Mean of squares df Sum squares Source Variable
0.53 0.001 14.175 34.301
2.210
2
25
68.602
60.500
Effect
Error
Decreased cooperation
0.69 0.009 28.531 44.493
1.559
2
25
88.985
38.987
Effect
Error
Decreased sexual relationship
0.58 0.001 16.995 94.015
5.532
2
25
188.029
138.299
Effect
Error
Increasing emotional reactions
0.00 0.917 0.091 0.067
0.738
2
25
0.134
18.446
Effect
Error
Increasing children support
0.66 0.001 24.016 53.204
0.215
2
25
106.48
55.384
Effect
Error
Increasing personal relationships with ones’ relatives
0.64 0.001 21.806 35.607
1.633
2
25
71.213
40.823
Effect
Error
Decreasing family relationships with the spouse’s friends and relatives
0.60 0.001 18.699 55.388
2.962
2
25
110.776
74.050
Effect
Error
Separating financial affairs from each other
0.69 0.001 28.528 262.729
9.210
2
25
524.485
230.241
Effect
Error
Decreasing effective relationship
0.250 0.001 68.140 6292.104
92.400
2
32
2592.208
2956.805
Effect
Error
Marital conflicts


Table 6. Comparison of marital conflict components using Bonferroni post hoc test
 
Sig. Std. Error Mean Difference (I-J) (J) Group (I) Group Variable
1 0.880 0.125 Redecision therapy Minuchin’ structural therapy Decreased cooperation
0.001 1.33 *-6.88 Control  
0.001 1.43 *-7 Control Redecision therapy
0.001 0.703 *3.193 Redecision therapy Minuchin’ structural therapy Decreased sexual relationship
0.001 1.07 *-5.23 Control  
0.001 1.15 *-8.48 Control Redecision therapy
0.156 1.32 2.70 Redecision therapy Minuchin’ structural therapy Increasing emotional reactions
0.001 2 *-9.88 Control  
0.001 2.16 *-12.58 Control Redecision therapy
1 0.48 0.192 Redecision therapy Minuchin’ structural therapy Increasing children support
1 0.73 0.170 Control  
1 0.73 -0.02 Control Redecision therapy
1 0.72 0.554 Redecision therapy Minuchin’ structural therapy Increasing personal relationships with ones relatives
0.001 1.09 *-6.82 Control  
0.001 1.17 *-7.38 Control Redecision therapy
1 0.72 0.554 Redecision therapy Minuchin’ structural therapy Decreasing family relationships with the spouse’s friends and relatives
0.001 1.09 *-6.82 Control  
0.001 1.17 *-7.38 Control Redecision therapy
0.001 0.97 *3.99 Redecision Minuchin’ structural therapy Separating financial affairs from each other
0.005 1.47 *-5.23 Control  
0.001 1.58 *-9.23 Control Redecision therapy
0.056 1.71 4.30 Redecision therapy Minuchin’ structural therapy Decreasing effective relationship
0.001 2.59 *-16.70 Control  
0.001 2.79 *-20.99 Control Redecision therapy
0.001 4.24 *19.04 Redecision therapy Minuchin’ structural therapy Marital conflicts
0.001 5.40 *-56.24 Control  
0.001 6.61 *-75.29 Control Redecision therapy
 

relationship between the Minuchin’s structural therapy and redecision therapy groups (P<0.01) and between redecision therapy and control groups (P<0.01). 
There was also a significant difference regarding emotional reactions between the Minuchin’s structural therapy and redecision therapy groups with the control group (P<0.01); nevertheless, there was no significant difference between the two Minuchin’s structural therapy and redecision groups in this regard (P0.05). There was no significant difference in increasing children support between the two Minuchin’s structural therapy and redecision groups (P0.05) and between Minuchin’s structural therapy and redecision groups with the control group (P0.05).
A significant difference was also observed regarding increasing personal relationships with ones’ relatives between the Minuchin’s structural therapy and redecision therapy groups with the control group (P<0.01); however, there was no significant difference between the two Minuchin’s structural therapy and redecision therapy groups in this regard (P0.05). A significant difference was noticed regarding decreasing family relationships with spouse’s friends and relatives between the Minuchin’s structural therapy and redecision therapy groups with the control group (P<0.01); nonetheless, there was no significant difference between the two Minuchin’s structural therapy and redecision therapy groups in this regard (P0.05).
There was also a significant difference in separating financial affairs from each other between the Minuchin’s structural therapy and redecision therapy groups (P<0.05), Minuchin’s structural therapy and control groups (P<0.05), and redecision therapy and control groups at (P<0.05). In addition, a significant difference was observed regarding decreasing effective relationship between the Minuchin’s structural therapy and redecision therapy groups with the control group (P<0.01); however, there was no significant difference between the two Minuchin’s structural therapy and redecision therapy groups in this regard (P0.05).  
Nevertheless, the difference between the mean of marital conflicts in pretest and posttest was significant. The difference was significant between the means of Minuchin’s structural therapy and redecision therapy groups (P<0.01), redecision therapy and control groups (P<0.01), and Minuchin’s structural therapy and control groups (P<0.01). According to the obtained results, it can be concluded that Minuchin’s structural couple therapy is generally more effective than redecision couple therapy in decreasing marital conflicts.
 
Discussion
The present study was carried out in order to compare the effectiveness of structural couple therapy and redecision couple therapy in decreasing marital conflicts among infertile couples. The obtained results indicated that training structural and redecision couple therapies were effective in decreasing marital conflicts of the couples, and the results of the current study are consistent with the findings of a study conducted by Vizheh et al. in this regard [19]. In explaining these findings, it can be said that according to Minuchin [20], the main idea of structural family therapy is that the symptoms of an individual’s disorder are better perceived and recognized when they are assessed at the context of family transactional patterns.
One of the special and unique techniques of structural couple therapy approach is the implementation of family transactional patterns, and its main goal is to facilitate solving present problems and healthy growth of the family by concentrating on interpersonal communication and important family members [21]. Therefore, in this approach, the therapist helps clients by concentrating on the structure or organization of the family to modify their stereotype patterns, increase their flexibility, and review relationships among the family members and modify them leading to decreasing marital conflicts and improving the mental health of the couples [22].
The structural couple therapy approach is successful due to its content and plan. The adherents of this approach are trying to pay attention to current transactional patterns and structures. They give special attention to the social context in which people show bad behaviors. Moreover, their main subject is a family reconstruction based on bordering, putting forward and solving conflicts of marital subsystems, modifying disruptive behavioral and communicative patterns, meeting family member needs especially the spouse, improving sexual relationships, and managing financial affairs resulting in decreasing marital conflicts and increasing marital satisfaction [23].
For a better explanation of the above-mentioned findings, it can be said that in structural and redecision couple therapies, it is tried that members share whatever which are hidden inside them with their spouses and reveal their feelings about life, future, fears, concerns, and painful experiences that they can rarely overcome in isolation by creating structures [24]. Another study has also clearly shown that modifying couples’ relationships can reduce marital conflicts and improve marital relationships. It can also present many challenges to marital life, including family conflicts and household violence, which are all the results of this lack of satisfaction with marital life [25].
Couple therapists in addition to arousing positive feelings in spouses, enhancing family functions, and creating intimacy between couples, improve satisfaction which in turn decreases marital conflicts [26]. They allow couples to know the scope of their responsibilities, freely defend their rights, easily access to other subsystems of the family, express their feelings with each other, and benefit from each other’s empathy and support [27]. Based on the evidence, it was demonstrated that family support and improvement of family functions can decrease marital conflicts.
In general, the findings of the present study on the subscales of marital conflicts showed that in all cases there was a significant difference between trained and untrained couples demonstrating that trained couples indicated better ability to decrease marital conflicts. However, before the experiment, there was no significant difference between the experimental and control groups in this regard. Therefore, it can be concluded that structural couple therapy and redecision couple therapy training were effective in the improvement of couples’ ability to decrease marital conflicts.
There were several limitations in this study, including the number of questionnaires and high number of items which made the respondents tired. Additionally, there was no follow-up due to participant refusal. As infertility has negative effects on marital satisfaction, it is recommended to provide necessary training in fertility clinics to reduce the social and psychological stress of clients and increase their marital adjustment. Since familial disputes are the most important causes of separation among infertile couples, training for marital relationships can prevent couples from divorce and instead reinforce their family foundation.
 
Conclusions
According to the obtained results of the present study, it can be concluded that structural couple therapy and redecision couple therapy are effective in decreasing marital conflicts.
 
Compliance with ethical guidelines
All the ethical principles were considered in this study. The participants were informed about the purpose of the study and implementation of the stages. In addition, informed consent was obtained from all the subjects. The participants were also assured of the confidentiality of their information. Moreover, the subjects were allowed to withdraw from the study at any time, and the results of the study would be available to them if desired. The current study was extracted from a doctoral dissertation in Psychology in Islamic Azad University of Sanandaj. Additionally, this study was approved by the Ethics Committee of Islamic Azad University of Sanandaj with the ethics code of IR.MUK.REC.1397.5007.
 
Funding/Support
The present study did not receive any specific grant from funding agencies in public, commercial, or not-for-profit sectors.
 
Conflicts of Interest
The authors declare that there is no conflict of interest.
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Article Type: Research Article | Subject: Clinical Psychology
Received: 2020/08/13 | Accepted: 2020/05/10 | Published: 2020/05/10

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