International Journal of Education and Cognitive Sciences

Effectiveness of a Three-Stage Combined Protocol of Progressive Muscle Relaxation, Cranial Electrotherapy Stimulation, and Virtual Reality–Guided Mindfulness on Preoperative Anxiety in Dental Surgery Patients

Behnood Khorsand Nobahar iD , Pegah Farokhzad ^* iD , Mina Mojtabaee iD

Purpose: This study aimed to determine the effectiveness of a three-stage combined protocol comprising progressive muscle relaxation, cranial electrotherapy stimulation, and virtual reality–guided mindfulness in reducing state anxiety and dental anxiety among patients undergoing dental surgery.

Methods and Materials: This quasi-experimental study employed a pretest–posttest design with an intervention group and a control group. The study population consisted of adult patients undergoing dental surgery at the Implant House Dental Clinic in District 3 of Tehran during 2025–2026. Forty eligible patients were selected through convenience sampling and allocated nonrandomly to an intervention group and a control group, with 20 participants in each group. The intervention group received an initial 45-minute instructional session, four 20-minute sessions combining progressive muscle relaxation with cranial electrotherapy stimulation, and virtual reality–guided mindfulness on the day of surgery. The control group received routine clinical care without any psychological, neuromodulatory, or virtual reality intervention. State anxiety was measured using the state subscale of the State–Trait Anxiety Inventory, and dental anxiety was assessed using the Dental Anxiety Inventory. Data were analyzed using descriptive statistics and analysis of covariance in SPSS version 26, with pretest scores entered as covariates and the significance level set at .05.

Findings: After controlling for baseline scores, analysis of covariance revealed a statistically significant difference between the intervention and control groups in posttest state anxiety, F(1, 37) = 34.11, p < .001, partial η² = .47. A statistically significant between-group difference was also found in posttest dental anxiety, F(1, 37) = 35.61, p < .001, partial η² = .49. Both effect sizes were large, indicating that the combined intervention produced substantial reductions in state anxiety and dental anxiety compared with routine clinical care.

Conclusion: The three-stage combined protocol of progressive muscle relaxation, cranial electrotherapy stimulation, and virtual reality–guided mindfulness was effective in reducing state anxiety and dental anxiety in patients undergoing dental surgery and may represent a practical nonpharmacological intervention for managing preoperative anxiety in dental settings.

Effectiveness of Bigdeli Neuro-Cognitive Learning in Improving Brain-Function Mapping Indicators Associated with Autism Spectrum Disorder

Mojtaba Bigdeli Shamloo iD , Hamid Kamarzarin ^* iD , Mohana Mohammadi iD , Fatemeh Pirzal Mobarak iD

Purpose: This study aimed to examine the effectiveness of Bigdeli Neuro-Cognitive Learning in improving EEG-based brain-function mapping indicators associated with ASD-related neurocognitive dysregulation.

Methods and Materials: A quasi-experimental pretest–posttest design with a control group was used. The sample included 66 participants with ASD-related symptoms, assigned to an intervention group (n = 33) and a control group (n = 33). The intervention group received six individual sessions of Bigdeli Neuro-Cognitive Learning over a three-month period, with sessions held approximately once every two weeks, while the control group did not receive the intervention. EEG-based brain-function mapping was conducted under open-eye conditions at pretest and posttest. The main outcomes included absolute and relative power indicators, high-beta activity, hyperconnectivity, and hypoconnectivity.

Findings: After controlling for baseline scores, the intervention group showed significantly lower posttest scores than the control group in absolute delta, absolute theta, relative delta, and hyperconnectivity. These findings indicate improvement in selected neurofunctional indicators related to slow-wave regulation and excessive connectivity patterns.

Conclusion: Bigdeli Neuro-Cognitive Learning may be a promising complementary intervention for improving selected brain-function mapping indicators associated with ASD-related neurocognitive dysregulation. However, future randomized studies with standardized behavioral ASD measures and follow-up assessments are needed.

The Effectiveness of Stress-Management-Based Cognitive-Behavioral Therapy on Bruxism Severity, Anxiety, and Sleep Quality in Patients with Sleep Bruxism

Ali Nasr Esfahani iD , Mohammad Shayan Kolahdouzan ^* iD

Purpose: This study aimed to examine the effectiveness of stress-management-based cognitive-behavioral therapy on bruxism severity, anxiety, and sleep quality in patients with sleep bruxism.

Methods and Materials: A quasi-experimental pretest–posttest–follow-up design with experimental and control groups was used. Sixty patients with probable sleep bruxism were selected from dental and oral medicine clinics and assigned to an experimental group (n = 30) or a control group (n = 30). The experimental group received eight weekly 90-minute sessions of stress-management-based cognitive-behavioral therapy, while the control group received routine dental recommendations. Bruxism severity, anxiety, and sleep quality were assessed at pretest, posttest, and six-week follow-up. Data were analyzed using mixed-design repeated-measures ANOVA and Bonferroni comparisons.

Findings: Significant time × group interactions were found for bruxism severity, F(2, 116) = 58.92, p < .001, ηp² = .504; anxiety, F(1.71, 99.18) = 44.85, p < .001, ηp² = .436; and sleep quality, F(1.82, 105.67) = 47.74, p < .001, ηp² = .452. Posttest and follow-up comparisons showed significantly greater improvement in the experimental group than the control group (p < .001).

Conclusion: Stress-management-based cognitive-behavioral therapy was effective in reducing bruxism severity, anxiety, and poor sleep quality in patients with sleep bruxism.

Developing a Predictive Model of Psychosocial Adjustment to Illness Based on Health Locus of Control with the Mediating Role of Optimism in Patients with Systemic Lupus Erythematosus

Nooshin Gharibpanah iD , Sara Hashemi ^* iD , Setareh Tehrani iD

Purpose: This study aimed to develop and test a structural model of psychosocial adjustment to illness based on health locus of control, with optimism as a mediating variable, among patients with systemic lupus erythematosus.

Methods and Materials: This descriptive-correlational study employed structural equation modeling. The statistical population comprised all female patients with systemic lupus erythematosus who attended Bouali, Farhikhtegan, and Amir Al-Momenin hospitals affiliated with Islamic Azad University in Tehran, as well as the Lupus Association, during the first six months of 2025. Based on the eligibility criteria, 280 patients were selected through purposive sampling. Data were collected using the Psychosocial Adjustment to Illness Scale developed by Derogatis (1986), the Life Orientation Test developed by Scheier and Carver (1985), and the Multidimensional Health Locus of Control Scale developed by Wallston et al. (1978). The data were analyzed using regression analysis and partial least squares structural equation modeling in SPSS and PLS software at a significance level of .05.

Findings: The overall goodness-of-fit index of the structural model was .341, indicating an acceptable predictive fit. The mean communality value was .399, and the mean coefficient of determination was .283, demonstrating that the exogenous variables in the model explained approximately 28% of the variance in psychosocial adjustment to illness. The structural analysis further indicated that optimism and pessimism significantly mediated the relationships of internal health locus of control and powerful-others health locus of control with psychosocial adjustment to illness. Accordingly, health-related control beliefs influenced patients’ psychosocial adjustment both directly and indirectly through motivational orientations toward positive and negative future outcomes.

Conclusion: Health locus of control and optimism are important psychological determinants of psychosocial adjustment to systemic lupus erythematosus. Patients who perceive greater personal control over their health and maintain more optimistic expectations may demonstrate better adjustment to the emotional, social, and functional demands of the disease. Therefore, psychological interventions designed to strengthen internal control beliefs, promote realistic optimism, and reduce pessimistic expectations may facilitate more effective adaptation to chronic illness among patients with systemic lupus erythematosus.

Structural Modeling of Dental Phobia Severity Based on Anxiety Sensitivity and Negative Dental Experiences: The Mediating Role of Experiential Avoidance in Adults

Mohammad Shayan Kolahdouzan iD , Ali Nasr Esfahani ^* iD

Purpose: This study examined a structural model of dental phobia severity based on anxiety sensitivity and negative dental experiences, with experiential avoidance as a mediator, among adults.

Methods and Materials: A cross-sectional correlational design was used. The sample comprised 400 adults aged 18–60 years recruited from public and private dental clinics. Participants completed the Modified Dental Anxiety Scale, Anxiety Sensitivity Index-3, dental-event section of the Level of Exposure–Dental Experiences Questionnaire, and Acceptance and Action Questionnaire-II. Data were analyzed using confirmatory factor analysis, structural equation modeling, and bias-corrected bootstrapping with 5,000 resamples.

Findings: The partial mediation model demonstrated acceptable fit, χ²/df = 2.07, CFI = .948, TLI = .941, RMSEA = .052, and SRMR = .047. Anxiety sensitivity (β = .31), negative dental experiences (β = .29), and experiential avoidance (β = .39) directly predicted dental phobia severity (all p < .001). Anxiety sensitivity (β = .42) and negative dental experiences (β = .24) also predicted experiential avoidance (both p < .001). Experiential avoidance significantly mediated the effects of anxiety sensitivity (β = .164, 95% CI [.112, .225]) and negative dental experiences (β = .094, 95% CI [.058, .142]) on dental phobia severity. The model explained 61% of outcome variance.

Conclusion: Experiential avoidance partially explains how cognitive vulnerability and adverse dental experiences contribute to dental phobia. Assessment and treatment should target catastrophic interpretations, distressing dental memories, and avoidance processes.

A Comparison of Cognitive Emotion Regulation, Hope, Psychological Flexibility, and Quality of Life Between Male Working Adolescents and Non-Working Male Adolescents

Farkhondeh Dashab ^* iD , Mahmood Borjali iD , Jafar Hasani iD , Farshid Fathy Karkaragh iD

Purpose: This study aimed to compare cognitive emotion regulation, hope, psychological flexibility, and quality of life between male working adolescents and non-working male adolescents.

Methods and Materials: In terms of its objective, this was an applied study, and in terms of the data-collection method, it employed a descriptive causal-comparative design. The statistical population consisted of all male working adolescents aged 12–18 years residing in Khorramabad, Iran, during 2023–2024 (N = 160), whose names and records were registered with the Welfare Organization of the city. G*Power software was used to determine the sample size required for two independent groups and the comparison of four variables. The results indicated that a sample of 30 participants was appropriate for this study. The participants were selected through simple random sampling. Four questionnaires were used to collect the data: Gross’s Cognitive Emotion Regulation Questionnaire, Snyder’s Hope Scale, the Psychological Flexibility Questionnaire developed by Bond et al., and the Quality of Life Questionnaire developed by Varni et al. Using SPSS version 23, multivariate analysis of variance was employed to examine differences between the groups, and independent-samples t tests were used to compare each of the study variables separately between the two groups.

Findings: The statistical analyses revealed significant differences between male working adolescents and non-working male adolescents in terms of quality of life, psychological flexibility, hope, and cognitive emotion regulation (p < .001).

Conclusion: Considering the findings and the significant differences between male working adolescents and non-working male adolescents in quality of life, psychological flexibility, hope, and cognitive emotion regulation, researchers in psychology, counseling, social work, and educational sciences are advised to design and conduct intervention-oriented studies in various institutions and organizations, including schools, municipalities, and welfare organizations, to improve the quality of life of working children and adolescents.

Examining the Relationship Between Ambivalence Over Emotional Expressiveness and Suicidal Ideation in Veterans: The Mediating Role of PTSD Symptoms

Rasoul Heshmati ^* iD , Dena Alizadeh iD , Murtadha Abd Salman Al-Dujaili iD

Purpose: This study aimed to examine the relationship between ambivalence over emotional expressiveness and suicidal ideation in veterans, with posttraumatic stress disorder (PTSD) symptoms considered as a mediating variable.

Methods and Materials: This descriptive-correlational, cross-sectional study included 100 Iran–Iraq War veterans hospitalized at Fajr Hospital who were recruited through convenience sampling. Participants completed the Ambivalence over Emotional Expressiveness Questionnaire, the Beck Scale for Suicide Ideation, and the Mississippi Scale for Combat-Related PTSD. Pearson’s correlation was used to examine relationships among the variables. Structural equation modeling with maximum likelihood estimation was conducted in Mplus version 8 to test the mediation model. Normality was assessed using skewness and kurtosis, and multicollinearity was evaluated through variance inflation factors. Model fit was assessed using the chi-square-to-degrees-of-freedom ratio, comparative fit index, Tucker–Lewis index, and root-mean-square error of approximation. Bootstrapping was used to test the indirect effect.

Findings: Suicidal ideation was significantly correlated with ambivalence over emotional expressiveness and PTSD symptoms. Ambivalence over emotional expressiveness significantly predicted suicidal ideation in the model without the mediator. In the mediation model, ambivalence over emotional expressiveness significantly predicted PTSD symptoms, and PTSD symptoms significantly predicted suicidal ideation. However, the direct path from ambivalence over emotional expressiveness to suicidal ideation was not statistically significant after PTSD symptoms were entered into the model. The indirect effect of ambivalence over emotional expressiveness on suicidal ideation through PTSD symptoms was statistically significant. The structural model demonstrated acceptable fit to the data.

Conclusion: PTSD symptoms fully mediated the relationship between ambivalence over emotional expressiveness and suicidal ideation, suggesting that interventions targeting emotional-expression conflicts and trauma-related symptoms may help reduce suicidal ideation among veterans.

Assessment of the Efficacy of Multicultural Therapy in Reducing Anxiety and Improving the Psychological and Socio-Affective Well-Being of International Students in West Asia

Mamoon Alwan Noori iD , Akbar Atadokht ^* iD , Niloofar Mikaeil iD , Malahat Amani iD

Purpose: This study aimed to assess the efficacy of multicultural therapy in reducing anxiety and psychological distress and improving social well-being and social performance among international students in West Asia.

Methods and Materials: This quantitative study was conducted in two descriptive and quasi-experimental phases. The statistical population consisted of 250 international students studying at Mohaghegh Ardabili University during the 2023–2024 academic year. In the screening phase, 124 students were selected through multistage cluster sampling and completed the Beck Anxiety Inventory, Keyes Social Well-Being Scale, Hadian-Nasab Social Performance Questionnaire, and Goldberg General Health Questionnaire. Following screening, 30 students who met the inclusion criteria, including a Beck Anxiety Inventory score greater than 17, were selected and randomly assigned to a multicultural therapy group and a wait-list control group, with 15 participants in each group. Both groups completed pretest and posttest assessments. The experimental group received multicultural therapy, whereas the control group received no active intervention during the study period. Data were analyzed using analysis of covariance after examining the relevant statistical assumptions.

Findings: After controlling for pretest scores, multicultural therapy produced a significant reduction in anxiety compared with the wait-list control condition, F(1, 27) = 44.83, p < .001, partial η² = .624. Significant group differences were also observed in social well-being, F(1, 27) = 35.63, p < .001, partial η² = .569, and social performance, F(1, 27) = 29.73, p < .001, partial η² = .524, with higher adjusted posttest scores in the experimental group. General psychological distress was also significantly lower in the multicultural therapy group, F(1, 27) = 40.25, p < .001, partial η² = .598.

Conclusion: Multicultural therapy appears to be an effective culturally responsive intervention for reducing anxiety and psychological distress and enhancing the social well-being and social performance of international students.

International Journal of Education and Cognitive Sciences

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Effectiveness of a Neuropsychology-Based Therapeutic Package on Distress Tolerance and Emotional Ambivalence in Individuals with Multiple Sclerosis

Comparison of the Effectiveness of Self-Efficacy Training and Mindfulness Training on the Academic Motivation of Female Secondary School Students

Examining and Evaluating the Effectiveness of the Curriculum Planning Course Using an Approach Aimed at Enhancing Self-Regulation and Active Learner Participation (A Case Study of Islamic Azad University Students)

Application of Artificial Intelligence Models to Explore the Optimal Structural/Predictive Model of Gender Transition Request Based on Childhood Trauma

Exploring the Components of Social and Emotional Competencies (SEC) for Iranian EFL Teachers: Teachers’ Perceptions in Focus

Effectiveness of Self-Regulatory Strategies Training on Achievement Motivation and Academic Self-Concept among Bilingual Male Middle School Students

The Association Between Psychological Distress and Pain Perception in Patients with Irritable Bowel Syndrome: The Mediating Role of Behavioral Activation and Inhibition Systems

The Effectiveness of Meaning-Centered Group Therapy on the Dimensions of Illness Attitude in Women with Amputation-Related Grief Syndrome Due to Cancer

Designing a Model of Fear of Missing Out Based on Identity Styles with the Mediating Role of Behavioral Brain Systems in Female University Students Using Cyberspace

The Effectiveness of Self-efficacy Training on Self-handicapping and Hope of Probation Students

A Phenomenological Study of the Spiritual Education Curriculum in Lower Secondary Education with a Dynamic Lifestyle Approach

The Relationship Between Attitudes Toward E-Learning and Information Literacy: The Mediating Role of Academic Resilience

Meta-analysis of the Effectiveness of Mindfulness-Based Interventions on Rumination: A Systematic Review of Iranian Trials

The Effect of AI-Supported Microlearning on the Development of Language Skills

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