Journal of Fundamentals Mashhad University Psychiatry and Behavioral Sciences

of Mental Health of Medical Sciences Research Center

Original Article

The prediction of parental self-efficacy and hyper-anxiety

symptoms based on the components of mindfulness in women
with multiple sclerosis
Mohammad Mohammadi Pour1; Elaheh Pourakbaran2*
1
Assistant professor, Department of Psychology, Islamic Azad University, Quchan Branch, Quchan, Iran
2
Young researchers and elite club, Islamic Azad University, Torbat-e-Heydarieh Branch, Torbat-e-Heydarieh, Iran

Abstract
Introduction: The present study aimed to predict parental self-efficacy and hyper-anxiety symptoms based on the
components of mindfulness in women with multiple sclerosis (MS).
Materials and Methods: The statistical population of this descriptive-correlational study included all women with MS
in Mashhad during March-Jun 2016 who referred for treatment to clinics, neurologists and psychological centers. The
statistical sample consisted of 105 women with MS who were selected using convenient sampling method. In order to
collect data, Parental Self-Efficacy Questionnaire, Beck Anxiety Inventory (BIA) and Mindfulness Questionnaire were
used. Data were analyzed using multivariate regression method.
Results: The results revealed that the components of mindfulness, judgment and non-reactivity can reduce anxiety
significantly in women with MS. In addition, action with awareness, judgment and non-reactivity can increase parental
self-efficacy (P<0.05).
Conclusion: Due to the results obtained from the study, it is suggested that components of mindfulness, judgment and
non-reactivity can increase parental self-efficacy and reduce anxiety among women with multiple sclerosis.
Keywords: Anxiety, Mindfulness, Multiple sclerosis, Parental, Self-efficacy
Please cite this paper as:
Mohammadi Pour M, Pourakbaran E. The prediction of parental self-efficacy and hyper-anxiety symptoms based on the components
of mindfulness in women with multiple sclerosis. Journal of Fundamentals of Mental Health 2017 Aug-Sep; 19(5): 366-73.

Introduction judgment and parent’s view about their abilities to

Multiple sclerosis (MS) is a chronic and perform parental duties (8,9). Colman and Karraker
progressive autoimmune disease of the central argue that the extent to which parents feel to be
nervous system that causes sensory impairment, effective by their abilities to achieve all aspects of
weakness, muscle cramp, visual and cognitive child rearing is considered as parental self-efficacy.
impairment, fatigue, shaking, voiding dysfunction, Parental self-efficacy refers to parent’s assessment of
defecation disorder, loss of balance and sexual their ability to perform parental role (11-14).
dysfunction, amnesia, hearing impairment, Increased stress along with their disease and its
numbness, blurred vision, diplopia, speech consequent problem can increase their anxiety
impairment in patient (1). It is considered as one of (15,16). Evidence suggests that high anxiety in these
the most common neurological diseases in human individuals is considered as one of the important
which can lead to disability in women (2,3) which factor in the recurrence of the disease and the failure
occurs mostly in adolescence and is more than twice to respond to treatment (17-19) which is mostly
as prevalent in women than men (4,5). associated with symptoms including shortness of
The compatibility of patients with MS is severely breath (dyspnea), heartbeat, transpiration, headache,
reduced according to the type of disorder in patients mild stomach discomfort and restlessness (20,21).
with MS (6). Parental self-efficacy is associated with Anxiety can severely disengage patients with MS
*Corresponding Author: Young Researchers and Elite Club, Islamic and disrupts many aspects of life. That is why the
Azad University, Torbat-e-Heydarieh Branch, Torbat-e-Heydarieh, Iran attention to anxiety in diseases and many other
[email protected]
Received: Apr. 12, 2017
problems has been contributed to various studies in
Accepted: Jul. 01, 2017 the field of psychology (22,23). Despite what has
been said, studies have shown that the responses to
Fundamentals of Mental Health, 2017 Aug-Sep http://jfmh.mums.ac.ir 366
PARENTING SELF-EFFICACY IN MULTIPLE SCLEROSIS MOHAMMADI POUR, POURAKBARAN

the disease varies in chronic patients including those Therefore, due to the necessity to pay attention to
with MS (24,25). However, some individuals, psychological aspects in women with MS including
despite having MS, have good relationship with parental self-efficacy and symptoms of anxiety on
their children and experience less anxiety (26). one hand, and the existing research vacuum on the
Mindfulness is a matter of being fully present in the other hand, the present study aimed to predict
moment without judgment and comment on what is parental self-efficacy and hyper-anxiety symptoms
happening – that is, the experience (27,28). based on the components of mindfulness in women
Mindfulness, in Buddhism, is defined as pure with MS.
attention or non-discursive registering
of events without reaction or mental evaluation Materials and Methods
(29,30). Kabat Zinn defines mindfulness as that This is a descriptive correlational study. This study
arises through paying attention, on purpose, in the can be considered as fundamental study in terms of
present moment, non-judgmentally (31). In this target point. The present study aimed to examine the
regard, studies conducted by Ghasemi et al. (33) relationship between the variables, that is, the level
indicate that there is a negative significant of coordination in changes of the two variables.
relationship between mindfulness and emotion The statistical population of the study included all
regulation. In addition, Sheikholslami (34) also women with Multiple sclerosis (MS) in the first
indicated that mindfulness-based stress reduction trimester in Mashhad who were referred for
(MBSR) appeared to be effective in reducing stress treatment to Imam Reza Hospital and Ghaem
and anxiety. Boroujerdi et al. (35) indicated that the Hospital, among whom were 120 women with MS.
change of dysfunctional attitudes, tolerability and The statistical sample consisted of 105 women with
disgust, tendency to attract attention, disrupted MS who were selected using purposive sampling
performance, evaluation, acceptability and therefore method. In this research, purposive sampling
mindfulness can be reduced. Kaviani et al. (36) method was used according to the necessity of the
indicated that mindfulness based cognitive therapy subject and researcher’s objective. In order to
(MBCT) can increase the quality of life and reduce estimate sample size in each group, Cochran's
depression. Among the studies conducted abroad, sample size formula was used. In this case, error rate
Sirois and Tosti (37) found that low mindfulness can d was considered to be equal to 0.05, and therefore
be a risk factor for poor mental and physical well- the confidence coefficient was 95%.
being. Singh et al. found that maternal training for As it can be seen, after locating population size (N)
mindful attention can reduce aggression, and the mentioned assumption in Cochran's sample
disobedience, self-harm behaviors and increase size formula, the sample is equal to 91 individuals.
mothers’ satisfaction in relation to care skills and On the other hand, given to the fact that regression
their interaction with their children (32). Kort also method is used in this study, it is necessary to
suggests that mindfulness is effective on examine the adequacy of sample size in terms of the
impulsivity, symptoms of depression, anxiety and number of variables. Tabachnick and Fidell (42)
the quality of life (38). Similar results have been suggested the following formula in order to
obtained from the studies conducted by Berrill et al. investigate the adequacy of sample size in terms of
(39), Van Ravesteijn (40) and Bohlmeijer (41). the number of predictive variables (in this formula,
According to conducted studies, it seems that m is the number of predictive variables; here the
mindfulness is considered to be an important factor components of mindfulness are considered as the
for individuals’ resistance to difficulties, particularly predictive variables):
their impact from the problems caused by chronic The sample size required for the present study is
diseases. Several research evidences suggest that equal to 90 by considering the number of predictive
mindfulness can increase the quality of life and variables which is equal to 5. Therefore, as it is clear
mental health while reducing depression. However, sample size consists of 91 individuals based on
most of the studies conducted in terms of the Cochran's sample size formula, which was more
effectiveness in the form of experimental studies. than the minimum recommended. According to the
However, few researches have been conducted probability of falling, 110 questionnaires were
concerning its predictive role of the variable in distributed among which 105 questionnaires were
relation to psychological aspects. In addition, there collected.
are few studies which contribute to determine the Research instruments
importance of this variable in relation to patients - Parental self-efficacy questionnaire: This
with chronic disease including those with MS. questionnaire was used for the first time by Dumka,

Fundamentals of Mental Health, 2017 Aug-Sep http://jfmh.mums.ac.ir 367

PARENTING SELF-EFFICACY IN MULTIPLE SCLEROSIS MOHAMMADI POUR, POURAKBARAN

Stoerzinger, Jackson and Roosa (43) for assessing through combining the items of mindfulness
parental self-efficacy. This scale consists of 10 item questionnaire by Freiburg, Walsh et al., Mindful
having negative and positive phrases which assess Attention Awareness Scale by Brown and Ryan,
the general sense of parents from confidence in Kentucky Mindfulness Inventory by Baer and Smith
parent’s role. The questions range from 1 = rarely using the factor analysis approach (46). Baer
to 7=always in 7-point Likert scale. In Tiller’s conducted an explanatory factor analysis on a
study, Cronbach alpha is 0.54.Tale'ee (11) in his sample of university students. This questionnaire
study, Cronbach’s alpha for the questionnaire were consisted of 112 items and 5 components which
calculated 0.70 and its visual validity was reported comparable based on the results of four factors of 5
to be desirable. Exploratory factor analysis was used factors with identified factors, and the fifth factor
in order to examine structural validity and indicates included items which defined as non-reactive state
that all the items of this scale are loaded on a factor. to internal experience. The obtained factors were
In addition, this study has indicated that the named as the following: observation, action along
reliability is equal to 0.76 using Cronbach’s with consciousness, being non-judgmental to
coefficient and 0.73 using splitting method (11). internal experience, description and non-reactivity.
- Beck anxiety inventory (BAI): This questionnaire The factor observation involves the attention to
was developed by Aaron T Beck and his colleagues outer and inner stimuli such as feelings, cognitions,
in 1988. This questionnaire consists of 21 items emotions, sounds and smells. The factor description
which lists the symptoms of anxiety which is similar is associated with appellation of outer experience
to checklist. Beck anxiety inventory (BAI) is using words and the factor action involves
developed in order to measure anxiety in consciousness with the immediacy at each moment
adolescents and adults. Each of the items measures which contrasts with mechanical action that occurs
on of the common symptoms, namely, mental when the individuals’ mind is in another place. Non-
symptoms, physical symptoms and fear. As it is judgmental ability to internal experience includes
previously mentioned, this questionnaire has 21 having non-judgmental ability towards thoughts and
items each of which is scored 0 to 3. The score 0 feelings and non-reactivity toward internal
indicates the absence of symptoms, and the score 1 experience, permission to enter into the thoughts
indicate a mild symptom, and the score 2 indicates and inner feeling (Brown, Ryan and Creswell,
mean symptoms and the score 3 indicates severe 2007). According to the results, there was an
symptom. After obtaining the scores, they are added appropriate internal consistency between the factors
and the total score is obtained ranging from 0 to 63. and alpha coefficient raged from 0.75 (in the factor
In 1988, Beck et al indicated the reliability of the the non-reactivity) to 0.91 (in the factor description).
questionnaire by re-testing on 83 outpatients with a The correlation between the factors was moderate
weekly interval, which was equal to 0.75. Alpha and significant in all cases ranging from 0.15 to
coefficient of the questionnaire for 160 outpatients 0.34. In addition, in a study conducted in Iran on
obtained to be 0.92. Friedrich et al. in 1992 reported validity and reliability of the questionnaire, the
to be 0.67 for reliability coefficient and 0.94 for correlation coefficient for test and retest in Iranian
alpha coefficient in 40 outpatients. In a study version was equal to 0.57 (for non-judgmental
conducted in Tehran University of medical sciences ability) and 0.84 (for observation). Moreover, alpha
and Rouzbeh hospital, the reliability of the test has coefficients were obtained at acceptable levels
been shown in a healthy and clinical population. In ranging from 0.55 (for non-judgmental ability) and
this study conducted on 56 infertile individuals, 0.83 (for description) (47).
Cronbach’s alpha was obtained to be 0.90 (44). In After obtaining necessary permission and selecting
addition, Rajabi and Yazdkhasti expresses that this the sample group, we referred to the specified
test has high reliability and validity, whose internal centers and after coordination with the authorities,
stability is 0.92 and data correlation is between 0.30 the questionnaires were given to individuals to
and 0.76. On 1513 males and women in different complete them. In case of ambiguity, the questions
age and gender in Tehran, a study was conducted in were answered. Then, the questionnaires were
order to examine the validity and reliability of Beck collected and analyzed using multivariate
Anxiety Inventory among the Iranian population, the regression.
results have indicated the reliability of 0.72, validity
of 0.83 and internal consistency of 0.92 (45). Results
- Mindfulness questionnaire: It is a self-report Total of participant were 105 cases. After data
scale consisting of 39 items developed by Baer et al. collection, mean age of the affected patient were

Fundamentals of Mental Health, 2017 Aug-Sep http://jfmh.mums.ac.ir 368

PARENTING SELF-EFFICACY IN MULTIPLE SCLEROSIS MOHAMMADI POUR, POURAKBARAN

34.2 with standard deviation 56.5 from the range of Table 1. Mean score and standard deviation for
22 years to 50 years. In this study, most individuals mindfulness, anxiety and parental self-efficacy
with MS (49%) had diploma certificate. 12% of the Mean SD Min Max
individuals had associate degree and 39% had Observation 19.7429 4.52988 13.00 31.00
Description 19.7810 3.31947 13.00 27.00
bachelor’s degree and higher. Of these, 34% were Action with awareness 20.8571 3.81401 13.00 30.00
married and 66% were single. In this study, anxiety, non-judgmental ability 19.0571 3.65015 14.00 27.00
mindfulness and parental self-efficacy were Non-reactivity 21.4095 4.18719 13.00 31.00
measured using questionnaire. Mindfulness Anxiety 33.7810 8.13584 17.00 46.00
Parental self-efficacy 35.0381 8.15938 16.00 70.00
questionnaire includes 5 components (observation,
description, action with awareness, non-judgmental In order to examine the predictive role,
ability and non-reactivity). Anxiety and self-efficacy multivariate regression analysis was used.
inventory includes one single component. In the Therefore, the components of mindfulness as the
following, mean scores and standard deviation for predictive variables and parental self-efficacy and
research variables are presented in the whole anxiety as the criterion variable were entered in
sample. regression equation. The results of this analysis are
reported in the following tales.

Table 2. Multiple correlation coefficient (regression coefficient) for prediction of parental self-efficacy and
anxiety
Model R R2 Modified R2 estimation criterion error
a
Model 1: prediction of anxiety based on mindfulness 0.486 0.236 0.198 7.28777
Model 2: prediction of parental self-efficacy based on mindfulness 0.386a 0.149 0.106 7.71406

Table 3. Variance analysis for the scores of anxiety and parental self-efficacy on predictive variables
Statistical index Sum of square Degree of freedom Mean square F P
Model 1 Regression 1625.917 5 325.183 6.123 0.000b
Remainder 5258.045 99 53.112
Total 6883.962 104
Model 2 Regression 1032.689 5 206.538 3.471 0.006b
Remainder 5891.158 99 59.507
Total 6923.848 104

Table 2 indicates values for R2, R and modified R2. As it can be seen, this value in the above analysis is
In this table the value for modified R2 is important equal to 0.19 for model 1 and 0.10 for model 2
indicating model fitness. The value of this which indicates that 19% and 10% of changes for
coefficient ranges from 0 to 1. The more it is closer anxiety and parental self-efficacy depend on
to 1, the more it shows the accuracy of the model. predictive variables.

Table 4. Standardized and non-standardized regression coefficients

Variable Non-standardized coefficients Standardized coefficients t Significance level
b Standard error Beta
1 (constant) 55.728 5.048 11.040 0.000
Observation -0.576 0.324 -0.321 -1.780 0.078
Description -0.732 0.374 -0.299 -1.959 0.053
Action with awareness -0.081 0.239 -0.038 -0.337 0.737
Non-judgmental ability -1.110 0.481 -0.498 2.307 0.023
Non-reactivity -0.727 0.257 -0.374 -2.823 0.006
2 (constant) 17.481 5.343 3.272 0.001
Observation 0.316 0.342 0.175 0.922 0.359
Description 0.426 0.396 0.173 1.077 0.284
Non-judgmental ability 0.601 0.253 0.281 2.374 0.020
Non-reactiveness 1.214 0.509 0.543 -2.384 0.019
0.630 0.273 0.323 2.313 0.023

According to the results given in the table and change in standard deviation for the factors
considering the significance levels of mindfulness “judgmental” and “non-reactiveness” (-0.49 and -
components, the factors judgment and non- 0.37) can change the standard deviation of the
reactiveness can predict anxiety in women with MS. overall anxiety. In addition, the second model
According to beta coefficient, it can be said that the indicates that the components of mindfulness
Fundamentals of Mental Health, 2017 Aug-Sep http://jfmh.mums.ac.ir 369
PARENTING SELF-EFFICACY IN MULTIPLE SCLEROSIS MOHAMMADI POUR, POURAKBARAN

“action with awareness, judgmental and non- women with MS are less able to cope with stressful
reactiveness can predict parental self-efficacy. situations due to lack of mindfulness and rumination
According to beta coefficient, it can be said that the about the future (52). In fact, mindfulness can be a
change in standard deviation for the factors “action method to cope with stressful situations that if one is
with awareness”, “judgmental” and “non- not able to handle it, he/she is more likely to be
reactiveness” (0.28, 0.54 and 0.32) can change the anxious (29). In health-threatening situations which
standard deviation of the overall anxiety. According is associated with the high level of threat, those with
to the above table, and due to the significant mindfulness techniques are able to positively
predicting variables, the diagram for predicting reevaluate the events and try to logically consider
anxiety and parental self-efficacy is as the stressful situations safe (48). While, some
following: individuals are not able to do so which make them
Anxiety= 55.72 – (judgment×1.10) -(non- unstable to resists against stress. If one does not
reactiveness×0.727) =17.48+(action with have complete presence of the mind, we cannot
awareness×0.601) +(judgement×1.214) +(non- exactly distinguish what facilities exist. Therefore,
reactiveness×0.630) parental self-efficacy. how can we access those facilities? And how can we
change and grow? Therefore, the lack of
Discussion mindfulness can make individuals unable to identify
The present study aimed to predict parental self- their own possibilities and facilities to cope with
efficacy and hyper-anxiety symptoms based on the disease and perhaps that is why mindful patients
components of mindfulness in women with MS. The have anxiety less than other patients (46).
results indicated that the components of The presence of the mind is considered as an
mindfulness, “judgment” and “non-reactiveness” important underlying factor in order to attain
can reduce anxiety in women with MS. In addition, emancipation, since it is a powerful and effective
“action with awareness”, “judgment” and “non- way to neutralize the external and internal pressures
reactiveness” can increase parental self-efficacy. of an individual. The correct immediacy means that
These results are in line with the findings obtained one brings his/her awareness from past and future to
by Ghasemi et al. (33), Sheikholslami (34), the presence time. When an individual is in the
Boroujerdi et al. (35), Kaviani et al. (36), Sirois & presence time, he views reality with all the internal
Tosti (37), Singh et al. (32), Kort (38), Berrill et al. and external aspects, and realizes that the mind, due
(39), Van Ravesteijn (40), Bohlmeijer et al. (41). to its judgment and interpretation, is constantly
Evidence suggests that high level of mindfulness having rumination and inward conversation (29).
can increase psychological health, adjustment, Such understanding and internal thinking can
openness to experiences and mental health. This can influence parental self-efficacy; therefore, the
be due to the quick and timely use in problem patient can control his/her mind against negative
solving strategies. In fact, mindful individuals have thoughts from inefficiencies. However, those who
more ability in identifying, managing and solving are not mindful, they are not able to control their
daily problems (48). Britton et al. (49) indicated that negative thought and they always move toward
mindfulness-based methods can be effective on effective behaviors with a sense of disabilities.
social tensions. In addition, Rose et al. (50) Therefore, some patients use mindfulness skills as a
indicated that mindfulness can be an effective method to cope with stress and illness and they
method for the increased general health, self- consider mindfulness as a method consisting of the
satisfaction, and reduced anxiety, worry and coping continuous acceptance of changing experience and
ability with stress. Therefore, mindful individuals the potential parenting problems and issues (53).
are well able to have self-awareness Therefore, mindfulness is a skill that allows
comprehensively. Mindfulness can lead to the individuals to receive and realize the problems in
awareness of events, the awareness of body, breath, the presence time in a sense that they are less
sounds and thought, the acceptance of ideas without annoying than it used to be. When individuals
judgment and then changes in certain emotional become aware of the present time, they put their
meanings, and one can realize that thoughts as focus on the present time not the past. Most
derived from internal processes rather than a psychological problems are usually associated with
reflection of position. In this regard, one realizes events that have been occurred in the past or in the
her/his own automatic activity and habitual future. For example, those who are depressed, often
behaviors and obtains an increased awareness in feel guilty and regret about the past and those who
his/her own daily activities (51). It seems that are anxious, the worry from the future problems can

Fundamentals of Mental Health, 2017 Aug-Sep http://jfmh.mums.ac.ir 370

PARENTING SELF-EFFICACY IN MULTIPLE SCLEROSIS MOHAMMADI POUR, POURAKBARAN

cause fear and anxiety (54). It should be mention experimental studies and in counseling centers for
that patients with MS are greatly prone to such psychological intervention in women with MS.
problems, since the disease can be an influencing Counselors and other therapists are recommended to
factor for depression, anxiety and mental tensions. explore the factor mindfulness in the clients in their
While some patients, despite of having such clinical interviews and cognitive analysis, therefore
problems, are able to use mindfulness as a method they can increase the effectiveness of the treatment
for “being” or “understanding” through which they by recognizing their ineffective strategies and train
can perceive their personal feelings and situations. them the effective ones.
The consequence of such understanding can be a
problem as one become resistant against the incident Conclusion
(i.e., disease) (55). However, due to the fact that the As it can be seen, mindfulness can play a
present study has been conducted on a small sample significant role in reducing anxiety and increasing
size, more studies on larger samples are required. parental self-efficacy.
According to the results of the study and high scores
for parental self-efficacy and reduced anxiety in Acknowledgment
mindful patients, it is suggested that according to the The authors would like to thank all the
available sources and theories presented in this area, participants. The authors had no conflict of interests
step-by-step training packages can be used in and financial support from special organ.

References
1. Golestani O, Omrani O, Ali Khani M, Delpasand Vafaee R, Muzaffar A. [Analysis of the cost of treatment of MS
patients with a disease-modifying drugs in Iran]. Journal of medical sciences 2013; 21(7): 12-15. (Persian)
2. Harbo H, Gold R, Tintoré M. Sex and gender issues in multiple sclerosis. Ther Adv Neurol Disord 2013; 6(4): 237-
48.
3. Koriem KM. Multiple sclerosis: New insights and trends. J Trop Biomed 2016; 6(5): 429-40.
4. Hayes CE, Spanier JA. Multiple sclerosis in women: Vitamin D and estrogen synergy for autoimmune T-cell
regulation and demyelinating disease prevention. In: Watson RR, Killgore DS. Nutritional lifestyle and neurological
autoimmune Diseases. 1st ed. USA: Elsevier; 2017: 81-107.
5. Hasler G. Excessive daytime sleepiness in young adults: A 20-year prospective community study. J Clin Psychiatry
2009; 66(4): 521-9.
6. Emmerik RE, Jones SL, Busa MA, Remelius JG, Averi JL, Emmerik RE, et al. Enhancing postural stability and
adaptability in multiple sclerosis. Adv Exp Med Biol 2014; 826: 251-76.
7. Pakenham KL, Tilling J, Cretchley J. Parenting difficulties and resources: the perspectives of parents with multiple
sclerosis and their partners. J Psychol 2012; 57(1): 52-60.
8. Chen Y, Fish MC. Parental involvement of mothers with chronic illness and children’s academic achievement. J Fam
Issues 2013; 34: 5.
9. Pennell C, Whittingham K, Boyd R, Sanders M, Colditz P. Prematurity and parental self-efficacy: The preterm
parenting and self-efficacy checklist. Infant Behav Dev 2012; 35(4): 678-88.
10. Abarashi Z, Tahmassian K, Mazaheri AR, Panaghi L, Mansoori N. Parental self-efficacy as a determining Factor in
healthy mother-child interaction: A pilot study in Iran. Iran J Psychiatry Behav Sci 2014; 8(1): 19-25.
11. Tale'ee A, Tahmasian K, Vafaei.N. Effectiveness of positive parenting program on the effects of maternal
satisfaction. Journal of family research 2011; 27(1): 311-23. (Persian)
12. Young L. Exploring the relationship between parental self-efficacy and social support systems Dissertation. USA:
Samantha Iowa State University; 2011.
13. Tahmasian K, Anari A. [Factors affecting efficacy of mothers of children 2-6 years old parents]. Shahid Beheshti
University of Medical Scviences; 2011. (Persian)
14. Sarabi M, Hassan Abadi H, Mashhadi A, Asghari Nekah M. [The impact of parental education on self-efficacy of
mothers of children with Autism]. Journal of mental health 2011; 3(4): 84-9. (Persian)
15. Prokopova B, Hlavacova N, Vlcek M, Penesova , Penesova A, Grunnerova L, et al. Early cognitive impairment
along with decreased stress-induced BDNF in male and female patients with newly diagnosed multiple sclerosis. J
Neuroimmunol 2017; 302(15): 34-40.
16. Briones-Buixassa L, Raimon M, Aragonès JM, Ufill E, Olaya B, Arrufat FX. Stress and multiple sclerosis: A
systematic review considering potential moderating and mediating factors and methods of assessing stress. Health
Psychol Open 2015; 2(2): 20-55.
17. Visser LD, Knaapa LJ, Weerda CM, Ohl F. Trait anxiety affects decision-making differently in healthy men and
women: Towards gender-specific endophenotypes of anxiety. Neuropsychologia 2010; 48: 1598-606.
18. Ghasempour A, Soure J, Sydtazeh M. [Forecast death anxiety by cognitive emotion regulation strategies]. Science
and research in applied psychology 2012; 48(8): 65-72. (Persian)
Fundamentals of Mental Health, 2017 Aug-Sep http://jfmh.mums.ac.ir 371
PARENTING SELF-EFFICACY IN MULTIPLE SCLEROSIS MOHAMMADI POUR, POURAKBARAN

19. Sadock B, Sadock V. [Brief of psychiatry]. Pour Afkari N. (translator). Tehran: Shahrab; 2003. (Persian)
20. Movahedi Rad N, Javadi H, Ahmadi M. [Compare the prevalence of anxiety among students with different
demographic characteristics]. Training and evaluation 2012; 5: 131-46. (Persian)
21. Galbraith T, Heimberg RG, Wang S, Schneier FR, Blanco C. Comorbidity of social anxiety disorder and antisocial
personality disorder in the National Epidemiological Survey on Alcohol and Related Conditions NESARC. J Anxiety
Disord 2014; 28(1): 56-7.
22. Mobini S, Mackintosh B, Illingworth J, Gega L, Langdon P, Hoppitt L. Effects of standard and explicit cognitive
bias modification and computer-administered cognitive-behavior therapy on cognitive biases and social anxiety. J
Behav Ther Experim Psychiatry 2014; 45(2): 272-9.
23. Boeschoten RE, Braamse AM, Beekman FT, Cuijpers, P, Oppen P, Dekker J, et al. Prevalence of depression and
anxiety in Multiple Sclerosis: A systematic review and meta-analysis. J Neurol Sci 2017; 372(15): 331-41.
24. Lyu SW, Seok HH, Byun JS, Kim WJ, Shim SH, Bak CW. Sexual dysfunctions induced by stress of timed
intercourse and medical treatment. BJU Int 2013; 111(4 Pt B): E227-34.
25. Soundy A, Elder T. Developing and applying the theory of psychological adaptation needs in patients with multiple
sclerosis. In: Watson RR, Killgore DS. Nutritional lifestyle and neurological autoimmune Diseases. 1st ed. USA:
Elsevier; 2017: 117-25.
26. Muñ oz A, Oreja-Guevara C, Lorenzo C, Notario L, Vega BR, Pérez CB. Psychotherapeutic and psychosocial
interventions for managing stress in multiple sclerosis: The contribution of mindfulness-based interventions. Neurología
2016; 31(2): 113-20.
27. Davidson RJ, Kabat-zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF. Alterations in Brain and
Immune Function Produced by Mindfulness Meditation. Psychosom Med 2003; 65(1): 564-70.
28. Segal ZV, Williams JM, Teasdale JD. Mindfulness based cognitive therapy for depression: A new approach to
preventing relapse. New York: Guilford; 2002.
29. Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J. Mindfulness: A proposed operational
definition. Sci Pract 2004; 11(3): 223-41.
30. Cardaciotto L, Herbert JD, Forman ED, Moitra E, Farrow V. The assessment of present-moment awareness and
acceptance: The Philadelphia Mindfulness Scale. Assessment 2008; 15(1): 204-23.
31. Kabat-Zinn J. Full catastrophe living. New York: Delta; 1990.
32. Singh NN, Lancioni GE, Singh AD, Winton AS, Singh AN, Singh S. Adolescents with Asperger syndrome can use
a mindfulness-based strategy to control their aggressive behavior. Res Autism Spectr Disord 2012; 5(3): 1103-9.
33. Ghasemi Jubaneh R, Mousavi S, Zanipour A, Hoseini Sadiq M. [The relationship between mindfulness and emotion
regulation with academic procrastination]. Strategies in medical education 2016; 9(2): 134-41. (Persian)
34. Sheikholslami A, Dortaj F, Delavar A, Qavam I. [The impact of mindfulness-based stress reduction program on
procrastination students]. Journal of educational psychology 2014; 10: 94-109. (Persian)
35. Boroujerdi F, Safa M, Karamloo S, Masjedi M. [The effectiveness of mindfulness-based cognitive therapy for
depression and dysfunctional attitudes on tolerance in patients with chronic lung disease]. Research in psychological
health 2014; 8(4): 6-7. (Persian)
36. Kaviani H, Hatam N, Javaheri F. [Lowering effect of mindfulness-based cognitive therapy on your thoughts and
dysfunctional attitudes]. Research on psychological health 2008; 2(2): 5-14. (Persian)
37. Sirois FM, Tosti N. Lost in the moment? an investigation of procrastination, mindfulness, and well-being. J Rat-
Emo Cogn-Behav Ther 2012; 30(1): 237-43.
38. Kort K. The effects of a mindfulness based intervention on impulsivity, symptoms of depression, anxiety,
experiences and quality of life of persons suffering from substance use disorders and traumatic brain injury. Minnesota:
University of Minnesota; 2012.
39. Berrill JW, Sadlier M, Hood K, Green J. Mindfulness-based therapy for inflammatory bowel disease patients with
functional abdominal symptoms or high perceived stress levels. J Crohn's Colitis 2014; 13(3): 43-9.
40. Van Ravesteijn H. Mindfulness-based cognitive therapy for patients with medically unexplained symptoms: A cost-
effectiveness study. J Psychosom Res 2013; 74(3): 197-205.
41. Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental
health of adults with a chronic medical disease: A meta-analysis. J Psychosom Res 2010; 68(6): 539-44.
42. Tabachnick BG, Fidell LS. Using Multivariate statistics. 5th ed. Boston: Pearson Education.
43. Dumka LE, Stoerzinger HD, Jackson KM, Roosa MW. Examination of the cross-cultural and cross-language
equivalence of the parenting self-agency measure. Fam Relat 1996; 45(2): 216-22.
44. Akbari H, Mohammeidan A, Ghanbarabadi B. Effectiveness of cognitive behavior therapy and pharmacotherapy on
anxiety and impulsivity symptoms in men with borderline personality disorder. Journal of mental health. 2008; 40(1):
317-23. (Persian)
45. Rajabi S, Yazdkhasti F. [The effectiveness of acceptance and commitment therapy on anxiety and depression in
women with multiple sclerosis]. Clinical psychology 2014; 21(10): 28-9. (Persian)
46. Baer R, Smith G, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of
mindfulness. Assessment 2006; 13(1): 27-45.
Fundamentals of Mental Health, 2017 Aug-Sep http://jfmh.mums.ac.ir 372
PARENTING SELF-EFFICACY IN MULTIPLE SCLEROSIS MOHAMMADI POUR, POURAKBARAN

47. Haidari Nasab L, Ahmadvand Z, Shaeiri M. [Check the validity and reliability of the five aspects of mindfulness in
non-clinical samples of Persia]. Journal of behavioral sciences 2013; 3(7): 11-12. (Persian)
48. Williams P, Penman D. Mindfulness: A practical guide to peace in a frantic world. MacMillan: Abridged; 2011.
49. Britton WB, Shahar B, Szepsenwol O, Jacobs WJ. Mindfulness-based cognitive therapy improves emotional
reactivity to social stress: Results from a randomized controlled trial. Behav Ther 2012; 43(2): 338-65.
50. Rose EA. Impact of children with developmental disabilities and behavior problems on parenting stress.
Dissertation: Ohio State University, 2012.
51. Paterniti A. Comparing the efficacy of a mindfulness-based program to a skills-training program in the treatment of
test anxiety. Ph.D. Dissertation. Island: University of Island.
52. Milà R, Aragonès JM, Bufill E, Olaya B, Arrufat FX. Stress and multiple sclerosis: A systematic review considering
potential moderating and mediating factors and methods of assessing stress. Health Psychol Open 2015; 2(2): 20-55.
53. Schütze R, Rees C, Preece M, Schütze M. Low mindfulness predicts pain catastrophizing in a fear-avoidance model
of chronic pain. Pain 2009; 148(1): 120-7.
54. Mousavi M, Atashpour S, Molavi H. [The effect of group mindfulness training on the symptoms of obsessive-
compulsive disorder in women of Isfahan]. New findings in psychology 2010; 5: 51-77. (Persian)
55. Azargoon H, Kajbaf M, Molavi H, Abedi M. [Effect of mindfulness training on mental rumination and depression in
students of Isfahan University]. Journal of behavior 2009; 34(1): 13-22. (Persian)

Fundamentals of Mental Health, 2017 Aug-Sep http://jfmh.mums.ac.ir 373

Copyright of Journal of Fundamentals of Mental Health is the property of Mashhad
University of Medical Sciences, Center Office of Fundamentals of Mental Health and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.