papers of 2015 issue

ISSN: 2277-5536 (Print); 2277-5641 (Online)

DAV International Journal of Science Volume-4, Issue-2, June 2015

Page | 136

COGNITIVE ADJUSTMENT, EMOTIONAL AND BODY IMAGE

STRATEGIES IN WOMEN SUFFERING FROM MULTIPLE SCLEROSIS

COMPARED TO HEALTHY WOMEN

Zahra Zargar Balayjame1, Mohammad Reza Seirafi2*

1 Department of Clinical Psychology, Qazvin Branch, Islamic Azad University, Qazvin, Iran 2Department of Health Psychology, Karaj Branch, Islmaic Azad University, Karaj, Iran

*Corresponding Author, Email: [email protected]

ABSTRACT Objective: the aim of this study is comparing strategies cognitive adjust, emotional and body image in

women suffering from multiple sclerosis with healthy women .method: in this study, the method of this

study is causal event - a comparison. The statistics population consisted of women suffering from MS who

are member of multiple sclerosis community of Iran (patient diagnosis by the specialists of the community

membership conditions is) that in the second half of 1393 year in MS community center of Iran (located in

city of Tehran,) were present.

The volume of study statistical sample consisted of 180 people (90 people of women suffering from

multiple sclerosis referred to the MS community of Iran and 90 people of healthy women for example,

investigated and aim sample), which is as a available sampling method as the statistical sample was

selected.

Research instruments were consisted of excitement cognitive emotion regulation order questionnaire by

Nadia Gernfesky et al and body image concerns (bici). To analyze the hypotheses of ANOVA was used.

Findings: the results showed that the fact that there is a significant difference between cognitive emotion

regulation strategies among women suffering from multiple sclerosis with healthy women was confirmed.

Also between body image of women suffering from multiple sclerosis with healthy women, there was a

significant difference. Conclusion: the results showed that women suffering from multiple sclerosis in

cognitive emotion regulation strategies and body image with serious probleMS are faced.

Therefore, it is suggested that patients who are suffering from multiple sclerosis are under supervision of

drug treatments besides psychologist treatment and by supportive treatments and creating positive attitude

to life, it is possible to help people in the face of sufferers disease from multiple sclerosis

KEYWORDS: excitement- cognitive regulation, body image, multiple sclerosis.

INTRODUCTION Multiple sclerosis (MS) is an autoimmune disease, since the immune system can not recognize your tissues,

mistakenly attact to myelin sheath covering nerves.

Melin is lipid membrane that surrounds nerve fibers and causes conduction facilitate of nerve shocks

(dennison, moss-morris and chalder, 2009). The loss of melin in multiple sclerosis is associated with

reducing the speed of nerve message. Where the destroyed melin of sclerotic levels and the hard-set (as a

scar) occurs and because these levels are as numerous in brain and spinal cord, numerous scleros or multiple

sclerosis are called. (Khanjani, 1391).

In multiple sclerosis the clinical symptoMS depend on the location and extent of damage have and

destruction of melin usually in certain regions, such as the optic nerve, brain stem, cerebellum and white

material of brain hemispheres and spinal cord, leading to a set of clinical symptoMS as sudden blurred

vision, inability in limbs movement, ataxia, diplopia, and sensory disorders, as feeling of numbness in the

limbs and other various symptoMS is (dennison, mouse-morris and chalder, 2009). Multiple sclerosis

different challenges for physical and mental health to follow.



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Empirical research literature indicates high rate of depression and feelings of helplessness, increasing

anxiety, decreasing subjective welfare, quality of life and probleMS related to relations and social role

(logio, 2008; dodyouvanaf moin and mazor, 2008; Harrington and badger, 2009).

Multiple sclerosis threaten independence and person ability to effective participate in the family and society,

conduct the patients towards lack of competence and their confidence. Personconfidence flawed health and

her body.

Patients in accordance with their disease suffere the general stress and increasing. Pretension and

complications of the disease strongly on the iperson mage of self affects and and the effects of very

destructive on the patient's self-esteem have (diamond et al., 2008).

Cognitive emotion regulation strategies have considerable effects on emotions that each person will

experience. Cognitive emotion strategy regulation is a process through which people adjusted their

emotions as the conscious or unconscious untill as properly to various environmental applications respond

(kampel- sailes, Barlow, 2010).

Also dissatisfaction of body is a cognitive-affective component from body image, which includes the

feelings and negative recognition and sickness about body (Galyuto, Garcia, Groder, 2012).

Fealamet, hill, butch hulz, henderson, taska, goldfild (2012, as quoted by dodyouvanaf moin and mazur,

2008) also pointed out that when persons advertising ideal body image internalize for them and as a

personal standard introduced person at body dissatisfaction risk will place, and at this time, a wide range

of disorder behaviors will be common.

Body image is one of the psychological structures and a central context for health psychologists. The term

body image has two dimensions of cognitive and attitudinal.

The perceptual components of body image, on how to see the size, shape, weight, face, movement and

actions is related while attitudinal component is related which we how feeling and about these features

have, and how these feelings, driven our behaviors (gleeson, 2006).

The concept of body image is defined for the first time by sholder and with a psychological outlook as the

image of our body that forMS in our minds and the way that body for us is clear.

This concept has two main dimensions of body image capital and body image assessment, which body

image capital deals to the degree of behavior importance and the cognitive that people to their body and

appearance attributed deals and body image evaluation the to the degree of satisfaction or dissatisfaction of

body image and appearance of persons body is related.(harrington and bajer, 2009). Since the concept of cognitive emotion regulation and body image now in the field of providing

psychological researches has been entered and in about comparing these styles in patients and healthy

people and also as regards multiple sclerosis is a chronic disease with debilitating and numerous physical

symptoMS and and most stressful events on person enters, people suffering from this disease have certain

mental traits and body image more different compared with healthy persons.

Therefore the purpose of this study was determining the difference between the cognitive regulation

strategies, emotional and body image in women suffering from multiple sclerosis with healthy women, and

the main hypothesis of this study were as follows.

1. Do dimensions of cognitive emotion regulation strategies in women suffering from multiple sclerosis

(MS) with healthy women are significant differences.

2. Do dimensions of suffering from multiple sclerosis (MS) with healthy women are significant

differences.

METHOD

Methodology in this study, after event causal - a comparison which in it comparison of cognitive regulation

strategies, emotional (its components, including: self-blame, blame others, subjective rumination,

catastrophic, acceptation, renewed attention on planning, positive renewed attention, positive re-evaluation

of vision) and body image (its components including: assessment of appearance status, tends to appearance,

fitness assessment, orientation to fitness , hobby with overweight or mental weight , satisfaction of the areas

of the body) in women suffering from multiple sclerosis (MS) with healthy women was studied.



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In this study the statistical population consisted of women suffering from MS patient who are member of

MS community of Iran. (Patient diagnosis by the specialists of the community membership conditions is.)

That in the second half of 1393 year in MS community center of Iran (located in city of Tehran,) were

present.

The volume of statistical sample in this study 180 people (90 people of women suffering from multiple

sclerosis( m.s) referred to the MS community of Iran and 90 people of healthy women as the control group)

that as a available sampling method as the statistical sample was selected.

Entry criteria for patients including: women suffering from MS past two years of their disease, minimum

age of 20 years and maximum age of 40 years, minimum education diploma and exit criteria for patients,

including severe mental disorder, mental retardation, suffering from chronic diseases, such as heart disease,

kidney disease, etc.

Research tools

1. Questionnaire of cognitive emotion regulation:

Questionnaire of cognitive emotion regulation is a multidimensional questionnaire in 1999 year by

nadia granefskietal (1999; quoted granefski and kraaij, 2002) designed to identification of persons

cognitive coping strategies after experiencing the events or negative situations has been used. This

questionnaire is a self-report tool and has36-item. Implementation of this questionnaire is very easy

and for people 12 years and older (both normal and clinical populations) has been used.

Questionnaire of cognitive emotion regulation has the basis of strong theoretical and empirical and

from 9 subscales his rebuke: questions (1, 10, 19 and 28), others rebuke: questions (9, 18, 27 and

36), admission: questions (2, 11, 20 and 29), refocusing on planning: questions (5, 14, 23 and 32),

positive refocusing: questions (4, 13, 22 and 31), rumination: questions (6, 15, 24, 33), the views

acceptance: questions (7, 16, 25 and 34), creating catastrophizing: questions (8, 17, 26 and 35) has

been formed. Scores range from 1 (almost never) till 5 (almost always) is. In a study hassani et al.

(1387), reliability of the scale based on internal consistency and test-retest the methods and the

validity of mentioned questionnaire through the main component analysis by using varimax

rotation, the correlation between subscales and good criterion validity were reported.

Reliability of tool in the present study, through cronbach's alpha 0.79 has been calculated, also its

formal validity has been approved by the teachers

2. Questionnaire of body image concerns (bici):

This questionnaire by lilton etal in 2005year to evaluate the level of people concerns around your

appearance has made. To evaluate and preparing the present questionnaire lilton etal the present

questionnaire on 1403 people carried out. Cronbach's alpha coefficient was 93% and internal

reliability coefficient by using cronbach's alpha was 92%.

Also highly correlation with other existing measurement scales in this area show. For example, present

questionnaire correlation with physical deformity disorder questionnaire 0.001equaly r =83% obtained

indicating from high validity this scale is. In Iran, a research by basaknejad on students done reliability the

questionnaire of body image concerns by cronbach's alpha for male and female all students, respectively,

93%, 95% and 95% have been reported.

This questionnaireis self-assessment scale 46-iteMS by cash etal in 1986 and 1987 years to assess

of body image was created in this study from final form that was prepared by the cash in 1997year,

will be used.

This questionnaire including a number of sentence s about way of thinking, feeling or individuals behavior is. The tool has six subscales including: assessment of appearance status, tends to appearance, fitness



Page | 139

assessment, and orientation to fitness, hobby with overweight or mental weight, and satisfaction of the areas

of the body (Cash and Fleming, 2002).

Manner of performing

After selecting two groups of 90 in available women suffering from (MS) who referred to the MS

community of Iran and healthy women and filling the informed consent forMS to participate in the

program, first the cognitive emotion regulation strategie questionnaires and questionnaire of body image

anxiety have been implemented over both groups. After completing research forMS, collected and by

entering into analysis program spss were analyzed.

Results

Descriptive findings show that from the 90 triable people18 people were (20%) between 20 till 25 years,

49 people (54%) between 25 till 30), 23 people (25%) between 35 till 40 years.

35people (38%) diploma, 37 people (41%) ba 13 people (14%) bachelor and more. Age of onset of the

disease of 15 people (16%) were between 2 till 4 years, 52 people (57%) between 4 and 6 years, 27 people

(30%) between 6 and 8 years, 10 people (11%) between 8 till 10 years and higher.

First hypothesis: there is a significant difference between aspects of cognitive emotion regulation strategies

in women suffering from multiple sclerosis (MS) and healthy women.

Table 1.the results of leven test based on default of variance equaliy in ANOVA

Sig Df2 Df1 F The dependent variable index

850.8 870 8 58.3 Aspects of cognitive emotion regulation index

According to data of figure 1, the results of this test show that because the obtained significant level is

higher than 0.05, thus there is not a significant difference between two groups of control and experimental

from the perspective of variance, so the default for doing ANOVA has been observed.

Table 2. The results of ANOVA analysis of variance between the scores of cognitive emotion regulation

strategies in women with multiple sclerosis (MS) in healthy women

Sig F MS Df Ss Source

840.8 078*.3 858.004 8 858.004 Variance between group

- - 428.258 870 044.44574 Variance within group

- - - 870 044.45550 Total variance 85.8p



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According with table 3, the results of this test show that because the obtained significance level is larger

than 0.05, so this default has been observed for doing ANOVA.

Table4. The results of ANOVA analysis of variance between the scores of body image between women

with multiple sclerosis (MS) and healthy women.

Sig F MS Df Ss Source

888.8 578*.40 422.7084 8 422.7084 Variance between group

- - 323.857 870 400.20883 Variances within groups

- - - 870 088. 87350 Total variance

8/85p



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Moreover, people suffering from multiple sclerosis with psycho-social consequences of the disease

including failures in life goals, career, money, relationships, leisure activities, and activities of daily living

(khanjani, 1391; sadooiing and remik, alen ans swartz, yeh, 2010). Thus it seems logic that psychological

and emotional problems in patients with multiple sclerosis compared to normal individuals without this

disease and compared with other chronic diseases are very common.

On one hand, it can be said that the high prevalence of anxiety, depression and other emotional problems

and the impact of these problems on the overall performance of individual makes a few researchers identify

and focus related factors with this problem.( baktash, yaghoubi, yousefi, 1392) including one of these

factors, there is a kind of emotional dysregulation listed. Stress disorder, depression and anxiety are seen

as a result of problems in the regulation of emotion (campbell - sales, barlow, 2010) to the extent that

researchers consider depression as the most common psychological disorder in patients suffering from

multiple sclerosis and high estimated frequency between 27% to 54%. (Khanjani, 1391; sadovinc, a.d.

Remick, Allen, Swartz, Yee). In addition, 37% of people suffering from multiple sclerosis anxiety as the

most debilitating symptom of this disease ( stinger, e. Knudsen, l. Jensen, k) and have reported it in the first

year after recognizing this disease (khanjani, 1391; sadovinc, kanudsen, l. Jensen, k). So what reason

women with greater use of strategies to regulate negative emotion and positive emotion regulation strategies

is to use less of anxiety, depression and stress in their wake is multiple sclerosis.

Moreover, the results that there is a significant difference between body image in women suffering from

multiple sclerosis and healthy women has been confirmed. Thus, significant differences can be found

between dimensions of body image in women suffering from multiple scloresis and healthy women and

this difference is statistically significant. Patients with chronic and debilitating diseases such as multiple

sclerosis face dependent problems with this disease.( sanglichi, salimi, dastoorpour, mansouri, ashraghi nia,

Esmail zadeh and asadi lari, 1392). These problems limit their activities related with well-being. And thus

a result increase the complications and limitations in their own lives and at the end leaves a negative impact

on their life quality. (Morgante, l, 2005). Most studies in patients with multiple sclerosis focuses on the

problems associated with the physical and psychological less on cognitive and psychological aspects have

noted (feinstein, 2004; diamond et al., 2008).

Most researches in patients suffering from multiple sclerosis have focused on problems related with

physical and body dimensions more than cognitive and psychological aspects (Feinstein, a, 2004; Diamond

and et al, 2008). Researches of Lujive (2008), Mouiin Dudyouvanaf and marz (2008), Harington and Bajer

(2009) indicate the role of body image and its dimensions in important variables of life including life

quality. The term body image has two dimensions of perceptual and attitudinal. Perceptional components

is related with body image, how to size, shape, weight, face, movement and our actions, while the attitudinal

dimension is concerned with how we feel about these features and how to guide these emotions and

behavioure (glison, 2996). The researches show that women having more positive body image are more

satisfied from their lives (Katez, 2007; qouted by asgari and shabaki, 1389). Since the women suffering

from multiple sclerosis have lower life quality due to their disease, they face serious problems i their body

images.

The statistical populations of this research to Tehran and women shuddering from MS disease the member

of multiple sclerosis society of Iran and the difficulty of access to the research sample members due to

limitations of movement and their disease and prolonging the time of responding because of number and

variety of questions and muscle weakness of sample members are the limitations of this study. It is

suggested that future research studies will be done in other cities and other parts of the country on women

with MS in order to be comparable with the results of present study. As well as future research should be

done as example of cognitive emotion regulation strategies and body image compared with other patients

such as breast cancer and MS patients. And due to having multiple sclerosis in a list of specific diseases

such as welfare support centers, they should apart from financial support with drug treatment; to support

people with multiple sclerosis to improve body image is also planning to do. And the patients suffering

from multiple sclerosis should be under supervision of psychologist beside medical treatment. And by

having supportive treatment and creating positive attitude to life, it is possible to help these people to face

their problem.



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