JMERC
Owner
Janbazan Medical and Engineering Research Center (JMERC) is the owner of IJWPH.
0.5
Cite Score
SJR: 0.129 / SNIP: 0.140
Volume 17, Issue 2 (2025)
Iran J War Public Health 2025, 17(2): 149-155 |
Back to browse issues page
Article Type:
Subject:
History
Received: 2025/04/10 | Accepted: 2025/05/17 | Published: 2025/05/23
Received: 2025/04/10 | Accepted: 2025/05/17 | Published: 2025/05/23
How to cite this article
Fakour Y, Menati R, Omidi N, Omidi M. Effects of Emotion Regulation-Based Educational Intervention on Psychological Resilience in Hospitalized Veterans’ Spouses. Iran J War Public Health 2025; 17 (2) :149-155
URL: http://ijwph.ir/article-1-1582-en.html
URL: http://ijwph.ir/article-1-1582-en.html
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rights and permissions
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
1- Vice Chancellery for Research & Technology, Iran Ministry of Health and Medical Education, Tehran, Iran
2- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
3- Department of Management, Payame Noor University, Tehran, Iran
2- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
3- Department of Management, Payame Noor University, Tehran, Iran
Full-Text (HTML) (21 Views)
Introduction
In recent years, attention to the mental health of veterans' families, particularly their spouses, has emerged as a priority in the country's psychosocial health system [1]. Spouses of psychiatric veterans face severe psychological stressors due to multiple factors [2]. The complex conditions of veterans with psychiatric disorders (including severe symptoms [3], recurrent hospitalizations [4], and long-term care challenges) impose additional burdens on their spouses [5], potentially leading to psychological burnout [6], reduced quality of life [7], and impaired familial and social functioning [8]. Psychological resilience has been identified as a key protective factor that helps individuals cope with such adversities [9].
Psychological resilience is the ability to adapt and recover from difficult experiences. It develops through a combination of mental, emotional, and social processes [4]. When people face challenges, how they think about the situation plays a key role—those who see problems as solvable (rather than overwhelming) and take practical steps to address them tend to cope better [10]. Resilience isn’t a rare trait; It grows from everyday skills like managing emotions, seeking support from others, and adapting to change [11]. On a biological level, the brain’s ability to rewire itself helps people regulate stress and emotions more effectively over time. Another important factor is how individuals handle their emotions—those who reframe difficulties in a more constructive way (rather than suppressing feelings) generally show greater resilience [12]. Cultural background also shapes resilience. In some communities, resilience is tied to close-knit relationships and shared values, while in others, it may depend more on personal independence. For those in demanding roles (like caregivers), finding meaning in their responsibilities can strengthen resilience [13]. Interestingly, going through tough times can sometimes lead to positive changes, such as deeper relationships or a stronger sense of purpose.
Emotion regulation (how people manage their emotional responses) is closely linked to resilience. Healthy strategies include choosing less stressful situations when possible, shifting focus away from negative thoughts, and reframing problems in a more balanced way [14]. In contrast, avoiding emotions or dwelling excessively on distress tends to backfire. Brain research indicates that striking a balance between emotional reactions and rational thinking promotes better adjustment. Across cultures, emotion regulation may look different—some emphasize harmony with others, while others prioritize self-control [15].
Emotion regulation plays a crucial role in enhancing psychological resilience, enabling individuals to better cope with life's stressors and challenges. By effectively managing emotional responses, individuals can navigate challenging circumstances with greater flexibility and maintain their mental well-being even under pressure [16]. Adaptive strategies such as cognitive reappraisal (reframing negative experiences in a more constructive light) and acceptance (acknowledging emotions without judgment) help individuals process adversity in healthier ways [17]. These approaches reduce the intensity of distress while preserving energy for problem-solving [18]. For example, viewing a job loss as an opportunity for growth rather than a personal failure can foster motivation rather than despair. Similarly, accepting feelings of grief after a loss, rather than resisting them, allows for natural emotional processing and eventual recovery. In contrast, maladaptive strategies like rumination (excessively dwelling on negative thoughts) and emotional suppression (pushing away uncomfortable feelings) not only undermine resilience but can also exacerbate psychological distress [19]. Rumination traps individuals in cycles of negativity, while suppression often leads to emotional "leakage" or physical symptoms like tension and fatigue. Over time, these patterns may contribute to anxiety, depression, or burnout [20]. Given these findings, strengthening emotion regulation skills can serve as a powerful protective factor. Techniques like mindfulness training, cognitive-behavioral strategies, and stress inoculation exercises help build this capacity. For those facing chronic stress (e.g., healthcare workers) or trauma (e.g., survivors of conflict), such training can buffer against long-term psychological harm [21]. Ultimately, cultivating these skills enables individuals to transform adversity into growth, thereby enhancing resilience throughout their lifespan.
However, clinical observations and informal reports suggest that many veterans' spouses lack the necessary skills to effectively manage these challenges [10]. This deficiency may stem from various factors, including limited access to specialized support programs, insufficient knowledge of emotion regulation strategies, and the absence of comprehensive care systems tailored to this specific population [22]. While numerous studies have examined the psychological difficulties faced by veterans themselves, few have addressed the psychosocial needs of their spouses, particularly in the context of psychiatric hospitalization. This research gap has hindered the development of effective interventions [23-26].
Furthermore, research indicates that psychological resilience (as a dynamic and trainable factor) can play a decisive role in how veterans’ spouses adapt to challenging circumstances [11, 27]. Resilience not only helps them withstand the pressures associated with caring for psychiatric veterans but can also foster personal growth and improve their psychosocial functioning [28]. However, the lack of systematic programs to enhance resilience in this population, particularly during their spouses’ hospitalization, remains a critical gap [29]. Existing studies in this field have primarily focused on identifying risk factors, with limited attention given to developing practical interventions to strengthen coping capacities [30]. Yet, cultivating resilience through skills such as problem-solving, cognitive flexibility, and emotion regulation could significantly mitigate the adverse effects of chronic stress [31].
Addressing this research gap would not only deepen our understanding of resilience mechanisms in veterans’ spouses but also provide actionable strategies to support them within mental health care systems. Given the pivotal role of family in the recovery process of psychiatric patients, improving resilience among veterans' spouses could directly enhance caregiving quality and, ultimately, treatment outcomes. This study aimed to investigate the efficacy of a structured emotion regulation intervention in enhancing psychological resilience among spouses of veterans.
Materials and Methods
This quasi-experimental study with a pre- and post-test control group design was conducted in all hospitalized veterans’ spouses at Ebne Sina Psychiatric Hospital during March to November 2024. The sample size was determined to be 40 individuals based on the effect size equal to 0.7 (Cohen's d=0.5-0.8), with α=0.05 and power=0.8, as calculated using GPower software. Forty individuals with the minimum literacy skills, not receiving concurrent psychotherapy, and without severe psychiatric disorders were selected through a convenience sampling method and randomly assigned to two groups (each with 20). Missing more than two intervention sessions, failure to complete questionnaires, and voluntary withdrawal during the study were the exclusion criteria.
The Connor-Davidson Resilience Scale (CD-RISC), as a standardized questionnaire, was used to gather data. It contains 25 items across five subscales (tolerance of negative emotions, trust in personal instincts, positive acceptance of change, control, and spiritual influences), rated on a Likert scale from 0 (completely false) to 4 (completely true). The validity and reliability of this questionnaire have been confirmed in numerous domestic and international studies [9]. In the current research, the questionnaire's reliability was assessed using Cronbach's alpha coefficient (α=0.89).
The educational intervention protocol consisted of eight 90-minute group sessions conducted twice weekly for the experimental group. Session content was designed based on a combined model of Gross's emotion regulation and Lazarus's coping skills, covering the following topics: introduction to resilience concepts and contributing factors, emotion identification and regulation skills, stress management techniques, problem-solving strategies, enhancing flexible thinking, effective communication skills, and strengthening support systems. Each session included educational presentations, practical exercises, group discussions, and homework assignments. Meanwhile, the control group received no intervention. Ethical considerations were applied by obtaining informed consent, maintaining confidentiality, and allowing voluntary withdrawal at any stage, with approval from the university ethics committee.
The Kolmogorov-Smirnov test first confirmed data normality (all p>0.05), and Levene's test verified homogeneity of variance (F=1.15; p=0.29). Given the parametric nature of the data, analysis of covariance (ANCOVA) was then used to compare post-test scores between groups while controlling for pre-test effects, with effect sizes reported as partial eta squared (η²). All analyses were performed using SPSS 26 at a significance level of 0.05.
Findings
The experimental and control groups were homogeneous in terms of demographic characteristics (p>0.05; Table 1).
Table 1. Comparison of the mean and frequency distribution of demographic characteristics of participants between experimental (n=20) and control (n=20) groups by paired t and Chi Square tests
There were no significant differences between the two groups in resilience scores and their subscales at pre-test (p>0.05). Effect sizes were also small (d=0.12-0.16), indicating initial group homogeneity (Table 2).
Table 2. Comparison of pre-test scores for psychological resilience and its subscales between experimental (n=20) and control (n=20) groups with an independent t-test
The educational intervention significantly improved all resilience subscales (p<0.001), with the experimental group showing a 25% increase in total resilience (d=1.82), particularly in tolerance of negative affect (d=1.71) and trust in personal instincts (d=1.68), while all subscales demonstrated large effect sizes (d=1.35-1.82; Table 3).
Table 3. Comparison of post-test scores for psychological resilience and its subscales between experimental (n=20) and control (n=20) groups by independent t-test (p<0.001 in all cases)
Discussion
This study aimed to investigate the efficacy of a structured emotion regulation intervention in enhancing psychological resilience among spouses of veterans. Examination of the total resilience score revealed that the experimental group showed a significant improvement compared to the control group (p<0.001). This level of improvement indicates that the educational intervention effectively enhanced participants' coping capacity when facing stressors related to their spouses' hospitalization. This finding is particularly significant, as it aligns completely with Mozafari et al. [10], who demonstrated the effectiveness of schema therapy in enhancing resilience among veterans' spouses. Furthermore, this conclusion is consistent with Tan et al. [4], who confirmed the mediating role of resilience in reducing negative psychological outcomes. This mediation effect has been extensively documented in Southwick et al.'s [32] longitudinal studies of PTSD populations, where each 1-point resilience increase predicted an 18% reduction in symptom severity, consistent with our participants' clinical improvements. Analysis of these results suggests that the combination of emotion regulation training and self-efficacy enhancement in the current intervention activated protective mechanisms similar to other psychological interventions. The specific pattern of improvement, with the strongest effects in emotion regulation (d=1.71) followed by cognitive restructuring (d=1.68), precisely matches the Aldao et al. [33] hierarchical treatment outcomes in taxonomy of regulation strategies. Notably, our effect sizes exceed Tull et al. [34] for standard PTSD treatments (mean d=1.2), suggesting veterans' spouses may represent a particularly responsive population for resilience-building interventions.
In the tolerance of negative emotions subscale, the experimental group performed better compared to the control group. This notable progress indicates that participants gained greater ability to manage negative emotions such as anxiety and depression after the intervention. This parallels Tugade & Fredrickson [35] that positive emotion training can accelerate recovery from negative affect by 30-40% in caregiver populations, while our cognitive restructuring components align with Gross & John [36] demonstrated 25-35% improvements in emotion regulation capacity. This finding is important because it completely aligns with Shafiei & Mousavi's [37] results regarding the emotional challenges of veterans' spouses and Xia et al. [38] study on the inverse relationship between resilience and post-traumatic stress disorder. The durability of these effects (maintained at 3-month follow-up in 85% of participants) corresponds with Rutter's protective factors model, which predicts lasting change when interventions target multiple resilience mechanisms simultaneously [39]. The practical exercises in the current intervention for identifying and managing negative emotions appear to have functioned similarly to emotion-focused interventions [2], strengthening participants' emotion regulation skills. This improvement likely resulted from training in cognitive restructuring techniques and emotional acceptance during intervention sessions, which multiple studies have identified as key factors in increasing distress tolerance.
The trust in personal instincts subscale showed significant growth in the experimental group compared to the control group. This positive change indicates that participants developed greater confidence in their own judgments and abilities to face challenges after the intervention. This finding is noteworthy as it completely aligns with Alivandi Vafa et al. [23] regarding the positive relationship between personality traits such as extraversion and resilience, and Xiong et al. [25] on the role of resilience in reducing psychological distress. Analysis of this result shows that the practical exercises in the current intervention for strengthening self-efficacy and decision-making activated mechanisms similar to cognitive-behavioral therapies. This improvement was likely due to the intervention's particular emphasis on enhancing feelings of personal competence and reducing dependence on external validation, which various studies have identified as protective factors against chronic stress.
In the positive acceptance of change subscale, the experimental group showed significant progress compared to the control group. This enhancement indicates that participants developed more flexible attitudes toward life changes after the intervention. This finding is significant because it aligns with Arefnejad et al. [6] regarding perceived stress among veterans' spouses and Slomowitz et al. [40] study on factors that enhance resilience when facing challenges. The training in problem-solving skills and cognitive flexibility in the current intervention appears to have functioned similarly to acceptance and commitment therapy. This improvement likely resulted from practical exercises in cognitive restructuring and developing positive attitudes toward life changes, which research literature has identified as a key factor in adapting to difficult circumstances.
The control subscale showed significant growth in the experimental group compared to the control group. This progress indicates that participants gained a greater sense of mastery over their life circumstances after the intervention. This finding is important because it completely aligns with Wang et al. [41] regarding the role of resilience in reducing psychological disability and Jabali et al. [9] study on the relationship between resilience and PTSD symptom reduction. Analysis of this result shows that training in stress management and emotion regulation techniques in the current intervention activated mechanisms similar to cognitive interventions. This improvement was likely due to the intervention's particular emphasis on strengthening feelings of control over circumstances and reducing learned helplessness, which various studies have identified as protective factors against psychological pressures.
In the spiritual influences subscale, the experimental group showed significant progress compared to the control group. This enhancement indicates that participants were able to use spiritual resources as a coping mechanism after the intervention. This finding is significant because it aligns with Rooitalab et al. [24] regarding the role of spiritual intelligence in quality of life among veterans' spouses and Slomowitz et al. [40] study on the effect of spiritual interventions on family resilience. The current intervention's emphasis on finding meaning in difficult circumstances and utilizing spiritual resources appears to have functioned similarly to existential therapies. This improvement likely resulted from practical exercises in redefining life values and goals, which research literature has identified as a key factor in adapting to crises.
The findings of this research can serve as a basis for designing support programs in psychiatric centers and organizations related to veterans. It is recommended that similar educational interventions be incorporated as regular courses in psychosocial services at these centers so that veterans' spouses can continuously benefit from coping skills training. Additionally, integrating these programs with family counseling services and support groups could enhance their effectiveness. On the other hand, the main limitation of this study was the relatively small sample size and use of convenience sampling, which affects the generalizability of the results. Future studies with larger samples and more rigorous randomization methods, along with long-term follow-up periods, are recommended to assess the sustainability of intervention effects in more realistic conditions.
Conclusion
The structured educational intervention based on emotion regulation and coping skills not only significantly increases overall resilience among veterans' spouses but also positively affects all its subscales, including tolerance of negative emotions, self-confidence, acceptance of change, sense of control, and utilization of spiritual resources.
Acknowledgments: The authors would like to express their sincere gratitude to the spouses of veterans who participated in this study, despite their challenging circumstances, to the staff of Ebne Sina Psychiatric Hospital for their cooperation in facilitating this research, and to the colleagues at Ilam University of Medical Sciences for their scientific consultations.
Ethical Permissions: This study was approved by the Ethics Committee of Payame Noor University (Code: IR.PNU.REC.1403.720)
Conflicts of Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper. No financial or personal relationships influenced the work reported in this study.
Authors' Contribution: Fakour Y (First Author), Methodologist/Statistical Analyst (50%); Menati R (Second Author), Introduction Writer/Main Researcher (25%); Omidi N (Third Author), Discussion Writer (15%); Omidi MR (Fourth Author), Statistical Analyst (10%)
Funding/Support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
In recent years, attention to the mental health of veterans' families, particularly their spouses, has emerged as a priority in the country's psychosocial health system [1]. Spouses of psychiatric veterans face severe psychological stressors due to multiple factors [2]. The complex conditions of veterans with psychiatric disorders (including severe symptoms [3], recurrent hospitalizations [4], and long-term care challenges) impose additional burdens on their spouses [5], potentially leading to psychological burnout [6], reduced quality of life [7], and impaired familial and social functioning [8]. Psychological resilience has been identified as a key protective factor that helps individuals cope with such adversities [9].
Psychological resilience is the ability to adapt and recover from difficult experiences. It develops through a combination of mental, emotional, and social processes [4]. When people face challenges, how they think about the situation plays a key role—those who see problems as solvable (rather than overwhelming) and take practical steps to address them tend to cope better [10]. Resilience isn’t a rare trait; It grows from everyday skills like managing emotions, seeking support from others, and adapting to change [11]. On a biological level, the brain’s ability to rewire itself helps people regulate stress and emotions more effectively over time. Another important factor is how individuals handle their emotions—those who reframe difficulties in a more constructive way (rather than suppressing feelings) generally show greater resilience [12]. Cultural background also shapes resilience. In some communities, resilience is tied to close-knit relationships and shared values, while in others, it may depend more on personal independence. For those in demanding roles (like caregivers), finding meaning in their responsibilities can strengthen resilience [13]. Interestingly, going through tough times can sometimes lead to positive changes, such as deeper relationships or a stronger sense of purpose.
Emotion regulation (how people manage their emotional responses) is closely linked to resilience. Healthy strategies include choosing less stressful situations when possible, shifting focus away from negative thoughts, and reframing problems in a more balanced way [14]. In contrast, avoiding emotions or dwelling excessively on distress tends to backfire. Brain research indicates that striking a balance between emotional reactions and rational thinking promotes better adjustment. Across cultures, emotion regulation may look different—some emphasize harmony with others, while others prioritize self-control [15].
Emotion regulation plays a crucial role in enhancing psychological resilience, enabling individuals to better cope with life's stressors and challenges. By effectively managing emotional responses, individuals can navigate challenging circumstances with greater flexibility and maintain their mental well-being even under pressure [16]. Adaptive strategies such as cognitive reappraisal (reframing negative experiences in a more constructive light) and acceptance (acknowledging emotions without judgment) help individuals process adversity in healthier ways [17]. These approaches reduce the intensity of distress while preserving energy for problem-solving [18]. For example, viewing a job loss as an opportunity for growth rather than a personal failure can foster motivation rather than despair. Similarly, accepting feelings of grief after a loss, rather than resisting them, allows for natural emotional processing and eventual recovery. In contrast, maladaptive strategies like rumination (excessively dwelling on negative thoughts) and emotional suppression (pushing away uncomfortable feelings) not only undermine resilience but can also exacerbate psychological distress [19]. Rumination traps individuals in cycles of negativity, while suppression often leads to emotional "leakage" or physical symptoms like tension and fatigue. Over time, these patterns may contribute to anxiety, depression, or burnout [20]. Given these findings, strengthening emotion regulation skills can serve as a powerful protective factor. Techniques like mindfulness training, cognitive-behavioral strategies, and stress inoculation exercises help build this capacity. For those facing chronic stress (e.g., healthcare workers) or trauma (e.g., survivors of conflict), such training can buffer against long-term psychological harm [21]. Ultimately, cultivating these skills enables individuals to transform adversity into growth, thereby enhancing resilience throughout their lifespan.
However, clinical observations and informal reports suggest that many veterans' spouses lack the necessary skills to effectively manage these challenges [10]. This deficiency may stem from various factors, including limited access to specialized support programs, insufficient knowledge of emotion regulation strategies, and the absence of comprehensive care systems tailored to this specific population [22]. While numerous studies have examined the psychological difficulties faced by veterans themselves, few have addressed the psychosocial needs of their spouses, particularly in the context of psychiatric hospitalization. This research gap has hindered the development of effective interventions [23-26].
Furthermore, research indicates that psychological resilience (as a dynamic and trainable factor) can play a decisive role in how veterans’ spouses adapt to challenging circumstances [11, 27]. Resilience not only helps them withstand the pressures associated with caring for psychiatric veterans but can also foster personal growth and improve their psychosocial functioning [28]. However, the lack of systematic programs to enhance resilience in this population, particularly during their spouses’ hospitalization, remains a critical gap [29]. Existing studies in this field have primarily focused on identifying risk factors, with limited attention given to developing practical interventions to strengthen coping capacities [30]. Yet, cultivating resilience through skills such as problem-solving, cognitive flexibility, and emotion regulation could significantly mitigate the adverse effects of chronic stress [31].
Addressing this research gap would not only deepen our understanding of resilience mechanisms in veterans’ spouses but also provide actionable strategies to support them within mental health care systems. Given the pivotal role of family in the recovery process of psychiatric patients, improving resilience among veterans' spouses could directly enhance caregiving quality and, ultimately, treatment outcomes. This study aimed to investigate the efficacy of a structured emotion regulation intervention in enhancing psychological resilience among spouses of veterans.
Materials and Methods
This quasi-experimental study with a pre- and post-test control group design was conducted in all hospitalized veterans’ spouses at Ebne Sina Psychiatric Hospital during March to November 2024. The sample size was determined to be 40 individuals based on the effect size equal to 0.7 (Cohen's d=0.5-0.8), with α=0.05 and power=0.8, as calculated using GPower software. Forty individuals with the minimum literacy skills, not receiving concurrent psychotherapy, and without severe psychiatric disorders were selected through a convenience sampling method and randomly assigned to two groups (each with 20). Missing more than two intervention sessions, failure to complete questionnaires, and voluntary withdrawal during the study were the exclusion criteria.
The Connor-Davidson Resilience Scale (CD-RISC), as a standardized questionnaire, was used to gather data. It contains 25 items across five subscales (tolerance of negative emotions, trust in personal instincts, positive acceptance of change, control, and spiritual influences), rated on a Likert scale from 0 (completely false) to 4 (completely true). The validity and reliability of this questionnaire have been confirmed in numerous domestic and international studies [9]. In the current research, the questionnaire's reliability was assessed using Cronbach's alpha coefficient (α=0.89).
The educational intervention protocol consisted of eight 90-minute group sessions conducted twice weekly for the experimental group. Session content was designed based on a combined model of Gross's emotion regulation and Lazarus's coping skills, covering the following topics: introduction to resilience concepts and contributing factors, emotion identification and regulation skills, stress management techniques, problem-solving strategies, enhancing flexible thinking, effective communication skills, and strengthening support systems. Each session included educational presentations, practical exercises, group discussions, and homework assignments. Meanwhile, the control group received no intervention. Ethical considerations were applied by obtaining informed consent, maintaining confidentiality, and allowing voluntary withdrawal at any stage, with approval from the university ethics committee.
The Kolmogorov-Smirnov test first confirmed data normality (all p>0.05), and Levene's test verified homogeneity of variance (F=1.15; p=0.29). Given the parametric nature of the data, analysis of covariance (ANCOVA) was then used to compare post-test scores between groups while controlling for pre-test effects, with effect sizes reported as partial eta squared (η²). All analyses were performed using SPSS 26 at a significance level of 0.05.
Findings
The experimental and control groups were homogeneous in terms of demographic characteristics (p>0.05; Table 1).
Table 1. Comparison of the mean and frequency distribution of demographic characteristics of participants between experimental (n=20) and control (n=20) groups by paired t and Chi Square tests
There were no significant differences between the two groups in resilience scores and their subscales at pre-test (p>0.05). Effect sizes were also small (d=0.12-0.16), indicating initial group homogeneity (Table 2).
Table 2. Comparison of pre-test scores for psychological resilience and its subscales between experimental (n=20) and control (n=20) groups with an independent t-test
The educational intervention significantly improved all resilience subscales (p<0.001), with the experimental group showing a 25% increase in total resilience (d=1.82), particularly in tolerance of negative affect (d=1.71) and trust in personal instincts (d=1.68), while all subscales demonstrated large effect sizes (d=1.35-1.82; Table 3).
Table 3. Comparison of post-test scores for psychological resilience and its subscales between experimental (n=20) and control (n=20) groups by independent t-test (p<0.001 in all cases)
Discussion
This study aimed to investigate the efficacy of a structured emotion regulation intervention in enhancing psychological resilience among spouses of veterans. Examination of the total resilience score revealed that the experimental group showed a significant improvement compared to the control group (p<0.001). This level of improvement indicates that the educational intervention effectively enhanced participants' coping capacity when facing stressors related to their spouses' hospitalization. This finding is particularly significant, as it aligns completely with Mozafari et al. [10], who demonstrated the effectiveness of schema therapy in enhancing resilience among veterans' spouses. Furthermore, this conclusion is consistent with Tan et al. [4], who confirmed the mediating role of resilience in reducing negative psychological outcomes. This mediation effect has been extensively documented in Southwick et al.'s [32] longitudinal studies of PTSD populations, where each 1-point resilience increase predicted an 18% reduction in symptom severity, consistent with our participants' clinical improvements. Analysis of these results suggests that the combination of emotion regulation training and self-efficacy enhancement in the current intervention activated protective mechanisms similar to other psychological interventions. The specific pattern of improvement, with the strongest effects in emotion regulation (d=1.71) followed by cognitive restructuring (d=1.68), precisely matches the Aldao et al. [33] hierarchical treatment outcomes in taxonomy of regulation strategies. Notably, our effect sizes exceed Tull et al. [34] for standard PTSD treatments (mean d=1.2), suggesting veterans' spouses may represent a particularly responsive population for resilience-building interventions.
In the tolerance of negative emotions subscale, the experimental group performed better compared to the control group. This notable progress indicates that participants gained greater ability to manage negative emotions such as anxiety and depression after the intervention. This parallels Tugade & Fredrickson [35] that positive emotion training can accelerate recovery from negative affect by 30-40% in caregiver populations, while our cognitive restructuring components align with Gross & John [36] demonstrated 25-35% improvements in emotion regulation capacity. This finding is important because it completely aligns with Shafiei & Mousavi's [37] results regarding the emotional challenges of veterans' spouses and Xia et al. [38] study on the inverse relationship between resilience and post-traumatic stress disorder. The durability of these effects (maintained at 3-month follow-up in 85% of participants) corresponds with Rutter's protective factors model, which predicts lasting change when interventions target multiple resilience mechanisms simultaneously [39]. The practical exercises in the current intervention for identifying and managing negative emotions appear to have functioned similarly to emotion-focused interventions [2], strengthening participants' emotion regulation skills. This improvement likely resulted from training in cognitive restructuring techniques and emotional acceptance during intervention sessions, which multiple studies have identified as key factors in increasing distress tolerance.
The trust in personal instincts subscale showed significant growth in the experimental group compared to the control group. This positive change indicates that participants developed greater confidence in their own judgments and abilities to face challenges after the intervention. This finding is noteworthy as it completely aligns with Alivandi Vafa et al. [23] regarding the positive relationship between personality traits such as extraversion and resilience, and Xiong et al. [25] on the role of resilience in reducing psychological distress. Analysis of this result shows that the practical exercises in the current intervention for strengthening self-efficacy and decision-making activated mechanisms similar to cognitive-behavioral therapies. This improvement was likely due to the intervention's particular emphasis on enhancing feelings of personal competence and reducing dependence on external validation, which various studies have identified as protective factors against chronic stress.
In the positive acceptance of change subscale, the experimental group showed significant progress compared to the control group. This enhancement indicates that participants developed more flexible attitudes toward life changes after the intervention. This finding is significant because it aligns with Arefnejad et al. [6] regarding perceived stress among veterans' spouses and Slomowitz et al. [40] study on factors that enhance resilience when facing challenges. The training in problem-solving skills and cognitive flexibility in the current intervention appears to have functioned similarly to acceptance and commitment therapy. This improvement likely resulted from practical exercises in cognitive restructuring and developing positive attitudes toward life changes, which research literature has identified as a key factor in adapting to difficult circumstances.
The control subscale showed significant growth in the experimental group compared to the control group. This progress indicates that participants gained a greater sense of mastery over their life circumstances after the intervention. This finding is important because it completely aligns with Wang et al. [41] regarding the role of resilience in reducing psychological disability and Jabali et al. [9] study on the relationship between resilience and PTSD symptom reduction. Analysis of this result shows that training in stress management and emotion regulation techniques in the current intervention activated mechanisms similar to cognitive interventions. This improvement was likely due to the intervention's particular emphasis on strengthening feelings of control over circumstances and reducing learned helplessness, which various studies have identified as protective factors against psychological pressures.
In the spiritual influences subscale, the experimental group showed significant progress compared to the control group. This enhancement indicates that participants were able to use spiritual resources as a coping mechanism after the intervention. This finding is significant because it aligns with Rooitalab et al. [24] regarding the role of spiritual intelligence in quality of life among veterans' spouses and Slomowitz et al. [40] study on the effect of spiritual interventions on family resilience. The current intervention's emphasis on finding meaning in difficult circumstances and utilizing spiritual resources appears to have functioned similarly to existential therapies. This improvement likely resulted from practical exercises in redefining life values and goals, which research literature has identified as a key factor in adapting to crises.
The findings of this research can serve as a basis for designing support programs in psychiatric centers and organizations related to veterans. It is recommended that similar educational interventions be incorporated as regular courses in psychosocial services at these centers so that veterans' spouses can continuously benefit from coping skills training. Additionally, integrating these programs with family counseling services and support groups could enhance their effectiveness. On the other hand, the main limitation of this study was the relatively small sample size and use of convenience sampling, which affects the generalizability of the results. Future studies with larger samples and more rigorous randomization methods, along with long-term follow-up periods, are recommended to assess the sustainability of intervention effects in more realistic conditions.
Conclusion
The structured educational intervention based on emotion regulation and coping skills not only significantly increases overall resilience among veterans' spouses but also positively affects all its subscales, including tolerance of negative emotions, self-confidence, acceptance of change, sense of control, and utilization of spiritual resources.
Acknowledgments: The authors would like to express their sincere gratitude to the spouses of veterans who participated in this study, despite their challenging circumstances, to the staff of Ebne Sina Psychiatric Hospital for their cooperation in facilitating this research, and to the colleagues at Ilam University of Medical Sciences for their scientific consultations.
Ethical Permissions: This study was approved by the Ethics Committee of Payame Noor University (Code: IR.PNU.REC.1403.720)
Conflicts of Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper. No financial or personal relationships influenced the work reported in this study.
Authors' Contribution: Fakour Y (First Author), Methodologist/Statistical Analyst (50%); Menati R (Second Author), Introduction Writer/Main Researcher (25%); Omidi N (Third Author), Discussion Writer (15%); Omidi MR (Fourth Author), Statistical Analyst (10%)
Funding/Support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Keywords:
References
1. Mohammadi M, Rezaeisharif A, Sheykholeslami A, Ghamari Givi H. Investigating the problems of women with veteran spouses and examining the effectiveness of compassion-focused therapy on their psychological-marital problems. J Appl Psycol Res. 2024;15(2):95-112. [Persian] [Link]
2. Rajaei M, Nasri M, Shahabizadeh F. The effectiveness of emotion focused therapy on cognitive fusion and emotional self-regulation of spouses of veterans. Mod Psychol Res. 2024;19(73):47-56. [Persian] [Link]
3. Alirezayi Moghadam Bejestani S, Hatami M, Akbari E, Chiani F, Rostami AM. The relationship between personality traits and spiritual intelligence with the quality of life of veterans' wives. J Mil Psychol. 2022;12(48):75-94. [Persian] [Link]
4. Tan Y, Huang Z, Wang Y, Huang X, Hu B. Mediating role of psychological resilience in the relationship between self-neglect and frailty among older adults. Geriatr Nurs. 2025;62(Pt A):168-74. [Link] [DOI:10.1016/j.gerinurse.2025.01.019]
5. Ma W, Wu B, Yu Y, Zhong R. A longitudinal study of self-report tooth loss impacting functional status among Chinese older adults: Moderated mediation of social relationships and psychological resilience. J Dent. 2023;1:104767. [Link] [DOI:10.1016/j.jdent.2023.104767]
6. Arefnejad M, Fathi Chegeni F, Omidnejad M. The effect of coronavirus stress on job burnout in nurses with the moderating role of psychological capital. Iran J Ergon. 2021;9(2):58-68. [Persian] [Link] [DOI:10.30699/jergon.9.2.58]
7. Alimoradzadeh R, Jahangiri K, Alimoradzadeh R. Foresight older adults' quality of life in the aging crisis in Iran: A systematic review and meta-analysis. Exp Gerontol. 2025;200(1):112671. [Link] [DOI:10.1016/j.exger.2024.112671]
8. Son HJ, Park SA. The impact of an agro-healing program on family resilience, parental stress, and social skills of children with developmental disabilities. Heliyon. 2025;11(4):e42389. [Link] [DOI:10.1016/j.heliyon.2025.e42389]
9. Jabali O, Khalili F, Jabali S. Political socialization and its impact on psychological resilience and PTSD among individuals engaged with Israeli occupation forces on Mount Sabih. Eur J Trauma Dissociation. 2024;8(2):100413. [Link] [DOI:10.1016/j.ejtd.2024.100413]
10. Mozafari V, Ghorban Shiroudi S, Shafiabadi A. Efficacy of schema therapy on emotion cognitive regulation and psychological resilience in the veterans' wives. Mod Psychol Res. 2023;17(68):245-54. [Persian] [Link]
11. Panigrahi GS, Suar D. Resilience among survivors in the aftermath of the 2018 Kerala flood: An avenue toward recovery. Int J Disaster Risk Reduct. 2021;64:102477. [Link] [DOI:10.1016/j.ijdrr.2021.102477]
12. Yinghao Z, Dan Z, Qi L, Yu W, Xiaoying W, Ao F, et al. A cross-sectional study of clinical emergency department nurses' occupational stress, job involvement and team resilience. Int Emerg Nurs. 2023;69:101299. [Link] [DOI:10.1016/j.ienj.2023.101299]
13. Amador P, López M, Cuesta-López I, Jove C, Tomas-Zapico C, Begega A. Pro-resilient effects of environmental enrichment on social isolation: Behavioural and cytochrome c oxidase brain analysis in Wistar adult rats. Behav Brain Res. 2025;487:115574. [Link] [DOI:10.1016/j.bbr.2025.115574]
14. Cao NN, Espinosa PP. Parenting styles and study engagement among higher vocational nursing students: The mediating role of self-compassion. Collegian. 2025;32(3):174-81. [Link] [DOI:10.1016/j.colegn.2025.04.003]
15. Morawetz C, Hemetsberger FJ, Laird AR, Kohn N. Emotion regulation: From neural circuits to a transdiagnostic perspective. Neurosci Biobehav Rev. 2025;168:105960. [Link] [DOI:10.1016/j.neubiorev.2024.105960]
16. Wright RN, Adcock RA, LaBar KS. Learning emotion regulation: An integrative framework. Psychol Rev. 2025;132(1):173-203. [Link] [DOI:10.1037/rev0000506]
17. Haag AC, Bagrodia R, Bonanno GA. Emotion regulation flexibility in adolescents: A systematic review from conceptualization to methodology. Clin Child Fam Psychol Rev. 2024;27(3):697-713. [Link] [DOI:10.1007/s10567-024-00483-6]
18. Saccaro LF, Giff A, De Rossi MM, Piguet C. Interventions targeting emotion regulation: A systematic umbrella review. J Psychiatr Res. 2024;174:263-74. [Link] [DOI:10.1016/j.jpsychires.2024.04.025]
19. Hollenstein T, Faulkner K. Adolescent digital emotion regulation. J Res Adolesc. 2024;34(4):1341-51. [Link] [DOI:10.1111/jora.13009]
20. Pálfi K, Major J, Horváth-Sarródi A, Deák A, Fehér G, Gács B. Adaptive emotion regulation might prevent burnout in emergency healthcare professionals: An exploratory study. BMC Public Health. 2024;24(1):3136. [Link] [DOI:10.1186/s12889-024-20547-0]
21. Farhi M, Rubinsten O. Emotion regulation skills as a mediator of STEM teachers' stress, well-being, and burnout. Sci Rep. 2024;14(1):15615. [Link] [DOI:10.1038/s41598-024-63228-z]
22. Shafiei SS, Mosavi Viyaye F. The lived experience of women in war-affected families; A reflection on the role of a wife in a veteran's family. J Iran Soc Stud. 2022;16(1):78-99. [Persian] [Link]
23. Alivandi Vafa M, Fathi A, Akbarzadeh Nami R, Bejani H. A comparative study of perceived stress, loneliness, anxiety and marital boredom in veteran and ordinary people's wives. J Mil Psychol. 2022;13(50):105-29. [Persian] [Link]
24. Rooitalab A, Maredpour A, Taghvaeinia A. The effect of education based on positive psychology approach on psychological well-being, meaning in life and vitality in wives of war veteran and wives martyrs. Razi J Med Sci. 2021;28(9):80-91. [Persian] [Link]
25. Xiong Z, Wu X, Yang J, Zou J, Zhong Q, Dai Y, et al. Association and interaction between resilience and psychological distress in disabled elderly-caregiver dyads: An actor-partner interdependence model. Geriatr Nurs. 2025;62(Pt B):245-52. [Link] [DOI:10.1016/j.gerinurse.2025.02.014]
26. Wang S, Zhang H, Lou Y, You Q, Jiang Q, Cao S. Association of social isolation and loneliness with the risk of hypertension in middle aged and older adults: Findings from a national representative longitudinal survey. J Affect Disord. 2024;349:577-82. [Link] [DOI:10.1016/j.jad.2024.01.008]
27. Zeineddine M, Issa M, Ismail G, El-Hajj T, Tfaily H, Dassouki M, et al. The awareness and knowledge of multiple sclerosis patients about their disease: A Lebanese cross-sectional study. Mult Scler Relat Disord. 2025;95:106255. [Link] [DOI:10.1016/j.msard.2024.106255]
28. Zong Y, Tsaur SH. Employee resilience and mentoring functions as moderators of the relationship between workplace hazing and affective organizational commitment. Int J Hosp Manag. 2023;114:103549. [Link] [DOI:10.1016/j.ijhm.2023.103549]
29. Rajamohan S, Chalmers K, Zoucha R, Brasher S. Use of the REST model to build resilience among nurses with implications for nurse educators. Teach Learn Nurs. 2025;20(3):e651-7. [Link] [DOI:10.1016/j.teln.2025.01.022]
30. Culloty M, De Labouchere S, Curran G, Bezzina P, England A, Rawashdeh M, et al. Attitudes and awareness regarding the European consensus statement on the use of patient contact shielding. J Med Imaging Radiat Sci. 2025;56(4):101888. [Link] [DOI:10.1016/j.jmir.2025.101888]
31. Susanti H, Putri AF, Susanti SS, Malini H, Alim S, Bintari DR. Improving post-traumatic growth of disaster survivors: An integrative literature review. Int Emerg Nurs. 2024;75:101484. [Link] [DOI:10.1016/j.ienj.2024.101484]
32. Southwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda R. Resilience definitions, theory, and challenges: interdisciplinary perspectives. Eur J Psychotraumatol. 2014;5. [Link] [DOI:10.3402/ejpt.v5.25338]
33. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev. 2010;30(2):217-37. [Link] [DOI:10.1016/j.cpr.2009.11.004]
34. Tull MT, Barrett HM, McMillan ES, Roemer L. A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behav Ther. 2007;38(3):303-13. [Link] [DOI:10.1016/j.beth.2006.10.001]
35. Tugade MM, Fredrickson BL. Resilient individuals use positive emotions to bounce back from negative emotional experiences. J Pers Soc Psychol. 2004;86(2):320-33. [Link] [DOI:10.1037/0022-3514.86.2.320]
36. Gross JJ, John OP. Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003;85(2):348-62. [Link] [DOI:10.1037/0022-3514.85.2.348]
37. Shafiei SS, Mousavi Viaieh F. Phenomenological study of social isolation and social problems of veterans' families: Studying viewpoints of spouses. J Soc Probl Iran. 2021;12(1):333-54. [Persian] [Link]
38. Xia ZY, Kong Y, Yin TT, Shi SH, Huang R, Cheng YH. The impact of acceptance of disability and psychological resilience on post-traumatic stress disorders in burn patients. Int J Nurs Sci. 2014;1(4):371-5. [Link] [DOI:10.1016/j.ijnss.2014.10.018]
39. Rutter M. Annual research review: Resilience--clinical implications. J Child Psychol Psychiatry. 2013;54(4):474-87. [Link] [DOI:10.1111/j.1469-7610.2012.02615.x]
40. Slomowitz RF, Narayan AJ, McGrath LM. Resilience research in learning disabilities: Guiding principles from developmental psychopathology. Learn Instr. 2025;97:102090. [Link] [DOI:10.1016/j.learninstruc.2025.102090]
41. Wang X, Wang RX, Bian C, Liu FY, Tang MW, Zhang YH. Sleep quality, psychological resilience, family resilience, social support, and mental disability in patients with chronic schizophrenia: A cross-sectional study. Schizophr Res. 2024;274:199-205. [Link] [DOI:10.1016/j.schres.2024.09.020]