Iranian Journal of War and Public Health

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Volume 13, Issue 1 (2021)                   Iran J War Public Health 2021, 13(1): 49-55 | Back to browse issues page

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Khoravandi M, Mardani Rad M, Mashayekh M, Salmani Pour R. Relationship of Early Maladaptive Schemas with Religion Orientation and Matrimony Conflicts of Veterans with more than 25% Disability Rate in Tehran City, Iran. Iran J War Public Health 2021; 13 (1) :49-55
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1- Consulting Department, Central Tehran Branch, Islamic Azad University, Tehran, Iran , marzie.khoravandi@gmail.com
2- Consulting Department, Central Tehran Branch, Islamic Azad University, Tehran, Iran
3- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
4- Janbazan Medical and Engineering Research Center, Tehran, Iran
* Corresponding Author Address: Consulting Department, Central Tehran Branch, Islamic Azad University, Tehran, Iran
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Introduction
The history of human life has witnessed many wars with different goals and has had consequences for the people of every land. One of the devastating consequences of any war is psychological and physical problems for people who have been directly or indirectly involved. These problems can become apparent over time and show their consequences [1]. The losses and devastation that war causes to public health have lasting and long-term effects [2]. The Iran-Iraq war had many consequences for the veterans during 1980-88 [3]. These conditions affect the veterans and the family system in various dimensions because the normal interaction pattern between family members is disrupted. When a family member becomes ill, the family members have felt powerless to present their roles, and the balance and homeostasis of the family will be lost [4]. Marital conflict is an interaction between couples with conflicting interests, views, and beliefs [5]. Marital conflicts are also defined as the negative, hostile emotions and weak conflict resolution strategies between the couples [6]. Therefore, if the interaction of family members is done properly, it will have a tremendous impact on their health. Because the methods used to solve problems can lead to a range of life dissatisfaction to satisfaction for both parties [7]. Studies on psychological problems of veterans (especially spinal amputees and chemical veterans) show that they suffer from interpersonal conflicts (Lack of adaptation and consensus of spouse and children and interpersonal relationships in the family and community), which can develop their problems. Therefore, it can damage the veteran's relationship with his spouse because physical and psychological problems affect the family system and make new actions [8].
According to Allport, the shortest way to divide religion thematically is to assume that the outside-aroused person uses religion and turns to God without turning away from themselves. While aroused persons from inside to adherence to religion, find their motives within religion and live their religion; in other words, their religion and personality will be one [9]. Pargament believed that people would not face the stressful events of life in a vacuum and without resources, and they rely on a system of beliefs and practices such as prayer and supplication [10]. In this regard, religion with an internal origin is comprehensive and has organized internal principles. Whoever, religion with an external origin, is a tool to meet needs such as peace, socialization, security, and to justify oneself and even the situation [9]. Therefore, it plays an important role in helping people to understand and deal with life events by providing support and hope [11]. Because religious tendencies and religiosity, like multidimensional structures, affect general and core beliefs [12] and may create core beliefs about life events [13]. Indeed, religion can be considered a general-cognitive schema, which helps people understand the world, reactions, and behaviors in daily life [14]. Religion in its mental state allows people to find lost elements by interpreting environmental stimuli, fill the cognitive and emotional gaps, and deal with the problem-solving process [15].
On this basis, it can be said that a person's adherence to religion is enlightening support, helping in the path of difficulties [14]. Yang believes that psychoses are the underlying assumptions or laws that control one's thoughts and behaviors. Early maladaptive schema is the deepest level of cognitive structures that manifest during the relationship with the environment and others [16]. Salehi Morkani & Al-Yasin also showed that emotional deprivation and distrust increase conflicts between couples [17]. In this regard, it has been shown in a study that pays attention to establishing the initially incompatible psyches increases family performance and decreases marital conflict [18]. There is a relationship between early maladaptive schemas with marital conflict of normal couples and instability of couples seeking divorce [19]. Research has also shown that sacrifice schema and avoid insecure attachment styles can predict marital conflicts [20]. Researchers in a study stated a negative relationship between life satisfaction with emotional deprivation, social isolation, disability, failure, vulnerability, dependence, obedience, self-sacrifice, emotional inhibition of stubborn criteria, and inadequate self-control and self-discipline [21]. Based on the studies, no research has been done on the relationship between variables such as early dysfunctional schemas, religious orientation, and marital conflicts in veterans. Therefore, this study aimed to investigate the relationship between early maladaptive schemas with a religious orientation, the relationship between the schemas according to marital conflict, and whether there is a relationship between early maladaptive schemas, religious orientation, and marital conflicts in veterans.
 

Instrument & Methods
This descriptive study was carried out between married veterans with a 25%-50% disability rate in Tehran 2020-2021. Out of the statistical population, 110 people were selected by the Cronbach's alpha formula. For sampling, Tehran was divided into four sections (north and northeast, south and southeast, north and northwest, south and southwest) based on the provided map by the municipality of Tehran city. Then, according to the location of the foundation's offices and the division of urban housing, the foundation offices of regions 4, 13, 5, and 17 were selected from north and northeast, south and southeast, north and northwest, and south and southwest regions, respectively by random sampling. Then 30 people from each region were randomly selected (n=120). Out of 120 subjects who completed the questionnaire, ten subjects were excluded due to failure to fill out the questionnaire.
Data were collected by the following questionnaires:
Demographic questionnaire: This questionnaire included basic information of name, age, level of education, type of disability, rate of disability, and place of residence.
Young early maladaptive scheme Questionnaire [22]: The 75-item questionnaire is retrieved from the 205-item in long-form version. The items were used to evaluate 15 subscales in the five areas of rejection and disconnection (25 items), autonomy (20 items), impaired limits (10 items), readiness (10 items), and other-directedness (10 items). Each item was scored using a 6-point scale. In this questionnaire, a high score indicates the existence of more maladaptive schemas in the individual. The validity and reliability of this questionnaire were assessed by Ahi et al. on 387 students of Tehran universities; they retrieved 11 factors by factor analysis using extracting the principal components [23]. In a study, Cronbach's alpha method was used to determine the reliability of the questionnaire, which its reliability was reported between 0.68-0.80 for five areas of the early maladaptive schemas [24]. Ghadipasha et al. also confirmed the reliability and validity of psychometric properties of the short form of the Young Questionnaire [25].
Allport and Ross Religious Orientation Questionnaire [26]: This questionnaire consists of 21 items graded from 1 to 4 based on a 4-point Likert scale. The more scores the subjects received, the more they have that trait. On this scale, 12 items measure external religious orientation, and nine items measure internal religious orientation. This test was translated and standardized in Iran in 1998. Its validity and reliability were obtained by Jan Bozorgi so that its internal consistency using Cronbach's alpha is 0.71 and its test reliability is 0.74 [27].
Barati and Sanai Marital Conflict Questionnaire [28] (MCQ): This questionnaire is a 42-item tool designed to measure marital conflict based on clinical experience, which assessed consequences after conflicts, such as decreased cooperation (5 items), decreased sex (5 items), and increased emotional reactions (8 items), increased child support (5 items), increased personal relationship with relatives (6 items), decreased family relationships with spouse relatives and friends (6 items), and separating finances from each other (7 items). For each item, five options with 1 to 5 scores are considered. The maximum total score of the questionnaire is 210, and the minimum is 42. A higher score means more conflict and a lower score shows less. Dehghan Payaie reported 0.71 as the reliability of this test by Cronbach's alpha method and 0.60-0.81 for the seven factors of the questionnaire [29]. Ethical permission was obtained from the Office of Studies and Research of the Martyr and Veterans Affairs Foundation. Participants were assured that their answers to the research questionnaires would be used for research purposes only. Therefore, they participated in the research with conscious consent. Due to the prevalence of Covid-19 disease, questionnaires were filled out by researchers through telephone calls. Quantitative data were displayed using mean and standard deviation, and qualitative data were displayed using frequency. External religious orientation questionnaire, The Internal Religious Orientation Questionnaire, total score, and each domain were quantitatively reported between 0-1. For this purpose, the difference between each person's score with the lowest score was obtained, and the result was divided by the obtained difference between the highest and the lowest score.
Independent T-test and analysis of variance were used to compare the scores of the Marital Conflict and the External and Internal Religious Orientation Questionnaires according to the variables. The Pearson correlation coefficient was used to examine the relationship between quantitative variables. Multiple regression was used to investigate the relationship between the studied variables and marital conflict. Data were analyzed using SPSS 25 software, and the significance level for sued statistical tests was 5%. 
 

Findings
Ten people were excluded due to the failure to incomplete the questionnaires, and 110 questionnaires were analyzed. The average age of the subjects was 55.47±5.92, which the youngest and oldest of them were 33 and 69 years old, respectively (Table 1).
 
Table 1) Demographic information of the subjects (n=110)
 
Among the variable of marital conflict, increased emotional response and decreased cooperation had the highest and lowest scores (Table 2). Also, in the schemas variables, the lowest and highest scores were related to the field of autonomy and inhibition, accordingly (Table 2).
There was no significant relationship between the variables with external and internal religious orientation and marital conflict (p<0.05) except the variable of psychiatric disability that had a significant relationship with marital conflict and internal religious orientation (p<0.05; Table 3).
A positive, significant relationship was observed between all areas of the Early Maladaptive Scheme and the Marital Conflict questionnaires (p<0.05). However, these domains were not linearly related to the internal and external religious orientations (p<0.05). Also, there was no significant relationship between age and the variables of marital conflict, internal and external religious orientation (p<0.05; Table 4).
Based on the findings of multiple regression through controlling the effect of variables in the county regions and each of the areas of schema, only the disconnection was associated with marital conflict (p<0.05). So that for each unit of increasing the score of the disconnection area, the average marital conflict increased by 0.71 (Table 5).
 
Table 2) Scores of variables of the studied questionnaires
 

Table 3) Results of the relationship between the studied variables and marital conflict, internal and external religious orientations (Mean±SD)
 
Table 4) Results of the correlation between schemas domains and age with the variables of marital conflict and internal and external religious orientations


Table 5)
Results of multiple regression test to determine the factors related to marital conflict
 
Discussion
The results of this study showed the relationship between maladaptive schemas with internal and external religious orientation. This result is somewhat in accordance with some research [14, 26, 30-32], which shows that early maladaptive schemas can predict religious adherence. The schemas are more than just a thought. They are a completely future of thoughts, feelings, and actions and, in addition to being practical, dynamically design human action. Negative schemas are no exception to this rule. They distort information about the relationship between the individual and the environment and activate negative automatic thoughts, and finally, they lead to abnormal attitudes and cognitive processing. These structures, formed in the early stages of evolution, are expected to affect the transformation process and create problems for the individual. In the meantime, spirituality as a structure can be transformed (including religion and related tendencies), and this transformation is influenced by cognitive development, which is influenced by the early maladaptive schemas [33]. People with maladaptive schemas cannot establish a secure and satisfying attachment in the area of disconnection and rejection, and traumatic limitations. These people expect that their need for affection, empathy, predictably sharing emotions will not be met [34]. It is natural for these people to use religion for calmness, emotional release, and impulsive behavior or consider the relationship with God as a matter of meeting the needs and the person stays in this position at a higher age because of the negative psychosis and being compatible with the content of maladaptive schema. Therefore, according to the schemas' content, people worship God to achieve pleasure and satisfaction of needs [31] Accordingly, if a person has more adaptability (lower scores) in the field of disconnection and rejection, possibly inclined to a religion of internal origin that is pervasive and has internal organized principles. Because for a person with an external religious orientation, religion is a tool to satisfy needs such as peace, socialization, security, and justify itself and even the situation [22]. Schemas in impaired limitations indicate a defect in inner limitations, a sense of responsibility towards others, or an orientation toward long-term life goals and create problems concerning the rights of others, cooperation with others, commitment or goal setting, and realistic goals. Therefore, compatible persons in this field believe that they are not particularly different from others and do not consider special rights for themselves or, in other words, do not feel greatness and perfection towards others. These people do not perform religious activities involuntarily [33], but rather a heartfelt and inner belief leads her to this direction, but their heart and inner beliefs lead them in this direction [33]. So, it can be pointed out that when the persons reach a degree of growth and maturity, they will be able to take control of emotions and feelings and to shape their perception of the situation based on the reality of the present, not on the stereotypes and repetitive patterns that guide their behavior and perceptions [35, 36].
The results showed that psychosis and rejection are related to marital conflicts, and this result is in accordance with the researches [13, 15, 17, 19, 20, 36-38], which shows the predictability of marital conflicts by maladaptive schemas. In other words, marital conflict can be reduced by making changes in the initial maladaptive schemas. Explaining the results, it can be said that people with psychiatry and rejection schema grow up in unfeeling, cold, troubled, isolated, irritable, unpredictable, and abusive families, and they expect that their need for security, stability, love, empathy, acceptance, and respect will not be met predictably [39]. These people, whose predominant attachment style is insecure, usually report lower marital satisfaction and intimacy and show lower compatibility. In this regard, Thomson mentioned that marriage directly reflects the initial relationship with the child, and schemas are considered the key factors in the structure of personality and lead the person to 
different relationships, the most obvious of which can be in married life and conflict between couples. Because satisfaction in a friendly relationship is seen only when both developmental needs and adult needs are met, because each couple, in addition to the schemas they have (in other words, each side has brought a part of their past to common life), also create special psychoses in their current relationship [40]. Accordingly, certain maladaptive schemas may develop when needs are not met that affect intimate relationships and create conflicts [36].
The study's limitations are as follows: 1) sampling was carried out on males in Tehran city, so the results cannot be generalized to females. 2) data collection by self-report method makes the possibility of information distortion due to repression and bias in response; 3) failure to fill out of some questionnaires by the subjects caused to be removed of them from the study; 4) lack of control over variables such as economic, cultural and other societal conditions and 5) Covid-19 viruses doubled the difficulty, especially for data collection. So, in this regard, the authors suggested to 1) use of the various instrument in future studies such as diagnostic interviews; 2) to increase the range of generalizability of the findings, and making the fit models, this study should be repeated in a larger sample and other communities; 4) It is suggested to study a larger set of variables simultaneously in order to have more accurate explanations of the considerable and underlying factors affecting marital conflicts, and the tendency of external religious orientation in veterans.
According to the research results on the role of maladaptive schema on increasing marital conflicts, it is suggested to provide psychotherapy courses to veterans by therapists and psychologists. Because by this way, it is possible to reduce the conflicts in the marital relationship and prevent its unpleasant consequences. Also, according to the results of the role of maladaptive schema in religious tendencies (internal and external), it is suggested to provide positive thinking workshops for veterans to make them more compatible with restrictions (conditions of veterans).
 

Conclusion
By removing the obstacles such as dysfunctional schemas, the ground for reducing the differences and conflicts of marital relationships was provided to provide the ground for satisfaction life by establishing a sincere and peaceful atmosphere in life.
 
Acknowledgment: The researchers would like to gratitude the Research Center of the Tehran Martyrs and Veterans Affairs Foundation (for their assistance in data collection, technical and writing assistance, in the article, etc.) and the veterans participating in the research.
Ethical Permissions: None declared by authors.
Conflicts of Interests: None declared by authors.
Authors' Contribution:  Khoravandi M. (First Author), Main Researcher/Methodologist (40%); Mardani Rad M. (Second Author), Introduction Writer (10%); Mashayekh M. (Third Author), Introduction Writer (10%); Salmani Pour R. (Forth Author), Statistical analyst/discussion writer (40%)
Funding/Support: None declared by authors.
 
 
Keywords:

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