EstematerialespublicadosegúnlostérminosdelaLicenciaCreativeCommonsAtribución–NoComercial4.0.Sepermiteeluso,distribuciónyreproducciónnocomercialesysinrestriccionesencualquiermedio,siemprequeseadebidamentecitadalafuenteprimariadepublicación. Disponibleenhtttp://www.revhph.sld.cu/ RevistadelHospitalPsiquiátricodeLaHabana Volumen22|Año2025|PublicacióncontinuaISSN:0138-7103|RNPS:2030 ___________________________________________ Original InfluenceofCognitiveDistortionsandFearofNegativeAssessmentonMaritalRelationshipinIranianWomenInfluenciadedistorsionescognitivasymiedoalaevaluaciónnegativasobrelarelaciónmatrimonialenmujeresiraníes RahilMahmoudi 1 ZeinabJalambadani 2 MaryamPedreh 3 1 DepartmentofCommunityMedicine,FacultyofMedicine,SabzevarUniversityofMedicalSciences,Sabzevar,Iran 2 Non-CommunicableDiseasesResearchCenter,DepartmentofCommunityMedicine,FacultyofMedicine,SabzevarUniversityofMedicalSciences,Sabzevar,Iran 3 MAStudent,DepartmentofEducationalPsychology,Torbat-eJambranch,IslamicAzadUniversity,Torbat-eJam,Iran Recibido:14/012025Aceptado:18/02/2025
TheRoleofCognitiveDistortionsonFearofNegativeAssessmentandMaritalRelationshipQualityinWomen Rev.Hosp.Psiq.Hab.Volumen22|Año2025|Publicacióncontinua EstematerialespublicadosegúnlostérminosdelaLicenciaCreativeCommonsAtribución–NoComercial4.0.Sepermiteeluso,distribuciónyreproducciónnocomercialesysinrestriccionesencualquiermedio,siemprequeseadebidamentecitadalafuenteprimariadepublicación. Abstract Introduction: Differentpsychologicalfactorssuchascognitivedistortionsandfearcanaffectqualityofmaritalrelationships Objective: DeterminethemoderatingroleofcognitivedistortionsonthenegativeassessmentandmaritalrelationshipqualityinmarriedwomenreferredtohealthcarecentersinIran,in2023. Method: Thiscross-sectionalstudywasconductedon330womenwhoattendedtheWomen'sHealthCareClinicinIranfromJanuarytoApril,2023.CognitiveDistortionQuestionnaire(CD-Quest),BriefFearofNegativeEvaluationScale(BFNE-S)andtheMaritalRelationshipQualityscale(MRQ)wereused.DatawereanalyzedbySPSS24andusingPearsoncorrelation,independentt,multipleregressionanddescriptivestatistics.P-valuelessthan0.05wasconsideredstatisticallysignificant. Results: Women'smeanagewas23.45+5.77years.Therewasasignificantcorrelationofcognitivedistortionsandfearofnegativeassessmentinmarriedwomen(P<0.001).Cognitivedistortionsontheassociationbetweenfearofnegativeassessmentwereabletoexplain71%ofthechangesinmaritalrelationshipqualityinmarriedwomen. Conclusions: Itisnecessarytoconsidertheroleofpsychologicalfactorssuchascognitivedistortionsanfearofnegativeassessmentforimprovingthequalityofmaritalrelationships.Therefore,healthplannersshouldadoptstrategiestoincreasequalityofmaritalrelationshipsandreductionofcognitivedistortionsandfearofnegativeassessmentinmarriedwomen. Keywords: cognitivedistortion;fearofnegativeassessment;maritalrelationshipquality . Resumen Introducción :Diferentesfactorespsicológicostalescomolasdistorsionescognitivasyelmiedoalaevaluaciónnegativapuedenafectarlacalidaddelasrelacionesmatrimoniales. Objetivo :determinarelpapelmoderadordelasdistorsionescognitivasenlaevaluaciónnegativaylacalidaddelarelaciónmaritalenmujerescasadasderivadasacentrosdesaludenIránen2023. Método :serealizóunestudiotransversalen330mujeresqueasistieronalaClínicadeSaluddelaMujerenIrándeeneroaabrilde2023.Loscuestionariosfueronelcuestionariodedistorsionescognitivas(CD-Quest),laescalabrevedemiedoalaevaluaciónnegativa(BFNE-S)ylaescaladecalidaddelarelaciónmarital(MRQ).LosdatosseanalizaronconSPSS24yseutilizaroncorrelacióndePearson,tindependiente,regresiónmúltipleyestadísticadescriptiva.Unvalordepinferiora0,05seconsideróestadísticamentesignificativo. Resultados: laedadmediadelasmujeresfuede23,45±5,77años.Hubounacorrelaciónsignificativaentrelasdistorsionescognitivasyelmiedoalaevaluaciónnegativaenlasmujerescasadas(p<0,01,r=0,71).Unaregresiónmúltiplemostróunarelaciónestadísticamentesignificativaentrelasdistorsionescognitivasyelmiedoalaevaluaciónnegativaylacalidaddelasrelacionesmaritales(p<0,001).Lasdistorsionescognitivasasociadasalmiedoalaevaluaciónnegativapudieronexplicarel71%deloscambiosenlacalidaddelarelaciónmaritalenmujerescasadas.
TheRoleofCognitiveDistortionsonFearofNegativeAssessmentandMaritalRelationshipQualityinWomen Rev.Hosp.Psiq.Hab.Volumen22|Año2025|Publicacióncontinua EstematerialespublicadosegúnlostérminosdelaLicenciaCreativeCommonsAtribución–NoComercial4.0.Sepermiteeluso,distribuciónyreproducciónnocomercialesysinrestriccionesencualquiermedio,siemprequeseadebidamentecitadalafuenteprimariadepublicación. Conclusiones: paramejorarlacalidaddelasrelacionesmaritales,esnecesarioconsiderarelpapeldelosfactorespsicológicos,comolasdistorsionescognitivasyelmiedoalaevaluaciónnegativa.Porlotanto,losplanificadoresdesaluddebenadoptarestrategiasparaaumentarlacalidaddelasrelacionesmaritalesyreducirlasdistorsionescognitivasyelmiedoalaevaluaciónnegativaenmujerescasadas. Palabrasclave :distorsióncognitiva,miedoalaevaluaciónnegativa,calidaddelarelaciónmarital Introduction Oneoftheissuesthatresearchersandexpertsinthefieldofbehavioralandfamilysciencesisthefearofnegativeevaluation. (1) Fearofnegativeevaluationrefersto“individuals'concernaboutothers'evaluations,excessivedistressregardingnegativeassessment,avoidanceofevaluativesituations,andanticipationofnegativeevaluationsfromothers”.Fearofnegativeevaluationcontributestothedevelopmentandmaintenanceofirrationalandsevereanxietyrelatedtosocialsituations. (2) Cognitivedistortions,orflawedbeliefs,cannegativelyimpactmaritalrelationships.Theyarisefromincorrectinformationprocessinginindividuals'minds.Whenthesedistortionshappenfrequently,theycancausediscomfortorpsychologicalissues. (3,4) Becksuggeststhatcouplesintroubledmarriagesdisplaycognitivedistortions,includingemotionalreasoning,selectiveabstraction,magnifyingnegativebehaviors,minimizingpositiveactions,labeling,andpersonalization. (5) Cognitiveerrorssuchasdichotomousthinkingcannegativelyaffectmaritalquality.Studiesshowastrongnegativeconnectionbetweentheseerrorsandrelationshiphealth.Thesedistortionscanleadtodiscomfortandpsychologicalissues.Individualsshouldrecognizeandaddresstheseerrors,andcognitive-behavioraltherapycanhelp. (6-9) Thestudyaimedtodeterminetheroleofcognitivedistortionsonfearofnegativeassessmentandmaritalrelationshipqualityinwomen. Método Thisresearchwasconductedasacross-sectionalstudy.Thefocusofthestudywasonasampleof330marriedwomenwhoareofreproductiveage,allofwhomattendedvarioushealthcentersinIranduringtheyear2023fortheirhealthcareneeds.Inclusioncriteriaweremarriedwomenof15-49years,whohadatendencytoparticipateinthestudyandwereIranian.Exclusioncriteriawereanincompletequestionnaire,havingseverementalandphysicaldisorders,orseveredepression. ThestudywasapprovedbytheResearchEthicsCommitteeinIram(IR.IAU.TJ.REC.1402.044).Beforetheenrolment,informedconsentwasobtainedfromalloftheparticipants.
TheRoleofCognitiveDistortionsonFearofNegativeAssessmentandMaritalRelationshipQualityinWomen Rev.Hosp.Psiq.Hab.Volumen22|Año2025|Publicacióncontinua EstematerialespublicadosegúnlostérminosdelaLicenciaCreativeCommonsAtribución–NoComercial4.0.Sepermiteeluso,distribuciónyreproducciónnocomercialesysinrestriccionesencualquiermedio,siemprequeseadebidamentecitadalafuenteprimariadepublicación. Thesamplesizewascalculatedbasedonthestudyonperceivedsocialsupportforwomenofreproductiveage (10) .Accordingtotheformula,thesamplesizewas300,andbyadding10%fordrop-outs,thesamplesizewasincreasedto330. 푛= (푍1− 훼2) 2 (휎) 2 (푑) 2 Theappropriatenumberofsampleswascalculatedasafractionofthetotalsamplesizeaccordingtothecenter’sdemographics(numberofmarriedfemaleclientsofthecenterbetween15and49yearsold).Theresearchercontactedparticipantsusingtheirphonenumberstoexplainthestudy'spurposeandmethods.Duringthecall,individualswereassessedforeligibility.Thosequalifiedwereinvitedtoahealthcenteronasetdatetocompletequestionnaires.Theyreceivedinformationaboutthestudy’ssignificanceandconfidentialitybeforesigningaconsentform.Datawerecollectedthroughinterviewswithsocio-demographicquestionsrelatedtoage,marriageduration,education,employment,income,residence,maritalcommitment,andnumberofchildren. ThequestionnairesweretheCognitiveDistortionsQuestionnaire, (11) TheBriefFearofNegativeEvaluationScale, (12) andthemaritalrelationshipqualityscale. (13) TheCognitiveDistortionsquestionnairecontains20phrases,whichassessthecognitivedistortionofAlbertAllisandeachirrationalthoughthastwospecificphrasesthatscoredthroughtheLikertscale,anditsCronbach’salphais0.80.TheBriefFearofNegativeEvaluationScale(BFNE-S)isanabbreviatedversionoftheoriginalBFNE(Leary,1983)usedtomeasurefearsofnegativeevaluation.Thescaleconsistsofeightitemsthatarestraightforwardlyworded,suchas"WhenIamtalkingtosomeone,Iworryaboutwhattheymaybethinkingaboutme."Participantsrateeachitemona5-pointLikertscale,rangingfrom0(notatallcharacteristicofme)to5(extremelycharacteristicofme).TheBFNE-Sisawidelyusedandvalidatedmeasureofsocialanxietyandfearofnegativeevaluationinbothclinicalandresearchsettings.TheMRQ(MaritalRelationshipQuality)measuresincludedintheFHWS(FamilyHealthandWell-beingStudy)comprisedfourvalidatedWesternscales,eachmeasuringdifferentrelationshipqualitydimensions:trust,communication,commitment,andsatisfaction.Eachscaleconsistedofaseriesof5to8statements,towhichspousesrespondedseparately.TheMRQmeasuresarewidelyusedinresearchtoassessthedifferentcomponentsofmaritalqualityandidentifyareasthatmayneedimprovementincouples’therapy.DatacollectedbyquestionnaireswereenteredintoSPSSver.22.Quantitativeandqualitativevariableswerereportedusingmean(SD:standarddeviation),andfrequency(percentage)indices,respectively.Thenormalityofthedatawasmeasuredusingkurtosisandskewness.Allthedatawerenormallydistributed.PearsoncorrelationtestwasusedfortheunivariateanalysisoftherelationshipsbetweencognitivedistortionsandfearofnegativeassessmentwithQualityofmaritalrelationsinmarriedwomenreferredtohealthcarecentersinIran.AP-valuelessthan0.05wasconsideredstatisticallysignificant.
TheRoleofCognitiveDistortionsonFearofNegativeAssessmentandMaritalRelationshipQualityinWomen Rev.Hosp.Psiq.Hab.Volumen22|Año2025|Publicacióncontinua EstematerialespublicadosegúnlostérminosdelaLicenciaCreativeCommonsAtribución–NoComercial4.0.Sepermiteeluso,distribuciónyreproducciónnocomercialesysinrestriccionesencualquiermedio,siemprequeseadebidamentecitadalafuenteprimariadepublicación. TheFHWS(FamilyHealthandWell-beingStudy)usedfourvalidatedscalestoassessrelationshipquality.TheCommitmentScale,derivedfromtheSternbergTriangularLoveScale,hasfiveitemsaboutlong-termcommitment.TheTrustScale,byLarzelereandHuston(1980),assessesagreementwitheightstatementsonaone-to-sevenscale.TheSatisfactionScale,partofSpanier's1976DyadicAdjustmentScale,includesnineitemsratedonasix-pointLikertscale.TheCommunicationScaleevaluatesconstructivecommunicationduringconflictwithsevenitems.NegativelywordeditemsinSatisfactionandCommunicationwerereversecoded.Higherscoresindicatebetter-perceivedrelationshipqualityincommitment,trust,satisfaction,andcommunication. Ethicalapproval Inthisstudy,allproceduresperformedonhumansampleswereconductedfollowingtherelevantguidelinesandregulationsoftheHelsinkiDeclaration.ThestudyprotocolwasapprovedbytheResearchEthicsCommittee(IR.IAU.TJ.REC.1402.044)inTorbatjamIran. Results Participantshadanaverageageof21.1(SD=10.7)andmarriagedurationof7.3years(SD=9.5).Morethanhalf(50.7%)werehighschoolgraduates;theirhusbandsmainlyheldcollege(48.3%)orhighschool(43.2%)diplomas.About48.3%ofhusbandswereself-employed,and70.2%reportedadequateincome.Nearlyhalf(44.5%)hadtwoormorechildren,and62.3%weresomewhatsatisfiedwiththeirmarriages.Cognitivedistortionscorrelatedsignificantlywithage(p=0.659)andmarriagelength(p=0.830).Multi-regressionindicatedthateducation(p<0.05),husband'sjob,income,andresidence(p<0.001)significantlyaffectedcognitivedistortionsandmarriagequality. Accordingtotheresultsoftable1,cognitivedistortionsandfearofnegativeassessmenthaveasignificantrelationshipwithmaritalrelationshipqualityinmarriedwomen.Also,cognitivedistortionshaveasignificantrelationshipwithmaritalrelationshipqualityinmarriedwomen(p<0.01). Table1. Mean,standarddeviation,andcorrelationcoefficientsofcognitivedistortionsandfearofnegativeassessmentwithmaritalrelationshipqualityinmarriedwomenExaminingtheassumptionsofmultipleregressionanalysisindicatesthattheassumptionofconfirmingnormalitybasedontheKolmogorov-Smirnovtest,theassumptionofrejectingmultiplecollinearitybased Variable Mean SD 1 2 3 Cognitivedistortions 67.30 8.20 1 Fearofnegativeassessment 78.48 9.30 0.71** 1 Maritalrelationshipquality 66.36 8.54 0.70** 0.73** 1
TheRoleofCognitiveDistortionsonFearofNegativeAssessmentandMaritalRelationshipQualityinWomen Rev.Hosp.Psiq.Hab.Volumen22|Año2025|Publicacióncontinua EstematerialespublicadosegúnlostérminosdelaLicenciaCreativeCommonsAtribución–NoComercial4.0.Sepermiteeluso,distribuciónyreproducciónnocomercialesysinrestriccionesencualquiermedio,siemprequeseadebidamentecitadalafuenteprimariadepublicación. onthevalueofthevarianceinflationfactor,andtheassumptionofrejectiontooththecorrelationoftheresidualswasbasedontheDurbin-Watsonvalue,sothereareconditionsforusingmultipleregressionanalysis. Thesummaryofmultipleregressionwithstep-by-stepmodelforpredictingmaritalrelationshipqualitybasedoncognitivedistortionsandfearofnegativeassessmentinmarriedwomenwasreportedin(table2andtable3). Table2. Summaryofmultipleregressionwithstepwisemodelforpredictingperceivedsocialsupportbasedonthesenseofcohesionandsocialhealthinmarriedwomen Model Variables R R 2 ChangeofR 2 ChangeofF Pvalue 1 Cognitivedistortions 0.71 0.62 0.26 32.29 0.001 2 Cognitivedistortionsandfearofnegativeassessment 0.89 0.71 0.20 9.18 0.001 Table3. Conditionalprocessanalysisresultsformoderatedcognitivedistortionsmodel Source b se t p FearofnegativeassessmentR:.749,R2:.562,F(7,171):31.297,p<0.001 0.75 0.38 4.87 <0.001 MaritalRelationshipQualityR:.683,R2:.466,F(9,169):16.412,p<.001AgreementSatisfactionCoherence 0.67 0.48 5.87 <0.001 .481 0.054 0.389 0.01 0.45 0.013 0.349 <0.01 0.48 0.032 0.269 0.01 Accordingtotheresultsoftable2inthefirstmodel,thecognitivedistortionswerefirstenteredintotheequationandthecorrelationcoefficientofthisvariablewithmaritalrelationshipqualityis0.71andthisvariablewasabletoexplain62%ofthechangesinmaritalrelationshipqualityinmarriedwomen.Inthesecondmodel,afterthecognitivedistortions,thefearofnegativeassessmentvariablewasenteredintotheequation,andthecorrelationcoefficientofthesetwovariableswithmaritalrelationshipqualityis0.89,andthesetwovariableswereabletoexplain71%ofthechangesinmaritalrelationshipqualityinmarriedwomen.
TheRoleofCognitiveDistortionsonFearofNegativeAssessmentandMaritalRelationshipQualityinWomen Rev.Hosp.Psiq.Hab.Volumen22|Año2025|Publicacióncontinua EstematerialespublicadosegúnlostérminosdelaLicenciaCreativeCommonsAtribución–NoComercial4.0.Sepermiteeluso,distribuciónyreproducciónnocomercialesysinrestriccionesencualquiermedio,siemprequeseadebidamentecitadalafuenteprimariadepublicación. MultivariateAnalysisResultsofGeneralizedLinearModels Inthemultivariatemodel,allthevariableswithp<0.1werefirstentered,andtheircollinearitywasthencheckedusingthevarianceinflationfactor(VIF),revealingthatsocioeconomicstatusandmonthlyincomeadequacywerehighlycollinear.Therefore,thevariableofmonthlyincomeadequacywasremovedfromthemultivariatemodel,andthesocioeconomicstatusvariablewasincluded(table4). Table4. Multivariateanalysisresultsofgeneralizedlinearmodels(GLMs)forrelationshipbetweenstudyvariables Variables B(95%CI) P-value Age 0.057(0.009,0.101) 0.093 Literacy Belowhighschool/universitydegree 0.057(0.113,0.020) 0.168 Highschool/universitydegree 0.067(0.087,0.013) 0.122 Husband'sliteracy Belowhighschool/universitydegree 0.040(0.116,0.026) 0.132 Highschool/universitydegree 0.002(0.049,0.055) 0.833 Job Housewife/employee 0.043(0.079,0.002) 0.063 Husband'soccupation Self-employed/employee 0.010(0.024,0.054) 0.548 Socioeconomicstatus Low/high 0.049(0.146,-0.003) 0.033 Moderate/high 0.031(0.087,0.016) 0.126 Homeownership Renting/Owingahouse 0.001(0.046,0.048) 0.764 Historyofchildbirth 1/>2 0.018(0.021,0.086) 0.226 2/>2 0.018(0.038,0.085) 0.130 Husband'sage 0.005(0.020,0.054) 0.634 B:regressioncoefficient,CI:confidenceinterval Inthemultivariatemodel,simultaneouslyconsideringallthevariables,onlysocioeconomicstatuswasrelatedtomaritalrelationshipquality,sotheM±SDscoresofthemaritalrelationshipqualityinthewomenwithalowsocioeconomicstatusweresignificantlylowerthanthosewithagoodsocioeconomicstatus(p=0.043).Althoughothervariableswerenotsignificantlyassociatedwithmaritalrelationshipqualityatthesignificancelevelof0.05,themaritalrelationshipqualityM±SDscoresofhousewivesweresignificantlylowerthanthoseofemployeesatthesignificancelevelof0.1(p=0.073).Moreover,asignificantrelationshipwasobservedbetweenmother'sageandmaritalrelationshipqualityatthe10%errorlevel,sothemaritalrelationshipqualityM±SDscoreswerehigheratolderages(p=0.053). Discussion Thisstudyaimedtodeterminetheroleofcognitivedistortionsonfearofnegativeassessmentandmaritalrelationshipqualityinwomenin2023.Thepresentstudyindicatesthatcognitivedistortionsareassociatedwithanincreaseinmaritalrelationshipquality.
TheRoleofCognitiveDistortionsonFearofNegativeAssessmentandMaritalRelationshipQualityinWomen Rev.Hosp.Psiq.Hab.Volumen22|Año2025|Publicacióncontinua EstematerialespublicadosegúnlostérminosdelaLicenciaCreativeCommonsAtribución–NoComercial4.0.Sepermiteeluso,distribuciónyreproducciónnocomercialesysinrestriccionesencualquiermedio,siemprequeseadebidamentecitadalafuenteprimariadepublicación. Thecurrentstudyrevealedasignificantnegativecorrelationbetweenthequalityofmaritalrelationshipsandcognitivedistortions.Thismeansthatascognitivedistortionsincrease,thequalityofmaritalrelationshipstendstodecrease,andviceversa.Itappearsthatcognitivedistortions,alongwiththefearofnegativeevaluation,mayaffectthequalityofmaritalrelationships.Forexample,BradleyM.Rosenfield (14) reportedthattheICDdeterminedthatapproximatelyhalfofthevarianceinboththenumberandseverityofpsychologicaldysfunction,onbothAxisIandAxisII,wasaccountedforbythefrequencyofcognitivedistortions. NeetuA.John's (13) findingssuggestthatintraditionalsocietiessuchasTaiwan,evenifamarriedwomaninTaiwanbelievesingenderequalityandexpectsanequalpartnershipwithherspouse,thepatriarchalnormsandvaluesofherfamilyandsocietymaystillexertapowerfulinfluenceonherdailylifeandinteractionswithherspouse.Thismayleadtolowerexpectationsforgenderequalitywithinthemarriage,andmayultimatelyimpactheroverallmaritalquality.ItisimportanttonotethatthesefindingsarespecifictotraditionalsocietiessuchasTaiwan,andmaynotnecessarilyapplytootherculturesorcontexts.Additionally,individualdifferencesingenderbeliefsandmaritalqualitymaystillexistwithinthesesocieties.ThepresentstudyisconsistentwithOrçunMuhammet,Simsekstudy (15) thatexaminedtheimpactofinterpersonalcognitivedistortionsonsatisfactionwithlifeandthemediatingroleofloneliness.OrçunMuhammet,Simsekstudyhasproventhenegativeeffectsoflonelinessoncognitivedistortionsanddecreasedlifesatisfactionwithintheseconditions. (15) SadiaYasminandetal. (16) instudyshowedFearofnegativeevaluation(thefearofbeingjudgedorevaluatednegativelybyothers)ispositivelyrelatedtoloneliness,meaningthatpeoplewhohaveagreaterfearofnegativeevaluationtendtofeelmorelonely. BadamiandZomorody'sstudy (17) showsthatcognitivebehavioraltherapy(CBT)iseffectiveforemotionalmaturityandfearofnegativeevaluationinmarriedwomen.Thisfearoftenleadstosocialanxietydisorder,causingintenseanxietyandavoidancethataffectsemotionalwell-being.CBThelpspeopleidentifyandchangenegativethoughtsusingtechniqueslikecognitiverestructuring,exposuretherapy,andsocialskillstraining,improvinganxietymanagementandcopingstrategies. Oneofthelimitationsofthestudyisthegeneralizabilityofitsresultstopeopleindifferentregionswithdifferentculturesbecausebothstudyvariablescanbeinfluencedbythecultureofsocieties.Therefore,itisrecommendedthatfurtherstudiesshouldbeconductedonalargersamplesizeinordertoshowthemaritalrelationshipqualityofcouplesasthebasisoffamilyandsociety.Ontheotherhand,thelimitationsofself-reportingandtheinfluenceofparticipants'mentalstatesincompletingthequestionnairesshouldbeconsidered.Therefore,theissueofgeneralizabilityshouldbetreatedwithcaution.
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