Emotional Schemas and Psychological Distress: Mediating Role of Resilience and Cognitive Flexibility
,
Abstract
Objective: This study aimed to explore the structural relation of emotional schemas with psychological distress and evaluate the mediating role of resilience and cognitive flexibility in this relationship.
Method: Participants were 300 students that voluntarily completed a questionnaire package that included the Leahy Emotional Schema Scale (LESS-P), Connor-Davidson Resilience Scale (CD-RISC), Cognitive Flexibility Inventory (CFI), and Depression Anxiety Stress Scale (DASS-21). Then, we utilized the LISREL software for structural equation modeling.
Results: Structural equation modeling and path analysis revealed the direct effects of adaptive and maladaptive emotional schemas on psychological distress. The results indicated that maladaptive emotional schemas indirectly affected psychological distress via resilience and cognitive flexibility (P < 0.01). In contrast, adaptive emotional schemas indirectly affected psychological distress via cognitive flexibility rather than resilience (P < 0.05). Evaluation of the proposed structural model revealed an acceptable fit.
Conclusion: The present research findings show the effect of emotional schemas on psychological distress via resilience and cognitive flexibility. Furthermore, the results suggest that resilience partially mediates the relationship between emotional schemas and psychological distress. At the same time, cognitive flexibility mediated this relationship.
1. Drapeau A, Marchand A, Beaulieu-Prévost D. Epidemiology of psychological distress. Mental illnesses-understanding, prediction and control. 2012;69(2):105-6.
2. Gibbons S, Trette-McLean T, Crandall A, Bingham JL, Garn CL, Cox JC. Undergraduate students survey their peers on mental health: Perspectives and strategies for improving college counseling center outreach. J Am Coll Health. 2019;67(6):580-91.
3. Arvidsdotter T, Marklund B, Kylén S, Taft C, Ekman I. Understanding persons with psychological distress in primary health care. Scand J Caring Sci. 2016;30(4):687-94.
4. Frostad S, Danielsen YS, Rekkedal G, Jevne C, Dalle Grave R, Rø Ø, et al. Implementation of enhanced cognitive behaviour therapy (CBT-E) for adults with anorexia nervosa in an outpatient eating-disorder unit at a public hospital. J Eat Disord. 2018;6:12.
5. Pengpid S, Peltzer K. Early Substance Use Initiation And Psychological Distress Among Adolescents In Five ASEAN Countries: A Cross-Sectional Study. Psychol Res Behav Manag. 2019;12:1003-8.
6. Assari S, Dejman M, Neighbors HW. Ethnic Differences in Separate and Additive Effects of Anxiety and Depression on Self-rated Mental Health Among Blacks. J Racial Ethn Health Disparities. 2016;3(3):423-30.
7. Bester G. Stress experienced by adolescents in school: the importance of personality and interpersonal relationships. J Child Adolesc Ment Health. 2019;31(1):25-37.
8. Haftgoli N, Favrat B, Verdon F, Vaucher P, Bischoff T, Burnand B, et al. Patients presenting with somatic complaints in general practice: depression, anxiety and somatoform disorders are frequent and associated with psychosocial stressors. BMC Fam Pract. 2010;11:67.
9. Greenberg PE, Fournier AA, Sisitsky T, Simes M, Berman R, Koenigsberg SH, et al. The Economic Burden of Adults with Major Depressive Disorder in the United States (2010 and 2018). Pharmacoeconomics. 2021;39(6):653-65.
10. Williams MT, Kanter JW, Ching THW. Anxiety, Stress, and Trauma Symptoms in African Americans: Negative Affectivity Does Not Explain the Relationship between Microaggressions and Psychopathology. J Racial Ethn Health Disparities. 2018;5(5):919-27.
11. Knighton JS, Dogan J, Hargons C, Stevens-Watkins D. Superwoman Schema: a context for understanding psychological distress among middle-class African American women who perceive racial microaggressions. Ethn Health. 2020:1-17.
12. Griffiths S, Mond JM, Murray SB, Touyz S. Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology. Aust N Z J Psychiatry. 2015;49(9):812-20.
13. Tull MT, Weiss NH, Adams CE, Gratz KL. The contribution of emotion regulation difficulties to risky sexual behavior within a sample of patients in residential substance abuse treatment. Addict Behav. 2012;37(10):1084-92.
14. Luminet O, Bagby RM, Taylor GJ. Alexithymia: advances in research, theory, and clinical practice: cambridge university press; 2018.
15. Faustino B, Vasco AB. Relationships between emotional processing difficulties and early maladaptive schemas on the regulation of psychological needs. Clin Psychol Psychother. 2020;27(6):804-13.
16. Edwards ER, Liu Y, Ruiz D, Brosowsky NP, Wupperman P. Maladaptive Emotional Schemas and Emotional Functioning: Evaluation of an Integrated Model Across Two Independent Samples. J Ration Emot Cogn Behav Ther. 2020;39(3):428-55.
17. Edwards ER, Wupperman P. Research on emotional schemas: A review of findings and challenges. Clin Psychol. 2019;23(1):3-14.
18. Leahy RL. Introduction: Emotional Schemas and Emotional Schema Therapy. Int J Cogn Ther. 2019;12(1):1-4.
19. Leahy RL. A model of emotional schemas. Cogn Behav Pract. 2002;9(3):177-90.
20. Leahy RL. Emotional Schemas and Resistance to Change in Anxiety Disorders. Cogn Behav Pract. 2007;14(1):36-45.
21. Leahy RL, Tirch D, Melwani P. Processes Underlying Depression: Risk Aversion, Emotional Schemas, and Psychological Flexibility. Int J CognTher. 2012;5:362-79.
22. Leahy RL. Emotional schemas in treatment-resistant anxiety. New York, NY, US: Routledge/Taylor & Francis Group;2010.
23. Young JE, Klosko JS, Weishaar ME. Schema therapy: A practitioner's guide. New York, NY, US: Guilford Press; 2003.
24. Boudoukha AH, Przygodzki-Lionet N, Hautekeete M. Traumatic events and early maladaptive schemas (EMS): Prison guard psychological vulnerability. Eur Rev Appl Psychol. 2016;66(4):181-87.
25. Leahy RL. Emotional Schema Therapy: A Bridge Over Troubled Waters. 2012.
26. Cámara M, Calvete E. Early maladaptive schemas as moderators of the impact of stressful events on anxiety and depression in university students. J Psychopathol Behav Assess. 2012;34(1):58-68.
27. Michl LC, McLaughlin KA, Shepherd K, Nolen-Hoeksema S. Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: longitudinal evidence in early adolescents and adults. J Abnorm Psychol. 2013;122(2):339-52.
28. Yu XN, Lau JT, Mak WW, Zhang J, Lui WW, Zhang J. Factor structure and psychometric properties of the Connor-Davidson Resilience Scale among Chinese adolescents. Compr Psychiatry. 2011;52(2):218-24.
29. Ding H, Han J, Zhang M, Wang K, Gong J, Yang S. Moderating and mediating effects of resilience between childhood trauma and depressive symptoms in Chinese children. J Affect Disord. 2017;211:130-5.
30. Hoppen TH, Chalder T. Childhood adversity as a transdiagnostic risk factor for affective disorders in adulthood: A systematic review focusing on biopsychosocial moderating and mediating variables. Clin Psychol Rev. 2018;65:81-151.
31. Burton NW, Pakenham KI, Brown WJ. Feasibility and effectiveness of psychosocial resilience training: a pilot study of the READY program. Psychol Health Med. 2010;15(3):266-77.
32. Hosseini S, Barker K, Ramirez-Marquez JE. A review of definitions and measures of system resilience. Reliab Eng Syst Safety. 2016;145:47-61.
33. Otero J, Muñoz MA, Fernández-Santaella MC, Verdejo-García A, Sánchez-Barrera MB. Cardiac defense reactivity and cognitive flexibility in high- and low-resilience women. Psychophysiology. 2020;57(11):e13656.
34. Seery MD, Quinton WJ. Understanding resilience: From negative life events to everyday stressors. Advances in experimental social psychology. Advances in experimental social psychology. San Diego, CA, US: Elsevier Academic Press; 2016.
35. Foster K, Roche M, Delgado C, Cuzzillo C, Giandinoto JA, Furness T. Resilience and mental health nursing: An integrative review of international literature. Int J Ment Health Nurs. 2019;28(1):71-85.
36. Howell KH, Miller-Graff LE, Schaefer LM, Scrafford KE. Relational resilience as a potential mediator between adverse childhood experiences and prenatal depression. J Health Psychol. 2020;25(4):545-57.
37. Babić R, Babić M, Rastović P, Ćurlin M, Šimić J, Mandić K, et al. Resilience in Health and Illness. Psychiatr Danub. 2020;32(Suppl 2):226-32.
38. Shute R, Maud M, McLachlan A. The relationship of recalled adverse parenting styles with maladaptive schemas, trait anger, and symptoms of depression and anxiety. J Affect Disord. 2019;259:337-48.
39. Ungar M, Theron L. Resilience and mental health: how multisystemic processes contribute to positive outcomes. Lancet Psychiatry. 2020;7(5):441-8.
40. Jin X, Xu X, Qiu J, Xu Z, Sun L, Wang Z, et al. Psychological Resilience of Second-Pregnancy Women in China: A Cross-sectional Study of Influencing Factors. Asian Nurs Res (Korean Soc Nurs Sci). 2021;15(2):121-8.
41. Westphal M, Seivert NH, Bonanno GA. Expressive Flexibility. Emotion. 2010;10(1):92-100.
42. Walsh MV, Armstrong TW, Poritz J, Elliott TR, Jackson WT, Ryan T. Resilience, Pain Interference, and Upper Limb Loss: Testing the Mediating Effects of Positive Emotion and Activity Restriction on Distress. Arch Phys Med Rehabil. 2016;97(5):781-7.
43. Reynaud E, Guedj E, Souville M, Trousselard M, Zendjidjian X, El Khoury-Malhame M, et al. Relationship between emotional experience and resilience: an fMRI study in fire-fighters. Neuropsychologia. 2013;51(5):845-9.
44. Dajani DR, Uddin LQ. Demystifying cognitive flexibility: Implications for clinical and developmental neuroscience. Trends Neurosci. 2015;38(9):571-8.
45. Braem S, Egner T. Getting a grip on cognitive flexibility. Curr Dir Psychol Sci. 2018;27(6):470-6.
46. Soltani E, Shareh H, Bahrainian SA, Farmani A. The mediating role of cognitive flexibility in correlation of coping styles and resilience with depression. Pajoohandeh. 2013;18(2):88-96.
47. Hildebrandt LK, McCall C, Engen HG, Singer T. Cognitive flexibility, heart rate variability, and resilience predict fine-grained regulation of arousal during prolonged threat. Psychophysiology. 2016;53(6):880-90.
48. Dennis JP, Vander Wal JS. The Cognitive Flexibility Inventory: Instrument development and estimates of reliability and validity. Cognit Ther Res. 2010;34(3):241-53.
49. Meiran N, Diamond GM, Toder D, Nemets B. Cognitive rigidity in unipolar depression and obsessive compulsive disorder: examination of task switching, Stroop, working memory updating and post-conflict adaptation. Psychiatry Res. 2011;185(1-2):149-56.
50. Murphy FC, Michael A, Sahakian BJ. Emotion modulates cognitive flexibility in patients with major depression. Psychol Med. 2012;42(7):1373-82.
51. Han DH, Park HW, Kee BS, Na C, Na DH, Zaichkowsky L. Performance enhancement with low stress and anxiety modulated by cognitive flexibility. Psychiatry Investig. 2011;8(3):221-6.
52. Johnco C, Wuthrich VM, Rapee RM. The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: Results of a pilot study. Behav Res Ther. 2014;57:55-64.
53. Rosa-Alcázar Á, Olivares-Olivares PJ, Martínez-Esparza IC, Parada-Navas JL, Rosa-Alcázar AI, Olivares-Rodríguez J. Cognitive flexibility and response inhibition in patients with Obsessive-Compulsive Disorder and Generalized Anxiety Disorder. Int J Clin Health Psychol. 2020;20(1):20-8.
54. Park J, Moghaddam B. Impact of anxiety on prefrontal cortex encoding of cognitive flexibility. Neuroscience. 2017;345:193-202.
55. Shnitko TA, Gonzales SW, Grant KA. Low cognitive flexibility as a risk for heavy alcohol drinking in non-human primates. Alcohol. 2019;74:95-104.
56. Mohammadkhani S, Soleimani H, Seyed Ali Naghei SA. The role of emotional schemas in the resilience of people living with HIV. J Knowl Health. 2014;9(3):1-10.
57. Khanzadeh M, Edrisi F, Mohammadkhani S, Saidian M. Investigation of the factor structure and psychometric properties of emotional schema scale on a normal sample of Iranian students. J Clin Psychol. 2013;11(3):91-119.
58. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.
59. Mohammadi M, Jazayeri AR, Rafie AH, Joukar B, Pourshahbaz A. Resilience factors in individuals at risk for substance abuse. J Psychol (TABRIZ UNIVERSITY). 2006;1(2-3):203-24.
60. Shareh H, Farmani A, Soltani E. Investigating the Reliability and Validity of the Cognitive Flexibility Inventory (CFI-I) among Iranian University Students. Pract Clin Psychol. 2014;2(1):43-50.
61. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43.
62. Norton PJ. Depression Anxiety and Stress Scales (DASS-21): psychometric analysis across four racial groups. Anxiety Stress Coping. 2007;20(3):253-65.
63. Sahebi A, Asghari M, Salari R. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. J Develop Psychol. 2005;1(4):36-54.
64. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1-55.
65. Carlucci L, D'Ambrosio I, Innamorati M, Saggino A, Balsamo M. Co-rumination, anxiety, and maladaptive cognitive schemas: when friendship can hurt. Psychol Res Behav Manag. 2018;11:133-44.
66. Tandetnik C, Hergueta T, Bonnet P, Dubois B, Bungener C. Influence of early maladaptive schemas, depression, and anxiety on the intensity of self-reported cognitive complaint in older adults with subjective cognitive decline. Int Psychogeriatr. 2017;29(10):1657-67.
67. Petzold MB, Bendau A, Plag J, Pyrkosch L, Mascarell Maricic L, Betzler F, et al. Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany. Brain Behav. 2020;10(9):e01745.
2. Gibbons S, Trette-McLean T, Crandall A, Bingham JL, Garn CL, Cox JC. Undergraduate students survey their peers on mental health: Perspectives and strategies for improving college counseling center outreach. J Am Coll Health. 2019;67(6):580-91.
3. Arvidsdotter T, Marklund B, Kylén S, Taft C, Ekman I. Understanding persons with psychological distress in primary health care. Scand J Caring Sci. 2016;30(4):687-94.
4. Frostad S, Danielsen YS, Rekkedal G, Jevne C, Dalle Grave R, Rø Ø, et al. Implementation of enhanced cognitive behaviour therapy (CBT-E) for adults with anorexia nervosa in an outpatient eating-disorder unit at a public hospital. J Eat Disord. 2018;6:12.
5. Pengpid S, Peltzer K. Early Substance Use Initiation And Psychological Distress Among Adolescents In Five ASEAN Countries: A Cross-Sectional Study. Psychol Res Behav Manag. 2019;12:1003-8.
6. Assari S, Dejman M, Neighbors HW. Ethnic Differences in Separate and Additive Effects of Anxiety and Depression on Self-rated Mental Health Among Blacks. J Racial Ethn Health Disparities. 2016;3(3):423-30.
7. Bester G. Stress experienced by adolescents in school: the importance of personality and interpersonal relationships. J Child Adolesc Ment Health. 2019;31(1):25-37.
8. Haftgoli N, Favrat B, Verdon F, Vaucher P, Bischoff T, Burnand B, et al. Patients presenting with somatic complaints in general practice: depression, anxiety and somatoform disorders are frequent and associated with psychosocial stressors. BMC Fam Pract. 2010;11:67.
9. Greenberg PE, Fournier AA, Sisitsky T, Simes M, Berman R, Koenigsberg SH, et al. The Economic Burden of Adults with Major Depressive Disorder in the United States (2010 and 2018). Pharmacoeconomics. 2021;39(6):653-65.
10. Williams MT, Kanter JW, Ching THW. Anxiety, Stress, and Trauma Symptoms in African Americans: Negative Affectivity Does Not Explain the Relationship between Microaggressions and Psychopathology. J Racial Ethn Health Disparities. 2018;5(5):919-27.
11. Knighton JS, Dogan J, Hargons C, Stevens-Watkins D. Superwoman Schema: a context for understanding psychological distress among middle-class African American women who perceive racial microaggressions. Ethn Health. 2020:1-17.
12. Griffiths S, Mond JM, Murray SB, Touyz S. Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology. Aust N Z J Psychiatry. 2015;49(9):812-20.
13. Tull MT, Weiss NH, Adams CE, Gratz KL. The contribution of emotion regulation difficulties to risky sexual behavior within a sample of patients in residential substance abuse treatment. Addict Behav. 2012;37(10):1084-92.
14. Luminet O, Bagby RM, Taylor GJ. Alexithymia: advances in research, theory, and clinical practice: cambridge university press; 2018.
15. Faustino B, Vasco AB. Relationships between emotional processing difficulties and early maladaptive schemas on the regulation of psychological needs. Clin Psychol Psychother. 2020;27(6):804-13.
16. Edwards ER, Liu Y, Ruiz D, Brosowsky NP, Wupperman P. Maladaptive Emotional Schemas and Emotional Functioning: Evaluation of an Integrated Model Across Two Independent Samples. J Ration Emot Cogn Behav Ther. 2020;39(3):428-55.
17. Edwards ER, Wupperman P. Research on emotional schemas: A review of findings and challenges. Clin Psychol. 2019;23(1):3-14.
18. Leahy RL. Introduction: Emotional Schemas and Emotional Schema Therapy. Int J Cogn Ther. 2019;12(1):1-4.
19. Leahy RL. A model of emotional schemas. Cogn Behav Pract. 2002;9(3):177-90.
20. Leahy RL. Emotional Schemas and Resistance to Change in Anxiety Disorders. Cogn Behav Pract. 2007;14(1):36-45.
21. Leahy RL, Tirch D, Melwani P. Processes Underlying Depression: Risk Aversion, Emotional Schemas, and Psychological Flexibility. Int J CognTher. 2012;5:362-79.
22. Leahy RL. Emotional schemas in treatment-resistant anxiety. New York, NY, US: Routledge/Taylor & Francis Group;2010.
23. Young JE, Klosko JS, Weishaar ME. Schema therapy: A practitioner's guide. New York, NY, US: Guilford Press; 2003.
24. Boudoukha AH, Przygodzki-Lionet N, Hautekeete M. Traumatic events and early maladaptive schemas (EMS): Prison guard psychological vulnerability. Eur Rev Appl Psychol. 2016;66(4):181-87.
25. Leahy RL. Emotional Schema Therapy: A Bridge Over Troubled Waters. 2012.
26. Cámara M, Calvete E. Early maladaptive schemas as moderators of the impact of stressful events on anxiety and depression in university students. J Psychopathol Behav Assess. 2012;34(1):58-68.
27. Michl LC, McLaughlin KA, Shepherd K, Nolen-Hoeksema S. Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: longitudinal evidence in early adolescents and adults. J Abnorm Psychol. 2013;122(2):339-52.
28. Yu XN, Lau JT, Mak WW, Zhang J, Lui WW, Zhang J. Factor structure and psychometric properties of the Connor-Davidson Resilience Scale among Chinese adolescents. Compr Psychiatry. 2011;52(2):218-24.
29. Ding H, Han J, Zhang M, Wang K, Gong J, Yang S. Moderating and mediating effects of resilience between childhood trauma and depressive symptoms in Chinese children. J Affect Disord. 2017;211:130-5.
30. Hoppen TH, Chalder T. Childhood adversity as a transdiagnostic risk factor for affective disorders in adulthood: A systematic review focusing on biopsychosocial moderating and mediating variables. Clin Psychol Rev. 2018;65:81-151.
31. Burton NW, Pakenham KI, Brown WJ. Feasibility and effectiveness of psychosocial resilience training: a pilot study of the READY program. Psychol Health Med. 2010;15(3):266-77.
32. Hosseini S, Barker K, Ramirez-Marquez JE. A review of definitions and measures of system resilience. Reliab Eng Syst Safety. 2016;145:47-61.
33. Otero J, Muñoz MA, Fernández-Santaella MC, Verdejo-García A, Sánchez-Barrera MB. Cardiac defense reactivity and cognitive flexibility in high- and low-resilience women. Psychophysiology. 2020;57(11):e13656.
34. Seery MD, Quinton WJ. Understanding resilience: From negative life events to everyday stressors. Advances in experimental social psychology. Advances in experimental social psychology. San Diego, CA, US: Elsevier Academic Press; 2016.
35. Foster K, Roche M, Delgado C, Cuzzillo C, Giandinoto JA, Furness T. Resilience and mental health nursing: An integrative review of international literature. Int J Ment Health Nurs. 2019;28(1):71-85.
36. Howell KH, Miller-Graff LE, Schaefer LM, Scrafford KE. Relational resilience as a potential mediator between adverse childhood experiences and prenatal depression. J Health Psychol. 2020;25(4):545-57.
37. Babić R, Babić M, Rastović P, Ćurlin M, Šimić J, Mandić K, et al. Resilience in Health and Illness. Psychiatr Danub. 2020;32(Suppl 2):226-32.
38. Shute R, Maud M, McLachlan A. The relationship of recalled adverse parenting styles with maladaptive schemas, trait anger, and symptoms of depression and anxiety. J Affect Disord. 2019;259:337-48.
39. Ungar M, Theron L. Resilience and mental health: how multisystemic processes contribute to positive outcomes. Lancet Psychiatry. 2020;7(5):441-8.
40. Jin X, Xu X, Qiu J, Xu Z, Sun L, Wang Z, et al. Psychological Resilience of Second-Pregnancy Women in China: A Cross-sectional Study of Influencing Factors. Asian Nurs Res (Korean Soc Nurs Sci). 2021;15(2):121-8.
41. Westphal M, Seivert NH, Bonanno GA. Expressive Flexibility. Emotion. 2010;10(1):92-100.
42. Walsh MV, Armstrong TW, Poritz J, Elliott TR, Jackson WT, Ryan T. Resilience, Pain Interference, and Upper Limb Loss: Testing the Mediating Effects of Positive Emotion and Activity Restriction on Distress. Arch Phys Med Rehabil. 2016;97(5):781-7.
43. Reynaud E, Guedj E, Souville M, Trousselard M, Zendjidjian X, El Khoury-Malhame M, et al. Relationship between emotional experience and resilience: an fMRI study in fire-fighters. Neuropsychologia. 2013;51(5):845-9.
44. Dajani DR, Uddin LQ. Demystifying cognitive flexibility: Implications for clinical and developmental neuroscience. Trends Neurosci. 2015;38(9):571-8.
45. Braem S, Egner T. Getting a grip on cognitive flexibility. Curr Dir Psychol Sci. 2018;27(6):470-6.
46. Soltani E, Shareh H, Bahrainian SA, Farmani A. The mediating role of cognitive flexibility in correlation of coping styles and resilience with depression. Pajoohandeh. 2013;18(2):88-96.
47. Hildebrandt LK, McCall C, Engen HG, Singer T. Cognitive flexibility, heart rate variability, and resilience predict fine-grained regulation of arousal during prolonged threat. Psychophysiology. 2016;53(6):880-90.
48. Dennis JP, Vander Wal JS. The Cognitive Flexibility Inventory: Instrument development and estimates of reliability and validity. Cognit Ther Res. 2010;34(3):241-53.
49. Meiran N, Diamond GM, Toder D, Nemets B. Cognitive rigidity in unipolar depression and obsessive compulsive disorder: examination of task switching, Stroop, working memory updating and post-conflict adaptation. Psychiatry Res. 2011;185(1-2):149-56.
50. Murphy FC, Michael A, Sahakian BJ. Emotion modulates cognitive flexibility in patients with major depression. Psychol Med. 2012;42(7):1373-82.
51. Han DH, Park HW, Kee BS, Na C, Na DH, Zaichkowsky L. Performance enhancement with low stress and anxiety modulated by cognitive flexibility. Psychiatry Investig. 2011;8(3):221-6.
52. Johnco C, Wuthrich VM, Rapee RM. The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: Results of a pilot study. Behav Res Ther. 2014;57:55-64.
53. Rosa-Alcázar Á, Olivares-Olivares PJ, Martínez-Esparza IC, Parada-Navas JL, Rosa-Alcázar AI, Olivares-Rodríguez J. Cognitive flexibility and response inhibition in patients with Obsessive-Compulsive Disorder and Generalized Anxiety Disorder. Int J Clin Health Psychol. 2020;20(1):20-8.
54. Park J, Moghaddam B. Impact of anxiety on prefrontal cortex encoding of cognitive flexibility. Neuroscience. 2017;345:193-202.
55. Shnitko TA, Gonzales SW, Grant KA. Low cognitive flexibility as a risk for heavy alcohol drinking in non-human primates. Alcohol. 2019;74:95-104.
56. Mohammadkhani S, Soleimani H, Seyed Ali Naghei SA. The role of emotional schemas in the resilience of people living with HIV. J Knowl Health. 2014;9(3):1-10.
57. Khanzadeh M, Edrisi F, Mohammadkhani S, Saidian M. Investigation of the factor structure and psychometric properties of emotional schema scale on a normal sample of Iranian students. J Clin Psychol. 2013;11(3):91-119.
58. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.
59. Mohammadi M, Jazayeri AR, Rafie AH, Joukar B, Pourshahbaz A. Resilience factors in individuals at risk for substance abuse. J Psychol (TABRIZ UNIVERSITY). 2006;1(2-3):203-24.
60. Shareh H, Farmani A, Soltani E. Investigating the Reliability and Validity of the Cognitive Flexibility Inventory (CFI-I) among Iranian University Students. Pract Clin Psychol. 2014;2(1):43-50.
61. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43.
62. Norton PJ. Depression Anxiety and Stress Scales (DASS-21): psychometric analysis across four racial groups. Anxiety Stress Coping. 2007;20(3):253-65.
63. Sahebi A, Asghari M, Salari R. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. J Develop Psychol. 2005;1(4):36-54.
64. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1-55.
65. Carlucci L, D'Ambrosio I, Innamorati M, Saggino A, Balsamo M. Co-rumination, anxiety, and maladaptive cognitive schemas: when friendship can hurt. Psychol Res Behav Manag. 2018;11:133-44.
66. Tandetnik C, Hergueta T, Bonnet P, Dubois B, Bungener C. Influence of early maladaptive schemas, depression, and anxiety on the intensity of self-reported cognitive complaint in older adults with subjective cognitive decline. Int Psychogeriatr. 2017;29(10):1657-67.
67. Petzold MB, Bendau A, Plag J, Pyrkosch L, Mascarell Maricic L, Betzler F, et al. Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany. Brain Behav. 2020;10(9):e01745.
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| Issue | Vol 17 No 3 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v17i3.9728 | |
| Keywords | ||
| Psychological Distress Resilience Structural Model | ||
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How to Cite
1.
Mohammadkhani S, Foroutan A, Akbari M, Shahbahrami M. Emotional Schemas and Psychological Distress: Mediating Role of Resilience and Cognitive Flexibility. Iran J Psychiatry. 2022;17(3):284-293.
