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November 2017 -
Volume 15, Issue 9

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Original contribution/Clinical Investigation
Diabetes Mellitus - Knowledge, Management and Complications: Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah Haider, Muhammad Masood Ahmad

Alanine aminotransferase indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley Pocock

Comparative Analysis of Antimicrobial Peptides Gene Expression in Susceptible/Resistant Mice Macrophages to Leishmania major Infection

Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani, Amir Tavakoli Kareshk, Arash Asadi

Does socio-economic status of the patients have effect on clinical outcomes after coronary artery bypass grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed Kouhpyma

Comparison of the uterine artery Doppler indices during pregnancy between gestational diabetes and diabetes mellitus and healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud Jaafarnejhad,
Parisa Bahrami Kamangar

Survey single dose Gentamicin in treatment of UTI in children with range of 1 month to 13 years old in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab

Evaluation of control of bleeding by electro cauterization of bleeding points of amplatz sheath tract after percutaneous nephrolithotomy (PCNL) in Jahrom Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo

Comparison of the three-finger tracheal palpation technique with triple ID formula to determine endotracheal tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori

Effect of Sevoflurane and Propofol on pulmonary arterial pressure during cardiac catheterization in children with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza Mohseni, Azim Zaraki
Population and Community Studies

Prevalence and risk factors of obesity in children aged 2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal Darwish

Study and comparison of psychological disorders in normal students and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Comparative study of self-concept, physical self-concept, and time perspective between the students with multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Relationship between Coping Styles and Religious Orientation with Mental Health in the Students of the Nursing-Midwifery Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid Dastras, Shirzad Arianmehr

Tuberculosis in Abadan, Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi, Rahil Hojjati,
Parvin Gholizadeh

Family Stability and Conflict of Spiritual Beliefs and Superstitions among Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad ; Hassan Zareei Mahmoodabadi ; Hossein Tavangar ; Seyed Mojtaba Yassini Ardekani ; Ali Akbar Vaezi

A comparative study of the self-actualization in psychology and Islam
Simin Afrasibi, Zakieh Fattahi

The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male students survivors of earthquake in the central district of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh


Effects and mechanisms of medicinal plants on stress hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley Pocock

Comparing Traditional and medical treatments for constipation : A Review Article
Mohammad Yaqub Rajput

A review of anti-measles and anti-rubella antibodies in 15- 25 year old women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab

Review of percutaneous nephrolithotomy in children below 12 years old in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo

Physical and mental health in Islam
Bahador Mehraki, Abdollah Gholami

International Health Affairs

The Challenges of Implementation of Professional Ethics Standards in Clinical Care from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi

Cognitive Determinants of Physical Activity Intention among Iranian Nurses: An Application of Integrative Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki, Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi

Effect of resilience-based intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader Aghakhani, Vahid Alinejad, Yaser Moradi

Education and Training

Calculation of Salaries and Benefits of Faculty Members in the Ministry of Health and Medical Education of Iran
Abdolreza Gilavand

The effect of education on self-care behaviors of gastrointestinal side effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram Razie, Lila Nezam Abadi Farahani

Creating and Validating the Faith Inventory for Students at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Creating and Validating the Adjustment Inventory for the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Evaluating the Quality of Educational Services from the Viewpoints of Radiology Students of Ahvaz Jundishapur University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl

An Investigation of Psychosocial aspect of Iranian Nursing Students' Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari Anbohi, Amir Almasi-Hashiani, Fariba Borhani

Clinical Research and Methods

Comparison of the Antibacterial Effects of Chlorhexidine Mouth washes with Jaftex Mouth wash on Some Common Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi

Study of the effect of plasma jet on Fusarium isolates with ability to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss

The comparison of anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger alcoholic extract after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran Mirzaie, Ramin Seyedian, Narges Aria, Saman Jokar

The effect of curcumin on growth and adherence of major microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami, Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab

Middle East Quality Improvement Program

Chief Editor -
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November 2017 - Volume 15, Issue 9

The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male student survivors of the earthquake in the central district of Varzeghan

Sakineh Salamat (1)
Ahad Ahangar
Robab Farajzadeh

(1) Department of psychology, Payame Noor University,(PNU)PO BOX 19395-3697, Tehran IRAN.
(2) Department of Counseling, Shabestar Branch, Islamic Azad University, Shabestar, Iran
(3) Graduate of Consultation (M.A).

Corresponding author:
Dr.Ahad Ahangar
Department of Counseling,
Shabestar Branch,
Islamic Azad University,
Shabestar, Iran


The aim of this study is investigating the effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male student survivors of the earthquake in the central district of Varzeghan.

Methodology: This study is a quasi-experimental study with pretest – Posttest design with control group. The population included all Central district of Varzaghan city high school II students in 2015-2016 who were evaluated based on secondary trauma stress scale (STSS) of Bride. Individuals with the highest scores were selected as the study subjects and divided into two experimental and control groups ( n 1 = n 2=25) randomly. The experimental group received 6 therapy sessions. The derived data from the groups were analyzed.

Findings: The results of covariance analysis showed that there is a significant difference between the experimental and control groups in intrusive thoughts scores and there was a significant difference in avoidance (P <0.05), but in arousal scale there was no significant difference (0.05>P).

Conclusion: In general, it can be concluded that this therapeutic intervention is effective and it can be used at health centers as well as schools in order to reduce the symptoms of post-traumatic stress.

Key words: Posttraumatic stress disorder, Cognitive - behavioral therapy, Students.


In recent decades, the psychological effects of earthquakes have been taken into consideration more than before. Studies which have been addressed to survey the natural disasters outcomes show that many earthquake survivors after confronting the stressful event (such as lack of interested people, social structure chaos and social supports loss), show certain clinical responses (Livanuo, Bassoglu, Salcioglu, & Kalendar, 2003). Studies have shown that severe earthquakes can cause severe long-term disabilities. In studies which were conducted on 430 people who were Turkey’s 1999 earthquake survivors, disability and mental disorders outbreaks such as post-traumatic stress disorder had a direct correlation with proximity and exposure to the earthquake (Kilic & Ulusoy, 2001). In another study which was conducted on 586 survivors of the earthquake in Turkey results in that severe and terrible earthquake lead to long-term psychological consequences, especially in people who had high exposure levels (Salcioglu, Basoglu & Livanou, 2003).

Typically, post-traumatic stress disorder is the first response of survivors to trauma, which is an important prediction of their subsequent mental and physical health status long-term outcome (March, Amaya-Jackson, Murray & Schulte, 1998). A study in Taiwan showed that 7.21 percent of the 323 earthquake survivors had PTSD symptoms, but in general, there are numerous reports that vary from 5.2 to 33 percent in adults and 28 to 70 percent in children (Hsu, Chong, Yang & Yen, 2002). Therefore, in order to reduce the disabilities, preventive and therapeutic interventions, such as supporting group psychotherapy and treatments based on cognitive-behavioral methods as well as other types of psychotherapy, have been paid attention (Livanuo, Bassoglu, Salcioglu & Kalendar, 2003). Many clinical studies have shown that cognitive behavioral programs are effective in controlling the symptoms of PTSD (Foa, 2006). In research performed by March et al (1998) showed that cognitive behavioral therapy intervention is effective in PTSD stress disorder.

Cognitive behavioral therapy is a way that helps people think differently about bad memories so that they will be less distressing and more manageable. Usually this type of treatment also involves several sessions of relaxation.

Wessely, Rose and Bisson (2002) also conducted a study on 35 earthquake victims which suggested the high effectiveness of cognitive-behavioral treatments for PTSD and grief. In other research Ehlers (2000) studied 28 people with PTSD and reported that PTSD symptoms and anxiety in patients who had undergone cognitive-behavioral therapy was reduced compared to the control group. In another study the group psychotherapy effect using psychological recounting for 30 natural events survivors was investigated 6 months after the event, which indicated symptom reduction in both intervention and control groups (Chemtob, Tomas and Law, 1997).

Foa (2004) treated 117 PTSD affected victims of traumatic events through flooding and a combination of spate and cognitive restructuring treatment. He concluded that both treatments reduced the symptoms of PTSD and depression identically.

Regarding the effectiveness of cognitive behavioral therapy in reducing symptoms of post-traumatic stress in relation to disasters caused by war, floods, storms, earthquakes and so on, this paper seeks to determine whether cognitive behavioral therapy is effective to alleviate the symptoms of post-traumatic stress in earthquake survivor male students in the central district of Varzaghan.


A quasi-experimental technique of pretest-posttest type with control group was used, through which a cluster of high school male students were selected randomly and the secondary trauma stress scale by Bride (STSS) was conducted on students. Among the students who gained high scores in each subscale in the Secondary Trauma Stress Bride questionnaire 50 students were selected randomly and 25 students were replaced in the experimental group and 25 in the control group.


Secondary Trauma Stress Scale Bride (STSS) of Bride

This scale was established by Bride and his colleagues in 2003 and has 17 items summarized in three subscales;
1. Nuisance
2. Avoid
3. Arousal
At this scale, using a five degrees Likert scale from 1 (never) to 5 (always) the participants were asked to identify to what extent each of the items happened to themin the previous week. High scores on each subscale indicate lack of health and less score, simply a healthy student. Bride studies results showed that the scale reliability is .93 which has an acceptable convergent and divergent and structure validity. In this study, the Cronbach’s alpha coefficient for the disturbance, avoidance and arousal subscale were estimated as 0.878, 0.798 and 0.847, respectively.

Treatment Plan


For data analysis, in addition to using descriptive statistics, multivariate analysis of covariance (MANCOVA) also used.

Descriptive Findings

Table 1. The mean and Standard deviation of pre-test, post-test scores of research variables in both experimental and control groups

Table 1 results imply the improvement of variables in the experimental group in posttest stage compared to the control group, but no difference was observed in the control group.

In the present study, the covariance analysis was used for inferential results analysis. Therefore, prior to study the hypotheses, the normality of scores distribution assumption was examined.

To test the assumption the Shapiro-Wilk test was used. The test results for research variables pre-test scores are given in Table 2.

Table 2: Shapiro-Wilk test results for pre-assumption scores distribution normality

As can be seen in Table 2, assuming zero for the scores distribution normality of two groups in research variables is confirmed, is that the scores distribution normality pre-assumption in pre-test and in both control and test tests groups were confirmed.

Inferential evaluation of data
Given that in each variable the post-test scores were the dependent variables and in order to control the effect of pre-test (as covariate and control variable) the ANCOVA was used on grades.

Cognitive-behavioral therapy is effective in reducing the symptoms of post-traumatic stress (intrusive thoughts, avoidance and arousal) of Varzaghan earthquake-stricken students.

Table 3:.The results of cognitive-behavioral therapy covariance analysis on intrusive thoughts - pre-test - group membership

As the Table 3 results show, after removing the effect of pre-test scores, except the arousal scale, given that a significant level obtained for both variables of intrusive thoughts and avoidance are less than Alpha 0.05, so the research hypothesis was confirmed. Thus, we can conclude with confidence of 95/0 that cognitive-behavioral therapy was effective in participant’s intrusive thoughts and avoidance reduction but it had no significant effect on the participant’s arousal reduction. Squared Eta was estimated as 0.14, 0.32 and 0.05 for intrusive thoughts, avoidance and arousal, respectively. Namely 0.14, 0.32 and 0.5 of intrusive thoughts, avoidance and arousal variances was explained by the cognitive-behavioral therapy independent variable.


Disasters have been an integral part of human life. Natural disasters cause death and disability to millions of people around the world every year and resulting financial damages. As various studies have shown, the confrontation with a damaging event can lead to various disorders, and PTSD stress and anxiety can be cited as the most important. To treat the post-PTSD stress disorder symptoms and associated disorders according to different perspectives of the etiology of this disorder, various therapies has been suggested which include cognitive behavioral therapy method. Thus, given that several researchers have confirmed the effectiveness of cognitive-behavioral treatment for post-traumatic stress disorder, the aim of this study was investigating the cognitive behavioral therapy effectiveness in symptoms of post-traumatic stress disorder reduction ,among the earthquake survivor male students of the central district of Varzaghan. The results showed that the cognitive-behavioral group therapy diminished the stress of earthquake survivor male students of the central district of Varzaghan PTSD shown in the posttest scores in the experimental group more than the control group.

The results obtained in this study are in good accordance with those of Foa (2004), Salcioglu, Basoglu & Livanou (2003), Wessely, Rose and Bisson (2002), March (1998), Ehlers (2000), Chemtob and et al (1997) .

In explaining how the cognitive behavioral therapy effects on PTSD symptoms of the earthquake survivor male students of the central district of Varzaghan it can be due to the effective factors on PTSD symptoms continuation in and given the cognitive-behavioral therapy techniques

by using relaxation, conceptual facing with the traumatic event education, identifying dysfunctional thoughts and challenging them and exposing and cognitive restructuring could reduce the effects of PTSD in the control group.
Given that the present study was performed on the earthquake survivor male students of the central district of Varzaghan and sampling was available and purposeful, we cannot generalize its results to other students’ disorders of other age groups and this generalization should be done with caution.

Another limitation of the study was the lack of six-months’ follow-up. It is recommended to conduct studies to assess the students’ family situation and their well-being regarding the extent of this problem in Iran as well as conducting research about adjustment to the adverse effects of close relatives loss in various ages.

Regarding the effectiveness of cognitive - behavioral therapy in reducing the bereaved students PTSD symptoms it is suggested to use these services in other organizations and schools. Establishing organizations and centers in order to support and train to prevent post-traumatic stress symptoms and use of experts, in agencies, governmental and non-governmental organizations for reducing psychological problems in children and adolescents who are affected by injuries, and educating their families and adolescents and providing appropriate support to their school officials are among other proposals.


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