Middle Eastern Journal of Disability Studies

Abstract
Background & Objectives: Psychological distress potentially affects a person's emotions and includes emotional and physical states. Cognitive flexibility is one of the important variables that play a special role in mental health and plays an important role in preventing depression and stress and reducing psychological problems. Another basic construct involved in a wide range of emotional disorders, especially depressive and anxiety disorders, is emotional flexibility. Given the high prevalence, effects, and consequences associated with psychological distress and knowing that people with psychological distress face multiple problems, including impaired emotional and cognitive flexibility, they need treatments to reduce their psychological problems and, ultimately, the health of society. In addition, given the weakness of the research background regarding the effect of cognitive behavioral therapy on comorbid disorders in people with psychological distress, this study aimed to determine the effectiveness of cognitive behavioral therapy on emotional and cognitive flexibility in people with psychological distress.
Methods: The present research was quasi–experimental and was conducted with a pretest–posttest design with the control and experimental groups. The statistical population of this research included people with psychological distress who were referred to counseling and psychology clinics in Tehran City, Iran, in 2021. Since the number of subjects in groups in quasi–experimental studies is considered to be at least fifteen people. Among the statistical population, 30 qualified volunteers were randomly entered into the study and randomly assigned to the experimental and control groups (each group includes 15 people). The implementation method was such that after selecting the people of the sample group and before starting the treatment program, the Cognitive Flexibility Inventory (Dennis & Vander Wal, 2010) and the Emotional Flexibility Questionnaire (Burton CL, Bonanno, 2016) were distributed between both groups. After that, cognitive behavioral therapy was performed on the experimental group (in the form of 8 sessions of 90 minutes, each session once a week), and the control group was not subjected to any treatment program. In the end, the posttest was done again from both groups. Also, after the end of the research, to maintain the ethical standards in the study, the treatment programs implemented in this research were implemented in the control group. The inclusion criteria for the research included an interview based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) and a higher–than–average score on the Psychological Distress Scale, which was conducted by an expert in the field of clinical psychology at least a diploma level of education, non–participation in other psychological interventions at the same time, absence of debilitating mental illnesses that were diagnosed by the researcher using a clinical interview. The exclusion criteria of the research included an absence of more than three sessions, non–observance of group therapy rules, and suffering from a mental illness that did not exist before the treatment and was identified during the implementation. Data analysis was performed in two parts: descriptive statistics and inferential statistics. At the descriptive level, frequency, percentage, mean, and standard deviation were used, and at the inferential level, univariate analysis of covariance was used. Data analysis was performed in SPSS version 24 software, and the significance level of the tests was considered to be 0.05.
Results: The results showed a significant difference between the experimental and control groups in the posttest after removing the pretest effect in the cognitive flexibility variable for the subscales of perception of evidence and substitution for human behavior and in the emotional flexibility variable for the subscales of negative emotion expression and positive emotion expression (p<0.001).
Conclusion: According to the findings, cognitive behavioral therapy effectively increases cognitive and emotional flexibility in people with psychological problems.