The Comparison of the Effectiveness of Mindfulness Based Therapy and Spiritual Therapy on Irrational Beliefs and Anxiety in the Older Women

Document Type : Original Article

Authors

1 Associate Professor of General Psychology, Faculty of Literature and Humanities, Payame Noor University of Tehran, Iran

2 General Psychology, Faculty of Literature and Humanities, Payame Noor University, Tehran, Iran.

Abstract

people in the old age are increasingly exposed to mental disorders such as anxiety and depression, due to the prevalence of numerous losses such as spouse, relatives, friends, occupation, social and economic status, beliefs, and suchlike. Therefore,the aim of the current study was to compare the effectiveness of mindfulness-based therapy (MBT) and spiritual therapy (ST) on irrational beliefs and anxiety in the older women. This was a semi-experimental study with pretest-posttest and follow-up with a control group design. The statistical population included all the elderly women who were the member of Jahandidegan center, Tehran among whom 45 (three groups containing 15 people) with the mean age of 60-70 (SD=4.58) were selected using convenience sampling method along with inclusion and exclusion criteria and assigned randomly into two experimental and one control group. Participants underwent Kabat’s MBT and Gallanter and Siegel’s ST in 90-minute sessions twice a week, and a follow-up test was performed one month after the posttest. Used to collect data were Jones's Irrational Belief and Spielberger's Overt and Covert Anxiety scales. The obtained data were analyzed by univariate analysis of covariance altogether with Bonferroni post-hoc. The results showed that both treatments were effective in reducing irrational beliefs and overt and covert anxiety, and this effect was persistent during the follow-up period (p < 0.001). The comparison of MBT and ST showed that although there is no difference between the effectiveness of the two kinds of therapy on irrational beliefs, MBT is more effective than ST in reducing overt and covert anxiety (p < /span><.001). According to the results, mindfulness-based and spiritual therapy can be used as effective interventions for reducing irrational beliefs and anxiety when it comes to designing programs regarding the promotion of mental health in the elderly.
References
Ahadi, H., & Jamhari, F. (2012). Developmental Psychology: Adolescence, Adulthood (Youth, Middle Age and Aging). Tehran: Aydayde Derakhshan Publications. [Persian]
Aloustani, S., & Mamashli, L. (2020). The effect of spiritual group therapy on death anxiety in the elderly. Hayat, 26 (1), 46-57. [Persian]
Arch, J. J., Ayers, C. R., Baker, A., Almklov, E., Dean, D. J., & Craske, M. G. (2013). Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behaviour Research and Therapy, 51(4–5), 185–196.
 Asgari, P. (2017). The Effectiveness of spiritual therapy on quality of life and adjustability in the elderly, with an emphasis on the teachings of Islam. Aging Psychology, 2 (4), 281-291.
 Askari, M., Mohammadi, H., Radmehr, H., & Jahangir, A. H. (2018). The Effect of spiritual–religious psychotherapy on enhancing quality of life and reducing symptoms of anxiety and depression among the elderly. Journal of Research on Religion & Health, 4(2), 29-41. [Persian] 
Babazadeh, T., Sarkhoshi, R., Bahadori, F., Moradi, F., Shariat, F., & Sherizadeh, Y. (2016). Prevalence of depression, anxiety and stress disorders in elderly people residing in Khoy, Iran (2014-2015). Journal of Research Clinical Medicine, 24 (2), 122-128. [Persian]
 Barrera, T. L., Zeno, D., Bush, A. L., Barber, C. R., & Stanley, M. A. (2012). Integrating religion and spirituality into treatment for late-life anxiety: Three case studies. Cognitive and Behavioral Practice, 19 (2), 346-358.
Basharpoor, S., Hoseinikiasari, S. T., Soleymani, E., & Massah, O. (2019). The Role of irrational beliefs and attitudes to death in quality of life of the older people. Salmand: Iranian Journal of Ageing, 14 (3), 260-271. [Persian]
 Brantley, J. (2011). Mindfulness-Based Stress Reduction. In S. M. Orsillo & L. Roemer (Eds), Acceptance and mindfulness-based approaches to anxiety (pp. 131-145.). Conceptualization and treatment New York.
 Crain, W. (2016). Theories of development: concepts and applications. London and New York: Routledge.
 Cramer, H., Haller, H., Lauche, R., & Dobos, G. (2012). Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Alternat Med, 25 (12), 162-170.
  Curran, E., Rosato, M., Ferry, F., & Leavey, G. (2020). Prevalence and factors associated with anxiety and depression in older adults: Gender differences in psychosocial indicators. Journal of Affective Disorders, 267, 114-122. 
 Ellis, A. (1999). Rational-Emotive behavior therapy and cognitive behavior therapy for elderly people. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 17, 5-18.
Excerpts from the results of the general census of population and housing. (2016). http://www.amar.org.ir [Persian]
 Forti, A. (2012). Mindfulness and quality of life among breast cancer survivors: the mediating role of eslf- kindess and alexithymia. Carolina: Harvard Health Publications. Library. Uncg Edu.
 Ghaderi, D., & Mostafaee, A. (2014). A Study on the relationship between religious orientations and quality of life among elderly men living in nursing homes and those living with their families in Tabriz. Salmand: Iranian Journal of Ageing, 9 (1), 14-21. [Persian]
 Maurice Gibbons, M. (2003). The self-directed learning handbook: Challengingadolescent students to excel: John Wiley & Sons.
 Haddadi Kuhsar, A. A., Moradi, A. Ghobari Bonab, B., & Imani, F. (2018). Comparing the effectiveness of spiritual therapy based on iranian culture with mindfulness based on reduction stress (MBSR) in reducing depression, anxiety and stress in patients with chronic pain. Clinical Psychology Studies, 8 (31), 1-30. [Persian]
 Harnish, R. J., Bridges, K. R., & Karelitz, J. L. (2017). Compulsive buying: prevalence, irrational beliefs and purchasing. International Journal of Mental Health and Addiction, 15 (5), 993-1007.
Hayslip, B. Jr., Galt, C. P., Lopez, F. G., & Nation, P. C. (1994). Irrational beliefs and depressive symptoms among younger and older adults: a cross-sectional comparison. International Journal of Aging and Human Development, 38(4), 307-326. 
 Horváth , A., Montana, X., Lanquart , J. P., Hubain , F., Szűcs, A., Linkowski , P., & Loas, G. (2016). Effects of state and trait anxiety on sleep structure: A polysomnographic study in 1083 subjects, Psychiatry Research, 244, (30), 279-283.
 Irani, Z., Rajabi, M., Nazami, M., & Bagiyan Koulemarz, M. J. (2017).The role of lifestyle, psychological capital and self-care behaviors in predicting subjective well-being of diabetic elderly peoples. Journal of Health Psychology, 6 (23), 17-38. [Persian]
 Jadidi, A., Farahaninia, M., Janmohammadi, S., Haghani, H. (2011). The Relationship between spiritual well-being and quality of life among elderly people residing in kahrizak senior house. Iran Journal Nursing, 24 (72), 48-56. [Persian]
 Javanmardi, F., Naeimi, E., & Moatamedi, A. (2020). The Effectiveness of mindfulness model on improving intimate attitudes and elderly depression. Aging Psychology, 6 (1), 39-52. [Persian]
 Jones, R. A. (1968). A factored measure of Ellis' irrational belief system with personality and maladjustment correlates. Dissertation Abstracts International, 29, 4379-4380.
 Kabat-Zinn, J. (2013). Full catastrophe living; using the wisdom of your body and mind to face stress, pain and illness. (Revised And Updated ed.). New York: The Random House Publishing Group.
Kakavand, A. (2017). The Effectiveness of mindfulness on dysfunctional attitudes and depressive symptoms among elderly women with major depressive disorder. Aging Psychology, 2 (2), 91-101. [Persian]
Kamranmehr, F., Farsi, A., & Kavyani, M. (2020). The Effectiveness of mindfulness and biofeedback-relaxation training on anxiety, depression and dynamic and static balance in the elderly women with mild anxiety and depression. Aging Psychology, 6(3), 233-248. [Persian]
 Kangasiemi, A. M., Lappalainen, R., Kankeenpaa, A., & Tammelin, T. (2014). Mindfulness skills, psychological flexibility, and psychological symptoms among physically less active and active adults. Mental Health and Physical Activity, 7(3), 2-28.
Khaleghipour, S., Masjedi, M., & Ahmadi, Z. (2016). Effectiveness of Islamic spiritual therapy on the lifestyle and the percentage of the white blood cells in the aged depressed people. Journal of Research in Psychological Health, 10 (3), 16-29. [Persian]
Kooshyar, H., Ghanbari Hashemabadi, B. A., Esmaili, H, Parvandi, Z., Ghandeharian, F., Habibi, R. (2012). Effects of group reminiscence therapy on disability of nursing home residents in Mashhad –Iran 1390. Salmand: Iranian Journal of Ageing, 7 (3), 21-29. [Persian]
 Larouche, E., Chouinard, A. M., Morin-Alain, V., Goulet, S., & Hudon, C. (2017). Higher mindfulness meditation practice predicts improvement of executive components of attention in older adults with amnestic mild cognitive impairment. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 13 (7), P610.
 LeDoux, J. E., & Pine, D. S. (2016). Using neuroscience to help understand fear and anxiety: a twosystem framework. American Journal of psychiatry, 173(11), 1083-1093.
  Lee, Y., Salman, A. (2018). The mediating effect of spiritual well-being on depressive symptoms and health-related quality of life among elders. Archives of Psychiatric Nursing, 32 (3), 418-424.
 Lengacher, C. A., Johnson-Mallard, V., Barta, M., Fitzgerald, S., Moscoso, M. S., Post-White, J., Jacobsen, P.B., Shelton, M. M., Le, N., Budhrani, P., Goodman, M., & Kip. K. E. (2011). Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. Journal of Holistic Nursing (JHN), 29(2), 107-117.
  Li, J., Vitiello, M. V., & Gooneratne, N. S. (2018). Sleep in Normal Aging. Sleep medicine clinics, 13 (1), 1–11.
Lotfi Kashani F., Mofid, B., & Sarafraz Mehr, S. (2013). Effectiveness of spirituality therapy in decreasing anxiety, depression and distress of women suffering from breast cancer. Journal of Thought & Behavior in Clinical Psychology, 7 (27), 27-42. [Persian]
 McCoubrie, R. C., & Davies, A. N. (2006). “Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer?” Support Care Cancer, 14 (4), 379-385.
 Medrano, M., Rosario, R. L., Payano, A. N., & Capellan, N. R. (2014). Burden, anxiety and depression in caregivers of Alzheimer patients in the Dominican Republic. Dementiatop & Neuro psychologia Journal. 8, 384-8.
 Memari, A., Dalvandi, A., Mohammadi-Shahbolaghi, F., Fallahi-Khoshknab, M., & Biglarian, A. (2016). Impact of spiritual care on spiritual health of elderly residents of Kahrizak nursing home. Iranian Journal of Rehabilitation Research in Nursing, 3 (1), 1-8. [Persian]
 Mherab. B. (1994). Spielberger Anxiety Test Guide (overt and covert). Mashhad: Publications of the Faculty of Educational Sciences and Psychology. [Persian]
 Miner, B., & Kryger, M. H. (2017). Sleep in the aging population. Sleep medicine clinics, 12 (1), 31–38.
Molajafar, H., Pour-Sharifii, H., Meschi, F., Bermas, H., & Tajeri, B. (2017). Effectiveness of protocol based on integrated view on psychological distress in elderly. Journal of Arak University Medical Sciences, 20 (3), 88-97. [Persian]
 Moschak, T. M., Terry, D. R., Daughters, S. B., & Carelli, R. M. (2018). Low distress tolerance predicts heightened drug seeking and taking after extended abstinence from cocaine self‐administration. Addiction Biology, 23(1), 130- 141.
Naeimi, E., Kazemi, Z., & Dehghan, D. (2016). The Relationship between the religious orientation and irrational beliefs in the elderly of Kahrizak Sanitarium. Clinical Psychology Studies, 6 (23), 179-199. [Persian]
Narimani, M., Bagiyan Koulemarz, M. J., & Mehdinejad Moghadam, B. (2015). The Comparison of unlogicul believes and self-skilfullness and psychological best lining in patients who are affected to migraine and healthy person. Journal of Health Psychology, 4 (13), 7-20. [Persian]
 Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2014). Improving the spiritual dimension of whole person care: reaching national and international consensus. Journal of Palliative Medicine, 17(6), 642-56. 
 Roohy, G. R., Rahmany, A., Abdollahy, A. A., & Mahmoody, G. H. R. (2005). The effect of music on anxiety level of patients and some of physiological responses before abdominal surgery. Journal Gorgan University Medical Sciences, 7 (1), 75-78. [Persian]
 Rostami, M., Rasouli, M., Kasaee, A. (2018). Comparison of the effect of group counseling based on spirituality-based therapy and acceptance and commitment therapy (ACT) on Reducing Demoralization of the Elderly. Aging Psychology, 4 (3), 165-178. [Persian]
 Sadri Damirchi, E., Mohammadi, N., Ramezani, S. H., & Amanzad, Z. (2018), The Effectiveness of spirituality group therapy on happiness and hardiness in elderly women. Journal of Research on Religion & Health, 4(2), 42- 53. [Persian]
 Safarinia, M., Saki, S.S., & Ahmadi, H. (2017). Analyzing the effectiveness of treatment techniques of life Revision on cognitive status of retired men in Tehran. Journal of Health Psychology, 5 (20), 21-23. [Persian]
 Sedghi, P., & Cheraghi, C. (2019). The Effectiveness of the mindfulness training on psychological wellbeing and resiliency of female-headed household. Journal of Family Research, 14(4), 549-562. [Persian]
 Shechtman, D., & Pastor, B. (2012). The effect of positive self-talk training on conflicts interpersonal in students with specific learning disabilities. Unpublished doctoral dissertation, Mississippi state University.
 Spielberger, C. D. (1989). State-Trait Anxiety Inventory: Bibliography (2nd ed.). Palo Alto, CA: Consulting Psychologists Press. 
 Thapa, D., Kornhaber, R. A., Michelle, C., & Visentin, D. C. (2020). Prevalence and factors associated with depression, anxiety and stress symptoms among older adults: A cross-sectional population-based study Accepted Article. Nursing and Health Sciences, 22 (6), 1139-1152.
Tiwari, S., Singh, R., & Chand, H. (2016). Spirituality and psychological wellbeing of elderly of uttarakhand: a comparative study across residential status.
Vasile, C., (2012). Rational/irrational beliefs dynamics in adults. Procedia-Social and Behavioral Sciences 69, 2108 – 2113.
 Wang, X., Zheng, C., Su, M., Chen, Y., Xie, H., Han, W., Yang, Q., Sun, J., & Chen, J. (2019). Biting force and tongue muscle strength as useful indicators for eating and swallowing capability assessment among elderly patients, Food Science and Human Wellness, 8, 149-155.
 Wu, L. F., & Koo, M. (2016). Randomized controlled trial of a six‐week spiritual reminiscence intervention on hope, life satisfaction, and spiritual well‐being in elderly with mild and moderate dementia. International Journal of Geriatric Psychiatry, 31(2), 120-127.
 Zhang, Y., Chen, Y., & Ma, L. (2018). Depression and cardiovascular disease in elderly: current understanding. Journal of Clinical Neuroscience, 47 (1), 1-5.
 Zhao, W., Zhang, Y., Liu, X., Yue. J., Hou, L., Xia, X., Zuo, Z., Liu, Y., Jia, S., Dong, B., & Ge, N. (2020). Comorbid depressive and anxiety symptoms and frailty among older adults: Findings from the West China health and aging trend study. Journal of Affective Disorders, 277, 907-976.
 

Keywords


References
Ahadi, H., & Jamhari, F. (2012). Developmental Psychology: Adolescence, Adulthood (Youth, Middle Age and Aging). Tehran: Aydayde Derakhshan Publications. [Persian]
Aloustani, S., & Mamashli, L. (2020). The effect of spiritual group therapy on death anxiety in the elderly. Hayat, 26 (1), 46-57. [Persian]
Arch, J. J., Ayers, C. R., Baker, A., Almklov, E., Dean, D. J., & Craske, M. G. (2013). Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behaviour Research and Therapy, 51(4–5), 185–196.
 Asgari, P. (2017). The Effectiveness of spiritual therapy on quality of life and adjustability in the elderly, with an emphasis on the teachings of Islam. Aging Psychology, 2 (4), 281-291.
 Askari, M., Mohammadi, H., Radmehr, H., & Jahangir, A. H. (2018). The Effect of spiritual–religious psychotherapy on enhancing quality of life and reducing symptoms of anxiety and depression among the elderly. Journal of Research on Religion & Health, 4(2), 29-41. [Persian] 
Babazadeh, T., Sarkhoshi, R., Bahadori, F., Moradi, F., Shariat, F., & Sherizadeh, Y. (2016). Prevalence of depression, anxiety and stress disorders in elderly people residing in Khoy, Iran (2014-2015). Journal of Research Clinical Medicine, 24 (2), 122-128. [Persian]
 Barrera, T. L., Zeno, D., Bush, A. L., Barber, C. R., & Stanley, M. A. (2012). Integrating religion and spirituality into treatment for late-life anxiety: Three case studies. Cognitive and Behavioral Practice, 19 (2), 346-358.
Basharpoor, S., Hoseinikiasari, S. T., Soleymani, E., & Massah, O. (2019). The Role of irrational beliefs and attitudes to death in quality of life of the older people. Salmand: Iranian Journal of Ageing, 14 (3), 260-271. [Persian]
 Brantley, J. (2011). Mindfulness-Based Stress Reduction. In S. M. Orsillo & L. Roemer (Eds), Acceptance and mindfulness-based approaches to anxiety (pp. 131-145.). Conceptualization and treatment New York.
 Crain, W. (2016). Theories of development: concepts and applications. London and New York: Routledge.
 Cramer, H., Haller, H., Lauche, R., & Dobos, G. (2012). Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Alternat Med, 25 (12), 162-170.
  Curran, E., Rosato, M., Ferry, F., & Leavey, G. (2020). Prevalence and factors associated with anxiety and depression in older adults: Gender differences in psychosocial indicators. Journal of Affective Disorders, 267, 114-122. 
 Ellis, A. (1999). Rational-Emotive behavior therapy and cognitive behavior therapy for elderly people. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 17, 5-18.
Excerpts from the results of the general census of population and housing. (2016). http://www.amar.org.ir [Persian]
 Forti, A. (2012). Mindfulness and quality of life among breast cancer survivors: the mediating role of eslf- kindess and alexithymia. Carolina: Harvard Health Publications. Library. Uncg Edu.
 Ghaderi, D., & Mostafaee, A. (2014). A Study on the relationship between religious orientations and quality of life among elderly men living in nursing homes and those living with their families in Tabriz. Salmand: Iranian Journal of Ageing, 9 (1), 14-21. [Persian]
 Maurice Gibbons, M. (2003). The self-directed learning handbook: Challengingadolescent students to excel: John Wiley & Sons.
 Haddadi Kuhsar, A. A., Moradi, A. Ghobari Bonab, B., & Imani, F. (2018). Comparing the effectiveness of spiritual therapy based on iranian culture with mindfulness based on reduction stress (MBSR) in reducing depression, anxiety and stress in patients with chronic pain. Clinical Psychology Studies, 8 (31), 1-30. [Persian]
 Harnish, R. J., Bridges, K. R., & Karelitz, J. L. (2017). Compulsive buying: prevalence, irrational beliefs and purchasing. International Journal of Mental Health and Addiction, 15 (5), 993-1007.
Hayslip, B. Jr., Galt, C. P., Lopez, F. G., & Nation, P. C. (1994). Irrational beliefs and depressive symptoms among younger and older adults: a cross-sectional comparison. International Journal of Aging and Human Development, 38(4), 307-326. 
 Horváth , A., Montana, X., Lanquart , J. P., Hubain , F., Szűcs, A., Linkowski , P., & Loas, G. (2016). Effects of state and trait anxiety on sleep structure: A polysomnographic study in 1083 subjects, Psychiatry Research, 244, (30), 279-283.
 Irani, Z., Rajabi, M., Nazami, M., & Bagiyan Koulemarz, M. J. (2017).The role of lifestyle, psychological capital and self-care behaviors in predicting subjective well-being of diabetic elderly peoples. Journal of Health Psychology, 6 (23), 17-38. [Persian]
 Jadidi, A., Farahaninia, M., Janmohammadi, S., Haghani, H. (2011). The Relationship between spiritual well-being and quality of life among elderly people residing in kahrizak senior house. Iran Journal Nursing, 24 (72), 48-56. [Persian]
 Javanmardi, F., Naeimi, E., & Moatamedi, A. (2020). The Effectiveness of mindfulness model on improving intimate attitudes and elderly depression. Aging Psychology, 6 (1), 39-52. [Persian]
 Jones, R. A. (1968). A factored measure of Ellis' irrational belief system with personality and maladjustment correlates. Dissertation Abstracts International, 29, 4379-4380.
 Kabat-Zinn, J. (2013). Full catastrophe living; using the wisdom of your body and mind to face stress, pain and illness. (Revised And Updated ed.). New York: The Random House Publishing Group.
Kakavand, A. (2017). The Effectiveness of mindfulness on dysfunctional attitudes and depressive symptoms among elderly women with major depressive disorder. Aging Psychology, 2 (2), 91-101. [Persian]
Kamranmehr, F., Farsi, A., & Kavyani, M. (2020). The Effectiveness of mindfulness and biofeedback-relaxation training on anxiety, depression and dynamic and static balance in the elderly women with mild anxiety and depression. Aging Psychology, 6(3), 233-248. [Persian]
 Kangasiemi, A. M., Lappalainen, R., Kankeenpaa, A., & Tammelin, T. (2014). Mindfulness skills, psychological flexibility, and psychological symptoms among physically less active and active adults. Mental Health and Physical Activity, 7(3), 2-28.
Khaleghipour, S., Masjedi, M., & Ahmadi, Z. (2016). Effectiveness of Islamic spiritual therapy on the lifestyle and the percentage of the white blood cells in the aged depressed people. Journal of Research in Psychological Health, 10 (3), 16-29. [Persian]
Kooshyar, H., Ghanbari Hashemabadi, B. A., Esmaili, H, Parvandi, Z., Ghandeharian, F., Habibi, R. (2012). Effects of group reminiscence therapy on disability of nursing home residents in Mashhad –Iran 1390. Salmand: Iranian Journal of Ageing, 7 (3), 21-29. [Persian]
 Larouche, E., Chouinard, A. M., Morin-Alain, V., Goulet, S., & Hudon, C. (2017). Higher mindfulness meditation practice predicts improvement of executive components of attention in older adults with amnestic mild cognitive impairment. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 13 (7), P610.
 LeDoux, J. E., & Pine, D. S. (2016). Using neuroscience to help understand fear and anxiety: a twosystem framework. American Journal of psychiatry, 173(11), 1083-1093.
  Lee, Y., Salman, A. (2018). The mediating effect of spiritual well-being on depressive symptoms and health-related quality of life among elders. Archives of Psychiatric Nursing, 32 (3), 418-424.
 Lengacher, C. A., Johnson-Mallard, V., Barta, M., Fitzgerald, S., Moscoso, M. S., Post-White, J., Jacobsen, P.B., Shelton, M. M., Le, N., Budhrani, P., Goodman, M., & Kip. K. E. (2011). Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. Journal of Holistic Nursing (JHN), 29(2), 107-117.
  Li, J., Vitiello, M. V., & Gooneratne, N. S. (2018). Sleep in Normal Aging. Sleep medicine clinics, 13 (1), 1–11.
Lotfi Kashani F., Mofid, B., & Sarafraz Mehr, S. (2013). Effectiveness of spirituality therapy in decreasing anxiety, depression and distress of women suffering from breast cancer. Journal of Thought & Behavior in Clinical Psychology, 7 (27), 27-42. [Persian]
 McCoubrie, R. C., & Davies, A. N. (2006). “Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer?” Support Care Cancer, 14 (4), 379-385.
 Medrano, M., Rosario, R. L., Payano, A. N., & Capellan, N. R. (2014). Burden, anxiety and depression in caregivers of Alzheimer patients in the Dominican Republic. Dementiatop & Neuro psychologia Journal. 8, 384-8.
 Memari, A., Dalvandi, A., Mohammadi-Shahbolaghi, F., Fallahi-Khoshknab, M., & Biglarian, A. (2016). Impact of spiritual care on spiritual health of elderly residents of Kahrizak nursing home. Iranian Journal of Rehabilitation Research in Nursing, 3 (1), 1-8. [Persian]
 Mherab. B. (1994). Spielberger Anxiety Test Guide (overt and covert). Mashhad: Publications of the Faculty of Educational Sciences and Psychology. [Persian]
 Miner, B., & Kryger, M. H. (2017). Sleep in the aging population. Sleep medicine clinics, 12 (1), 31–38.
Molajafar, H., Pour-Sharifii, H., Meschi, F., Bermas, H., & Tajeri, B. (2017). Effectiveness of protocol based on integrated view on psychological distress in elderly. Journal of Arak University Medical Sciences, 20 (3), 88-97. [Persian]
 Moschak, T. M., Terry, D. R., Daughters, S. B., & Carelli, R. M. (2018). Low distress tolerance predicts heightened drug seeking and taking after extended abstinence from cocaine self‐administration. Addiction Biology, 23(1), 130- 141.
Naeimi, E., Kazemi, Z., & Dehghan, D. (2016). The Relationship between the religious orientation and irrational beliefs in the elderly of Kahrizak Sanitarium. Clinical Psychology Studies, 6 (23), 179-199. [Persian]
Narimani, M., Bagiyan Koulemarz, M. J., & Mehdinejad Moghadam, B. (2015). The Comparison of unlogicul believes and self-skilfullness and psychological best lining in patients who are affected to migraine and healthy person. Journal of Health Psychology, 4 (13), 7-20. [Persian]
 Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2014). Improving the spiritual dimension of whole person care: reaching national and international consensus. Journal of Palliative Medicine, 17(6), 642-56. 
 Roohy, G. R., Rahmany, A., Abdollahy, A. A., & Mahmoody, G. H. R. (2005). The effect of music on anxiety level of patients and some of physiological responses before abdominal surgery. Journal Gorgan University Medical Sciences, 7 (1), 75-78. [Persian]
 Rostami, M., Rasouli, M., Kasaee, A. (2018). Comparison of the effect of group counseling based on spirituality-based therapy and acceptance and commitment therapy (ACT) on Reducing Demoralization of the Elderly. Aging Psychology, 4 (3), 165-178. [Persian]
 Sadri Damirchi, E., Mohammadi, N., Ramezani, S. H., & Amanzad, Z. (2018), The Effectiveness of spirituality group therapy on happiness and hardiness in elderly women. Journal of Research on Religion & Health, 4(2), 42- 53. [Persian]
 Safarinia, M., Saki, S.S., & Ahmadi, H. (2017). Analyzing the effectiveness of treatment techniques of life Revision on cognitive status of retired men in Tehran. Journal of Health Psychology, 5 (20), 21-23. [Persian]
 Sedghi, P., & Cheraghi, C. (2019). The Effectiveness of the mindfulness training on psychological wellbeing and resiliency of female-headed household. Journal of Family Research, 14(4), 549-562. [Persian]
 Shechtman, D., & Pastor, B. (2012). The effect of positive self-talk training on conflicts interpersonal in students with specific learning disabilities. Unpublished doctoral dissertation, Mississippi state University.
 Spielberger, C. D. (1989). State-Trait Anxiety Inventory: Bibliography (2nd ed.). Palo Alto, CA: Consulting Psychologists Press. 
 Thapa, D., Kornhaber, R. A., Michelle, C., & Visentin, D. C. (2020). Prevalence and factors associated with depression, anxiety and stress symptoms among older adults: A cross-sectional population-based study Accepted Article. Nursing and Health Sciences, 22 (6), 1139-1152.
Tiwari, S., Singh, R., & Chand, H. (2016). Spirituality and psychological wellbeing of elderly of uttarakhand: a comparative study across residential status.
Vasile, C., (2012). Rational/irrational beliefs dynamics in adults. Procedia-Social and Behavioral Sciences 69, 2108 – 2113.
 Wang, X., Zheng, C., Su, M., Chen, Y., Xie, H., Han, W., Yang, Q., Sun, J., & Chen, J. (2019). Biting force and tongue muscle strength as useful indicators for eating and swallowing capability assessment among elderly patients, Food Science and Human Wellness, 8, 149-155.
 Wu, L. F., & Koo, M. (2016). Randomized controlled trial of a six‐week spiritual reminiscence intervention on hope, life satisfaction, and spiritual well‐being in elderly with mild and moderate dementia. International Journal of Geriatric Psychiatry, 31(2), 120-127.
 Zhang, Y., Chen, Y., & Ma, L. (2018). Depression and cardiovascular disease in elderly: current understanding. Journal of Clinical Neuroscience, 47 (1), 1-5.
 Zhao, W., Zhang, Y., Liu, X., Yue. J., Hou, L., Xia, X., Zuo, Z., Liu, Y., Jia, S., Dong, B., & Ge, N. (2020). Comorbid depressive and anxiety symptoms and frailty among older adults: Findings from the West China health and aging trend study. Journal of Affective Disorders, 277, 907-976.