The Effectiveness of Self-Differentiation Training on Cognitive Emotion Regulation and Psychosomatic Symptoms of Nurses


  • Peyman Yousefzadeh PhD, Department of Psychology, Medical Sciences Branch of Tehran, Islamic Azad University, Tehran, Iran
  • Amrollah Ebrahimi Associate Professor, Department of Health Psycholog, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran



Background: Nurses are exposed to mental and physical illnesses due to burnout and high job stress and lack of adequate adaptation resources, and ultimately, reduced mental health. The aim of this study was to determine the effectiveness of self-differentiation training on psychosomatic symptoms and cognitive emotion regulation in nurses.

Methods: This quasi-experimental study was conducted with a pretest-posttest design and a control group. The study population consisted of nurses of Omid and Jamaran hospitals in Tehran, Iran. From among them, 36 nurses were selected based on Morgan's table using convenience sampling method and were randomly divided into two groups (experimental and control) of 18 individuals. The experimental group underwent ‎10 training sessions (once a week for 60 minutes) ‎based on Bowen's system theory, during which time the group did not receive training. Screening for Somatic Symptom Disorders-7 (SOMS-7) questionnaire and Cognitive Emotion Regulation Questionnaire (CERQ) were administered in both groups before and after the training sessions. Data were analyzed using repeated measures analysis of variance (ANOVA) in SPSS software. The significance level of the tests was considered to be 0.05. This article is taken from a postdoctoral thesis in psychosomatic medicine and psychotherapy between Isfahan University of Medical Sciences, Iran, and Albert Ludwigs University of Freiburg, Germany. This article was approved under the ethical codex IR.MED.REC.1399.465 of the Isfahan University of Medical Sciences.

Results: The results showed that self-differentiation training was effective on psychosomatic symptoms and cognitive emotion regulation in nurses (P < 0.001).

Conclusion: It can be concluded that self-differentiation training was effective on psychosomatic symptoms and cognitive emotion regulation in nurses.



Alaedein, J. M. (2008). Is Bowen Theory universal? Differentiation of self among Jordanian male and female college students and between them and a sample of American students through Bowen's propositions. Dirasat, Educational Sciences, 35(2).

Alikhani, M., Geravand, S., Rashidi, A. R., Janjani, H., Zakiee, A., & Janjani, P. (2014). The relationship between personality traits (self-differentiation and resilience) and the individual characteristics, family functioning and economic status with mental health among women with diabetes II in Kermanshah. Adv.Environ.Biol., 8(9), 999-1006.

Balzarotti, S., Biassoni, F., Villani, D., Prunas, A., & Velotti, P. (2016). Individual differences in cognitive emotion regulation: Implications for subjective and psychological well-being. Journal of Happiness Studies: An Interdisciplinary Forum on Subjective Well-Being, 17(1), 125-143.

Bamonti, P., Conti, E., Cavanagh, C., Gerolimatos, L., Gregg, J., Goulet, C. et al. (2019). Coping, cognitive emotion regulation, and burnout in long-term care nursing staff: A preliminary study. J Appl.Gerontol., 38(1), 92-111. doi:10.1177/0733464817716970 [doi]. Retrieved from PM:28671027

Besharat, M. A., & Bazzazian, S. (2015). Psychometri properties of the Cognitive Emotion Regulation Questionnaire in a sample of Iranian population. Advances in Nursing and Midwifery, 24(84), 61-70.

Bowen, M. (1978). Family therapy in clinical practice. New York, NY: J. Aronson.

Cabrera-Sanchez, P., & Friedlander, M. L. (2017). Optimism, self-differentiation, and perceived posttraumatic stress disorder symptoms: Predictors of satisfaction in female military partners. Couple and Family Psychology: Research and Practice, 6(4), 235-246.

Chang, J. J., & Shin, S. H. (2017). Mediating Effects of Cognitive Emotion Regulation on Influences of Self-differentiation and Family Function in High School Students' Problem Behavior. Journal of Korean Academy of Psychiatric and Mental Health Nursing, 26(3), 248-259. doi:doi: 10.12934/jkpmhn.2017.26.3.248.

Cherniss, C. (2016). Beyond burnout: Helping teachers, nurses, therapists and lawyers recover from stress and disillusionment. Taylor & Francis.

Choi, S. D., & Brings, K. (2015). Work-related musculoskeletal risks associated with nurses and nursing assistants handling overweight and obese patients: A literature review. Work, 53(2), 439-448. doi:WOR2222 [pii];10.3233/WOR-152222 [doi]. Retrieved from PM:26835850

Dadfar, M., Kalibatseva, Z., & Lester, D. (2018). Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients. Trends.Psychiatry.Psychother., 40(2), 144-151. doi:S2237-60892018000200144 [pii];10.1590/2237-6089-2017-0116 [doi]. Retrieved from PM:29995159

Darban, F., Balouchi, A., Narouipour, A., Safarzaei, E., & Shahdadi, H. (2016). Effect of communication skills training on the burnout of nurses: A cross-sectional study. J Clin.Diagn.Res., 10(4), IC01-IC04. doi:10.7860/JCDR/2016/19312.7667 [doi]. Retrieved from PM:27190832

Dickinson, T., & Wright, K. M. (2008). Stress and burnout in forensic mental health nursing: a literature review. Br.J Nurs, 17(2), 82-87. doi:10.12968/bjon.2008.17.2.28133 [doi]. Retrieved from PM:18414278

Ebrahimi, A., Rief, W., Mirshahzadeh, P., Afshar, Z. H., Nasiri, D. H., Roohafza, H. et al. (2018). Psychometric properties of the Persian version of Screening for Somatic Symptom Disorders-7(SOMS-7). Iran.J Psychiatry., 13(4), 264-273. Retrieved from PM:30627200

Engels, J. A., van der Gulden, J. W., Senden, T. F., & van't Hof, B. (1996). Work related risk factors for musculoskeletal complaints in the nursing profession: Results of a questionnaire survey. Occup.Environ.Med., 53(9), 636-641. doi:10.1136/oem.53.9.636 [doi]. Retrieved from PM:8882121

Freimann, T. (2017). Musculoskeletal pain among nurses: prevalence, risk factors, and intervention.

Garnefski, N., & Kraaij, V. (2007). The Cognitive Emotion Regulation Questionnaire: Psychometric features and prospective relationships with depression and anxiety in adults. Eur J Psychol Assess, 23(3), 141-149.

Heintzelman, A., Murdock, N. L., Krycak, R. C., & Seay, L. (2014). Recovery from infidelity: Differentiation of self, trauma, forgiveness, and posttraumatic growth among couples in continuing relationships. Couple and Family Psychology: Research and Practice, 3(1), 13-29.

Jaradat, Y., Bast-Pettersen, R., Nijem, K., Bjertness, E., Lien, L., Kristensen, P. et al. (2012). The impact of shift work on mental health measured by GHQ-30: a comparative study. Middle East Journal of Psychiatry and Alzheimers, 3(1), 8-16.

Jaradat, Y., Nijem, K., Lien, L., Stigum, H., Bjertness, E., & Bast-Pettersen, R. (2016). Psychosomatic symptoms and stressful working conditions among Palestinian nurses: a cross-sectional study. Contemp Nurse., 52(4), 381-397.

Kane, P. P. (2009). Stress causing psychosomatic illness among nurses. Indian J Occup.Environ.Med., 13(1), 28-32. doi:10.4103/0019-5278.50721 [doi]. Retrieved from PM:20165610

Kawano, Y. (2008). Association of job-related stress factors with psychological and somatic symptoms among Japanese hospital nurses: effect of departmental environment in acute care hospitals. J Occup.Health., 50(1), 79-85. doi:JST.JSTAGE/joh/50.79 [pii];10.1539/joh.50.79 [doi]. Retrieved from PM:18285650

Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work related stress, burnout, job satisfaction and general health of nurses. Int.J Environ.Res.Public.Health., 12(1), 652-666. doi:ijerph120100652 [pii];10.3390/ijerph120100652 [doi]. Retrieved from PM:25588157

Kim, B. J., Choi, M. R., Kim, T. H., Kim, H. W., & Eun, H. J. (2014). Psychosomatic Symptoms of Rotating Shift and Daytime Working Nurses in a General Hospital. Korean Journal of Psychosomatic Medicine, 22(2), 79-86.

Lahav, Y., Stein, J. Y., & Solomon, Z. (2016). Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives. J Psychosom.Res., 89, 61-68. doi:S0022-3999(16)30374-9 [pii];10.1016/j.jpsychores.2016.08.008 [doi]. Retrieved from PM:27663112

Lampis, J. (2016). Does partner s’ differentiation of self predict dyadic adjustment? J.Fam.Ther., 38(3), 303-318. doi:doi: 10.1111/1467-6427.12073. Retrieved from

Lee, E., & Chang, S. (2016). Factors influencing depression of nurses among comprehensive nursing care service ward. Korean Journal of Occupational Health Nursing, 25, 340-351.

Lee, I., & Wang, H. H. (2002). Perceived occupational stress and related factors in public health nurses. J Nurs Res., 10 (4), 253-260. doi:10.1097/01.jnr.0000347606.91295.76 [doi]. Retrieved from PM:12522738

Lindegard, A., Larsman, P., Hadzibajramovic, E., & Ahlborg, G., Jr. (2014). The influence of perceived stress and musculoskeletal pain on work performance and work ability in Swedish health care workers. Int.Arch.Occup.Environ.Health, 87(4), 373-379. doi:10.1007/s00420-013-0875-8 [doi]. Retrieved from PM:23609321

Luan, X., Wang, P., Hou, W., Chen, L., & Lou, F. (2017). Job stress and burnout: A comparative study of senior and head nurses in China. Nurs Health Sci, 19(2), 163-169. doi:10.1111/nhs.12328 [doi]. Retrieved from PM:28139874

Oyama, Y., & Fukahori, H. (2015). A literature review of factors related to hospital nurses' health-related quality of life. J Nurs Manag., 23(5), 661-673. doi:10.1111/jonm.12194 [doi]. Retrieved from PM:25807874

Paine, D. R., Jankowski, P. J., & Sandage, S. J. (2016). Humility as a predictor of intercultural competence: Mediator effects for differentiation-of-self. The Family Journal, 24(1), 15-22. doi:doi:10.1177/1066480715615667. Retrieved from Sage Publications.

Park, S. A., & Park, K. W. (2017). The mediating effect of Self-differentiation between College Student's Family Functioning and Smart Phone Addiction. Journal of the Korea Academia-Industrial cooperation Society, 18(4), 325-333.

Piko, B. F. (2006). Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: A questionnaire survey. Int.J Nurs Stud., 43(3), 311-318. doi:S0020-7489(05)00095-7 [pii];10.1016/j.ijnurstu.2005.05.003 [doi]. Retrieved from PM:15964005

Reknes, I., Pallesen, S., Mageroy, N., Moen, B. E., Bjorvatn, B., & Einarsen, S. (2014). Exposure to bullying behaviors as a predictor of mental health problems among Norwegian nurses: results from the prospective SUSSH-survey. Int.J Nurs Stud., 51(3), 479-487. doi:S0020-7489(13)00199-5 [pii];10.1016/j.ijnurstu.2013.06.017 [doi]. Retrieved from PM:23891534

Rodriguez-Gonzalez, M., Schweer-Collins, M., Skowron, E. A., Jodar, R., Cagigal, V., & Major, S. O. (2019). Stressful Life Events and Physical and Psychological Health: Mediating Effects of Differentiation of Self in a Spanish Sample. J Marital.Fam.Ther, 45(4), 578-591. doi:10.1111/jmft.12358 [doi]. Retrieved from PM:30239996

Ross, A. S., & Murdock, N. L. (2014). Differentiation of self and well-being: The moderating effect of self-construal. Contemp.Fam.Ther, 36(4), 485-496. doi:doi:10.1007/s10591-014-9311-9. Srinivasan, K., & Samuel, D. (2014). Psychological Problem Factors Faced by Staff Nurses Working in Hospitals. IOSR Journal of Humanities and Social Science, 19(3), 01-04.

Violante, F. S., Fiori, M., Fiorentini, C., Risi, A., Garagnani, G., Bonfiglioli, R. et al. (2004). Associations of psychosocial and individual factors with three different categories of back disorder among nursing staff. J Occup.Health, 46(2), 100-108. doi:10.1539/joh.46.100 [doi]. Retrieved from PM:15090684

Yoosefi, N., Etemadi, O., Bahram, F., Bashlideh, K., & Shir-Bagi, N. (2010). Structural relationship between pathology of selfdifferentiation in Bowen's family therapy with subjective well being, mental health and hygiene of marital quality, Fitting Bowen Theory. J Shahrekord Univ Med Sci, 12(3), 68-76.

Zarei, S., Farahbakhsh, K., & Esmaeili, M. (2011). The determination of the share of self-differentiation, trust, shame, and guilt in the prediction of marital adjustment. Knowledge & Research in Applied Psychology 12 (3 (45)), 51-63.




How to Cite

Yousefzadeh, P., & Ebrahimi, A. (2020). The Effectiveness of Self-Differentiation Training on Cognitive Emotion Regulation and Psychosomatic Symptoms of Nurses. International Journal of Body, Mind and Culture, 7(3), 140-150.



Quantitative Study(ies)

Most read articles by the same author(s)