Year 2023,
, 559 - 572, 29.01.2024
Ömer Yüncü
,
Emel Aner Aktan
References
- 1. Kerle N, Oppenheimer C. Satellite remote sensing as a tool in lahar disaster management. Disasters. 2002;26(2):140-160.
- 2. Ozisik D, Kerle N. Post-earthquake damage assessment using satellite and airborne data in the case of the 1999 Kocaeli Earthquake, Turkey. Proc. of the XXth ISPRS congress: Geo-imagery bridging continents. 2004 (pp. 686-691).
- 3. Bedirli B. Deprem travmasının kronik psikolojik etkileri: Düzce Depremi’nden 14 yıl sonra travma sonrası stres ve depresyon belirtilerinin yaygınlığı ve ilişkili risk faktörleri. 2014; Yüksek lisans tezi.
- 4. Afet ve Acil Durum Yönetimi Başkanlığı [AFAD]. 06 Şubat 2023 Pazarcık-Elbistan Kahramanmaraş (Mw: 7.7 – Mw: 7.6) depremleri raporu. 2 Haziran 2023.
- 5. Güven K. Marmara Depremini yaşayan yetişkinlerin algıladıkları sosyal destek düzeyleri ile travma sonrası gelişim ve depresyon arasındaki ilişkinin incelenmesi. 2010; Yüksek lisans tezi.
- 6. Kurt E, Gülbahçe A. Van Derpemini yaşayan öğrencilerin travma sonrası stres bozukluğu düzeylerinin incelenmesi. Atatürk Üniversitesi Sosyal Bilimler Enstitüsü Dergisi. 2019;23(3):957-972.
- 7. Javidi H, Yadollahie M. Post-traumatic stress disorder. The International Journal of Occupational and Environmental Medicine. 2012;3:2-9.
- 8. Adams PR, Adams GR. Mount Saint Helen’s Ashfall evidence for a disaster stress reaction. American Psychologist. 1984;39(2):252.
- 9. Bonanno GA, Brewin CR, Kaniasty K, et al. Weighing the costs of disaster: Consequences, risks, and resilience in individuals, families, and communities. Psychological Science in the Public Interest. 2010;11(1):1-49.
- 10. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology. 1991;61(1):115.
- 11. Norris FH, Smith T, Kaniasty K. Revisiting the experience–behavior hypothesis: The effects of Hurricane Hugo on hazard preparedness and other self-protective acts. Basic and Applied Social Psychological. 2010; 21(1):37-47.
- 12. Palinkas LA, Dwons MA, Petterson JS et al. Social, cultural, and psychological ımpacts of The Exxon Valdez Oil Spill. Human Organization. 1993;52(1):1-13.
- 13. Smith EM, North CS, McCool RE et al. Acute postdisaster psychiatric disorders: Identification of persons at risk. The American Journal of Psychiatry. 1990;147(2):202-206.
- 14. Şakiroğlu M. Posıtıve outcomes among the 1999 Düzce Earthquake survıvors: Earthquake preparedness behavior and posttraumatic growth. 2011; Doctoral thesis.
- 15. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock psikiyatri davranış bilimleri/klinik psikiyatri. Çev: Bozkurt A. 11. Baskı. İstanbul: Güneş Tıp Kitabevi; 2016. Bölüm 11, Travma ve Tetikleyici Etkenler ile İlişkili Bozukluklar; p. 437-446.
- 16. Foa EB. Psychosocial therapy for posttraumatic stress disorder. The Journal of Cllinical Psychiatry. 2006;67(Suppl 2):4045.
- 17. Bolu A, Erdem M, Öznur T. Travma sonrası stres bozukluğu. The Anatolian Journal of Clinical Investigation. 2014; 8(2):98-104.
- 18. Livanou M, Kasvikis Y, Başoğlu M et al. Earthquake-related psychological distress and associated factors 4 years after the Parnitha earthquake in Greece. European Psychiatry. 2005;20(2):137-144.
- 19. Chen CH, Tan HKL, Liao LR et al. Long-term psychological outcome of 1999 Taiwan earthquake survivors: A survey of a high-risk sample with property damage. Comprehensive Psychiatry. 2007;48(3):269-275.
- 20. Başoğlu M, Şalcıoğlu E, Livanou M. Traumatic stress responses in earthquake survivors in Turkey. Journal of Traumatic Stress. 2002;15(4):269-276.
- 21. Şalcıoğlu E, Başoğlu M, Livanou M. Long-term psychological outcome for non–treatment- seeking earthquake survivors in Turkey. The Journal Of Nervous And Mental Dısease. 2003;191(3):154-160.
- 22. Öztürk MO, Uluşahin NA. Ruh sağlığı ve bozuklukları. 15. Baskı. Ankara: Nobel Tıp Kitabevleri; 2018. Bölüm 3, Örselenme ya da Zorlanma Etkisine Bağlı Bozukluklar; p. 380- 389.
- 23. Duman N. Travma sonrası büyüme ve gelişim. International Journal of Afro-Eurasian Research. 2019;4(7):178-184.
- 24. İnci F, Boztepe H. Travma sonrası büyüme: Öldürmeyen acı güçlendirir mi? Journal of Psychiatric Nursing. 2013;4(2):80-84.
- 25. Hayes SC, Levin ME, Plumb-Vilardaga J et al. Acceptance and Commitment Therapy and Contextual Behavioral Science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy. 2013;44(2):180-198.
- 26. Kul A, Türk F. Kabul ve Adanmışlık Terapisi (ACT) üzerine bir derleme çalışması. OPUS International Journal of Society Researches. 2020; 16(29 Ekim Özel Sayısı):3773-3805.
- 27. Neff. K, Tirch D. Self-compassion and ACT [eBook]. In: Kashdan TB, Ciarrochi J, editors. Mindfulness, acceptance, and positive psychology: The seven foundations of well- being. Oakland, California, USA: New Harbinger Publacations; 2013. [citied 2024 Jan 7] p. 78-106. Available from: https://self- compassion.org/wp- content/uploads/publications/Chap4_Mindfuln ess-Acceptance-and-Positive- Psychology_11.06.pdf
- 28. Köksal B. Kabul ve kararlılık terapisine dayalı kendi kendine yardım müdahalesinin üniversite öğrencilerinin depresyon, anksiyete, stres ve psikolojik esneklik düzeylerine etkisi. 2023; Doktora tezi.
- 29. Gloster A, Walder N, Levin ME et al. The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science. 2020;18:181- 192.
- 30. Larsson A. Hartley S, McHugh L. A randomised controlled trial of brief web-based Acceptance and Commitment Therapy on the general mental health, depression, anxiety and stress of college Students. Journal of Contextual Behavioral Science. 2022;24:10-17.
- 31. Levin ME, Hayes SC, Pistorello J et al. Web- based self-help for preventing mental health problems in universities: Comparing Acceptance and Commitment training to mental health education. Journal of Clinical Psychology. 2016;72(3):207-225.
- 32. Levin ME, An W, Davis CH et all. Evaluating Acceptance and Commitment Therapy and Mindfulness-Based stress reduction self-help books for college student mental health.
Mindfulness. 2020;11:1275-1285.
- 33. Muto T, Hayes SC, Jeffcoat T. The effectiveness of Acceptance and Commitment Therapy Bibliotherapy for enhancing the psychological health of Japanese college students living abroad. Behavior Therapy. 2011;42:323-335.
34. Räsänen P, Lappalainen P, Muotka J et al. An online guided ACT intervention for enhancing the psychological well-being of university students: A randomized controlled clinical trial.
Behaviour Research and Therapy. 2016;78:30- 42.
- 35. Viskovich S, Pakenham KI. Randomized controlled trial of a web‐based Acceptance and Commitment Therapy (ACT) program to promote mental health in university students.
Journal of Clinical Psychology. 2020;76:929- 951.
- 36. Walser RD, Steven CH. Cognitive-Behavioral Therapies for trauma 2nd ed. [eBook]. New York City: Guilford Pressi, Inc; 2006. Chapter 7, Acceptance and Commitment Therapy in the treatment of posttraumatic stress disorder. [cited 2024 Jan 7]. Avaliable from: https://books.google.com.tr/books?hl=tr&lr=&i d=cBLxWyhYD_IC&oi=fnd&pg=PA146&dq =Walser+ve+Hayes&ots=Ov_SB6u4mY&sig= 82pv3MmViQUOqDHf8L_GpXnpWk0&redir _esc=y#v=onepage&q=Walser%20ve%20Hay es&f=false
- 37. Bean RC, Ong CW, Lee J et al. Acceptance and Commitment Therapy for PTSD and trauma: An empirical review. The Behavior Therapist Journal. 2017;40:145-150.
- 38. Pohar R, Argaez C. Acceptance and Commitment Therapy for post-traumatic stress disorder, anxiety, and depression: a review of clinical effectiveness. CADTH, 1-32. (CADTH rapid response reports: summary with critical appraisal). 2018.
- 39. Thompson RW, Arnkoff DB, Glass CR. Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, & Abuse. 2011;12(4):220-235).
- 40. Spidel A, Lecomte T, Kelly D et al. Acceptance and Commitment Therapy for psychosis and trauma: Improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention. Psychology and Psychotherapy: Theory, Research and Practice. 2018;91:248-261.
- 41. Follette VM, Briere J, Rozelle D et al. Mindfulness-0riented interventions for trauma: Integrating contemplative practices 2nd ed. [eBook]. New York City: Guilford Press, Inc; 2015 [citied 2024 Jan 7]. Avaliable from: Google Books.
- 42. Orsillo SM, Batten SV. Acceptance and Commitmnet Therapy in the treatment of posttraumatic stress disorder. Behavior Modification. 2005:29(1):95-129.
- 43. Wirmando W, Alfrida A, Saranga Jl et al. Effectiveness of Acceptance and Commitment Therapy on resilience for victims of natural disaster experiencing physical disability.
- 44. Büyüköztürk Ş, Kılıç Çakmak E, Akgün ÖE et al. Bilimsel araştırma yöntemleri. Geliştirilmiş 2. Baskı. Ankara: Pegem Akademi Yayıncılık; 2008.
- 45. Tanhan F, Kayri M. Deprem Sonrası Travma Düzeyini Belirleme Ölçeğinin geçerlik ve güvenirlik çalışması. Kuram ve Uygulamada Eğitim Bilimleri. 2013;13(2):1013-1025.
- 46. Rolffs JL, Rogge RD, Wilson Kg. Disentangling components of flexibility via the hexaflex model: Development and validation of the Multidimensional Psychological Flexibility Inventory (MPFI). Assessment. 2018;25(4):458-482.
- 47. Ulubay G. Çok Boyutlu Psikolojik Esneklik Envanterinin Türkçeye uyarlanması. 2020; Yüksek Lisans Tezi. 48. Kline RB. Principles and practice of structural equation modeling. 5th ed. New York, USA: Guilford Press; 2011.
- 49. Adiloğlu Takmaz Z, Kurtuluş Yıldırım H. Effectiveness of the Acceptance and Commitment Therapy-Based Intervention Program for Women. Turkish Psychological Counseling and Guidance Journal. 2023;13(69):240-255.
- 50. Yapan S, Murat M ve Yavuz KF. Kabul ve kararlılık terapisi ve bilişsel davranışçı terapi temelli psikoeğitim programlarının sınav kaygısına etkisi. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi. 2021;10(2),194-208.
- 51. Wetherell JL, Liu L, Patterson TL et al. Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report. Behavior therapy. 2011;42(1):127-134.
- 52. Pennebaker JW. Confession, inhibition, and disease. In Advances in experimental social psychology. 1989;22:211-244.
The Impact of Acceptance and Commitment Therapy on Trauma and Psychological Flexibility among University Students Affected by the Earthquake
Year 2023,
, 559 - 572, 29.01.2024
Ömer Yüncü
,
Emel Aner Aktan
Abstract
This study aims to examine the impact of Acceptance and Commitment Therapy (ACT) on the trauma levels and psychological flexibility of university students affected by the earthquake. The study included a total of 15 participants in the research. Participants in the research were divided into two groups, an experimental group and a control group, using the stratified random sampling method. In the experimental group, there were 8 males (53.3%) and 7 females (46.7%) aged between 18-30 (M = 23.26; SD = 3.19). Similarly, in the control group, there were 8 males (53.3%) and 7 females (46.7%) aged between 18-30 (M = 23.33; SD = 3.47). The study employed a true experimental design and a 2x2 split-plot the randomized pre-test post-test control group design. The instruments used for data collection were the Post-Earthquake Trauma Level Determination Scale and the Multidimensional Psychological Flexibility Inventory. The experimental group received a 6-week ACT intervention, while no intervention was applied to the control group. In data analysis, paired-sample t-tests, independent samples t-tests, and Pearson correlation analysis were conducted using IBM SPSS 26.0 software. The research found that ACT intervention reduces the impact of earthquake related trauma and enhances psychological flexibility. Additionally, a negative correlation has been observed between earthquake induced trauma and psychological flexibility.
Ethical Statement
İstanbul Nişantaşı Üniversitesi Etik kurulu 2023/23 nolu toplantı kararı
Thanks
İstanbul Nişantaşı Üniversitesi
References
- 1. Kerle N, Oppenheimer C. Satellite remote sensing as a tool in lahar disaster management. Disasters. 2002;26(2):140-160.
- 2. Ozisik D, Kerle N. Post-earthquake damage assessment using satellite and airborne data in the case of the 1999 Kocaeli Earthquake, Turkey. Proc. of the XXth ISPRS congress: Geo-imagery bridging continents. 2004 (pp. 686-691).
- 3. Bedirli B. Deprem travmasının kronik psikolojik etkileri: Düzce Depremi’nden 14 yıl sonra travma sonrası stres ve depresyon belirtilerinin yaygınlığı ve ilişkili risk faktörleri. 2014; Yüksek lisans tezi.
- 4. Afet ve Acil Durum Yönetimi Başkanlığı [AFAD]. 06 Şubat 2023 Pazarcık-Elbistan Kahramanmaraş (Mw: 7.7 – Mw: 7.6) depremleri raporu. 2 Haziran 2023.
- 5. Güven K. Marmara Depremini yaşayan yetişkinlerin algıladıkları sosyal destek düzeyleri ile travma sonrası gelişim ve depresyon arasındaki ilişkinin incelenmesi. 2010; Yüksek lisans tezi.
- 6. Kurt E, Gülbahçe A. Van Derpemini yaşayan öğrencilerin travma sonrası stres bozukluğu düzeylerinin incelenmesi. Atatürk Üniversitesi Sosyal Bilimler Enstitüsü Dergisi. 2019;23(3):957-972.
- 7. Javidi H, Yadollahie M. Post-traumatic stress disorder. The International Journal of Occupational and Environmental Medicine. 2012;3:2-9.
- 8. Adams PR, Adams GR. Mount Saint Helen’s Ashfall evidence for a disaster stress reaction. American Psychologist. 1984;39(2):252.
- 9. Bonanno GA, Brewin CR, Kaniasty K, et al. Weighing the costs of disaster: Consequences, risks, and resilience in individuals, families, and communities. Psychological Science in the Public Interest. 2010;11(1):1-49.
- 10. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology. 1991;61(1):115.
- 11. Norris FH, Smith T, Kaniasty K. Revisiting the experience–behavior hypothesis: The effects of Hurricane Hugo on hazard preparedness and other self-protective acts. Basic and Applied Social Psychological. 2010; 21(1):37-47.
- 12. Palinkas LA, Dwons MA, Petterson JS et al. Social, cultural, and psychological ımpacts of The Exxon Valdez Oil Spill. Human Organization. 1993;52(1):1-13.
- 13. Smith EM, North CS, McCool RE et al. Acute postdisaster psychiatric disorders: Identification of persons at risk. The American Journal of Psychiatry. 1990;147(2):202-206.
- 14. Şakiroğlu M. Posıtıve outcomes among the 1999 Düzce Earthquake survıvors: Earthquake preparedness behavior and posttraumatic growth. 2011; Doctoral thesis.
- 15. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock psikiyatri davranış bilimleri/klinik psikiyatri. Çev: Bozkurt A. 11. Baskı. İstanbul: Güneş Tıp Kitabevi; 2016. Bölüm 11, Travma ve Tetikleyici Etkenler ile İlişkili Bozukluklar; p. 437-446.
- 16. Foa EB. Psychosocial therapy for posttraumatic stress disorder. The Journal of Cllinical Psychiatry. 2006;67(Suppl 2):4045.
- 17. Bolu A, Erdem M, Öznur T. Travma sonrası stres bozukluğu. The Anatolian Journal of Clinical Investigation. 2014; 8(2):98-104.
- 18. Livanou M, Kasvikis Y, Başoğlu M et al. Earthquake-related psychological distress and associated factors 4 years after the Parnitha earthquake in Greece. European Psychiatry. 2005;20(2):137-144.
- 19. Chen CH, Tan HKL, Liao LR et al. Long-term psychological outcome of 1999 Taiwan earthquake survivors: A survey of a high-risk sample with property damage. Comprehensive Psychiatry. 2007;48(3):269-275.
- 20. Başoğlu M, Şalcıoğlu E, Livanou M. Traumatic stress responses in earthquake survivors in Turkey. Journal of Traumatic Stress. 2002;15(4):269-276.
- 21. Şalcıoğlu E, Başoğlu M, Livanou M. Long-term psychological outcome for non–treatment- seeking earthquake survivors in Turkey. The Journal Of Nervous And Mental Dısease. 2003;191(3):154-160.
- 22. Öztürk MO, Uluşahin NA. Ruh sağlığı ve bozuklukları. 15. Baskı. Ankara: Nobel Tıp Kitabevleri; 2018. Bölüm 3, Örselenme ya da Zorlanma Etkisine Bağlı Bozukluklar; p. 380- 389.
- 23. Duman N. Travma sonrası büyüme ve gelişim. International Journal of Afro-Eurasian Research. 2019;4(7):178-184.
- 24. İnci F, Boztepe H. Travma sonrası büyüme: Öldürmeyen acı güçlendirir mi? Journal of Psychiatric Nursing. 2013;4(2):80-84.
- 25. Hayes SC, Levin ME, Plumb-Vilardaga J et al. Acceptance and Commitment Therapy and Contextual Behavioral Science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy. 2013;44(2):180-198.
- 26. Kul A, Türk F. Kabul ve Adanmışlık Terapisi (ACT) üzerine bir derleme çalışması. OPUS International Journal of Society Researches. 2020; 16(29 Ekim Özel Sayısı):3773-3805.
- 27. Neff. K, Tirch D. Self-compassion and ACT [eBook]. In: Kashdan TB, Ciarrochi J, editors. Mindfulness, acceptance, and positive psychology: The seven foundations of well- being. Oakland, California, USA: New Harbinger Publacations; 2013. [citied 2024 Jan 7] p. 78-106. Available from: https://self- compassion.org/wp- content/uploads/publications/Chap4_Mindfuln ess-Acceptance-and-Positive- Psychology_11.06.pdf
- 28. Köksal B. Kabul ve kararlılık terapisine dayalı kendi kendine yardım müdahalesinin üniversite öğrencilerinin depresyon, anksiyete, stres ve psikolojik esneklik düzeylerine etkisi. 2023; Doktora tezi.
- 29. Gloster A, Walder N, Levin ME et al. The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science. 2020;18:181- 192.
- 30. Larsson A. Hartley S, McHugh L. A randomised controlled trial of brief web-based Acceptance and Commitment Therapy on the general mental health, depression, anxiety and stress of college Students. Journal of Contextual Behavioral Science. 2022;24:10-17.
- 31. Levin ME, Hayes SC, Pistorello J et al. Web- based self-help for preventing mental health problems in universities: Comparing Acceptance and Commitment training to mental health education. Journal of Clinical Psychology. 2016;72(3):207-225.
- 32. Levin ME, An W, Davis CH et all. Evaluating Acceptance and Commitment Therapy and Mindfulness-Based stress reduction self-help books for college student mental health.
Mindfulness. 2020;11:1275-1285.
- 33. Muto T, Hayes SC, Jeffcoat T. The effectiveness of Acceptance and Commitment Therapy Bibliotherapy for enhancing the psychological health of Japanese college students living abroad. Behavior Therapy. 2011;42:323-335.
34. Räsänen P, Lappalainen P, Muotka J et al. An online guided ACT intervention for enhancing the psychological well-being of university students: A randomized controlled clinical trial.
Behaviour Research and Therapy. 2016;78:30- 42.
- 35. Viskovich S, Pakenham KI. Randomized controlled trial of a web‐based Acceptance and Commitment Therapy (ACT) program to promote mental health in university students.
Journal of Clinical Psychology. 2020;76:929- 951.
- 36. Walser RD, Steven CH. Cognitive-Behavioral Therapies for trauma 2nd ed. [eBook]. New York City: Guilford Pressi, Inc; 2006. Chapter 7, Acceptance and Commitment Therapy in the treatment of posttraumatic stress disorder. [cited 2024 Jan 7]. Avaliable from: https://books.google.com.tr/books?hl=tr&lr=&i d=cBLxWyhYD_IC&oi=fnd&pg=PA146&dq =Walser+ve+Hayes&ots=Ov_SB6u4mY&sig= 82pv3MmViQUOqDHf8L_GpXnpWk0&redir _esc=y#v=onepage&q=Walser%20ve%20Hay es&f=false
- 37. Bean RC, Ong CW, Lee J et al. Acceptance and Commitment Therapy for PTSD and trauma: An empirical review. The Behavior Therapist Journal. 2017;40:145-150.
- 38. Pohar R, Argaez C. Acceptance and Commitment Therapy for post-traumatic stress disorder, anxiety, and depression: a review of clinical effectiveness. CADTH, 1-32. (CADTH rapid response reports: summary with critical appraisal). 2018.
- 39. Thompson RW, Arnkoff DB, Glass CR. Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, & Abuse. 2011;12(4):220-235).
- 40. Spidel A, Lecomte T, Kelly D et al. Acceptance and Commitment Therapy for psychosis and trauma: Improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention. Psychology and Psychotherapy: Theory, Research and Practice. 2018;91:248-261.
- 41. Follette VM, Briere J, Rozelle D et al. Mindfulness-0riented interventions for trauma: Integrating contemplative practices 2nd ed. [eBook]. New York City: Guilford Press, Inc; 2015 [citied 2024 Jan 7]. Avaliable from: Google Books.
- 42. Orsillo SM, Batten SV. Acceptance and Commitmnet Therapy in the treatment of posttraumatic stress disorder. Behavior Modification. 2005:29(1):95-129.
- 43. Wirmando W, Alfrida A, Saranga Jl et al. Effectiveness of Acceptance and Commitment Therapy on resilience for victims of natural disaster experiencing physical disability.
- 44. Büyüköztürk Ş, Kılıç Çakmak E, Akgün ÖE et al. Bilimsel araştırma yöntemleri. Geliştirilmiş 2. Baskı. Ankara: Pegem Akademi Yayıncılık; 2008.
- 45. Tanhan F, Kayri M. Deprem Sonrası Travma Düzeyini Belirleme Ölçeğinin geçerlik ve güvenirlik çalışması. Kuram ve Uygulamada Eğitim Bilimleri. 2013;13(2):1013-1025.
- 46. Rolffs JL, Rogge RD, Wilson Kg. Disentangling components of flexibility via the hexaflex model: Development and validation of the Multidimensional Psychological Flexibility Inventory (MPFI). Assessment. 2018;25(4):458-482.
- 47. Ulubay G. Çok Boyutlu Psikolojik Esneklik Envanterinin Türkçeye uyarlanması. 2020; Yüksek Lisans Tezi. 48. Kline RB. Principles and practice of structural equation modeling. 5th ed. New York, USA: Guilford Press; 2011.
- 49. Adiloğlu Takmaz Z, Kurtuluş Yıldırım H. Effectiveness of the Acceptance and Commitment Therapy-Based Intervention Program for Women. Turkish Psychological Counseling and Guidance Journal. 2023;13(69):240-255.
- 50. Yapan S, Murat M ve Yavuz KF. Kabul ve kararlılık terapisi ve bilişsel davranışçı terapi temelli psikoeğitim programlarının sınav kaygısına etkisi. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi. 2021;10(2),194-208.
- 51. Wetherell JL, Liu L, Patterson TL et al. Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report. Behavior therapy. 2011;42(1):127-134.
- 52. Pennebaker JW. Confession, inhibition, and disease. In Advances in experimental social psychology. 1989;22:211-244.