Iran Journal of Nursing

Introduction
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain and changes in bowel habits that occur in the absence of a specific structural abnormality. The present study aims to compare the effects of emotion regulation training and mindfulness-based cognitive therapy (MBCT) on the resilience and self-compassion of women with IBS.

Methods
This is a quasi-experimental study with a pre-test/post-test/follow-up design with a control group. The study population consists of all women with IBS referred to the clinics of internal medicine physicians in Ilam, Iran, in 2018-2019 (n=635). Of these, 60 were selected as samples by cluster random method and based on the entry criteria. According to the demographic characteristics, they were divided into three groups of 20, including emotion regulation, MBCT, and control. The samples were in the age range of 25-40 years and had their disease for at least 1 year. The data collection tools included a demographic checklist, the Conner-Davidson resilience scale, and the self-compassion scale (SCS).
The Connor-Davidson Resilience scale has 25 items rated on a Likert scale from 0 (completely false) to 4 (always true). The total score ranges from 0 to 100. Higher scores indicate greater resilience. For its reliability, Connor and Davidson reported a Cronbach's alpha coefficient of 0.89. Also, its test-retest reliability with a 4-week interval was 0.87. The Persian version of this scale has been validated in Iran by Mohammadi (2004). He reported a Cronbach's alpha of 0.89. The reliability of the questionnaire in the present study was reported as α=0.87.
The SCS was developed by Neff in 2003 and has 26 items and 6 subscales of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification. The scoring is based on a 5-point Likert scale from 1 (almost never) to 5 (almost always).
After the pre-test assessments, the interventions (i.e. emotional regulation training and MBCT) were provided at 8 sessions (one session per week, each session for 1 hour) were applied to the experimental groups online using webinars. After the interventions, post-test assessments were performed. For data analysis, the repeated measures analysis of variance was used.

Results
The mean age of women was 36.5 years in the emotion regulation group, 38 years in the MBCT group, and 37.5 years in the control group. The results of the independent t-test showed no significant difference among the groups before the interventions, but there was a significant difference after the interventions. The paired t-test results showed a significant difference in the mean score of self-compassion and resilience before and after the intervention in the experimental groups, but no significant statistical difference was found in the control group. The results of the Benferroni post hoc test for pairwise comparison of the groups showed that both emotion regulation and MBCT were significantly effective in increasing resilience and self-compassion, where MBCT was more effective. The effect size on resilience and self-compassion in groups was 0.89 and 0.859, respectively, indicating that 89% and 85.9% of individual differences in post-test scores of resilience and self-compassion were related to the effect of treatment.

Conclusion
Regarding the resilience variable, there was a significant difference between the two interventions where MBCT had a greater impact than emotional regulation training in women with IBS. To explain this result, it can be said that mindfulness is a kind of non-judgmental attention that is presented to nurture and regulate emotions. People with mindfulness are more able to deal with a wide range of thoughts, emotions, and experiences. The increase in mindfulness leads to the reduction of human suffering and the development of positive qualities such as wisdom, compassion, relaxation, and calmness, which can affect and improve resilience. Another finding of this study was that there was a significant difference between the two interventions in the self-compassion of women with IBS, where MBCT had a greater impact compared to emotional regulation training. Self-compassion makes it possible to forgive others by increasing the tolerance of failures and mistakes. To explain this result, it can be said that during group therapy, people learn effective social skills and then use their learned skills on other group members. They feel comfortable and encouraged when see that other people’s problems are similar to theirs or are even more severe. This can help improve their self-compassion. Overall. It can be concluded that MBCT is more effective in increasing the resilience and self-compassion of women with IBS.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Ilam University of Medical Sciences (Code: IR.MEDILAM.REC.1400.066).

Funding
This study was extracted from the PhD thesis of Aida Omidi registered by Ilam University of Medical Sciences. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.. 

Authors' contributions
Conceptualization and investigation: Aida Omedi; Editing and review: Vahid Ahmadi and Reza Valizadeh. 

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all women participated in this research for their cooperation.

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