الفهرس 
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Abstract
Depression is a highly prevalent condition that takes a recurrent course with an increased
probability of relapse with each episode. Patients with depression display substantial difficulties
in handling and regulating their emotions. These difficulties indicate inability to control
emotions in interactions, describe, and label emotional status, as well as having difficulty
tolerating distress and setting realistic goals and expectations. Emotion regulation difficulties
seem to persist after individuals are remitted from depression.
Dialectical behavior therapy (DBT) including emotion regulation skills evolved from Marsha
Linehan’s efforts (1993a, 2015) to help patients with depression. Emotion regulation skill
intervention include learn to properly identify and label emotions, identify obstacles to change
emotions, reduce vulnerability to “emotion mind”, increase positive emotional events, increasing
mindfulness to current emotions, and adopting opposite action. It is worth reminding that,
investigation of emotion regulation profile among patients with depression and applying emotion
regulation skills intervention are important to help patients to communicate their emotions,
enhance problem solving of difficult emotions, and increase ability to tolerate negative emotions.
The present study aimed to investigate emotion regulation profile of patients with
depression and determine the effect of implementing emotion regulation skills training
intervention on their emotional regulation difficulties.
The study followed Both a descriptive research design and a quasi-experimental research
design. It was conducted at the psychiatric outpatient clinics of El-Hadra University
Hospital, and the Main University Hospital.
Study subjects comprised eighty patients with depression to assess their emotion
regulation profile. Out of these patients 30 patients were chosen for applying the emotion
regulation skills training intervention.
Tools for data collection included:
I: A Socio-Demographic and Clinical Data Structured Interview Schedule.
II: Difficulties in Emotional Regulation Scale (DERS) developed by Gratz and Roemer
(2004) to assess multiple difficulties of emotion regulation. This scale has 36 items classified
into six subscales.
Tool III: Cognitive Emotion Regulation Questionnaire (CERQ) developed by
Garnefski et al., (2001) is a 36 items questionnaire assessing cognitive emotion regulation
strategies. It consists of nine subscales grouped into adaptive strategies (5 subscales) and less
adaptive strategies (4 subscales).
Official written permissions from appropriate authorities were obtained.
The researcher received online training on Emotion Regulation Skills
intervention.
The DERS and CERQ proved to be internally consistent (Cronbach’s alpha=0.72
and 0.83 consequently).
Eighty patients with depression (60 males and 20 females) were recruited using a
convenient sample method.
Patients included in the study group were chosen having the highest scores in
DERS, using less adaptive and more maladaptive emotion regulation strategies.
Written plan for every session (time, meetings and setting) was scheduled.
Methods of training on emotion regulation skill intervention were based on
personalized education by using individualized interactive training sessions,
demonstration, and rehearsal.
Emotion regulation skills training intervention were given four parts divided of
nine sessions.
Corrective feedback was given by the researcher to the patients in order to make
the skills of sessions more efficient.
Follow up was conducted using different means of communication as face to face meeting, messaging and telephone coaching.
A closing session at the end of emotion regulation skills intervention was done to get the patients’ feedback, opinions about the therapy and plan follow up after 3 months.
After completion of three months training intervention, each patient in the study
group has interviewed using tool II, and III at the outpatient clinics to determine
the effect of emotion regulation skills intervention.
The collected data were revised, coded, computerized and then analyzed using the
SPSS program version 20.0.
The followings are the main results yielded by this study:
I- Distribution of the total studied subjects according to their sociodemographic
characteristics:
Male patients constituted 75% of the subjects.
Patients aged from 20 to 30 years constituted 48.8 % of the total subjects.
Married subjects amounted to 41.3% of the total subjects.
Patients who had secondary level of education constituted 43.75% of the total
studied subjects and 50.0% of the total subjects were unemployed.
Seventy-eight point eight percent of total subjects were living with their
families and 37.5% of the total subjects had a duration of illness from 4
months to one year
Sixty five percent of the total subjects had positive family history of mental
illness. Out of this percentage, 71.2% had a history of depression among
family and 28.8% had a history of bipolar disorder.
More than three quarter of total subjects reported having family support.
The half of total subjects received both pharmacotherapy and psychotherapy
as treatment modalities. Patients receiving pharmacological treatment
amounted to 72 patients. Out of these, 56.9% received antidepressants only.
Fourty percent from the total descriptive subjects were non-compliants.
Among them 53.1% reported side effects of medication as the main cause of
their noncompliance.
II- Distribution of the total subjects according to their Difficulties in Emotional Regulation scores:
Studied subjects’ overall scores ranged from 158 to 169 with a mean score of
164.5 ± 3.21 denoting higher emotional regulation difficulties.
The highest percentages of subjects’ emotion regulation difficulties subscales
were in “Lack of emotional clarity” (81.3%) and “Non-acceptance of
emotional responses” (80%).
III- Distribution of the total subjects according to their Cognitive Emotion
Regulation Questionnaire scores:
The total overall scores ranged from 39 to 95 with a mean equal 56.07± 2.67.
The subjects’ score related to adaptive strategies ranged between 20-38 with a mean
31± 1.55. Those who had higher percentage of adaptive cognitive emotion regulation,
Putting into perspective was the highest (78.8%), followed by Acceptance (60%).
less adaptive strategies overall scores indicated less use of adaptive cognitive emotion
regulation ranging from 29 to 77 and a mean of 48.34± 2.38. Those who scored highest
were Self-blame and Catastrophizing (100%, and 90 respectively).
IV- The mean difference of studied subjects according to Difficulties in Emotional
Regulation scores pre and post emotion regulation skill intervention.
The mean score of the overall subjects decreased from 167.35 ± 2.21 in preintervention
to105.85 ± 3.33 post-intervention, with a high statistical significant
difference (p<0.0001).
The mean score of non-acceptance of emotional responses decreased from 29.85
± 0.40. to17.74 ± 0.44 after intervention. As well, impulse control difficulties
declined from 28.75 ± 3.40 pre-intervention to 10.95 ± 2.40 post intervention,
with highly statistically significant difference of both subscales (p<0.0001).
The mean score of difficulty engaging in goal-directed behaviors and limited
access to emotional regulation strategies decreased from 24.74 ± 0.44 and 39.55 ± 0.53 to 12.74 ± 2.50 and 20.25 ± 2.36 after training with statistically significant
difference (p<0.001).