The effectiveness of rational-emotional-behavioral group therapy on experiential avoidance and emotional expression in patients with irritable bowel syndrome

Document Type : Original Article


1 Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran.

2 Department of Psychology and Educational Sciences, Ghaemshahr Department, Islamic Azad University, Ghaemshahr, Iran.

3 Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran.

4 Clinical Psychology, Pars University, Tehran, Iran


Background: Functional gastrointestinal disorders are a class of medical patients that are characterized by unknown causes, questionable diagnostic queens, long-term and unpredictable periods of sickness.
Objectives: This study aimed to determine the effectiveness of rational-emotional-behavioral group therapy on experiential avoidance and emotional expression in patients with irritable bowel syndrome.
Methods: The present study was semi-experimental research with pre-test, post-test, and follow-up with the control group. The statistical population consisted of all patients with irritable bowel syndrome in Rouhani Hospital of Babol in 2019, among whom 30 patients with irritable bowel syndrome volunteered to participate in the study were randomly assigned to two experimental groups (n=15) and Control (n=15). Data were obtained using Peacock and Long Questionnaire (1990), Bund et al. Empirical Avoidance Questionnaire (2007), and King's and Owens' Emotional Expression Questionnaire (1990) in the pre-test, post-test, and follow-up stages. The rational-emotional-behavioral group training protocol was performed in 12 sessions (one session per week) for 90 minutes. Data were analyzed using repeated measure analysis of variance method and the above statistical analysis was performed using SPSS.22 software. The significance level of the tests was considered 0.05.
Results: The results showed that rational, emotional-behavioral therapy was effective on decreasing experiential avoidance (P<0.001) and increasing emotional expression (P<0.001) in patients with irritable bowel syndrome.
Conclusion: It can be said that rational-emotional-behavioral group therapy was effective on experiential avoidance and emotional expression in patients with irritable bowel syndrome. Rational-emotional-behavioral group therapy can be used to reduce psychological problems in patients with irritable bowel syndrome.


 1.Pittayanon R, Lau JT, Yuan Y, Leontiadis GI, Tse F,
Surette M, Moayyedi P. Gut microbiota in patients with

Zadhasan Z et al.
16 Razavi Int J Med. 2022; 10(2):e1090.
irritable bowel syndrome—a systematic review.
Gastroenterology. 2019 Jul 1;157(1):97-108.
2.Rodiño-Janeiro BK, Vicario M, Alonso-Cotoner C,
Pascua-García R, Santos J. A review of microbiota and
irritable bowel syndrome: future in therapies. Advances
in therapy. 2018 Mar;35(3):289-310.
3.Langa KM, Ryan LH, McCammon RJ, Jones RN,
Manly JJ, Levine DA, Sonnega A, Farron M, Weir DR.
The health and retirement study harmonized cognitive
assessment protocol project: study design and methods.
Neuroepidemiology. 2020;54(1):64-74.
4.Delgado C, Araneda A, Behrens MI. Validation of the
Spanish-language version of the Montreal Cognitive
Assessment test in adults older than 60 years. Neurología
(English Edition). 2019 Jul 1;34(6):376-85.
5.O’Driscoll C, Shaikh M. Cross-cultural applicability of
the Montreal Cognitive Assessment (MoCA): a
systematic review. Journal of Alzheimer's disease. 2017
Jan 1;58(3):789-801.
6.Thomann AE, Goettel N, Monsch RJ, Berres M, Jahn
T, Steiner LA, Monsch AU. The Montreal Cognitive
Assessment: normative data from a German-speaking
cohort and comparison with international normative
samples. Journal of Alzheimer's Disease. 2018 Jan
7.Jaffary F, Kharatzadeh H, Hoseini SM, Mohammadi
A. The Relationship between Difficulties in Emotion
Regulation and Experimental Avoidance with
Depression in Patients with Vitiligo. Journal of North
Khorasan University of Medical Sciences. 2020 Feb
8.Rezaei M, Ghazanfari F. The role of childhood trauma,
early maladaptive schemas, emotional schemas and
experimental avoidance on depression: A structural
equation modeling. Psychiatry research. 2016 Dec
9.Basharpoor S, Shafiei M, Daneshvar S. The
comparison of experimental avoidance, mindfulness and
rumination in trauma-exposed individuals with and
without posttraumatic stress disorder (PTSD) in an
Iranian sample. Archives of psychiatric nursing. 2015
Oct 1;29(5):279-83.
10.Samson DR, Louden LA, Gerstner K, Wylie S, Lake
B, White BJ, Nunn CL, Hunt KD. Chimpanzee (Pan
troglodytes schweinfurthii) group sleep and pathogenvector avoidance: experimental support for the
encounter-dilution effect. International Journal of
Primatology. 2019 Dec;40(6):647-59.
11.Burton CL, Bonanno GA. Measuring ability to
enhance and suppress emotional expression: The
Flexible Regulation of Emotional Expression (FREE)
Scale. Psychological assessment. 2016 Aug;28(8):929.
12.Vidal L, Ares G, Jaeger SR. Use of emoticon and
emoji in tweets for food-related emotional expression.
Food Quality and Preference. 2016 Apr 1;49:119-28.
13.Chang A, Kragness HE, Livingstone SR, Bosnyak
DJ, Trainor LJ. Body sway reflects joint emotional
expression in music ensemble performance. Scientific
reports. 2019 Jan 18;9(1):1-1.
14.Ho MD, Ling Y, Yap LW, Wang Y, Dong D, Zhao
Y, Cheng W. Percolating network of ultrathin gold
nanowires and silver nanowires toward “invisible”
wearable sensors for detecting emotional expression and
apexcardiogram. Advanced Functional Materials. 2017
15.Zahrakar K, Kasaee A. The Effectiveness of Training
Based on Rational-Emotional-Behavioral Therapy on
Career Decision-Making Self-Efficacy. International
Clinical Neuroscience Journal. 2019 Apr 1;6(2):69.
16.Afshari A. Investigating the effects and comparisons
of Adler's individual counseling with Ellis’ rationalemotional behavioral therapy on conduct disorder of
students. Journal of Psychological Achievements
(Journal of Education & Psychology). 2019;26(1): 95-
17.El-Nahhas AS. The effectiveness of a rational,
emotional, behavioral program in modifying the
irrational thoughts related to the pressures of life for
forced retirees. International Journal of Halal Research.
2020 Dec 31;2(2):106-25.
18.Rostami H, Karimisani P, Fathi A, Karimi A. The
Effectiveness of Group-based Rational Emotional
Behavioral Therapy on Family Function, Incompatible
Schemas, and Couple Burnout in Couples. Journal of
Health and Care. 2019 Sep 10;21(3):192-202.
19.Buruck G, Dörfel D, Kugler J, Brom SS. Enhancing
well-being at work: The role of emotion regulation skills
as personal resources. Journal of occupational health
psychology. 2016 Oct;21(4):480.
20.Peacock EJ, Wong PT. The cognitive assessment
Measure: A multidimensional approach to cognitive
assessment. cognitive assessment Medicine.
21.Ghasemi Navab A, Amiri S, Azadmarzabadi E.
Comparison of emotion regulation strategies, emotional
experience and ambivalence of emotional expression in
soldiers with suicide attempts and normal. Journal Mil
Med. 2017;19(3):282-90.
22.King LA, Emmons RA. Conflict over emotional
expression: psychological and physical correlates. J Pers
Soc Psychol. 1990;58(5):864–77.
23.Sharifinia MA, Haroonrashidi H. The relationship
between the dark traits of personality and emotional
expressiveness with satisfaction of life among the
military personnel in Ahvaz, Iran. Military Psychology.
2020;11(41):41–9. [Persian]