Download The Effect of Group Poetry Therapy on Cognitive Emotion

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CULTURAL STUDIES ISSN 2356-5926
The Effect of Group Poetry Therapy on Cognitive Emotion Regulation and
Moods of Psychotic Patients: The Case of Razi Psychiatric Hospital, Tehran
Arab Parastoo
Master of science in nursing (psychiatric nurse), Razi psychiatry Hospital, Tehran
Kazemi Amenehsadat*
(Corresponding author)
Tehran medical science branch Islamic Azad University faculty of medicine, department of
psychology
Mollahosseini Shahla
Tehran medical science branch Islamic Azad University faculty of medicine, Master of science
in midwifery
Abstract
The main objective of this study was to examine the effect of group poetry therapy on cognitive
emotion regulation and on the changes in the mood of psychotic patients in Razi Psychiatric
Hospital of Tehran in 2015. The study was quasi-empirical and used pretest and posttest with a
control group of 22 psychotic patients (11 people in intervention group and 11 people in control
group). For the intervention group, a one-hour group poetry therapy session was performed
twice a week for four weeks. Data collection methodology included demographic information
questionnaire, Garnefski’s Cognitive Emotion Regulation Questionnaire (CERQ) (36 items), and
Brunel Mood Scales (BRUMS) (24 items). Statistical analysis was conducted by multivariate
covariance analysis in SPSS (v.21). The results showed that the intervention of poetry therapy, in
comparison to the control group, significantly improved the scores of positive aspects of
cognitive emotion regulation of the patients (p <0.05) whereas no significant change was
observed in the negative strategies (p> 0.05). Also, poetry therapy intervention, compared to the
control group, did not make any changes in the mood of the patients (p> 0.05). It can be
concluded that group poetry therapy is effective on the positive aspects of cognitive emotion
regulation of psychotic patients while it is not effective on the negative aspects of cognitive
emotion regulation and moods of the patients.
Keywords: Group poetry therapy, Cognitive emotion regulation, Mood, Psychotic, Test
group, Control group.
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1. Introduction
Mental disorders along with delusions and hallucinations and lack of awareness about the
pathological nature of these is called psychosis. Some types of psychosis include schizophrenia,
mood disorders with psychotic symptoms, and schizoaffective disorders [1]. Among psychiatric
disorders, psychotic disorders are especially important with regard to their personal, familial,
economic, and social consequences [2]. Acute mental diseases such as schizophrenia,
schizoaffective, and bipolar disorders have been cases of high rates of death [3]. The emotional
turmoil in these patients indicates abnormalities in the brain regions responsible for emotional
processing [4]. Psychotic patients face certain problems in using skills for cognitive emotion
regulation which are related to their awareness, understanding, and acceptance of regulating
anger, shame, anxiety, pain, and sorrow [5]. Researchers believe that deploying different
strategies in the face of stressful situations can be an important phenomenon. In their study,
Samani and Sadeghi have divided these strategies into two kinds: positive strategies (positive
refocusing, planning, positive reappraisal/evaluation, and perspective development), and
negative strategies (self-blame, blaming others, mental rumination, catastrophizing, and
acceptance). They showed that negative strategies were directly correlated with depression,
anxiety and stress, and that positive strategies have indirect correlations with these mental health
indexes [6]. Other research done in this area showed that psychotic patients used repression
mechanism over reevaluation mechanism much more than the control group [7]. Emotional
problems are considered as an index of schizophrenia which can naturally lead to many
consequences in the daily lives of the schizophrenics [8]. In a study done by Ponizovsky et al., it
was found out that in comparison to control group, patients with depression and schizophrenics
use maladaptive cognitive emotion regulation strategies to deal with emotions and distress and
other forms of anxiety. Training these patients to manage their stress can give them more
efficient skills to regulate their emotions [9]. In general, schizophrenic symptoms and other
psychotic disorders are studied in three major categories: positive symptoms (delusion and
hallucination), negative symptoms, and cognitive disorders [10]. In a research done by Patel et
al. on 27704 adults with mental disorders during 2006 to 2013 it was found out that 22/6 percent
of the patients with bipolar disorders, 17/8 percent of patients with personality disorders, and
15/5 percent of schizophrenic patients suffer from mood swings. This indicates the fact that
mood swings and instabilities occur in a wide range of mental disorders such as schizophrenia
and is not limited to only mood disorders [11].
Nowadays the primary method of treating schizophrenia and other psychotic disorders is
medicine therapy; however, what has been widely accepted is the fact that though antipsychotic
medicines are an indispensable part of therapy, they cannot be considered the main treatment of
schizophrenics and other psychotic disorders. Side effects, limitations and failure to comply with
drug regimens are some of the disadvantages of antipsychotic medicine which has led to a
stronger tendency for psychological and psychosocial treatment [12]. Group therapy is a form of
therapy where the therapist guides the patients to help one another in creating positive changes in
their behaviors. In America more than half of the general hospitals use group therapy in their
psychiatry sections. Group therapy for psychotic patients in a non-acute phase can improve
interpersonal relationships, cognitive functions, emotional expressions, and realism [13]. One
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type of group therapy is group poetry therapy. Poetry therapy is a creative art therapy which uses
poetry and other forms of literature for treatment goals and personal growth [14]. In a research
dealing with art therapy in psychotic patients, it was found out that art enables the patients to
explore their mental experiences and to also distinguish between their real experiences and their
delusions and hallucinations [15]. Since linguistic disorders in a psychotic patient may be due to
disorders in metaphoric understanding, learning how to understand metaphors in poetry and
using them for expressing inner emotions can be a useful tool for these patients [16]. Given the
problems in cognitive emotion regulation and moods in psychotic patients and also the fact that
no previous research has been carried out on the role of poetry therapy in cognitive emotion
regulation and psychotic patients’ moods, this study investigates the effect of group poetry
therapy on cognitive emotion regulation and mood changes in the psychotic patients of Razi
Psychiatric Hospital in 2015.
2. Materials and methods
Type of research: the present study is semi-empirical in its nature and aims.
Research data: this study has three variables, one independent variable (poetry therapy), and two
dependent variables (cognitive emotion regulation and moods). There is only one test group in
the study. Data is both quantitative (age, number of children, etc.) and qualitative (gender,
marital status, education, employment). In terms of measurement scale the study uses nominal
and distance scales.
Data collection tools:
Data collection tools in this study included three questionnaires: demographic questionnaire for
assessing personal information (age, education, etc.), Garnefski’s standard cognitive emotion
regulation – the structure of this questionnaire is multidimensional and is used to identify the
cognitive strategies for coping with a sad experience. In comparison to other defense mechanism
questionnaires which do not consider a difference between thought and action among people, this
latter questionnaire deals specifically with the thoughts of a person after a negative experience.
The original version of this questionnaire has 9 components (self-blaming, acceptance, mental
rumination, positive refocusing and renewed attention to planning, positive reevaluation,
perspective taking, catastrophizing, and blaming others) and 36 items. The materials of this
questionnaire are designed theoretically and systematically. Each factor assesses one strategy.
The third questionnaire used in this study is Brunel Mood Scales (BRUMS) which has 24
statements and their answers are organized according to Likert’s 5-scales as Never, A Little,
Medium, High, Very high and were set to the range of scores between 0-4. This questionnaire
measures six variables: tension, depression, anger, energy level, fatigue, and confusion. Each
subscale is measured by four statements.
Poetry therapy: poetry therapy is a creative form of art therapy which deploys poetry and other
forms of literature to achieve therapeutic goals and personal growth [14]. As for the present
study, poetry therapy refers to reading classic and modern poetry for psychotic patients in the
treatment group. Based on the characteristics of the group, pre-written poetry, personal poetry
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composition, and group poetry compassion were used. This was performed for eight one-hour
sessions twice a week and for four weeks.
Cognitive emotion regulation: cognitive emotion regulation is a planned process which takes
place in order to influence the intensity, duration, and type of experienced emotion by a person;
people use cognitive emotion regulation to balance their emotions, whether consciously or
unconsciously [18]. In this study, cognitive emotion regulation refers to the scores obtained from
Garnefski’s standard 36-item questionnaire which are organized in six scales: Always, Almost
always, often, Sometimes, Hardly ever, Never. This questionnaire measures these variables:
positive refocusing and planning, appraisal and adopting a vaster perspective, acceptance,
blaming others, self-blame, mental rumination, and catastrophizing.
Mood: the emotional state of having a keen and continuous inner feeling which is one of the
inner manifestations of emotional excitement (Noghabi et al., 2011, p.132). In this study, moods
refer to the scores obtained from the BRUMS standard 24-item questionnaire which were
organized in five scales: Not at all, A little, Medium, High, Very high. This questionnaire
measures these variables: anger, fatigue, depression, confusion, tension, and energy levels.
Psychotic disorders: it refers to a disorder or a set of mental disorders in which perception,
thought, temperament, and the behavior of a person changes significantly and its symptoms
manifest themselves as positive symptoms (delusions and hallucination) and negative symptoms
(lack of emotions and motivations, verbal insufficiency, isolation) [12].
In this study, psychotic patients refers to all patients hospitalized in different wards of Razi
Psychiatric Hospital who were examined by a psychiatrist and diagnosed to have schizophrenic,
schizoaffective, or mood disorders with symptoms.
Research case study:
This study used Razi Psychiatric Hospital in Tehran as its research environment. The research
population included all male patients hospitalized in different wards of this hospital who were
diagnosed by psychiatrists to have schizophrenic, schizoaffective, or mood disorders with
symptoms.
Research sample:
The research sample was calculated as 11 by using the following relation: 11 people in the
control group, 11 people in the test group, thus all in all 22 people.
=
p=0/5
z=1/96
= 11
=0/05 d=0/3
The sampling methodology used was based on the objective of the study.
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The criteria for participating in the study included: interest in attending group poetry therapy
sessions, literacy to read and write, not being in an acute phase of illness, no mental retardedness,
non-addiction to narcotics, consciousness of time and place and people. Exclusion criteria were:
lack of personal interest to attend the sessions, frequent absence in the sessions, and appearance
of an acute phase of illness.
Data analysis:
To determine the normal distribution of data, Kolmogorov-Smirnov test was used. To compare
the cognitive emotion regulation of the patients in the test and control groups and also to
compare their moods multi-variable covariance analysis was used by SPSS (v.21).
3. Results
The overall goal of the present study was to investigate the role of group poetry therapy on
cognitive emotion regulation and moods of psychotic patients hospitalized in Razi Psychiatric
Hospital (Tehran) in 2015. To achieve this goal, the obtained information is organized in 20
tables. We have tried to compare the findings in this study with the findings in previous
researches.
Tables 1 to 8 (demographic data) show respectively, age, season of birth, marital status, number
of children, education, type of psychosis, illness in the family record, and physical illness.
The “age” average of the test group was 45.72 years, and the age average of the control group
was 53.36 years. In the test group, the highest age frequency belonged to 46-55 years (45.45%)
and the lowest frequency belonged to 36-45 years (52≥) (0%). In the control group, the highest
frequency belonged to people with more than 55 years old (54.54%), and the lowest frequency
belonged to 36-45 years (52≥) (0%). In the test group, the highest frequency of “season of birth”
was spring (54.54%) and the lowest frequency was autumn (9.09%). In the control group, the
highest frequency for season of birth was summer (45.45%) and the lowest frequency was spring
(0%). In the test group, the highest frequency for “marital status” was single (63.63%) and the
lowest frequency was widowed (0%) and married (0%). In the control group, the highest
frequency for marital status was single (90.90%) and the lowest frequency was married (0%) or
widowed (0%). In the test group, the highest frequency for “number of children” was no children
(72.72%) and the lowest frequency was more than two children (0%). In the control group, the
highest frequency for number of children was no children (90.90%) and the lowest frequency
was two children (0%) or more than two children (0%).
Tables 1 to 4: 1) Distribution of absolute and relative frequency of psychotic patients in Razi
Psychiatric Hospital according to age, 2) season of birth, 3) marital status, 4) number of children.
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Table (1)
Test group
Control group
Age
Number Percentage Number Percentage
>=52
0
0
0
0
52-52
1
9009
5
11011
52-52
5
52052
0
0
52-22
2
52052
5
52052
< 22
1
9009
2
25025
Total
11
100
11
100
Average
52025
25052
Standard 9022
deviation
15052
Table (2)
Test group
Control group
Season
of birth
Number Percentage Number Percentage
Spring
2
25025
0
0
Summer 5
11011
2
52052
Autumn
1
9009
5
52052
Winter
5
11011
5
52052
Total
11
100
11
100
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Table (3)
Test group
Control
group
Marital
status
Number Percentage Number Percentage
Single
2
25025
10
90090
Married
0
0
0
0
Divorced
5
52052
1
9009
Widowed 0
0
0
0
Total
100
11
100
11
Table (4)
Test group
Control
group
Number Number Percentage Number Percentage
of
children
None
1
25025
10
90090
One
1
9009
1
9009
Two
5
11011
0
0
More
than
two
0
0
0
0
Total
11
100
11
100
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In both test and control groups,the highest frequency for Education was “higher than highschool” (54.54%). The fluency of “lower than high-school” in both test and control group was
45.45%. In the test control, the highest frequency for Type of Psychosis was “schizophrenic”
(54.54%) and the lowest frequency was “psychotic mood disorder” (18.18%). In the control
group, the highest frequency belonged to “schizophrenic” (81.81%) and the lowest frequency
belonged to “schizoaffective” (0%). 90.90% of the people in the test group, and 100% of the
people in the control group did not have a history of family illness. 81.81% of the people in the
test group, and 100% people in the control group did not have a physical illness.
Tables 5 to 8: 5) Distribution of absolute and relative frequency of psychotic patients in Razi
Psychiatric Hospital (Tehran) according to Education, 6) Type of psychosis, 7) Family History of
Mental Illness, 8) Physical illness.
Table (5)
Test
group
Control group
Education Number Percentage Number Percentage
Below
highschool
2
52052
2
52052
Above
highschool
2
25025
2
25025
Total
11
100
11
100
Table (6)
Test group
Type
psychosis
Control
group
of Number Percentage Number Percentage
Schizophrenic
2
25025
9
11011
Schizoaffective 5
52052
0
0
Mood
psychotic
11011
5
11011
5
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Total
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100
11
100
Table (7)
Test group
Control
group
Family history
Number Percentage Number Percentage
Schizophrenic
1
9009
0
0
Schizoaffective 10
90090
11
100
Total
100
11
100
11
Table (8)
Test
group
Control
group
Physical illness
Number
Percentage
Number
Percentage
Yes
5
11011
0
0
No
9
11011
11
100
Total
11
100
11
100
To achieve the goal of the present study – to determine the cognitive emotion regulation of
psychotic patients in the test group before and after the test, and in the control group before and
after the test; to compare the cognitive emotion regulation in the test and control groups; to
determine the mood conditions of psychotic patients in the test and control groups before and
after the test – Tables 9 to 14 have been designed. Table (9) shows the mean and standard
deviation of the positive aspects of cognitive emotion regulation which includes positive
refocusing and planning, reevaluation and adopting a broader perspective, and acceptance in the
test and control groups in pretest. The mean of positive strategies in the test group is 70 and
standard deviation is 21.45. In the control group, the mean of positive strategies is 61.36 and
standard deviation is 23.5. Table (10) shows the mean and standard deviation of the negative
aspects of cognitive emotion regulation which includes self-blame, blaming others, mental
rumination, and catastrophizing in the test and control groups before the test. The mean of
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negative strategies in the test group is 45.09 and standard deviation is 21.20. In the control group,
the mean of negative strategies is 37.27 and standard deviation is 10.44. Table (11) shows the
mean and standard deviation of positive aspects of cognitive emotion regulation in the test and
control groups after the test. The mean of positive strategies in the test group is 82 and standard
deviation is 11.56. In the control group, the mean of positive strategies is 49.90 and standard
deviation is 23.33. Table (12) shows the mean and standard deviation of the negative aspects of
cognitive emotion regulation in the test and control groups after the test. The mean of negative
strategies in the test group is 39.36 and standard deviation is 18.78. In the control group, the
mean of negative strategies is 36.27 and standard deviation is 21.38. Table (13) shows the singlesample Kolmogorov-Smirnov test where the level of error in the pretest is more than 0/05 which
shows that the distribution is normal in all aspects. Table (14) shows the single-sample
Kolmogorov-Smirnov test where the level of error in the posttest is more than 0/05 which shows
that data distribution is normal.
Tables 9-14: 9) Mean of positive aspects of cognitive emotion regulation in psychotic
patients in the pretest, 10) Mean of negative aspects of cognitive emotion regulation in the
pretest, 11) Mean of positive aspects of cognitive emotion regulation of psychotic patients in the
posttest, 12) Mean of negative aspects of cognitive emotion regulation in the posttest, 13) Singlesample Kolmogorov-Smirnov test to show that the distribution of cognitive emotion regulation
data is normal in the pretest, 14) Single-sample Kolmogorov-Smirnov test in the posttest.
Table (9)
Test
group
Control
group
Positive
Mean Standard Mean Standard
aspects
of
deviation
deviation
cognitive
emotion
regulation
Positive
55025 15021
refocusing
and planning
51052
15051
Reevaluation 19090
and adoption
of a broader
perspective
2051
12011
1092
Acceptance
15025
502
15052
2025
Positive
strategies
20
51052
21052
5502
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Table (10)
Test
group
Negative
aspects
cognitive
emotion
regulation
Control
group
Mean
Standard Mean
deviation
Standard
deviation
Self-blame
1
2025
2009
2015
Blaming others
9052
2091
1025
2029
Mental
rumination
12011
2025
15
5005
2015
1052
5015
52052
10055
of
Catastrophizing 11
Negative
strategies
52009 51050
Table (11)
Test group
Control
group
Positive aspects of cognitive Mean
emotion regulation
Standard
deviation
Mean
Standard
deviation
Positive
planning
and 55052
1012
52052
12020
Evaluation and adoption of a 55025
broader perspective
2052
15025
9025
Acceptance
12009
5052
9052
2055
Positive strategies
15
11022
59090
55055
refocusing
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Table (12)
Test group
Control
group
Negative aspect of cognitive Mean
emotion regulation
Standard
deviation
Mean
Standard
deviation
Self-blame
1009
2021
2052
5022
Blaming others
2025
2025
9009
2015
Mental rumination
15
2015
15009
2011
Catastrophizing
11025
2055
9025
2025
Negative strategies
59052
11021
52052
51051
Table (13)
Positiv
e
refocus
ing and
plannin
g
Evaluati Blami
on and ng
adoptio others
n
of
broader
perspect
ive
Self
bla
me
Mental
ruminat
ion
Catastrophi Accepta
zing
nce
Positiv
e
strateg
ies
Negati
ve
strateg
ies
k-s
index
0020
0012
0021
0021
0050
0052
0020
0025
0025
Reliabi
lity
0092
0052
0015
0025
0099
0091
0021
0015
0092
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Table (14)
Positiv
e
refocus
ing and
plannin
g
Evaluat Blami Selfion and ng
blami
adoptio others ng
n
of
broader
perspec
tive
Mental Catastroph
ruminat izing
ion
Accepta Positi
nce
ve
strateg
ies
Negati
ve
strateg
ies
k-s
index
1001
0022
0012
0010
0025
0025
1002
0011
0022
Reliabi
lity
0052
0019
0052
0025
0015
0011
0051
0025
0022
Table (15) is a comparison of cognitive emotion regulation in the test and control groups. In this
table, the multi-variable covariance analysis of cognitive emotion regulation statistical scores in
the test and control groups shows that the level of significance in terms of “positive refocusing
and planning” is 0.003, “evaluation and adoption of broader perspective” 0.006, “acceptance”
0.008, and in terms of “positive strategies” 0.001. In terms of “blaming others” it is 0.056, “selfblaming” 0.39, “mental rumination” 0.86, “catastrophizing” 0.87, “negative strategies” 0.75.
Table (15) shows that significant changes with regard to positive refocusing and planning,
evaluation and adoption of broader perspective, acceptance, and positive strategies have occurred
in the psychotic patients of Razi hospital (p<0.05). This significant change in the scores of
positive aspects of cognitive emotion regulation and positive strategies shows that group poetry
therapy improves the positive aspects of cognitive emotion regulation and positive strategies in
the psychotic patients of Razi hospital. However, with regard to self-blaming, blaming others,
mental rumination, catastrophizing, and negative strategies, no significant change was observed
(p>0.05).
Previous research on the role of group poetry therapy have clearly proven its efficiency for
improving the cognitive emotion regulation of patients [19,22].
Table (15): Multi-variable covariance analysis for comparing the cognitive emotion regulation of
psychotic patients in the two groups (using statistical scores of the pretest)
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Dependent
variable
Sum of Level of Mean of F
squares freedom squares
Significance
Positive
951005
refocusing and
planning
1
951005
15052
00005
Evaluation and 551015
adoption
of
broader
perspective
1
551015
10025
00002
Blaming others
1520515
1
1520515
5051
00022
Self-blaming
51091
1
51091
0022
0059
Mental
rumination
0025
1
0025
0005
0012
Catastrophizing 0012
1
0012
0005
0012
Acceptance
552052
1
552052
9015
00001
Positive
strategies
5221012
1
5221012
55025
00001
Negative
strategies
55011
1
55011
0009
0022
To determine the mood conditions of the test group before the intervention and to achieve the
seventh goal of the study, that is, determine the mood conditions of the control group in the
pretest, Tables 16 and 17 were designed. Table (16) shows the mean and standard deviation of
aspects of mood in the test and control groups in the pretest. In the test group, the mean of
general mood is 28.09 and standard deviation is 12.49. In the control group, the mean of general
mood is 26.63 and standard deviation is 12.35. Table (17) shows the single-sample KolmogorovSmirnov test where all the aspects of mood in pretest have an error level less than 0/05,
therefore, data distribution is normal.
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Tables (16): Mean of aspects of moods in the psychopathic patients in pretest
Test
group
Aspects
mood
of Mean
Control
group
Standard Mean
deviation
Standard
deviation
Anger
5009
5010
5052
5095
Confusion
5052
5012
5025
5002
Depression
5025
5015
5025
5052
Fatigue
5090
5091
5090
5025
Tension
5011
5092
5052
5055
Energy level
9090
5022
2009
5055
General
mood
51009
15095
52025
15052
Table (17)
Anger
Confusion Depression Fatigue Tension Energy Score
level
of
general
mood
0012
0021
1011
0022
0021
0025
0092
Significance 0055
0021
0012
0022
0025
0010
0055
k-s index
To analyze the mood conditions of test group after intervention and to achieve the ninth goal of
the study, that is, explaining the mood of control group in posttest, Tables 18 and 19 were
designed. Table (18) shows the mean and standard deviation of aspects of mood conditions in the
test and control groups in posttest. In the test group, the mean of general moods is 20.36 and
standard deviation is 11.96. In the control group, the mean of general moods is 34.63 and
standard deviation is 15.16. Table (19) shows the single-sample Kolmogorov-Smirnov test where
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all aspects of mood conditions in posttest has an error level more than 0/05, thus, data
distribution is normal. The comparison of moods in the test and control groups is presented in
Table 20. In this table, multi-variable covariance analysis and statistical scores is used to
compare the mood conditions in the two groups which shows that the significance level in terms
of “anger” is 0.44, “confusion” 0.88, “depression” 0.18, “fatigue” 0.99, “tension” 0.27, and in
terms of “energy level” it is 0.23.Table (20) shows that no significant changes has occurred in
the mood conditions of psychotic patients in Razi hospital (p>0.05). This indicates that group
poetry therapy has not improved the mood conditions of psychotic patients.
Table (18): Mean of aspects of moods of the psychotic patients in posttest
Test
Control
group
group
Aspects of Mean
Standard
mood
deviation
Mean
Standard
deviation
Anger
1090
5015
5052
5022
Confusion
1091
5025
2052
2052
Depression 5011
5052
2052
5055
Fatigue
5025
5025
2025
5025
Tension
1011
5095
2052
5052
Energy
9052
2051
2052
5022
55025
12012
level
General
50052 11092
mood
conditions
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Table (19): Single-sample Kolmogorov-Smirnov test to show that the distribution of mood
conditions data is normal in posttest
Anger
Confusion Depression Fatigue Tension Energy Total
level
of
general
moods
k-s index
1001
0092
0025
0025
1010
0029
0011
Significance 0019
0051
0025
0022
0012
0012
0021
Table (20): Multi-variable covariance analysis to compare the mood conditions of the two groups
(by using statistical scores of pretest)
Source Dependent
Group
Sum
of Level
of Mean
of F
Significance
variable
squares
freedom
squares
Anger
1.93
1
1.93
0.61
0.44
Confusion
0.157
1
0,157
0.02
0.88
Depression
8.73
1
8.73
1.98
0.18
Fatigue
0.001
1
0.001
0.00
0.99
Tension
3.73
1
3.73
1.30
0.27
Energy level
9.71
1
9.71
1.25
0.23
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4. Conclusion
The results of data analysis can be interpreted according to the assumption of the present study.
The results of multi-variable covariance analysis and statistical scores for comparing aspects of
cognitive emotion regulation in the test and control groups show that significant changes have
occurred in the positive aspects of cognitive emotion regulation and positive strategies (p<0/05).
However, no significant change has occurred with regard to negative strategies. This shows that
group poetry therapy improves: positive refocusing and planning, evaluation and adoption of
broader perspective, acceptance, and mean of positive strategies in the psychotic patients of Razi
Psychiatric Hospital in 2015. Research done by Montage et al. [19] and Tegner et al. [20] also
proves the positive effect of poetry therapy on cognitive emotion regulation. Nevertheless, the
results of multi-variable covariance analysis for comparing mood conditions of patients in the
two groups, with the pretest scores, shows that no significant change has occurred in any aspects
of moods (p>0.05). This shows that poetry therapy has had no effect on the moods of the
psychotic patients of Razi hospital in 2015. Previous research [21,22] show the effectiveness of
poetry therapy on mood regulation; however, no change was observed in this study. It seems that
to achieve such a goal needs longer period of therapy and more therapy sessions.
Despite the above findings, there have been some limitations in the study including,
-
-
-
Fatigue and exhaustion of the patients in the study, unsuitable time and place for the
patients during the questionnaire and therapy sessions. It is clear that more suitable
conditions would have been more effective.
Mental preoccupations, ways of thinking, and personal abilities are effective in filling out
the questionnaires and participating in the poetry sessions which are not controllable by
the researchers.
Because of insufficient samples, this study limited itself to male schizophrenic,
schizoaffective, and mood disorders patients. It is obvious that the findings may not be
generalizable to other forms of psychotic disorders.
The findings of this research can be used by instructors and students of different disciplines such
as nursing, counseling, and psychology to improve the mental health of psychotic patients. Also,
a simple method can be suggested to nurses and health administration for improving the positive
aspect of cognitive emotion regulation of psychotic patients. Given the findings of this study and
cost effectiveness of poetry therapy, it is recommended that poetry therapy be used as a
supplementary therapy in psychiatric centers and clines. Further research can be done to improve
the cognitive emotion regulations with regard to other forms of mental disorders.
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