Journal of Psychology & Psychotherapy
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The Prediction of Fear of Death Based on Early Maladaptive Schemas (Failure, Vulnerability) and Psychosocial Flexibility in Master Degree Students of Islamic Azad University, Hamadan Branch

Amin Daraee^1*, Nasrollah Erfani², Mohammad Esmaeil Ebrahimi³ and Tina Hamimi^{1 *}Correspondence: Amin Daraee, Department of Clinical Psychology, Faculty of Social Sciences, Islamic Azad University-Hamadan, Iran, Email:

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Introduction

The fear of death is so great that a significant part of life’s energy is spent denying death. As Freud has said, the primary human community and the bits of social life are formed because of fear of death. The early humans because of fear of separation and of what lies in the dark, gathered together and they got close together. We keep the community alive so that we can live our eternal life [1].

Fear of death includes obvious or implicit horror elements, whose amount varies and it is devoted to real experience in a different way [2].

From the perspective doctrine of Ontologists, death is the central point of human life. Demonstrations of this way of thinking can be found in the thoughts of Soren-Kierkegaard, Danish philosopher, Heidegger, and Irwin Yalom. Death anxiety is a factor in health- related factors and it is before human life. In this view, one who does not find a meaning for the dynamics of his life is suffering from the threat of destruction which is called fear of death. Death anxiety when it is a stimulant for people will make them fully live and will be a part of the natural existence. Yalom believes in the existence of a bilateral relationship between fear of death and the sense of regret in life. In other words, in terms of Yalom, the less we use life, death anxiety is greater. And the more we fail in experiencing a complete

Life, we will be more afraid of death [3].

Fear of death by increasing awareness of the apparent nature of death starts (Through the reminders of a person’s mortality). Death reminders are overlapping and categorized into three distinct groups. Stressful environments such as war or unexpected experience of conditions, the diagnosis of a life-threatening illness or life-threatening event, and experiences related to death and dying [4].

The schema is a cognitive-emotional pattern, associated with physical feelings that trigger behaviors. According to Young, early maladaptive schemas have these features:

1. Patterns are either profound.

2. There are memories, excitements, schemas, and physical emotions.

3. They are formed in childhood or adolescence.

4. Continue in the course of life.

5. They are about themselves and their relationships with others.

6. Highly inefficient [5].

As Young said, the schema has emotional dimensions, body feelings, memories, and cognition. There are different systems for recording each of these in the brain. The emotional dimensions and body feelings of the schema are recorded in the amygdala. And the memories and the accompanying cognitive systems are stored in the hippocampus and the superficial cerebral cortex. The emotions and body feelings stored in the amygdala system have amygdala system features. The amygdala system is unconscious, it works faster, is automatic, the emotional memories recorded in the amygdala are long-lasting and enduring, the amygdala system does not recognize the differences accurately, and the amygdala system is evolutionarily ahead of the cerebral cortex (it is formed earlier and completed).

When a person comes up with stimuli that remind him of his childhood events and are involved in the formation of schemas, the emotions and body feelings associated with this event are unconsciously activated by the amygdala system. Excitements and body feelings are used much faster than cognitive systems. Also, cognitive components of the schema are often formed later than emotions and body feelings. Many of the schemas are formed in pre-verbal stages. It is because of this emotional dimension of schemas and their location that many people know enough of their problem, but they cannot behave appropriately when necessary. This is one of the defects in cognitive therapy [6].

Psychological flexibility is the ability to be in the moment with full knowledge and openness to our experiences and the exercise of value-oriented behavior. Psychosocial flexibility is achieved through six main processes of acceptance and commitment therapy.

These six processes are Relationship with the present moment (being here and now), diffusion (Look at your thoughts), acceptance (giving space), self as a field (pure consciousness), values (know what matters), an act of commitment [7].

The world in which humans live in a verbal world. Language and cognition enable a person to solve everyday problems and it creates a world of comfort for the person. But language and cognition make it possible for humans to evaluate, compare, draw their painful past to the present and imagine a frightening future. Although many psychological problems of humans are rooted in language and cognition, life is not possible without language and cognition. Treatment based on acceptance and commitment is the third wave of therapeutic behavior, this approach is rooted in a philosophical theory called functional contextualism and is based on a research program on communication framework theory. This treatment, which is a kind of behavioral therapy, tends to change behavior to change the functioning of thoughts and feelings, rather than changing the content and form of thought [8].

Given that death anxiety is one of the most important components in mental health, on the other hand, the effective role of initial maladaptive schemas and psychological flexibility in people’s quality of life, one can appreciate the importance of helping those who are facing death anxiety through schema therapy and increasing psychological flexibility to deal with death anxiety more rationally and it would be easier for them to face death. It is also important to pay attention to the student’s anxiety about death and its impact on the lives of these people. Therefore, researches should be carried out in this field, and by identifying the effective factors related to the anxiety of death and use them to reduce the fear of death and, consequently, increase their health. As a result, this study aimed to investigate the relationship between early maladaptive schemas and cognitive flexibility with fear of death.

Research hypotheses

1. There is a relationship between the failure schema and the fear of the death of master’s degree students of the Islamic Azad University of Hamedan.

2. There is a relationship between the vulnerability schema and the fear of death of the master degree students of Hamedan Islamic Azad University.

3. There is a relationship between the early maladaptive schemas and the fear of the death of master’s degree students of the Islamic Azad University of Hamedan.

4. here is a relationship between psychological flexibility and the fear of the death of master’s degree students of the Islamic Azad University of Hamedan.

5. There is a relationship between the early maladaptive schemas and the psychological flexibility of master’s degree students of the Islamic Azad University of Hamadan

Research Methodology

The research method is a correlation because the relationships between the predictor variables and the criteria are investigated. The statistical population of the study consists of all master’s degree students of Islamic Azad University, Hamedan Branch. That number is 4926 people. The sample size was calculated as 104+3=107 by the Tupachenig and Fidel guidelines (2013). The sampling method is the random category. The questionnaires were replicated to the sample size and distributed randomly among the students.

The data collection tools were as follows: Templer death anxiety questionnaire: This questionnaire was developed by Templer in 1970 to collect information on the Death Anxiety Survey. This scale is a self-executing questionnaire consisting of 15 blank questions. An answer is a sign of anxiety in an individual. Scores range from zero to fifteen, and a high score (score above average: score 8) represents a high degree of death anxiety. In this way, the scores of this scale vary between zero and 15, with a high score indicating higher anxiety in people about death. The studies conducted on the validity of the Death Anxiety Scale show that this scale has an acceptable validity. Cronbach’s alpha coefficients for the three factors that were obtained by factor analysis and Italian editing of this scale have been reported to be 0/68, 0/49, 0/60, respectively. Templer (1970) achieved the scaling factor of 0/83. The reliability of this questionnaire is 0.71. Young schema questionnaire (short form-75 questions): This questionnaire was compiled by Young’s 1998 questionnaire to evaluate 15 initial schemas. In this research, five of its schemes have been evaluated, including schematics of emancipation/instability, mistrust/mistreatment, social isolation/alienation, failure, and vulnerability to harm and disease. Each question is scored on a scale of 6 degrees. 1 for completely false, 6 for perfectly correct. If the average of each subscale is above 25, then the schema is inefficient. The standardization of this questionnaire in Iran was carried out by Ahi in Tehran University in 1384, the internal consistency is obtained using Cronbach’s alpha, and the Cronbach’s alpha coefficient in the male population is 0.98 in the female population of 0.97.

The reliability of the failure schema is 0.85. The reliability of the damage vulnerability and disease schema is 0.76. The total schema reliability is 0.90. Acceptance and Practice Questionnaire- Revised (AAQ-R): The questionnaire was created by Ross Harris in 2008 to measure the specificity of acceptance, commitment, and psychological flexibility and consists of 19 questions that are graded in a seven-degree range from never to ever. Performance is possible individually and in a group, questions 2, 3, 6, 8, 9, 11, 14, 15, 17, 19 are scored in reverse order, which means the inverse of the selected score is taken into account. For the remaining questions, the same grade is considered, and then the score of all the questions comes together to calculate the total score of the individual. The higher the individual’s score, the greater the acceptance, commitment, and psychological flexibility, and the lower the score, the less is the feature. The average of the alpha coefficient is 0/84, 78/8, 0/88 and the reliability of the test at 3 and 12 months was 0.81 and 0.79, respectively. The reliability of this questionnaire was 0.78 for this research.

Data analysis method

Data analysis was performed by SPSS software version 24 using descriptive statistical methods with frequency tables and dispersion indicators. Inferential method using k-s test was used to examine the normal distribution of data and Pearson correlation coefficient and multiple regression for analyzing the hypotheses.

Results

To predict the fear of death based on early maladaptive schemas and psychological flexibility of master’s degree students at the Islamic Azad University of Hamedan in the academic year 1396- 97. After completing the questionnaires by the individuals in the sample group, the data were extracted, coded and analyzed.

In Table 1, the distribution of the sample group is shown by gender.

Table 1: Distribution of sample groups based on students’ gender.

Table 2 also describes the initial maladaptive schemas of the sample group and the results indicate that the average of early maladaptive schemas is 57/70 and the standard deviation is 18.02.

Table 2: Describes the initial maladaptive schemas of the sample group.

Describes the psychological flexibility of the sample group (Table 3). The results indicate that the mean of psychological flexibility is 75.20 and the standard deviation is 8.33 (Tables 4-11). Describes the fear of death in the sample group. The results indicate that the mean fear of death is 8.18 and the standard deviation is 2.82.

Table 3: Describes the psychological flexibility of the sample group.

Table 4: Describes the fear of death in the sample group. The results of the Kolmogorov-Smirnov test shows that distribution of variables data for the Failure (Z=1.351, P=0.052), vulnerability to disease (Z=1.332, P=0.058), initial maladaptive schemas (Z=0.686, P=0.734), psychosocial flexibility (Z=0.662, P=0.773) and the fear of death (Z=1.220, P=0.102) is normal.

Table 5: Results of the test of the natural distribution of the data of the research variables. To test the first hypothesis of the research, the results of the Pearson correlation coefficient test showed that there is a significant relationship between the failure schema and the fear of death of the master degree students of Islamic Azad University, Hamedan (r=0.248, P<0.01 ). Therefore, the fourth hypothesis of the research was confirmed.

Table 6: Relationship between Failure Schemes and Students’ Fear of Death. To test the second hypothesis of the research, the results of the Pearson correlation coefficient test showed that there is a significant relationship between the vulnerability to disease schema and the fear of death of the master degree students of Islamic Azad University, Hamedan (r=0.304, P<0.01 ). Therefore, the fifth hypothesis of the research was confirmed.

Table 7: Relationship between Failure Schemes and Students’ fear of Death. To test the third hypothesis of the research, the results of the Pearson correlation coefficient test showed that there is a significant relationship between the early maladaptive schemas and the fear of death of the master degree students of Islamic Azad University, Hamedan (r=0.390, P<0.01 ). Therefore, the sixth hypothesis of the research was confirmed.

Table 8: Relationship between early maladaptive schemas and fear of student deaths. To test the fourth hypothesis of the research, the results of the Pearson correlation coefficient test showed that there is a significant relationship between the Psychological Flexibility and the fear of death of the master degree students of Islamic Azad University, Hamedan (r=0.316, P<0.01 ). Therefore, the seventh hypothesis of the research was confirmed.

Table 9: Relationship between early maladaptive schemas and fear of student deaths. To test the fifth hypothesis of the research, the results of the Pearson correlation coefficient test showed that there is a significant relationship between the early maladaptive schemas and the psychological flexibility of the master degree students of the Islamic Azad University of Hamedan (r=0.318, P<0.01 ). Therefore, the eighth hypothesis of the research was confirmed.

Table 10: Relationship between Early Maladaptive Schema and Students’ Psychological Flexibility. To test the sixth hypothesis of the research, the results of the corrected multiple correlation coefficient show that based on the first model, the psychological flexibility variable is 10/0, and based on the second model, the variables of the psychological flexibility and the abandonment/alienation scheme together is explained, 0.6 percent of the variance in the fear of death of master degree students of Islamic Azad University, of Hamadan.

Table 11: Summary of the Fear of Death Regression Model Based on the Psychological Flexibility and Student Abandonment/Alienation Scheme.

Discussion

The purpose of this study was to predict the fear of death based on cognitive schemas and psychological flexibility of master’s degree students of Islamic Azad University, Hamedan Branch. According to the results, there is a significant relationship between the failure schema and the fear of the death of master’s degree students. Research is consistent with the results obtained by Shahamat [9]. Those who have a failure schema play a role in their minds that have failed to reach their peers in areas of advancement such as occupation, financial affairs, social status, education, or sports. They feel that they are incompetent in comparison to others in a way that they consider themselves unworthy, insane, and ignorant [10]. Regarding the content expressed in the explanation of these results, the schema can form the disadvantaged and unpleasant emotions in these individuals, and ultimately these people conclude that they have not succeeded in life, and they leave the world without gain, which can lead to death anxiety.

According to the results, it can be concluded that there is a meaningful relationship between the vulnerability schema and the fear of death of master’s degree students. Research consistent with these results has been carried out by Saeed Rahimi, Hamid Reza Vatan Khah, Ali Shahbazi and Martin and Young [11,12]. In explaining the results, it can be said that people who have a vulnerability to disease schema, this belief is in their minds, which always happens to them horrible and uncontrollable events.

They believe that they suddenly develop a physical illness, natural disasters happen to them, they are victims of a crime, they have a terrible accident, lose their money, suffer from neurological crises or they are crazy. Therefore, it can be concluded that the vulnerability schema whose dominant emotion is anxiety, causes the fear of death, and there is a meaningful relationship between this variable and the fear of death.

According to the results, it can be concluded that there is a significant relationship between the early maladaptive schemas and the fear of the death of master’s degree students. Along with these results, research has been carried out by Massoudi, Hatami, Modarres Gharavi, Bani-Jamali [13]. In explaining this hypothesis, it can be said that the schema is generally defined as a structure, template, or framework. In the domain of cognition, the schema is considered as a form that is formed based on reality or experience to help individuals explain their experiences. In other words, the outline of a feature of an event is called a schema. Death anxiety, on the other hand, is a depressive state, which causes mental stress and worries due to death is the major syndrome of this disease. Many internal and external factors can shape death anxiety, one of which may be the internal early maladaptive schemas that can be directly referred to as the cognitive system of mankind. Considering the importance of early maladaptive schemas in the formation of psychological disorders and anxiety of depression, it can be concluded that early maladaptive schemas can lead to fear of death.

According to the results of the research, it can be concluded that there is a relationship between the psychological flexibility and the fear of the death of the master degree students of the Islamic Azad University of Hamedan, and therefore the seventh research hypothesis was confirmed. By the results of this research, another research was carried out by Taqizadeh and Farmani. In explaining this hypothesis, given the definitions and the results obtained, we can say, the more flexible a person is and he can consider difficult situations as a controllable position and in the face of life and people’s behavior, they can have several alternative justifications and in difficult situations, he can think of alternative solutions, his capacity for coping, adapting and improving the stress and fear of death is higher.

According to the results, there is a meaningful relationship between the early maladaptive schemas and the psychological flexibility of the master degree students of the Islamic Azad University of Hamedan, and therefore the eighth hypothesis of the research was confirmed. Along with these research results, another research was carried out by Barzegar, Aghajani, Ansari Nejad [14]. In explaining this hypothesis, it can be said that schemas influence behavior through information processing and help to make decisions in the course of thinking and provide the most anticipated prediction. But some mental processes, such as inflexibility, may act as a resistant factor in change and slow down the process of changing behavior patterns. Therefore, schemas while facilitating cognitive function can cause persistent mental problems. Therefore, those schemas that lead to the formation of psychological problems are called early maladaptive schemas. Early maladaptive schemas that cause emotional disorders are more inflexible and more objective than ordinary people’s schemas [15-18].

Conclusion

One of the limitations of this research is the lack of identical answering conditions for students and the limitation in similar research. Regarding the results, it is recommended that through the use of schema therapy and increasing the psychological flexibility of people in the community, tries to reduce their fear of death and increase the quality of life of individuals through this way.

References

1. Yalom, Erwin. Existential Psychotherapy (Sepideh Habib). Tehran: Ney Publications. 2013.
2. Brown J, Hanson JE, Schmotzer B, Webel AR. Spirituality and optimism: a holistic approach to component-based, self-management treatment for HIV. J Relig Health. 2014;53(5):1317-28.
3. Karimi, Abdul A. Research on the concept of death in the child's mind. Tehran: Ghorbani Publication. 2013.
4. Despelder, Strickland L. The Last Dance. New York: Academic Press. 2015.
5. Ghaderi, Farzad, Kalantari, Mehrdad, Mehrabi, Hossein A. Effectiveness of group schema therapy on modifying early maladaptive schemas and reducing the symptoms of social anxiety disorder. J Clin Psychol, 2017; 6(24):28-31.
6. Moghadam, Fatemeh. Comparison of mental health, body image and maladaptive schemas in applicants for beauty surgery and other patients. 2015.
7. Harris, Ross. Act in a simple word, alphabet treatment based on acceptance and commitment. Tehran: Arjmand Publications. 2015.
8. Hayes SC, Pistorello J, Levin ME. Acceptance and commitment therapy as a unified model of behavior change. Couns Psychol. 2012; 40(7):976-1002.
9. Shahamat F. Predicting general health symptoms (somatization, anxiety, depression) from early maladaptive schemas. J Mod Psychol Res. 2011;5(20):103-24.
10. Rahimi Saeed, Vatan Khah, Hamidrez, Shahbazi, Ali. Relationship between early maladaptive schemas and signs of obsessive-compulsive disorder among medical students in tehran. Educ Behav Sci.2017;1(3): 55-70.
11. Martin R, Young J. Schema therapy. Handbook of cognitive-behavioral therapies. 2010;317.
12. Massoudi Shahed, Hatami, Hamid Reza, Modares Ghoravi, Morteza. The role of mediator of early maladaptive schemas in the relationship between attachment styles and death anxiety in cancer patients. Q J Tho Behav Clin Psychol,2017;10 (33): 44.
13. Barzegar, Zohreh, Aghajani, Tahmouris, Ansari N, Nasrollah. Investigating the relationship between early maladaptive schemes and avoidance coping behaviors and students' death anxiety. Q J Couns Psychol. 2015; 4 (16): 92-93.
14. Johnston C, Dorahy M J , Courtney D, Bayles T, O'Kane M. Dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder. J Behav Ther Exp Psychiatry. 2009; 40(2):248-255.
15. Riso LP, Maddux RE, Santorelli NT. Early maladaptive schemas in chronic depression.2007
16. Taghizadeh, Mohammad E, Farmani, Azam. Investigating the role of cognitive flexibility in predicting hopelessness and coping in students. Q Cognitive Psychol. 2013;72(2):15-30.
17. Yang, Jeffrey, Classical, Janet, Vishar, Marjorie. Schema Therapy Volume I and II. (Hasan Hamidpour, Zahra Endouz). Tehran: Arjmand Publications. 2007.