Effect of group problem-solving skills training on the severity of aggression in patients with bipolar I disorder
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Evidence-Based Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Midwifery, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
Submission date: 2020-12-10
Final revision date: 2021-02-01
Acceptance date: 2021-02-01
Online publication date: 2021-07-05
Corresponding author
Maliheh Eshaghzadeh   

Department of Midwifery, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
Pol. Ann. Med. 2021;28(2):134-140
Psychological interventions can help prevent patients’ problems by increasing insight.

This study was aimed to determine the effect of problem-solving skills training on the severity of aggression in patients with bipolar I disorder.

Material and methods:
In this randomized controlled trial, we enrolled 60 patients with bipolar I disorder admitted to Ibn Sina Psychiatric Hospital in Mashhad during 2018. The patients were assigned to the two groups of intervention (n = 30) and control (n = 30). In addition to pharmacological therapy, the intervention group attended six 45-minute problem-solving group training sessions, while the control group received medication alone. The data collection instrument was the Buss and Perry aggression questionnaire (BPAQ), which was filled out before and a month after the intervention.

Results and discussion:
In the pre-intervention phase, there was no significant difference in the mean score of aggression between the problem-solving skills training and control groups (119 ± 5.6 vs. 120.5 ± 8.5; P = 0.222); while, the total score of aggression after the intervention was significantly different between two groups (86.9 ± 5.5 vs. 120.2 ± 5.8; P <0.001).

Problem-solving skills training can reduce the severity of aggression in patients with bipolar disorder. It is recommended that these skills used in individual and family care for patients with bipolar I disorder.

We appreciate all the professors of Mashhad School of Nursing and Midwifery, the officials of Ibn Sina Hospital in Mashhad, and the patients who cooperated with us in this study.
None declared.
The authors declare that there are no conflicts of interests regarding the publication of this article.
Grande I, Berk M, Birmaher B, Vieta E. Bipolar disorder. Lancet. 2016;387(10027):1561–1572.
Salvatore P, Tohen M, Khalsa H-MK, Baethge C, Tondo L, Baldessarini RJ. Longitudinal research on bipolar disorders. Epidemiol Psychiatr Sci. 2007;16(2):109–117.
Shabani A, Teimurinejad S, Kokar S, et al. Suicide risk factors in Iranian patients with bipolar disorder: a 21-month follow-up from BDPF study. Iran J Psychiatry Behav Sci. 2013;7(1):16–23.
Shirazi E, Shabani A, Hakim Shooshtari M, Ghadiri Vasfi M. Definition of cycle and episode in rapid cycling bipolar disorder: An area of debate in diagnosis and research. Iran J Psychiatr Clin Psychol. 2017;23(3):254–259.
Goodwin G, Haddad P, Ferrier I, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2016;30(6):495–553.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th Ed. Washington, DC: APA. 2013;21.
Mahmoudi F, Khosravi Z, Paivastegar M, Khodabakhsh R. Qualitative evaluation of recovery process in patients with bipolar disorder. J Res Psychol Health. 2020;13(4):29–51.
McKnight RF, Bilderbeck AC, Miklowitz DJ, Hinds C, Goodwin GM, Geddes JR. Longitudinal mood monitoring in bipolar disorder: course of illness as revealed through a short messaging service. J Affect Disord. 2017;223:139–145.
Molavi P, Salvat H, Aghdam NS, Mohammadi MN. The efficacy of cognitive-behavioral therapy (CBT+ TAU) on reducing type-I Bipolar disorder symptoms. Shenakht J Psychol Psychiatr. 2018;7(2):92–103.
Roberts J, Canales AG, Blanthorn-Hazell S, Boldeanu AC, Judge D. Characterizing the experience of agitation in patients with bipolar disorder and schizophrenia. BMC Psychiatry. 2018;18(1):1–8.
Genovese T, Dalrymple K, Chelminski I, Zimmerman M. Subjective anger and overt aggression in psychiatric outpatients. Compr Psychiatry. 2017;73:23–30.
Belete H, Mulat H, Fanta T, et al. Magnitude and associated factors of aggressive behaviour among patients with bipolar disorder at Amanual Mental Specialized Hospital, outpatient department, Addis Ababa, Ethiopia: cross-sectional study. BMC Psychiatry. 2016;16(1):443.
Verdolini N, Perugi G, Samalin L, et al. Aggressiveness in depression: A neglected symptom possibly associated with bipolarity and mixed features. Acta Psychiatr Scand. 2017;136(4):362–372.
Mohammadi N. Preliminary study of psychometric indices of Bass-Perry aggression questionnaire. J Social Sci Hum Shiraz Uni. 2006;25(4):135–151.
Kleinman LS, Lowin A, Flood E, Gandhi G, Edgell E, Revicki DA. Costs of bipolar disorder. Pharmacoeconomics. 2003;21(9):601–622.
Moczulska B., Kubiak M. Analysis of socioeconomic factors and their influence on the incidence of complications in patients with acute coronary syndrome in Warmia and Mazury Province. Pol Ann Med. 2015;22(1):30–34.
López-Muñoz F, Shen WW, D’ocon P, Romero A, Álamo C. A history of the pharmacological treatment of bipolar disorder. Int J Mol Sci. 2018;19(7):1–38.
Machado-Vieira R, Manji HK, Zarate CA Jr. The role of lithium in the treatment of bipolar disorder: convergent evidence for neurotrophic effects as a unifying hypothesis. Bipolar Disord. 2009;11(Suppl 2):92–109.
Stange JP, Eisner LR, Hölzel BK, et al. Mindfulness-based cognitive therapy for bipolar disorder: effects on cognitive functioning. J Psychiatr Pract. 2011;17(6):410–419.
Ye BY, Jiang ZY, Li X, et al. Effectiveness of cognitive behavioral therapy in treating bipolar disorder: A n updated meta-analysis with randomized controlled trials. Psychiatry Clin Neurosci. 2016;70(8):351–361.
Maleki S, Khoshknab MF, Rahgooi A, Rahgozar M. The effect of anger management training in groups on aggression of 12–15 years old male students. Iran J Nurs. 2011;24(69):26–35.
Wilkowicz W, Byś A, Zieliński G, Gawda P. The impact of stress on psychological and physiological aspects of health of patients with TMD: A literature review from 2015–2020. Pol Ann Med. 2021;28(1):82–87.
Afrasibi S, Fattahi Z. A comparative study of self-actualization in psychology and Islam. World Fam Med J: Inc Middle East J Fam Med. 2017;99(5548):1–8.
Ghane G, Farahani M, Seyedfatem N, Haghani H. Effect of problem-focused coping strategies on the quality of life in family caregivers of hemodialysis patients. Koomesh. 2017;19(2):391–400.
Ghasemi Gojani M, Kordi M, Asgharipur N, Amirian M, Esmaeli H, Eskandarnia E. Comparing the effect of positive reappraisal coping intervention on anxiety of waiting period in IUI treatment using problem-solving skills training. J Mazandaran Uni Med Sci. 2017;27(149):111–123.
Samani S. Study of reliability and validity of the Buss and Perry’s aggression questionnaire. Iran J Psychiatr Clin Psychol. 2008;13(4):359–365.
Akhavan S, Sajjadian I. Effectiveness of dialectical behavior therapy on emotional instability and impulsivity in bipolar patients. J Clin Psychol. 2016; 8(3):11–23.
Aucoin M, Lalonde-Parsi M-J, Cooley K. Mindfulness-based therapies in the treatment of functional gastrointestinal disorders: a meta-analysis. Evid-Based Complementary Altern Med. 2014;2014:140724.
Khodabakhshi Koolaee A, Ebrahim Baighi H, Navidian A. Effects of Communication Skills Training on Aggression and Quality of Life of Male Patients with Chronic Mental Illnesses. JCCNC. 2016;2(1):3–10.
Chibanda D, Mesu P, Kajawu L, Cowan F, Araya R, Abas MA. Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC Public Health. 2011;11(1):828–837.
Hatamifard S, Kafi SM, Khoshravesh V. The effectiveness of training skills of parents in problem solving and expressiveness on the social adaptation and educational progress of their children. 2011. Counsel Culture Psychother. 2011;2(7):67–73.
Ganjeh SA, Dehestani M, Zadeh Mohammadi A. Comparison of effectiveness of problem-solving skills and emotional intelligence training on decreasing aggression in male high school students. Knowl Res Appl Psychol. 2013;14(52):38–50.
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