Volume 24, Issue 3 (12-2025)
TB 2025, 24(3): 15-31 |
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Soleymani S, Gorji Y, Sharifi Esfahani M. An Evaluation of Reduction Self-System Therapy's Effectiveness in Reducing Perfectionism and Persistent Depressive Symptoms Among Women in Isfahan. TB 2025; 24 (3) :15-31
URL: http://tbj.ssu.ac.ir/article-1-3788-en.html
URL: http://tbj.ssu.ac.ir/article-1-3788-en.html
, gorji@iaukhsh.ac.ir
Keywords: Persistent depression, Dysthymia, Self-system therapy, Psychotherapy, Perfectionism, Women
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An Evaluation of Reduction Self-System Therapy's Effectiveness in Reducing Perfectionism and Persistent Depressive Symptoms Among Women in Isfahan
Somayeh Soleymani(Ph.D.)1, Yousef Gorji(Ph.D.)2, Mahmood Sharifi Esfahani(Ph.D.)3
1.Ph.D. Student in Department of Counseling, Kho.C., Islamic Azad University, Khomeinishahr, Iran.
2.Corresponding Author: Assistant Professor, Department of Psychology, Kho.C., Islamic Azad University, Khomeinishahr, Iran Email: gorji@iaukhsh.ac.ir Tel: 09131280635
3.Assistant Professor, Department of Counseling, , Kho.C., Islamic Azad University, Khomeinishahr, Iran
Abstract
Introduction: Persistent depressive disorder is nearly twice as prevalent in women as in men and is closely linked to perfectionistic traits. This chronic condition is associated with reduced quality of life, impaired social functioning, and increased suicide risk. Self-System Therapy (SST) is a novel and specialized approach for treating depression. Although its effectiveness has been demonstrated internationally, SST has not yet been independently and systematically evaluated in Iran, and its cultural adaptation remains in early stages. This study aimed to examine the effectiveness of SST in reducing persistent depression and perfectionism.
Methods: A semi-experimental pretest-posttest design with a control group was employed. Twenty-four women aged 20–50 with persistent depressive symptoms were selected from counseling centers in Isfahan based on DSM-5 criteria and scores on the Cornell Dysthymia Rating Scale (CDRS). Participants were purposefully and randomly assigned to SST (n=12) or control (n=12). The experimental group received 10 weekly sessions of SST therapy. Assessment tools included the CDRS and Hill’s Perfectionism Questionnaire, both validated in prior Iranian studies. Data were analyzed using repeated measures ANOVA across three phases: pretest, posttest, and three-month follow-up.
Results: The results of the study showed that the mean scores of persistent depression and perfectionism in the experimental group decreased compared to the control group after the intervention, and this change was reported to be significant (p<0/001, η²=0/80). Moreover, the therapeutic effects remained stable during the follow-up phase.
Conclusion: The study showed that the use of SST can be effective in reducing persistent depression and perfectionism.
Keywords: Persistent depression, Dysthymia, Self-system therapy, Psychotherapy, Perfectionism, Women
Conflict of interest: The authors declared no conflict of interest.
1-GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22.
2-World Health Organization. Depressive disorder (depression) [Internet]. Geneva: World Health Organization; 2023.
3-Dinis de Sousa R, Zagalo DM, Costa T & et al. Exploring depression in adults over a decade: A review of longitudinal studies. BMC Psychiatry. 2025;25(1):378.
4-KC A, Chandna J, Acharya A & et al. A longitudinal multi-centric cohort study assessing infant neurodevelopment delay among women with persistent postpartum depression in Nepal. BMC Med. 2024;22(1):284.
5-Butler G, Hope T. Treating depression (The common cold of the mind). 3rd ed. Translated by Koshiyar Karimi Tari. Tehran: Nasl-e No Andish Publications; 2020: 1–112.[Persian]
6-Sotodeh Asl N, Gholami B, Ghorbani R. Investigating the effects of three treatment methods: Cognitive-behavioral therapy, drug therapy, and a combination of both in treating major depression. Koumesh Journal. 2019;13(1):41.[Persian]
7-Ganji M. Psychopathology based on DSM-5. 2nd ed. Tehran: Savalan Publications; 2022: 1–320.[Persian]
8-World Population Review. World population by Country – 2022 [cited 2025 Oct 5].
9-World Health Organization. Depression and other common mental disorders: Global health estimates [Internet]. Geneva: World Health Organization; 2025 [cited 2025 Oct 5].
10-Liu Q, He H, Yang J & et al. Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. J Psychiatr Res. 2020;126:134–40.
11-Society for Women's Health Research. C2A Depression Dashboard: Illuminating the disease burden of chronic forms of depression in women [Internet]. Washington (DC): Society for Women's Health Research; 2025 [cited 2025 Oct 5].
12-Yun Y, Mun S, Lee S & et al. Serum L-selectin levels as predictive markers for chronic major depressive disorder progression. Ann Gen Psychiatry. 2024;23:37.
13-Nezami L, Alivandi Vafa M, Khademi A & et al. Native modeling of psychosocial vulnerability to persistent depression in women: A grounded theory study. Quarterly Journal of Woman and Society. 2022;12(48):51–66.[Persian]
14-Sirois FM, Molnar DS. Conceptualizations of perfectionism, health, and well-being: An introductory overview. In: Sirois FM, Molnar DS, editors. Perfectionism, health, and well-being. Cham: Springer; 2019: 1–21.
15-Besharat MA, Hosseini SE, Jahed H. Obsessive personality disorder and perfectionism: A review study. Journal of Thought and Behavior. 2018;13(51):77–88.[Persian]
16-Musumeci MD, Cunningham CM, White TL. Disgustingly perfect: An examination of disgust, perfectionism, and gender. Motiv Emot. 2022;46(3):336–49.
17-Hewitt PL, Smith MM, Ge SYJ & et al. Perfectionism and its role in depressive disorders. Can J Behav Sci / Rev Can Sci Comport. 2022;54(2):121–31.
18-Besharat M, Mirzamani S. Dimensions of perfectionism in depressed and anxious patients. Iranian Journal of Medical Sciences. 2015;29(4):157–60.[Persian]
19-Wei Y, Chen H, Sun B & et al. The relationship between physical appearance perfectionism on subthreshold depression in college students: The role of gender and fear of negative evaluation. Front Public Health. 2025;13:1559815.
20-Eddington KM, Strauman TJ, Vieth AZ & et al. Self-system therapy for depression: Client workbook. New York: Oxford University Press; 2017: 1–128.
21-Soleymani S, Gorji Y, Sharifi Esfahani M. The effectiveness of self-system therapy with cognitive-behavioral therapy mixed with spirituality-religion on the symptoms of persistent depression in women. Armaghanj. 2025;30(2).[Persian]
22-Soleymani S. Comparing the effectiveness of spiritually-integrated cognitive behavioral therapy, hope therapy, and self-system therapy on perfectionism and persistent depressive symptoms in women in Isfahan [PhD thesis]. Islamic Azad University, Khomeinishahr Branch. 2025.[Persian]
23-Strauman TJ, Veith AZ, Kolden GG & et al. Self-system therapy as an intervention for self-regulatory dysfunction in depression: A randomized comparison with cognitive therapy. J Consult Clin Psychol. 2006;74:367–76.
24-Behpajooh A, Seyednouri Z. Step-by-step self-therapy for depression. Tehran: Danjeh Publishing; 2020: 1–166.[Persian]
25-Blackstock J. Self-System Therapy (SST): An in-depth look at the innovative therapeutic model [Internet]. Birmingham (AL): GetTherapyBirmingham; 2024 Oct 7 [cited 2025 Oct 2].
26-Barton SB, Armstrong PV, Robinson LJ & et al. CBT for difficult-to-treat depression: Self-regulation model. Behav Cogn Psychother. 2023;51(6):543–58.
27-Strauman TJ, Vieth AZ, Merrill KA & et al. Self-system therapy (SST): A theory-based psychotherapy for depression [Internet]. 2006 [cited 2025 Oct 2].
28-Strauman TJ, Eddington KM. Treatment of depression from a self-regulation perspective: Basic concepts and applied strategies in self-system therapy. Cogn Ther Res. 2019;41(1):1–15.
29-Eddington KM. Self-system therapy as an intervention for self-regulatory dysfunction in depression: A randomized comparison with cognitive therapy. J Consult Clin Psychol. 2014;83(3):602–16.
30-Kim J, Ryu N, Chibanda D. Effectiveness of single-session therapy for adult common mental disorders: A systematic review. BMC Psychol. 2023;11:373.
31-Simon PD, Salanga MGC, Aruta JJB. The distinct link of perfectionism with positive and negative mental health outcomes. Front Psychiatry. 2025;16:1492466.
32-Niels-Kessels H, Stikkelbroek YAJ, Vermulst AA & et al. Perfectionism and suicidal ideation in outpatient depressed adults: The moderating role of self-esteem, loneliness and rumination. J Rat-Emo Cogn Behav Ther. 2025;43:10.
33-Waters SJ, Strauman TJ, McKee DC & et al. Self-system therapy for distress associated with persistent low back pain: A randomized clinical trial. Psychother Res. 2019;26(4):472–83.
34-Eddington KM, Silvia PJ, Foxworth TE & et al. Motivational deficits differentially predict improvement in a randomized trial of self-system therapy for depression. J Consult Clin Psychol. 2015;83(3):602–16.
35-Neacsiu A, Luber B, Davis MS & et al. On the concurrent use of self-system therapy (SST) and fMRI-guided transcranial magnetic stimulation (TMS) as treatment for depression. J ECT. 2019;34(4):266–73.
36-Hoet AC, Burgin CJ, Eddington KM & et al. Reports of therapy skill use and their efficacy in daily life in the short-term treatment of depression. Cogn Ther Res. 2018;42(2):184–92.
37-Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988: 1–567.
38-Burlingame GM, Seebeck JD, Janis RA & et al. Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective. Psychotherapy (Chic). 2019;53(4):446–61.
39-Mason BJ, Kocsis JH, Leon AC & et al. Rating scales in mental health. In: Sajatovic M, Ramirez LF, editors. Rating scales in mental health. 2nd ed. Hudson (OH): Lexi-Comp; 2003: 83–88.
40-Jamshidi B, Hosseinchari M, Haghighat S & et al. Validation of new measure of perfectionism. Int J Behav Sci. 2009;3(1):35–43.[Persian]
41-Emadi S, Mirhashemi M, Sharifi HP. A structural model for prediction of couple burnout based on sensation seeking, perfectionism and emotion regulation strategies with the mediation of resiliency in married women. J Psychol Sci. 2020;19(92):1011–22.[Persian]
42-Zivari Azhar M, Khanmohammadi A, Abasi Asfajir AA & et al. The structural relationship of perfectionism on academic achievement anxiety with the mediating role of spiritual intelligence and happiness. J Psychol Sci. 2024;23(133):79–94.[Persian]
Somayeh Soleymani(Ph.D.)1, Yousef Gorji(Ph.D.)2, Mahmood Sharifi Esfahani(Ph.D.)3
1.Ph.D. Student in Department of Counseling, Kho.C., Islamic Azad University, Khomeinishahr, Iran.
2.Corresponding Author: Assistant Professor, Department of Psychology, Kho.C., Islamic Azad University, Khomeinishahr, Iran Email: gorji@iaukhsh.ac.ir Tel: 09131280635
3.Assistant Professor, Department of Counseling, , Kho.C., Islamic Azad University, Khomeinishahr, Iran
Abstract
Introduction: Persistent depressive disorder is nearly twice as prevalent in women as in men and is closely linked to perfectionistic traits. This chronic condition is associated with reduced quality of life, impaired social functioning, and increased suicide risk. Self-System Therapy (SST) is a novel and specialized approach for treating depression. Although its effectiveness has been demonstrated internationally, SST has not yet been independently and systematically evaluated in Iran, and its cultural adaptation remains in early stages. This study aimed to examine the effectiveness of SST in reducing persistent depression and perfectionism.
Methods: A semi-experimental pretest-posttest design with a control group was employed. Twenty-four women aged 20–50 with persistent depressive symptoms were selected from counseling centers in Isfahan based on DSM-5 criteria and scores on the Cornell Dysthymia Rating Scale (CDRS). Participants were purposefully and randomly assigned to SST (n=12) or control (n=12). The experimental group received 10 weekly sessions of SST therapy. Assessment tools included the CDRS and Hill’s Perfectionism Questionnaire, both validated in prior Iranian studies. Data were analyzed using repeated measures ANOVA across three phases: pretest, posttest, and three-month follow-up.
Results: The results of the study showed that the mean scores of persistent depression and perfectionism in the experimental group decreased compared to the control group after the intervention, and this change was reported to be significant (p<0/001, η²=0/80). Moreover, the therapeutic effects remained stable during the follow-up phase.
Conclusion: The study showed that the use of SST can be effective in reducing persistent depression and perfectionism.
Keywords: Persistent depression, Dysthymia, Self-system therapy, Psychotherapy, Perfectionism, Women
Conflict of interest: The authors declared no conflict of interest.
1-GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22.
2-World Health Organization. Depressive disorder (depression) [Internet]. Geneva: World Health Organization; 2023.
3-Dinis de Sousa R, Zagalo DM, Costa T & et al. Exploring depression in adults over a decade: A review of longitudinal studies. BMC Psychiatry. 2025;25(1):378.
4-KC A, Chandna J, Acharya A & et al. A longitudinal multi-centric cohort study assessing infant neurodevelopment delay among women with persistent postpartum depression in Nepal. BMC Med. 2024;22(1):284.
5-Butler G, Hope T. Treating depression (The common cold of the mind). 3rd ed. Translated by Koshiyar Karimi Tari. Tehran: Nasl-e No Andish Publications; 2020: 1–112.[Persian]
6-Sotodeh Asl N, Gholami B, Ghorbani R. Investigating the effects of three treatment methods: Cognitive-behavioral therapy, drug therapy, and a combination of both in treating major depression. Koumesh Journal. 2019;13(1):41.[Persian]
7-Ganji M. Psychopathology based on DSM-5. 2nd ed. Tehran: Savalan Publications; 2022: 1–320.[Persian]
8-World Population Review. World population by Country – 2022 [cited 2025 Oct 5].
9-World Health Organization. Depression and other common mental disorders: Global health estimates [Internet]. Geneva: World Health Organization; 2025 [cited 2025 Oct 5].
10-Liu Q, He H, Yang J & et al. Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. J Psychiatr Res. 2020;126:134–40.
11-Society for Women's Health Research. C2A Depression Dashboard: Illuminating the disease burden of chronic forms of depression in women [Internet]. Washington (DC): Society for Women's Health Research; 2025 [cited 2025 Oct 5].
12-Yun Y, Mun S, Lee S & et al. Serum L-selectin levels as predictive markers for chronic major depressive disorder progression. Ann Gen Psychiatry. 2024;23:37.
13-Nezami L, Alivandi Vafa M, Khademi A & et al. Native modeling of psychosocial vulnerability to persistent depression in women: A grounded theory study. Quarterly Journal of Woman and Society. 2022;12(48):51–66.[Persian]
14-Sirois FM, Molnar DS. Conceptualizations of perfectionism, health, and well-being: An introductory overview. In: Sirois FM, Molnar DS, editors. Perfectionism, health, and well-being. Cham: Springer; 2019: 1–21.
15-Besharat MA, Hosseini SE, Jahed H. Obsessive personality disorder and perfectionism: A review study. Journal of Thought and Behavior. 2018;13(51):77–88.[Persian]
16-Musumeci MD, Cunningham CM, White TL. Disgustingly perfect: An examination of disgust, perfectionism, and gender. Motiv Emot. 2022;46(3):336–49.
17-Hewitt PL, Smith MM, Ge SYJ & et al. Perfectionism and its role in depressive disorders. Can J Behav Sci / Rev Can Sci Comport. 2022;54(2):121–31.
18-Besharat M, Mirzamani S. Dimensions of perfectionism in depressed and anxious patients. Iranian Journal of Medical Sciences. 2015;29(4):157–60.[Persian]
19-Wei Y, Chen H, Sun B & et al. The relationship between physical appearance perfectionism on subthreshold depression in college students: The role of gender and fear of negative evaluation. Front Public Health. 2025;13:1559815.
20-Eddington KM, Strauman TJ, Vieth AZ & et al. Self-system therapy for depression: Client workbook. New York: Oxford University Press; 2017: 1–128.
21-Soleymani S, Gorji Y, Sharifi Esfahani M. The effectiveness of self-system therapy with cognitive-behavioral therapy mixed with spirituality-religion on the symptoms of persistent depression in women. Armaghanj. 2025;30(2).[Persian]
22-Soleymani S. Comparing the effectiveness of spiritually-integrated cognitive behavioral therapy, hope therapy, and self-system therapy on perfectionism and persistent depressive symptoms in women in Isfahan [PhD thesis]. Islamic Azad University, Khomeinishahr Branch. 2025.[Persian]
23-Strauman TJ, Veith AZ, Kolden GG & et al. Self-system therapy as an intervention for self-regulatory dysfunction in depression: A randomized comparison with cognitive therapy. J Consult Clin Psychol. 2006;74:367–76.
24-Behpajooh A, Seyednouri Z. Step-by-step self-therapy for depression. Tehran: Danjeh Publishing; 2020: 1–166.[Persian]
25-Blackstock J. Self-System Therapy (SST): An in-depth look at the innovative therapeutic model [Internet]. Birmingham (AL): GetTherapyBirmingham; 2024 Oct 7 [cited 2025 Oct 2].
26-Barton SB, Armstrong PV, Robinson LJ & et al. CBT for difficult-to-treat depression: Self-regulation model. Behav Cogn Psychother. 2023;51(6):543–58.
27-Strauman TJ, Vieth AZ, Merrill KA & et al. Self-system therapy (SST): A theory-based psychotherapy for depression [Internet]. 2006 [cited 2025 Oct 2].
28-Strauman TJ, Eddington KM. Treatment of depression from a self-regulation perspective: Basic concepts and applied strategies in self-system therapy. Cogn Ther Res. 2019;41(1):1–15.
29-Eddington KM. Self-system therapy as an intervention for self-regulatory dysfunction in depression: A randomized comparison with cognitive therapy. J Consult Clin Psychol. 2014;83(3):602–16.
30-Kim J, Ryu N, Chibanda D. Effectiveness of single-session therapy for adult common mental disorders: A systematic review. BMC Psychol. 2023;11:373.
31-Simon PD, Salanga MGC, Aruta JJB. The distinct link of perfectionism with positive and negative mental health outcomes. Front Psychiatry. 2025;16:1492466.
32-Niels-Kessels H, Stikkelbroek YAJ, Vermulst AA & et al. Perfectionism and suicidal ideation in outpatient depressed adults: The moderating role of self-esteem, loneliness and rumination. J Rat-Emo Cogn Behav Ther. 2025;43:10.
33-Waters SJ, Strauman TJ, McKee DC & et al. Self-system therapy for distress associated with persistent low back pain: A randomized clinical trial. Psychother Res. 2019;26(4):472–83.
34-Eddington KM, Silvia PJ, Foxworth TE & et al. Motivational deficits differentially predict improvement in a randomized trial of self-system therapy for depression. J Consult Clin Psychol. 2015;83(3):602–16.
35-Neacsiu A, Luber B, Davis MS & et al. On the concurrent use of self-system therapy (SST) and fMRI-guided transcranial magnetic stimulation (TMS) as treatment for depression. J ECT. 2019;34(4):266–73.
36-Hoet AC, Burgin CJ, Eddington KM & et al. Reports of therapy skill use and their efficacy in daily life in the short-term treatment of depression. Cogn Ther Res. 2018;42(2):184–92.
37-Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988: 1–567.
38-Burlingame GM, Seebeck JD, Janis RA & et al. Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective. Psychotherapy (Chic). 2019;53(4):446–61.
39-Mason BJ, Kocsis JH, Leon AC & et al. Rating scales in mental health. In: Sajatovic M, Ramirez LF, editors. Rating scales in mental health. 2nd ed. Hudson (OH): Lexi-Comp; 2003: 83–88.
40-Jamshidi B, Hosseinchari M, Haghighat S & et al. Validation of new measure of perfectionism. Int J Behav Sci. 2009;3(1):35–43.[Persian]
41-Emadi S, Mirhashemi M, Sharifi HP. A structural model for prediction of couple burnout based on sensation seeking, perfectionism and emotion regulation strategies with the mediation of resiliency in married women. J Psychol Sci. 2020;19(92):1011–22.[Persian]
42-Zivari Azhar M, Khanmohammadi A, Abasi Asfajir AA & et al. The structural relationship of perfectionism on academic achievement anxiety with the mediating role of spiritual intelligence and happiness. J Psychol Sci. 2024;23(133):79–94.[Persian]
Type of Study: Research |
Subject:
Psychology
Received: 2025/06/12 | Accepted: 2025/08/12 | Published: 2025/09/22
Received: 2025/06/12 | Accepted: 2025/08/12 | Published: 2025/09/22
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