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TB 2025, 24(6): 49-64 |
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Hosseini F, Tabatabainejad F S, Afrakhte S. Comparing the Effectiveness of Positive Psychology-Based Therapy and Cognitive-Behavioral Therapy on Depressive Symptoms in Nurses. TB 2025; 24 (6) :49-64
URL: http://tbj.ssu.ac.ir/article-1-3841-en.html
URL: http://tbj.ssu.ac.ir/article-1-3841-en.html
, Naein Branch, Islamic Azad University , FS.Tabatabaei1349@iau.ac.ir
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Comparing the Effectiveness of Positive Psychology-Based Therapy and Cognitive-Behavioral Therapy on Depressive Symptoms in Nurses
Fatemeh Sadat Hosseini(Ph.D. Candidate)¹, Fatemeh Sadat Tabatabaei-Nejad(Ph.D.)², Sagha Afrakhteh(Ph.D.)³
1.Ph.D. Candidate in Psychology, Tehran North Branch, Islamic Azad University, Tehran, Iran.
2.Corresponding Author: Assistant Professor, Department of Psychology, Naein Branch, Islamic Azad University, Naein, Iran Email: FS.Tabatabaei1349@iau.ac.ir Tel: 09133233543
3.Assistant Professor, Department of Psychology, Tehran Branch, Imam Hossein University (AS), Tehran, Iran.
Abstract
Introduction: Nurses are at high risk of depression due to the challenging nature of their work, long shifts, and constant exposure to stressful situations. This study aimed to compare the effectiveness of positive psychology-based therapy and cognitive-behavioral therapy (CBT) on depressive symptoms among nurses in Yazd.
Methods: This Randomized Controlled Trial (RCT) employed a pretest–posttest design with a control group and a three-month follow-up. The population included all nurses working in public and private hospitals in Yazd in 2025 (n=2/991). A total of 60 nurses were selected using cluster random sampling and were randomly assigned to cognitive–behavioral therapy (CBT), positive psychology-based therapy, or control groups (20 per group). Data were collected using the Beck Depression Inventory–II (1996) and analyzed using repeated measures ANOVA in SPSS version 26.
Results: Both interventions significantly reduced depressive symptoms at posttest and follow-up (p<0/001). Repeated measures ANOVA showed significant effects of time (η²=0/42), group (η²=0/31), and time × group interaction (η²=0/23). Pairwise comparisons indicated that CBT had a greater effect in reducing depressive symptoms than positive psychology-based therapy (F=7/80, p=0/009; η²=0/23).
Conclusion: Psychological interventions, particularly CBT, are effective in improving nurses’ mental health and producing sustained reductions in depressive symptoms.
Keywords: Positive psychology, Cognitive–behavioral therapy, Depression, Nurses, Yazd
Conflict of interest: The authors declared no conflict of interest.
References
1-Occupational Safety and Health Administration (US). Healthcare: stress and burnout [Internet]. Washington (DC): U. S. Department of Labor; 2023 [cited 2023 Oct 26]. Available from: https://www.osha.gov/healthcare/mental-health
2-Mousavi-Asl SA, Parouni S. The effectiveness of positive psychotherapy on sense of coherence, self-efficacy, psychological well-being, and resilience among nurses in Social Security hospitals. J Psychol Res. 2021;21(1):45–60. Persian.
3-Zhang Y, Li X, Chen H. Cognitive reappraisal and ruminative thinking as mediators of depression in nursing students. J Nurs Educ. 2024;63(1):12–19.
4-Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol. 2022;131(2):116–129.
5-Sharif-Nia H, Hosseini SH, Rahmatpour P & et al. Post-COVID-19 depression prevalence in Iranian nurses: a systematic review and meta-analysis. BMC Psychiatry. 2025;25(1):45–58.
6-Li JN, Wang Y, Chen L & et al. Effect of depressive symptoms on quality of work life in nurses: a cross-sectional study. Front Psychiatry. 2023; 14:1125432.
7-Li LZ, Zhang HY, Xu Y & et al. Nurse burnout and patient safety, satisfaction, and quality: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(4): e240312.
8-Wampold BE, Imel ZE. The great psychotherapy debate: the evidence for what makes psychotherapy work. 3rd ed. New York: Routledge; 2021.
9-Zhang Y, Li J, Chen H & et al. Cognitive behavior therapy for adult depression: a meta-analysis of randomized controlled trials. J Affect Disord. 2025; 282:4–13.
10-Beg S, Verma A, Chanthar V & et al. Artificial intelligence for psychotherapy: Current status and future directions. Frontiers in Psychiatry. 2024;16(2):45–56.
11-Hosseini F, Farina H, Vaziri A. Prediction of depression in nurses based on self-compassion and resilience. Behdasht Kar va Ertegha Salamat. 2021;5(3):215–260.[Persian]
12-Wang L, Huang Q, Zhang Y & et al. Prevalence of depression and depressive symptoms among intensive care nurses: A meta‑analysis. Nursing in Critical Care.2022; 27(6), 739–746.
13-Jarrad R, Karajah A, Mahmoud N & et al. The effectiveness of group cognitive behavioral therapy in reducing the risk of depression among mental health nurses. Perspect Psychiatr Care. 2025;61(2):114–122.
14-Mikaeili-Baghi N, Abdollahzadeh M, Samadi-Fard N & et al. The effectiveness of positive psychology intervention on depression and quality of life in post-stroke depressed patients. Int J Educ Cogn Sci. 2024;5(4):101–109.
15-Kaya R, Tanrıverdi D. The effect of a positive psychology program on mental health, life attitudes, and depression levels in patients with depression. Curr Psychol. 2024;43(3):2317–2328.
16-Zhou X, Zhou X, Zhou X & et al. The effect of physical activity on depression in university students: the mediating role of self-esteem and positive psychological capital. Front Psychol. 2024; 15:1485641.
17-Peng R, Guo Y, Zhang Q & et al. Internet-delivered psychological interventions for older adults with depression: a scoping review. Geriatr Nurs. 2024; 55:102–115.
18-Beck JS. Cognitive behavior therapy: basics and beyond. 2nd ed. New York: The Guilford Press; 2011.
19-Taheri Tanjani P& et al. Validity and reliability of the Beck Depression Inventory‑II among Iranian older adults. Journal of Sabzevar University of Medical Sciences.2014; 22 (1), 189–198.[Persian]
20-Lim WL, Tierney S. The effectiveness of positive psychology interventions for promoting well-being of adults experiencing depression compared to other active psychological treatments: a systematic review and meta-analysis. J Happiness Stud. 2023;24(1):249–273.
21-Beck AT. Cognitive therapy and the emotional disorders. New York: International Universities Press; 1976.
22-Clark DA, Beck AT. Cognitive theory and therapy of anxiety and depression. 2nd ed. New York: Guilford Press; 2010.
23-Wang L, Guo Y, Liu Y & et al. Positive psychotherapy for depression and self-efficacy in undergraduate nursing students: a randomized controlled trial. Int J Nurs Pract. 2023;29(2): e13123.
24-Cuijpers P, Karyotaki E, Ciharova M & et al. The effects of cognitive behavioral therapy on depression: A comprehensive meta-analysis. World Psychiatry. 2023;22(1):105–115.
25-Dimidjian S, Hollon SD, Amsterdam JD & et al. Randomized trial of behavioral activation and cognitive therapy for depression: Outcomes and mechanisms. Journal of Consulting and Clinical Psychology. 2024;92(2):145–158.
26-Carr A, Cullen K, Keeney C & et al. Effectiveness of positive psychology interventions: A systematic review and meta-analysis. Journal of Positive Psychology. 2023;18(3):321–345. doi:10.1080/17439760.2022.2036795
27-Choi KW, Kim YK, Jeon HJ. Positive psychological interventions and depressive symptoms: Differential effects by severity level. Depression and Anxiety. 2024;41(1):56–68. doi:10.1002/da.23456
28-Disner SG, Beevers CG, Haigh EAP & et al. Neural mechanisms of depression: a roadmap for cognitive therapy. Trends in Cognitive Sciences. 2011;15(7):317-325.
29-Borsboom D, Cramer AOJ. Network analysis: an integrative approach to the structure of psychopathology and mental illness. Annual Review of Clinical Psychology. 2013; 9:91-121.
30-Wells A. Metacognitive therapy for anxiety and depression. New York (NY): Guilford Press; 2009.
Fatemeh Sadat Hosseini(Ph.D. Candidate)¹, Fatemeh Sadat Tabatabaei-Nejad(Ph.D.)², Sagha Afrakhteh(Ph.D.)³
1.Ph.D. Candidate in Psychology, Tehran North Branch, Islamic Azad University, Tehran, Iran.
2.Corresponding Author: Assistant Professor, Department of Psychology, Naein Branch, Islamic Azad University, Naein, Iran Email: FS.Tabatabaei1349@iau.ac.ir Tel: 09133233543
3.Assistant Professor, Department of Psychology, Tehran Branch, Imam Hossein University (AS), Tehran, Iran.
Abstract
Introduction: Nurses are at high risk of depression due to the challenging nature of their work, long shifts, and constant exposure to stressful situations. This study aimed to compare the effectiveness of positive psychology-based therapy and cognitive-behavioral therapy (CBT) on depressive symptoms among nurses in Yazd.
Methods: This Randomized Controlled Trial (RCT) employed a pretest–posttest design with a control group and a three-month follow-up. The population included all nurses working in public and private hospitals in Yazd in 2025 (n=2/991). A total of 60 nurses were selected using cluster random sampling and were randomly assigned to cognitive–behavioral therapy (CBT), positive psychology-based therapy, or control groups (20 per group). Data were collected using the Beck Depression Inventory–II (1996) and analyzed using repeated measures ANOVA in SPSS version 26.
Results: Both interventions significantly reduced depressive symptoms at posttest and follow-up (p<0/001). Repeated measures ANOVA showed significant effects of time (η²=0/42), group (η²=0/31), and time × group interaction (η²=0/23). Pairwise comparisons indicated that CBT had a greater effect in reducing depressive symptoms than positive psychology-based therapy (F=7/80, p=0/009; η²=0/23).
Conclusion: Psychological interventions, particularly CBT, are effective in improving nurses’ mental health and producing sustained reductions in depressive symptoms.
Keywords: Positive psychology, Cognitive–behavioral therapy, Depression, Nurses, Yazd
Conflict of interest: The authors declared no conflict of interest.
References
1-Occupational Safety and Health Administration (US). Healthcare: stress and burnout [Internet]. Washington (DC): U. S. Department of Labor; 2023 [cited 2023 Oct 26]. Available from: https://www.osha.gov/healthcare/mental-health
2-Mousavi-Asl SA, Parouni S. The effectiveness of positive psychotherapy on sense of coherence, self-efficacy, psychological well-being, and resilience among nurses in Social Security hospitals. J Psychol Res. 2021;21(1):45–60. Persian.
3-Zhang Y, Li X, Chen H. Cognitive reappraisal and ruminative thinking as mediators of depression in nursing students. J Nurs Educ. 2024;63(1):12–19.
4-Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol. 2022;131(2):116–129.
5-Sharif-Nia H, Hosseini SH, Rahmatpour P & et al. Post-COVID-19 depression prevalence in Iranian nurses: a systematic review and meta-analysis. BMC Psychiatry. 2025;25(1):45–58.
6-Li JN, Wang Y, Chen L & et al. Effect of depressive symptoms on quality of work life in nurses: a cross-sectional study. Front Psychiatry. 2023; 14:1125432.
7-Li LZ, Zhang HY, Xu Y & et al. Nurse burnout and patient safety, satisfaction, and quality: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(4): e240312.
8-Wampold BE, Imel ZE. The great psychotherapy debate: the evidence for what makes psychotherapy work. 3rd ed. New York: Routledge; 2021.
9-Zhang Y, Li J, Chen H & et al. Cognitive behavior therapy for adult depression: a meta-analysis of randomized controlled trials. J Affect Disord. 2025; 282:4–13.
10-Beg S, Verma A, Chanthar V & et al. Artificial intelligence for psychotherapy: Current status and future directions. Frontiers in Psychiatry. 2024;16(2):45–56.
11-Hosseini F, Farina H, Vaziri A. Prediction of depression in nurses based on self-compassion and resilience. Behdasht Kar va Ertegha Salamat. 2021;5(3):215–260.[Persian]
12-Wang L, Huang Q, Zhang Y & et al. Prevalence of depression and depressive symptoms among intensive care nurses: A meta‑analysis. Nursing in Critical Care.2022; 27(6), 739–746.
13-Jarrad R, Karajah A, Mahmoud N & et al. The effectiveness of group cognitive behavioral therapy in reducing the risk of depression among mental health nurses. Perspect Psychiatr Care. 2025;61(2):114–122.
14-Mikaeili-Baghi N, Abdollahzadeh M, Samadi-Fard N & et al. The effectiveness of positive psychology intervention on depression and quality of life in post-stroke depressed patients. Int J Educ Cogn Sci. 2024;5(4):101–109.
15-Kaya R, Tanrıverdi D. The effect of a positive psychology program on mental health, life attitudes, and depression levels in patients with depression. Curr Psychol. 2024;43(3):2317–2328.
16-Zhou X, Zhou X, Zhou X & et al. The effect of physical activity on depression in university students: the mediating role of self-esteem and positive psychological capital. Front Psychol. 2024; 15:1485641.
17-Peng R, Guo Y, Zhang Q & et al. Internet-delivered psychological interventions for older adults with depression: a scoping review. Geriatr Nurs. 2024; 55:102–115.
18-Beck JS. Cognitive behavior therapy: basics and beyond. 2nd ed. New York: The Guilford Press; 2011.
19-Taheri Tanjani P& et al. Validity and reliability of the Beck Depression Inventory‑II among Iranian older adults. Journal of Sabzevar University of Medical Sciences.2014; 22 (1), 189–198.[Persian]
20-Lim WL, Tierney S. The effectiveness of positive psychology interventions for promoting well-being of adults experiencing depression compared to other active psychological treatments: a systematic review and meta-analysis. J Happiness Stud. 2023;24(1):249–273.
21-Beck AT. Cognitive therapy and the emotional disorders. New York: International Universities Press; 1976.
22-Clark DA, Beck AT. Cognitive theory and therapy of anxiety and depression. 2nd ed. New York: Guilford Press; 2010.
23-Wang L, Guo Y, Liu Y & et al. Positive psychotherapy for depression and self-efficacy in undergraduate nursing students: a randomized controlled trial. Int J Nurs Pract. 2023;29(2): e13123.
24-Cuijpers P, Karyotaki E, Ciharova M & et al. The effects of cognitive behavioral therapy on depression: A comprehensive meta-analysis. World Psychiatry. 2023;22(1):105–115.
25-Dimidjian S, Hollon SD, Amsterdam JD & et al. Randomized trial of behavioral activation and cognitive therapy for depression: Outcomes and mechanisms. Journal of Consulting and Clinical Psychology. 2024;92(2):145–158.
26-Carr A, Cullen K, Keeney C & et al. Effectiveness of positive psychology interventions: A systematic review and meta-analysis. Journal of Positive Psychology. 2023;18(3):321–345. doi:10.1080/17439760.2022.2036795
27-Choi KW, Kim YK, Jeon HJ. Positive psychological interventions and depressive symptoms: Differential effects by severity level. Depression and Anxiety. 2024;41(1):56–68. doi:10.1002/da.23456
28-Disner SG, Beevers CG, Haigh EAP & et al. Neural mechanisms of depression: a roadmap for cognitive therapy. Trends in Cognitive Sciences. 2011;15(7):317-325.
29-Borsboom D, Cramer AOJ. Network analysis: an integrative approach to the structure of psychopathology and mental illness. Annual Review of Clinical Psychology. 2013; 9:91-121.
30-Wells A. Metacognitive therapy for anxiety and depression. New York (NY): Guilford Press; 2009.
Type of Study: Research |
Subject:
Psychology
Received: 2025/07/11 | Accepted: 2025/09/11 | Published: 2025/11/19
Received: 2025/07/11 | Accepted: 2025/09/11 | Published: 2025/11/19
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