Process Model of Emotion Regulation Integrated Musical Rhythm Interventions' Effects on Student Nurses' Anger

Study Overview
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Brief Summary
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Aim: The study aims to determine the effect of the anger management program to be implemented by integrating the rhythm component of music with the Gross Process Model of Emotion Regulation on the anger expression and anger types of nursing students determined to be under risk through screenings. Materials and Methods: This single-blind factorial designed randomized experimental research was conducted with three control groups. The study group consisted of third-grade students (N=67) who were determined to have scores above average from The State-Trait Anger Expression Inventory (STAXI). The study data were collected with pre-post tests and follow-up measurements using STAXI. The experimental interventions were completed in five sessions after pilot study with a specialist. The data were analyzed using one-way and two-way variance analyses (4x3 Factorial ANOVA). Effect size was measured with ε^2.

Detailed Description
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Introduction: Nursing students' anger regulation functionally has increasingly gained importance. It is known that cognitive behavioral approaches and music can be used as effective tools for young adults. It is important that the rhythm component of music be integrated with the Gross Model of Emotion Regulation, which analyzes the emotional regulation processes on a cognitive-behavioral basis, and new interventional tools be developed, which can be regularly and easily accessed in psychiatric nursing. The study results will shed light on future studies in terms of using the Gross Model, integrated in musical rhythm studies, to manage functional anger in student nurses. Aim: The study aims to determine the effect of the anger management program to be implemented by integrating the rhythm component of music with the Gross Model of Emotion Regulation on the anger expression and anger types of nursing students determined to be under risk through screenings. Materials and Methods: This single-blind factorial designed randomized experimental research was conducted with three control groups. The study group consisted of third-grade students (N=67) who were enrolled in Ege University Faculty of Nursing and determined to have scores above average from The State-Trait Anger Expression Inventory (STAXI). The study data were collected from 38 students who met the inclusion criteria. They were collected with pre-post tests and follow-up measurements using STAXI and introductory information form developed in light of the literature. The Gross Model of Emotion Regulation intervention program, integrated with musical rhythms, was completed in five sessions after pilot study. The sessions in the musical rhythms were carried out in company with a specialist. The data were analyzed using one-way and two-way variance analyses (4x3 Factorial ANOVA). The statistical significance level was measured with p˂0.05, and effect size was measured with ε^2. Ethical permissions were obtained to conduct the study.

Official Title
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The Effect of Gross' Process Model of Emotion Regulation Integrated in Musical Rhythm Interventions on Student Nurses' Anger Expressions and States

Conditions
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Anger

Intervention / Treatment
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* Behavioral: Gross's Process of Emotion Regulation Model Interventions
* Behavioral: Musical Rhythm Interventions
* Behavioral: Musical Rhythm Integrated Gross's Emotion Regulation Process Interventions


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: To be a third year student in the Faculty of Nursing To have a higher score than the average limits calculated according to the State Anger score to be obtained from all students, Willingness and volunteering for a musical practice Exclusion Criteria: To benefit from regular psychological counseling in the last three months, To have a professional music education, To have a physical handicap that will affect musical sense and skill.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 24 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Interventional Model Description: One experimental and three control groups involved study model.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control 1<br>Applied any intervention. | |
| Active Comparator: Control 2<br>Gross's Process of Emotion Regulation Model interventions applied. | Behavioral: Gross's Process of Emotion Regulation Model Interventions<br>* Interventions were based on Gross's Process Model which include the basis concepts of cognitive-behavioral therapy and carried on with five semi-structured sessions. Cognitive-behavioral theories accept the existence of a thought process (attention-perception-interpretation) that appears in the mind about the event just before the anger emerges. Therefore, anger studies with cognitive-behavioral approach generally proceed with the steps of gaining awareness about this concealed thought, identifying behavioral response and avoidance attitudes and thus regulating emotion. It consists of five 90-minute group sessions structured in this context. While being an accredited cognitive behavioral therapist, investigator have qualified to manage these approach. The effectiveness of these semi-structured sessions were evaluated by using: Pretest application of STAXI Taking feedback after each intervention session Posttest application of STAXI Follow-up test application of STAXI<br>|
| Active Comparator: Control 3<br>Musical rhythm interventions applied. | Behavioral: Musical Rhythm Interventions<br>* This musical group rhythm intervention was continued with 90 minute long five sessions. The students participated in the practice together with a music expert and lead researcher. The lead researcher took on the role of observer in these sessions. Each session was continued with warming, improvisation and targeted semi-structured rhythm practices aiming anger regulation. The effectiveness of these semi-structured sessions were evaluated by using: Pretest application of STAXI Taking feedback after each intervention session Posttest application of STAXI Follow-up test application of STAXI<br>|
| Experimental: Experimental<br>Musical rhythm integrated Gross's Process of Emotion Regulation Model interventions applied. | Behavioral: Gross's Process of Emotion Regulation Model Interventions<br>* Interventions were based on Gross's Process Model which include the basis concepts of cognitive-behavioral therapy and carried on with five semi-structured sessions. Cognitive-behavioral theories accept the existence of a thought process (attention-perception-interpretation) that appears in the mind about the event just before the anger emerges. Therefore, anger studies with cognitive-behavioral approach generally proceed with the steps of gaining awareness about this concealed thought, identifying behavioral response and avoidance attitudes and thus regulating emotion. It consists of five 90-minute group sessions structured in this context. While being an accredited cognitive behavioral therapist, investigator have qualified to manage these approach. The effectiveness of these semi-structured sessions were evaluated by using: Pretest application of STAXI Taking feedback after each intervention session Posttest application of STAXI Follow-up test application of STAXI<br>Behavioral: Musical Rhythm Interventions<br>* This musical group rhythm intervention was continued with 90 minute long five sessions. The students participated in the practice together with a music expert and lead researcher. The lead researcher took on the role of observer in these sessions. Each session was continued with warming, improvisation and targeted semi-structured rhythm practices aiming anger regulation. The effectiveness of these semi-structured sessions were evaluated by using: Pretest application of STAXI Taking feedback after each intervention session Posttest application of STAXI Follow-up test application of STAXI<br>Behavioral: Musical Rhythm Integrated Gross's Emotion Regulation Process Interventions<br>* The students participated in the practice together with a music expert and lead researcher. The lead researcher ensured the integration of rhythm applications into the Process Model through cognitive-behavioral semi-structured interventions. Five semi-structured 90-minute group sessions were performed. The effectiveness of the experiment was evaluated by using: Pretest application of STAXI Taking feedback after each intervention session Posttest application of STAXI Follow-up test application of STAXI<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anger State and Anger Expressions (first evaluation with posttest) | Anger state and expressions were evaluated with using The State-Trait Anger Expression Inventory. This scale originally organized by Charles D. Spielberger in 1988. The scale, which evaluated trait anger (10 items) and state anger behavior (24 items), was adapted to Turk society by Özer N. in 1992. This tool was used to diagnose anger severity and behavioral reactions of anger in many national studies in child, adolescent and adult groups. Scale's Trait Anger dimension (anger expressions) were separated in three subscales as 'anger out', 'anger in' and 'anger control' which each includes eight items (subscale total score min:8, max:32). State Anger subscale has 10 items and total score range is between 10-40 points. | Through study completion, an average of 4 months | 
| Anger State and Anger Expressions (second evaluation with follow up) | Anger state and expressions were evaluated with using The State-Trait Anger Expression Inventory. | Through study completion, an average of 7 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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music, Cognitive Behavioral Therapy, randomized controlled trial, rhythm