Original Article

Exploring the effects of self-reflection practice on cognitive emotion regulation and resilience among mothers of premature neonates


Background & Aim: Despite the well-known benefits of practicing self-reflection in educational settings, little is known regarding the effects of applying it in clinical settings. The objective of the current study was to investigate the effects of self-reflective practice on cognitive emotion regulation and resilience of mothers of preterm infants in the NICU.
Methods & Materials: A total of 90 mothers whose preterm infants were admitted to NICU enrolled in the current non-randomized clinical trial study by convenience sampling (n=45 in each group). The data of the control group were gathered prior to the intervention group. Pre- and post-test data were gathered using the demographic questionnaire, the Cognitive Emotion Regulation Questionnaire, and the Conner and Davidson Resilience Scale. Self–reflection practice was designed and conducted based on the Gibbs' reflective cycle for the intervention group, which applied a blended model (face-to-face and virtual). Statistical analysis was conducted by SPSS-25 and using the repeated measure ANOVA.
Results: Using ANCOVA, the results indicated that the self-reflection practice was effective in improving cognitive emotion regulation (F=66.01, P≤0.001, Eta=0.60) and resilience (F=89.43, P≤0.001, Eta= 0.67) among mothers in the intervention group. 
Conclusion: Self-reflection practice was an effective intervention for improving mothers’ skills, helping them be more resilient, and assisting them in regulating their emotions. Further studies should support the current study findings in different clinical settings.

1. Aagaard H, Hall EO. Mothers' experiences of having a preterm infant in the neonatal care unit: a meta-synthesis. Journal of Pediatric Nursing. 2008 Jun 1;23(3):e26-36.
2. Provenzi L, Santoro E. The lived experience of fathers of preterm infants in the Neonatal Intensive Care Unit: a systematic review of qualitative studies. Journal of Clinical Nursing. 2015;24(13-14):1784-94.
3. Al Maghaireh DaF, Abdullah KL, Chan CM, Piaw CY, Al Kawafha MM. Systematic review of qualitative studies exploring parental experiences in the Neonatal Intensive Care Unit. Journal of Clinical Nursing. 2016;25(19-20):2745-56.
4. Caldwell J, Meredith P, Whittingham K, Ziviani J. Shame and guilt in the postnatal period: A systematic review. Journal of Reproductive and Infant Psychology. 2021;39(1):67-85.
5. Al Maghaireh DaF, Abdullah KL, Chong MC, Chua YP, Al Kawafha MM. Stress, Anxiety, Depression and Sleep Disturbance among Jordanian Mothers and Fathers of Infants Admitted to Neonatal Intensive Care Unit: A Preliminary Study. Journal of Pediatric Nursing. 2017;36:132-40.
6. Dryman MT, Heimberg RG. Emotion regulation in social anxiety and depression: a systematic review of expressive suppression and cognitive reappraisal. Clinical Psychology Review. 2018;65:17-42.
7. Gross JJ. Emotion Regulation: Past, Present, Future. Cognition and Emotion. 1999;13(5):551-73.
8. Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences. 2001;30(8):1311-27.
9. Stefana A, Lavelli M. Parental engagement and early interactions with preterm infants during the stay in the neonatal intensive care unit: protocol of a mixed-method and longitudinal study. BMJ Open. 2017;7(2):e013824.
10. Masten AS. Resilience Theory and Research on Children and Families: Past, Present, and Promise. Journal of Family Theory & Review. 2018;10(1):12-31.
11. Crane MF, Searle BJ, Kangas M, Nwiran Y. How resilience is strengthened by exposure to stressors: the systematic self-reflection model of resilience strengthening. Anxiety, Stress, & Coping. 2019;32(1):1-17.
12. Crane MF, Kangas M, Karin E, Searle B, Chen D. Leveraging the experience of stressors: the role of adaptive systematic self-reflection. Anxiety, Stress, & Coping. 2020;33(3):231-47.
13. Perry MA, Creavey K, Arthur E, Chance Humer J, Lundgren PJ, Rivera I. Cultivating emotional intelligence in child welfare professionals: A systematic scoping review. Child Abuse & Neglect. 2020;110:104438.
14. Cadman K, Clack E, Lethbridge Z, Millward J, Morris J, Redwood R. Reflection: a casualty of modularisation?: Enquiry Based Reflection Research Group. Nurse Education Today. 2003;23(1):11-8.
15. Lew MD, Schmidt HG. Self-reflection and academic performance: is there a relationship? Advances in Health Sciences Education. 2011;16(4):529.
16. Cowden RG, Meyer-Weitz A. Self-reflection and self-insight predict resilience and stress in competitive tennis. Social Behavior and Personality: an international journal. 2016;44(7):1133-49.
17. Falon SL, Karin E, Boga D, Gucciardi DF, Griffin B, Crane MF. A clustered-randomized controlled trial of a self-reflection resilience-strengthening intervention and novel Mediators. Journal of Occupational Health psychology. 2021;26(1):1.
18. Gibbs G. Learning by doing: A guide to teaching and learning methods. Further Education Unit. 1988.
19. Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety. 2003;18(2):76-82.
20. Abdi S, Taban S, Ghaemian A. Cognitive emotion regulation questionnaire: Validity and reliability of Persian translation of CERQ-36 item. Procedia-Social and Behavioral Sciences. 2012 Jan 1;32:2-7.
21. Cook DA, Beckman TJ. Current Concepts in Validity and Reliability for Psychometric Instruments: Theory and Application. The American Journal of Medicine. 2006;119(2):166.e7-.e16.
22. Derakhshanrad SA, Piven E, Rassafiani M, Hosseini SA, Mohammadi Shahboulaghi F. Standardization of Connor-Davidson Resilience Scale in Iranian subjects with Cerebrovascular Accident. Journal of Rehabilitation Sciences & Research. 2014;1(4):73-7.
23. Edraki MMS, Rambod MP. Psychological Predictors of Resilience in Parents of Insulin-Dependent Children and Adolescents. International Journal of Community Based Nursing and Midwifery. 2018;6(3):239-49.
24. Haga SM, Kraft P, Corby E-K. Emotion Regulation: Antecedents and Well-Being Outcomes of Cognitive Reappraisal and Expressive Suppression in Cross-Cultural Samples. Journal of Happiness Studies. 2009;10(3):271-91.
25. Naragon-Gainey K, McMahon TP, Chacko TP. The structure of common emotion regulation strategies: A meta-analytic examination. Psychological Bulletin. 2017;143(4):384.
26. Wosnitza M, Delzepich R, Schwarze J, O’Donnell M, Faust V, Camilleri V. Enhancing teacher resilience: From Self-Reflection to professional development. Resilience in Education: Springer; 2018. p. 275-88.
27. Stephens TM, Smith P, Cherry C. Promoting Resilience in New Perioperative Nurses. AORN Journal. 2017;105(3):276-84.
28. Kim GM, Lim JY, Kim EJ, Park S-M. Resilience of patients with chronic diseases: A systematic review. Health & Social Care in the Community. 2019;27(4):797-807.
29. Soenens B, Deci EL, Vansteenkiste M. How parents contribute to children’s psychological health: The critical role of psychological need support. Development of self-determination through the life-course: Springer; 2017. p. 171-87.
30. Ettenberger M, Bieleninik Ł, Epstein S, Elefant C. Defining Attachment and Bonding: Overlaps, Differences and Implications for Music Therapy Clinical Practice and Research in the Neonatal Intensive Care Unit (NICU). 2021;18(4):1733.
IssueVol 9 No 3 (2022): Summer QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v9i3.10223
family-centered care; reflection; cognitive emotion regulation; resilience; premature infants

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How to Cite
Khoshnavay Fomani F, Mirlashari J, Sharif Nia H, Begjani J, Khoshakhlagh F, Shiri M, Teymuri E. Exploring the effects of self-reflection practice on cognitive emotion regulation and resilience among mothers of premature neonates. NPT. 2022;9(3):211-220.