Volume 4, Issue 3 (7-2025)                   JRHMS 2025, 4(3): 17-28 | Back to browse issues page

XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Rabbani A, Khalili Senobari S, Mirzaei A. Emotion regulation and cognitive flexibility in undergraduate nursing students: A descriptive correlational study. JRHMS 2025; 4 (3) :17-28
URL: http://jrhms.thums.ac.ir/article-1-156-en.html
1- Department of Nursing, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran & Nursing and Midwifery Student Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2- Department of Nursing, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
3- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
Abstract:   (2 Views)

Nursing students are exposed to numerous academic and clinical stressors that require effective psychological adaptation. Emotion regulation and cognitive flexibility are two important psychological constructs associated with coping and resilience; however, the relationship between these variables has received limited attention among Iranian nursing students. This study aimed to investigate the relationship between emotion regulation strategies and cognitive flexibility among undergraduate nursing students. In this descriptive correlational cross-sectional study, 82 second- to fourth-year undergraduate nursing students at Torbat Heydariyeh University of Medical Sciences, Iran, participated during the 2025–2026 academic year. Data were collected using the Emotion Regulation Questionnaire (ERQ) and the Cognitive Flexibility Inventory (CFI). Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26. Spearman’s rank-order correlation coefficient and independent-samples t-test were used for data analysis, and the level of statistical significance was set at P < 0.05. The mean total score of cognitive flexibility was 100.54 ± 13.58, and the mean total score of emotion regulation was 45.34 ± 8.25. A significant positive correlation was found between total emotion regulation and total cognitive flexibility (rho = 0.31, P = 0.004). Cognitive reappraisal showed significant positive correlations with total cognitive flexibility (rho = 0.48, P < 0.001) and the Alternatives subscale (rho = 0.57, P < 0.001), whereas expressive suppression was not significantly associated with any dimension of cognitive flexibility. No significant gender differences were observed in the main study variables. The findings suggest that cognitive reappraisal is positively associated with cognitive flexibility among nursing students. Strengthening adaptive emotion regulation strategies may contribute to improved cognitive flexibility and better adaptation to educational and clinical challenges.

Full-Text [PDF 751 kb]   (2 Downloads)    
Type of Study: Orginal Article | Subject: Special
Received: 2026/05/31 | Accepted: 2026/06/1 | Published: 2026/07/13

References
1. Beanlands H, McCay E, Fredericks S, Newman K, Rose D, Santa Mina E, et al. Decreasing stress and supporting emotional well-being among senior nursing students: A pilot test of an evidence-based intervention. Nurse education today. 2019;76:222-7. [DOI:10.1016/j.nedt.2019.02.009]
2. Salvarani V, Ardenghi S, Rampoldi G, Bani M, Cannata P, Ausili D, et al. Predictors of psychological distress amongst nursing students: A multicenter cross-sectional study. Nurse Education in Practice. 2020;44:102758. [DOI:10.1016/j.nepr.2020.102758]
3. Cucás PMN, Enríquez VJG, Mina JEC. Factores estresantes en estudiantes de enfermería durante la rotación hospitalaria. Una revisión sistemática. Horizon Nexus Journal. 2026;4(1):35-45. [DOI:10.70881/hnj/v4/n1/96]
4. Engelbrecht M, Wilke M. Factors associated with emotional exhaustion in undergraduate and postgraduate nursing students. African Journal of Health Professions Education. 2021;13(2):140-4. [DOI:10.7196/AJHPE.2021.v13i2.1300]
5. Martinez-Fierro ML, Ramirez-Hernandez LA, Trejo-Ortiz PM, Lozano-Razo G, Zavala-Rayas J, Vazquez-Reyes S, et al. Psychosocial and Mental Health Determinants of Suicidal Behavior Among Nursing Students: A Cross-Sectional Study in Mexico. Nursing Reports. 2025;15(12):441. [DOI:10.3390/nursrep15120441]
6. Nway NC, Phetrasuwan S, Putdivarnichapong W, Vongsirimas N. Factors contributing to depressive symptoms among undergraduate nursing students: A cross-sectional study. Nurse Education in Practice. 2023;68:103587. [DOI:10.1016/j.nepr.2023.103587]
7. Gross JJ. Emotion regulation: Current status and future prospects. Psychological inquiry. 2015;26(1):1-26. [DOI:10.1080/1047840X.2014.940781]
8. Cutuli D. Cognitive reappraisal and expressive suppression strategies role in the emotion regulation: an overview on their modulatory effects and neural correlates. Frontiers in systems neuroscience. 2014;8:175. [DOI:10.3389/fnsys.2014.00175]
9. Lee M, Jang K-S, editors. Mediating effects of emotion regulation between socio-cognitive mindfulness and achievement emotions in nursing students. Healthcare; 2021: MDPI. [DOI:10.3390/healthcare9091238]
10. Nadeem A, Umer F, Anwar MJ. Emotion regulation as predictor of academic performance in university students. Journal of Professional & Applied Psychology. 2023;4(1):20-33. [DOI:10.52053/jpap.v4i1.157]
11. Gross JJ. Antecedent-and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. Journal of personality and social psychology. 1998;74(1):224. [DOI:10.1037/0022-3514.74.1.224]
12. Zhu Y, Wang H, Wang A. An evaluation of mental health and emotion regulation experienced by undergraduate nursing students in China during the COVID‐19 pandemic: A cross‐sectional study. International Journal of Mental Health Nursing. 2021;30(5):1160-9. [DOI:10.1111/inm.12867]
13. Hohl K, Dolcos S. Measuring cognitive flexibility: A brief review of neuropsychological, self-report, and neuroscientific approaches. Frontiers in Human Neuroscience. 2024;18:1331960. [DOI:10.3389/fnhum.2024.1331960]
14. Kupis LB, Uddin LQ. Developmental neuroimaging of cognitive flexibility: update and future directions. Annual Review of Developmental Psychology. 2023;5:263-84. [DOI:10.1146/annurev-devpsych-120221-035310]
15. Kalhory P, Shojaa M. Clinical reasoning in nursing education. Journal of Nursing Advances in Clinical Sciences. 2025;2(Issue 4):219-20. [DOI:10.32598/JNACS.2412.1125]
16. Kruczek A, Basińska MA, Janicka M. Cognitive flexibility and flexibility in coping in nurses-the moderating role of age, seniority and the sense of stress. International journal of occupational medicine and environmental health. 2020;33(4):507-21. [DOI:10.13075/ijomeh.1896.01567]
17. Sarpdağı Y, Kaplan E, Sir Ö, Yıldız M, Kaymaz D, Çiftci N, et al. The effect of secondary traumatic stress and cognitive flexibility on psychological well-being in health education students. BMC Medical Education. 2025;25(1):929. [DOI:10.1186/s12909-025-07489-w]
18. Yurt E, Hayli ÇM. Mediating role of self-efficacy and cognitive flexibility in the relationship between critical thinking and positive mental health in Turkish nursing students: a cross-sectional study. BMJ open. 2025;15(8):e097631. [DOI:10.1136/bmjopen-2024-097631]
19. Gu C, Guo M, Cui Y, Yu F, Chen Y, Chu J, et al. Cognitive flexibility mediates the impact of emotion regulation strategies on negative emotions in preschool teachers. Frontiers in psychology. 2025;16:1609872. [DOI:10.3389/fpsyg.2025.1609872]
20. Foroudifard F, Amini P, Navid B, Omani-Samani R, Sepidarkish M, Maroufizadeh S. Cognitive emotion regulation, anxiety, and depression in infertile women: a cross-sectional study. Middle East Fertility Society Journal. 2020;25(1):24. [DOI:10.1186/s43043-020-00035-2]
21. Salamat M, Moradi A, Hasani J, Farahimanesh S, Ayatmehr F, Yavarzadeh H, et al. Exploring the efficacy of memory specificity training on depression among Iranian adolescents: a comparative analysis of online vs. in-person delivery. Scientific Reports. 2024;14(1):22412. [DOI:10.1038/s41598-024-68709-9]
22. Ramzan N, Amjad N. Cross cultural variation in emotion regulation: A systematic review. Annals of King Edward Medical University. 2017;23(1). [DOI:10.21649/akemu.v23i1.1512]
23. Tahmouresi N, Bender C, Schmitz J, Baleshzar A, Tuschen-Caffier B. Similarities and differences in emotion regulation and psychopathology in Iranian and German school-children: A cross-cultural study. International journal of preventive medicine. 2014;5(1):52.
24. Vaziri A, Esmaeilinasab M, Hamdieh M, Farahani H. Cultural obstacles in emotion expression among patients with Somatic Symptom Disorder (SSD) in an Iranian sample: A qualitative study. International Journal of Behavioral Sciences. 2019;13(1):8-13.
25. Gross JJ, John OP. Emotion regulation questionnaire. Journal of personality and social psychology. 2012.
26. Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research. 2010;34(3):241-53. [DOI:10.1007/s10608-009-9276-4]
27. Gross JJ. Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology. 2002;39(3):281-91. [DOI:10.1017/S0048577201393198]
28. Öztekin GG, Gómez-Salgado J, Yıldırım M. Future anxiety, depression and stress among undergraduate students: psychological flexibility and emotion regulation as mediators. Frontiers in Psychology. 2025;16:1517441. [DOI:10.3389/fpsyg.2025.1517441]
29. Zarotti N, Povah C, Simpson J. Mindfulness mediates the relationship between cognitive reappraisal and resilience in higher education students. Personality and individual differences. 2020;156:109795. [DOI:10.1016/j.paid.2019.109795]
30. Karakuş İ. University students' cognitive flexibility and critical thinking dispositions. Frontiers in psychology. 2024;15:1420272. [DOI:10.3389/fpsyg.2024.1420272]
31. Najafi GE, Yazdanbakhsh K, MOMENI K. Predicting vicarious post traumatic growth based on cognitive flexibility and cognitive reappraisal in nurses providing services to Kermanshah earthquake victims. JOURNAL OF HEALTH AND CARE Учредители: CMV Verlag. 2020;22(1):17-24. [DOI:10.29252/jhc.22.1.17]
32. Szczygieł D, Maruszewski T. Why expressive suppression does not pay? Cognitive costs of negative emotion suppression: The mediating role of subjective tense-arousal. Polish Psychological Bulletin. 2015;46(3):336-49. [DOI:10.1515/ppb-2015-0041]
33. Wei M, Su JC, Carrera S, Lin S-P, Yi F. Suppression and interpersonal harmony: a cross-cultural comparison between Chinese and European Americans. Journal of counseling psychology. 2013;60(4):625. [DOI:10.1037/a0033413]
34. Butler EA, Lee TL, Gross JJ. Emotion regulation and culture: Are the social consequences of emotion suppression culture-specific? Emotion. 2007;7(1):30. [DOI:10.1037/1528-3542.7.1.30]
35. Vatandoost S, Baetens I, Erjaee Z, Azadfar Z, Van Heel M, Van Hove L, editors. A comparative analysis of emotional regulation and maladaptive symptoms in adolescents: insights from Iran and Belgium. Healthcare; 2024: MDPI. [DOI:10.20944/preprints202312.0780.v1]
36. Spătaru B, Podină IR, Tulbure BT, Maricuțoiu LP. A longitudinal examination of appraisal, coping, stress, and mental health in students: A cross‐lagged panel network analysis. Stress and Health. 2024;40(5):e3450. [DOI:10.1002/smi.3450]
37. Chaabane S, Chaabna K, Bhagat S, Abraham A, Doraiswamy S, Mamtani R, et al. Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews. Systematic reviews. 2021;10(1):136. [DOI:10.1186/s13643-021-01691-9]
38. Sargazi M, Hamzehpour R, Shirafkan H, Moudi S. Depression, Anxiety and Stress in Students of Various Fields of Medical Sciences: A survey at Babol University of Medical Sciences, North of Iran. Shiraz E-Medical Journal. 2025;26(26):e159484. [DOI:10.5812/semj-159484]
39. Seyedfatemi N, Tafreshi M, Hagani H. Experienced stressors and coping strategies among Iranian nursing students. BMC nursing. 2007;6(1):11. [DOI:10.1186/1472-6955-6-11]
40. Coutinho VRD, Martins JCA, Pereira F. Structured debriefing in nursing simulation: students' perceptions. Journal of Nursing Education and Practice. 2016;6(9):127-34. [DOI:10.5430/jnep.v6n9p127]
41. Lee M. The Effect of a Mindfulness-Based Class on Mindfulness, Achievement Emotions, Emotion Regulation, and Empathy in Nursing Students. Nursing Reports. 2025;15(11):374. [DOI:10.3390/nursrep15110374]
42. Li Y, Cao F, Cao D, Liu J. Nursing students' post‐traumatic growth, emotional intelligence and psychological resilience. Journal of psychiatric and mental health nursing. 2015;22(5):326-32. [DOI:10.1111/jpm.12192]
43. Al Fahmi AR. Implementation of Mindfulness Techniques in Managing Academic Stress among University Students: Penerapan Teknik Mindfulness untuk Mengelola Stres Akademik pada Mahasiswa Perguruan Tinggi. Journal of Educational Research and Learning Analytics. 2025;1(1):30-40. [DOI:10.65101/jerlra.v1i1.64]
44. Sheykhangafshe FB, Nouri E, Niri VS, Choubtashani M, Farahani H. The efficacy of cognitive behavioral therapy on mental health, self-esteem and emotion regulation of medical students with imposter syndrome. Educational Research in Medical Sciences. 2024;13(13):e150577. [DOI:10.5812/ermsj-147868]
45. Viskovich S, Pakenham KI. Randomized controlled trial of a web‐based Acceptance and Commitment Therapy (ACT) program to promote mental health in university students. Journal of clinical psychology. 2020;76(6):929-51. [DOI:10.1002/jclp.22848]

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2026 CC BY-NC 4.0 | Journal of Research in Health and Medical Sciences

Designed & Developed by : Yektaweb