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Original Article

Effect of the Penn Resiliency Program on student

with emotional problems
  Shahram Vahedi, Rahim Badri Gargari, Somayeh Gholami
Department of Psychology, Tabriz University, Tabriz, Iran

Address for Correspondence:
Dr. Somayeh Gholami,
Department of Psychology,
Tabriz University, 29 Bahman
Blvd, Tabriz, East Azerbaijan, Iran.
E‑mail: somayeg@yahoo.com
ABSTRACT
Aim: Education in university is difficult for some students and so depression, stress, and anxiety are
prevalent problems in colleges across the country. People experiencing such psychosocial difficulties
are more likely to be defeated in the course. Resilience training can target these risk factors, but
there is little research evaluating the effectiveness of such programs.This paper describes the design
and measures of a study to evaluate a resilience training program to decrease emotional problems.
Methods: This study followed a randomized controlled trial and included a pretest and posttest.
A  purposive sampling was used. In this way, participants were 30 students randomly selected
between who have emotional problems in 2014 at Tabriz University, Iran. They were assigned into
control and experimental group. Data were collected using depression, anxiety, and stress scale 21.
Cronbach’s alpha coefficients for each subscale indicate high internal reliability. Multivariate analysis of
variance (MANOVA) was run to analyze the data. Results: The findings of this study show a decrease
in the mean score in the mean score of the experimental group in the posttest. Multivariate variance
analysis MANOVA showed difference in posttest mean scores of participants’ anxiety, depression,
and stress in the experimental group. Conclusions: The Penn Resiliency Program will promote
psychosocial well‑being for student with emotional problems.
Key words: Anxiety, depression, Penn Resiliency Program, stress

Introduction and could noting observe deep in thought, and other

Emotional problems such as stress, depression, and anxiety
are prevalent problems in college students across the
country. Emotional problems such as stress, depression,
and anxiety are prevalent problems in college students
across the country. A person suffering from emotional
problems create serious problems for university because
depressed persons have lack of hope, lacking in or deprived
of strength or power, sense of worthless, guilty, loneliness,
an hedonic, easily irritated, and ashamed or unable to
relax.[1]
They have no interest to do activities that were once
pleasurable. In addition, cognitive problems in depressed
person such as concentrating, remembering details,
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difficulties such as insomnia, sense of exhaustion and
fatigue, excessive sleeping leading persons unable to study,
active in classroom, listening to lessons, and so on. Other
prevalent disturbance in emotion is anxiety and stress.
Anxiety known with features such as autonomic arousal,
poor sleep, being irritable a lot of the time, skeletal muscle,
and difficulty in concentrating. Symptoms of stress are
difficulty relaxing, constant worrying, memory problems,
inability to concentrate nervous arousal, being unhappy,
and irritable/over‑reactive and restless.[1]
All of these features are in conflict with what a student
needs to be successful. Despite these, emotional disorders
are prevalent among the most common causes of disability.
National Institute of Mental Health reported that 13 million
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DOI: How to cite this article: Vahedi S, Gargari RB, Gholami S. Effect of the
penn resiliency program on student with emotional problems. Int J Educ
10.4103/2395-2296.180302
Psychol Res 2016;2:145-9.

© 2016 International Journal of Educational and Psychological Researches | Published by Wolters Kluwer ‑ Medknow 145
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Vahedi, et al.: Effect of the Penn Resiliency Program on emotion
American adults (almost one in 17) have a serious mental
illness.[2] Mental health disorders cause a severe problem
in life. Persons with high levels of depressive symptoms or
depressive disorders are at risk for having academic and
interpersonal difficulties. It is expected that these students
become cigar smoker, use other substances, and make
an effort for suicide.[3] In the United States and Canada,
accounting for 25% of all years of life lost to disability and
premature mortality.[4] Moreover, suicide is the eleventh
leading cause of death in the United States, accounting
for the deaths of approximately 30,000 Americans each
year (WISQARS, 2010). Iranian student population also
suffers from depression, anxiety, and stress. For example,
study by Najafikolyani and Poornajm showed that 76%
of students have stressed, 56% and 53% suffer from
depression and anxiety.[5] Another researches show a rise
in the number of mental health problems. Meta‑analysis
of the result in 35 articles in Iran from 1995 to 2012 with
a sample size of 9743 show prevalence of depression in
the University as 33%.[6] The best explanation we should
consider about it is many mental health conditions start
in the typical age range (i.e. 18–24‑year‑old), during college,
students deal with a unique amount of stressors, including
new lifestyle, friends, roommates that they should share
a room, exposure to new cultures, and alternate ways of
mannerism and thinking. If the freshmen have difficulty
adjusting to a new environment, they are more likely to
struggle. Harrison[4] states “if students feel inadequate
or incomplete to cope with the new environment of a
college campus, they could easily become more prone
to depression and anxiety.” There are great academic
stressors such as competition, poor management of time,
the perceptible pressure to do well the tasks and exams.
The emotional problems affect aspects of everyday life
functions. Untreated emotional problems last for a long
time interrupt day‑to‑day activities, and are much more
than just being “a little down” or “feeling blue.”[7] The
American College Health Association–National College
Health Assessment (ACHA–NCHA) found that nearly
30% college students reported feeling “so depressed that
it was difficult to function” at some time in the past year.[8]
The question that arises is how emotional problems affect
college students? Depression can have an impact on college
student academic performance.[9] Studies suggested that
college students who have depression are more likely to
smoke.[10] Also, students with depression do not necessarily
drink alcohol more heavily than other college students.
But, depression among students, especially women are
more likely to get drunk and experience problems related
to alcohol abuse, such as engaging in unprotected sex.[11]
Depression and other mental disorders often accompanied
by substance abuse, which can complicate treatment.[12,13]
Depression should be considered as a major risk factor for
146 International Journal of Educational and Psychological Researches / Vol 2 / Issue 3 / July-September 2016
suicide.[14] Better diagnosis and treatment of depression
can bestead reducing suicide rates among college students.
ACHA–NCHA declares in the fall 2011 survey that more
than 6% college students asserted seriously considering
suicide, and about 1% reported attempting suicide in the
previous year .[8]  Suicide is the third leading cause of death
for teens and young adults aged 15–24 years.[15] As for this
discussion, when we evaluate universities condition, it
seems clear that having mental health resources is necessary
for students, and it is necessary to treat depression and
other emotional problem.
The Penn Resiliency Program (PRP) researched depression
prevention programs, and there are numerous works
on it. This curriculum teaches cognitive‑behavioral and
social problem‑solving skills. This package based in
part on cognitive‑behavioral theories of depression by
Aaron Beck, Albert Ellis, and Martin Seligman. Ellis’
Adversity‑Consequences‑Beliefs (ABC) model is central
of the program, demonstrating the idea that our beliefs
about events mediate their impact on our emotions
and behavior. Through this model, students learn to
detect unhelpful thoughts, evaluate the accuracy of those
thoughts, and challenge negative beliefs by considering
alternative interpretations. PRP also teaches a variety of
strategies that can be used for solving problems and coping
with difficult situations and emotions. Students learn
techniques for assertiveness, negotiation, decision‑making,
social problem‑solving, and relaxation. The skills taught
in the program can be applied to many contexts of life,
including relationships with peers and family members as
well as an achievement in academics or other activities.[8]
Therefore, although there is enough evidence indicating
the effectiveness of the PRP, there has been little research
in this area among nonclinical college student in Iran. The
present study aimed at investigating the effects of PRP
on emotional problems of students. We hypothesize that
students in the PRP intervention will show lower levels of
emotional problems compared to control group.
Methods
The study was a randomized controlled trial and included
the pretest‑posttest control group design. No treatment is
given to the control group, while the experimental group
was given the Penn Resiliency Training. Participants
of the study were new freshmen students who were
screened by monitoring health plan via Tabriz university
counseling center. Also, Participants were re‑screened
and re‑evaluated by using depression, anxiety, and stress
scales (DASS 21). DASS 21 was designed by Lovibond
and Lovibond in 1995 to measure emotional distress in
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Vahedi, et al.: Effect of the Penn Resiliency Program on emotion
three subcategories of depression (e.g., loss of self‑esteem/
incentives and depressed mood), anxiety (e.g., fear and
anticipation of negative events), and stress (e.g., persistent
state of overarousal and low frustration tolerance). It was a
self‑reporting questionnaire with 21‑items (7‑items for each
category) based on a four‑point rating scale. To calculate
comparable scores with full DASS, each 7‑item scale
was multiplied by two. Items included, “I found it hard
to wind down,” “I was aware of dryness of my month,”
and “I couldn’t seem to experience any positive feeling
at all.” Participants were asked to rate their agreement
with each of items (in the form of statements) on a four
point Likert scale from “0 = did not apply to me at all” to
“3 = applied to me very much, or most of the time”. The
higher the score, the more severe the emotional distress
was. Internal consistencies (alpha) coefficients for each
subscale of depression, anxiety, and stress were 91, 81,
and 90, respectively.[16]
Entrance criteria for this study include no use drugs
and lack of psychiatric. After reassessing those who have
criteria to enter in the study, 30 people were assigned by
the hidden and confidential method to equal experimental
and control groups. All experimental participants were
exposing to 11 sessions in the Penn resiliency training
program. Components of the PRP include the cognitive
component that made of the ABC model, recognizing
cognitive (“thinking”) styles, cognitive restructuring,
avoiding erroneous beliefs, decatastrophizing, putting it in
perspective and the hot seat, challenging negative thoughts.
The second part in this program is social‑problem‑solving
component consist of assertiveness, relaxation, and
problem solving.
Result
The mean and standard deviation of all the variables were
reported in Table 1. The findings showed that emotional
problems were reduced from pre‑ to post‑assessment.
Because, these data did not meet the assumption of
homogeneity of regression slopes (F‑ratio = 154.57, df = 2,
P > 0.05), we conducted further analysis with multivariate
analysis of variance (MANOVA).
Table 1: The mean and SDs of the study variables in pretest and posttest between the groups
Group Sample size Statistics
Anxiety
Experimental 15 Mean 9.6
SD 4.5
Control 14 Mean 10.7
SD 4.01
SD: Standard deviation
International Journal of Educational and Psychological Researches / Vol 2 / Issue 3 / July-September 2016
Data were improved by subtracting the pretest scores from
the posttest scores then run a MANOVA on them, and
the results are presented in Table 2.
Before the parametric test of multivariate variance
analysis, Box and Leven’s tests were used in order to
regarding its hypothesis. According to Box test that
it was not significant in P ≤  0.01 for any of variables,
condition of equality is regarded in variance/covariance’s
matrixes (P = 0/029, F = 2/34, Box = 16/19). According
to Leven test and its insignificant for all of the variables,
the condition of equality is regarded in variances of
intergroup.
As it is seen in Table 2, significance test of MANOVA
showed that there is a significant difference between
experimental and control groups considering at least
one of the dependent variables (Wilks’ lambda = 0.59,
F = 11.42, P =  0.001, Eta  =  0.59). Also, the results of
the multivariate variance analysis showed the significant
decrease in the mean of scores in stress (F = 40/11),
anxiety (F = 0/81), and depression (F = 77/72). In other
words, PRP decreases emotional symptoms in experiment
group and decreased 43% stress, 45% anxiety, and 53%
depression.
Discussion
The present study aimed at investigating how the PRP
would influence the student with emotional problems.
The results of the MANOVA indicated a decrease in the
scores of emotional problems (anxiety, depression, and
stress) and its relevant dimensions for the experimental
group in the posttest. This finding is at line with Peng and
Brun, wasser, Gillham, and Kim that showed that PRP
could make better positive emotions, particularly for the
low‑resilience individuals.[17,18]
The simplest explanation for this finding is that PRP’s
effects on a wide range of risk factors, such as difficulties
and conflicts with family and friends and pessimistic
cognitive styles. PRP improve cognitive style and coping
skills. Cognitive style plays a role as a mediator variable
in PRP’s effects on depressive symptoms.[19]
Pretest Posttest
Depression Stress Anxiety Depression Stress
9.6 12.9 5.8 6.9 10.2
4.8 4.4 4.8 4.8 4.1
11 14.07 11.07 11.8 14.36
3.6 3.7 4.1 4.05 3.3
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Vahedi, et al.: Effect of the Penn Resiliency Program on emotion
Table 2: The MANOVA of the means stress, anxiety, and
depression in the experiment and control groups
Source of Sum of df Mean F Significant
variation squares square
Group
Stress 40.11 1 40.11 19.08
Anxiety 0.81 1 0.81 21.11
Depression 77.72 1 77.72 29.02
MANOVA: Multivariate analysis of variance
PRP teaches a variety of behavioral coping, problem‑solving
skills, assertion techniques, decision making, and relaxation
that succumbing to depression and its sequel. Indeed having
behavioral skills assist youths to pass this part of life without
any abnormality following or resulting from a mental
disease or injury. In addition, students have a collective
life, so those who are nonassertive usually get depressed
and experience stress and anxiety. Assertion training is
a popular treatment technique and uses a wide a variety
of interpersonal problems. The results of the research
showed that over a relatively short period of time, assertion
training has effective than traditional psychotherapy in
alleviating depression.[20,21] Also, Yamagishi et  al. found
that all participants benefited from assertion knowledge
and voluntary behavior with regard to job stress, mental
workload decreased.[22] Countless studies are reported
that problem‑solving training is a viable and promising
approach to stress management which increases positive
psychological resources (problem‑solving ability, self‑esteem,
and life satisfaction). Also, researchers reported that lower
anxiety and depression follow after sessions of relaxation
training.[23‑25] Another factor that promotes mental health
in Penn Program is decision‑making training. Indecision
causes anxiety and depression. Participating in decision
making and problem solving program enables persons
to analysis tough problems. Analyzing problems make
tough problems to operational priorities that this process
causes identify and plan for the resolution of high-priority
issues. These abilities decrease negative emotion somewhat.
In total, all of these skills could help members reduce their
negative emotions, increase their positive emotions, and
step by step acquire a positive emotion regulation style and
that positive emotions protect from impact daily stresses.[26]
This study had several notable limitations. First this
finding alone is not sufficient evidence that PRP can
produce effects in community settings over time or only
affect during the course of training. This needs a follow‑up
study to concern long‑term effects of PRP. Second
research could not examine moderators of intervention
effects, for example, PRP effects on depressive symptoms
may differ in boys and girls or preintervention levels
148
of depressive symptoms moderated the intervention
effects. Therefore, further research is required to consider
moderated factors and delayed posttests for generalizable
and reliable findings of the present study. Third limitation
that should be mentioned is that PRP trains a different
0.001
0.001
behavioral coping and problem‑solving skills, but few
0.001 studies have considered the cognitive and behavioral
program components separately. We recommend future
studies should evaluate these behavioral skills as potential
mediators of PRP’s effects. If behavioral components are
the active component, it may be recommendable to revise
the program, putting greater intense on these skills.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM‑5). United States:
American Psychiatric Association; 2013.
2. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE.
Prevalence, severity, and comorbidity of 12‑month DSM‑IV
disorders in the National Comorbidity Survey Replication. Arch
Gen Psychiatry 2005;62:617‑27.
3. Covey LS, Glassman AH, Stetner F. Cigarette smoking and major
depression. J Addict Dis 1998;17:35‑46.
4. The World Health Organization (WHO). The World Health Report
2004: Changing history. Annex Table 3: Burden of disease in
DALYs by cause, sex, and mortality stratum in WHO regions,
Estimates for 2002. Geneva: WHO; 2004. p. 126-7.
5. Najafikolyani M, Poornajm E, Jamshidi N, Karimi N, Najafikolyani V.
Stress, anxiety, depression and self Fasa University of Medical
Sciences in 2009. Fasa Univ Med Sci 2013;3:23.
6. Sarokhani D, Delpisheh A, Veisani Y, Sarokhani MT, Manesh RE,
Sayehmiri K. Prevalence of depression among university
students: A systematic review and meta‑analysis study. Depress
Res Treat 2013;2013:373857.
7. National Institute of Mental Health. Depression and college
student. NIH Publication 2012; No 12–4266. p. 2-8. Available
from: https://infocenter.nimh.nih.gov/pubstatic/NIH%2012-4266/
NIH%2012-4266.pdf.
8. American College Health Association. American College Health
Association‑National College Health Assessment II: Reference
Group Executive Summary Fall 2011. Hanover, MD: American
College Health Association; 2012.
9. Eisenberg D, Gollust SE, Golberstein E, Hefner JL. Prevalence
and correlates of depression, anxiety, and suicidality among
university students. Am J Orthopsychiatry 2007;77:534‑42.
10. Cranford JA, Eisenberg D, Serras AM. Substance use behaviors,
mental health problems, and use of mental health services
in a probability sample of college students. Addict Behav
2009;34:134‑45.
11. Weitzman ER. Poor mental health, depression, and
associations with alcohol consumption, harm, and abuse in a
national sample of young adults in college. J Nerv Ment Dis
2004;192:269‑77.
International Journal of Educational and Psychological Researches / Vol 2 / Issue 3 / July-September 2016
[Downloaded free from http://www.ijeprjournal.org on Monday, March 30, 2020, IP: 39.42.149.224]
Vahedi, et al.: Effect of the Penn Resiliency Program on emotion
12. Griswold KS, Aronoff H, Kernan JB, Kahn LS. Adolescent
substance use and abuse: Recognition and management. Am
Fam Physician 2008;77:331‑6.
13. Glantz MD, Anthony JC, Berglund PA, Degenhardt L, Dierker L,
Kalaydjian A, et al. Mental disorders as risk factors for later
substance dependence: Estimates of optimal prevention and
treatment benefits. Psychol Med 2009;39:1365‑77.
14. Garlow SJ, Rosenberg J, Moore JD, Haas AP, Koestner B,
Hendin H, et al. Depression, desperation, and suicidal ideation
in college students: Results from the American Foundation for
Suicide Prevention College Screening Project at Emory University.
Depress Anxiety 2008;25:482‑8.
15. National Center for Health Statistics. Health, United States, 2011:
With Special Feature on Socioeconomic Status and Health.
Hyattsville, MD: National Center for Health Statistics; 2012.
16. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety
Stress Scales. 2nd ed. Sydney: Psychology Foundation; 1995.
17. Peng L. Application of the Pennsylvania resilience training
program on medical students. Pers Individ Dif 2014;61‑62:47‑51.
18. Brunwasser SM, Gillham JE, Kim ES. A meta‑analytic review of
the Penn Resiliency Program’s effect on depressive symptoms.
J Consult Clin Psychol 2009;77:1042‑54.
19. Jacobson NS, Dobson KS, Truax PA, Addis ME, Koerner K,
International Journal of Educational and Psychological Researches / Vol 2 / Issue 3 / July-September 2016
Gollan JK, et al. A component analysis of cognitive‑behavioral
t r e a t m e n t f o r d e p r e s s i o n . J   C o n s u l t C l i n Ps y c h o l
1996;64:295‑304.
20. Sanchez VC, Lewinsohn PM, Larson DW. Assertion training:
Effectiveness in the treatment of depression. J Clin Psychol
1980;36:526‑9.
21. Mueen B, Khurshid M, Hassan I. Relationship of depression and
assertiveness in normal population and depressed individuals.
Internet J Med Update 2006;1:10‑7.
22. Yamagishi M, Kobayashi T, Kobayashi T, Nagami M, Shimazu A,
Kageyama T. Effect of web‑based assertion training for stress
management of Japanese nurses. J Nurs Manag 2007;15:603‑7.
23. Field T, Grizzle N, Scafidi F, Schanberg S. Massage and
relaxation therapies’ effects on depressed adolescent mothers.
Adolescence 1996;31:903‑11.
24. Turner L, Linden W, van der Wal R, Schamberger W. Stress
management for patients with heart disease: A pilot study. Heart
Lung 1995;24:145‑53.
25. Broota A, Dhir R. Efficacy of two relaxation techniques in
depression. J Pers Clin Stud 1990;6:83‑90.
26. Ong AD, Bergeman CS, Bisconti TL, Wallace KA. Psychological
resilience, positive emotions, and successful adaptation to stress
in later life. J Pers Soc Psychol 2006;91:730‑49.
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