Improving Subjective Well-Being by Using Eye Movement Desensitization and Reprocessing (EMDR) Therapy among Patients with Moderate to Severe Post-Traumatic Stress Symptoms in Jordan: A Quasi-Experimental Study

Improving Subjective Well-Being by Using Eye Movement Desensitization and Reprocessing (EMDR) Therapy among Patients with Moderate to Severe Post-Traumatic Stress Symptoms in Jordan: A Quasi-Experimental Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving Subjective Well-Being by Using Eye Movement Desensitization and Reprocessing (EMDR) Therapy among Patients with Moderate to Severe Post-Traumatic Stress Symptoms in Jordan: A Quasi-Experimental Study Rabia H. Haddad, Malena M. Price, Razan Haddad, Ashraf J. Abuejheisheh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6206142/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Numerous man-made and naturally occurring incidents raise human suffering, psychologically and mentally. Such circumstances endanger people's emotional, physical, and social well-being if left untreated or if appropriate intervention is delayed. This trial examines the effectiveness of an Eye Movement Desensitization and Reprocessing (EMDR) intervention on improving the subjective well-being of patients with Post-Traumatic Stress symptoms in Jordan. Methods The current trial employed the quasi-experimental, interrupted time series design. This includes measuring the subjective well-being (SWB) three times: once before intervention (pre-test) and twice after the intervention (post-tests), as well as immediately and one-month follow-ups for both the intervention and control group. 70 patients (35 patients for each group) were recruited from a specialized psychiatric trauma healing center in Jordan. The primary outcome variable was measured using the World Health Organization- Five Well-Being Index (WHO-5). Results The statistical analysis of repeated measures of ANCOVA showed significant differences across the three measurement times within subjects [F1, 56 = 5.18, p = 0.027, partial η2 = 0.085], the value of η2 is a large effect according to Cohen, which indicates how much of the variance in the dependent variable is explained by the independent variable. The covariate effect was not controlled and showed statistically significant differences in the SWB across the three points of measurement in both interventional and control groups (between subjects) (F = 12.41, P = 0.001). There are no statistical differences in the total mean score of SWB correlated with socio-demographics and health-related factors. Conclusion The current trial showed significant improvements in subjective well-being scores among individuals in the interventional group across all times of measurements after three sessions of EMDR therapy compared to the control group. Indicates that EMDR therapy applied to patients with PTSD was effective. may make EMDR employment sustainable in the field of psychiatric care for promoting SWB among patients experiencing post-traumatic symptoms in Jordan Post-Traumatic Stress Disorder Eye Movement Desensitization and Reprocessing Subjective Well-being Jordan Figures Figure 1 Figure 2 Introduction In recent years, psychological research has increasingly underscored positive mental health and human assets, shifting beyond a focus on dysfunction and psychopathology. This transition has been influenced, in part, by global organizations, such as the World Health Organization (WHO), which prioritizes the promotion of worldwide health. The WHO defines positive mental health as “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community” ( 1 ). This state of mental well-being has been associated with a plethora of positive outcomes, such as healthy aging and lifelong health ( 2 ), flexible and creative thinking ( 3 ), and good physical health ( 4 ). Given such benefits, subjective well-being is deemed a psychological protective factor, enabling those with greater levels of SWB to cope more effectively with stressful circumstances and decreasing their vulnerability to the adverse effects of distress ( 5 ). On the other hand, individuals with low SWB may be less equipped to manage distress, potentially leading to greater psychological dysfunction ( 6 ). One such dysfunction that can significantly affect an individual’s SWB is post-traumatic stress. In the aftermath of traumatic exposure, symptoms such as re-experiencing the traumatic event, alterations in cognition and mood, and being on guard or hypervigilant of one’s environment may occur ( 7 ). For those experiencing such symptoms, the ability to achieve psychological well-being or live with contentment and satisfaction can be significantly compromised ( 8 ). Recently, PTSS was found to be negatively associated with psychological well-being ( 8 ). Meanwhile, previous studies maintained that individuals with PTSS may engage in behaviors to avoid further harm, such as withdrawing from social connections that further diminish their SWB ( 9 ). Moreover, disaster trauma was predicted to decrease social-psychological well-being via increased withdrawal from interpersonal contacts ( 9 ). These findings underscore the vulnerability of individuals facing PTSS— not only to psychological dysfunction but also to decreased subjective well-being. As such, in the aftermath of a trauma, not only is PTSS a target for intervention, but so too is the preservation of psychological well-being. Given that psychological well-being is often compromised in individuals with PTSS, interventions should target not only PTSS but also psychological well-being. In this context, we propose Eye Movement Desensitization and Reprocessing Therapy (EMDR) ( 10 ) as one such intervention that addresses both PTSS and the enhancement of psychological well-being. During EMDR therapy, patients are instructed to confront their trauma memory while engaging in bilateral stimulation, such as eye movements, which helps reduce the vividness of the memory and associated distress. EMDR has been found to effectively attenuate symptoms of PTSD ( 11 – 13 ). In addition, emerging research suggests that EMDR may also promote psychological well-being ( 14 ). For instance, a prior study examining an EMDR-based online therapy group reported significant improvements in psychological well-being in a cohort of university students ( 14 ). While such findings are promising, they have yet to be widely replicated. Furthermore, to our knowledge, no studies have examined the effects of EMDR on psychological well-being in individual therapy settings, as opposed to group therapy. The current study attempts to bridge this empirical gap by investigating the effects of EMDR individual therapy on the subjective well-being of Jordanian patients presenting with moderate to severe PTSS. Building on previous findings, albeit limited, we hypothesize that, relative to a no-treatment control group, individuals who undergo an EMDR individual therapy intervention will experience significant increases in their subjective well-being immediately after the intervention period and one month later. The hypothesis of this trial is: There is a positive effect of using Eye Movement Desensitization and Reprocessing (EMDR) therapy on subjective well-being level, immediately and one month after receiving three sessions and when compared with the control group and controlling for specific socio-demographic and health-related factors among patients experiencing moderate to severe post-traumatic symptoms. Method Design This trial utilized the quasi-experimental, interrupted time series design. The design includes measuring the study outcomes (subjective well-being) at three points of time: Once before intervention (pre-test) and twice after the intervention (post-tests): immediately and one-month follow-up for both the interventional and control groups. This design was suitable for examining the effectiveness of eye movement desensitization and reprocessing (EMDR) intervention on patients experiencing moderate to severe post-traumatic symptoms. In addition to recognizing the differences in socio-demographics and health-related factors that contribute to the effectiveness of using EMDR therapeutics module. Participants and Setting Participants were recruited from a specialized psychiatric trauma healing center that provides cognitive behavioral and psychological services for a population with traumatic experiences. The center was established in 2013, and its main aim is to promote the knowledge and abilities of the local community and provide psychological consultation, conducting EMDR therapy and other psychotherapy approaches and run by trained and certified specialists and psychotherapists to meet current and future development challenges. The center provides psychological services through active participation, effective relationships with national and international organizations, and a wide connection with the local community. The physical structure of this center makes it appropriate for this study in that the center consists of many private, comfortable, and large therapeutics rooms that allow for effective interaction during the sessions, and this is appropriate for conducting EMDR sessions. Inclusion criteria included: For eligibility, ( 1 ) Patients must be 18 years or older. ( 2 ) have a likelihood of Moderate to Severe Post-Traumatic Stress Symptoms score from a screening instrument. ( 3 ) Patients have experienced a traumatic episode within the recent six months, such as the death of a family member or the loss of loved ones. And ( 4 ) had no prior experience with EMDR therapy. Exclusion criteria included: ( 1 ) Individuals with acute cognitive or intellectual disabilities may struggle to complete study questionnaires. ( 2 ) Medical health histories may show visual impairment or eye pathology that prevents full participation in the EMDR therapeutics sessions. Sample size This trial included 70 participants; the total was approached and recruited according to symptoms severity and were experiencing moderate to severe post-traumatic symptoms from the assigned center. A power analysis has been performed using the G.Power program (version 3.0.10) ( 15 ) to estimate the minimum sample size to achieve a fully powered sample and to minimize errors in statistical tests. The minimum sample size needed was 62 participants, accounting for a medium effect size of 0.3, an alpha 0.05 level of significance (two-tailed), power of 0.8, two groups, and three points of data collection. Considering 10% of the dropouts, 70 patients were recruited after screening for eligibility. The 70 patients were divided into two groups (35 patients in the interventional group and another 35 patients in the control group). The recruitment process was continued until the desired sample size was reached. Data Collection Procedure The data collection process started after the ethical committees approved it. All participants provided informed consent in compliance with the IRB. The researchers met the targeted center director. Then, the researchers explained the nature of the study, the purpose, the EMDR intervention, the implementation process and required data, and all possible resources needed for the study. The sample was recruited using a multi-strategic sampling technique. Initially, convenience sampling was employed to recruit the participants, and then random assignment was conducted to assign them to control and interventional groups. Using the accessible database and medical records of the target trauma healing center, the researcher approached and invited patients experiencing moderate to severe symptoms to participate in this trial. Patients who showed interest in participation were screened for eligibility. Participants were administered a series of telephone-based questionnaires indexing the severity of PTSS and subjective well-being before random assignment to groups (T0), immediately following the third session of the EMDR therapeutics module (T1), and one month after the EMDR therapeutics module was accomplished (T2). The study took place over a total of 10 weeks. Participants assigned to the intervention group engaged in three weekly, 90-minute individual EMDR therapy sessions conducted by a licensed and expert EMDR therapist. After T2, those participants in the control group were allowed to be involved in the three weekly, 90-minute individual EMDR therapeutics sessions. EMDR Therapeutics Module The EMDR therapy module was established by modifying the published clinical EMDR protocol (Shapiro, 2017), and eight EMDR therapeutic steps were accepted and approved. In the first phase, a complete assessment and history taking were conducted. This step consists of gathering the patient’s history and specifying the traumatic experience that led to their present distressed status. In the second step, rapport and a therapeutic relationship between the therapist and patient were established, and the EMDR therapy module was described to patients. The patient also had the chance to ask questions regarding the EMDR therapy module throughout this step. In the third step, the patient and the EMDR therapist reviewed the traumatic episodes that the patient had experienced throughout their life, as well as rated the subjective distress they felt when reliving this event on a scale of 1 to 10. Based on their SUDs, patients can select which traumatic event to highlight in succeeding EMDR sessions, named the target event. In the fourth step, the desensitization stage, the therapist used bilateral stimulation (BLS), in which the patient erudite regarding side-by-side eye movements, sounds, and taps though concentrating on the traumatic incident. BLS consisted of 24 two-way arrangements using finger movements. Each arrangement continued for one second, and the patient and therapist were separated by one meter throughout the session. In the fifth step, the installation stage, patients were requested to imagine positive perceptions or thoughts they may associate with the target traumatic event pending it touched true. In the sixth step, the body scan stage, after replacing the positive thought, patients were requested to imagine both the positive cognition and target event in their mind while directing attention to their bodies and responding with BLS if needed. In the seventh step, the closure stage, the therapist helped the patient return to a state of comfort. In the final step, the reevaluation stage, the EMDR therapist and patient communicated about the newly discussed and recently processed target traumatic event. They confirmed that their distress over this experience is minimal while their positive cognition is significant. This phase also involved determining future treatment directions. Patients in the control group did not receive any EMDR therapeutic sessions. They accomplished study questionnaires before the intervention, immediately after the third EMDR therapy session in which the intervention group was involved, and one month after the EMDR therapy module. Instruments To ensure accessibility for all participants, an Arabic version of the study measures was used, aligning with the participants’ native language. Self-report measures assessed the primary study variable, including the subjective well-being level. Instruments assessing participants’ sociodemographic and health-related factors were also administered. Sociodemographic and Health-Related Questionnaire Sociodemographic, lifestyle, and health-related variables were assessed by a researcher-developed questionnaire. This instrument collected information on participants’ age, sex, marital status, educational level, working status, monthly salary, smoking status, presence of chronic physical illness(es), history of mental illness(es), and receiving psychological intervention or psychiatric medications. The World Health Organization- Five Well-Being Index The World Health Organization-Five Well-Being Index ( 16 , 17 ) was administered to assess participants’ subjective well-being. Participants were asked to indicate how frequently they experienced a series of five statements over the last two weeks. Example statements included, “I have felt cheerful and in good spirits” and “I have felt calm and relaxed.” Each item was rated 0 (at no time), 1 (some of the time), 2 (less than half of the time), 3 (more than half of the time), 4 (most of the time), and 5 (all of the time). Items were summed to obtain a total raw score ranging from 0 to 25. This raw score is then multiplied by 4 to calculate a final score ranging from 0 to 100, with higher scores indicating greater subjective well-being. Cronbach's alpha for the WHO-5 in the current study was 0.89, indicating high reliability. Data Analysis Preliminary data screening and cleaning process conducted before analysis of data. The collected data was analyzed using SPSS version 26.0, IBM Crop, 2017 ( 18 ). A repeated measures ANOVA test was used to address our main question about group differences in SWB. Time (i.e., T0, T1, and T2) was a constant within-subjects factor, while group (i.e., interventional vs. control) was a fixed between-subjects factor. The homogeneity of variances was examined using Levene's test. To examine for the potential impact of sociodemographic and health-related variables on research results, a repeated measures ANCOVA test was used. Each model included sociodemographic and health-related factors as covariates, with time fixed within subjects and group fixed between subjects. Ethical Consideration The first step in conducting this study was to obtain the Institutional Review Board (IRB) approval from the Scientific and Ethics Research Committee at the School of Nursing at the University of Jordan. which granted permission with a reference number of (2348/2023/1). Following this approval, approvals from the Ethics Committees of the accessible organization were then obtained. with a reference number (50/KCBS/2023). Permissions to approach the patients for data collection were also obtained from the administration of the selected center and the managers of the targeted departments to facilitate the process of data collection. Furthermore, all eligible patients were invited to participate, and those who expressed an interest in the study were approached and given relevant information about the study's purpose and significance, after which they were given consent to sign and approve their participation. Confidentiality and voluntary participation were assured and sustained. Results Sample Characteristics During this trial, 70 participants from the intervention (n = 35) and control (n = 35) groups were assessed. The intervention group's mean age was 30 years (SD = 9.62), while the control group's average age was 30 years (SD = 7.92). In terms of sex, there were 18 (25.7%) males and 17 (24.3%) females in the intervention and control groups, respectively; 19 (27.1%) females and 16 (22.9%) males. Furthermore, the majority of the participants in the intervention group (n = 18) and the control group (n = 17) were single, with 13 (50%) in each group married. In terms of educational background, 10 (14.3%) of the participants in the intervention group and 11 (15.7%) in the control group had completed high school education, and 12 (17.1%) in the intervention group and 13 (18.6%) in the control group they held the first university degree. In terms of Employment Status, 13 (18.6%) of participants in the intervention group and 16 (21.4%) in the control group were employed and working full-time, whereas 12 (17.1%) in the intervention group and 10 (14.3%) in the control group were not currently employed. For more details, see Table 1, which presents participants' sociodemographic characteristics. Table (1): Participants’ Sociodemographic Characteristics ( N = 70) Intervention Group Control Group Variable Age M (SD) 30 (9.62) 30 (7.92) N % N % Sex Male 18 25.7 16 22.9 Female 17 24.3 19 27.1 Marital Status Single 18 25.7 17 24.3 Married 13 18.6 13 18.6 Divorced 3 4.3 5 7.1 Widow 1 1.4 0 0 Educational Background Less than high school 6 8.6 1 1.4 High school 10 14.3 11 15.7 Diploma 3 4.3 6 8.6 Bachelor 12 17.1 13 18.6 Postgraduate 4 5.7 4 5.7 Employment Status Not working 12 17.1 10 14.3 Yes and full-time 13 18.6 15 21.4 Yes and part-time 10 14.3 10 14.3 Retired 0 0 0 0 Salary Status Low 13 18.6 13 18.6 Moderate 16 22.9 20 28.6 Higher 6 8.6 2 2.9 M: mean, SD; standard deviation, N: number, %: percentage This table represents the sociodemographic characteristics of the participants in both groups control and interventional. Table (2) represents the participants' daily lifestyles and health-related factors. In terms of smoking status, 15.7% (n = 11) in the intervention group and 21.4% (n = 15) in the control group are smokers, and 28.6% (n = 20) in the intervention group and 27.1% (n = 19) in the control group they are non-smokers. Additionally, 25.7% ( n = 18) of the same in both groups reported a history of at least one chronic physical illness, and 21 (30%) in the intervention group and 10 (14.3%) had a positive family history of mental illnesses. In terms of engaging previously with other forms of psychotherapy, 25 (35.7%) were the same in each group. The participants reported that they had not received any type of psychotherapy previously. In addition, 9 (12.9%) in the intervention group and 11 (15.7%) in the control group revealed that they were now using psychiatric medications. Table (2): Participants' Daily Lifestyles and Health-Related Factors ( N = 70) Intervention Group Control Group Variable n % N % Smoking Status Smoker 11 15.7 15 21.4 Non-Smoker 4 5.7 1 1.4 Quit Smoking 20 28.6 19 27.1 Hx of chronic physical illness Yes 18 25.7 18 25.7 No 17 24.3 17 24.3 Hx of mental illness or symptoms Yes 27 38.6 34 48.6 No 8 11.4 1 1.4 Family history of mental illness Yes 21 30.0 10 14.3 No 14 20.0 25 35.7 Hx of psychological intervention Yes 10 14.3 10 14.3 No 25 35.7 25 35.7 Hx of psychiatric medications Yes 9 12.9 11 15.7 No 26 37.1 24 34.3 Hx: History, N: number, %: percentage. This table represents Daily Lifestyles and Health-Related Factors in both groups control and interventional. Variables of the study Subjective Well-being When comparing the Subjective Well-being SWB of Participants in intervention and control groups, the statistical analysis showed that the overall mean score of SWB for all study participants (n = 70) at baseline (Before intervention T0) was 4.24 (SD = 2.63) ranging from (1 to 15). of them, 85.7% (n = 60) had scores ranging from (1 to 7) indicating the participants have had a low score in well-being. To compare SWB among participants in both intervention and control groups, the independent samples t-test was conducted. At the first point of measurement, before conducting EMDR intervention, the overall mean score of SWB at baseline (T0) among participants in the intervention group was (4.51, SD = 2.77), and participants in the control group at baseline was (3.97, SD = 2.49). There was no significant mean difference between the two groups (t = 0.86, p = 0.93). The second point of measurement was immediately after conducting 3 sessions of EMDR intervention (TI), participants in the control group had a SWB mean score of 5.29 (SD = 2.62) ranging from 2 to 10 with 82.9% (n = 29) of participants had a very low score in SWB. The mean score of participants in the interventional group increased to 12.03 (SD = 4.04), ranging from 3 to 21, and the majority of participants had an SWB mean score of 71.51% (n = 25), ranging from 10 to 21, indicating improvement in their well-being score. These mean differences were significant (t = 8.29, P = 0.03), with participants in the interventional group and their SWB scores improved. At the third point of measurement (TII), one-month follow-up post-EMDR intervention, the mean score of the SWB in the control group was 7.11 (SD = 2.75), ranging from 2 to 12 with almost 85.7% (n = 30) of participants having very low SWB scores. On the other hand, the mean score of SWB participants in the interventional group increased to 21.54 (SD = 1.82), ranging from 18 to 25. The analysis showed that there were significant mean differences between the two groups with (t = 25.87, P = .007), which indicates that the SWB scores among participants in the intervention group had significantly increased and improved than participants in the control group. See Table (3( Table (3): Subjective Well-being differences between Interventional and Control Groups at all points of measurement Group Interventional Control Independent t-test M SD M SD t-test P Mean Difference Subjective Well-being T0 4.51 2.77 3.97 2.49 0.86 0.928 0.54 Subjective Well-being T1 12.03 4.04 5.29 2.62 8.29 0.038 6.74 Subjective Well-being T2 21.54 1.82 7.11 2.75 25.87 0.007 14.43 M: mean, SD: standard deviation, P values ≤ 0.05 3.3. Bivariate Analysis 3.3.1. Repeated Measures Mixed ANOVA for the Subjective Well-being A Repeated Measures Mixed ANOVA test has been used to assess if SWB scores improved during and after the EMDR intervention. Sphericity is the main assumption for using repeated measures mixed ANOVA, which indicates that all variances of the different points of measurements are essential to be homogenous. To investigate whether the sphericity assumption was violated, the Mauchly test was used; the results were not significant (Mauchly's W = .972, 2 ( 2 ) = 1.885, p = .390), as well as, the Greenhouse-Geisser value of .973 which indicated that the sample variance/covariance matrix did not deviate significantly from sphericity; however, since the Greenhouse-Geisser value was near 1.00, no correction was needed to the degrees of freedom that had been used to assess the significance of the F ratio. The results of repeated measure ANOVA (see Table 4) showed that there were significant differences across the three times of measurement within the subject (F 1, 68 =827.32 p < 0.001). Also, the Time of Measurement * Group was significant (F 1, 68 =392.05 p < 0.001), and there were significant differences between groups (F 1, 68 =196.3 p < 0.001), indicating that there is a significant increase in SWB scores after EMDR sessions. This supports the hypothesis of the study that the EMDR intervention is effective and can be used successfully to improve the level of SWB among PTSD patients. The analysis also showed that there is a significant effect of EMDR sessions on the level of SWB (Wilk’s Lambda = .076, (F 2, 67 = 408.08, p = > .001). Additionally, the relevant effect size (partial η2) was 0.92, demonstrating that the EMDR sessions were responsible for most of the variance in SWB. The EMDR intervention was effective in improving the level of SWB among PTSD patients. Table (4): Overall Results of Repeated Measures Mixed ANOVA for the Subjective Well-being across the three observations within-subject and between-subject Source Df SS MS F P value Effect size η² Within-subject Time of Measurement 1 3560.3 3560.3 827.32 < .001 0.924 Time of Measurement * Group 1 1687.1 1687.1 392.05 < .001 0.852 Residuals (errors) 68 292.6 4.3 Between-subject Groups 1 2750.5 2750.5 196.3 <.001 0.743 Residuals (errors) 68 953 14.01 • df : degree of freedom; SS: sum of squares; MS: mean square; Significant at α = 0.05 This table represents the overall results of Repeated Measures Mixed ANOVA for the Subjective Well-being across the three observations within-subject and between-subject. As indicated in Table 4, the significant F test means differences or changes within the three points of measurement and between the groups. As the EMDR intervention took place after the baseline, the intervention showed a positive effect on increasing the level of SWB at Time I and Time II; see Figure (1) below. Testing the SWB mean differences among the intervention group across all points of measurement, a post-hoc pairwise comparison test was obtained by using the Bonferroni test to determine where the differences occurred. and the result showed significant differences between the baseline and each point of time (T0, TI, and TII) with (p = < .001). Based on the result; there is a statistically significant difference (p = < .001) in the mean of SWB scores after three sessions of EMDR interventions at (TI ) and the mean of SWB before the EMDR sessions compared with the baseline (T0) and the control group, as well as there is a statistically significant difference (p = < .001) in the mean of the SWB after one month follow up post three sessions of EMDR intervention (TII) and the mean of SWB before EMDR sessions compared with the baseline (T0) and the control group. Consequently, this means that the Psychological Well-being after EMDR interventions for patients experiencing moderate to severe symptoms of PTSD was increased significantly from the baseline in both measurement points (TI and TII). See Table (5) Table (5): Pairwise comparison of Subjective Well-being means differences across all times of measurement in the Interventional group (N = 35) and Control Group (n = 35) Time (I) Group (J) Group Mean Difference (I-J) SE P 95% Confidence Interval for Difference Lower Upper T0 Interventional Control .543 .630 .392 − .713 1.799 Control Interventional − .543 .630 .392 -1.799 .713 T1 Interventional Control 6.743 .814 < 0.001 5.119 8.367 Control Interventional -6.743 .814 < 0.001 -8.367 -5.119 T2 Interventional Control 14.429 .558 < 0.001 13.316 15.542 Control Interventional -14.429 .558 < 0.001 -15.542 -13.316 Significant at α = 0.05 SE: standard error, significance at P ≤ 0.05, T0: the time of baseline, T1: Immediately after the intervention, T2: One month follow up after the intervention. This table represents Pairwise comparison of Subjective Well-being means differences across all times of measurement in the Interventional group (N = 35) and Control Group (n = 35). 3.3.1. Repeated Measures Mixed ANCOVA for Subjective Well-being with controlling for specific socio-demographics and health-related factors A repeated measure mixed ANCOVA was used to examine the hypothesis which states that “Exposing individuals diagnosed with Post-Traumatic Stress Disorder and experiencing moderate to severe symptoms after receiving three sessions of EMDR intervention will increase the SWB level with controlling for specific socio-demographic and health-related factors”. The mean total scores of SWB increased gradually across all three points of time among PTSD patients in the interventional group, before EMDR intervention T0 (M 4.51, SD = 2.77) and continuing immediately after three sessions of EMDR intervention TI (M = 12.03, SD 4.04), with PTSD patients' the SWB increased at one month of EMDR intervention TII (M = 21.54, SD 1.82). After meeting the assumptions, a repeated measure analysis of covariance (ANCOVA) mixed design test was used to see if there were significant differences between dependent variables SWB at time T0, TI, and TII after controlling for particular socio-demographic and health-related factors. Sphericity : Mauchly's test was used to assess the assumption of sphericity. To investigate whether the sphericity assumption was violated, the Mauchly test was used; the results were not significant: Mauchly's W = .989, 2 ( 2 ), p = .74, as well as the also the Greenhouse-Geisser value of .989 revealed that the sample variance/covariance matrix did not deviate significantly from sphericity; however, since the Greenhouse-Geisser value was near to 1.00, no correction was applied to the degrees of freedom used to assess the significance of the F ratio. The results of a repeated measure analysis of covariance (ANCOVA) mixed design test (including interaction) between dependent variable SWB at time 1(T0), time 2(TI), and time 3(TII) and covariance variables (specific socio-demographics and health-related factors: (age, sex, marital status, educational level, working status, monthly salary, smoking status, presence of chronic physical illness(es), history of mental illness(es), and receiving psychological intervention or psychiatric medications). The Null hypothesis was rejected since the overall result showed that there is a significant difference between the SWB at time 1(T0), time 2(TI), and time 3(TII). After controlling for specific socio-demographics and health-related factors within subjects [F1, 56 = 5.18, p = 0.027, partial η2 = 0.085], the value of η2 is a large effect according to Cohen, which indicates how much of the variance in the dependent variable is explained by the independent variable. Furthermore, the results of the final ANCOVA were that the covariate effect was not controlled and showed that there are statistically significant differences in the SWB across the three points of measurements in both interventional and control groups (between subjects) (F = 12.41, P = 0.001). There was no relationship between the SWB and socio-demographics and health-related factors. (see Table 6), there is a statistically significant difference in F value after adjusting the covariate. Finally, there are no statistical differences in the total mean score of SWB correlated with socio-demographics and health-related factors. Levene’s test for homogeneity of variance was used and showed that no significant violation was found [ F 1, 68 = 2.66, P = 0.608]. See Figure ( 2 ) Figure 2: Subjective Well-being means scores across the three points of measurement while controlling for specific socio-demographic and health-related factors. This figure represents the subjective well being with controlling for specific socio-demographics and health-related factors and across three points of measurements. The blue line represents interventional group and the red line represent the control group. It seems from the Fig. 2 an improvement in the subjective wellbeing scores in the interventional group at second and the third points of measurements over the time. Table (6). Result of Repeated Measures Mixed ANCOVA Concerning the Subjective Well-being with controlling for specific socio-demographics and health-related factors Source SS MS F P value Effect size η² Subjective Well-being at T0, T1 and T2 22.85 22.85 5.18 0.03 0.09 SWB* Age 1.16 1.16 0.30 0.61 0.01 SWB* Sex 0.00 0.00 0.00 0.99 0.00 SWB* Marital Status 1.58 1.58 0.36 0.60 0.01 SWB* Educational Background 8.19 8.19 1.86 0.18 0.03 SWB* Employment Status 5.22 5.22 1.86 0.28 0.02 SWB* Salary 0.65 0.65 0.15 0.70 0.00 SWB* Smoking Status 1.25 1.25 0.28 0.60 0.00 SWB* Hx of chronic physical illness 3.01 3.01 0.70 0.41 0.01 SWB* Hx of mental illness or symptoms 13.37 13.37 3.03 0.90 0.05 SWB* Family Hx of Mental Illness 2.89 2.89 0.66 0.42 0.01 SWB* Hx of Psychological Intervention 1.89 1.89 0.43 0.51 0.01 SWB* Hx of Psychiatric Medications 3.09 3.09 0.70 0.41 0.01 Residuals (errors) 246.9 4.41 Subjective Well-being at T0, T1 and T2 185.27 185.27 12.41 < .001 0.18 Age 1.58 1.58 0.11 0.75 0.00 Sex 17.90 17.90 1.20 0.28 0.02 Marital Status 0.222 0.22 0.02 0.90 0.00 Educational Background 8.549 8.55 0.57 0.45 0.01 Employment Status 5.878 5.88 0.39 0.53 0.01 Salary 7.649 7.65 0.51 0.48 0.01 Smoking Status 1.579 1.58 0.11 0.75 0.00 Chronic Physical Illness 3.521 3.52 0.24 0.63 0.00 Mental Illness or Symptoms 6.273 6.27 0.42 0.52 0.01 Family Hx of Mental Illness 4.716 4.72 0.32 0.58 0.01 Hx of Psychological Intervention 30.441 30.44 2.04 0.16 0.04 Hx of Psychiatric Medications 3.121 3.12 0.21 0.65 0.01 Groups 1675.42 1675.42 112.19 < .001 0.67 SWB: Subjective wellbeing, Hx: History, SS: Sum of squares, MS: mean square, Significance at ≤ 0.05. This table represents the result of Repeated Measures Mixed ANCOVA concerning the Subjective Well-being with controlling for specific socio-demographics and health-related factors. Discussion The findings of this trial showed that patients who were exposed to EMDR, in general, across the three measurement times, had significant and positive improvement in their SWB scores. SWB levels, among participants of the current study, at baseline in the interventional group were slightly higher than the control group. It is noted, further, that the interventional group had a significantly lower mean difference in SWB scores than the control group immediately after the intervention and one month later. On the other hand, at time 2 (immediately post-intervention), there were also significant differences despite the increase in SWB levels of the interventional group. It has been found that a significant mean increase in the post-test and one-month follow-up among individuals in an interventional group compared to their scores at baseline. In contrast, no significant increase was found among individuals in the control group across the mentioned times. Posing EMDR intervention caused a significant increase in the level of SWB, and that improvement was in favor of interventional groups over the control group. In other words, the intervention has significantly improved the score of the interventional group compared to the control group, supporting the higher positive differences between the two groups before and after EMDR intervention (T0, TI, and TII). However, at TI (immediately after three sessions of EMDR intervention), there were significant differences between the interventional and control groups and improved SWB scores in the interventional group. In contrast, no significant decrease was found among individuals in the control group across the mentioned times. The positive outcomes of the EMDR intervention and the study results could be related to the methods used in this study. The participants in this study were all able to strictly adhere to the intervention protocol, which allowed better benefits and interaction with the therapies. However, the current study findings agree with ( 19 ), who reported that using EMDR therapy can be an effective treatment for patients experiencing a psychological crisis who are suffering from PTSD, subsequent in significant enhancements in their SWB scores. In addition, there were positive and fast improvements in SWB scores after fewer sessions. This confirmed the feasibility of EMDR intervention. Also, Studies have consistently shown that EMDR is a safe, feasible, and effective intervention among individuals suffering from PTSD (Paauw et al., 2023). In addition, EMDR therapy has been relatively underutilized as a treatment for PTSD patients. In contrast, Kraiss et al. (2022) ( 20 ) reported that psychological interventions play a significant role in promoting overall well-being. Based on current study findings, having the score statistically different at time Ⅰ and time II compared to baseline scores in SWB infers that EMDR is a fast and practical intervention in the treatment process duration to show its significant effect. Such results are also alarming the psychotherapists aiming at using EMDR, which requires sustainable promoter sessions, and such an interventional approach requires sustainable promoter sessions and cannot be done once and ever. Furthermore, Yilmaz Dinç and Sapmaz ( 14 ) conducted a clinical trial to evaluate the effectiveness of EMDR among individuals with trauma pictures. Their study finding revealed that EMDR intervention was not only effective in managing the severity of symptoms but was also proved to be effective concerning resilience and well-being. In the current study, multiple sociodemographic and health-related characteristics were examined, including age, sex, marital status, educational background, employment status, salary, smoking status, chronic illnesses, psychiatric history, positive family history of mental illnesses, psychological treatment, and psychiatric medications. The null hypothesis was rejected since the overall result showed that there is a significant difference between SWB at three measurement times, after controlling specific socio-demographic and health-related factors. Also, the results of the final results showed that the covariate effect was not controlled and showed that there are statistically significant differences in SWB across the three points of measurement in both interventional and control groups. There is a statistically significant difference after adjusting the covariate. Finally, there are no statistical differences in the total mean score of SWB correlated with socio-demographics and health-related factors. In the existing literature, Gonzalez-Vazquez, Rodriguez-Lago ( 21 ) conducted a study in 2018 to assess the effectiveness of EMDR intervention among patients with PTSD. Their results showed positive outcomes through improvement in well-being scores among the EMDR group after intervention. This concludes that the differences caused due to EMDR intervention over the one month in the interventional group compared to the baseline were much more statistically significant. comprehensible than that of the control group across the mentioned times, such results indicated the positive effect of EMDR interventional sessions on SWB scores of individuals. Although the components of EMDR intervention would naturally lead to the enhanced SWB level of the participants. Moreover, the heart of EMDR intervention encompasses the change of the stored traumatic experiences into an adaptive resolution and replacing them with positive feelings and emotions that lead to improvement in the psychological status of patients ( 22 – 24 ). One of the strengths of this study is being the first to investigate the effectiveness of EMDR intervention in Jordan. In addition, this study supports the assertions that the components of EMDR interventions are also effective among PTSD patients who experience moderate to severe symptoms of PTSD. This adds to the body of knowledge that the EMDR intervention showed a positive effect on improving the levels of SWB at Time I and Time II. Hence, the significant increase in the SWB scores among individuals in the interventional group across all times of measurements compared to the control group indicates that EMDR intervention applied to individuals with PTSD was effective. Eventually, the consequences of PTSD and its handling concerning psychological, physical, and social well-being are indicators of how the disorder affects functioning and the overall quality of life. may make EMDR intervention implementation sustainable in the field of psychiatric care for promoting SWB among patients experiencing moderate to severe symptoms of PTSD. Conclusions The current trial showed significant improvements in subjective well-being scores among individuals in the interventional group across all times of measurements after three sessions of EMDR therapy compared to the control group. Indicates that EMDR therapy applied to patients with PTSD was effective. may make EMDR employment sustainable in the field of psychiatric care for promoting SWB among patients experiencing post-traumatic symptoms in Jordan. This study offers solutions to decrease the gap in the empirical validation of treatment methods, provide a comprehensive assessment of EMDR effectiveness, and support their implementation with solid evidence. The findings of this study are anticipated to have wide-ranging impacts on various stakeholders within the healthcare system, including nurses, patients, healthcare leaders, and agencies in Jordan. Abbreviations EMDR Eye Movement Desensitization and Reprocessing PTSD Post-Traumatic Stress Disorder SWB Subjective Well-being PTS Post-Traumatic Symptoms Declarations Source(s) of support/funding: This review was not funded by a specific project grant. Ethics approval and consent to participate: Prior to their involvement in the trial, all subjects provided written informed consent. The Institutional Review Board (IRB) and the research and ethics committee at the assigned community-based center approved this study, which has the reference number 50/KCBS/2023. All human research procedures were carried out under the moral standards of the committee responsible for human experimentation (institutional and national), as well as the Helsinki Declaration of 1964, as revised in 2009, and its amendments. Consent for publication is not applicable. Competing interests: The authors declare that they have no competing interest Clinical Trial Number: Not Applicable Contributors RHH, AH: Conceptualization, methodology, formal analysis, validation, investigation, writing- original draft preparation, visualization, writing- reviewing and editing. MP, RH, YA, AA: Methodology, data collection, and RH, AA: writing-reviewing and editing the final manuscript. The authors read and approved the final manuscript. References WHO, Mental. health. wwwwhoint https://wwwwhoint/news-room/fact-sheets/detail/mental-health-strengthening-our-response . 2022. Ortega FB, Lee D-c, Sui X, Kubzansky LD, Ruiz JR, Baruth M, et al. Psychological well-being, cardiorespiratory fitness, and long-term survival. Am J Prev Med. 2010;39(5):440–8. Bless H, Mackie DM, Schwarz N. Mood effects on attitude judgments: independent effects of mood before and after message elaboration. J Personal Soc Psychol. 1992;63(4):585. !!! INVALID CITATION !!! {}. Layous K, Chancellor J, Lyubomirsky S. Positive activities as protective factors against mental health conditions. J Abnorm Psychol. 2014;123(1):3. Huppert FA. Psychological well-being: Evidence regarding its causes and consequences. Appl psychology: health well‐being. 2009;1(2):137–64. APA. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. American psychiatric association; 2013. Ala S, Ramos-Campos F, Relva IC. Symptoms of post-traumatic stress and mental health in a sample of university students: the mediating role of resilience and psychological well-being. Eur J Invest Health Psychol Educ. 2024;14(8):2262–81. Kaniasty K. Predicting social psychological well-being following trauma: The role of postdisaster social support. Psychological Trauma: theory, research, practice, and policy. 2012;4(1):22. Shapiro F. Eye movement desensitization: A new treatment for post-traumatic stress disorder. J Behav Ther Exp Psychiatry. 1989;20(3):211–7. Carletto S, Malandrone F, Berchialla P, Oliva F, Colombi N, Hase M, et al. Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis. Eur J psychotraumatology. 2021;12(1):1894736. Chen Y-R, Hung K-W, Tsai J-C, Chu H, Chung M-H, Chen S-R, et al. Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: A meta-analysis of randomized controlled trials. PLoS ONE. 2014;9(8):e103676. Haddad RH, Alhusamiah BK, Haddad RH, Hamdan-Mansour AM, Abuhashish YH, Alshraideh JA. The effectiveness of using eye movement desensitization and reprocessing therapy on reducing the severity of symptoms among individuals diagnosed with post-traumatic stress disorder: a systematic review of literature to highlight the standardized therapy-based interventional protocol. Mental Health Social Inclusion. 2024;28(6):1411–31. Yilmaz Dinç S, Sapmaz F. The effect of eye movement desensitization and reprocessing-based online group counseling for university students: Psychological need satisfaction, psychological resilience, psychological well-being, and small ‘t’trauma. Psychological Trauma: Theory, Research, Practice, and Policy.; 2023. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91. Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167–76. Organization WH, editor. Wellbeing measures in primary health care/the DepCare Project: report on a WHO meeting: Stockholm, Sweden, 12–13 February 1998. : report on a WHO meeting: Stockholm, Sweden, 12–13 February 1998; 1998. IBM Corp N. IBM SPSS statistics for windows. IBM corp Armonk, NY; 2017. Proudlock S, Peris J. Using EMDR therapy with patients in an acute mental health crisis. BMC Psychiatry. 2020;20:1–9. Kraiss J, Redelinghuys K, Weiss LA. The effects of psychological interventions on well-being measured with the Mental Health Continuum: a meta-analysis. J Happiness Stud. 2022;23(7):3655–89. Gonzalez-Vazquez AI, Rodriguez-Lago L, Seoane-Pillado MT, Fernández I, García-Guerrero F, Santed-Germán MA. The progressive approach to EMDR group therapy for complex trauma and dissociation: A case-control study. Front Psychol. 2018;8:2377. Shapiro F, Kaslow FW, Maxfield L. Handbook of EMDR and family therapy processes. Wiley Online Library; 2007. Shapiro F. Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. Guilford Press; 2001. Shapiro F. Eye movement desensitization and reprocessing (EMDR) and the anxiety disorders: Clinical and research implications of an integrated psychotherapy treatment. J Anxiety Disord. 1999;13(1–2):35–67. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6206142","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":445297269,"identity":"1e676e1c-0b01-480e-ae05-6e1f9511a8b2","order_by":0,"name":"Rabia H. Haddad","email":"","orcid":"","institution":"Philadelphia University","correspondingAuthor":false,"prefix":"","firstName":"Rabia","middleName":"H.","lastName":"Haddad","suffix":""},{"id":445297271,"identity":"f8857af4-11f6-4538-8662-789118cfc32f","order_by":1,"name":"Malena M. Price","email":"","orcid":"","institution":"University of Miami. Florida","correspondingAuthor":false,"prefix":"","firstName":"Malena","middleName":"M.","lastName":"Price","suffix":""},{"id":445297272,"identity":"c459d16f-cca7-402e-92b2-b5de62195054","order_by":2,"name":"Razan Haddad","email":"","orcid":"","institution":"Jadara University","correspondingAuthor":false,"prefix":"","firstName":"Razan","middleName":"","lastName":"Haddad","suffix":""},{"id":445297274,"identity":"7b146086-0554-4aa5-bb5e-bf218d0c2ddc","order_by":3,"name":"Ashraf J. Abuejheisheh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIie2Qv2rDMBCHTxjcRU5WB1r7FWQM7RDIszgY6iUZugRDChEENBW6dsvQF3Dp0lFGYC8Cr1pLILMyeimVl0L/iGYsVB/8kDj0obsDcDj+KBxRiIaLLgHOzUlMvF+VFHxADxIAn6SAUeb0ZGV8/1jX/cus2O22r5TDDI9U/qyhnM6pRQnVIROBzJdV4ydGyfFEXa9CkIVVASWJQMxbVj5c7TV4mKjFJSAmrEqsOl33bFPE7OxoftkMSqrRm10h3R3wgIkMGjw0JgaFhIjalUT5RASsTapmcUM5afFEHlZh1hSpTYk6sT/2bB3H2/aJ8nIdjVqzMX07vbCOH2af+jThJtkPLz8Y86+VbwWHw+H477wDURtl2+oD2K0AAAAASUVORK5CYII=","orcid":"","institution":"Al-Quds University","correspondingAuthor":true,"prefix":"","firstName":"Ashraf","middleName":"J.","lastName":"Abuejheisheh","suffix":""},{"id":445297275,"identity":"a2075247-5e27-4cef-9e3d-854584fe1ccd","order_by":4,"name":"Younis H. Abuhashish","email":"","orcid":"","institution":"The Jordanian Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Younis","middleName":"H.","lastName":"Abuhashish","suffix":""},{"id":445297277,"identity":"3d297f3f-4f4e-4725-95a4-81031d427a41","order_by":5,"name":"Ayman M. Hamdan-Mansour","email":"","orcid":"","institution":"the University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Ayman","middleName":"M.","lastName":"Hamdan-Mansour","suffix":""}],"badges":[],"createdAt":"2025-03-11 19:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6206142/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6206142/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81932233,"identity":"b2f7ce8b-5581-4796-8f0c-48bb9019880f","added_by":"auto","created_at":"2025-05-05 05:34:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16783,"visible":true,"origin":"","legend":"\u003cp\u003eSubjective well-being means scores across the three points of measurement without controlling covariates. The blue column represents interventional group and the red column represent the control group. It seems from the figure 1 an improvement in the subjective well being scores in the interventional group at second and the third points of measurements.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6206142/v1/eda27be0853a0c64cf962956.png"},{"id":81935484,"identity":"003bf949-0f8b-4f6a-8174-c283c5b27a27","added_by":"auto","created_at":"2025-05-05 06:00:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":70948,"visible":true,"origin":"","legend":"\u003cp\u003eSubjective Well-being means scores across the three points of measurement while controlling for specific socio-demographic and health-related factors. This figure represents the subjective well being with controlling for specific socio-demographics and health-related factors and across three points of measurements. The blue line represents interventional group and the red line represent the control group. It seems from the figure 2 an improvement in the subjective wellbeing scores in the interventional group at second and the third points of measurements over the time.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6206142/v1/2c9b74b97f5d7653d48c5f11.png"},{"id":81936052,"identity":"d1b10cb5-f909-4c8a-8406-0c7fc099c193","added_by":"auto","created_at":"2025-05-05 06:02:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1780262,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6206142/v1/4e07afca-b116-48d5-821a-84bf9d3130aa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving Subjective Well-Being by Using Eye Movement Desensitization and Reprocessing (EMDR) Therapy among Patients with Moderate to Severe Post-Traumatic Stress Symptoms in Jordan: A Quasi-Experimental Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, psychological research has increasingly underscored positive mental health and human assets, shifting beyond a focus on dysfunction and psychopathology. This transition has been influenced, in part, by global organizations, such as the World Health Organization (WHO), which prioritizes the promotion of worldwide health. The WHO defines positive mental health as \u0026ldquo;a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community\u0026rdquo; (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This state of mental well-being has been associated with a plethora of positive outcomes, such as healthy aging and lifelong health (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), flexible and creative thinking (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and good physical health (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Given such benefits, subjective well-being is deemed a psychological protective factor, enabling those with greater levels of SWB to cope more effectively with stressful circumstances and decreasing their vulnerability to the adverse effects of distress (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). On the other hand, individuals with low SWB may be less equipped to manage distress, potentially leading to greater psychological dysfunction (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne such dysfunction that can significantly affect an individual\u0026rsquo;s SWB is post-traumatic stress. In the aftermath of traumatic exposure, symptoms such as re-experiencing the traumatic event, alterations in cognition and mood, and being on guard or hypervigilant of one\u0026rsquo;s environment may occur (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). For those experiencing such symptoms, the ability to achieve psychological well-being or live with contentment and satisfaction can be significantly compromised (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Recently, PTSS was found to be negatively associated with psychological well-being (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Meanwhile, previous studies maintained that individuals with PTSS may engage in behaviors to avoid further harm, such as withdrawing from social connections that further diminish their SWB (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Moreover, disaster trauma was predicted to decrease social-psychological well-being via increased withdrawal from interpersonal contacts (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These findings underscore the vulnerability of individuals facing PTSS\u0026mdash; not only to psychological dysfunction but also to decreased subjective well-being. As such, in the aftermath of a trauma, not only is PTSS a target for intervention, but so too is the preservation of psychological well-being.\u003c/p\u003e \u003cp\u003eGiven that psychological well-being is often compromised in individuals with PTSS, interventions should target not only PTSS but also psychological well-being. In this context, we propose Eye Movement Desensitization and Reprocessing Therapy (EMDR) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) as one such intervention that addresses both PTSS and the enhancement of psychological well-being. During EMDR therapy, patients are instructed to confront their trauma memory while engaging in bilateral stimulation, such as eye movements, which helps reduce the vividness of the memory and associated distress. EMDR has been found to effectively attenuate symptoms of PTSD (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In addition, emerging research suggests that EMDR may also promote psychological well-being (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For instance, a prior study examining an EMDR-based online therapy group reported significant improvements in psychological well-being in a cohort of university students (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). While such findings are promising, they have yet to be widely replicated. Furthermore, to our knowledge, no studies have examined the effects of EMDR on psychological well-being in individual therapy settings, as opposed to group therapy.\u003c/p\u003e \u003cp\u003eThe current study attempts to bridge this empirical gap by investigating the effects of EMDR individual therapy on the subjective well-being of Jordanian patients presenting with moderate to severe PTSS. Building on previous findings, albeit limited, we hypothesize that, relative to a no-treatment control group, individuals who undergo an EMDR individual therapy intervention will experience significant increases in their subjective well-being immediately after the intervention period and one month later. The hypothesis of this trial is: There is a positive effect of using Eye Movement Desensitization and Reprocessing (EMDR) therapy on subjective well-being level, immediately and one month after receiving three sessions and when compared with the control group and controlling for specific socio-demographic and health-related factors among patients experiencing moderate to severe post-traumatic symptoms.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis trial utilized the quasi-experimental, interrupted time series design. The design includes measuring the study outcomes (subjective well-being) at three points of time: Once before intervention (pre-test) and twice after the intervention (post-tests): immediately and one-month follow-up for both the interventional and control groups. This design was suitable for examining the effectiveness of eye movement desensitization and reprocessing (EMDR) intervention on patients experiencing moderate to severe post-traumatic symptoms. In addition to recognizing the differences in socio-demographics and health-related factors that contribute to the effectiveness of using EMDR therapeutics module.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Setting\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited from a specialized psychiatric trauma healing center that provides cognitive behavioral and psychological services for a population with traumatic experiences. The center was established in 2013, and its main aim is to promote the knowledge and abilities of the local community and provide psychological consultation, conducting EMDR therapy and other psychotherapy approaches and run by trained and certified specialists and psychotherapists to meet current and future development challenges. The center provides psychological services through active participation, effective relationships with national and international organizations, and a wide connection with the local community. The physical structure of this center makes it appropriate for this study in that the center consists of many private, comfortable, and large therapeutics rooms that allow for effective interaction during the sessions, and this is appropriate for conducting EMDR sessions.\u003c/p\u003e\n\u003ch3\u003eInclusion criteria included:\u003c/h3\u003e\n\u003cp\u003eFor eligibility, (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Patients must be 18 years or older. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) have a likelihood of Moderate to Severe Post-Traumatic Stress Symptoms score from a screening instrument. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Patients have experienced a traumatic episode within the recent six months, such as the death of a family member or the loss of loved ones. And (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) had no prior experience with EMDR therapy.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria included:\u003c/h3\u003e\n\u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Individuals with acute cognitive or intellectual disabilities may struggle to complete study questionnaires.\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Medical health histories may show visual impairment or eye pathology that prevents full participation in the EMDR therapeutics sessions.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eThis trial included 70 participants; the total was approached and recruited according to symptoms severity and were experiencing moderate to severe post-traumatic symptoms from the assigned center. A power analysis has been performed using the G.Power program (version 3.0.10) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) to estimate the minimum sample size to achieve a fully powered sample and to minimize errors in statistical tests. The minimum sample size needed was 62 participants, accounting for a medium effect size of 0.3, an alpha 0.05 level of significance (two-tailed), power of 0.8, two groups, and three points of data collection. Considering 10% of the dropouts, 70 patients were recruited after screening for eligibility. The 70 patients were divided into two groups (35 patients in the interventional group and another 35 patients in the control group). The recruitment process was continued until the desired sample size was reached.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Procedure\u003c/h2\u003e \u003cp\u003e The data collection process started after the ethical committees approved it. All participants provided informed consent in compliance with the IRB. The researchers met the targeted center director. Then, the researchers explained the nature of the study, the purpose, the EMDR intervention, the implementation process and required data, and all possible resources needed for the study.\u003c/p\u003e \u003cp\u003eThe sample was recruited using a multi-strategic sampling technique. Initially, convenience sampling was employed to recruit the participants, and then random assignment was conducted to assign them to control and interventional groups. Using the accessible database and medical records of the target trauma healing center, the researcher approached and invited patients experiencing moderate to severe symptoms to participate in this trial. Patients who showed interest in participation were screened for eligibility.\u003c/p\u003e \u003cp\u003eParticipants were administered a series of telephone-based questionnaires indexing the severity of PTSS and subjective well-being before random assignment to groups (T0), immediately following the third session of the EMDR therapeutics module (T1), and one month after the EMDR therapeutics module was accomplished (T2). The study took place over a total of 10 weeks. Participants assigned to the intervention group engaged in three weekly, 90-minute individual EMDR therapy sessions conducted by a licensed and expert EMDR therapist. After T2, those participants in the control group were allowed to be involved in the three weekly, 90-minute individual EMDR therapeutics sessions.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEMDR Therapeutics Module\u003c/h3\u003e\n\u003cp\u003eThe EMDR therapy module was established by modifying the published clinical EMDR protocol (Shapiro, 2017), and eight EMDR therapeutic steps were accepted and approved. In the first phase, a complete assessment and history taking were conducted. This step consists of gathering the patient\u0026rsquo;s history and specifying the traumatic experience that led to their present distressed status. In the second step, rapport and a therapeutic relationship between the therapist and patient were established, and the EMDR therapy module was described to patients. The patient also had the chance to ask questions regarding the EMDR therapy module throughout this step.\u003c/p\u003e \u003cp\u003eIn the third step, the patient and the EMDR therapist reviewed the traumatic episodes that the patient had experienced throughout their life, as well as rated the subjective distress they felt when reliving this event on a scale of 1 to 10. Based on their SUDs, patients can select which traumatic event to highlight in succeeding EMDR sessions, named the target event. In the fourth step, the desensitization stage, the therapist used bilateral stimulation (BLS), in which the patient erudite regarding side-by-side eye movements, sounds, and taps though concentrating on the traumatic incident. BLS consisted of 24 two-way arrangements using finger movements. Each arrangement continued for one second, and the patient and therapist were separated by one meter throughout the session. In the fifth step, the installation stage, patients were requested to imagine positive perceptions or thoughts they may associate with the target traumatic event pending it touched true.\u003c/p\u003e \u003cp\u003eIn the sixth step, the body scan stage, after replacing the positive thought, patients were requested to imagine both the positive cognition and target event in their mind while directing attention to their bodies and responding with BLS if needed. In the seventh step, the closure stage, the therapist helped the patient return to a state of comfort. In the final step, the reevaluation stage, the EMDR therapist and patient communicated about the newly discussed and recently processed target traumatic event. They confirmed that their distress over this experience is minimal while their positive cognition is significant. This phase also involved determining future treatment directions.\u003c/p\u003e \u003cp\u003ePatients in the control group did not receive any EMDR therapeutic sessions. They accomplished study questionnaires before the intervention, immediately after the third EMDR therapy session in which the intervention group was involved, and one month after the EMDR therapy module.\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eTo ensure accessibility for all participants, an Arabic version of the study measures was used, aligning with the participants\u0026rsquo; native language. Self-report measures assessed the primary study variable, including the subjective well-being level. Instruments assessing participants\u0026rsquo; sociodemographic and health-related factors were also administered.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic and Health-Related Questionnaire\u003c/h2\u003e \u003cp\u003eSociodemographic, lifestyle, and health-related variables were assessed by a researcher-developed questionnaire. This instrument collected information on participants\u0026rsquo; age, sex, marital status, educational level, working status, monthly salary, smoking status, presence of chronic physical illness(es), history of mental illness(es), and receiving psychological intervention or psychiatric medications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe World Health Organization- Five Well-Being Index\u003c/h2\u003e \u003cp\u003eThe World Health Organization-Five Well-Being Index (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) was administered to assess participants\u0026rsquo; subjective well-being. Participants were asked to indicate how frequently they experienced a series of five statements over the last two weeks. Example statements included, \u0026ldquo;I have felt cheerful and in good spirits\u0026rdquo; and \u0026ldquo;I have felt calm and relaxed.\u0026rdquo; Each item was rated 0 (at no time), 1 (some of the time), 2 (less than half of the time), 3 (more than half of the time), 4 (most of the time), and 5 (all of the time). Items were summed to obtain a total raw score ranging from 0 to 25. This raw score is then multiplied by 4 to calculate a final score ranging from 0 to 100, with higher scores indicating greater subjective well-being. Cronbach's alpha for the WHO-5 in the current study was 0.89, indicating high reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003ePreliminary data screening and cleaning process conducted before analysis of data. The collected data was analyzed using SPSS version 26.0, IBM Crop, 2017 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A repeated measures ANOVA test was used to address our main question about group differences in SWB. Time (i.e., T0, T1, and T2) was a constant within-subjects factor, while group (i.e., interventional vs. control) was a fixed between-subjects factor. The homogeneity of variances was examined using Levene's test. To examine for the potential impact of sociodemographic and health-related variables on research results, a repeated measures ANCOVA test was used. Each model included sociodemographic and health-related factors as covariates, with time fixed within subjects and group fixed between subjects.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration\u003c/h2\u003e \u003cp\u003e The first step in conducting this study was to obtain the Institutional Review Board (IRB) approval from the Scientific and Ethics Research Committee at the School of Nursing at the University of Jordan. which granted permission with a reference number of (2348/2023/1). Following this approval, approvals from the Ethics Committees of the accessible organization were then obtained. with a reference number (50/KCBS/2023). Permissions to approach the patients for data collection were also obtained from the administration of the selected center and the managers of the targeted departments to facilitate the process of data collection. Furthermore, all eligible patients were invited to participate, and those who expressed an interest in the study were approached and given relevant information about the study's purpose and significance, after which they were given consent to sign and approve their participation. Confidentiality and voluntary participation were assured and sustained.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSample Characteristics\u003c/h2\u003e \u003cp\u003eDuring this trial, 70 participants from the intervention (n\u0026thinsp;=\u0026thinsp;35) and control (n\u0026thinsp;=\u0026thinsp;35) groups were assessed. The intervention group's mean age was 30 years (SD\u0026thinsp;=\u0026thinsp;9.62), while the control group's average age was 30 years (SD\u0026thinsp;=\u0026thinsp;7.92). In terms of sex, there were 18 (25.7%) males and 17 (24.3%) females in the intervention and control groups, respectively; 19 (27.1%) females and 16 (22.9%) males. Furthermore, the majority of the participants in the intervention group (n\u0026thinsp;=\u0026thinsp;18) and the control group (n\u0026thinsp;=\u0026thinsp;17) were single, with 13 (50%) in each group married. In terms of educational background, 10 (14.3%) of the participants in the intervention group and 11 (15.7%) in the control group had completed high school education, and 12 (17.1%) in the intervention group and 13 (18.6%) in the control group they held the first university degree. In terms of Employment Status, 13 (18.6%) of participants in the intervention group and 16 (21.4%) in the control group were employed and working full-time, whereas 12 (17.1%) in the intervention group and 10 (14.3%) in the control group were not currently employed. For more details, see Table\u0026nbsp;1, which presents participants' sociodemographic characteristics.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(1): Participants\u0026rsquo; Sociodemographic Characteristics (\u003c/b\u003e \u003cb\u003eN\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;70)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eIntervention Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge M (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e30 (9.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e30 (7.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational Background\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes and full-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes and part-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSalary Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eM: mean, SD; standard deviation, N: number, %: percentage\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis table represents the sociodemographic characteristics of the participants in both groups control and interventional.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(2) represents the participants' daily lifestyles and health-related factors. In terms of smoking status, 15.7% (n\u0026thinsp;=\u0026thinsp;11) in the intervention group and 21.4% (n\u0026thinsp;=\u0026thinsp;15) in the control group are smokers, and 28.6% (n\u0026thinsp;=\u0026thinsp;20) in the intervention group and 27.1% (n\u0026thinsp;=\u0026thinsp;19) in the control group they are non-smokers. Additionally, 25.7% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18) of the same in both groups reported a history of at least one chronic physical illness, and 21 (30%) in the intervention group and 10 (14.3%) had a positive family history of mental illnesses. In terms of engaging previously with other forms of psychotherapy, 25 (35.7%) were the same in each group. The participants reported that they had not received any type of psychotherapy previously. In addition, 9 (12.9%) in the intervention group and 11 (15.7%) in the control group revealed that they were now using psychiatric medications.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(2): Participants' Daily Lifestyles and Health-Related Factors (\u003c/b\u003e \u003cb\u003eN\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;70)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIntervention Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuit Smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHx of chronic physical illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHx of mental illness or symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily history of mental illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHx of psychological intervention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHx of psychiatric medications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHx: History, N: number, %: percentage. This table represents Daily Lifestyles and Health-Related Factors in both groups control and interventional.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eVariables of the study\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eSubjective Well-being\u003c/h2\u003e \u003cp\u003eWhen comparing the Subjective Well-being SWB of Participants in intervention and control groups, the statistical analysis showed that the overall mean score of SWB for all study participants (n\u0026thinsp;=\u0026thinsp;70) at baseline (Before intervention T0) was 4.24 (SD\u0026thinsp;=\u0026thinsp;2.63) ranging from (1 to 15). of them, 85.7% (n\u0026thinsp;=\u0026thinsp;60) had scores ranging from (1 to 7) indicating the participants have had a low score in well-being.\u003c/p\u003e \u003cp\u003eTo compare SWB among participants in both intervention and control groups, the independent samples t-test was conducted. At the first point of measurement, before conducting EMDR intervention, the overall mean score of SWB at baseline (T0) among participants in the intervention group was (4.51, SD\u0026thinsp;=\u0026thinsp;2.77), and participants in the control group at baseline was (3.97, SD\u0026thinsp;=\u0026thinsp;2.49). There was no significant mean difference between the two groups (t\u0026thinsp;=\u0026thinsp;0.86, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.93). The second point of measurement was immediately after conducting 3 sessions of EMDR intervention (TI), participants in the control group had a SWB mean score of 5.29 (SD\u0026thinsp;=\u0026thinsp;2.62) ranging from 2 to 10 with 82.9% (n\u0026thinsp;=\u0026thinsp;29) of participants had a very low score in SWB. The mean score of participants in the interventional group increased to 12.03 (SD\u0026thinsp;=\u0026thinsp;4.04), ranging from 3 to 21, and the majority of participants had an SWB mean score of 71.51% (n\u0026thinsp;=\u0026thinsp;25), ranging from 10 to 21, indicating improvement in their well-being score. These mean differences were significant (t\u0026thinsp;=\u0026thinsp;8.29, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03), with participants in the interventional group and their SWB scores improved.\u003c/p\u003e \u003cp\u003eAt the third point of measurement (TII), one-month follow-up post-EMDR intervention, the mean score of the SWB in the control group was 7.11 (SD\u0026thinsp;=\u0026thinsp;2.75), ranging from 2 to 12 with almost 85.7% (n\u0026thinsp;=\u0026thinsp;30) of participants having very low SWB scores. On the other hand, the mean score of SWB participants in the interventional group increased to 21.54 (SD\u0026thinsp;=\u0026thinsp;1.82), ranging from 18 to 25. The analysis showed that there were significant mean differences between the two groups with (t\u0026thinsp;=\u0026thinsp;25.87, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.007), which indicates that the SWB scores among participants in the intervention group had significantly increased and improved than participants in the control group. See Table\u0026nbsp;(3(\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(3): Subjective Well-being differences between Interventional and Control Groups at all points of measurement\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInterventional\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eIndependent t-test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubjective Well-being T0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubjective Well-being T1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubjective Well-being T2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eM: mean, SD: standard deviation, P values\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Bivariate Analysis\u003c/h2\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1. Repeated Measures Mixed ANOVA for the Subjective Well-being\u003c/h2\u003e \u003cp\u003eA Repeated Measures Mixed ANOVA test has been used to assess if SWB scores improved during and after the EMDR intervention.\u003c/p\u003e \u003cp\u003eSphericity is the main assumption for using repeated measures mixed ANOVA, which indicates that all variances of the different points of measurements are essential to be homogenous. To investigate whether the sphericity assumption was violated, the Mauchly test was used; the results were not significant (Mauchly's W\u0026thinsp;=\u0026thinsp;.972, 2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1.885, p\u0026thinsp;=\u0026thinsp;.390), as well as, the Greenhouse-Geisser value of .973 which indicated that the sample variance/covariance matrix did not deviate significantly from sphericity; however, since the Greenhouse-Geisser value was near 1.00, no correction was needed to the degrees of freedom that had been used to assess the significance of the F ratio.\u003c/p\u003e \u003cp\u003eThe results of repeated measure ANOVA (see Table\u0026nbsp;4) showed that there were significant differences across the three times of measurement within the subject (F \u003csub\u003e1, 68\u003c/sub\u003e =827.32 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Also, the Time of Measurement * Group was significant (F\u003csub\u003e1, 68\u003c/sub\u003e =392.05 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and there were significant differences between groups (F\u003csub\u003e1, 68\u003c/sub\u003e =196.3 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that there is a significant increase in SWB scores after EMDR sessions. This supports the hypothesis of the study that the EMDR intervention is effective and can be used successfully to improve the level of SWB among PTSD patients. The analysis also showed that there is a significant effect of EMDR sessions on the level of SWB (Wilk\u0026rsquo;s Lambda\u0026thinsp;=\u0026thinsp;.076, (F \u003csub\u003e2, 67\u003c/sub\u003e = 408.08, p\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;.001). Additionally, the relevant effect size (partial η2) was 0.92, demonstrating that the EMDR sessions were responsible for most of the variance in SWB. The EMDR intervention was effective in improving the level of SWB among PTSD patients.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(4): Overall Results of Repeated Measures Mixed ANOVA for the Subjective Well-being across the three observations within-subject and between-subject\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eDf\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEffect size η\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eWithin-subject\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of Measurement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3560.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3560.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e827.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of Measurement * Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1687.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1687.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e392.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.852\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResiduals (errors)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e292.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBetween-subject\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2750.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2750.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e196.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResiduals (errors)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026bull; \u003cem\u003edf\u003c/em\u003e: degree of freedom; SS: sum of squares; MS: mean square; Significant at α\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis table represents the overall results of Repeated Measures Mixed ANOVA for the Subjective Well-being across the three observations within-subject and between-subject.\u003c/p\u003e \u003cp\u003eAs indicated in Table\u0026nbsp;4, the significant F test means differences or changes within the three points of measurement and between the groups. As the EMDR intervention took place after the baseline, the intervention showed a positive effect on increasing the level of SWB at Time I and Time II; see Figure (1) below.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTesting the SWB mean differences among the intervention group across all points of measurement, a post-hoc pairwise comparison test was obtained by using the Bonferroni test to determine where the differences occurred. and the result showed significant differences between the baseline and each point of time (T0, TI, and TII) with (p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003eBased on the result; there is a statistically significant difference (p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.001) in the mean of SWB scores after three sessions of EMDR interventions at (TI ) and the mean of SWB before the EMDR sessions compared with the baseline (T0) and the control group, as well as there is a statistically significant difference (p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.001) in the mean of the SWB after one month follow up post three sessions of EMDR intervention (TII) and the mean of SWB before EMDR sessions compared with the baseline (T0) and the control group. Consequently, this means that the Psychological Well-being after EMDR interventions for patients experiencing moderate to severe symptoms of PTSD was increased significantly from the baseline in both measurement points (TI and TII). See Table\u0026nbsp;(5)\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(5): Pairwise comparison of Subjective Well-being means differences across all times of measurement in the Interventional group (N\u0026thinsp;=\u0026thinsp;35) and Control Group (n\u0026thinsp;=\u0026thinsp;35)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(I) Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(J) Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Difference (I-J)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95% Confidence Interval for Difference\u003c/p\u003e \u003cp\u003eLower Upper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eT0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterventional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.799\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterventional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.713\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eT1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterventional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.367\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterventional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-6.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-5.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eT2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterventional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterventional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-14.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-15.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-13.316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificant at\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eα\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSE: standard error, significance at P\u0026thinsp;\u0026le;\u0026thinsp;0.05, T0: the time of baseline, T1: Immediately after the intervention, T2: One month follow up after the intervention. This table represents Pairwise comparison of Subjective Well-being means differences across all times of measurement in the Interventional group (N\u0026thinsp;=\u0026thinsp;35) and Control Group (n\u0026thinsp;=\u0026thinsp;35).\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.3.1. Repeated Measures Mixed ANCOVA for Subjective Well-being with controlling for specific socio-demographics and health-related factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA repeated measure mixed ANCOVA was used to examine the hypothesis which states that \u0026ldquo;Exposing individuals diagnosed with Post-Traumatic Stress Disorder and experiencing moderate to severe symptoms after receiving three sessions of EMDR intervention will increase the SWB level with controlling for specific socio-demographic and health-related factors\u0026rdquo;.\u003c/p\u003e \u003cp\u003eThe mean total scores of SWB increased gradually across all three points of time among PTSD patients in the interventional group, before EMDR intervention T0 (M 4.51, SD\u0026thinsp;=\u0026thinsp;2.77) and continuing immediately after three sessions of EMDR intervention TI (M\u0026thinsp;=\u0026thinsp;12.03, SD 4.04), with PTSD patients' the SWB increased at one month of EMDR intervention TII (M\u0026thinsp;=\u0026thinsp;21.54, SD 1.82).\u003c/p\u003e \u003cp\u003eAfter meeting the assumptions, a repeated measure analysis of covariance (ANCOVA) mixed design test was used to see if there were significant differences between dependent variables SWB at time T0, TI, and TII after controlling for particular socio-demographic and health-related factors.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSphericity\u003c/b\u003e: Mauchly's test was used to assess the assumption of sphericity. To investigate whether the sphericity assumption was violated, the Mauchly test was used; the results were not significant: Mauchly's W\u0026thinsp;=\u0026thinsp;.989, 2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), p\u0026thinsp;=\u0026thinsp;.74, as well as the also the Greenhouse-Geisser value of .989 revealed that the sample variance/covariance matrix did not deviate significantly from sphericity; however, since the Greenhouse-Geisser value was near to 1.00, no correction was applied to the degrees of freedom used to assess the significance of the F ratio.\u003c/p\u003e \u003cp\u003eThe results of a repeated measure analysis of covariance (ANCOVA) mixed design test (including interaction) between dependent variable SWB at time 1(T0), time 2(TI), and time 3(TII) and covariance variables (specific socio-demographics and health-related factors: (age, sex, marital status, educational level, working status, monthly salary, smoking status, presence of chronic physical illness(es), history of mental illness(es), and receiving psychological intervention or psychiatric medications).\u003c/p\u003e \u003cp\u003eThe Null hypothesis was rejected since the overall result showed that there is a significant difference between the SWB at time 1(T0), time 2(TI), and time 3(TII). After controlling for specific socio-demographics and health-related factors within subjects [F1, 56\u0026thinsp;=\u0026thinsp;5.18, p\u0026thinsp;=\u0026thinsp;0.027, partial η2\u0026thinsp;=\u0026thinsp;0.085], the value of η2 is a large effect according to Cohen, which indicates how much of the variance in the dependent variable is explained by the independent variable. Furthermore, the results of the final ANCOVA were that the covariate effect was not controlled and showed that there are statistically significant differences in the SWB across the three points of measurements in both interventional and control groups (between subjects) (F\u0026thinsp;=\u0026thinsp;12.41, P\u0026thinsp;=\u0026thinsp;0.001). There was no relationship between the SWB and socio-demographics and health-related factors. (see Table\u0026nbsp;6), there is a statistically significant difference in F value after adjusting the covariate. Finally, there are no statistical differences in the total mean score of SWB correlated with socio-demographics and health-related factors. Levene\u0026rsquo;s test for homogeneity of variance was used and showed that no significant violation was found [ F\u003csub\u003e1, 68\u003c/sub\u003e= 2.66, P\u0026thinsp;=\u0026thinsp;0.608]. See Figure (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFigure 2: Subjective Well-being means scores across the three points of measurement while controlling for specific socio-demographic and health-related factors. This figure represents the subjective well being with controlling for specific socio-demographics and health-related factors and across three points of measurements. The blue line represents interventional group and the red line represent the control group. It seems from the Fig.\u0026nbsp;2 an improvement in the subjective wellbeing scores in the interventional group at second and the third points of measurements over the time.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(6). Result of Repeated Measures Mixed ANCOVA Concerning the Subjective Well-being with controlling for specific socio-demographics and health-related factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEffect size η\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjective Well-being at T0, T1 and T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Marital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Educational Background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Employment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Salary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Smoking Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Hx of chronic physical illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Hx of mental illness or symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Family Hx of Mental Illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Hx of Psychological Intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSWB* Hx of Psychiatric Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResiduals (errors)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e246.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjective Well-being at T0, T1 and T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e185.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSalary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic Physical Illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Illness or Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Hx of Mental Illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHx of Psychological Intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHx of Psychiatric Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1675.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1675.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSWB: Subjective wellbeing, Hx: History, SS: Sum of squares, MS: mean square, Significance at \u0026le;\u0026thinsp;0.05. This table represents the result of Repeated Measures Mixed ANCOVA concerning the Subjective Well-being with controlling for specific socio-demographics and health-related factors.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this trial showed that patients who were exposed to EMDR, in general, across the three measurement times, had significant and positive improvement in their SWB scores. SWB levels, among participants of the current study, at baseline in the interventional group were slightly higher than the control group. It is noted, further, that the interventional group had a significantly lower mean difference in SWB scores than the control group immediately after the intervention and one month later. On the other hand, at time 2 (immediately post-intervention), there were also significant differences despite the increase in SWB levels of the interventional group. It has been found that a significant mean increase in the post-test and one-month follow-up among individuals in an interventional group compared to their scores at baseline. In contrast, no significant increase was found among individuals in the control group across the mentioned times. Posing EMDR intervention caused a significant increase in the level of SWB, and that improvement was in favor of interventional groups over the control group. In other words, the intervention has significantly improved the score of the interventional group compared to the control group, supporting the higher positive differences between the two groups before and after EMDR intervention (T0, TI, and TII). However, at TI (immediately after three sessions of EMDR intervention), there were significant differences between the interventional and control groups and improved SWB scores in the interventional group. In contrast, no significant decrease was found among individuals in the control group across the mentioned times. The positive outcomes of the EMDR intervention and the study results could be related to the methods used in this study. The participants in this study were all able to strictly adhere to the intervention protocol, which allowed better benefits and interaction with the therapies. However, the current study findings agree with (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), who reported that using EMDR therapy can be an effective treatment for patients experiencing a psychological crisis who are suffering from PTSD, subsequent in significant enhancements in their SWB scores. In addition, there were positive and fast improvements in SWB scores after fewer sessions. This confirmed the feasibility of EMDR intervention. Also, Studies have consistently shown that EMDR is a safe, feasible, and effective intervention among individuals suffering from PTSD (Paauw et al., 2023). In addition, EMDR therapy has been relatively underutilized as a treatment for PTSD patients. In contrast, Kraiss et al. (2022) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) reported that psychological interventions play a significant role in promoting overall well-being.\u003c/p\u003e \u003cp\u003eBased on current study findings, having the score statistically different at time Ⅰ and time II compared to baseline scores in SWB infers that EMDR is a fast and practical intervention in the treatment process duration to show its significant effect. Such results are also alarming the psychotherapists aiming at using EMDR, which requires sustainable promoter sessions, and such an interventional approach requires sustainable promoter sessions and cannot be done once and ever. Furthermore, Yilmaz Din\u0026ccedil; and Sapmaz (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) conducted a clinical trial to evaluate the effectiveness of EMDR among individuals with trauma pictures. Their study finding revealed that EMDR intervention was not only effective in managing the severity of symptoms but was also proved to be effective concerning resilience and well-being.\u003c/p\u003e \u003cp\u003eIn the current study, multiple sociodemographic and health-related characteristics were examined, including age, sex, marital status, educational background, employment status, salary, smoking status, chronic illnesses, psychiatric history, positive family history of mental illnesses, psychological treatment, and psychiatric medications.\u003c/p\u003e \u003cp\u003eThe null hypothesis was rejected since the overall result showed that there is a significant difference between SWB at three measurement times, after controlling specific socio-demographic and health-related factors. Also, the results of the final results showed that the covariate effect was not controlled and showed that there are statistically significant differences in SWB across the three points of measurement in both interventional and control groups. There is a statistically significant difference after adjusting the covariate. Finally, there are no statistical differences in the total mean score of SWB correlated with socio-demographics and health-related factors. In the existing literature, Gonzalez-Vazquez, Rodriguez-Lago (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) conducted a study in 2018 to assess the effectiveness of EMDR intervention among patients with PTSD. Their results showed positive outcomes through improvement in well-being scores among the EMDR group after intervention.\u003c/p\u003e \u003cp\u003eThis concludes that the differences caused due to EMDR intervention over the one month in the interventional group compared to the baseline were much more statistically significant. comprehensible than that of the control group across the mentioned times, such results indicated the positive effect of EMDR interventional sessions on SWB scores of individuals. Although the components of EMDR intervention would naturally lead to the enhanced SWB level of the participants. Moreover, the heart of EMDR intervention encompasses the change of the stored traumatic experiences into an adaptive resolution and replacing them with positive feelings and emotions that lead to improvement in the psychological status of patients (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne of the strengths of this study is being the first to investigate the effectiveness of EMDR intervention in Jordan. In addition, this study supports the assertions that the components of EMDR interventions are also effective among PTSD patients who experience moderate to severe symptoms of PTSD. This adds to the body of knowledge that the EMDR intervention showed a positive effect on improving the levels of SWB at Time I and Time II. Hence, the significant increase in the SWB scores among individuals in the interventional group across all times of measurements compared to the control group indicates that EMDR intervention applied to individuals with PTSD was effective. Eventually, the consequences of PTSD and its handling concerning psychological, physical, and social well-being are indicators of how the disorder affects functioning and the overall quality of life. may make EMDR intervention implementation sustainable in the field of psychiatric care for promoting SWB among patients experiencing moderate to severe symptoms of PTSD.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe current trial showed significant improvements in subjective well-being scores among individuals in the interventional group across all times of measurements after three sessions of EMDR therapy compared to the control group. Indicates that EMDR therapy applied to patients with PTSD was effective. may make EMDR employment sustainable in the field of psychiatric care for promoting SWB among patients experiencing post-traumatic symptoms in Jordan.\u003c/p\u003e \u003cp\u003eThis study offers solutions to decrease the gap in the empirical validation of treatment methods, provide a comprehensive assessment of EMDR effectiveness, and support their implementation with solid evidence. The findings of this study are anticipated to have wide-ranging impacts on various stakeholders within the healthcare system, including nurses, patients, healthcare leaders, and agencies in Jordan.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMDR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEye Movement Desensitization and Reprocessing\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePTSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePost-Traumatic Stress Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSWB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSubjective Well-being\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePTS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePost-Traumatic Symptoms\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSource(s) of support/funding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review was not funded by a specific project grant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrior to their involvement in the trial, all subjects provided written informed consent. The Institutional Review Board (IRB) and the research and ethics committee at the assigned community-based center approved this study, which has the reference number 50/KCBS/2023. All human research procedures were carried out under the moral standards of the committee responsible for human experimentation (institutional and national), as well as the Helsinki Declaration of 1964, as revised in 2009, and its amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e is not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRHH, AH: Conceptualization, methodology, formal analysis, validation, investigation, writing- original draft preparation, visualization, writing- reviewing and editing. MP, RH, YA, AA: Methodology, data collection, and RH, AA: writing-reviewing and editing the final manuscript. The authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO, Mental. health. \u003cem\u003ewwwwhoint\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://wwwwhoint/news-room/fact-sheets/detail/mental-health-strengthening-our-response\u003c/span\u003e\u003cspan address=\"https://wwwwhoint/news-room/fact-sheets/detail/mental-health-strengthening-our-response\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrtega FB, Lee D-c, Sui X, Kubzansky LD, Ruiz JR, Baruth M, et al. Psychological well-being, cardiorespiratory fitness, and long-term survival. Am J Prev Med. 2010;39(5):440\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBless H, Mackie DM, Schwarz N. Mood effects on attitude judgments: independent effects of mood before and after message elaboration. J Personal Soc Psychol. 1992;63(4):585.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e!!! INVALID CITATION !!! {}.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLayous K, Chancellor J, Lyubomirsky S. Positive activities as protective factors against mental health conditions. J Abnorm Psychol. 2014;123(1):3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuppert FA. Psychological well-being: Evidence regarding its causes and consequences. Appl psychology: health well‐being. 2009;1(2):137\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAPA. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. American psychiatric association; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAla S, Ramos-Campos F, Relva IC. Symptoms of post-traumatic stress and mental health in a sample of university students: the mediating role of resilience and psychological well-being. Eur J Invest Health Psychol Educ. 2024;14(8):2262\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaniasty K. Predicting social psychological well-being following trauma: The role of postdisaster social support. Psychological Trauma: theory, research, practice, and policy. 2012;4(1):22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShapiro F. Eye movement desensitization: A new treatment for post-traumatic stress disorder. J Behav Ther Exp Psychiatry. 1989;20(3):211\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarletto S, Malandrone F, Berchialla P, Oliva F, Colombi N, Hase M, et al. Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis. Eur J psychotraumatology. 2021;12(1):1894736.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Y-R, Hung K-W, Tsai J-C, Chu H, Chung M-H, Chen S-R, et al. Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: A meta-analysis of randomized controlled trials. PLoS ONE. 2014;9(8):e103676.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaddad RH, Alhusamiah BK, Haddad RH, Hamdan-Mansour AM, Abuhashish YH, Alshraideh JA. The effectiveness of using eye movement desensitization and reprocessing therapy on reducing the severity of symptoms among individuals diagnosed with post-traumatic stress disorder: a systematic review of literature to highlight the standardized therapy-based interventional protocol. 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J Happiness Stud. 2022;23(7):3655\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonzalez-Vazquez AI, Rodriguez-Lago L, Seoane-Pillado MT, Fern\u0026aacute;ndez I, Garc\u0026iacute;a-Guerrero F, Santed-Germ\u0026aacute;n MA. The progressive approach to EMDR group therapy for complex trauma and dissociation: A case-control study. Front Psychol. 2018;8:2377.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShapiro F, Kaslow FW, Maxfield L. Handbook of EMDR and family therapy processes. Wiley Online Library; 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShapiro F. Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. Guilford Press; 2001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShapiro F. Eye movement desensitization and reprocessing (EMDR) and the anxiety disorders: Clinical and research implications of an integrated psychotherapy treatment. J Anxiety Disord. 1999;13(1\u0026ndash;2):35\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Post-Traumatic Stress Disorder, Eye Movement Desensitization and Reprocessing, Subjective Well-being, Jordan","lastPublishedDoi":"10.21203/rs.3.rs-6206142/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6206142/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNumerous man-made and naturally occurring incidents raise human suffering, psychologically and mentally. Such circumstances endanger people's emotional, physical, and social well-being if left untreated or if appropriate intervention is delayed. This trial examines the effectiveness of an Eye Movement Desensitization and Reprocessing (EMDR) intervention on improving the subjective well-being of patients with Post-Traumatic Stress symptoms in Jordan.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe current trial employed the quasi-experimental, interrupted time series design. This includes measuring the subjective well-being (SWB) three times: once before intervention (pre-test) and twice after the intervention (post-tests), as well as immediately and one-month follow-ups for both the intervention and control group. 70 patients (35 patients for each group) were recruited from a specialized psychiatric trauma healing center in Jordan. The primary outcome variable was measured using the World Health Organization- Five Well-Being Index (WHO-5).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe statistical analysis of repeated measures of ANCOVA showed significant differences across the three measurement times within subjects [F1, 56\u0026thinsp;=\u0026thinsp;5.18, p\u0026thinsp;=\u0026thinsp;0.027, partial η2\u0026thinsp;=\u0026thinsp;0.085], the value of η2 is a large effect according to Cohen, which indicates how much of the variance in the dependent variable is explained by the independent variable. The covariate effect was not controlled and showed statistically significant differences in the SWB across the three points of measurement in both interventional and control groups (between subjects) (F\u0026thinsp;=\u0026thinsp;12.41, P\u0026thinsp;=\u0026thinsp;0.001). There are no statistical differences in the total mean score of SWB correlated with socio-demographics and health-related factors.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe current trial showed significant improvements in subjective well-being scores among individuals in the interventional group across all times of measurements after three sessions of EMDR therapy compared to the control group. Indicates that EMDR therapy applied to patients with PTSD was effective. may make EMDR employment sustainable in the field of psychiatric care for promoting SWB among patients experiencing post-traumatic symptoms in Jordan\u003c/p\u003e","manuscriptTitle":"Improving Subjective Well-Being by Using Eye Movement Desensitization and Reprocessing (EMDR) Therapy among Patients with Moderate to Severe Post-Traumatic Stress Symptoms in Jordan: A Quasi-Experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 05:34:20","doi":"10.21203/rs.3.rs-6206142/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"679fe36a-4f55-4fef-aea1-1cf564198dd7","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T05:42:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 05:34:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6206142","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6206142","identity":"rs-6206142","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}