Effect of Online Training of Emotion Regulation in Terms of Locus of Control on Medical Students’ Anger Control and Impulsiveness: A Quasi-Experimental Study

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Extended Abstract
Background
The inability to control anger and impulses among medical students may lead to consequences with irreparable damages. It is commonly observed that medical students suffer a high rate of mental disorders. Inability to manage anger, in addition to personal distress, disruption of public health and interpersonal relationships, lead to maladaptation and harmful consequences and aggressive behavior. In a study, more than half of the students (54.3%) had committed at least one case of physical violence during their current academic year. Impulsiveness is considered a major factor in many mental disorders such as bulimia nervosa, suicidal ideation, aggressive behaviors, and self-harming behaviors. Many problems of students are caused by the locus of control. Emotion regulation is a term commonly used to describe the individuals’ ability to respond effectively to an emotional experience. Some evidence support training students on emotion regulation skills in anger management and aggression programs. Accordingly, this study aimed to investigate the effect of emotion regulation training according to the source of control on anger control and impulsiveness of medical students.
Methods
The present study is applied in terms of purpose and quasi-experimental in terms of research methodology. In this study, emotion regulation training, anger control score and impulsiveness, and control locus were, independent, dependent and moderating variables, respectively. The statistical population included all general medicine students who had entered Tabriz University of Medical Sciences in September and February of the academic years 2015 to 2019. The participants were taking classes in basic sciences and physiopathology (n = 1115). The participants completed a demographic questionnaire, part 3 of the State-trait Anger Expression Inventory on Anger Control, Barratt,s impulsivity questionnaire, and Rotter Control locus questionnaire, which were all uploaded to the Medical School (SAJAB) Exam System. Thirty students with internal control locus and 30 with external control locus were selected as the participants, and voluntarily took part in the study. Due to the prevalence of COVID-19, all classes and tests were held virtually while doing the study. The participants were randomly assigned into two equal groups of experimental and control (n=15 in each). For the experimental group, emotion regulation training course was held virtually in eight sessions through Gross method using Adobe Connect program. Furthermore, to evaluate the durability of the training effect, two months after the last day of training (follow-up), part 3 of the State-trait Anger Expression Inventory on Anger Control and Barratt Impulsivity questionnaires were given to the participants in experimental and control groups. Data collection tools included four questionnaires. First, State-trait Anger Expression Inventory developed by Spielberger in 1983; this tool consists of 57 items (six scales and five subscales) for the age group of 16-35 years. Second, Barratt Impulsiveness Scale, which includes 30 questions to evaluate three factors of cognitive impulsiveness, behavioral impulsiveness, and lack of planning. The questions are graded in four choices and the highest score is 120. Thrid, Rotter Control Center Questionnaire to evaluate the control source as generalized expectations; this tool consists of 29 questions and measures an individual's perceptions of the control source.
Results
The F values for the group variable in terms of anger control and impulsiveness on the post-test and follow-up post-test were found to be 31.26, 6.54, 17.84, and 18.04, respectively. The results showed that the difference between the experimental and control groups with respect to anger control and impulsiveness on the post-test and follow-up was significant (P <0.01). The adjusted mean scores of the anger control variable on the post-test were 50.67 and 41.71 for the experimental and control groups, respectively, and in the follow-up post-test they were found to be 50.68 and 42.52 in the experimental and control groups, respectively. Regarding impulsivity, the mean score of the experimental group was 55.31 and that of control group was 60.7 in the post-test phase, and the mean scores of the experimental and control groups were 54.97 and 64.05, respectively in the follow-up phase. The data showed that in the post-test and follow-up stages, the impulsiveness scores average of the participants in the experimental group decreased more significantly compared to the control group. The F values for group interaction with control locus regarding anger control and impulsiveness in post-test and follow-up stages were calculated to be 0.205, 13.52, 0.44 and 2.49, respectively. The results revealed that the difference between the experimental and control groups in terms of impulsiveness control variable in the post-test stage was significant (P <0.01). The mean score of modulated impulsiveness in interaction with the control locus in the post-test phase for the experimental group in the internal control locus was 58.67 and in the external control locus was 51.96, and for the control group in the post-test phase for the internal and external control locus was 56.43 and 98.64, respectively. The data showed that the impulsiveness scores of the participants with external control locus decreased more significantly than those with internal control locus after receiving emotion regulation training.The F values of the control locus variable in anger control and impulsiveness in the post-test and follow-up phases were 7.58, 0.16, 3.09, and 0.93, respectively. The results revealed that the difference between the two groups of the participants with the locus of internal and external control in terms of anger control variable in the post-test stage was significant (P <0.01). There was no significant difference in anger control between the two groups. However, the subjects with internal locus of control showed a greater increase, which indicates a better performance in the post-test phase.
Conclusion
The results of this study confirmed the effectiveness of emotion regulation training in controlling anger and impulsiveness of medical students. Thus, theoretically, it can be concluded that in addition to confirming the results of previous research, two more hypotheses were examined and confirmed. One of them was the simultaneous investigation of the effect of emotion regulation training on both anger and impulsiveness control. The other one was determining the role of control locus as a moderating variable in the relation between emotion regulation and anger and impulsiveness control, as well as comparing anger and impulsiveness control status among the participants with internal and external control locus. Practically, the findings of this research can be used by educational planners in universities and even in schools to teach emotion regulation and other effective coping skills as a guide.