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A study of the relationship between internet

addiction, psychopathology and dysfunctional

Article in Computers in Human Behavior · August 2016

DOI: 10.1016/j.chb.2016.03.043


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Ibrahim Taymur Ersin Budak

Bursa Şevket Yilmaz Training and Research H… Bursa Yuksek Ihtisas Egitim Ve Arastirma Has…


Hakan Demirci Kadir Ozdel

University of Health Sciences Bursa Yuksek Ih… Diskapi Yildirim Beyazit Teaching and Resear…


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Computers in Human Behavior 61 (2016) 532e536

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A study of the relationship between internet addiction,

psychopathology and dysfunctional beliefs
Ibrahim Taymur a, *, Ersin Budak b, Hakan Demirci c, Hatice Alkan Akdag
Buket Belkız Güngo €
€ r a, Kadir Ozdel d

Şevket Yılmaz Teaching & Research Hospital, Psychiatry Department, Bursa, Turkey
Şevket Yılmaz Training Research Hospital, Psychiatry Department, Bursa, Turkey
Şevket Yılmaz Teaching & Research Hospital, Family Medicine, Bursa, Turkey
Dışkapı Yıldırım Beyazıd Training Research Hospital, Psychiatry Department, Ankara, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: Background and aims: Psychopathological symptoms, particularly depression and anxiety, increase with
Received 30 September 2015 the severity of Internet Addiction (IA). In this study, we aimed to assess the relationship of severity of IA
Received in revised form and Dysfunctional Attitudes (DA) with psychopathological characteristics.
11 March 2016
Methods: Two hundred and twelve university students were included in the study. The subjects were
Accepted 12 March 2016
assessed using the Internet Addiction Scale (IAS), the Symptom Checklist (SCL-90) and the Dysfunctional
Attitude Scale (DAS).
Results: The subjects were divided into three groups according to the IAS, which was conducted to screen
Internet addiction
for IA: no addiction, mild and moderate/high addiction. 108 (50.9%) of the subjects were found to have no
Psychopathology addiction, 70 (33.01%) to have a mild addiction and 34 (16.03%) to have a moderate/high addiction.
Dysfunctional attitudes Psychopathological symptoms and dysfunctional attitudes increase with the severity of IA. In addition to
Perfectionist attitudes the psychopathologic features, dysfunctional attitudes have limited effects on explaining the IA.
Need for approval Conclusions: In the cognitive-behavioral treatment of IA, focusing on a perfectionist attitude and a need
for approval, which are part of a dysfunctional attitude, may be beneficial.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction with university students in Turkey, 12.2% of students (Dalbudak

et al., 2013) were found to have IA, and this number was deter-
Although the Internet has accelerated and has facilitating effects mined to be 7.2% in another study (Şenormancı et al., 2014).
on most aspects of our lives, Internet addiction is one of the It is considered that IA is linked to several psychopathologies.
negative results of this technology (Przepiorka, Blachnio, Miziak, & The study of Alavi, Maracy, Jannatifard, and Eslami (2011) with
Czuczwar, 2014). Internet addiction, which is associated with an university students showed that many psychopathologic features
individual's loss of control over their Internet use, is considered to (somatization, depression, anxiety, paranoid ideation, hostility,
be a health problem requiring attention (Brand, Young, & Laier, interpersonal sensitivity, obsessive-compulsive specifications) are
2014; Ko, Yen, Yen, Chen, & Chen, 2012; Morrison & Gore, 2010). much more frequent in adolescents with IA. In a similar study by
In an extensive study carried out in Europe, it was found that the Adalıer and Balkan (2012), it was found that many symptoms
prevalence of IA is 1% among adolescents, the group at risk for IA is related to psychopathologic features are much more frequent in
12.7%, and this rate is 13.7% in total (Tsitsika et al., 2014). In a study adolescents with IA than in those without IA. Moreover, in studies
analyzing psychiatric comorbidity in IA, it was found that psycho-
pathologies such as ADHD, depression, schizophrenia and OCD
* Corresponding author. Şevket Yılmaz Training & Research Hospital, Psychiatry accompany IA (Ha et al., 2006; Ko, Yen, Chen, Chen, & Yen, 2008).
Department, Şevket Yılmaz Eg itim Araştırma Hastanesi, Postal Code: 16100, It can be said that depression and anxiety are among the most
Yıldırım, Bursa, Turkey.
emphasized psychopathologies in the process of understanding IA.
E-mail addresses: (I. Taymur),
(E. Budak), (H. Demirci), It was found that individuals with IA are affected more by
(H.A. Akdag ), (B.B. Güngo €r), depression and anxiety (Goel, Subramanyam, & Kamath, 2013), and

(K. Ozdel).
0747-5632/© 2016 Elsevier Ltd. All rights reserved.
I. Taymur et al. / Computers in Human Behavior 61 (2016) 532e536 533

nearly half of the Internet addicts seeking treatment have depres- university in 2014 were interviewed. Before participation, students
sive symptoms (Müller, Ammerschlaeger, Freisleder, Beutel, & were informed about the study.
Woelfling, 2012). In studies on IA, addiction scores showed a pos-
itive correlation with depression and anxiety scores (Müller, Beutel, 2.1. Participants
& Wo €lfling, 2014) and those individuals with IA had higher
depression and anxiety scores (Tonioni et al., 2012). Ko et al. (2014) Two hundred and fifty students who indicated that they use the
found in their study that resistant depressive symptoms accom- Internet were included in our study. Participation in the study was
pany resistant IA individuals, and following treatment of IA, on a voluntary basis, and consent for participation was obtained
depression, social anxiety and aggressive behaviors diminish in from each student assessed. Exclusion criteria were faulty or
Internet addicts. incomplete measurement. Data from the faulty and incomplete
Dysfunctional attitudes (DA) used to evaluate a depressive in- analysis for 38 students were excluded from the study. Therefore,
dividual's prevailing negative attitudes are associated with the self, our study was conducted with 212 people, 124 men, and 88 women.
the outer world, and the future, and compose an important part of
Beck's dysfunctional cognitive items (Weissman & Beck, 1978). This
is why Weissman and Beck developed the Dysfunctional Attitude 2.2. Procedure
Scale to analyze dysfunctional attitudes, and this scale has
frequently been used in the literature to discuss dysfunctional be- The students were assessed in groups in a silent class environ-
liefs which are strongly related to dysfunctional schemas. This ment. The subjects were initially given the required information,
scale, which is used especially for the aim of evaluating the pre- and then they were assessed using scales with socio-demographic
disposition of individuals towards depressive symptoms, analyzes data forms and paper-and-pencil tests.
negative thoughts, negative emotional schemas and negative be-
liefs in the framework of a perfectionist attitude and a need for 2.3. Measures
approval basically. Besides this, it is reported that DA is linked with
many psychologic factors, such as approval, love, success, right, 2.3.1. Sociodemographic form
afford, autonomy and anaclitic self-esteem, which are necessary The socio-demographic questionnaire was composed of 8
regarding cognitive therapy (Weissman & Beck, 1978; Wong, Chan, questions. These were age, gender, tablet use (yes/no), Smart phone
& Lau, 2008). use (yes/no), presence of failing school year (yes/no), smoking (yes/
There are a considerable number of studies reporting a signifi- no), family history of psychiatric referral (yes/no) and history of
cant relationship between changes in DAS and depressive symp- psychiatric referral (yes/no).
toms (Wong et al., 2008; De Graaf, Roelofs, & Huibers, 2009). It was
found that DA is an important factor particularly in patients with 2.3.2. Internet addiction
depression, that DA may contribute to the development of The Internet Addiction Scale (IAS), developed by Nichols and
depression along with environmental stress factors, and that DA is Nicki in 2004, was used by Kayri and Günüç (2009) with univer-
decreased during the process of depression treatment (Beevers, sity students in Turkey. The scale consists of 31 items and has no
Strong, Meyer, Pilkonis, & Miller, 2007; Farmer et al., 2001). reverse-scoring items. Attitudes are scored as “1- Never 2- Rarely 3-
Moreover, it is known that depressive symptoms have significant Sometimes 4- Frequently and 5- Always” using a Likert scale
effects on many addictions. Despite this, it can be said that there are (a ¼ 0.93). Dalbudak et al. (2013) determined the cutoff score of the
not so many studies in the literature on the interaction between scale for addiction at 81 and divided the IA into three groups for
addiction and dysfunctional attitudes. Heinz, Veilleux, and Kassel IAS: 30e60 (no addiction), 61e80 (mild addiction) and 81 and
(2009) have shown in their study that DA has a potential impor- higher (risk for addiction/addicted).
tance in problematic alcohol use and the amount of alcohol con-
sumption. Ramsey, Brown, Stuart, Burgess, and Miller (2002) have
reported that negative experiences associated with addiction can 2.3.3. Psychopathology
be decisive in the treatment of alcohol addiction. Thus we can focus The Symptom Checklist-90 (SCL-90) is an assessment tool con-
on dysfunctional attitudes during the cognitive behavioral therapy sisting of 90 items and nine subscales to assess psychiatric symp-
process. toms (Derogatis, 1983). The validity and reliability study of the scale
was carried out by Dag  (1991) in Turkey, and the reliability co-
Our knowledge of IA and DA is limited, and the one study in the
literature in this field showed that DA scores were high in in- efficients for sub-scales were determined as Somatization
dividuals with IA, and that a perfectionist attitude (PA) is a pre- (a ¼ 0.82); Obsessive-Compulsive (a ¼ 0.84); Interpersonal Sensi-
dictor of IA (Şenormancı et al., 2014). Numerous tivity (a ¼ 0.79); Depression (a ¼ 0.78); Anxiety (a ¼ 0.73); Anger-
psychopathological components were assessed in the treatment Hostility (a ¼ 0.79); Phobic Anxiety (a ¼ 0.78); Paranoid Ideation
and investigation of the causes of Internet addiction, and it was (a ¼ 0.63); Psychoticism (a ¼ 0.73); and Additional Scale (a ¼ 0.77).
emphasized that these psychopathological elements are essential
regarding addiction. However, the literature contains a limited 2.3.4. Dysfunctional attitudes
number of studies investigating IA together with psychopatholog- The Dysfunctional Attitudes Scale (DAS) is used for analyzing
ical components and dysfunctional situations. In this study, we dysfunctional beliefs, thoughts, and emotions (Weissman & Beck,
aimed to assess the relationship of the severity of IA and DA with 1978; Şahin & Şahin, 1992). The scale consists of 40 items, and
psychopathological characteristics. We designed this study to each item is scored between 1 (completely disagree) and 7
investigate the level of effect that dysfunctional attitudes, as well as (completely agree). The internal consistency of the scale was
general psychopathology, have in explaining IA. determined at 0.79, and the total item correlation coefficient at
0.34. The scale was found to be a valid and reliable assessment tool.
2. Method Turkish version of the DAS consists of 4 factors: Perfectionist Atti-
tude (PA), Need for approval (NA), Autonomous Attitude (AA), and
This study was carried out by assessing students studying at Tentative Attitude (TA). Higher scores refer to higher levels of
Bursa Orhan Gazi University in 2014. Students attending the dysfunctional attitudes (Şahin & Şahin, 1992).
534 I. Taymur et al. / Computers in Human Behavior 61 (2016) 532e536

3. Results According to the correlation analysis of IAS, SCL-90 and its sub-
scales, and DAS and its sub-scales in our study, a statistically high
Independent samples t-test was used for assessing socio- positive correlation was found between IAS and total SCL-90 scores
demographic data; One-Way ANOVA for comparing the psycho- (r ¼ 0.47; p < 0.001) and IAS and total DAS scores (r ¼ 0.34;
pathology and dysfunctional attitudes in the three different p¼ < 0.001) (Table 2).
Internet addiction groups; and Pearson correlations and hierar- A statistically high positive correlation was found between IAS
chical regression analysis for investigating the relationship be- and scl-90 sub-scales of Somatization (r ¼ 0.37; p < 0.001),
tween general psychopathology and dysfunctional attitudes. Obsessive-Compulsive (r ¼ 0.43; p < 0.001), Interpersonal Sensi-
124 (58.5%) of our subjects were men, and 88 (41.5%) were tivity (r ¼ 0.41; p < 0.001), Depression (r ¼ 0.44; p < 0.001), Anxiety
women. The subjects, whose average age was 19.36 ± 1.75, were (r ¼ 0.47; p < 0.001), Anger-Hostility (r ¼ 0.37; p < 0.001), Phobic
divided into three groups (no Internet addiction, mild Internet Anxiety (r ¼ 0.36; p < 0.001), Paranoid Ideation (r ¼ 0.34;
addiction, and moderate/severe Internet addiction). 108 (50.94%) p < 0.001), Psychoticism (r ¼ 0.41; p < 0.001), and Additional Scale
subjects were found to have no Internet addiction, 70 (33.02%) to (r ¼ 0.34; p < 0.001) (Table 2).
have a mild addiction and 34 (16.04%) to have a moderate/severe A high positive correlation was found between IAS scores and
addiction. 62 of our participants (29.24%) declared the presence of a scores for the sub-scale of PA (r ¼ 0.28; p < 0.001), a moderate
failing school year. In addition to this, 167 of our participants positive correlation was found between IAS scores and scores of the
(78.77%) reported that they used a smart phone, and 36 (16.98%) sub-scale of NA (r ¼ 0.21; p < 0.01), and no statistically significant
used a tablet. 42 participants (19.81%) were smokers. An assess- correlation was found between IAS scores and scores for the sub-
ment of socio-demographic characteristics revealed no statistically scales of AA (r ¼ 0.10) and TA (r ¼ 0.09) (Table 2).
significant difference between average scores for Internet addiction According to hierarchical regression analysis; Step 1 (General
according to independent samples t-test carried out based on Psychopathology) explained 21.6% of IAS scores. According to hi-
gender (t ¼ 0.793, p ¼ 0.429), tablet use (t ¼ 0.499, p ¼ 618), erarchical regression analysis; Step 2 (General Psychopathology
Android phone use (t ¼ 0.030, p ¼ 0.976), presence of failing scores, Perfectionist Attitude, Need for Approval, Autonomous
school year (t ¼ 0.308, p ¼ 0.759), and smoking (t ¼ 1.388, Attitude, Tentative Attitude subscales scores) explained 22.8% of
p ¼ 0.167). Subjects that had a family history of psychiatric referral IAS scores (Table 3).
(n: 27) had statistically significantly higher IAS scores than those
who did not (n: 185) (F ¼ 1.73; t ¼ 2.34; p ¼ 0.020). Subjects that
had a history of psychiatric referral (n:29) had statistically signifi- 4. Discussion
cantly higher IAS scores than those who did not (n:183) (F ¼ 1.212;
t ¼ 3.78 p ¼ 0.001). In our study, the percentage of people who were at risk for IA
A comparison of the average of the three IA groups revealed that and who had IA was 16.04%. Studies conducted in Turkey found
the scores of total SCL-90 and Somatization, Obsessive-Compulsive, varying rates of university students who have IA, such as 12.2% and
Interpersonal Sensitivity, Hostility, Depression, Anxiety, Phobic 7.2% (Dalbudak et al., 2013; Şenormancı et al., 2014). Considering
Anxiety, Paranoid Ideation, Psychoticism And Additional scale the fact that different assessment tools and different methods for IA
increased with the severity of Internet addiction (p < 0.001 for total assessment were used, and that the incidence of IA varies between
SCL-90 and all subscales). A comparison of DAS and sub-scale countries, regions and studies, we might say that the percentage of
scores of the three groups revealed that while average scores for addicted people in our study was higher than some studies and
DAS (p ¼ 0.005) and the sub-scales of PA (p ¼ 0.001) and NA lower than others (Budak et al., 2015; Tsitsika et al., 2014; Alavi
(p ¼ 0.035) were statistically significantly higher in IA groups, no et al., 2011; Ni, Yan, Chen, & Liu, 2009).
statistically significant difference in the averages for the sub-scales The findings achieved in our study show that Internet addiction
of AA (p ¼ 0.473) and TA (p ¼ 0.266) was found (Table 1). interacts with general psychopathologic features and dysfunctional
attitudes (Table 1, Table 2). Depressive symptoms and adverse life

Table 1
Comparing scale and subscale scores according to severity of Internet addiction (IA).

Without IA n ¼ 108 Mild IA n ¼ 70 Moderate/high IA F P

n ¼ 34

Mean SD Mean SD Mean SD

Somatizationa 0.49 0.47 0.75 0.48 1.05 0,68 16.66 <0.001

Obsessive-compulsivea 0.97 0.65 1.39 0.73 1.75 0,84 17.58 <0.001
Interpersonal sensitivitya 0.71 0.65 1.08 0.62 1.46 0.90 16.95 <0.001
Depressiona 0.66 0.61 0.95 0.61 1.55 0.95 22.16 <0.001
Anxietya 0.59 0.62 1.00 0.71 1.57 0.99 24.76 <0.001
Anger-hostilitya 0.65 0.73 0.95 0.77 1.42 0.91 12.85 <0.001
Phobic anxietya 0.34 0.50 0.52 0.57 0.94 0.90 12.65 <0.001
Paranoid thoughtsa 0.79 0.70 1.06 0.61 1.31 0.80 8.24 <0.001
Psychotisma 0.40 0.48 0.70 0.60 1.00 0.79 15.39 <0.001
Additional scalea 0.71 0.62 1.01 0.63 1.28 0.92 10.26 <0.001
General psychopathologya 0.63 0.50 0.95 0.52 1.36 0.80 22.50 <0.001
Dysfunctional attitudesb 117.31 29.10 123.40 23.60 134.35 24.64 5.37 0.005
Perfectionist attitudec 43.38 14.28 45.48 12.10 53.47 14.13 7.14 0.001
Need for approvald 37.62 11.42 41.03 10.41 42.44 9.93 3.39 0.035
Autonomous attituded 17.75 6.28 18.41 5.76 19.14 6.04 0.75 0.473
Tentative attituded 18.17 4.96 18.76 3.61 19.55 4.43 1.33 0.266
Moderate/high > mild > no.
Moderate/high > no.
Moderate/high > mild, no.
Moderate/high, mild, no.
I. Taymur et al. / Computers in Human Behavior 61 (2016) 532e536 535

Table 2
Correlations between the scale and the subscale scores.


IAS 0.37*** 0.43*** 0.41*** 0.44*** 0.47*** 0.37*** 0.36*** 0.34*** 0.41*** 0.34*** 0.47***
DAS 0.25*** 0.18** 0.27*** 0.40*** 0.29*** 0.26*** 0.34*** 0.32*** 0.37*** 0.33*** 0.26*** 0.34***
PA 0.28*** 0.21** 0.31*** 0.37*** 0.30*** 0.33*** 0.37*** 0.34*** 0.40*** 0.38*** 0.31*** 0.37***
NA 0.21** 0.07 0.15* 0.29*** 0.16* 0.10 0.19** 0.14* 0.20** 0.17* 0.10 0.18**
AA 0.10 0.04 0.07 0.26*** 0.16* 0.09 0.21** 0.19** 0.21** 0.19** 0.12 0.16*
TA 0.09 0.23** 0.24*** 0.26*** 0.23** 0.19** 0.23** 0.23** 0.23** 0.19** 0.21** 0.26***

Internet Addiction Scale (IAS), Somatization (S), Obsessive-Compulsive (OC), Interpersonal Sensitivity (IS), Depression (D), Anxiety (A), Anger-Hostility (AH), Phobic Anxiety
(PHA), Paranoid Thoughts (PT), Psychotism (PSY), Additional Scale (AS), General Psychopathology (GP), Dysfunctional Attitudes (DA), Perfectionist Attitude (PA), Need for
Approval (NA), Autonomous Attitude (AA), Tentative Attitude (TA) ***p < 0.001, **p < 0.01, *p < 0.05.

Table 3
Hierarchical regression analysis results associated with the IAS scores.

95% confidence interval

Predictor R2 Adjusted R2 b SE Beta LB UB

Step 1
General psychopathology 12.730 1.671 0.469*** 9.436 16.025
0.220*** 0.216***
Step 2
General psychopathology 12.116 1.829 0.446*** 8.509 15.722
Dysfunctional attitudes 0.087 0.095 0.072 0.100 0.275
Perfectionist attitude 0.208 0.127 0.132 0.042 0.458
Need for approval 0.060 0.204 0.021 0.461 0.342
Autonomous attitude 0.370 0.270 0.097 0.902 0.161
0.246*** 0.228***

Dependent variables: Internet Addiction Scale, 1 point (Never), 2 points (Rarely) 3 points (Sometimes) 4 points (Frequently) and 5 points (Always). ***p < 0.001, LB ¼ Lower
Bound, UP ¼ Upper Bound.

events have a significant role in the severity of addiction, relapse, People with high Perfectionist Attitude were found to have
and treatment process. DA are closely associated with depressive greater expectations and standards, and to be highly self-critical
symptoms and disorders and are found to be an important deter- and self-blaming (Kaviani, Mohammadi, & Zarei, 2014). It was
minant of the psychopathology of addiction (Heinz et al., 2009; found that people with abnormal perfectionist attitude had
Ramsey et al., 2002). In the literature, there is only one study impaired problem-solving skills (O'Connor & O'Connor, 2003),
investigating DA in IA. This study found that DA scores are high in were susceptible to anxiety and depression and may demonstrate
people with IA, and perfectionist attitude (PA) is an important addiction-predisposed behaviors (Kaviani et al., 2014). In their
predictor of IA (Şenormancı et al., 2014). In another study investi- studies with healthy subjects on DAS and mood and character
gating only perfectionism and problem Internet use, perfectionism traits, Otani et al. (2013b) found that a perfectionist pattern is
was similarly found to be a significant predictor of IA (Lehmann associated with increased preservation and repetitive behaviors.
&Konstam, 2011). At this point, we can assume that more studies With a dysfunctional perfectionist attitude, the Internet may create
are needed to enlighten the interaction between IA, DA, and psy- an enabling environment for preservative and repetitive behaviors.
chopathologic features. The Internet may provide a compelling arena for perfectionist
Studies investigating the general psychopathology of Internet people, where they can be alone, away from expectations and
addiction reported that depression and anxiety are a prominent criticism. However, receiving a rapid and easy response in some-
psychopathology (Müller et al., 2014; Tonioni et al., 2012; Goel thing that they control or engage in may also be associated with a
et al., 2013; Müller et al., 2012). As a result of correlation analysis reward system.
carried out in our study, anxiety and depression were found to be The need for approval in DAS is considered to be a pattern
prominent psychopathological symptoms associated with IA. The associated with addiction. Need for approval and high reward
findings of our study and the previous studies are highly consistent. dependence were found to be correlated with healthy subjects
In addition to this, dysfunctional attitudes have an important place (Otani et al., 2013a). The fact that the Internet is easily accessible
in assessing depression and anxiety in terms of cognitive- and that it is easily possible to avoid feelings of loneliness thanks to
behavioral therapy. It might be beneficial to focus on depression social networks may be an enabler for Internet addiction. Never-
and anxiety in the assessment of IA and not to disregard these theless, attitudes of the need for approval associated with addiction
characteristics in the treatment process. As a result of the correla- increase with negative life events and may be predisposing for
tion analysis carried out in our study, a significant positive corre- Internet addiction.
lation was found between DA and all psychopathologies in SCL-90. Positive effects of using cognitive and behavioral therapies for
Besides this, many studies in the literature show that there are the treatment of alcohol and substance addiction, smoking addic-
effects of DA on several psychopathologic characteristics, such as tion, eating disorders, and pathological gambling have been re-
psychosis, bipolar disorder and personality problems (Farabaugh ported (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). Also,
et al., 2007; Wright, Lam, & Newsom-Davis, 2005; Zimmerman, cognitive-behavioral therapy and treatments based on motiva-
Coryell, Corenthal, & Wilson, 1986). Because DA focuses on cogni- tional interviewing were found to be beneficial in the treatment of
tions, emotions, and behaviors for many aspects and conditions in IA (vanRooij, Zinn, Schoenmakers, & van de Mheen, 2012). It was
one's life, it may demonstrate a predisposing effect in the devel- concluded that CBT is effective in the treatment of IA and that time
opment of all psychopathologies. management skills are improved, and emotional, cognitive and
536 I. Taymur et al. / Computers in Human Behavior 61 (2016) 532e536

behavioral symptoms are affected positively by CBT (Hall & Research, 36(5), 427e440.
Kaviani, N., Mohammadi, K., & Zarei, E. (2014). The relationship between perfec-
Parsons, 2011; Young, 2007). Identifying dysfunctional attitudes
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