Modeling Anger Management Based on Mindfulness with the Mediating Role of Experiential Avoidance in Nurses
Keywords:
Anger Management, Mindfulness, Experiential Avoidance, NursesAbstract
Introduction and Aim: Effective anger management is particularly important for nurses because they are continuously exposed to high-pressure clinical situations, interpersonal conflicts, and demanding professional responsibilities that may affect both their psychological well-being and the quality of patient care. This study aimed to develop and test a model of anger management based on mindfulness, considering the mediating role of experiential avoidance among nurses.
Methodology: This applied study employed a descriptive-correlational design based on structural equation modeling. The statistical population comprised all nurses working in Qom, Iran, during 2024–2025, estimated at at least 3,000 individuals. A sample of 200 nurses was selected through purposive sampling according to predetermined inclusion and exclusion criteria. Data were collected using the State-Trait Anger Expression Inventory, the Mindful Attention Awareness Scale, and the Acceptance and Action Questionnaire-II. Pearson correlation analysis, regression analysis, and structural equation modeling were performed using SPSS and AMOS, with the significance level set at 0.05.
Findings: Inferential analyses indicated a significant positive association between mindfulness and anger management and significant negative associations involving experiential avoidance. Mindfulness directly and significantly accounted for 33% of the variance in anger management. Structural equation modeling showed a significant positive direct effect of mindfulness on anger management (β=0.33, P=0.001), a significant negative direct effect of mindfulness on experiential avoidance (β=-0.49, P=0.001), and a significant negative direct effect of experiential avoidance on anger management (β=-0.53, P=0.001). The indirect effect of mindfulness on anger management through experiential avoidance was also significant (β=-0.11, P=0.001). Model-fit indices indicated an acceptable fit of the proposed structural model to the observed data.
Conclusion: Mindfulness appears to contribute to nurses’ anger management both directly and indirectly through reduced experiential avoidance. Accordingly, interventions designed to strengthen mindful awareness and decrease avoidance of unpleasant internal experiences may improve emotional regulation and anger management in nurses, with potential benefits for their psychological well-being, professional interactions, and quality of patient care.
Downloads
References
Asgari Tarazoj, A., Ali Mohammadzadeh, K., & Hejazi, S. (2018). Relationship Between Moral Intelligence and Anger Among Nurses in Emergency Units of Hospitals Affiliated to Kashan University of Medical Sciences. Journal of Health Care, 19(4), 262-271.
Baer, R. (2019). Assessment of Mindfulness by Self-Report. Current opinion in psychology, 28, 42-48. https://doi.org/10.1016/j.copsyc.2018.10.015
Bahadori, H., Hosseini Amiri, M., Sharafi, H., & Entezari, A. (2022). The Effect of Aromatherapy with Damask Rose on Anxiety, Accuracy and Job Stress in Operating Room Nurses. Evidence Based Care, 12(1), 56-62.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., & Carmody, J. (2004). Mindfulness: A Proposed Operational Definition. Clinical Psychology: Science and Practice, 11(3), 230. https://doi.org/10.1093/clipsy.bph077
Cezar, E. S., & Marziale, M. H. (2006). Occupational Violence Problems in an Emergency Hospital in Londrina, Paraná, Brazil. Cadernos de Saúde Pública, 22, 217-221. https://doi.org/10.1590/S0102-311X2006000100024
Cookson, C., Luzon, O., Newland, J., & Kingston, J. (2020). Examining the Role of Cognitive Fusion and Experiential Avoidance in Predicting Anxiety and Depression. Psychology and Psychotherapy, 93(3), 456-473. https://doi.org/10.1111/papt.12233
Dil, S., & Çam, M. (2024). The Mediator Role of Mindfulness in the Relationship Between the Listening Skills and Anger Management Skills of Emergency Health Care Professionals. International Emergency Nursing, 75, 101475. https://doi.org/10.1016/j.ienj.2024.101475
Dou, J., Lian, Y., Lin, L., Asmuri, S. N., Wang, P., & Rajen Durai, R. A. (2025). Effectiveness of Mindfulness-Based Interventions on Burnout, Resilience and Sleep Quality Among Nurses: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. BMC Nursing, 24(1), 739. https://doi.org/10.1186/s12912-025-03101-0
Esmaeili, R., & Lameh Jouybari, A. (2020). Violence Against Emergency Nurses and Some Related Factors. Clinical Excellence, 9(4), 34-44.
Felix-Junior, I. J., Opaleye, E. S., Donate, A. P., Bedendo, A., Machado, M. P., & Galduroz, J. C. (2025). Effectiveness of Mindfulness for Anger Expression on Men in Treatment for Substance Use Disorders: A Randomized Controlled Trial. International journal of mental health and addiction, 23(1), 281-299. https://doi.org/10.1007/s11469-023-01113-y
Gholami, M. R., & Kiamarsi, A. (2024). The Effectiveness of Mindfulness-Based Stress Reduction Training on the Beliefs Related to Pain and Anger in Women with Rheumatoid Arthritis. Iranian Journal of Health Psychology, 7(3).
Hayes-Skelton, S. A., & Eustis, E. H. (2020). Experiential Avoidance. In. https://doi.org/10.1037/0000150-007
Heidari, T., Shafipour, V., Shamshiri, S., Mousavinasab, S. N., & Jannati, Y. (2022). The Relationship Between Anger, Moral Distress, and Self-Esteem in Nurses. Journal of Holistic Nursing And Midwifery, 32(4), 243-253. https://doi.org/10.32598/jhnm.32.4.2216
Jafari Samie, M., Farsi, Z., & Azizi, M. (2019). Effect of Training Interaction and Anger Controlling Skill on Nurses' Exposure to Aggressive Behaviors in Hospitalized Patients in Psychiatric Departments of Selected Military Hospitals. Military Caring Sciences, 6(2), 93-104. https://doi.org/10.29252/mcs.6.2.93
Kabat-Zinn, J. (2003). Mindfulness-Based Interventions in Context: Past, Present, and Future.
Karimi, N., Hasanvand, S., Beiranvand, A., Gholami, M., & Birjandi, M. (2024). The Effect of Aromatherapy with Pelargonium graveolens (P. graveolens) on the Fatigue and Sleep Quality of Critical Care Nurses During the COVID-19 Pandemic: A Randomized Controlled Trial. Explore (NY), 20(1), 82-88. https://doi.org/10.1016/j.explore.2023.06.006
Khalifa, S. M., Abu Almakarem, A. S., Elnabawey, M. G., & Salama, E. S. (2024). Effectiveness of Mindfulness Program on Anxiety, Anger, and Self-Esteem Among Academic Nursing Student. Sohag Journal of Nursing Science, 3(4), 42-52.
La, I. S., & Yun, E. K. (2019). Effects of Trait Anger and Anger Expression on Job Satisfaction and Burnout in Preceptor Nurses and Newly Graduated Nurses: A Dyadic Analysis. Asian Nursing Research, 13(4), 242-248. https://doi.org/10.1016/j.anr.2019.09.002
Lee, H. Y., Jang, M. H., Jeong, Y. M., Sok, S. R., & Kim, A. S. (2021). Mediating Effects of Anger Expression in the Relationship of Work Stress with Burnout Among Hospital Nurses Depending on Career Experience. Journal of Nursing Scholarship, 53(2), 227-236. https://doi.org/10.1111/jnu.12627
Lim, J. Y., Kim, G. M., & Kim, E. J. (2022). Factors Associated with Job Stress Among Hospital Nurses: A Meta-Correlation Analysis. International journal of environmental research and public health, 19(10), 5792. https://doi.org/10.3390/ijerph19105792
Pachi, A., Panagiotou, A., Soultanis, N., Ivanidou, M., Manta, M., & Sikaras, C. (2024). Resilience, Anger, and Insomnia in Nurses After the End of the Pandemic Crisis. Epidemiologia, 5(4), 643-657. https://doi.org/10.3390/epidemiologia5040045
Park, J., & Shin, N. (2023). Influence of the Clinical Nurse's Self-Acceptance and Experiential Acceptance on Leadership Versatility. Sage Open Nursing, 9, 23779608231175329. https://doi.org/10.1177/23779608231175329
Rudaz, M., Twohig, M. P., Ong, C. W., & Levin, M. E. (2017). Mindfulness and Acceptance-Based Trainings for Fostering Self-Care and Reducing Stress in Mental Health Professionals: A Systematic Review. Journal of Contextual Behavioral Science, 6(4), 380-390. https://doi.org/10.1016/j.jcbs.2017.10.001
Salem, G. M., Hashimi, W., & El-Ashry, A. M. (2025). Reflective Mindfulness and Emotional Regulation Training to Enhance Nursing Students' Self-Awareness, Understanding, and Regulation: A Mixed Method Randomized Controlled Trial. BMC Nursing, 24(1), 478. https://doi.org/10.1186/s12912-025-03086-w
Soheili, A., Mohammadpour, Y., Jafarizadeh, H., Habibzadeh, H., & Mehryar, H. (2014). Violence Against Nurses in Emergency Departments of Urmia University Hospitals in 2013. Nursing and Midwifery Journal, 12(9), 874-882.
Sulianta, F. (2024, 2024/12/27). Mindfulness in Modern Life-the Impact of Vipassana Meditation on Stress and Anger Management 1st Widyatama International Conference on Management, Social Science and Humanities (ICMSSH 2024), https://doi.org/10.2991/978-94-6463-608-6_21 https://doi.org/10.2991/978-94-6463-608-6_21
Wang, Y., Tian, J., & Yang, Q. (2024). Experiential Avoidance Process Model: A Review of the Mechanism for the Generation and Maintenance of Avoidance Behavior. Psychiatry and Clinical Psychopharmacology, 34(2), 179. https://doi.org/10.5152/pcp.2024.23777
Yang, B. X., Stone, T. E., Petrini, M. A., & Morris, D. L. (2018). Incidence, Type, Related Factors, and Effect of Workplace Violence on Mental Health Nurses: A Cross-Sectional Survey. Archives of Psychiatric Nursing, 32(1), 31-38. https://doi.org/10.1016/j.apnu.2017.09.013
Yun, K., & Yoo, Y. S. (2021). Effects of the Anger Management Program for Nurses. Asian Nursing Research, 15(4), 247-254. https://doi.org/10.1016/j.anr.2021.07.004
Downloads
Publication Timeline
- Submitted
- Revised
- Accepted
Issue
Section
License
Copyright (c) 2025 Niloofar Alimohammadi (Author); Sagha Afrakhteh; Fereshteh Afkari (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
