title: The Effectiveness of Assertiveness Training on the Levels of Stress, Anxiety, and Depression of High School Students.
abstract: BACKGROUND
  Adolescence is a transition period from childhood to early adulthood. Because of the immense pressure imposed on adolescents due to the complications and ambiguities of this transition, their level of excitement increases and sometimes it appears in the form of sensitivity and intense excitement.
  
  
  OBJECTIVE
  This study aimed at determining the effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students.
  
  
  METHODS
  This quasi-experimental study was conducted on high school students of Isfahan in academic year 2012 - 13. A total of 126 second grade high school students were collected according to simple random sampling method and divided into two groups: experimental with 63 participants and control with the same number. Data gathering instruments included a demographic questionnaire, Gambill-Richey assertiveness scale, and depression anxiety stress scales (DASS-21). Assertiveness training was carried out on the experimental group in 8 sessions; after 8 weeks, posttest was carried out on both groups. Statistical tests such as independent t test, repeated measures ANOVA, Chi-square test, and the Mann-Whitney test were used to interpret and analyze the data.
  
  
  RESULTS
  The Chi-square and Mann-Whitney tests did not show significant statistical differences between the two groups in terms of demographic variables (P ≥ 0.05). Repeated measures ANOVA showed no significant difference between the mean scores for assertiveness before (100.23 ± 7.37), immediately after (101.57 ± 16.06), and 2 months after (100.77 ± 12.50) the intervention in the control group. However, the same test found a significant difference between the mean score for assertiveness in the experimental group before (101.6 ± 9.1), immediately after (96.47 ± 10.84), and 2 months after (95.41 ± 8.37) implementing the training program (P = 0.002). The independent t test showed no significant difference in the mean score for anxiety and stress between two groups before the assertiveness training program; however, 2 months after the intervention, the mean score for anxiety in the experimental group was found significantly lower than the control group. As for the mean score for depression, the independent t test showed no significant difference between two groups before training; however, despite the decrease in the mean scores for depression in the experimental group following the intervention, the difference was not significant (P = 0.09).
  
  
  CONCLUSIONS
  The results of the current study show that conducting assertive training in high school students decreases their anxiety, stress, and depression. Given that high school years are among the most sensitive stages of one's life plus the fact that conducting such training programs besides their safe and low cost nature are effective and practical, it is highly recommended that such programs be carried out among high school adolescents.
authors.affiliation: Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors.forename: Ahmad Ali
authors.initials: AA
authors.lastname: Eslami
authors.affiliation: Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors.forename: Leili
authors.initials: L
authors.lastname: Rabiei
authors.affiliation: Department of Nursing, Nursing and Midwifery School, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, IR Iran.
authors.forename: Seyed Mohammad
authors.initials: SM
authors.lastname: Afzali
authors.affiliation: Department of Nursing, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamidizadeh
authors.affiliation: Department of Nursing, Nursing and Midwifery School, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, IR Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Masoudi
keywords: Assertiveness; Depression; Stress, Anxiety; Student