Background and purpose: our country is one of the young and developing countries that a significant number of their populations are students, especially high school students who pass the critical period of adolescence. The aim of this study was to evaluate the effectiveness of reality therapy on adjustment in adolescent girls with anxiety.

Method: The research method was experimental with pre-test, post-test, and control group. The population of the research includes all female students of high school in Shirvan city in the academic year1394. Using purposive sampling or easy access, 20 students were selected who gained high anxiety scores in Depression, Anxiety, Stress Scale (DASS-21), and randomly assigned to two experimental and control groups (n = 10 in each group). The experimental group received eight sessions of 2 hours reality therapy. The used instrument in this study, was the Adjustment Inventory for School Students that filled in the pre-test and post-test by experimental and control groups. Data were analyzed using SPSS software and analysis of covariance.

Results: The results indicated the effectiveness of reality therapy in increasing overall consistency, emotional, social and educational adjustment in the experimental group compared with the control group. (P <0.001)

Conclusion: Because adolescence is associated with inconsistencies, according to results from this study, the reality therapy can be used as an effective method to increase adjustment among adolescent girls.

Keywords: Reality therapy; Adolescent girls; Adjustment; Anxiety

Adolescence is one of the most important periods of life. A transitional period in which a person moves from the childhood safety towards responsibility and privileges of adulthood [1]. In this period, due to puberty the individual is faced with rapid physical changes and changes in emotions and feelings [2]. Statistics show that the largest generation of adolescents in terms of number, are related to the present time [3]. According to the last census of the Statistical Center of Iran in 1390, teens constitute almost 15 million people (12.9 percent) of the total population [4].

The changes of this period of development can be laying the groundwork for specific problems. When adolescents are not able to successfully overcome the crisis and the developmental challenges, they will experience psychological distress and will occur significant disruption in the normal flow of everyday life and aspects of emotional, social and cognitive development of which following their personality will be confused [5]. Anxiety is one of the most common psychiatric disorders in adolescence [6]. Some researchers report that the puberty factor in adolescence is accompanied with morphological changes that is considered a crisis for adolescent and can lead to development and continuity of adolescence problems [7]. In addition, in early adolescence, anxiety can lead to interpersonal sensitivity and reduction of adaptability. So anxious adolescent, experiences more psychological problems than their peers [8].

In contrast of the wide range of changes and transformations, earn of appropriate adjustment strategies for adolescents is very important so that deficit in this area could have disastrous consequences consist of abnormalities, insecurity feeling, personality, affective and behavioral problems.

In this regard, Poul (2004) also believes that the adjustment requires to change, modify and an attempt to restraining tensions effectively. That has special importance for adolescents who face with puberty stresses.

Between the different therapeutic approaches, reality therapy is known more than other approaches for working with adolescents in educational settings. Reality therapy that is considered as the newest counseling and psychotherapy approaches, is based on choice and control theory and considers the cause of psychological problems in the choice of individuals and the lack of responsibility of the individuals or satisfying its own needs. In this therapy, it is tried that people through better choices, meet their basic needs. In fact, the main objective of reality therapy approach is helping people to be aware of their needs, monitoring behavior, and appropriate decision makings [9,10].

Given that this short-term treatment, has the applicability to group performance in schools, can treat the large number of adolescents at the same time. This study attempts to measure influence of reality therapy on adjustment in adolescent girls with anxiety.

This study from the perspective of research purpose was applied and the research was conducted in semi-experimental with pre - test and post - test design with control group in two experimental and control groups. The study population included all high school students in the Hazrate Maryam high school in Shirvan in the second semester of 94-93. The sampling method in the first stage has been performed based on "purposive available sampling method". In this regard, referring to the high school, the DASS questionnaire was distributed to all students and the filled questionnaires that their anxiety score was up to 7were selected, if they were reluctant to participate in the project and had other inclusion criteria, and 20 patients were assigned randomly into control and experimental groups. Used tools in this study were, the "anxiety, stress, depression scale" and "Adjustment Inventory for School Students, Sinha and Singh". The Depression, Anxiety, Stress Scale, DASS (Loviandand Loviand, 1995), is a series of three self reported subscales for evaluating states of negative affects in depression, anxiety and stress. The application of this scale is measuring the severity of main symptoms of depression, anxiety and stress. To complete the questionnaire, individual must identify the state of a symptom during last week. Since this scale could provide a comparison of the severity of symptoms over several weeks, it can be used to assess the progress of treatment over time. Antony and colleagues (1998) factor analyzed the mentioned scale, that results of their research again indicated three factors of depression, anxiety and stress. The results of this study showed that 68 percent of the total variance of scale is measured by these three factors. The special value of stress, depression and anxiety in the mentioned study, was 07 / 9.89 / 2.23 / 1 respectively and alpha coefficients for these factors was, 97/0, 92/0, 95/0, respectively. The results of the study of the correlation between factors in Anthony and colleagues (1998) study implicating a 0.48 correlation coefficient between the two factors of depression and stress, 0.53 between anxiety and stress and 0.28 between anxiety and depression. The validity and reliability of the questionnaire has been studied in Iran so that the reported test-retest reliability for depression, anxiety and stress was 80/0, 76/0 and 77/0 respectively, and Cronbach's alpha for depression, anxiety and stress, 81/0, 74/0 and 78/0 respectively. Each of the subscales of DASS includes 7 questions that final score of any item is obtained by sum of its question scores (Table 1). Any question is scored of zero (does not apply at all in my case) to 3 (completely true in my case) [11].

Adjustment inventory, has been published by Sinha and Singh and translated and written in 1377 by Karami. The inventory has 60 questions and options of each question have been designed as yes or no. The reliability coefficient of this test reported using the split half and test-retest was 0.95 and 0.93 respectively. The validity of this test has been confirmed by a team of psychologists. The content and face validity of this questionnaire has been confirmed by three professors of consultation, psychometrics and statistics. They have confirmed that the questionnaire is certifiable for assessing the adjustment of high school and pre-university students in three areas of emotional, social and educational. According to Karami, the reliability of this inventory through the split half method for emotional adjustment was 0.94 and to social adjustment 0.93 respectively. This questionnaire seeks to discriminates the high school students (aged 14 to 18 years) with good adjustment from students with poor adjustment in three areas: emotional, social and educational.

Inclusion criteria for the study

1. Earn a higher score of 7 on the subscale of anxiety in the DASS-21
2. Do not get other psychological treatments
3. Willingness to participate in group therapy sessions

The exclusion criteria were as following

1. Evidence of severe illness in person
2. Absence of more than two sessions during group therapy
3. The participate could don’t enter the session for any reason.

Frequency of experimental and control groups were for each of 10 adolescents with anxiety that were randomly assigned in two groups of 10 subjects into experimental and control groups. All subjects were also matched in terms of age, so that the 14-year-old girl is used in this study. To investigate the trained effect value, mean and standard deviation, pretest - posttest and follow-up in both experimental and control groups in terms of adjustment is shown in Table 1. The results indicate an increase in the adjustment subscale (emotional, social and educational) as a result of the post-test and follow-up in the experimental group, and the control group was very low.

The multivariate analysis of covariance (MANCOVA) was used to investigate the effectiveness of the reality therapy program. In this study has been used from Shapiro-Wilk test to prove normality. As a result p>0.05 is the sign of test normality (Tables 2&3).

Using analysis of covariance to determine the effectiveness of reality therapy training on adjustment in the experimental group, the results showed that there are significant differences between the mean scores in, emotional adjustment, social adjustment and academic adjustment subscales in the post-test experimental group and the control group, (P <0.001). And since this influence is significant in follow-up in P <0.001, it is suggested that the influence of this training on enhancing adjustment (emotional, social and educational) has been remained. This means that the reality therapy, improves emotional, social and educational adjustment in adolescent girls with anxiety.

The aim of present study was the investigation of effectiveness of reality therapy on adjustment in adolescent girls with anxiety, that the results showed the reality therapy has improved adjustment in adolescent girls with anxiety. It was also shown in this study, teaching reality therapy is effective on three subscales: emotional adjustment, social adjustment and academic adjustment. These results are in consistent with , Mehrbakhsh(1389), which indicating the effectiveness of reality therapy on emotional, social, and educational adjustment, Armstrong and colleagues (2005) which indicating the effectiveness of group counseling based on reality therapy on increasing responsibility and academic performance, Asner and kabrely (1983) which indicating the effectiveness of reality therapy on academic success and passion for education, chunk (1994) which indicating the effectiveness of reality therapy on improvement of social and comunication skills, Farzam(1380) which indicating the effectiveness of reality therapy on academic performance.

In the explanation of training of the reality therapy on emotional adjustment of adolescents, it can mention that the emotional adjustment can consider as coordination between feelings, activities, thoughts, and good mental health. One of the main components in related to emotional adjustment and mental health of adolescents is the acceptance of responsible behavior. Reality therapy with emphasis on acceptance of responsibility and meet the basic needs leads to more self awareness that this factor causes the adolescent has a deep comprehension of her/ his emotions, weak points, powers and needs, and able to evaluation, conduction and control the life events that these capabilities play a clear role in development of insight and intuition to self and surrounding environment, and promote the individual compatibility power in terms of emotional and prevent from individual locating in domination of emotions; Therefore training of reality therapy leads to emotional adjustment in adolescent girls [12].

In related to social adjustment, also can such explain that in accordance with reality therapy features that are based on comprehension, responsibility and meet of needs, the reality therapy enhances the emotional perception of individuals and this level of perception is accompanied by power enhancement, evaluation of environmental stimuli, increasing the power of establishment of social and affective relations and expression of organized functioning empathy for person, which this state provides the necessary within mental setting for achieving to social adjustment [13]. Person in relate to training of reality therapy through organization of thoughts, memory, and memory content faces more integrated with issues and tensions related to social environment. Furthermore the emotional facilitation feature with positive behavioral changes help to better adoption of individual with environment and environmental stimuli. Also under the emotional cognition feature, individuals are applied for increasing the probability of correct and realistic cognition of emotions and stressfull situations that according this, emotional cognition with predictive mechanisms, controls and efficient encounter strategies, helps to improvement the quality of social communications and reach to appropriate social adjustment [14].

In explanation of educational adjustment, also can such argue that, today high anxiety is known as a disruptive phenomenon of function that causes the individual not be able to establishment of communication with others and don’t consider any responsible for himself/herself. Reality therapy is an approach that could apply for various problems of school and educational issues. In this approach, it is tried adolescents understand reasons and motives of their behaviors and helped to them to evaluate and investigate their behaviors [15]. Indeed This approach is a composition of existential believes and behavioral techniques where in has been very emphasized on responsibility and control sense. Which these two, are personality variables that have a positive association with educational and academic adjustment, on the other hand the training of reality therapy leads their to believe that they under any condition, themselves are responsible for meet their needs finally, that this training optimize them that they comprehend the importance of their surrounding environmental issues such as educational issues to satisfy their needs and earn sufficient motivation for more adjustment.