Introduction
Post-traumatic stress disorder (PTSD) can occur in all people with any ethnicity, nationality or culture and at any age. This disorder affects approximately 3.5% of adults annually and 1 in 11 people had experienced PTSD. Symptoms of PTSD may begin in the first month after a traumatic event, but sometimes symptoms may have a delay for many years. These symptoms cause significant problems in social or work-related relationships. They can also interfere with the ability to perform normal daily activities. The symptoms of PTSD are generally divided into four types: intrusive memories, avoidance, negative changes in thinking/mood and changes in physical and emotional reactions. The symptoms are more common in early adulthood. 
Various theories have been presented to explain the aetiology of PTSD. Ehlerz and Clarck (2000) believe that patients with PTSD process the truma in a way that leads to a sense of current and serious threat. Individual differences in the appraisal of the truma and its consequences increase the frequency of PTSD. In psychoanalytic theories, there is hypothesis that the injury causes the reactivation of psychological conflicts that were inactive before, but in fact they were not still resolved. The return of childhood trauma leads to the use of defense mechanisms of repression, denial and undoing. Freud considered the symptoms of PTSD to be the sinking of defenses, which originates from intense and threatening experiences of uncontrollable anxiety. The experiences themselves can be traumatic enough to cause this reaction, or they can trigger painful memories of previously unresolved unconscious conflicts, resulting in an inability to suppress these memories, and anxiety.
Considering that relief workers (Red Crescent, Emergency, Fire workers) have a stressful job and regularly face events that remain in their minds, this research aims to survey the perceptions of these relief force workers in Iran regarding the quality of emergency group therapy sessions for controlling their PTSD and identify the related causal, intervening, contextual, processual and consequential factors. 

Methods
This is a qualitative study. Interviews were used to collect data. In this research, chain or snowball sampling was used to select participants from among relief workers who had participated in at least six or more emergency group therapy sessions for PTSD. The participants were 26 relief workers (Red Crescent, Emergency, Fire workers) who had resuced people injured in accidents, natural disasters, etc. in their missions in Fars province, Iran, in 2022. They had witnessed a traumatic event and had at least five years of work experience. Two were used to determine the reliability of the interview contents including validaty content using the opinions of participants and the auditing technique using the opinions of experts. The data were analyzed according to the grounded theory method using open, axial and selective coding.

Results
The results indicate that causal factors included organizational rules and regulations, accountability, efficient management, and psychol-personality concepts. Contexual factors included irregular holding of sessions, media capacity, lifestyle, communication skills, and history of mental illness. The intervening factors included the rereconstruction of memories and emotional excitability. The strategies included relaxation and religious activities. The consequence included reduced stress, being of the same mind and group cohesion, Unloading psychological burden.

Conclusion
The quality of group therapy sessions to reduce PTSD in relief workers is influenced by factors related to their lifestyle and organization. According to the participants, strengths of group therapy sessions for relief workers included: 1) Reducing stress, 2) Being of the same mind and group cohesion, 3) Unloading psychological burden, 4) Reducing mental pressure, 5) Solving or minimizing individual and group problems, 6) Using the experiences of others and the techniques of experts and registering problems in the rescue file, 7) Causing discipline and concentration and reducing stress and negative burdens caused by accidents and 8) Psycho-behavioral support.
Weaknesses of group therapy sessions for relief workers included: 1) Lack of motivation in psychologists, 2) Long duration of meetings, 3) Not holding meetings in some units (e.g. the 115 emergency center), 4) Failure to treat PTSD in a specialized way and by drug therapy, 5) Lack of sufficient expert staff to manage and hold meetings, 6) Not holding the meetings regularly and 7) Not holding psychotherapy sessions in the 115 emergency center.
The most important extracted theme regarding the quality of emergency group therapy sessions for controlling PTSD in resuce workers was “reconstruction of memories”.

Ethical Considerations
Compliance with ethical guidelines
All the rights of the participants have been respected.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declared no conflict of interest.

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