Efficacy of Child-Oriented Unified Trans-Diagnostic Treatment for Alexithymia in Divorce-Engaged Children with Emotional Self-Regulation Difficulties

Document Type : Research Paper

Authors

1 Department of Counseling, Faculty of Humanities, North Tehran Branch, Islamic Azad University, Tehran, Iran.

2 Department of Psychology, Faculty of Humanities, North Tehran Branch, Islamic Azad University, Tehran, Iran.

3 Department of Educational Sciences, Faculty of Humanities, North Tehran Branch, Islamic Azad University, Tehran, Iran.

Abstract

The purpose of the current study was to investigate the efficacy of child-oriented unified trans-diagnostic treatment for Alexithymia in divorce-engaged children with emotional self-regulation difficulties. The study employed a quasi-experimental design with a pre-test, post-test, and two-month follow-up period. The statistical population of the present study consisted of female divorced children (9 to 12 years old) with difficulty in emotional self-regulation who attended primary school in Tehran during the academic year 2021-22. 26 female children of divorced parents with difficulties in emotional self-regulation were selected using a purposive sampling method and randomly assigned to experimental and control groups of 13 children each. The experimental group received ten sixty-five-minute sessions of unified trans-diagnostic treatment intervention geared toward children over the course of two months. In this study included Children’s Emotional Regulation Questionnaire (ERQ) and Alexithymia Questionnaire (AQ) were applied as questionnaires. The data were analyzed using SPSS-23 and the mixed ANOVA method. The findings revealed that the child-focused Unified Trans-Diagnostic Treatment has a significant effect on Alexithymia and emotional self-regulation in divorce-engaged children with difficulties in emotional self-regulation (p<0.001). Identifying emotions, teaching emotional awareness, cognitive reevaluation, identifying emotion avoidance models, and examining behaviors resulting from emotions were found to be effective in decreasing alexithymia in divorce-engaged children with difficulty in emotional self-regulation.

Keywords

References

ابوالقاسمی، ع.، رضایی جمالویی، ح.، و حرفتی، ر. (1390). ارتباط بین نارسایی هیجانی، کودک‌آزاری و پیشرفت تحصیلی در دانش‌آموزان پسر دبیرستانی. اندیشه‌های نوین تربیتی. 3(2)، 58-47.
اصلی آزاد، م.، منشئی، غ. ر.، و قمرانی، ا. (1398). اثربخشی درمان مبتنی بر پذیرش و تعهد بر تنظیم شناختی هیجان و تحمل ابهام دانش‌آموزان مبتلا به اختلال وسواس فکری-عملی. روان‌شناسی افراد استثنایی. 9(36)، 56-33.
آشنا، م.، بشارت، م.، ملیحی الذاکرینی، س.، و رافضی، ز. (1400). اثربخشی گروه‌درمانی فراتشخیصی یکپارچه بر فراشناخت‌ها و فراهیجان‌های مثبت مادران کودکان مبتلا به سرطان. مجلۀ علوم روان‌شناختی. 20(97)، 22-13.
بارلو، د.، اهرنیش-می، ژ.، کندی، س.م.، شرمن، ج.، بیلک، ا.، و بوزلا، ب. (1400). پروتکل یکپارچه برای درمان فراتشخیصی اختلالات هیجانی کودکان کتاب تمرین بارلو. ترجمۀ سوگند قاسم‌زاده و لیلا سالک ابراهیمی. تهران: ابن‌سینا.
حسن‌پور، پ.، آقایوسفی، ع.، ضمیر، م.، و علی‌پور، ا. (1398). مقایسۀ اثربخشی درمان فراتشخیصی و مواجه‌سازی-بازداری پاسخ بر اجتناب تجربه‌ای و تنظیم شناختی هیجان در مبتلایان به وسواس فکری-عملی. روان‌شناسی بالینی. 11(3)، 37-25.
زراعتکار، م.، سراوانی، ش.، زینلی‌پور، م.، و اربابی، ف. (1400). مقایسۀ مقبولیت اجتماعی، اختلالات سلوک و دشواری در تنظیم هیجان در کودکان طلاق، کودکان با مرگ والدین و کودکان عادی شهر قم در سال ۱۳۹۹: یک مطالعۀ توصیفی. مجلۀ دانشگاه علوم پزشکی رفسنجان. ۲۰(۱۰)، ۱۱۱۶-۱۰۹۹.
عثمانی، ه‍.، و شکری، ل. (1398). اثربخشی درمان فراتشخیصی یکپارچه بر نظم‌جویی شناختی هیجان و همدلی شناختی دانش‌آموزان با اختلال رفتار برونی‌سازی‌شده. توانمندسازی کودکان استثنایی. 10(1)، 136-125.
عطارد، ن.، میکاییلی، ن.، مهاجری، ن.، و وجودی، ب. (1395). اثر درمان فراتشخیصی یکپارچه بر اختلالات اضطرابی و افسردگی همایند: طرح تک‌موردی. مجلۀ دانشگاه علوم پزشکی تربت حیدریه. 4(4)، 62-54.
قاسم‌زاده، س.، نقش، ز.، غلامی فشارکی، م.، و شفیعی، ا. (1400). اثربخشی برنامۀ درمان فراتشخیصی بر بهبود کیفیت زندگی و کاهش افسردگی کودکان مبتلا به دیابت نوع یک: یک مطالعۀ تجربی. مجلۀ علوم اعصاب شفای خاتم. 9(4)، 80-71.
قره‌داغی، ع.، و مبینی‌کشه، ف. (1399). مقایسۀ خودپنداره، نقش جنسیتی و بلوغ عاطفی در فرزندان با و بدون تجربۀ طلاق والدین. فصلنامۀ فرهنگ مشاوره و روان‌درمانی. 11(42)، 260-231.
محمدی، ر.، نهنگ، ع. ا.، و حسینی، م. ا. (1398). اثربخشی درمان فراتشخیص یکپارچه بر خودپنداشت و آشفتگی روان‌شناختی دانش‌آموزان دارای علائم افسردگی. فصلنامۀ سلامت روان کودک. 6(4)، 118-108.
مشهدی، ع.، حسنی، ج.، و میردورقی، ف. (1391). بررسی ساختار عاملی، اعتبار و روایی نسخۀ فارسی پرسشنامۀ نظم‌جویی شناختی هیجان-فرم کودکان. مجلۀ اصول بهداشت روانی. 14(3)، 259-246.
مهدوی، ع.، گلستانی، ع.، آقائی، م.، همتی‌راد، گ.، حاج حسینی، م.، غلامعلی لواسانی، م.، سپهر یگانه، ش.، و قربانی‌نیا، ف. (1398). اثربخشی آموزش مهارت حل مسئله بر افزایش سازگاری اجتماعی و راهبردهای خودتنظیمی کودکان طلاق. مطالعات روان‌شناسی تربیتی. 16(33)، 157-170.
نرگسی، ف.، فتحی آشتیانی، ع.، داودی، ا.، و اشرفی، ع. (1398). اثربخشی درمان فراتشخیصی یکپارچه بر حساسیت اضطرابی، تحمل پریشانی و علائم وسواسی-اجباری در افراد دچار اختلال وسواسی اجباری. مجلۀ دستاوردهای روان‌شناختی. 28(2)، 39-26.
Abolghasemi, A., Rezaeu Jamaloei, H., & Herafti, R. (2017). The relationship between alexithymia, child abuse and academic achievement among male high school students. Quarterly Journal of New Thoughts on Education, 3(2), 47-58. (In Persian)
Amone-P’Olak, K., Garnefski, N., & Kraaij, V. (2007). Adolescents caught between fires: Cognitive emotion regulation in response to war experiences in Northern Uganda. Journal of Adolescent, 30(4), 655-669. https://doi.org/10.1016/j.adolescence.2006.05.004
Arabatzoudis, T., Rehm, I. C., Nedeljkovic, M., & Moulding, R. (2017). Emotion regulation in individuals with and without trichotillomania. Journal of Obsessive-Compulsive and Related Disorders, 12, 87-94. https://doi.org/10.1016/j.jocrd.2017.01.003
Ashena, M. S., Besharat, M. A., Malihialzuckerini, S., & Rafezi, Z. (2021). The effectiveness of unified transdiagnostic therapy on strategies cognitive emotion regulation in mothers of children with cancer. Journal of Psychological Science, 20(104), 1383-1402. (In Persian)
Asli Azad, M., Manshaei, G.H., Ghamarani, A. (2020). Effectiveness of acceptance and commitment therapy on cognitive emotion regulation and intolerance of uncertainty of the students with obsessive-compulsive disorder. Psychology of Exceptional Individuals, 9(36), 33-56. (In Persian)
Barlow, D., Ehrenisch-May, J., Kennedy, S.M., Sherman, J., Bilek, A., Bozella, B. (2021). Unified protocols for transdiagnostic treatment of emotional disorders in children: therapist guide. Translated by Sogand Ghasemzadeh and Leila Salek Ebrahimi. Tehran: Sina Publications. (Date of publication in original language, 2018). (In Persian)
Barnhart, W. R., Braden, A. L., & Price, E. (2021). Emotion regulation difficulties interact with negative, not positive, emotional eating to strengthen relationships with disordered eating: An exploratory study. Appetite, 158, 105038. https://doi.org/10.1016/j.appet.2020.105038
Bastaits, K., Pasteels, I., & Mortelmans, D. (2019). How do post-divorce paternal and maternal family trajectories relate to adolescents’ subjective well-being? Journal of Adolescence, 64(1), 98-108. https://doi.org/10.1016/j.adolescence.2018.02.005.
Blalock, D. V., Kashdan, T. B., & Farmer, A. S. (2016). Trait and daily emotion regulation in social anxiety disorder. Cognitive Therapy and Research, 40(3), 416-425.          https://doi.org/10.1007/s10608-015-9739-8
Boisseau, C. L., & Rasmussen, S. A. (2018). Unified protocol for the discontinuation of long-term serotonin reuptake inhibitors in obsessive compulsive disorder: Study protocol and methods, Contemporary Clinical Trials, 65, 157-163. https://doi.org/10.1016/j.cct.2017.12.017
Carlucci, L., Saggino, A., & Balsamo, M. (2021). On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clinical Psychology Review, 87, 101999. https://doi.org/10.1016/j.cpr.2021.101999
Cassiello-Robbins, C., Rosenthal, M. Z., & Ammirati, R. J. (2021). Delivering transdiagnostic treatment over telehealth during the COVID-19 pandemic: Application of the unified protocol. Cognitive and Behavioral Practice, 28(4), 555-572. https://doi.org/10.1016/j.cbpra.2021.04.007
Castro-Camacho, L., Díaz, M. M., & Barbosa, S. (2022). Effect of a group prevention program based on the unified protocol for college students in Colombia: A quasi-experimental study. Journal of Behavioral and Cognitive Therapy, 32(2), 111-123. https://doi.org/10.1016/j.jbct.2021.04.001
Chalah, M. A., & Ayache, S. S. (2017). Alexithymia in multiple sclerosis: A systematic review of literature. Neuropsychologia, 104, 31-47.  https://doi.org/10.1016/j.neuropsychologia.2017.07.034.
Coates, A.A., & Messman-Moore, L. (2014). A structural model of mechanisms predicting depressive symptoms in women following childhood psychological maltreatment. Child Abuse Neglect, 38, 103–113. https://doi.org/10.1016/j.chiabu.2013.10.005
Davyod, D. M. (2017). Alexithymia as a health risk and resilience factor. Journal of Psychosomatic Research, 101, 66-67. https://doi.org/10.1016/j.jpsychores.2017.08.004.
Eckhardt, S., Martell, C., Lowe, K.D., Grange, D., & Ehrenreich-May , J. (2019). An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children. Journal of Eating Disorder,7, 34, https://doi.org/10.1186/s40337-019-0267-x
Garnefski, N., Rieffe, C., Jellesma, F., Terwogt, M.M., & Kraaij, V. (2007). Cognitive emotion regulation strategies and emotional problems in 9-11-year-old children: The development of an instrument. Eurly Children and Adolescent Psychiatry, 16, 1-9. https://doi.org/10.1007/s00787-006-0562-3
Gharedaghi, A., & Mobini Kashe, F. (2020). comparison of self concept clarity, role gender and emotional maturity in children with and without experience of divorce in parents. Counseling Culture and Psychotherapy, 11(42), 231-260. (In Persian)
Ghasemzadeh, S., Naghsh, Z., Gholami Fesharaki, M., & Shafiee, E. (2021). The effectiveness of transdiagnostic treatment program on improving the quality of life and reducing depression in children with type 1 diabetes: An experimental study. Shefaye Khatam, 9(4), 71-80. (In Persian)
Gross, J. J., & Jazaieri, H. (2014). Emotion, emotion regulation, and psychopathology: an affective science perspective. Clinical Psychological Science, 2(4), 387-401.   https://doi.org/10.1177/2167702614536164.
Grossman, R. A., & Ehrenreich-May, J. (2020). Using the unified protocol for transdiagnostic treatment of emotional disorders with youth exhibiting anger and irritability. Cognitive and Behavioral Practice, 27(2), 184-201. https://doi.org/10.1016/j.cbpra.2019.05.004
Hasanpoor, P., Aghayousefi, A., Zamir, M., & Alipour, A. (2019). The effectiveness of transdiagnostic treatment on experiential avoidance and cognitive emotion regulation in patients with obsessive-compulsive disorder and its comparison with exposure and prevention response therapy. Journal of Clinical Psychology, 11(3), 25-37. (In Persian)
Kennedy, S. M., Bilek, E. L., & Ehrenreich-May, J. (2019). A randomized controlled pilot trial of the unified protocol for transdiagnostic treatment of emotional disorders in children. Behavior Modification, 43(3), 330-360. https://doi.org/10.1177/0145445517753940
Kennedy, S. M., Tonarely, N. A., Sherman, J. A., & Ehrenreich-May, J. (2018). Predictors of treatment outcome for the unified protocol for transdiagnostic treatment of emotional disorders in children (UP-C). Journal of Anxiety Disorders, 57, 66-75. https://doi.org/10.1016/j.janxdis.2018.05.004
Liu, X., Cao, J., & Xie, C. (2019). Finite-time and fixed-time bipartite consensus of multi-agent systems under a unified discontinuous control protocol. Journal of the Franklin Institute, 356 (2), 734-751. https://doi.org/10.1016/j.jfranklin.2017.10.009
Mahdavi, A., Golestani, A., Aghaei, M., Hemmati Rad, G., Hajhoseini, M., Gholamali Lavasani, M., Sepehr Yeganeh, S. H., & Ghorbaninia, F. (2019). The effectiveness of problem-solving skills training on increasing social adjustment and regulatory self strategies in children of divorce. Journal of Educational Psychology Studies, 16(33), 157-170. (In Persian)
Mashhadi, A., Hasani, J., & Mirtoroghi, F. (2012). Factor structure, reliability and validity of Persian version of the cognitive emotion regulation questionnaire-children form (CERQ-K-P). Journal of Fundamentals of Mental Health, 14(3), 246-259. (In Persian)
Mohammadi, R., Nahang, A. A., & Hoseini, M. A. (2020). The effectiveness of unified transdiagnostic therapy on self-concept and psychological disorder of the students with depression symptoms. Journal of Children Mental Health, 6(4), 108-118. (In Persian)
Nargesi, F., Fathi Ashtiani, A., Davodi, A., & Ashrafi, A. (2019). The effect of unifled transdiagnostic treatment on anxiety sensitivity, distress tolerance and obsessive-compulsive symptoms in individuals with obsessive-compulsive disorder. Psychological Achievements, 28(2), 26-39. (In Persian)
Osmani, H., & Shokri, L. (2019). Effectiveness of unified trans-diagnostic treatment on emotion’s cognitive regulation and cognitive empathy of students with externalized behavior disorder. Empowering Exceptional Children, 10(1), 125-136. (In Persian)
Otared, N., Mikaeili, N., Mohajeri, N., & Vojoudi, B. (2017). The effect of unified transdiagnostic treatment on anxiety disorders and comorbid depression: Single-case design. Journal of Torbat Heydariyeh University of Medical Sciences, 4(4), 54-62. (In Persian)
Radetzki, P. A., Deleurme, K. A., & Rogers, S. M. (2022). The implications of high-conflict divorce on adult–children: Five factors related to well-being. Journal of Family Studies, 28(3), 801-821. https://doi.org/10.1080/13229400.2020.1754277
Rieffe, C., Oosterveld, P., & Terwogt, M. (2006). An alexithymia questionnaire for children: Factorial and concurrent validation results. Personality and Individual Differences, 40(1), 123-133. https://doi.org/10.1016/j.paid.2005.05.013
Rufino, K. A., Ward-Ciesielski, E. F., Webb, C. A., & Nadorff, M. R. (2020). Emotion regulation difficulties are associated with nightmares and suicide attempts in an adult psychiatric inpatient sample. Psychiatry Research, 293, 113437. https://doi.org/10.1016/j.psychres.2020.113437
Sakiris, N., & Berle, D. (2019). A systematic review and meta-analysis of the unified protocol as a transdiagnostic emotion regulation-based intervention. Clinical Psychology Review, 72, 101751. https://doi.org/10.1016/j.cpr.2019.101751
Sandín, B., Julia, G., Valiente, M., & Espinosa, V. (2020). Clinical utility of an internet-delivered version of the unified protocol for transdiagnostic treatment of emotional disorders in adolescents (iUP-A): A pilot open trial. International Journal of Environment Research Public Health, 17(22), 8306. https://doi.org/10.3390/ijerph17228306
Sauer-Zavala, S., Bentley, K. H., Steele, S. J., Tirpak, J. W., Ametaj, A. A., Nauphal, M., ... & Barlow, D. H. (2020). (2020). Treating depressive disorders with the Unified Protocol: A preliminary randomized evaluation. Journal of Affective Disorders, 264, 438-445. https://doi.org/10.1016/j.jad.2019.11.072
Shaw, A. M., Halliday, E. R., & Ehrenreich-May, J. (2020). The effect of transdiagnostic emotion-focused treatment on obsessive-compulsive symptoms in children and adolescents. Journal of Obsessive-Compulsive and Related Disorders, 26, 100552.  https://doi.org/10.1016/j.jocrd.2020.100552
Sorek, Y. (2019). Children of divorce evaluate their quality of life: The moderating effect of psychological processes. Children and Youth Services Review, 107, 104553. https://doi.org/10.1016/j.childyouth.2019.104533
Stapp, E. K., Mendelson, T., Mrikangas, K. R., & Wilcox, H.C. (2020). Parental bipolar disorder, family environment, and offspring psychiatric disorders. A systematic review. Journal of Affective Disorder, 268(1), 69-81. https://doi.org/10.1016/j.jad.2020.03.005
Steele, S. J., Farchione, T. D., Cassiello-Robbins, C., Ametaj, A., Sbi, S., Sauer-Zavala, S., & Barlow, D. H. (2018). Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders. Journal of Psychiatric Research, 104, 211-216.     https://doi.org/10.1016/j.jpsychires.2018.08.005.
Stokkebekk, J., Iversen, A. C., Hollekim, R., & Ness, O. (2019). “Keeping balance”, “Keeping distance” and keeping on with life”: Child positions in divorced families with prolonged conflicts. Children and Youth Services Review, 102, 108-119. https://doi.org/10.1016/j.childyouth.2019.04.021.
Thorberg, F. A., Young, R. M., Sullivan, K. A., & Lyvers, M. (2011). Parental bonding and alexithymia: A meta-analysis. European Psychiatry, 26(3), 187-193.    https://doi.org/10.1016/j.eurpsy.2010.09.010.
Weibe, S. A., & Johnson, S. M. (2018). Creating relationships that foster resilience in emotionally focused therapy. Current Opinion in Psychology, 13, 65–69.        https://doi.org/10.1016/j.copsyc.2016.05.001.
Zeraatkar, M., Saravani, S., Zeinalipour, M., & Arbabi, F. (2022). Comparison of social acceptability, conduct disorders, and difficulty in emotion regulation between children of divorce, children with parental death, and normal children in qom in 2020: A descriptive study. Journal of Rafsanjan University of Medical Sciences, 20(10), 1099-1116. (In Persian)
Zhang, J., Hua, Y., Xiu, L., Oei, T., & Hu, P. (2020). Resting state frontal alpha asymmetry predicts emotion regulation difficulties in impulse control. Personality and Individual Differences, 159, 109870. https://doi.org/10.1016/j.paid.2020.109870
Journal of Applied Psychological Research
Volume 14, Issue 2
2023
Pages 179-194

Files

History

  • Receive Date: 30 March 2022
  • Revise Date: 08 June 2022
  • Accept Date: 18 June 2022
  • First Publish Date: 23 July 2023
  • Publish Date: 23 July 2023

Share

How to cite

Statistics