مقایسه اثربخشی طرحواره‌درمانی و درمان فراتشخیصی بر عقاید وسواسی پسران نوجوان مبتلا به اختلال وسواس فکری-عملی

الهام  اسودی; افسانه خواجوند خوشلی; سمانه  فرنیا; الناز  پوراحمدی

Authors

Elham Asvadi Department of Psychology, Go.C., Islamic Azad University, Gorgan, Iran Author https://orcid.org/0009-0002-6946-7330
Afsaneh khajevandkhoshli Department of Psychology, Go.C., Islamic Azad University, Gorgan, Iran. Author https://orcid.org/0000-0001-5310-424X
Samaneh Farnia Department of Psychiatry ,Psychiatry and Behavioral Sciences Research Center, School of Medicine, Addiction Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Author https://orcid.org/0000-0002-6419-4903
Elnaz Pourahmadi Department of Psychology, BG.C., Islamic Azad University, Bandar Gaz, Iran Author https://orcid.org/0009-0007-1538-718X

Keywords:

Obsessive-compulsive beliefs, schema therapy, transdiagnostic therapy, obsessive-compulsive disorder

Abstract

Objective: The present study aimed to develop a structural model for predicting asthma symptom control based on self-compassion with the mediating role of emotion regulation in patients with asthma.

Methodology: This descriptive–correlational study using path analysis was conducted on 153 patients with asthma who attended clinics and hospitals in Tehran in 2023. Participants were selected through purposive sampling. Data collection instruments included the Asthma Control Test (ACT), the Self-Compassion Scale, and the Cognitive Emotion Regulation Questionnaire. Data were analyzed using Pearson correlation and path analysis through SPSS-24 and AMOS-24 software. Model fit was assessed using χ²/df, CFI, GFI, AGFI, and RMSEA indices.

Findings: The results demonstrated that self-compassion had a positive and significant relationship with asthma symptom control (β=0.486, p<0.001). Adaptive emotion regulation strategies positively predicted asthma symptom control (β=0.354, p<0.001), whereas maladaptive emotion regulation strategies negatively predicted symptom control (β=-0.188, p=0.002). The indirect effect of self-compassion on asthma symptom control through emotion regulation was also significant (β=0.065, p=0.041). Model fit indices indicated an acceptable fit between the proposed model and the collected data (χ²/df=1.69, CFI=0.987, GFI=0.993, AGFI=0.895, RMSEA=0.066). Moreover, the study variables explained 44% of the variance in asthma symptom control.

Conclusion: The findings indicated that self-compassion and emotion regulation play substantial roles in asthma symptom control, and emotion regulation—particularly maladaptive strategies—mediates the relationship between self-compassion and asthma symptom control. Therefore, incorporating psychological interventions aimed at enhancing self-compassion and improving adaptive emotion regulation strategies may contribute to better asthma management and treatment outcomes among patients with asthma.

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References

Aali, A., Mozaffari, N., Iranpour, S., Alizadeh Mirashrafi, H., & Dadkhah, B. (2020). Assessment of Mothers' Self-Efficacy in Caring for Children with Asthma Referred to the Subspecialty Clinic and Bou-Ali Educational-Therapeutic Center in Ardabil. Journal of Health and Care, 22(2), 114-122.

Aflakian, M., Atashpour, S. H., & Khayatan, F. (2020). Developing the Schema Therapy Based on Obsessive-Compulsive Disorder and Comparing with Cognitive-Behavioral Therapy. Caspian Journal of Neurological Sciences, 6(2), 108-123.

Ahmadi, E., Shalchi, B., & Mansourzadeh, Z. (2020). The Effectiveness of Self-Compassion Training on Symptoms of Irritable Bowel Syndrome. Journal of Qom University of Medical Sciences, 14(4), 1-10.

Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Latin, H. M., Ellard, K. K., & Bullis, J. R. (2021). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. Oxford University Press.

Berryhill, M. B., Hayes, A., & Lloyd, K. (2018). Chaotic-Enmeshment and Anxiety: The Mediating Role of Psychological Flexibility and Self-Compassion. Contemporary Family Therapy, 40, 326-337.

Bigdeli, M., & Shamsian, M. (2021). Comparison of Difficulties in Emotion Regulation and Cognitive Flexibility in Patients with Asthma and Healthy Individuals in Ahvaz. Fifth International Congress of Psychological Sciences and Education, Tehran.

Bytamar, F. (2023). The Effectiveness of Transdiagnostic Cognitive-Behavioral Therapy on Improving Occupational-Social Adjustment in Patients with Obsessive-Compulsive Disorder Comorbid with Other Emotional Disorders: A Randomized Clinical Trial Study.

Chavoshi, H., Sarafraz, M. R., & Goodarzi, M. A. (2022). The Mediating Role of Self-Compassion and Mindfulness in the Relationship Between Perceived Stress and Mental-Physical Health. Rooyesh-e-Ravanshenasi Journal, 11(8), 13-24.

Cunha, M. S., Amaral, R., Pereira, A. M., Almeida, R., Alves-Correia, M., Loureiro, C. C., & Jacome, C. (2023). Symptoms of Anxiety and Depression in Patients with Persistent Asthma: A Cross-Sectional Analysis of the INSPIRERS Studies. BMJ open, 13(5), e068725.

Deperrois, R., & Combalbert, N. (2022). Links Between Cognitive Distortions and Cognitive Emotion Regulation Strategies in Non-Clinical Young Adulthood. Cognitive Processing, 23(1), 69-77.

Fazlollahi, M. R., Najmi, M., Fallahnezhad, M., Sabetkish, N., Kazemnejad, A., Bidad, K., & Moin, M. (2018). The Prevalence of Asthma in Iranian Adults: The First National Survey and the Most Recent Updates. The Clinical Respiratory Journal, 12(5), 1872-1881.

Finlay-Jones, A. L. (2017). The Relevance of Self-Compassion as an Intervention Target in Mood and Anxiety Disorders: A Narrative Review Based on an Emotion Regulation Framework. Clinical Psychologist, 21, 90-103. https://doi.org/10.1111/cp.12131

Firouzkouhi, M. R., Ghaderi, G., Hosseinzadeh, A., & Aali, H. (2022). Examining Psychological Symptoms in Patients with Type 2 Diabetes Based on Self-Efficacy, Quality of Life, and Self-Compassion. Diabetes Nursing Quarterly(4), 1976-1989.

Ghanbari, F., Abdolrahimi Noshad, L., Bazzazadeh, N., Eskandari, A., & Moazzen, N. (2018). A Comparative Study of Cognitive Emotion Regulation Strategies and Health Locus of Control in Children with Asthma and Normal Children. Iranian Journal of Nursing Research, 13(3), 76-82.

Ghasemi, S., & Visani, M. (2024). The Effectiveness of Training Schema Therapy Concepts on Cognitive Avoidance and Intolerance of Ambiguity in Adolescents with Symptoms of Obsessive-Compulsive Disorder. Rooyesh-e-Ravanshenasi, 13(8), 41-50. http://frooyesh.ir/article-1-5265-fa.html

Ghorbani, F., Khosravani, V., Ardakani, R. J., Alvani, A., & Akbari, H. (2017). The Mediating Effects of Cognitive Emotion Regulation Strategies on the Relationship Between Alexithymia and Physical Symptoms: Evidence from Iranian Asthmatic Patients. Psychiatry research, 247, 144-151.

Gillan, G., Brid, F., & Woody, G. (2023). A Transdiagnostic Perspective on Obsessive-Compulsive Disorder. Child and adolescent psychiatry and mental health, 15(2), 30-46.

Green, V. A. (2021). Emotion Regulation Among Adults with Asthma: Links with Short-Acting Inhaler Medication Overuse and Utilization of Acute Medical Care

Hawke, L. D., & Provencher, M. D. (2021). Schema Theory and Schema Therapy in Mood and Anxiety Disorders: A Review. Journal of Cognitive Psychotherapy, 25(4), 257-276. https://doi.org/10.1891/0889-8391.25.4.257

Hertenstein, A., Nissen, E., & Voderholzer, C. (2022). Schema Therapy Augmented Exposure and Response Prevention in Patients with Obsessive-Compulsive Disorder: Feasibility and Efficacy of a Pilot Study. Journal of Behavior Therapy and Experimental Psychiatry, 52, 59-67.

Hughes, M., Brown, S. L., Campbell, S., Dandy, S., & Cherry, M. G. (2021). Self-Compassion and Anxiety and Depression in Chronic Physical Illness Populations: A Systematic Review. Mindfulness, 12, 1597-1610.

Hussain, S., Khawar, R., Amin, R., Hamdani, A., & Majeed, A. (2023). Psychological Flexibility, Cognitive Emotion Regulation and Mental Health Outcomes Among Patients with Asthma in Pakistan. Peerj, 11, e15506.

Leynaert, B., Real, F. G., Idrose, N. S., & Dharmage, S. C. (2023). Gender Differences and Sex-Related Hormonal Factors in Asthma. In Asthma in the 21st Century (pp. 63-86). Academic Press.

Lopez, G., William, G., & Arnold, F. (2023). Effectiveness of a Preventive Intervention Indicating Transdiagnosticity for Adolescents at High Risk of Anxiety and Depressive Disorders. Journal of Clinical Psychology, 14(3), 1-15.

Lor, J., Fishbein, A., & Cheng, B. (2023). Mental Health Symptoms Are Associated with Low Patient Satisfaction Among Adults with Asthma. Journal of Allergy and Clinical Immunology, 151(2), AB73.

Manzari, V., Visani, M., & Ghasemi, S. (2024). The Effectiveness of Training Schema Therapy Concepts on Delusional Beliefs and Cognitive Avoidance in Individuals with Symptoms of Obsessive-Compulsive Disorder. Journal of Sabzevar University of Medical Sciences, 1(4).

Mistretta, E. G., & Davis, M. C. (2021). Meta-Analysis of Self-Compassion Interventions for Pain and Psychological Symptoms Among Adults with Chronic Illness. Mindfulness, 1-18.

Mohammadi Kamsorkh, A., Sotoudeh Asl, N., & Mehrafzoun, D. (2025). The Effectiveness of Integrated Transdiagnostic Treatment on Psychological Distress and Alexithymia in Adolescent Girls with Obsessive-Compulsive Disorder. Quarterly Journal of New Psychological Research, 20(77), 143-156.

Mohammadpour, F. (2021). The Relationship of Moral Intelligence and Self-Compassion with Quality of Life in Patients with Multiple Sclerosis. Ethics in Science and Technology, 16(1), 30-35.

Narimani, M., Ghasem Khanlou, A., & Sabri, V. (2020). Comparison of Self-Compassion, Anxiety, and Depression in Patients with Chronic Pain and Normal Individuals. Anesthesia and Pain, 11(3), 57-65.

Nasri, M., Ahadi, H., & Dortaj, F. (2021). The Effectiveness of Transdiagnostic Treatment on Cognitive Flexibility, Emotion Regulation and Hb Factor in Patients with Type 2 Diabetes. Psychological Achievements, 24(2), 81-100.

Nazari, F., Gharaei, B., & Zahedi Tajrishi, K. (2022). The Mediating Role of Emotion Dysregulation, Experiential Avoidance, and Rumination in the Relationship between Emotional Schemas and Obsessive-Compulsive Symptoms. Iranian Journal of Psychiatry and Clinical Psychology, 28(4), 466-479.

Nguyen, A., Grummitt, L., Barrett, E. L., Bailey, S., Gardner, L. A., Champion, K. E., & Birrell, L. (2025). The relationship between emotion regulation and mental health in adolescents: Self-compassion as a moderator. Mental Health & Prevention, 38. https://doi.org/10.1016/j.mhp.2025.200430

Nielsen, E., Sayal, K., & Townsend, E. (2018). Correction: Exploring the Relationship Between Experiential Avoidance, Coping Functions and the Recency and Frequency of Self-Harm. PLoS One, 13(2), e0192795.

Ocampo, J., Gaviria, R., & Sanchez, J. (2022). Prevalence of Asthma in Latin America: Critical Look at ISAAC and Other Studies. Revista Alergia Mexico, 64(2), 188-197.

Oussedik, E., Cline, A., Su, J. J., Masicampo, E. J., Kammrath, L. K., Ip, E., & Feldman, S. R. (2019). Accountability in Patient Adherence. Patient Preference and Adherence, 1511-1517.

Prentice, K., Rees, C., & Finlay-Jones, A. (2021). Self-Compassion, Wellbeing, and Distress in Adolescents and Young Adults with Chronic Medical Conditions: The Mediating Role of Emotion Regulation Difficulties. Mindfulness, 12, 2241-2252.

Przybyszowski, M., Pilinski, R., Sliwka, A., Polczyk, R., Nowobilski, R., Sladek, K., & Bochenek, G. (2022). The Impact of Clinical and Psychological Factors on Asthma Control: The Experience of a Single Asthma Center in Poland. Journal of Asthma, 59(2), 407-417.

Ranjouri, S., Meyer, D., & Bates, G. W. (2025). Self-Compassion Components and Emotional Regulation Strategies as Predictors of Psychological Distress and Well-Being. Behavioral Sciences, 15(11), 1576. https://doi.org/10.3390/bs15111576

Saeedi, Z., Bahrami Ehsan, H., & Alipour, A. (2016). Self-Control and Health: The Moderating Role of Self-Compassion. Health Psychology, 5(19), 85-98.

Sangngam, J., Prasopkittikun, T., Nookong, A., Pacharn, P., & Chamchan, C. (2023). Causal Relationships Among Self-Management Behaviors, Symptom Control, Health-Related Quality of Life and the Influencing Factors Among Thai Adolescents with Asthma. International journal of nursing sciences. https://doi.org/10.1016/j.ijnss.2023.06.001

Semenchuk, B. N., Kullman, S. M., Neilson, C. J., Ceccarelli, L., Boreskie, K., Kehler, D. S., & Strachan, S. M. (2022). Self-Compassion, Health Behaviors, Self-Regulation, and Affective States Among Individuals at Risk of or Diagnosed with a Chronic Disease: A Scoping Review. Mindfulness, 13(5), 1085-1111.

Sharma, E., Sharma, L. P., Balachander, S., Lin, B., Manohar, H., Khanna, P., & Stewart, S. E. (2021). Comorbidities in Obsessive-Compulsive Disorder across the Lifespan: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry, 12, 703701. https://doi.org/10.3389/fpsyt.2021.703701

Sohani, A., & Mahmoudi, M. (2025). Examining the Relationship between Maladaptive Schemas and Obsessive-Compulsive Disorder in Male Secondary School Students and the Effectiveness of Individual Schema Therapy on Obsessive Symptoms in Adolescent Girls. Fourth International Conference on New Achievements in Educational Sciences and Education in Iran and the World, Tehran. https://civilica.com/doc/2383934

Storch, E. A., McGuire, J. F., Schneider, S. C., Small, B. J., Murphy, T. K., Wilhelm, S., & Geller, D. A. (2019). Sudden Gains in Cognitive Behavioral Therapy among Children and Adolescents with Obsessive Compulsive Disorder. Journal of Behavior Therapy and Experimental Psychiatry, 64, 92-98. https://doi.org/10.1016/j.jbtep.2019.03.003

Valero-Moreno, S., Montoya-Castilla, I., & Perez-Marin, M. (2023). Quality of Life in Patients with Asthma: Medical Indicators and Psychological Variables. Journal of Pediatric Nursing.

Weertman, A., & Arntz, A. (2022). Effectiveness of Treatment of Childhood Memories in Cognitive Therapy for Personality Disorders: A Controlled Study Contrasting Methods Focusing on the Present and Methods Focusing on Childhood Memories. Behaviour Research and Therapy, 45, 2133-2143.

Wierenga, K. L., Lehto, R. H., & Given, B. (2017). Emotion Regulation in Chronic Disease Populations: An Integrative Review. Research and Theory for Nursing Practice, 31(3), 247-271.

Wild, M. G., Coppin, J. D., Mendoza, C., Metts, A., Pearson, R., & Creech, S. K. (2025). Self-compassion, mindfulness, and emotion regulation predict multiple dimensions of quality of life in US post-9/11 veterans. Quality of Life Research, 1-10. https://doi.org/10.1007/s11136-025-03908-

Wong, J. X., & Caporino, N. E. (2022). Youth Intolerance of Uncertainty-Parent-Report (YIU-PR): A Developmentally Sensitive Measure of Intolerance of Uncertainty in Children and Adolescents. Journal of psychopathology and behavioral assessment, 9, 1-3. https://doi.org/10.1007/s10862-022-10016-6

Yoosefi, N., Etemadi, O., Bahrami, F., Ahmadi, A., & Fatehezadeh, M. (2023). An Investigation on Early Maladaptive Schema in Marital Relationship as Predictors of Divorce. Journal of Reimaging and Divorce.

Zarneshan, A. (2018). The Effectiveness of Aerobic and Breathing Exercises in Controlling Asthma and Improving the Physical-Psychological Health of Women with Asthma. Health Education and Health Promotion, 6(2), 179-188.