Effectiveness of Emotion-Focused Therapy on Suicidal Ideation and Distress Tolerance in Adolescents with Borderline Personality Disorder Symptoms
Keywords:
suicidal ideation, distress tolerance, emotion-focused therapy, borderline personality disorderAbstract
Purpose: The present study aimed to investigate the effectiveness of Emotion-Focused Therapy (EFT) on suicidal ideation and distress tolerance in adolescents with symptoms of borderline personality disorder (BPD).
Methods and Materials: This quasi-experimental study employed a pretest–posttest design with a control group. The statistical population included all adolescents with BPD symptoms who referred to Sepidaran Ravan Counseling Center and Shorooe Zendegi Clinic in Tehran in 2024 due to interpersonal problems. Using multi-stage sampling (convenience in the first stage and purposive in the second), 30 eligible adolescents were selected. Participants were randomly assigned to the experimental and control groups (15 each). The experimental group received 12 ninety-minute EFT sessions twice weekly based on Greenberg’s (1980) protocol, while the control group was placed on a waiting list. Research instruments included the Borderline Personality Assessment Questionnaire (STB), Beck Suicidal Ideation Questionnaire (1961), and the Distress Tolerance Scale (DTS-15; Simons & Gaher, 2005). Data were analyzed using descriptive statistics and analysis of covariance (ANCOVA) with SPSS-24.
Findings: After controlling for pretest scores, ANCOVA results indicated a significant reduction in suicidal ideation in the experimental group compared to the control group (F = 15.11, p < 0.01, η² = 0.36), with EFT accounting for 36% of the variance in suicidal ideation. Similarly, a significant improvement in distress tolerance was observed in the experimental group compared to the control group (F = 5.86, p < 0.01, η² = 0.249), with EFT explaining 24.9% of the variance in distress tolerance.
Conclusion: EFT effectively reduced suicidal ideation and enhanced distress tolerance in adolescents with BPD symptoms. By targeting maladaptive emotional responses and fostering adaptive emotional processing, EFT can be considered a valuable therapeutic option for high-risk adolescents to improve emotional resilience and reduce self-destructive tendencies.
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Ali Mohammadi, F., Sotoodeh Asl, N., & Karami, A.-F. (2019). Designing a model for the quality of life of the elderly based on perceived stress and distress tolerance. Journal of Health and Care, 21(1), 53-65. https://doi.org/10.29252/jhc.21.1.53
Bentley, K. H., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Fox, K. R., & Nock, M. K. (2016). Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: a meta-analytic review. Clinical psychology review, 43, 30-46. https://doi.org/10.1016/j.cpr.2015.11.008
Benton, T. D. (2022). Suicide and suicidal behaviors among minoritized youth. Child and Adolescent Psychiatric Clinics, 31(2), 211-221. https://doi.org/10.1016/j.chc.2022.01.002
Greenberg, L. S. (2004). Emotion-focused therapy. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 11(1), 3-16. https://doi.org/10.1002/cpp.388
Greenman, P. S., Johnson, S. M., & Wiebe, S. (2019). Emotionally focused therapy for couples: At the heart of science and practice. https://psycnet.apa.org/record/2018-59954-018
Hancock, L., & Bryant, R. A. (2018). Posttraumatic stress, uncontrollability, and emotional distress tolerance. Depression and Anxiety, 35(11), 1040-1047. https://doi.org/10.1002/da.22783
Huang, X., Ribeiro, J. D., Musacchio, K. M., & Franklin, J. C. (2017). Demographics as predictors of suicidal thoughts and behaviors: A meta-analysis. PLoS One, 12(7), e0180793. https://doi.org/10.1371/journal.pone.0180793
Kazan, D., Calear, A. L., & Batterham, P. J. (2016). The impact of intimate partner relationships on suicidal thoughts and behaviours: a systematic review. Journal of affective disorders, 190, 585-598. https://doi.org/10.1016/j.jad.2015.11.003
Khoda-Bakhshi-Koolayi, A., Matin, L., Falsafi-Nejad, M.-R., & Sanago, A. (2019). Investigating an educational package for increasing awareness of puberty changes on resilience and distress tolerance in adolescent girls. Nursing Psychology, 7(1), 1-8. http://ijpn.ir/article-1-1287-en.html
Larrazabal, M. A., Naragon-Gainey, K., & Conway, C. C. (2022). Distress tolerance and stress-induced emotion regulation behavior. Journal of research in personality, 99, 104243. https://doi.org/10.1016/j.jrp.2022.104243
Lin, Y. H., Lin, S. H., & Chen, I. M. (2022). The direct effect of cognitive behavioral therapy for insomnia on depression prevention and the mediation effect via insomnia remission. JAMA Psychiatry, 79(5), 514-515. https://doi.org/10.1001/jamapsychiatry.2022.0149
Mars, B., Heron, J., Klonsky, E. D., Moran, P., O'Connor, R. C., Tilling, K., & Gunnell, D. (2018). What distinguishes adolescents with suicidal thoughts from those who have attempted suicide? A population‐based birth cohort study. Journal of Child Psychology and Psychiatry, 60(1), 91-99. https://doi.org/10.1111/jcpp.12878
Moieni, F., Hosseini, A., Karabasi, T., Tozandeh Jani, H., Rah-e-Najat, A.-H., & Danavi, V. (2022). The effectiveness of emotion-focused therapy on feelings of rejection, marital adjustment, and emotional regulation in women affected by domestic violence. Journal of Nurse and Physician in Combat, 10(36), 15-16. https://www.sid.ir/paper/1134078/en
Mouton, A., Hansenne, M., Delcour, R., & Cloes, M. (2013). Emotional intelligence and self-efficacy among physical education teachers. Journal of Teaching in Physical Education, 32(4), 342-354. https://doi.org/10.1123/jtpe.32.4.342
Payandeh, F., & Barjali, M. (2018). The effectiveness of emotion-focused therapy on resilience and coping self-efficacy in women with diabetes. Proceedings of the Second International Conference on Psychology, Counseling, Education, and Training, Mashhad, Iran.
Power, E., Coughlan, H., Clarke, M., Kelleher, I., Lynch, F., Connor, D., & Cannon, M. (2016). Nonsuicidal self‐injury, suicidal thoughts and suicide attempts among sexual minority youth in Ireland during their emerging adult years. Early Intervention in Psychiatry, 10(5), 441-445. https://doi.org/10.1111/eip.12249
Sepehri-Nejad, M., & Hatamian, P. (2018). Predicting suicidal thoughts based on emotional regulation difficulties and experiential avoidance in nurses. Iranian Nursing Research Journal, 55(11), 44-39. https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.16122
Seyed Sharifi, M., Navabi-Nejad, S., & Farzad, V. (2019). Comparing the effectiveness of emotion-focused therapy and schema therapy on parenting self-efficacy in single mothers. Journal of Psychological Sciences, 18(76), 415-407. https://shenakht.muk.ac.ir/browse.php?a_id=1853&sid=1&slc_lang=en&ftxt=0
Wiebe, S. A., Elliott, C., Johnson, S. M., Burgess Moser, M., Dalgleish, T. L., Lafontaine, M. F., & Tasca, G. (2019). Attachment change in emotionally focused couple therapy and sexual satisfaction outcomes in a two -year follow -up study. Journal of Couple & Relationship Therapy, 18(1), 1-21. https://doi.org/10.1080/15332691.2018.1481799
Wittenborn, A. K., Liu, T., Ridenour, T. A., Lachmar, E. M., Mitchell, E. A., & Seedall, R. B. (2019). Randomized controlled trial of emotionally focused couple therapy compared to treatment as usual for depression: Outcomes and mechanisms of change. Journal of marital and family therapy, 45(3), 395-409. https://doi.org/10.1111/jmft.12350
Yu, Y., Peng, L., Tang, T., Chen, L., Li, M., & Wang, T. (2014). Effects of emotion regulation and general self‐efficacy on posttraumatic growth in Chinese cancer survivors: assessing the mediating effect of positive affect. Psycho‐Oncology, 23(4), 473-478. https://doi.org/10.1002/pon.3434
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