Comparing the Effectiveness of Emotion-Based and Attachment-Based Family Therapy on Emotional Distress Tolerance, Self-Differentiation and Alexithymia in Adolescent Girls with Psychosomatic Disorders
Keywords:
Emotion-Based Family Therapy, Attachment-Based Family Therapy, Emotional Distress Tolerance, Self-Differentiation, Alexithymia, Psychosomatic DisordersAbstract
Background and Objective: Psychosomatic disorders as one of the most common mental disorders are considered important public health challenges and cause many psychological problems. Consequently, the aim of this study was to comparing the effectiveness of emotion-based and attachment-based family therapy on emotional distress tolerance, self-differentiation and alexithymia in adolescent girls with psychosomatic disorders.
Methods and Materials: This research was a quasi-experimental with a pre-test and post-test design with a control group. The research population was high school girl students of Ahvaz city who referred to counseling and psychological services centers in this city. The research sample was 60 people who were selected through simple random sampling method and randomly assigned to three groups of 20 people. The first experimental group received 5 sessions of two-hour by method of emotion-based family therapy, the second experimental group received 10 sessions of two-hour by method of attachment-based family therapy and during this period the control group received no training. To collect data were used the emotional distress tolerance scale (Simmons & Gaher, 2005), self-differentiation inventory (Skowron & Frielander, 1998) and Toronto alexithymia scale (Bagby et al., 1994) and its data were analyzed by methods of multivariate analysis of covariance and Bonferroni post hoc tests in SPSS software.
Findings: The findings showed that both intervention methods of emotion-based and attachment-based family therapy in compared to the control group significantly reduced emotional distress tolerance and alexithymia and significantly increased self-differentiation in adolescent girls with psychosomatic disorders (P<0.05). Also, there was no significant difference between the effectiveness of both intervention methods of emotion-based and attachment-based family therapy on reducing emotional distress tolerance and alexithymia and increasing self-differentiation in adolescent girls with psychosomatic disorders (P<0.05).
Conclusion: According to the results of this research, health professionals and therapists can use both emotion-based and attachment-based family therapy methods in their interventions to improve psychological characteristics.
Downloads
References
Abagheri Meyari, A., Dokaneifard, F., & Behboodi, M. (2024). Providing a model for predicting children's differentiation based on communication patterns and personality structure with the mediation of dysfunctional attitudes in parents attending counseling centers in Tehran. Journal of Psychological Dynamics in Mood Disorders, 3(1), 139-159. https://doi.org/10.61838/kman.pdmd.3.1.12
Alvarez-Hierro, S., & Oliver, J. (2024). Differentiation of self and its relationship with metacognitions about worry and anxiety. Personality and Individual Differences, 222, 112596. https://doi.org/10.1016/j.paid.2024.112596
Asgari, A., Azizi Ziabari, L., Asadi, J., & Hosseinae, A. (2022). The effectiveness of emotionally-focused couple therapy on differentiation and emotion regulation of women affected by marital infidelity. Rooyesh-e-Ravanshesasi Journal, 11(5), 59-68. http://dorl.net/dor/20.1001.1.2383353.1401.11.5.3.8
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto alexithymia
scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic
Research, 38(1), 23-32. https://doi.org/10.1016/0022-3999(94)90005-1
Bekhnoodeh, M., Ghiyasi Pirzaman, M., & Elahian, M. S. (2021). Effectiveness of attachment-based therapy on reducing symptoms of anxiety, loneliness, and self-esteem in orphaned boy children. Journal of Community Health, 15(2), 1-11. https://doi.org/10.22123/chj.2021.255715.1614
Beltran-Ruiz, M., Fernandez, S., Garcia-Campayo, J., Puebla-Guedea, M., Lopez-del-Hoyo, Y., Navarro-Gil, M., & Montero-Marin, J. (2023). Effectiveness of attachment-based compassion therapy to reduce psychological distress in university students: a randomised controlled trial protocol. Frontiers in Psychology Logo, 14(1185445), 1-11. https://doi.org/10.3389/fpsyg.2023.1185445
Billingsley, A. L., & Steinman, S. A. (2021). The role of emotional distress tolerance on fear responding in a heights-fearful sample: Perceived versus actual behavior. Behavior Therapy, 52(4), 945-955. https://doi.org/10.1016/j.beth.2020.12.002
Conradi, H. J., Meuwese, D., Rodenburg, L., Dingemanse, P., & Mooren, T. (2023). Effectiveness and feasibility of structured emotionally focused family therapy for parents and adolescents: Protocol of a within-subjects pilot study. PLOS ONE, 18(6), e0287472. https://doi.org/10.1371/journal.pone.0287472
Coolhart, D., & Shipman, D. L. (2017). Working toward family attunement: Family therapy with transgender and gender-nonconforming children and adolescents. Psychiatric Clinical of North America, 40(1), 113-125. https://doi.org/10.1016/j.psc.2016.10.002
Dana, M., Keshavarzi Arshadi, F., Hassani, F., & Mohammadkhani , P. (2023). The effectiveness of emotion-focused therapy on rumination, alexithymia, and sleep quality in woman with irritable bowel syndrome. Psychology of Woman Journal, 4(2), 49-61. https://doi.org/10.61838/kman.pwj.4.2.7
Diamond, G., Diamond, G. M., & Levy, S. (2021). Attachment-based family therapy: Theory, clinical model, outcomes, and process research. Journal of Affective Disorders, 294, 286-295. https://doi.org/10.1016/j.jad.2021.07.005
Diamond, G. M., Diamond, G., & Hogue, A. (2007). Attachment-based family therapy: Adherence and differentiation. Journal of Marital and Family Therapy, 33(2), 177-191. http://dx.doi.org/10.1111/j.1752-0606.2007.00015.x
Diamond, G. S., Kobak, R. R., Ewing, E. S. K., Levy, S. A., Herres, J. L., Russon, J. M., & Gallop, R. J. (2019). A randomized controlled trial: attachment-based family and nondirective supportive treatments for youth who are suicidal. Journal of the American Academy of Child & Adolescent Psychiatry, 58(7), 721-731. https://doi.org/10.1016/j.jaac.2018.10.006
Diamond, G., Rivers, A. S., Winston-Lindeboom, P., Russon, J., & Roeske, M. (2024). Evaluating attachment-based family therapy in residential treatment in the United States: does adolescents’ increased attachment security to caregivers lead to decreases in depressive symptoms? Child and Adolescent Psychiatry and Mental Health, 18(147), 1-10. https://doi.org/10.1186/s13034-024-00833-w
Doba, K., Berna, G., Constant, E., & Nandrino, J. L. (2018). Self-differentiation and eating disorders in early and middle adolescence: A cross-sectional path analysis. Eating Behaviors, 29, 75-82. https://doi.org/10.1016/j.eatbeh.2018.03.003
Farshchiyan, Yazdi, M., Bagherzadeh Golmakani, Z., & Mansouri, A. (2021). Comparison of the effectiveness of emotionally focused therapy and self-compassion skills training on differentiation of self and sexual intimacy of women affected by marital infidelity. Razavi International Journal of Medicine, 9(3), e1079, 34-43. https://doi.org/10.30483/rijm.2021.254236.1079
Foroughe, M., Browne, D. T., Thambipillai, P., Cordeiro, K., & Muller, R. T. (2023). Brief emotion-focused family therapy: A 12-month follow-up study. Journal of Marital and Family Therapy, 49(2), 394-410. https://doi.org/10.1111/jmft.12628
Ghamarani, A., Ghasemi Arganeh, H., Azimi Garosi, S., & Ghasemi Arganeh, M. (2019). Effect of attachment-based therapy training on intimacy and alexithymia in parents of children with intellectual disabilities. Journal of Research & Health, 9(1), 3-10. https://doi.org/10.29252/jrh.9.1.3
Ghorbani, N., & Bagheri Houseinabadi, Sh. (2021). The effect of Satir brief family therapy on alexithymia and emotional maturity in couples seeking a divorce. Journal of Assessment and Research in Applied Counseling, 3(3), 33-44. https://journals.kmanpub.com/index.php/jarac/article/view/62
Haroonrashidi H. (2023). The effectiveness of emotion regulation training on uncertainty tolerance and psychological distress of women with substance-dependent spouses. Scientific Quarterly of Research on Addiction, 17(68), 303-326. http://dx.doi.org/10.61186/etiadpajohi.17.68.303
Hernandez, D. C., Daundasekara, S. S., Arlinghaus, K. R., Sharma, A. P., Reitzel, L. R., Kendzor, D. E., & Businelle, M. S. (2019). Fruit and vegetable consumption and emotional distress tolerance as potential links between food insecurity and poor physical and mental health among homeless adults. Preventive Medicine Reports, 14, 100824. https://doi.org/10.1016/j.pmedr.2019.100824
Heydari Faela, F., Atashpour, S. H., & Khayatan, F. (2024). The effectiveness of emotion-focused therapy on emotional suppression and distress tolerance in divorced women. Psychology of Woman Journal, 5(4), 101-110. http://dx.doi.org/10.61838/kman.pwj.5.4.12
Johnson, S. M., Maddeaux, C., & Blouin, J. (1998). Emotionally focused family therapy for bulimia: Changing attachment patterns. Psychotherapy: Theory, Research, Practice, Training, 35(2), 238-247. https://doi.org/10.1037/h0087728
Khadem Dezfuli, Z., Alavi, S. Z., & Shahbazi, M. (2023). The effectiveness of emotion focused therapy on alexithymia and internalized self-criticism in neurotic perfectionist girls. Journal of Research in Behavioral Sciences, 21(1), 151-164. http://dx.doi.org/10.48305.21.1.151
Khedr, M. A., El-Ashry, A. M., El-Sayed, M. M., Elkot, M. A., 7 Hussein, R. M. (2024). The effect of physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders: A randomized control trial. Archives of Psychiatric Nursing, 49, 83-92. https://doi.org/10.1016/j.apnu.2024.02.002
Koranian, F., Arefi, M., & Amiri, H. (2021). A Comparison of the effectiveness of Bowenian family therapy and acceptance and commitment-based therapy (ACT) on differentiation of mothers with one child. Quarterly Journal of Islamic-Iranian Family Studies, 1(2), 31-44. https://doi.org/10.30495/iifs.2021.685877
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136(4), 576-600. https://doi.org/10.1037/a0019712
Li, D., Yang, R., Hu, J., Xue, Y., Huang, X., Wan, Y., & et al. (2022). Patterns of six behaviors and psychosomatic symptoms in adolescents: A six-province study in China. Journal of Affective Disorders, 297, 593-601. https://doi.org/10.1016/j.jad.2021.10.118
Li, W., Liu, Y., Qiu, J., & Li, Y. (2023). Bidirectional relationship between insular grey matter volume and alexithymia: Evidence from a longitudinal study. Journal of Affective Disorders, 339, 799-806. https://doi.org/10.1016/j.jad.2023.07.041
Lotfi, B., Jajarmi, M., & Mohammadipor, M. (2020). The effectiveness of communication theory based on distinction and couples’ marital conflict. Nursing and Midwifery Journal, 18(4), 330-340. https://unmf.umsu.ac.ir/article-1-4069-en.html
Nagamitsu, S., Okada, A., Sakuta, R., Habukawa, C., Koyanagi, K., Ishii, R., & et al. (2023). Effectiveness of a smartphone CBT application interventions for children with psychosomatic disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 62(10), 200-201. https://doi.org/10.1016/j.jaac.2023.09.150
Nagata, J. M., Sui, S., Kim, A. E., Shao, I. Y., Otmar, C. D., Ganson, K. T., & et al. (2025). Gender diversity and daily steps: Findings from the adolescent brain cognitive development study. Annals of Epidemiology, 101, 1-6. https://doi.org/10.1016/j.annepidem.2024.11.004
Nasiri Karbasdehi, Z., Fakhri, M. K., & Ghanadzadegan, H. A. (2023). The effectiveness of mindfulness training on distress tolerance, resilience and emotion regulation in students with symptoms of generalized anxiety disorder. Sociology of Education, 9(1), 413-423. https://doi.org/10.22034/ijes.2023.2014010.1484
Pirzad, A., Senobar, A., Naghash, S., Amanihamedani, M., Abasi, R., & Hatamipour, Kh. (2024). Effectiveness of compassion-based mindfulness training on psychological health and alexithymia in women with marital maladjustment. Journal of Psychological Dynamics in Mood Disorders, 3(2), 203-213. https://maherpub.com/pdmd/article/view/194/174
Plumed, J., Gago, B., González-Valls, P. I., Sierra, P., Livianos, L., Zapata, C., & Garcia-Blanco, A. (2023). Differentiation of self and social functioning in severe mental disorders. Psychoanalytic Psychology, 40(2), 121-127. https://doi.org/10.1037/pap0000422
Sadri, M., Zare Bahramabadi, M., & Ghiasi, M. (2016). Effectiveness of attachment-oriented therapy on the quality of attachment and social skills in children with oppositional defiant disorder. Journal of Child Mental Health, 3(2), 21-30. https://childmentalhealth.ir/article-1-113-en.html
Salemi, P., Hosseinian, S., Zandipour, T., Rasouli, R., & Abdollahi, A. (2022). Comparison of the effectiveness of emotion-focused therapy and acceptance-commitment therapy on mothers' distress tolerance with mentally retarded children. Medical Journal of Mashhad University of Medical Sciences, 65(3), 1125-1138. https://doi.org/10.22038/mjms.2021.60718.3552
Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: Development and
validation of a self-report measure. Motivation and Emotion, 29(2), 83-102. https://psycnet.apa.org/doi/10.1007/s11031-005-7955-3
Skowron, E. A., & Friedlander, M. L. (1998). The differentiation of self-inventory: Development and initial validation. Journal of Counseling Psychology, 45(3), 235–246. https://doi.org/10.1037/0022-0167.45.3.235
Sutcliffe, K., Levett, K., Dahlen, H., Newnham, E., & MacKay, L. (2023). Sense of self in the birth room: how a woman’s differentiation of self affects the use of childbirth education strategies during childbirth. Women and Birth, 36(1), 23. https://doi.org/10.1016/j.wombi.2023.07.059
Xu, L., Shi, J., & Li, C. (2024). Addressing psychosomatic symptom distress with mindfulness-based cognitive therapy in somatic symptom disorder: mediating effects of self-compassion and alexithymia. Frontiers in Psychiatry, 15(1289972), 1-10. https://doi.org/10.3389/fpsyt.2024.1289872
Van Vlierbeghe, L., Diamond, G., & Bosmans, G. (2023). Middle childhood attachment-based family therapy: Theory and model description. Family Process, 62(3), 1040-1054. https://doi.org/10.1111/famp.12887
Wecht, S., Hendrixson, M., & Radovic, A. (2024). A mixed method investigation of parent-adolescent communication about mental health. Journal of Adolescent Health, 75(6), 904-911. https://doi.org/10.1016/j.jadohealth.2024.07.012
Wild, M. G., Herbert, M. S., & Creech, S. (2024). Longitudinal associations of physical and emotional distress tolerance with pain intensity and pain-related disability in United States veterans. The Journal of Pain, 25(4), 60-61. https://doi.org/10.1016/j.jpain.2024.01.278
Wilhelmsen-Langelang, A., Aardal, H., Hjelmseth, V., Fyhn, K. H., & Stige, S. H. (2020). An emotion focused family therapy workshop for parents with children 6-12 years increased parental self-efficacy. Emotional and Behavioral Difficulties, 25(1), 29-41. https://doi.org/10.1080/13632752.2019.1655921
Wong, N. R., Carta, K. E., Weintraub, M. J., & Miklowitz, D. J. (2022). Therapeutic alliance in family therapy and clinical outcomes among adolescents at risk for mood disorders. Journal of Affective Disorders, 300, 66-70. https://doi.org/10.1016/j.jad.2021.12.088
Zollghadrnia, L., Jahangir, P., & Dokaneifard, F. (2021). The effectiveness of attachment-based play therapy on alexithymia of children and their mother’s parental self-efficacy in divorced family in Tehran in covid-19 pandemic. Medical Journal of Mashhad University of Medical Sciences, 64(4), 3785-3795. https://doi.org/10.22038/mjms.2021.20195
