اثربخشی درمان فراتشخیصی یکپارچه‌نگر بر شایستگی اجتماعی و همجوشی شناختی نوجوانان مبتلا به اختلال رفتاری- هیجانی برونی‌سازی شده

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری روانشناسی عمومی، واحد نایین، دانشگاه آزاد اسلامی، نایین، ایران

2 گروه روانشناسی، واحد نایین، دانشگاه آزاد اسلامی، نایین، ایران

10.22034/jmpr.2024.59991.6018

چکیده

اختلال رفتاری- هیجانی برونی‌سازی شده با نمود رفتارهای قانون‌شکنانه و پرخاشگرانه سبب تخریب عملکرد تحصیلی یا اجتماعی نوجوان می­‌شود. این نوجوانان بر رفتار خود کنترل کمی داشته که این روند توانایی‌های آنان را مختل می­‌کند. بر این اساس این پژوهش با هدف بررسی اثربخشی درمان فراتشخیصی یکپارچه‌نگر بر شایستگی اجتماعی و همجوشی شناختی نوجوانان مبتلا به اختلال رفتاری- هیجانی برونی‌سازی شده انجام شد. پژوهش حاضر کاربردی، از نوع نیمه‌آزمایشی با طرح پیش‌آزمون- پس‌آزمون با گروه گواه و دوره پیگیری دوماهه بود. جامعه آماری شامل دانش‌آموزان دارای مشکلات رفتاری- هیجانی برونی‌سازی شده بود که در دوره اول متوسطه در سال تحصیلی 1402-1401 در شهر اصفهان مشغول به تحصیل بودند. در پژوهش حاضر 35 دانش‌آموز مبتلا به اختلال رفتاری- هیجانی برونی‌سازی شده با روش نمونه‌گیری هدفمند انتخاب و با شیوه تصادفی در گروه­‌های آزمایش و گواه جای‌دهی شدند (18 دانش‌آموز در گروه آزمایش و 17 دانش‌آموز در گروه گواه). دانش‌آموزان گروه آزمایش درمان فراتشخیصی یکپارچه‌نگر را طی ده هفته در ده جلسه 90 دقیقه‌ای دریافت نمودند. در این پژوهش از سیاهه رفتاری- هیجانی کودکان و نوجوانان (CABEI) (آخنباخ و رسکورلا، 2001)، پرسشنامه شایستگی اجتماعی (SCQ) (فلنر، لیاس و فیلیپس، 1990) و پرسشنامه‌ همجوشی شناختی (CFQ) (گیلاندرز و همکاران، 2014) استفاده شد. داده‌ها با تحلیل واریانس آمیخته با استفاده از نرم‌افزار آماری SPSS23 تجزیه و تحلیل شد. نتایج نشان داد که درمان ذهن‌آگاهی نوجوان‌محور بر شایستگی اجتماعی (0/0001>P؛ 0/69=Eta؛ 74/11=F) و همجوشی شناختی (0/0001>P؛ 0/56=Eta؛ 39/71=F) نوجوانان مبتلا به اختلال رفتاری- هیجانی برونی‌سازی شده تأثیر معنادار دارد. بر اساس یافته‌های پژوهش حاضر، درمان فراتشخیصی یکپارچه‌نگر با بهره‌گیری از شناختن هیجان‌ها، آموزش آگاهی هیجانی، بازارزیابی شناختی، شناسایی الگوهای اجتناب از هیجان و بررسی رفتارهای ناشی از هیجان می‌تواند به عنوان یک درمان کارآمد جهت بهبود شایستگی اجتماعی و کاهش همجوشی شناختی نوجوانان مبتلا به اختلال رفتاری- هیجانی برونی‌سازی شده مورد استفاده قرار گیرد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

The Effectiveness of Unified Trans-Diagnostic Treatment on Social Competence and Cognitive Fusion of Adolescents with Externalizing Behavioral-Emotional Disorder

نویسندگان [English]

  • Anahita Ghorbani 1
  • Mohammad Zare Neyestanak 2
  • Hassan Khoshakhlagh 2
1 PhD student in General Psychology, Naein Branch, Islamic Azad University, Naein, Iran
2 Department of Psychology, Nayin Branch, Islamic Azad University, Nayin, Iran
چکیده [English]

Externalized behavioral-emotional disorder with the appearance of law-breaking and aggressive behaviors causes the destruction of the adolescent's academic or social performance. These teenagers do not have enough control over their behavior, which disrupts their abilities. according to this the present study was conducted to investigate the effectiveness of unified trans-diagnostic treatment on social competence and cognitive fusion of adolescents with externalizing behavioral-emotional disorder. The statistical population included students with externalized behavioral-emotional problems who were studying in the first period of secondary school in the academic year of 2022-2023 in Isfahan city. In this research, 35 students with externalized emotional-behavioral problems were selected by purposeful sampling and randomly assigned to experimental and control groups (18 students in the experimental group and 17 students in the control group). The parents of the students in the experimental group received the unified trans-diagnostic treatment during ten weeks in ten 90-minute sessions. Children and Adolescents Behavioral- Emotional Inventory (CABEA) (Achenbach, Rescorla, 2001), Social Competence Questionnaire (SCQ) (Felner, Lease, Philips, 1990) and Cognitive Fusion Questionnaire (CFQ) (Gillanders et al, 2014) were used in the present study. The data were analyzed through mixed ANOVA via SPSS23 software. The results showed that unified trans-diagnostic treatment has significant effect on the social competence (p<0001, Eta=0.69, F=74.11) and cognitive fusion (p<0001, Eta= 0.56, F=39.71) in the adolescents with externalizing behavioral-emotional disorder. Based on the findings of the present research, unified trans-diagnostic treatment can be used as an efficient method to improving social competence and reducing cognitive fusion in adolescents with externalized emotional behavioral through applying techniques such as knowing emotions, cognitive reevaluation training, identifying emotion avoidance models and investigating behaviors coming from emotion.

کلیدواژه‌ها [English]

  • unified trans-diagnostic treatment
  • externalized behavioral-emotional disorder
  • cognitive fusion
  • social competence
Asli Azad, M., Aminian, M. (2024). Efficacy of Play Therapy Based on Cognitive-Behavioral Approach on the Executive Functions and Social Competence in Female Students with Signs of Attention Deficit/ Hyperactivity Disorder, Psychological Achievements, 31(1), 99-120. (In Persian) https://doi.org/10.22055/psy.2022.40864.2851
Barlow, D.H., Ellard, K.K., Fairholme, C.P., Farchione, T.J., Boisseau, C.L., Allen, L.B., Ehrenreich-May, J. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: Client workbook. New York: Oxford University Press. https://doi.org/10.1016/j.beth.2012.01.001
Bodenlos, J.S., Hawes, E.S., Burstein, S.M., Arroyo, K.M. (2020). Association of cognitive fusion with domains of health. Journal of Contextual Behavioral Science, 18, 9-15. https://doi.org/10.1016/j.jcbs.2020.08.001
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, 1019-1024. 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, 52, 628-633. https://doi.org/10.1016/j.jbct.2021.04.001
Chi, X., Cui, X. (2020). Externalizing problem behaviors among adolescents in a southern city of China: Gender differences in prevalence and correlates. Children and Youth Services Review, 119, 1056-1059. https://doi.org/10.1016/j.childyouth.2020.105632
Collie, R.J. (2022). Perceived social-emotional competence: A multidimensional examination and links with social-emotional motivation and behaviors. Learning and Instruction, 82, 1016-1020. https://doi.org/10.1016/j.learninstruc.2022.101656
Darawshy, N.A., Haj-Yahia, M.M. (2018). Palestinian adolescents' exposure to community violence and internalizing and externalizing symptoms: Parental factors as mediators. Children and Youth Services Review, 95, 397-406. https://doi.org/10.1016/j.childyouth.2018.11.017
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, 34, 154-165. https://doi.org/10.1186/s40337-019-0267-x
Farhadi, T., Asli Azad, M., Sadat Shokrkhodaei, N. (2019).Effectiveness of mindfulness therapy on executive functions and cognitive fusion of adolescents with Obsessive-Compulsive Disorder. Empowering Exceptional Children, 9(4), 81-92. (In Persian)  10.22034/ceciranj.2018.91194
Felner, R.D., Lease, A.M., Philips, R.C. (1990). Social Competence and the Language of Adequacy as a Subject Matter for Psychology: A Quadripartite Travel Framework. In T. P. Gullotta. G. R. Adams, & R Montemayor (Eds), The Development of Social Competence (pp. 254-264).
Finch, J.E., Akhavein, K., Patwardhan, I., Clark, C.A.C. (2023). Teachers' self-efficacy and perceptions of school climate are uniquely associated with students' externalizing and internalizing behavior problems. Journal of Applied Developmental Psychology, 85, 1015-1019. https://doi.org/10.1016/j.appdev.2023.101512
Flynn, M.K., Hernandez, J.O., Hebert, E.R., James, K.K., Kusick, M.K. (2018). Cognitive fusion among hispanic college students: Further validation of the Cognitive Fusion Questionnaire. Journal of Contextual Behavioral Science, 7, 29-34. https://doi.org/10.1016/j.jcbs.2017.11.003
Gallegirian, S., Deireh, E., Ghamarani, A., Poladi Reishahri, A. (2022). The Effect of Unified Trans-Diagnostic Treatment on the Experiential Avoidance And Suicidal Ideation in the Girls Victim of Domestic Violence. Psychological Models and Methods, 12(46), 69-84. (In Persian) 10.30495/jpmm.2022.27578.3344
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.  Journal of Shefaye Khatam. 9(4), 71-80. (In Persian)  10.52547/shefa.9.4.71
Gillanders, D.T., Bolderston, H., Bond, F.W., Dempster, M., Flaxman, P.E., Campbell, L., et al. (2014). The development and initial validation of the cognitive fusion questionnaire. Behavior Therapy, 45(1), 83-101. https://doi.org/10.1016/j.beth.2013.09.001
Golpayegani, F., Bayat, B., Majdian, V., Agha Bozorgi, S. Effectiveness of Acceptance and Commitment Therapy on the quality of attachment and altruism of the children with externalized behavioral problems. Journal of Exceptional Children, 17(4), 77-88. (In Persian) 20.1001.1.16826612.1397.18.4.10.3
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
Herwaarden, A., Schuiringa, H., Nieuwenhuijzen, M., Castro, B., Lochman, J.E., Matthys, W. (2022). Therapist alliance building behavior and treatment adherence for dutch children with mild intellectual disability or borderline intellectual functioning and externalizing problem behavior. Research in Developmental Disabilities, 128, 1042-1047. https://doi.org/10.1016/j.ridd.2022.104296
Holakouee, A., Ghasemzadeh, S., Arjmandnia, A A. (2022). The Effectiveness of unified protocol of trans-diagnostic treatment on Adolescent Anxiety and maternal parenting methods. RJMS, 29(4), 150-159. (In Persian)  20.1001.1.22287043.1401.29.4.15.2
Huang, C., Chen, Y., Greene, L., Cheung, S., Wei, Y. (2019). Resilience and emotional and behavioral problems of adolescents in China, Effects of a short-term and intensive mindfulness and life skills training. Children and Youth Services Review, 100, 291-297. https://doi.org/10.1016/j.childyouth.2019.03.015
Jurkic, A., Halliday, S.E., Hascher, T. (2023). The relationship of language and social competence of preschool- and kindergarten-age single and dual language learners in Switzerland and Germany. Early Childhood Research Quarterly, 64, 72-83. https://doi.org/10.1016/j.ecresq.2023.02.003
Kang, Y., Ha, J., Ham, G., Lee, E., Jo, H. (2022). A structural equatin model of the relationships between social-emotional competence, social support, depression, and aggression in early adolescents in South Korea. Children and Youth Services Review, 138, 1064-1068. https://doi.org/10.1016/j.childyouth.2022.106498
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
Keute, M., Krauel, K., Heinze, H., & Stenner, M.(2018). Intact automatic motor inhibition in attention deficit hyperactivity disorder. Cortex, 109, 215-225. https://doi.org/10.1016/j.cortex.2018.09.018
Knappe, S., Martini, J., Muris, P., Wittchen, H., Beesdo-Baum, K. (2022). Progression of externalizing disorders into anxiety disorders: Longitudinal transitions in the first three decades of life. Journal of Anxiety Disorders, 86, 1025-1029. https://doi.org/10.1016/j.janxdis.2022.102533
Lau, W., Chisholm, K., Gallagher, M.W., Felmingham, K., Murray, K., Pearce, A., Doyle, N., Alexander, S., O'Brien, H., Putica, A., Khatri, J., Bockelmann, P., Hosseiny, F., Librado, A., Notarianni, M., O'Donnell, M.L. (2023). Comparing the unified protocol for transdiagnostic treatment of emotional disorders to prolonged exposure for the treatment of PTSD: Design of a non-inferiority randomized controlled trial. Contemporary Clinical Trials Communications, 33, 1011-1015. https://doi.org/10.1016/j.conctc.2023.101134
Liu, G., Fang, L., Pan, Y., Zhang, D. (2019). Media multitasking and adolescents' sleep quality, The role of emotional-behavioral problems and psychological sushi. Children and Youth Services Review, 100, 415-421. https://doi.org/10.1016/j.childyouth.2019.03.026
Low, J., Bishop, A., Pilkington, P.D. (2022). The longitudinal effects of paternal perinatal depression on internalizing symptoms and externalizing behavior of their children: A systematic review and meta-analysis. Mental Health & Prevention, 26, 2002-2008. https://doi.org/10.1016/j.mhp.2022.200230
Mancini, V., Rigoli, D., Roberts, L., Piek, J.(2019). Motor skills and internalizing problems throughout development: An integrative research review and update of the environmental stress hypothesis research. Research in Developmental Disabilities, 84, 96-111. https://doi.org/10.1016/j.ridd.2018.07.003
Mansurnejad, Z., Malekpor, M., Ghamarani, A. (2019). Explanation of Self-determination Experiences in Students with Externalized Behavior Disorders: A Phenomenological Approach. JQRHS, 8(2), 183-191.  https://jqr1.kmu.ac.ir/article_90966.html
Mathews, B.L., Koehn, A.J., Abtahi, M.M., Kerns, K.A. (2016). Emotional competence and anxiety in childhood and adolescence: A meta-analytic review. Clinical Children Family Psychology Review, 19(2), 162-184. https://doi.org/10.1007/s10567-016-0204-3
Miller, C.J., Brooker, B. (2017). Mindfulness programming for parents and teachers of children with ADHD. Complementary Therapies in Clinical Practice, 28, 108-115. https://doi.org/10.1016/j.ctcp.2017.05.015
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 Child Mental Health, 6(4), 108-118. 10.29252/jcmh.6.4.11
Nakamura, B., Ebesutani, C., Bernstein, A., & Chorpita, B. (2009). A psychometric analysis of the Child Behavior Checklist DSM-oriented Scales. Journal of Psychopathology and Behavioral Assessment, 31, 178-189. https://doi.org/10.1007/s10862-008-9119-8
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. 10.22034/ceciranj.2019.91938
Parandin, S.H. (2007). Construction and normalization of social competence in teenagers of Tehran city. Master's thesis, Faculty of Psychology and Educational Sciences, Allameh Tabatabai University. (In Persian) 
Peris-Baquero, O., Moreno-Pérez, J.D., Navarro-Haro, M.V., Díaz-García, A., Osma, J. (2023). Emotion dysregulation and neuroticism as moderators of group Unified Protocol effectiveness outcomes for treating emotional disorders. Journal of Affective Disorders, 331, 313-321. https://doi.org/10.1016/j.jad.2023.03.079
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. Int J Environ Res Public Health, 10(6), 1-17. https://doi.org/10.3390/ijerph17228306
Sauer-Zavala, S., Bentley, K.H., Steele, S.J., Tirpak, J.W., Ametaj, A.A., Nauphal, M., Cardona, N., Wang, M., Farchione, T.J., Barlow, D.H. (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
Shahriari, Y., Ghasemzadeh, S., Kashani Vahid, L., Vakili, S., (2022). The effectiveness of unified transdiagnostic treatment protocols on parental stress and depression in adolescents with type 1 diabetes. Daneshvar medicine.  30(158), 72-83. (In Persian) 10.22070/daneshmed.2022.15423.1148
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, 1005-1009. https://doi.org/10.1016/j.jocrd.2020.100552
Sherman, J.A., Ehrenreich-May, J. (2020). Changes in Risk Factors During the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents. Behavior Therapy, 51(6), 869-881. https://doi.org/10.1016/j.jocrd.2020.100552
Silva, C.T.B., Costa, M.A., Kapczinski, F., Aguiar, B.W., Salum, G.A., Manfro, G.G.(2017). Inflammation and internalizing disorders in adolescents. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 77, 133-137. https://doi.org/10.1016/j.pnpbp.2017.03.023
Thomas, K.N., Bardeen, J.R. (2020). The buffering effect of attentional control on the relationship between cognitive fusion and anxiety. Behaviour Research and Therapy, 132, 103-108. https://doi.org/10.1016/j.brat.2020.103653
Trent, E.S., Viana, A.G., Raines, E.M., Woodward, E.C., Storch, E.A., Zvolensky, M.J. (2019). Parental threats and adolescent depression, The role of emotion dysregulation. Psychiatry Research, 276, 18-24. https://doi.org/10.1016/j.psychres.2019.04.009
Wang, Y., Fu, C., Wang, M. (2021). The additive and interactive effects of parental harsh discipline and boys’ gender-related traits on boys’ externalizing problem behaviors. Children and Youth Services Review, 112, 1059-1064. https://doi.org/10.1016/j.childyouth.2020.105908
Wu, X.Y., Bastian, K., Ohinmaa, A., Veugelers, P.(2018). Influence of physical activity, sedentary behavior, and diet quality in childhood on the incidence of internalizing and externalizing disorders during adolescence: a population-based cohort study. Annals of Epidemiology, 28(2), 86-94. https://doi.org/10.1016/j.annepidem.2017.12.002
Zacharia, M., Ioannou, M., Theofanous, A., Vasiliou, V.S., Karekla, M. (2021). Does Cognitive Fusion show up similarly across two behavioral health samples? Psychometric properties and invariance of the Greek–Cognitive Fusion Questionnaire (G-CFQ). Journal of Contextual Behavioral Science, 36(12), 214-218. https://doi.org/10.1016/j.jcbs.2021.01.003
Zhang, Y., Yang, X., Liu, X., Jia, C. (2023). Longitudinal association of family conflict and suicidal behaviors among Chinese adolescents: The mediation effect of internalizing and externalizing problems. Journal of Affective Disorders, 321, 96-101. https://doi.org/10.1016/j.jad.2022.10.028