Comparison of Effectiveness of Integrated Models of Attachment Narrative Therapy and Unified Transdiagnostic on Cognitive Emotion Regulation Strategies in Distressed Couples

Document Type : Original

Authors

1 Ph.D Student, Department of Psychology, Borujerd Branch, Islamic Azad University, Borujerd, Iran.

2 Associate Professor, Department of Psychology, Faculty of Literature and Humanities, Lorestan University, Khorramabad, Iran.

3 professor, Department of Psychology, Lorestan University, Khorramabad, Iran.

Abstract

Attachment Narrative Therapy (ANT) and Unified Transdiagnostic therapy(UP) are integrated therapies that pay attention to psychological and communication components from different perspectives to identify and reduce the common causes of distress in couples. This study aimed to evaluate the effectiveness of these two models on cognitive emotion regulation strategies in distressed couples. In this research, a single-case experimental design of multiple asynchronous baselines was used. The statistical population included all distressed couples (based on the list of marital distress) who in the second half of 1399 referred to the Counseling Center of Education Department of Khorramabad City, There were 68 couples (136 men and women), finally, 6 couples were selected by available non-random sampling method. The attachment narrative therapy model (Dallos, 2008) and Unified Transdiagnostic therapy model (Barlow, 2011) were conducted in two to four baseline stages, 14 and 12 sessions of 60 and 90-minute intervention, and two-month follow-up. Subjects responded to the scale of cognitive emotion regulation strategies (Garnefski, 2001).  Data were analyzed by visual mapping, stable change index, and improvement percentage formula. In the attachment narrative group, the level of recovery in the post-treatment and follow-up phase for cognitive emotion regulation strategies was positive (50/16, 47/92) and negative (48/62, 44/44) percent, and in the Unified Transdiagnostic group, it was positive (66/43, 63/42) for cognitive emotion regulation strategies and negative (60/19, 58/31) percent. The results showed that Unified Transdiagnostic therapy was more effective in the treatment with attachment narrative therapy both in treatment (16/27,15/5) and in the follow-up period (11/5713/65).

Keywords


References
Ahmadi,s., Brqaie,sh., & Abbasi,z.(2016). A Comparison between the Effect of Education based on Attachment Narrative Therapy and spirituality Therapy on Marital Conflicts.  Journal of Islam and Psychological Research,2(4),99-112. http://dx.doi.org/10.29252/bjcp.14.2.15.[Persian].
Amato, P. R., & Rogers, S. J. (1999). Do attitudes toward divorce affect marital quality? Journal of Family Issues, 20 (1), 69-86. https://doi.org/10.1177/019251399020001004
Banker, J. E., Kaestle, C. E., & Allen, K. R. (2010). Dating is hard work: A narrative approach to understanding sexual and romantic relationships in young adulthood. Journal of Contemporary Family Therapy, 32(2), 173-191. https://doi.org/10.1007/s10591-009-9111-9
Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a Unified Treatment for Emotional Disorders. Behavior Therapy, 35(2), 205–230. https://doi.org/10.1016/S0005-7894(04)80036-4
Barlow, D.H., Farchione, TJ., Fairholme, CP., Ellard, KK., Boisseau, CL., Allen, LB., & hrenreich-May, J.(2011). The unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide (2nd ed.).  New York: Oxford University Press. DOI: 10.1093/med:psych/9780199772667.001.000
Birditt, K. S., Wan, W. H., Orbuch, T. L., & Antonucci, T. C. (2017). The development of marital tension: Implications for divorce among married couples. Developmental psychology, 53(10).  https://doi.org/10.1037/dev0000379
Bookwala, J., Sobin, J. & Zdaniuk, B. (2005). Gender and aggression in the marital relationship: A life-span perspective. Sex Roles, 52, 506-797. https://doi.org/10.1007/S11199-005-4200-1
Dallos, R. (2008). ANT-Attachment Narrative Therapy Narrative and Attachment Theor Approaches in Systemic Family Therapy with Eating Disorders. journal of psychotherapy family, 12,43-72. https://doi.org/10.1300/J085v12n02_04.
Dallos, R .(2006). Attachment Narrative Therapy (1nd ed.). McGraw-Hill Education (UK).
ISBN
0335224695, 9780335224692
Dallos, R. & Vetere, S (2009). Systemic Therapy and Attachment Narratives(1nd ed.). New York   Routledge. ISBN  9780415416580
Dan, O.(2020). Recognition of emotional facial expressions in adolescents with attention-deficit/hyperactivity disorder. Journal of Adolescence, 82(5),1-10. https://doi.org/10.1016/j.adolescence.2020.04.010
Ehring T, Tuschen-Caffier B, Schnulle J, Fischer S,. & Gross JJ.(2010) Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10(4), 563-572. http://dx.doi.org/10.1037/a0019010.
  Fallahchai, R., Fallahi, M., & Ritchie, L. L. (2016). The impact of prep training on marital conflicts reduction: a randomized controlled with Iranian distressed couples. Journal of Couple & Relationship Therapy,16(1),61-76. https://doi.org/10.1080/15332691.2016.1238793 [Persain]
Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L., Thompson-Hollands, J., Carl, J.R., Gallagher, M.W., & Barlow, D.H. (2012). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Randomized controlled trialBehav Ther, 43(3), 666–678.  https://doi.org/10.1016/j.beth.2012.01.001.
Fotouhi, S., Mikayeli, N., Atta Dukht, A., & Hajlou, N. (2018). Comparing the effectiveness of meta- emotion-based couple therapy with narrative couple therapy on adjustment and couple burnout in conflicting couples. Journal of Culture Counseling, 34(9), 77-101.https://dio.org/  10.22054/QCCPC.2018.27362.1672 [Persian]
Fruzzetti, A., & Iverson, KM. (2004). Couples dialectical behavior therapy: An approach to both individual and relational distress. Coupl Res Ther, 10,8-13.
https://doi.org/10.1037/11468-012.

 García, J., M.Valiente, R., Sandín, B., Ehrenreich, J., Antonio, A., & Chorot, P .(2019). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Anxiety and Depression Prevention Program: An Initial Cluster Randomized Wait-List-Controlled Trial. Behavior Therapy ,51(3) ,461-473. https://doi.org/10.1016/j.beth.2019.08.003.

Garnefski, N., Kraaij, V., & Spinhoven, P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Pers Individ Differ, 30, 1311- 1327. https://doi.org/10.1016/S0191-8869(00)00113-6.
Gerard, J. A., & Buehler, C. (2003). Marital conflict: Parent-child relations and young maladjustment, Family Process, 38(1), 105-116. https://doi.org/10.1177/0192513X05286020
Ghodsi, M., Ahmad Barabadi, H., & Heydarnia, A. (2017). Effectiveness of narrative therapy on reducing divorce tendency and its components in women with early marriage. Journal of Culture Counseling, 9(33), 73-98.https://dx.doi.org/10.22054/qccpc.2018.28555.1712.[Persian] .
Jaremka, L.M., Glaser, R., Malarkey, W.B. & Kiecolt-Glaser, J.K. (2013). Marital distress prospectively predicts poorer cellular immune function. Psychoneuroendocrinology, 38(11), 2713-2719. http://dio.org/10.1016/j.psyneuen.2013.06.031
Johnson, S. (2019).  The Practice of Emotionally Focused Couple Therapy: Creating Connection (3nd Ed.). Routledge. ISBN 9780815348016
Karris, M., & Arger, k. (2019). Religious Couples Re-Storying After Infidelity: Using Narrative Therapy Interventions with a Focus on Attachment. Counseling and Family Therapy Scholarship Review,2(1),1-16 http://doi.org /10.53309/JCDM6423. .
Kirby, J. (2007). Treating emotion Dysregulation in a couple’s context: a Pilot study of a couple’s skills Group intervention. Journal of marital and family therapy. 33(3),375-91.https://doi.org/10.1111/j.1752-0606.2007.00037.x.
Lebow, J. (1997).The integrative revolution in couple and family therapy. Family Process,36(1),1-17. https://doi.org/10.1111/j.1545-5300.1997.00001.x
 
Lee, S. J., Kim, S., Han, S. Y., Lee, Y. J., & Chae, H. (2019). Is the cognitive emotion
regulation strategy related to Yin-Yang personality traits? European Journal of Integrative Medicine, 26, 24-30. https://doi.org/10.1016/j.eujim.2019.01.004
Liu, L., & Wang, M. (2015). Parenting stress and harsh discipline in China: The moderating roles of marital satisfaction and parent gender. Child Abuse & Neglect, 43(1), 73–82. https://doi.org/10.1016/j.chiabu.2015.01.014.
Mao, K., Niu, J., Chen, H., Wang, L., & Atiquzzaman, M. (2018). Mining of marital distress from microblogging social networks: A case study on Sina Weibo. Future GenerationComputer Systems, 86, 1481-1490. https://doi.org/10.1016/j.future.2017.05.030.
Means‐ Christensen, A. J., Snyder, D. K., & Negy, C. (2003). Assessing nontraditional couples: validity of the marital satisfaction inventory‐ revised with gay, lesbian, and cohabiting heterosexual couples. Journal of Marital and Family Therapy,29(1),69-83. https://doi.org/10.1111/j.1752-0606.2003.tb00384.x
 
Mozaffari, v., Ghorban Shiiroudi,sh & Shafiabadi. (2020). Effectiveness of Integrated Meta-Diagnostic Therapy on Cognitive Emotion Regulation and Psychological Resilience of Veterans’ Spouses   Iranian. Journal of War & Public Health;12(3):149-155. http://dx.doi.org/10.52547/ijwph.12.3.149. .[Persian] .
Norton PJ, & Barrera TL. (2013).  Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depress Anxiety; 29(10), 874-82. https://dx.doi.org/10.1002%2Fda.21974.
  Ornelas Maia, A.C.C., Nardi, A.E., & Cardoso, A. (2015). The utilization of unified protocols in behavioral cognitive therapy in transdiagnostic group subjects: A clinical trial. Journal of Affective Disorders, 172, 179-183. https://doi.org/10.1016/j.jad.2014.09.023 .
 
Roozdar, Ebrahim .,Hamid ,Najme., Beshlideh, Kioumars & Arshadi, Nasrin.(2019). The Effectiveness of Narrative Couple Therapy on Improving the Psychological Well-Being maladaptive Couples.  Biannual Journal of Applied Counseling (JAC), 9(1), 67-86. http//: DOI: 10.22055/jac.2020.31058.1703. [Persian] .
 
sadr, A., Doustkam,M.,  Shareh, H., &  Bolghan-Abadi,M. (2020). Comparison of Effectiveness of Barlow's Transdiagnostic, and Mennin and Fresco’s Emotion Regulation Therapy in the Symptoms of Generalized Anxiety Disorder (case study). Journal of ResearchinBehavioral Sciences, 18(1),11-25. [link]
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, 101-107. https://doi.org/10.1016/j.cpr.2019.101751.
Sauer-Zavala, S., Bentley, K. H., Ametaj, Steele,S.G.,Tirpak,G.W., Ametaj,A.A., Nauphal,M., Cardona,N.,Wang,M., Farchione,T.G& 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
Schudlich, T. D. D. R., Jessica, N. W., Erwin, S. E., & Rishor, A. (2019). Infants' emotional security: The confluence of parental depression, Interparental conflict, and parenting. Journal of Applied Developmental Psychology, 63, 42-53. https://doi.org/10.1016/J.APPDEV.2019.05.006.
Sharifi, M. Mami , SH. Mohammadzadeh , J. Ahmadi ,V., & Kakabaraei,K. (2020). Evaluation of the effectiveness of unified protocol for the transdiagnostic treatment and emotion regulation intervention in patients with generalized anxiety disorder in a military hospital. Journal of EBNESINA, 22(3), 73-77. http://dx.doi.org/10.22034/22.3.73
Snyder, D. K. (1997). Marital satisfaction inventory, revised (MSI-R). Journal of Marriage and the Family,41(4) ,813-823. https://doi.org/10.2307/351481
Snyder, DK. (2006). Emotion Regulation in Families: Pathways to Dysfunction and Health. Washington, DC: American Psychology Association press, 115-35. ISBN: 978-1-59147-394-7
             
Snyder, D. K., Castellani, A. M., & Whisman, M. A. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317–344. 10.1146/annurev.psych.56.091103.070154
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
Stutzman, S. V., Bean, A. R., Miller, R. B., Day, R. D., Feinauer, L. L., Porter, Ch. L., & Moore, A. (2011). Marital conflict and adolescent outcomes: A cross-ethnic group comparison of Latino and European American youth. Children and Youth Services Review, 33(5),663–668. https://doi.org/10.1016/j.childyouth.2010.11.009.
Szymon, Ch. (2020). couple conflicts from an attachment and narrative therapy
Perspective. psychotherapy,3(194), 31–44.  https://doi.org/10.12740/PT/127513
Talkovsky, A.M., Green, K.L., Osegueda, A., & Norton, P.J. (2017). Secondary depression in transdiagnostic group cognitive behavioral therapy among individuals diagnosed with anxiety disorders. Journal of Anxiety Disorders, 46, 56-64. https://doi.org/10.1016/j.janxdis.2016.09.008.
 Zelomke, K. R & Hahn, K. S. (2010). Cognitive emotion regulation strategies: Gender differences and associations to worry. Personality and Individual Differences, 48, 408-413. https://doi.org/10.1016/j.paid.2009.11.007.
Zhou, N., & Buehler, C. (2019). Marital hostility and early adolescents’ adjustment: The role of cooperative marital conflict. The Journal of Early Adolescence, 39, 5-27.  https://doi.org/10.1177/0272431617725193