نویسندگان:

ثنا دهقانپور¹ ، خالد اصلانی² ، عباس امان الهی³ ، ذبیح اله عباس‌پور⁴ .

¹گروه مشاوره، دانشکده علوم تربیتی و روان‌شناسی، دانشگاه شهید چمران اهواز، اهواز، ایران

²گروه مشاوره، دانشکده علوم تربیتی و روانشناسی، دانشگاه شهید چمران اهواز، اهواز، ایران.

³گروه مشاوره، دانشکده علوم تربیتی و روانشناسی، دانشگاه شهید چمران اهواز، اهواز، ایران.

⁴دانشگاه شهید چمران اهواز

چکیده فارسی: تروما، تأثیری ویرانگر بر رشد شناختی، هیجانی، رفتاری و اجتماعی افراد دارد. آسیب‌های دوران کودکی، بزرگسالانی را به بار می‌آورد که از نشانه‌های اختلالات هیجان رنج می‌برند. هدف پژوهش حاضر تعیین اثربخشی درمان هیجان‌مدار فردی بر بهبود اضطراب، افسردگی و بدتنظیمی هیجانی مرتبط با ترومای پیچیده بود. این پژوهش تک‌موردی و از نوع خط پایه چندگانه ناهمزمان بود. جامعه پژوهش شامل افراد بالای 18 سال دارای دست کم یک نوع تجربه ترومای پیچیده دوران کودکی بود که در سال 1402 به مراکز روانشناختی شهر کرج مراجعه کردند. از این بین به روش هدفمند سه نفر به عنوان نمونه انتخاب شدند. پژوهش در سه مرحله خط پایه، 15 جلسه هفتگی درمان هیجان‌مدار فردی (هر جلسه یک ساعت) و پیگیری دو ماهه اجرا شد. ابزارهای اندازه‌گیری شامل پرسشنامه ترومای دوران کودکی ، پرسشنامه دشواری در تنظیم هیجانی، پرسشنامه اضطراب بک و فرم کوتاه پرسشنامه افسردگی بک بودند. برای تجزیه و تحلیل داده‌ها از شاخص تغییر پایا، فرمول درصد بهبودی و روش-های تحلیل دیداری (نمودار) استفاده شد. یافته‌ها نشان داد درمان هیجان مدار فردی می‌تواند در بهبود اضطراب، افسردگی و بدتنظیمی هیجانی افراد دارای تجربه ترومای پیچیده مؤثر باشد(به ترتیب با 55/26، 38/30 و 36/28 درصد بهبودی). این نتیجه در کنار شاخص پایای بالاتر از اندازه 96/1=z همچنان بعد از دو ماه پیگیری، از نظر بالینی معنادار بود. این پژوهش نشان داد که درمان هیجان‌مدار فردی با ایجاد فضایی امن و تسهیلگر بر بهبود اضطراب و افسردگی و بدتنظیمی هیجانی افراد تجربه کننده‌ی ترومای پیچیده مفید است.

کلمات کلیدی: افسردگی ، اضطراب ، بدتنظیمی هیجانی ، درمان هیجان مدار فردی ، ترومای پیچیده .

The effectiveness of emotionally focused individual therapy on improving anxiety, depression, and emotional dysregulation associated with complex trauma

English Abstract: Introduction Complex trauma is a child’s exposure to multiple pervasive, intense, aggressive, traumatic, and interpersonal events and the effects of prolonged exposure to these events (Hughes et al., 2017). The combination of separation from caregivers with pervasive abuse and negligence creates conditions that ultimately lead to complex trauma (Bouvette-Turcot et al., 2017). The effects of complex trauma manifest in the chronic and pervasive disturbances in terms of emotion regulation, negative self-concept, and interpersonal relationships (Maercker et al., 2022). Childhood trauma has also been shown to be associated with an increased risk of depression later in life. Some findings suggest that the severity of depression also depends on the type of reported trauma (i.e., physical, emotional, sexual) (Humphreys et al., 2020). Exposure to complex childhood trauma increases the risk of depression and anxiety by three to four times (Hughes et al., 2017). Since trauma is a painful emotional experience, it is not far-fetched to think that emotion-focused therapy would be useful in improving its symptoms. Emotionally focused individual therapy is a new and experimental human intervention for symptoms of depression, anxiety, and complex trauma (Johnson et al., 2021). Kale (2021) showed that increasing the client’s internal awareness of his physical condition during the emotion-focused therapy process will lead to a reduction in the symptoms of emotional disorders. The average quality of life of Karaj residents which is accompanied by life problems, lack of supportive networks, high hours and workload, and painful childhood experiences strengthens the likelihood of difficulty of people regulating their emotions and facilitates the development of emotional disorders such as anxiety and depression. Therefore, given the importance of mental health in the quality of individual and social life of people as well as the limited history of emotionally focused individual therapy for complex trauma, the present study aimed to investigate the effectiveness of this therapy in improving emotional symptoms in individuals who experienced complex childhood trauma.   Methodology   The present study included a single-case, asynchronou multiple baseline design to investigate the effectiveness of emotionally focused individual therapy. The statistical population included all individuals who experienced complex trauma in childhood and referred to psychological treatment centers in Karaj. The sample consisted of three individuals who experienced at least one type of consecutive childhood abuse; they were selected through purposive sampling method. They were invited through calls from among individuals who had referred to psychological treatment centers in Karaj seeking treatment for anxiety and depression. Each volunteer who accepted to participate in the study had to obtain a score of at least the threshold or higher in at least one of the complex trauma types (i.e., at least 10 for physical abuse, at least 13 for emotional abuse, at least 8 for sexual abuse, at least 10 for physical negligence, and at least 15 for emotional negligence). Each participant underwent 15 one-hour sessions of emotionally focused individual therapy. The instruments included the Childhood Trauma Questionnaire (Bernstein et al, 2003), Difficulty in Emotion Regulation Questionnaire (Gratz & Roemer, 2004), Beck Anxiety Inventory (Beck, 1988), and Beck Depression Inventory-Short Form (Beck, 1986). The emotionally focused individual therapy protocol (Johnson & Campbell, 2021) was used for the treatment. The reliable change index, percentage recovery formula, and visual analysis methods (diagrams) were used to analyze the data. Findings Three volunteers participated in the present study. The first was a 28-year-old female who was a master’s student. She was unemployed and single. The second participant was a 39-year-old male with a PhD degree; he was employed and had a child. The third participant was a 42-year-old female with a bachelor’s degree. She was unemployed and had two children.    According to Table 1, the recovery percentages (after the treatment) of the three participants in terms of anxiety were 33.32, 30, and 34.78, respectively, and the reliability indices were 3.25, 2.79, and 3.72. The recovery percentages (the second follow-up) were 28.57, 25, and 26.08, respectively; the reliability indices ​​after the second follow-up were 2.82, 2.41, and 3.22. Moreover, the recovery percentages (after the treatment) of the three participants in terms of depression were 40.9, 33.32, and 36.84, respectively; the reliability indices were 2.9, 2.49, and 3.31. The recovery percentages (the second follow-up) were 31.81, 27.77, and 31.57, respectively; the reliability indices were 2.51, 2.46, and 2.7. The recovery percentages (after the treatment) of the participants in terms of emotional dysregulation were 32.52, 36.97, and 31.94, respectively; the reliability indices were 2.28, 2.51, and 2.68, respectively. The recovery percentages (the second follow-up) were 28.45, 30.25, and 26.38, respectively; the reliability indices at the end of the two follow-up stages were 1.98, 2.03, and 2.14. Since the reliability indices of the three dependent variables after the treatment were higher than the z value of 1.96, it can be stated with 95% confidence that the improvement was due to the emotionally focused individual therapy intervention. Figures 1, 2, and 3 show the changes in anxiety, depression, and emotional dysregulation as a result of emotionally focused individual therapy intervention.                   According to the graphs, anxiety, depression, and emotional dysregulation scores decreased during the intervention and follow-up phases compared to the baseline. This visual analysis showed that emotionally focused individual therapy was effective in improving anxiety, depression, and emotional dysregulation in individuals with a history of complex trauma.   Conclusion  The present study was conducted to determine the effectiveness of emotionally focused individual therapy in improving anxiety, depression, and emotional dysregulation associated with complex trauma. The results indicated the effectiveness of emotionally focused individual therapy in improving the anxiety and depression of the participants. In other words, the anxiety and depression scores decreased significantly at the end of the emotionally focused individual therapy and the recovery percentage of all participants increased steadily compared to the baseline stage. This finding was consistent with the results of Billings (2021), Wittenborn (2019), and Weissman et al. (2018). If the emotional symptoms resulting from complex trauma are modulated through effective therapeutic interventions, depression, anxiety, social withdrawal, and even physical complaints can be improved (Bouvette-Turcot et al., 2017). Another finding of the study was the effectiveness of emotionally focused individual therapy in improving emotional dysregulation of the participants. The findings of the present study were consistent with those of Kale (2021), Pascual-Leone et al., (2019), and Khayyat-Abuaita (2016), who found that emotionally focused individual therapy was effective in developing emotional flexibility and reducing emotional disorders. The significant point of the findings of this study is how the participants, influenced by the therapist’s interventions and skills, overcame the fear of remembering and confronting childhood suffering, rediscovered current symptoms of anxiety, depression, and emotional regulation problems in attachment relationships, overcame the barrier of defense mechanisms, experienced fear, shame, and anger, became aware of emotions, and reached a level of self-compassion that led to the improvement of emotional disorders (Rollet, 2023). Finally, given the effectiveness of emotionally focused individual therapy in improving the emotional state of people with trauma, interested therapists are advised to consider this treatment as a beneficial option in treating clients with a history of complex trauma.   Conflict of Interest This article is derived from the first author’s dissertation in Counseling at Shahid Chamran University of Ahvaz with ethics code 005.1403IR.SCU.REC. It has no conflict of interest.    Acknowledgements We hereby thank the participants in the study who assisted in developing knowledge.