The Effectiveness of Emotional Schema Therapy on Emotion Regulation Strategies in Adolescents with Oppositional Defiant Disorder

Document Type : Original Article

Authors

• Jafar Ghaitasi ¹
• Ahmad Amani ²

¹ PhD Student in Counseling, Faculty of Humanities and Social science, University of Kurdistan, Sanandaj, Iran

² Associate Professor, Department of Counseling, Faculty of Humanities and Social science, University of Kurdistan, Sanandaj, Iran

10.22067/tpccp.2024.77697.1316

Abstract

Introduction
It is evident that the period of puberty and adolescence plays a pivotal role in an individual's life trajectory. During this period, adolescents are more susceptible to psychological issues compared to other age groups due to the crises they experience. One of the most significant issues that arises during this period is Oppositional Defiant Disorder (ODD). The advent of such disorder, particularly during adolescence, is regarded as a highly challenging phenomenon. The lack of timely treatment for this disorder may result in the development of traumatic psychological problems in adulthood. In other words, the period of childhood and adolescence is regarded as a crucial and vulnerable phase of human development, during which many mental disorders that manifest in adulthood have their origins (American Psychiatric Association, 2013). ODD is among the most significant reasons for children and adolescents to seek counseling and psychological services (Steiner & Remsing, 2007).
The disruptive and destructive behavior of students has been a prominent area of focus for researchers in recent years (Charles, 2013). Among the most prominent destructive behaviors and behavioral disorders that disrupt the performance of children and adolescents are oppositional, aggressive, and disobedient behaviors (Booker, et al., 2016; Herpers, et al., 2019). On the other hand, concern in the field of adolescent mental health and its impact on growth and psychological and behavioral functions and executive functions has increased significantly in parallel with the rise in the prevalence of mental disorders in children over the past few decades (Doyle, et al., 2019; Lin, et al., 2016).
Concurrently, ODD has emerged as the most challenging condition for therapists and researchers in this field (Cavanagh, et al., 2017; Doyle, et al., 2019). Based on the available statistics, the global prevalence of this disorder has been estimated 2% to 11% (American Psychiatric Association, 2013). It is also repeatedly reported as the third most common mental disorder among children and adolescents aged 2 to 16 years (Brammer & Lee, 2012). Additionally, internal studies have indicated that this disorder is prevalent in 3.9% of individuals over the course of their lifetime (Mohammadi, et al., 2019). Over the course of many years, a variety of treatment methods have been employed to address the behavioral, cognitive, and emotional issues associated with ODD in children and adolescents. These methods include parent training, behavior management, psychotherapy, and family therapy.
Despite the effectiveness of psychotherapy and counseling in treating these children, there are numerous challenges associated with their implementation (Abdollahi Boughrabadi, 2018). One of the efficacious treatments is emotional schema therapy, which is currently in the early stages of becoming an effective treatment in Iran. This treatment method is a meta-diagnostic structure that was recently introduced for the formulation and treatment of psychological harms. Tt addresses the conceptualization of perceptions and the responses of individuals to their feelings and affections (Silberstein, et al., 2012).
Method
The research design was a single-subject AB design, comprising three baselines, three treatment periods, and three follow-up periods. The statistical population consisted of all students enrolled in the first secondary schools of Dalaho City during the 2020-2021 academic year. Using purposeful sampling method and executing inclusion and exclusion criteria (e.g., informed consent, diagnosis of ODD, and absence of medication), the selection of the six students was conducted in accordance with the highest ethical standards. The instruments utilized in this investigation were as follows: The research employed a semi-structured clinical interview based on DSM-5, ODD rating scale (Hommersen, et al., 2006) and emotion regulation questionnaire for children and adolescents (Gross & John, 2003). Subsequently, the subjects underwent ten intervention sessions based on the Leahy emotional schema therapy model. Subsequent to the fourth, seventh, and tenth sessions, the participants were evaluated using the research tool.
Results
In addition to visual analysis based on AB process analysis graphs, statistical interpretation of the effectiveness of emotional schema therapy on emotion regulation strategies in adolescents with ODD was conducted using Cohen's d indices, Percentage of Non-overlapping Data (PND), Percentage of All Non-overlapping Data (PAND), Percentage Exceeding the Median (PEM), and Reliable Change Index (RCI). Cohen's d values and RCI less than 0.2 indicate a weak effect, between 0.2 and 0.8 indicate a moderate effect, and higher values indicate a large and strong effect. The PEM, PND, and PAND indices are obtained in the range of 0 to 1, with a value closer to 1 indicating a significant impact. Based on the results of the statistical analysis of the total score for emotion regulation, the Cohen's d values are in the range of 0.58 to 1, indicating a moderate effect. The PEM, PND, and PAND indices are all equal to one, and the absolute value of the RCI is greater than one in all cases. Additionally, the reappraisal strategy in emotion regulation yielded Cohen's d values between 0.41 and 0.90, indicating a moderate effect. The PEM, PND, and PAND indices were all obtained as 1, and the absolute value of RCI was greater than 1 in all cases. Furthermore, the Cohen's d values for the suppression strategy in emotion regulation fall within the range of 0.40 to 0.80, indicating a moderate effect. It is notable that the PEM, PND, and PAND indices all yielded a value of 1, and that the absolute value of RCI exceeded 1 in all instances. The results of the AB process analysis and total statistical indicators demonstrate a significant and consistent impact of emotional schema therapy on the overall score for emotion regulation, reappraisal strategies, and suppression strategy across all six participants.
Discussion and Conclusion
The results of this research demonstrate that the trend of the participants' scores on the total scale of emotion regulation and the subscales of reappraisal and suppression strategies exhibited an upward pattern during the treatment periods. Furthermore, this increasing trend was sustained in the follow-up period. These results suggest that emotional schema therapy is an effective and durable approach for improving emotion regulation strategies in adolescent patients diagnosed with ODD. A review of the literature revealed no studies that have directly investigated the effectiveness of emotional schema therapy on emotion regulation strategies of adolescents with ODD. In a similar study (Ghodrati Shahtoori, et al., 2020), the efficacy of emotional schema therapy in improving all dimensions of cognitive-emotional regulation in soldiers with suicidal behavior was demonstrated. Also, a study by Izadi, et al. (2019) showed that emotional schema therapy model, which is based on the relationship between negative emotional schemas and alexithymia with physical symptoms, reduces negative emotional schemas and alexithymia by correcting the underlying processes of emotions and improving people's maladaptive strategies toward emotions. Among other research in line with this finding, we can refer to the research by of Leahy (2016, 2019) and Naderi, et al. (2015). Emotion regulation strategies give aggressive people the ability to recognize the process of occurrence of their negative emotions when negative emotions occur and then be able to control, manage and organize these emotions (Sheikhi Gerakoui, et al., 2021). It is suggested that due to the influence of different factors on the emergence and exacerbation of ODD, the role of emotional factor can be considered less in some participants, which indicates the need for similar research in different areas affecting this disorder. 

Keywords

• Oppositional defiant disorder
• Emotion Regulation strategies
• Emotional Schema Therapy

Main Subjects

• Cognetive Psy

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