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Kamalian T, Mirzahosseini H, Monirpoor N. The Effects of Emotional Schema Therapy and Differentiation Training on Emotional Divorce in Women. JCCNC 2021; 7 (1) :65-74
URL: http://jccnc.iums.ac.ir/article-1-297-en.html
1- Department of Psychology, Qom Branch, Islamic Azad University, Qom, Iran.
2- Department of Psychology, Qom Branch, Islamic Azad University, Qom, Iran. , mirzahoseni.hasan@gmail.com
Full-Text [PDF 641 kb]   (1048 Downloads)     |   Abstract (HTML)  (2296 Views)
● Emotional schema therapy was effective in reducing the studied women’s emotional divorce.
● The differentiation intervention program significantly reduced emotional divorce in the study participants.
● Emotional schema therapy was more effective in reducing emotional divorce than the differentiation intervention among the study participants.
Plain Language Summary 
In an emotional divorce, the couples act against each other to harass, defeat, and degrade each other’s self-esteem and to find a reason to prove each other’s faults and shortcomings. Accordingly, effective and timely treatment of emotional divorce is critical. Emotional schema therapy and differentiation training are among the major cognitive behavior therapy approaches. The present study data suggested the following conclusions: women undergoing emotional schema therapy and differentiation intervention program could control their emotions and improve their marital relations; in turn, it reduced the probability of emotional divorce in them.

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1. Introduction
Family is among the main pillars and prominent institutions in any society. It is the main center for the emergence of human emotions and sincere relationships among individuals, formed following the marriage of a man and a woman. In this regard, marriage has always been approved as the most significant and supreme social tradition to meet adults’ emotional and security needs (Izadi-Avanji et al. 2020; Brown, Manning & Stykes 2015). Naturally, each individual begins his/her marital relationship with love and affection; intending to maintain and continue such a relationship. After a while, either the husband or the wife or both may encounter numerous problems, including obsession, external stressful sources, unemployment, financial issues, and children-relevant problems. Subsequently, such challenges would enhance the odds of emotional and physical distance and decreased marital satisfaction and intimacy, which ultimately lead to divorce (Jamalnik, Falsafinejad & Khodabakhshi-Koolaee 2020; Zaheri et al. 2016). The official divorce statistics do not completely reflect the couples’ failure in their marital life. This is because, in addition to legal divorce, Emotional Divorce (ED) accounts for higher frequencies. ED represents silent lives and empty families in which a man and a woman live without mutual emotions and do not plead for a legal divorce (Shirzadi, Khakpour & Khodabakhshi-Koolaee 2021). In other words, marriage in some cases terminates in no legal divorce; however, they convert to emotionless marital lives lacking love, intimacy, and friendship. Accordingly, the couples only move on in line with their family life and spend time with them. The first step in the divorce process is ED, which indicates a declining marital relationship replaced by feelings of alienation. In such a life, the couples may continue to be together as social group mates having no attraction and trust in each other. Under such conditions, instead of supporting each other, the couples act against each other to harass, defeat, and degrade each other’s self-esteem and to find a reason to prove each other’s faults and shortcomings (Hirschberger et al. 2009; Scott et al. 2013). According to previous research, eD is associated with destructive biopsychological effects on couples, including depression, anxiety, low self-esteem, isolation, and physical and mental illnesses (Dehghani Tafti, Mohamadi & Haghighatian 2019; Hashemi & Homayuni 2017; Kanter, Proulx & Monk 2019; Mattson et al. 2015). In an ED, lower levels of Emotion Regulation ER), adaptation, and mental health are observed; subsequently, all such pressures aroused by ED raise stress in various dimensions and complicate ER (Iri et al. 2020; Mohammadi, Sepehri Shamloo & Asghari Ebrahim Abad 2019A). Accordingly, the effective and timely treatment of ED is crucial.
Emotional Schema Therapy (EST), as a novel approach to the treatment of emotional problems, is a socio-cognitive model of emotion and ER. This is because emotions are individual and a social phenomenon interpreted by oneself and others (Leahy 2019; Mohammadi et al. 2020). In this model, individuals differ concerning the interpretations and assessments of their emotional experiences and may cope with their emotions by adopting different strategies, such as experiential avoidance, fruitless cognitive strategies of social support, and so on (Wiebe & Johnson 2016; Suh et al. 2019). Accordingly, individuals with high levels of negative emotions tend to exhibit violent behaviors under relatively anxious or undesirable conditions. They mostly blame and criticize themselves harshly and exhibit too much sensitivity toward others. Such negative traits prone couples to separation and distance from each other in the long run (Pirsaghi et al. 2015). Studies revealed that emotional schemas in marital and family contexts decrease marital boredom, improve marital intimacy, and decrease psychological turmoil and marital satisfaction in couples (Kamalian, Mirzahoseini & Monirpoor 2020; Mohammadi et al. 2019A; Dadomo et al. 2016).
Differentiation, as another emotional factor, critically influences ED (Kamalian et al. 2020). Bowen’s differentiation theory, as one of the most prominent theories, highlights the primary relations in a family and considers that they affect the subsequent ones. Differentiation describes a level at which an individual can develop a balance between one’s intellectual and emotional functioning concerning intimacy and autonomy. According to this theory, ≥4 factors (i.e. emotional reactivity, emotional cutoff, fusion with others, and I-position) predict an individual’s differentiation level (Cepukiene 2021). Differentiated individuals recognize realistic dependence on others in their relations; however, they can keep calm and rational enough when encountering a conflict or criticism (Timm & Keiley 2011). Differentiation determines the foundations of intimacy and mutual acceptance in marriage. Couples with low levels of differentiation are expected to experience less emotional maturity and limited capacity for intimacy and unity in their marital life. In contrast, in differentiated marital systems, the husband and the wife let each other play a more flexible role and enjoy a more intimate relationship, tolerate each other’s differences, and experience fewer emotional reactions (Mohammadi, Alibakhshi & Sedighi 2019B). According to Lampis et al. (2017) and Skowron et al. (2009), individuals with high levels of differentiation, compared to those with low differentiation levels, encounter fewer psychological problems and interpersonal conflicts over time; accordingly, they exhibit higher levels of marital satisfaction and decreased odds of ED. In this regard, Zarei and Hosseingholi (2014), and Skowron (2000) have found a significant and positive relationship between differentiation, marital commitment, and intimacy as well as a significant and negative association between differentiation and marital boredom.
According to the provided research background, the present study aimed to investigate the effects of EST and Differentiation Training (DT) on ED among women.

2. Materials and Methods
This was a quasi-experimental study with a pre-test, post-test and a control group design. The statistical population consisted of all women referring to the Education Counseling Center of district 6 of Tehran Municipality in Tehran City, Iran, in 2018. Using the convenience sampling technique, we selected 45 women who were willing to participate in the study. We randomly assigned the research participants into two experimental groups (EST & DT) and a control group. Fifteen participants were assigned per group by G×Power. The inclusion criteria of the study were as follows: having ≥3 years of married life experience, have a minimum of high school education, and achieving a high score on the Emotional Divorce Scale (EDS). The exclusion criteria of the study were receiving concurrent psychotherapy or medication training, drug use disorders, and absence from >2 therapy sessions.
The EDS was employed to collect the required data in this research. Guttman’s EDS was first translated and used in Iran by Jazayeri in 2008 (Kianipour & Aminiha 2020). EDS contains 24 Yes/No statements (Yes=1 & No=0) on different aspects of life, with which the respondents may agree or disagree. The minimum and maximum obtainable scores of this scale are 0 and 24, respectively. Accordingly, the scores 0-8, 8-16, and >16 indicate a low, moderate, and high probability of divorce, respectively. In other words, higher scores indicate greater odds of ED. Mousavi and Rahiminezhad (2015) reported a Cronbach alpha coefficient of 0.93 for this scale. In the present study, the Cronbach’s alpha of the scale was measured to be 0.87.
Group treatment sessions were held weekly for the experimental groups (i.e. EST & DT). The intervention programs provided to the experimental groups were conducted by the first author and a psychotherapist in the Somayeh Girls High School meeting hall in Tehran. The intervention programs were performed in 8 weeks. All research groups completed the EDS in the pre-test and post-test phases. To observe the ethical considerations; after the completion of the study, the control group members were divided into two groups, and each group received EST and DT in eight 90-minute sessions. The researchers received written informed consent forms from the study participants for participation in the current research.
The first experimental group received EST in eight 90-minute weekly sessions as per the related instructions (Leahy 2016). Table 1 presents a summary of the treatment sessions program.




The second experimental group received eight 90-minute weekly sessions of DT. This intervention was invented by Kerr and Bowen (1988) and performed on the couples (Table 2).
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The obtained data were analyzed by descriptive and inferential statistics, including mean, standard deviation, and one-way Analysis of Covariance (ANCOVA) in SPSS. Furthermore, the Kolmogorov-Smirnov test was performed to examine the normal distribution of the pre-test and the post-test scores. Levene’s test was performed to examine the equality of variances. The significance level of the research was considered at P=0.05.

3. Results
The study participants included 45 women with marital conflicts. Their Mean±SD age was 30.53±3.72 years. The demographic variables of the research participants are presented in Table 3.



Table 4 lists the Mean±SD scores of the studied variables in the experimental and control groups at the pre-test and post-test phases. The Mean±SD post-test values of ED for EST, DT, and control groups were 10.60±1.35, 11.00±1.13, and 12.60±1.68, respectively.



Regarding the normal distribution of dependent variables in the study groups, the Kolmogorov–Smirnov test data indicated that the studied variable followed a normal distribution. Levene’s test results also confirmed the homogeneity variance of the study variables in the experimental groups. The regression line slope results also indicated that the regression line slope was homogeneous or the same for the covariate variable (pre-test) and dependent variable at different levels of the independent variable.
The ANCOVA results for ED scores indicated that the impacts of the independent variable (F=8.302, 41, P=0.001) were significant after eliminating the effects of the covariance variable (P<0.05). Regarding the significant effect of the independent variable (group), the mean scores of ED were significantly different between the research groups (i.e. EST, DT, & control groups). According to the Eta-squared coefficient, the independent variable (group) explained 34% of ED variance (Table 5).




Bonferroni modified multiple comparison tests were also used to detect the exact location of the difference among the three groups. According to Bonferroni test data, the mean scores of ED were significantly lower in the EST and DT groups, compared to the controls (P˂0.05). Moreover, comparing the two experimental groups revealed that the EST group was significantly more successful in decreasing the mean values of ED, compared to the DT group (P=0.016). Accordingly, there was a significant difference between the effects of EST and DT in reducing ED (P˂0.05) (Table 6).



4. Discussion 
The present study investigated the effects of EST and DT on ED among women in Tehran City, Iran, in 2018. The relevant findings suggested that the mean values of ED were significantly lower in the experimental groups, compared to the controls. This finding is consistent with those of Mohanaee et al. (2019) on the effectiveness of ST on marital adjustment and ED in divorce applicants; 75 et al.’s data (2018) on the effects of family therapy; Bowen and Minuchin’s findings on ED and improving the quality of life of couples, and Lampis et al.’s data (2017) on the role of self-differentiation and dyadic adjustment in couple’s relationships. Accordingly, positive emotions do not emerge in ED despite the husband’s positive behaviors, and negative behaviors and emotions are exhibited in revenge. Most of their interactions begin and continue with hostile statements. They usually respond negatively to each other and fail to control their negative emotions. They gradually establish their behavior patterns on keeping distance and deliberately distance from each other, instead of sparing efforts to become more intimate (Mohanaee et al. 2019). 
The EST approach can help individuals to change and gain more control over their interpersonal relationships; the most important of which is the relationship with their spouse. This goal is achieved by increasing awareness and emotional symbolism, the awareness of agency in the experience, and changing processes. This approach aims to detect emotions and emotional schemas and convert them into understandable messages and constructive behaviors (Leahy 2019). Following the detection of the evolutionary roots of each schema, couples realize that their current behaviors are caused by their established thoughts and attitudes; therefore, they can be modified by special training and strategies (Yousefi 2011). Moreover, the techniques in this intervention also help each couple to reduce the activation of emotional schemas and learn how to cope with them effectively. Accordingly, EST enhances marital adaptability; consequently, it reduces the odds of ED by decreasing marital problems and promoting marital relationships and marital life satisfaction (Masley et al. 2011).
To explain the effects of DT on reducing ED regarding the nature and focus of therapeutic interventions, as highlighted in Bowen’s theory, it can be stated that a low differentiation level raises problems in the family. Bowen considers differentiation an equivalent to emotional maturity; Bowen also introduces this concept as the family system and its members’ potentials to manage emotional reactions; act wisely in emotional crises; balance intimacy and independence; distinguish thoughts and feelings; choose between being guided by thoughts or emotions; define oneself and ones’ goals and values despite the pressure of the environment to follow others; have maximum accountability for one’s goals and identity, and to differentiate oneself as an individual independent from the emotional context of the family (Rashid & Moradi 2017). In this treatment process, the researchers attempt to modify the problems that arose in the family using 3 basic strategies, including de-triangulation by discovering and solving fusion and informing individuals of the family’s emotional processes and interactions. To this end, the therapist creates a new therapeutic triangle (Shirzadi et al. 2018). In this regard, if the therapist is in contact with the couple and remains emotionally neutral, they can begin the de-triangulation and differentiation processes. Such emotion management creates a profound and lasting change in the family, i.e. decreased emotional reactions, increased intellectual reactions, reduced emotional withdrawal, increased support, promoted self-esteem, and responsibility by reducing blame and projection. In the intervention sessions, the aforementioned points were highlighted; thus, they played a critical role in decreasing participants’ ED scores in the post-test phase.
This study had some limitations. A specific region and female gender were only included in this study; thus, the possibility of generalizing the results to other groups in society was restricted. Future researchers are recommended to conduct the same study in other regions as well as on the male gender. Regarding the effectiveness of EST and DT in reducing ED, the relevant public centers and private organizations are suggested to adopt this approach to solve family-related problems. Using the results of the present study to solve women’s emotional problems is recommended to psychotherapists, psychiatric nurses, and midwifery consultants.


5. Conclusion
EST was more effective in reducing ED than the DT intervention. The differentiation of family members is a key indicator of family functioning, i.e. inversely related to the level of anxiety within the family system. Accordingly, the main consequence of low levels of differentiation is the experience of chronic anxiety by family members. Therefore, differentiation requires a longer treatment to be effective. This is because it has an older root in the personality of individuals, is formed in the early years of life, and is also more dependent on factors within the family system.

Ethical Considerations
Compliance with ethical guidelines

The present study was approved by the Ethics Committee of Islamic Azad University, Qom branch (code: 15421602981009). A written informed consent form was received from the study participants. Some sessions of therapy were held for the control group after the termination of the study. 

Funding
This article was extracted from the PhD dissertation of the first author at the Department of Psychology, Qom Branch, Islamic Azad University, Qom, Iran. 

Authors' contributions
Conceptualization, supervision: Tahmineh Kamalian, Hassan Mirzahosseini; Methodology: Tahmineh Kamalian, Nader Monirpoor; Investigation, writing–review & editing: Tahmineh Kamalian, Hassan Mirzahosseini, and Nader Monirpoor. Writin – original draft: Hassan Mirzahosseini, Tahmineh Kamalian; Funding acquisition, Resources: Tahmineh Kamalian.

Conflict of interest
The authors declared no conflicts of interest.

Acknowledgments
The researchers would like to thank all individuals who participated in this study as well as the director and staff of the Education Counseling Center of district 6 of Tehran Municipality.


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Type of Study: Research | Subject: General
Received: 2020/03/6 | Accepted: 2020/07/7 | Published: 2021/02/1

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