Citation

Pouladi S, Hasanshahi MM, Rabiei M, Baghery N. Res. Cognit. Behav. Sci. 2022; 12(1): 141-164.

Copyright

(Copyright © 2022, University of Isfahan)

DOI

10.22108/cbs.2022.133945.1655

PMID

unavailable

Abstract

This study aimed to investigate the effect of Unified Transdiagnostic treatment on improving internalizing behavioral problems, emotional regulation, and empathy in children with anxiety disorders. The present study was a single case pilot design of multiple baseline designs with different subjects that were performed on three patients (8,9,10 years) in 15 sessions with two follow-up periods of 2 months. Data were analyzed using visual drawing methods, stable change index, and recovery percentage. The instruments used included a Child Behavioral Checklist (parent form), an Emotion Regulation Checklist, and Griffith Empathy Measure. The results of Unified Transdiagnostic treatment showed that all three children with anxiety disorders, during treatment and after treatment, showed a significant reduction in child behavioral scores, emotion regulation, and empathy, and therapeutic achievements were maintained during the two 2-month periods. The results showed the effectiveness of Unified Transdiagnostic treatment in the scores of subscales of internalizing behavioral problems in the child's behavioral list, emotion regulation subscales, and empathy subscales in children with anxiety disorders.IntroductionOne of the most common internalizing disorders of childhood and adolescence is anxiety disorders, which are associated with excessive fear, anxiety, and behavioral abnormalities (Creswel, Waite, & Hudson, 2020). According to epidemiological studies, one out of every 10 people suffers from one of the anxiety disorders before the age of 16 (Ghandour et al, 2019). Due to the high prevalence, traumatic nature, and meaning of this category of disorders, finding innovative approaches in description, etiology, treatment, and prevention strategies are one of the main lines of research in this field, and the Unified Transdiagnostic approach is one of the newest methods.The Unified Transdiagnostic approach focuses on the significant overlap in the phenomenology of emotional disorders, etiology or common vulnerability factors in their formation, and the generalization of the therapeutic outcome of one disorder to other disorders (Sauer-Zavala, 2017). Accordingly, the identification of common pathological processes among these disorders has been able to lead to both the explanation of their nature and the development of efficient meta-diagnostic protocols for the treatment of these disorders. One of the most important Transdiagnostic variables of internalizing and externalized childhood disorders is emotional dysregulation and empathy ability. Psychiatrists believe that emotional dysregulation is one of the common vulnerability factors in the formation of many mental disorders, including anxiety disorders. Researchers believe that children with anxiety disorders cannot regulate their emotions well (Melero et al, 2020) and have difficulty with empathy (Battagliese et al, 2015). Various methods have been used to treat the psychological injuries of children suffering from anxiety disorders. One of the newest treatments is the integrated protocol for emotional disorders in children and adolescents. In Unified Transdiagnostic treatment, these common factors as well as emotions and maladaptive strategies of emotion regulation are emphasized, and emotional experience and response to emotions are the main basis of this approach (Barlow et al, 2011). Caiado et al. (2022), in the study of the efficacy of Unified Transdiagnostic treatment for Portuguese children, reported a significant reduction in children's anxiety and/or depression symptoms and the continuation of the therapeutic effect after 3 months of follow-up. Many other studies also reported that transdiagnostic integrated treatment is effective in improving the symptoms of anxiety disorders, adjusting emotion regulation strategies and empathy in children (Kennedy et al., 2020; Løvaas et al, 2020; Fujisato et al, 2021).According to the above, this study examines whether Unified Transdiagnostic therapy affects improving internalized behavior problems, emotion regulation, and empathy in children with anxiety disorders. Research methodThe present study was a single-case experimental design of the multiple baseline design type with different subjects and continuous measurement. The statistical population of the present study was all children aged 8 to 10 years who, within the scope of the research, referred to psychiatrists and psychologists' offices in Shahrekord to receive therapeutic interventions. Among them, three children who had received a definitive diagnosis of anxiety disorders based on DSM5 multidimensional evaluations, diagnosis of psychiatrist, psychologist, and parent form of child behavior list, were selected and entered treatment by purposeful sampling method. Subjects were evaluated at the baseline, treatment, post-treatment, and two follow-up periods (2 months) using the child behavior inventory (parent form), Emotion Regulation Checklist, and Griffith Empathy Measure.

RESULTSTable 1. Mean, Recovery Percent, and Reliable Change Index of the Baseline, Intervention, and Follow-Up Periods in the Child Behavior ChecklistInternalizingAnxious/DepressedSomatic ComplaintsWithdrawnStatistical indicators321321321321subject40.3344.3338.332823.6614.66414.6613.58.33610Baseline Mean26.6625.3323.6619.513.838.662.667.168.334.54.336.66Treatment Mean%68%79.7%71.4%67.8%83.3%65.5%75%86.2%85.1%64.7%50%60Treatment Recovery percentage%57.8%79.7%71.4%67.5%83.3%68.9%87.5%86.2%85.1%64.7%50%60Follow-up Recovery percentage5.668.275.996.447.193.223.412.7513.063.661.773.97Treatment reliable change indexTable 1 shows the percentage of recovery after treatment and after follow-up of the studied subjects in different subscales of internalized problems. Based on the obtained results, the effectiveness of Unified Transdiagnostic treatment in both intervention and follow-up stages is placed in the category of successful treatment. The value of the reliable index is also higher than 1.96 in all the subjects, which shows that there is a clinically significant difference between the average of the subscales, before and after the intervention. Table 2. Mean, Recovery Percent, and Reliable Change Index of the Baseline, Intervention, and Follow-Up Periods in Emotion Regulation and Empathy VariablesCognitive empathyEmotional empathyInstability-negativityEmotion regulationStatistical indicators321321321321subject21.32022.617.623.6145139.645.61818.314.6Baseline Mean16141824.132.3223626.63423.525.322Treatment Mean%53.1%65%55.8%52.8%64.8%92.8%60.7%52%44.5%61.1%69.1%77.3Treatment Recovery percentage%60.1%65%65%52.8%66.9%89.2%60.7%52%46.2%66.6%69.1%77.3Follow-up Recovery percentage4.54.95.33.77.55.44.77.87.15.565.5Treatment reliable change indexTable 2 shows the percentage of recovery after the intervention and follow-up of the studied subjects in emotion regulation and empathy indicators. Based on the results, Unified Transdiagnostic treatment has been successful in regulating emotion and empathy in both intervention and follow-up stages. It should be noted that the value of the reliable change index in emotion regulation subscales and empathy in all subjects is higher than 1.96, which shows that the changes after the intervention and in the follow-up phase are clinically significant.

DISCUSSION and conclusionThe present study was conducted to investigate the effectiveness of Unified Transdiagnostic treatment on internalizing behavioral problems, emotion regulation, and empathy of children suffering from anxiety disorders. The results showed that Unified Transdiagnostic treatment was effective in reducing internalized behavioral problems, improving emotion regulation, instability-negativity, and emotional and cognitive empathy of children with anxiety disorders, and statistical and clinical changes in passing from the intervention period to the first and the second follow-up period (2 and 4 months) has continued. These findings are in line with previous research (Kennedy et al, 2020; Løvaas et al, 2019; Løvaas et al, 2020), support the Unified Transdiagnostic model for the treatment of emotional disordersIn explaining the mechanism of the Unified Transdiagnostic treatment effect, it can be said that one of the important parts of this treatment protocol is increasing emotional awareness and understanding the nature of emotions using mindfulness techniques. In therapy sessions, children and their parents were taught about investigating and recognizing emotions so that they can recognize all kinds of emotions and emotional situations, respond to their emotions more consistently, tolerate negative emotions, and face them. From another point of view, this treatment helps children and their parents to have a better understanding of the interaction of thoughts, body sensations, and behaviors in creating emotional experiences and recognizing them. Also, during the treatment process, parents were taught how to express empathy with their children. Also, during treatment, children learned to gain a better understanding of their emotional experiences, including the triggers of emotions and the consequences of emotional behaviors. In this therapeutic intervention, they learned that avoiding emotions and emotional situations can cause them to escape from emotional situations and not control them. Therefore, they learned how to face emotions and manage them and were able to regulate their emotions in different situations by interacting efficiently with their mothers. All these skills, by correcting the wrong habits of emotional regulation, lead to reducing the intensity of the difficulty in regulating emotions and returning emotions to the level of proper functioning and the ability of proper empathy. The small size of the examined sample and the use of a purposed sampling method can make it difficult to generalize the results. It is suggested to implement this research in the framework of experimental designs with the control group. This research ensures that Unified Transdiagnostic treatment is an efficient protocol with met diagnostic value and stability of achievements over time. Therefore, this method seems to be a flexible and valuable treatment for psychotherapists for clients who internalize a wide range of psychopathologies, while it seems that more research is still needed. * Corresponding author

Language: en