Abstract
Background:
Couples therapy has become a top priority due to the increasing prevalence of divorce cases in Iran, particularly among young couples, and the escalating family conflicts.Objectives:
The present study aimed to investigate the impact of emotionally focused therapy (EFT) on couples' emotion regulation and relationship distress in cases of emotional divorce.Methods:
This experimental research utilized a pretest-posttest follow-up design. The study population included all couples with emotional divorce seeking counseling at the counseling centers in Ramshir County, Khuzestan Province (Iran) in 2022. Purposive sampling was employed to select 12 couples (24 individuals). The experimental group participated in EFT for couples, consisting of 9 sessions lasting 90 minutes each. Data were collected using the Gottman Emotional Divorce Scale, Emotion Regulation Questionnaire, and Marital Disturbance Questionnaire. Repeated measures ANOVA was used for data analysis.Results:
The mean ± SD scores for emotion regulation in couples who underwent EFT in the pretest, posttest, and follow-up stages were 77.25 ± 10.17, 115.50 ± 12.40, and 125.00 ± 7.71, respectively. Additionally, the mean ± SD scores for relationship distress in couples during the pretest, posttest, and follow-up stages were 40.33 ± 1.88, 21.04 ± 3.04, and 19.79 ± 2.06, respectively. The findings indicated that EFT for couples significantly improved emotion regulation and relationship distress in couples experiencing emotional divorce (P < 0.001).Conclusions:
Emotionally focused therapy for couples can enhance emotion regulation and alleviate relationship distress in couples dealing with marital conflicts and emotional divorce. It is recommended for psychotherapists and family counselors as an effective intervention to address marital conflicts in couples experiencing emotional divorce. Furthermore, it can be incorporated into premarital counseling sessions.Keywords
Emotionally Focused Therapy Emotions Distress Family Conflict
1. Background
Family is an institution rooted in the union between a man and a woman, serving as the bedrock of human personality and a pivotal force in the progression of human society. Marriage, being the initial emotional and legal commitment made by adults, stands as the most vital social tradition for fulfilling people's emotional needs (1). Marriage is primarily pursued to acquire love, compassion, companionship, and emotional-psychological fulfillment, ultimately leading to profound happiness. It has been substantiated that the institution of marriage undergoes significant changes over time, yet it remains a valuable cornerstone, with marital relationships still forming the basis for personal and familial development (2, 3). The initial harmony and shared interests that draw two individuals together may not suffice to maintain their connection over the years. At times, conflicts arising within couples must be addressed, as these conflicts have the potential to alter the love and positive emotions they feel for each other (4).
Emotional divorce, representing the initial phase of divorce, signifies the deterioration of marital bonds, where unity and intimacy are replaced by a bitter sense of estrangement (5). Even though couples experiencing emotional divorce may continue to coexist as a social unit, the allure of mutual trust dwindles significantly. In essence, couples may inhabit the same household while their relationships are either severed or marked by volatility (6, 7).
Interpersonal qualities, along with personality and emotional factors, are recognized as influential factors in marital relationships. Research demonstrates that personality and emotional factors hold significant predictive power concerning marital adjustment and emotional divorce (8, 9). Emotion regulation is a distinct process that involves managing emotional experiences and achieving emotional and physical stability for social benefit (10). It enhances the capacity to respond appropriately to internal and external demands, including recognizing, labeling, and interpreting emotions, perceiving emotions that trigger emotional responses, actively altering emotional quality, managing the intensity or distress associated with negative emotions, accepting or tolerating negative emotions, coping with circumstances, and providing oneself with self-compassionate support (11). Emotions are pivotal to the development and maintenance of intimate relationships, as they impact personal and interpersonal emotional dynamics (12).
The success and longevity of marital relationships are influenced by various internal and external factors such as personality traits, mental health, age, gender, sexual characteristics, attitudes, and cultural compatibility (13). In this context, the quality of spousal relationships and the absence of distress and conflicts contribute to the success and persistence of marital bonds (14, 15). Despite its close connection with marital conflicts, marital disturbance is defined as the disruption of established patterns of marital relationships and communication structures resulting from the accumulation of suppressed emotions towards one's partner (16).
Emotionally focused therapy (EFT) for couples, aimed at fostering intimate connections and secure attachments, is an eclectic and short-term approach initially proposed and utilized by Johnson and Greenberg (17). This approach encompasses two key components: Firstly, it concentrates on couples' emotional experiences regarding each other, and secondly, it explores how these interactive and emotional patterns affect the quality of their relationships (18). The central hypothesis of EFT posits that marital conflicts persist until each partner effectively communicates their attachment needs in terms of satisfaction and security (19). This therapeutic approach emphasizes the development of compatible attachment styles through caregiving, support, and mutual attention to each partner's needs. In this framework, marital disturbance arises and persists due to pervasive negative emotions and a disrupted sense of attachment (20). Troubled relationships are perceived as a result of couples' intense struggles within negative interaction cycles stemming from unmet attachment needs. This approach can impact emotion regulation and negative emotions experienced by distressed partners (21, 22). Previous research has demonstrated that EFT for couples has the potential to ameliorate marital conflicts (18, 23, 24).
In general, the effects and conflicts stemming from emotional divorce cast a shadow over all parties involved, including spouses and children. A joyless and unsatisfactory marital life is associated with a range of psychological and physical issues, such as behavioral disorders, depression, anxieties about the future, diminished self-confidence, reduced feelings of happiness and vitality, and social isolation. These factors collectively render emotional hardships for couples, leading to a decline in their positive emotions towards each other. These factors underscore the significance of couples therapy.
2. Objectives
Based on this background, the current study aimed to investigate the effectiveness of EFT for couples in enhancing the emotion regulation and reducing the relationship distress of couples experiencing emotional divorce.
3. Methods
3.1. Design and Participants
This experimental research utilized a pretest-posttest follow-up design. The statistical population comprised all couples experiencing emotional divorce who sought assistance at the counseling centers of Ramshir County, Khuzestan Province (Iran), during the period from October 23 to December 22, 2022. The purposive sampling method was employed to select the sample, resulting in the enrollment of a total of 24 eligible subjects.
3.2. Inclusion and Exclusion Criteria
The inclusion criteria were as follows: Couples who received a clinical diagnosis of emotional divorce through a clinical interview and scored above the average on the emotional divorce scale; couples with a marriage duration of at least 2 years; couples holding a minimum of a middle school education degree; and couples without acute psychiatric disorders or substance abuse issues.
The exclusion criteria were as follows: At least 1 member of the couple actively struggling with drug and alcohol addiction; severe instances of verbal and physical violence within the relationship; diagnosed psychiatric disorders; and failure to attend the required training sessions.
3.3. Instruments
3.3.1. Gottman Emotional Divorce Scale
Developed by Gottman and Levenson (25), this 24-item scale comprises questions answered with either "yes" or "no." A higher number of affirmative answers (≥8) indicates marital dissatisfaction and emotional divorce, signifying a broken marriage with evident signs of divorce within the couple (25). Mirzadeh Koohshahi et al. (26) reported a Cronbach alpha coefficient of 0.97 for this instrument.
3.3.2. Emotion Regulation Questionnaire
Designed by Gratz and Roemer (27), the Emotion Regulation Questionnaire (ERQ) is a 36-item scale featuring six subscales (rejecting emotional responses, difficulty in purposive behaviors, difficulty in impulse control, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity) to assess emotion regulation. Each subscale employs a 5-point Likert-type scale, ranging from 1 for "never" to 5 for "always." The total scores range from 36 to 180, with higher scores indicating better emotion regulation. Ghazanfari Shabankare et al. (28) reported a total Cronbach's alpha coefficient of 0.81 for the ERQ.
3.3.3. Marital Disturbance Questionnaire
The Marital Disturbance Questionnaire (MDQ), developed by Whisman et al. (29), serves to assess marital disturbance. The original version of MDQ consists of ten items designed to evaluate various aspects of marital disturbance, including overall marital disruption, sexual dissatisfaction, the presence of verbal or physical violence, problem-solving techniques, and conflict resolution. Whisman et al. (29) administered this questionnaire to 1 020 couples. A cutoff score of four or higher indicates the presence of marital disturbance. Behrad Far et al. (30) reported a Cronbach alpha coefficient of 0.82 for this instrument.
3.3.4. Emotionally Focused Therapy for Couples
In this study, emotionally focused therapy (EFT) for couples refers to a series of nine 90-minute group counseling sessions based on Johnson and Wittenborn's (31) emotion-focused couples therapy. Table 1 provides an overview of the EFT for couples.
An Overview of the Emotionally Focused Therapy on the Couples
| Session | Content |
|---|---|
| 1 | Becoming acquainted and creating empathy and therapeutic alliance with couples, creating a safe atmosphere, and evaluating the motivation and goals of training sessions. |
| 2 | Assessing the problem and discovering the negative and incompatible interactions, tracing and describing the recurring chains that cause the stability of spouses' confusion, finding the obstacles to couples' attachment, and familiarizing couples with negative cycles. |
| 3 | Discovering known emotions hidden in interactive situations; knowing the primary and secondary emotions of each partner; and reviewing the problem, negative, and incompatible interactive cycles of couples. |
| 4 | Clarifying the key emotional responses and reframing the problems by intensifying the emotional experience; increased desire for emotional exposure; and increased responsiveness to the spouse by reframing the problem based on latent emotions and attachment needs; identifying and accepting interactive cycles. |
| 5 | Expression and acceptance of emotions; increasing awareness of attachment needs; increasing the depth of conflict and accepting vulnerability, attachment fears, and helping the spouse to hear and accept them. |
| 6 | Focusing on self and taking responsibility concerning the problem; deepening the emotional conflicts; expressing one's expectations from the partner; facilitating one's acceptance by the partner; and creating new emotional responses. |
| 7 | Rebuilding and changing the relationship and interaction patterns of couples; facilitating the expression of needs and expectations from the partner in new ways; increasing emotional conflicts; softening the scolding partner; and facilitating responses to the partner's needs and requests. |
| 8 | Finding new solutions for old problems; rebuilding relationships and interactions; redefining relationships by couples; creating a secure environment away from distress; creating trust. |
| 9 | Identifying and reinforcing healthy, accessible, and responsive interactive patterns; building secure attachment; integrating new interactive patterns; terminating treatment; implementing posttest. |
3.4. Statistical Analyses
To analyze the pretest, posttest, and follow-up data, descriptive statistics, including mean and standard deviation, were utilized alongside inferential statistics, specifically repeated measures ANOVA.
4. Results
The mean ± SD of the age for the men and women participating in the current study was 32.64 ± 3.11 and 28.59 ± 2.71 years, respectively. Table 2 displays the mean ± SD of the research variables during the pretest, posttest, and follow-up phases.
Mean ± Standard Deviation (SD) of the Emotion Regulation and Relationship Distress in the Pretest, Posttest, and Follow-up Phases
| Variables | Pretest | Posttest | Follow-up |
|---|---|---|---|
| Emotion regulation | 77.25 ± 10.17 | 115.50 ± 12.40 | 125.00 ± 7.71 |
| Relationship distress | 40.33 ± 1.88 | 21.04 ± 3.04 | 19.79 ± 2.06 |
Prior to conducting data analysis, the research hypotheses underwent examination to ensure that the research data satisfied the assumptions of repeated measures ANOVA. To assess data normality, the Kolmogorov–Smirnov test was conducted, yielding significant results. The outcomes confirmed the normal distribution of data pertaining to relationship distress (Z = 0.232, P = 0.206) and emotion regulation (Z = 0.687, P = 0.365). Additionally, Levene’s test was employed to assess the homogeneity of variances, which was established for emotion regulation (F = 0.026, P = 0.872) and nearly met the criterion for relationship distress (F = 3.824, P = 0.057). Another assumption for repeated measures ANOVA is the homogeneity of covariance. Accordingly, Mauchly's sphericity test was applied to assess the homogeneity of the ANCOVA matrix for variable scores.
Table 3 demonstrates that all four multivariate statistics (Pillai's trace, Wilks' lambda, Hotelling's trace, and Roy's largest root) were statistically significant (P < 0.001). In other words, there existed a significant relationship among different measurement stages in couples who had received EFT, either for emotion regulation or relationship distress.
The Results of the Multivariate Analysis of Variance (MANOVA) with Repeated Measures Related to the Effects of Time on the Research Variables
| Variables | Values | df | Error df | F | P-Value | η2 |
|---|---|---|---|---|---|---|
| Pillais trace | 0.99 | 4 | 20 | 641.43 | 0.001 | 0.99 |
| Wilks lambda | 0.01 | 4 | 20 | 641.43 | 0.001 | 0.99 |
| Hotelling's trace | 128.29 | 4 | 20 | 641.43 | 0.001 | 0.99 |
| Roy's largest root | 128.29 | 4 | 20 | 641.43 | 0.001 | 0.99 |
Table 4 demonstrates a significant relationship between the EFT for couples and variables of emotion regulation (F = 179.79, P < 0.001, η2 = 0.88) and relationship distress (F = 640.80, P < 0.001, η2 = 0.96).
Repeated Measures ANOVA for Within-Group Effects in the Emotionally Focused Therapy Group
| Variables | SS | df | MS | F | P-Value | η2 |
|---|---|---|---|---|---|---|
| Emotion regulation | 30667.00 | 2 | 15333.50 | 179.79 | 0.001 | 0.88 |
| Relationship distress | 6365.52 | 1.64 | 3863.59 | 640.80 | 0.001 | 0.96 |
The LSD test was utilized to differentiate between the pretest, posttest, and follow-up phases of the research variables. The results are detailed in Table 5. According to these findings, significant differences were observed between the pretest and posttest phases in both relationship distress and emotion regulation (P < 0.001). Therefore, it can be concluded that EFT for couples effectively improved emotion regulation and relationship distress in couples experiencing emotional divorce. Furthermore, significant differences were noted between the pretest and follow-up scores for emotion regulation and relationship distress (P < 0.001). In summary, EFT for couples demonstrated enduring effects.
The Results of the LSD Test for Paired Comparison of the Emotion Regulation and Relationship Distress in the Pretest, Posttest, and Follow-up Phases
| Variables | Phase A | Phase B | Mean Difference (A-B) | Standard Error (SE) | P-Value |
|---|---|---|---|---|---|
| Emotion regulation | Pretest | Posttest | -38.25 | 2.48 | 0.001 |
| Follow-up | -47.75 | 2.63 | 0.001 | ||
| Posttest | Follow-up | -9.50 | 2.87 | 0.003 | |
| Relationship distress | Pretest | Posttest | 19.29 | 0.54 | 0.001 |
| Follow-up | 20.54 | 0.56 | 0.001 | ||
| Posttest | Follow-up | 1.25 | 0.80 | 0.130 |
5. Discussion
The primary objective of this study was to investigate the effectiveness of EFT for couples in enhancing emotion regulation and reducing relationship distress in couples experiencing emotional divorce. The research findings demonstrated the efficacy of EFT for couples in improving emotion regulation. Consistent with these findings, Panabad et al. (18) observed that emotionally-focused couples therapy can reduce marital violence and incompatibility among couples with poor marital adjustment, ultimately enhancing sexual intimacy. Furthermore, Najafi et al. (20) reported that EFT contributed to improved marital adjustment and the overall quality of life for couples. Ghahari et al. (32) concluded that emotion-focused couple therapy effectively addressed marital conflicts and enhanced emotion regulation strategies for married women. A significant aspect of EFT interventions involves facilitating access to couples' emotions and fundamental needs. Techniques such as empathy and validation were employed to help couples access their emotions and provide each other with emotional responses that could fulfill their needs. Additionally, the intervention aimed to improve emotional accessibility, provide emotional responses and assist couples in experiencing compassion, forgiveness, and security (24). Consequently, experiencing forgiveness, compassion, and security may increase couples' motivation to access and express their emotions while effectively managing emotional responses.
Emotionally focused therapy for couples also focuses on enhancing security within the relationship. The intervention aims to identify attachment cycles within couples and address attachment as a factor that disrupts emotion regulation, all with active participation from the couples themselves. In essence, the goal is to create an environment where couples can explore and alleviate the attachment-oriented needs underlying their interactive cycles, which may include the emotional burden of fear of intimacy (23). During this therapeutic process, efforts were made to promote acceptance and healing-based responses from partners. Therefore, responses like accepting emotions that foster positive interactive cycles among couples may reduce difficulties in emotion regulation, particularly regarding emotional accessibility and the provision of emotional responses, by mitigating the risk of emotional accessibility and emotional emergence (22).
Furthermore, the results indicated that EFT effectively improved relationship distress in couples. Commonly, disturbed relationships are characterized by the failure to meet each other's intimacy needs. Marital disturbance is a consequence of such disrupted relationships and can lead to various psychological disorders, including physical, cognitive, behavioral, and stress-related disorders. Practically, marital disturbance can be defined as spousal dissatisfaction with the quality of their marital relationships (19). Within the EFT framework, practices like couples' conversations enable couples to understand each other better, which in turn facilitates problem-solving and the amelioration of marital distress. Specifically, the factors considered crucial in this approach for sustaining healthy and long-lasting relationships involve the ability to address stress-inducing factors mutually recognized by both partners (21). Through the creation of a supportive atmosphere during conversations, EFT enhances partners' abilities to comprehend each other's perspectives, establish connections, perceive each other's true selves, manage the exchange of harmful communications, control anger, and effectively resolve problems. Engaging in conscious conversations during therapy can help couples avoid becoming trapped in negative interactions, resolve conflicts and disturbances, and experience higher levels of intimacy by openly sharing their issues and concerns (20).
While this study provided valuable insights, it had certain limitations, such as relying on self-report measures and having a relatively small sample size. Future research should consider conducting similar studies in other cities to enhance the generalizability of results. Additionally, due to participant limitations in this study, there was no control group. It is recommended that future studies include control groups to facilitate comparisons of results.
5.1. Conclusions
Considering the heightened emotional intensity within marital relationships, it becomes crucial for couples to employ effective emotion regulation strategies. In light of the study's outcomes, therapists are encouraged to incorporate EFT for couples into their training and intervention workshops as a means to enhance spouses' emotion regulation and alleviate relationship distress. Additionally, the utilization of EFT for couples can be extended to premarital counseling sessions.
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