Protocol summary

Study aim
Comparing the effectiveness of emotion-focused therapy and attachment-based therapy on difficulty in emotion regulation, self-compassion, social adjustment, and perceived stress in aggressive adolescents
Design
A controlled clinical trial with parallel groups, double‑blind design, and purposive sampling method, with a sample size of 45 participants, who will be assigned through simple randomization into three groups of 15 individuals each.
Settings and conduct
The research will be conducted as a semi-experimental field study with a pre-test, post-test, and follow-up design at the Psychological Services Center of Ahvaz. Participants will be randomly assigned to three groups. The assessment will be conducted in the pre-test, post-test, and follow-up stages and in a double-blind manner (clinical caregivers, outcome assessor, and data analyst).
Participants/Inclusion and exclusion criteria
Inclusion Criteria: Be at least 9 and at most 12 years old Have symptoms of aggression Achieving an above-average score on the aggression questionnaire Exclusion criteria: Having a physical problem that interferes with the research process Having mental disorders History of taking psychiatric medications
Intervention groups
Intervention Group 1: Emotion-focused therapy based on Greenberg's Emotion-focused Approach protocol (2002; quoted from Golestan, 1404) will be implemented in the form of 8 60-minute weekly training sessions for experimental group 1. Intervention Group 2: Attachment-based therapy, derived from Bowlby's attachment theory (1969) and developed by Nezamdoost et al. (1404), will be implemented in the form of 12 60-minute weekly sessions for experimental group 2. Control Group: They will not receive any intervention.
Main outcome variables
Difficulty in emotion regulation; Self‑compassion; Social adjustment; Perceived stress

General information

Reason for update
Acronym
IRCT registration information
IRCT registration number: IRCT20260609069733N1
Registration date: 2026-06-11, 1405/03/21
Registration timing: prospective

Last update: 2026-06-11, 1405/03/21
Update count: 0
Registration date
2026-06-11, 1405/03/21
Registrant information
Name
zahra akhondnezhad
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 916 005 8300
Email address
zahraakhondezhad@gmail.com
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2026-07-21, 1405/04/30
Expected recruitment end date
2026-08-06, 1405/05/15
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
Comparing the effectiveness of emotion-focused therapy and attachment-based therapy on difficulty in emotion regulation, self-compassion, social adjustment, and perceived stress in aggressive adolescents
Public title
Comparing the effectiveness of emotion-focused therapy and attachment-based therapy
Purpose
Education/Guidance
Inclusion/Exclusion criteria
Inclusion criteria:
Be at least 9 and at most 12 years old Have symptoms of aggression Achieving an above-average score on the aggression questionnaire
Exclusion criteria:
Having a physical problem that interferes with the research process Having mental disorders History of taking psychiatric medications History of using psychotropic or narcotic substances
Age
From 9 years old to 12 years old
Gender
Male
Phase
N/A
Groups that have been masked
  • Care provider
  • Outcome assessor
  • Data analyser
Sample size
Target sample size: 45
Randomization (investigator's opinion)
Randomized
Randomization description
In this study, in order to achieve completely random allocation of participants to groups and to reduce any potential researcher bias, the simple randomization method will be used. First, a complete list of male adolescents with aggressive behavior in secondary schools of Ahvaz who meet the study inclusion criteria will be prepared. After the initial screening and confirmation of the inclusion criteria, a numerical identification code will be assigned to each participant. In the next step, these codes will be entered into a Random Number Generator software so that a unique random number will be generated for each participant. Then, the participants will be arranged in ascending order based on the generated random numbers. After sorting, the individuals will be sequentially assigned to three research groups; such that the first to fifteenth individuals on the list will be placed in the first experimental group (Emotion-Focused Therapy), the sixteenth to thirtieth individuals in the second experimental group (Attachment-Based Therapy), and the thirty-first to forty-fifth individuals in the control group. This allocation procedure will be designed in such a way that the order of participants’ entry into the study or the researcher’s familiarity with them will have no role in the allocation process, and it will not be possible to predict the group assignment of any participant before the completion of the randomization process.
Blinding (investigator's opinion)
Double blinded
Blinding description
In this study, in order to reduce bias, blinding will be performed at the level of clinical caregivers, outcome assessor, and data analyst. The list of participants’ allocation to the study groups will be available only to the researcher responsible for allocation or to a person who will not be directly involved in the process of assessment and data analysis. Therefore, the clinical caregivers who will provide the usual services and care to the participants will remain unaware of their allocation to the study groups. In addition, the assessment of outcomes will be carried out by a person who will not participate in the group allocation process and will not have access to the allocation list. This assessor will collect and record the data related to the variables under study, including aggression, difficulties in emotion regulation, self-compassion, and social adjustment, solely on the basis of the participants’ identification codes, in such a way that he/she will not be aware of each participant’s assignment to the emotion-focused therapy group, the attachment-based therapy group, or the control group. Furthermore, the data will be coded before entering the statistical analysis stage, and the groups will be identified using neutral labels such as A, B, and C. The statistical analyst will receive the data in the form of these codes and will remain unaware, until the completion of the statistical analysis, of the actual assignment of the codes to the emotion-focused therapy group, the attachment-based therapy group, and the control group. The unblinding of the groups will be carried out only after the completion of the initial data analysis.
Placebo
Not used
Assignment
Parallel
Other design features

Secondary Ids

empty

Ethics committees

1

Ethics committee
Name of ethics committee
Ethics Committee of Islamic Azad University of Ahvaz
Street address
Islamic Azad University of Ahvaz, Farhang Shahr
City
Ahvaz
Province
Khouzestan
Postal code
6134937333
Approval date
2026-06-02, 1405/03/12
Ethics committee reference number
IR.IAU.AHVAZ.REC.1405.191

Health conditions studied

1

Description of health condition studied
Aggression in adolescents
ICD-10 code
F60.3
ICD-10 code description
Borderline personality disorder

Primary outcomes

1

Description
Difficulty in emotion regulation
Timepoint
before performing the intervention and two weeks after completion of the intervention
Method of measurement
Difficulties in Emotion Regulation Scale by Gratz and Roemer (2004)

2

Description
Self-compassion
Timepoint
before performing the intervention and two weeks after completion of the intervention
Method of measurement
Self-Compassion Questionnaire by Raes et al. (2011)

3

Description
Social adjustment
Timepoint
before performing the intervention and two weeks after completion of the intervention
Method of measurement
Social Adjustment Scale by Bell (1961)

4

Description
Perceived stress
Timepoint
before performing the intervention and two weeks after completion of the intervention
Method of measurement
Perceived Stress Questionnaire by Cohen et al. (1983)

Secondary outcomes

empty

Intervention groups

1

Description
First intervention group: The emotion‑focused therapy intervention consists of eight 60‑minute sessions designed to increase emotional awareness, identify and accept emotions, modify maladaptive emotional patterns, and facilitate healthy emotion regulation. This approach is implemented based on Greenberg’s Emotion‑Focused Therapy protocol (2002; cited in Golestan, 2025). In the first session, group members become acquainted with the therapist and with one another, and a therapeutic relationship based on empathy and trust is established. The goals of treatment, clients’ expectations, and basic concepts related to emotions and their role in human behavior are also introduced. In the second session, topics such as anger, bullying, depression, and emotional and problem‑solving skills are discussed, emotional awareness training begins, and participants become familiar with identifying and recording their emotional experiences. In the third session, the consequences of violent and bullying behaviors for oneself and others are examined, and exercises such as mindfulness and preparation for the two‑chair technique are implemented to enhance emotional awareness. In the fourth session, the conflicting aspects of clients’ internal experiences are explored, and efforts are made to increase their awareness of the consequences of delaying the self‑forgiveness process while initiating the reconciliation of conflicting inner voices. In the fifth session, mindfulness exercises continue and clients identify their personal values. Needs and motivations associated with aggressive behaviors are also examined, and healthier ways of fulfilling these needs are discussed. In the sixth session, clients express feelings of remorse and regret regarding harmful behaviors and learn compensatory behaviors and healthier ways to meet their needs in the future. In the seventh session, by reviewing the positive changes that have occurred, efforts are made to reduce remaining negative emotions and replace them with feelings such as self‑acceptance and self‑forgiveness, and clients’ progress toward therapeutic goals is evaluated. In the eighth session, therapeutic progress and achievements are reviewed and ways to maintain them in daily life are discussed. Finally, the session contents are summarized and the treatment process concludes with a farewell among group members. This therapeutic program is implemented in eight 60‑minute weekly sessions for the experimental group.
Category
Behavior

2

Description
Second intervention group: The attachment‑based therapy intervention consists of twelve 60‑minute sessions designed to improve the quality of parent–adolescent relationships, increase attachment security, strengthen emotional and communication skills, and reduce family conflicts. This program is implemented based on Bowlby’s attachment theory (1969) and the protocol developed by Nezamdoost et al. (2025). In the introductory session, the therapist becomes acquainted with the parents and the adolescent and explains the goals of the treatment, the structure of the sessions, and the group rules. In addition, a foundation is established for building a therapeutic relationship, mutual understanding, and the expression of expectations among family members. In the first session, an initial agreement is formed between the adolescent and the parents to work toward improving family relationships. During this session, by examining past conflicts and relational injuries, the process of rebuilding family relationships begins and family members are encouraged to participate in treatment and strengthen attachment bonds. In sessions two to four, the adolescent’s motivation to address attachment‑related issues is increased. During these sessions, the adolescent is encouraged to express experiences related to attachment injuries and personal feelings and gradually learns to communicate thoughts and emotions with parents in a more mature and regulated manner. In sessions five and six, the focus is on preparing parents to listen to and better understand the adolescent. In these sessions, parents are helped to identify stress‑inducing factors within family relationships, reconsider their parenting approaches, and strengthen their skills in emotional management and empathy toward their child. In sessions seven and eight, attention is given to improving attachment experiences and increasing mutual trust and respect between the adolescent and the parents. The adolescent is encouraged to express dissatisfaction and feelings in a more organized manner, while parents, with the therapist’s guidance, work toward deeper understanding and empathy with their child. In sessions nine to twelve, emphasis is placed on enhancing the adolescent’s autonomy and consolidating the family’s emotional and communication skills. At this stage, parents function as a secure base for the adolescent, and family members practice skills such as expressing affection, managing emotions, problem solving, and conflict resolution in order to establish relationships based on secure attachment within the family. This therapeutic program will be implemented for the experimental group in twelve weekly sessions of 60 minutes each.
Category
Behavior

3

Description
Control group: They do not receive any intervention or treatment.
Category
N/A

Recruitment centers

1

Recruitment center
Name of recruitment center
Fanous Rah Counseling and Psychological Clinic
Full name of responsible person
Zahra Akhondnezhad
Street address
Corner of 14th St., Vahhabi St., Kian Abad
City
Ahvaz
Province
Khouzestan
Postal code
6155745140
Phone
+98 61 5574 5140
Email
zahraakhondezhad@gmail.com

Sponsors / Funding sources

1

Sponsor
Name of organization / entity
Islamic Azad University
Full name of responsible person
Aslan Egdernezhad
Street address
Islamic Azad University of Ahvaz, Farhang Shahr.
City
Ahvaz
Province
Khouzestan
Postal code
6134937333
Phone
+98 61 3334 8421
Email
a_eigder@yahoo.com
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Islamic Azad University
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic

Person responsible for general inquiries

Contact
Name of organization / entity
Islamic Azad University
Full name of responsible person
Zahra Akhondnezhad
Position
PhD student
Latest degree
Master
Other areas of specialty/work
Consulting
Street address
Unit 8, No. 37, Kaabi Complex, Danesh 2 St., Bahonar
City
Ahvaz
Province
Khouzestan
Postal code
6178654513
Phone
+98 916 005 8300
Email
zahraakhondezhad@gmail.com

Person responsible for scientific inquiries

Contact
Name of organization / entity
Islamic Azad University
Full name of responsible person
Zahra Akhondnezhad
Position
PhD student
Latest degree
Master
Other areas of specialty/work
Consulting
Street address
Unit 8, No. 37, Kaabi Complex, Danesh 2 St., Bahonar
City
Ahvaz
Province
Khouzestan
Postal code
6178654513
Phone
+98 916 005 8300
Fax
Email
zahraakhondezhad@gmail.com

Person responsible for updating data

Contact
Name of organization / entity
Islamic Azad University
Full name of responsible person
Zahra Akhondnezhad
Position
PhD student
Latest degree
Master
Other areas of specialty/work
Consulting
Street address
Unit 8, No. 37, Kaabi Complex, Danesh 2 St., Bahonar
City
Ahvaz
Province
Khouzestan
Postal code
6178654513
Phone
+98 916 005 8300
Fax
Email
zahraakhondezhad@gmail.com

Sharing plan

Deidentified Individual Participant Data Set (IPD)
Undecided - It is not yet known if there will be a plan to make this available
Study Protocol
Undecided - It is not yet known if there will be a plan to make this available
Statistical Analysis Plan
No - There is not a plan to make this available
Informed Consent Form
Undecided - It is not yet known if there will be a plan to make this available
Clinical Study Report
Undecided - It is not yet known if there will be a plan to make this available
Analytic Code
No - There is not a plan to make this available
Data Dictionary
No - There is not a plan to make this available
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