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IRCT20260609069733N1 IRCT 2026-06-11 Islamic Azad University Comparing the effectiveness of emotion-focused therapy and attachment-based therapy 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 2026-07-21 anticipated 45 Complete https://irct.ir/trial/90743 interventional Randomization: Randomized, Blinding: Double blinded, Placebo: Not used, Assignment: Parallel, Purpose: Education/Guidance, 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 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. N/A Aggression in adolescents. Intervention 1: 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. Intervention 2: 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. Intervention 3: Control group: They do not receive any intervention or treatment. Undecided - It is not yet known if there will be a plan to make this available Justification or reason for indecision in sharing IPD is Participant data is completely confidential and I do not intend to publish it.
public Zahra Akhondnezhad
Unit 8, No. 37, Kaabi Complex, Danesh 2 St., Bahonar
Ahvaz Iran (Islamic Republic of) 6178654513 +98 916 005 8300 zahraakhondezhad@gmail.com Islamic Azad University scientific Zahra Akhondnezhad
Unit 8, No. 37, Kaabi Complex, Danesh 2 St., Bahonar
Ahvaz Iran (Islamic Republic of) 6178654513 +98 916 005 8300 zahraakhondezhad@gmail.com Islamic Azad University Iran (Islamic Republic of) Be at least 9 and at most 12 years old Have symptoms of aggression Achieving an above-average score on the aggression questionnaire 9 years 12 years Male 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 F60.3 Borderline personality disorder Behavior Behavior N/A 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. 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. Control group: They do not receive any intervention or treatment. 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). 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). Social adjustment. Timepoint: before performing the intervention and two weeks after completion of the intervention. Method of measurement: Social Adjustment Scale by Bell (1961). 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). Islamic Azad University Approved 2026-06-02 Ethics Committee of Islamic Azad University of Ahvaz Islamic Azad University of Ahvaz, Farhang Shahr Ahvaz Khouzestan Iran (Islamic Republic of)