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Bahredar N, Kadkhodaee M. The Effectiveness of Schema Therapy on Differentiation and Emotional Expression of Parents with Autistic Children in Isfahan. TB 2026; 24 (4) :1-18
URL: http://tbj.ssu.ac.ir/article-1-3794-en.html
URL: http://tbj.ssu.ac.ir/article-1-3794-en.html
Islamic Azad University , mkadkhodaie@gmail.com
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The Effectiveness of Schema Therapy on Differentiation and Emotional Expression of Parents with Autistic Children in Isfahan
Najmeh Bahredar (M.A.)1, Maryam Kadkhodaee(Ph.D.)2
1.MA Student in Psychology, Mo. C., Islamic Azad University, Isfahan, Iran.
2.Corresponding author:Assistant Professor of Psychology, Department of Psychology, Mo. C., Islamic Azad University, Isfahan, Iran.
Email: m.kadkhodaee@iau.ac.ir Tel: +98-09217721289
Abstract
Introduction: Autism is a neurodevelopmental disorder in the group of pervasive developmental disorders characterized by persistent difficulties in social interaction and communication, which can place considerable psychological stress on parents. Given these challenges, the present study aimed to examine the effectiveness of schema therapy on differentiation and emotional expression among parents of children with autism in Isfahan.
Methods: The current research method is a quasi-experimental research that was conducted as a pre-test-post-test design with a control group. The study population included all parents of children with autism who attended a rehabilitation center in Isfahan. Among them, 30 people were selected as a sample and according to the entry and exit criteria and were randomly assigned to two experimental and control groups. The questionnaires used in the present study are: Drake's Self-Differentiation Scale questionnaire (2015), King and Emmons' Emotional Expression Questionnaire (1990). For the experimental group, Young’s schema therapy protocol was used over 9 sessions, once per week. Data were analyzed using descriptive statistics and analysis of covariance (ANCOVA) in SPSS version 26.
Results: Data analysis shows a value of F: 2228/831 for differentiation and F: 4062/285 for emotional expression at the P<0/05 level. Therefore, schema therapy led to increased differentiation and emotional expressiveness in parents of autistic children.
Conclusion: Schema therapy can help reduce emotional problems in parents of children with autism by improving emotional differentiation and expression.
Keywords: Schema Therapy; Autism Spectrum Disorder; Parents; Expressed Emotion; Differentiation.
Conflict of interest: The authors declared no conflict of interest.
References
1-American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders (DSM-5-TR) 5th Edition., Text Revision American Psychiatric Publishing, Washington DC. 2022. doi.org/10.1176/appi.books.9780890425787
2-Murray C, Kovshoff H, Brown A & et al. A Exploring the anxiety and depression profile in individuals diagnosed with an autism spectrum disorder in adulthood. Res Autism Spectr Disord. 2019; 58: 1-8.
3-Mandy W, Midouhas E, Hosozawa M & et al. Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence. J Child Psychol Psychiatry. 2022; 63(11):1405-1414.
4- Alkhateeb JM, Hadidi MS and Mounzer W. The Impact of Autism Spectrum Disorder on Parents in Arab Countries: A Systematic Literature Review. Front. Psychol.2022; 13:955442. doi: 0.3389/fpsyg.2022.955442
5-Vivanti G, Algur Y, Ryan V & et al. The Impact of Using Standardized Autism Screening on Referral to Specialist Evaluation for Young Children on the Autism Spectrum: A Cluster-Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2025; 64(6): 686-698.
6-Green CC, Smith J, Bent CA & et al. Predictors of Change in Wellbeing and Mental Health of Parents of Autistic Pre-Schoolers. J Autism Dev Disord.2025; 55, 3798–3810.
7-Turda S. The Impact of Parental Stress among the Quality of Life of mothers of children with Autism Spectrum Disorder and Down Syndrome. Int J Spec Edu.2023; 38(3), 95–106.
8- Jordan R, Kalvin CB, Ibrahim K & et al. Parent Emotion Socialization in Children with Autism Spectrum Disorder and Co-Occurring Anxiety. Res Child Adolesc Psychopathol. 2021;49(1):125-137.
9-Van Niekerk K, Stancheva V, Smith C. Caregiver burden among caregivers of children with autism spectrum disorder. S Afr J Psychiatr. 2023; 20;29:2079.
10-Godarzi M. Comparison of the Maladaptive Schemas and Coping Styles among the Mothers of Children with Autism and Children with Down syndrome in Shiraz. J Adv Pharm Edu Res. 2020;10(S4):51-56.[Persian]
11-Calatrava M, Martins MV, Schweer-Collins M & et al. Rodríguez-González. Differentiation of self: A scoping review of Bowen Family Systems Theory’s core construct.
Clin Psychol Rev.2022 ; 91: 102101.
12-Ghanbarian E, Hajhosseini M, Mikani M & et al. Differentiation of Self and Mate Retention Behaviors: The Mediating Role of Communication Patterns. Evol Psychol. 2020; 18(4):1474704920972051.
13-Gladding S. Family therapy (history, theory, application). Translated by Farshad Bahari et al. Tehran. Published by: Tazkiye. Second edition.2023.[Persian]
14-Álvarez-Hierro S & Oliver J. Differentiation of self and its relationship with metacognitions about worry and anxiety. Pers Individ Dif. 2024;222(3):112596.
15-Peleg M, Peleg O. Personality and Family Risk Factors for Poor Mental Well-Being. Int J Environ Res Public Health. 2023;20(1):839.
16-Jafari SGh, Heidari A, Asgari P & et al. The relationship between maternal self-differentiation and behavioral disorders in children with autism: The mediating role of maternal mental health. J Shahrekord Univ Med Sci. 2025;27(2): 67-72.
17-Fong VC, Shim J, Yoon A & et al. A preliminary exploration of different coping strategies used by Korean immigrant parents of autistic children in high versus low family quality of life ratings. Autism. 2023; 27(5):1307-1319.
18-Şerifali Dokuzlar S, Ozbiler S & et al. The mediating role of emotional expressivity between differentiation of self and co-dependency among couples: A common fate mediation model.Res Sq. 2024.
19-Zang X, Yang J. Dynamic facial emotional expressions in self-presentation predicted self-esteem. Behav Sci. 2025;15(5):709.
20-Zou M., Liu B, Ren L & et al. The association between aspects of expressive suppression emotion regulation strategy and rumination traits: a network analysis approach. BMC Psychol. 2024;12:501.
21-Rovane AK, Hock RM, Yang CH & et al. Parent Facilitation of Child Emotion Regulation in ASD: An Ecological Momentary Assessment Study. 2025;55(12):4197-4211.
22- Edwards E, Wupperman P. Research on emotional schemas: A review of findings and challenges. Clin Psychol. 2019;23(1):3-14.
23- Young JE, Klosko JS, Weishaar ME. Schema therapy: A practitioner’s guide. (Hamidpour H, Andouz Z, Trans.). Tehran: Arjmand; 2012. [Persian]
24-Abbady AS. The effectiveness of emotional schema therapy on improving emotion regulation and reducing neurotic perfectionism among university students. Nat Sci. 2023; 12(4): 1853-1862.
25- Le Vigouroux S, Bernat K, Charbonnier E. Risk factors and consequences of parental burnout: Role of early maladaptive schemas and emotion-focused coping. Trends in Psychology. 2023;33:518–535. https://doi.org/10.1007/s43076-023-00288-6.
26-Siadat M, Khajovand Khoshli A, Akbari H. The effectiveness of schema therapy on the psychological well-being (emotional, psychological and social) of mothers with autistic children in Gorgan city. J Soc Psychol. 2019; 13(51): 78-69.[Persian]
27-Oshima F, Shaw I, Ohtani T & et al. Individual schema therapy for high-functioning autism spectrum disorder with comorbid psychiatric conditions in young adults: Results of a naturalistic multiple case study. J Brain Sci. 2018; 48: 43-69.
28-Organi ME, Gorji Y. The Effectiveness of Schema Therapy on Differentiation of Women with Addicted Spouses. Acad J Psychol Stud. 2023; 12(1): 28-36.
29-Simpson SG, Navot L. Differentiating authentic versus pseudo vulnerability in therapeutic practice. Front Psychiatry. 2023;14(30):1200981. doi: 10.3389/fpsyt.2023.1200981.
30-Pilkington PD, Karantzas GC, Faustino B & et al. Early maladaptive schemas, emotion regulation difficulties and alexithymia: A systematic review and meta-analysis. Clin Psychol Psychother. 2024;31(1):e2914.
31-Naderiasl L, Kadkhodaee M. The Effectiveness of Emotion Regulation Training on Quality of Life, Coping Strategies, and Emotional Alexithymia of Mothers of Children with Autism Spectrum Disorder in Isfahan City. Q J Edu Psychol. 2024; 14(4): 38-52.[Persian]
32-Behnamfar K, Rajaei AR, Teymouri S. Comparison of cognitive-behavioral therapy and acceptance and commitment therapy on cognitive flexibility in mothers with autistic children. Soc Determin Health. 2022;8(1):1-9.
33-Mahjoor F, Fazeli Mehrababadi A.The Effectiveness of Lyubomirsky’s Happiness Training on Negative Emotions (Depression, Stress, and Anxiety) and Cognitive Flexibility in Mothers of Children with Autism Spectrum Disorder.Appl Fam Ther J.2025;6(3),1-8.
34-Operto FF, Pastorino GMG, Scuoppo C & et al. Adaptive behavior, emotional/behavioral problems and parental stress in children with autism spectrum disorder. Front Neurosci. 2021; 15: 751465.
35-Delavar A. Research Methods in Psychology and Educational Sciences. 5th ed. Tehran: Roshd Publications; 2016:100-99
36-Drake JR, Murdock NL, Marszalek JM & et al. Differentiation of Self Inventory—Short Form: Development and Preliminary Validation. J Contemp Fam Ther. 2015; 37(2): 101-112.
37-King LA, Emmons RA. Conflict over emotional expression: Psychological and physical correlates. J Pers Soc Psychol. 1990; 58(1): 864-77.
38-Rasouli M, Asodeh MH, Tamarchi F & et al. Factor structure and validation of Self-Differentiation Inventory Short Form (SDI-SF). J Psychom, 2016; 4(16):1-10.[Persian]
39-Shaham N, Kazemian Moghadam K, Haroon Rshidi H. The Effectiveness of Schema Therapy on Parental Stress and Psychological Hardiness of Mothers of Children with Autism Spectrum Disorder. J Except Educ. 2021; 3(163): 51-60.[Persian]
Najmeh Bahredar (M.A.)1, Maryam Kadkhodaee(Ph.D.)2
1.MA Student in Psychology, Mo. C., Islamic Azad University, Isfahan, Iran.
2.Corresponding author:Assistant Professor of Psychology, Department of Psychology, Mo. C., Islamic Azad University, Isfahan, Iran.
Email: m.kadkhodaee@iau.ac.ir Tel: +98-09217721289
Abstract
Introduction: Autism is a neurodevelopmental disorder in the group of pervasive developmental disorders characterized by persistent difficulties in social interaction and communication, which can place considerable psychological stress on parents. Given these challenges, the present study aimed to examine the effectiveness of schema therapy on differentiation and emotional expression among parents of children with autism in Isfahan.
Methods: The current research method is a quasi-experimental research that was conducted as a pre-test-post-test design with a control group. The study population included all parents of children with autism who attended a rehabilitation center in Isfahan. Among them, 30 people were selected as a sample and according to the entry and exit criteria and were randomly assigned to two experimental and control groups. The questionnaires used in the present study are: Drake's Self-Differentiation Scale questionnaire (2015), King and Emmons' Emotional Expression Questionnaire (1990). For the experimental group, Young’s schema therapy protocol was used over 9 sessions, once per week. Data were analyzed using descriptive statistics and analysis of covariance (ANCOVA) in SPSS version 26.
Results: Data analysis shows a value of F: 2228/831 for differentiation and F: 4062/285 for emotional expression at the P<0/05 level. Therefore, schema therapy led to increased differentiation and emotional expressiveness in parents of autistic children.
Conclusion: Schema therapy can help reduce emotional problems in parents of children with autism by improving emotional differentiation and expression.
Keywords: Schema Therapy; Autism Spectrum Disorder; Parents; Expressed Emotion; Differentiation.
Conflict of interest: The authors declared no conflict of interest.
References
1-American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders (DSM-5-TR) 5th Edition., Text Revision American Psychiatric Publishing, Washington DC. 2022. doi.org/10.1176/appi.books.9780890425787
2-Murray C, Kovshoff H, Brown A & et al. A Exploring the anxiety and depression profile in individuals diagnosed with an autism spectrum disorder in adulthood. Res Autism Spectr Disord. 2019; 58: 1-8.
3-Mandy W, Midouhas E, Hosozawa M & et al. Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence. J Child Psychol Psychiatry. 2022; 63(11):1405-1414.
4- Alkhateeb JM, Hadidi MS and Mounzer W. The Impact of Autism Spectrum Disorder on Parents in Arab Countries: A Systematic Literature Review. Front. Psychol.2022; 13:955442. doi: 0.3389/fpsyg.2022.955442
5-Vivanti G, Algur Y, Ryan V & et al. The Impact of Using Standardized Autism Screening on Referral to Specialist Evaluation for Young Children on the Autism Spectrum: A Cluster-Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2025; 64(6): 686-698.
6-Green CC, Smith J, Bent CA & et al. Predictors of Change in Wellbeing and Mental Health of Parents of Autistic Pre-Schoolers. J Autism Dev Disord.2025; 55, 3798–3810.
7-Turda S. The Impact of Parental Stress among the Quality of Life of mothers of children with Autism Spectrum Disorder and Down Syndrome. Int J Spec Edu.2023; 38(3), 95–106.
8- Jordan R, Kalvin CB, Ibrahim K & et al. Parent Emotion Socialization in Children with Autism Spectrum Disorder and Co-Occurring Anxiety. Res Child Adolesc Psychopathol. 2021;49(1):125-137.
9-Van Niekerk K, Stancheva V, Smith C. Caregiver burden among caregivers of children with autism spectrum disorder. S Afr J Psychiatr. 2023; 20;29:2079.
10-Godarzi M. Comparison of the Maladaptive Schemas and Coping Styles among the Mothers of Children with Autism and Children with Down syndrome in Shiraz. J Adv Pharm Edu Res. 2020;10(S4):51-56.[Persian]
11-Calatrava M, Martins MV, Schweer-Collins M & et al. Rodríguez-González. Differentiation of self: A scoping review of Bowen Family Systems Theory’s core construct.
Clin Psychol Rev.2022 ; 91: 102101.
12-Ghanbarian E, Hajhosseini M, Mikani M & et al. Differentiation of Self and Mate Retention Behaviors: The Mediating Role of Communication Patterns. Evol Psychol. 2020; 18(4):1474704920972051.
13-Gladding S. Family therapy (history, theory, application). Translated by Farshad Bahari et al. Tehran. Published by: Tazkiye. Second edition.2023.[Persian]
14-Álvarez-Hierro S & Oliver J. Differentiation of self and its relationship with metacognitions about worry and anxiety. Pers Individ Dif. 2024;222(3):112596.
15-Peleg M, Peleg O. Personality and Family Risk Factors for Poor Mental Well-Being. Int J Environ Res Public Health. 2023;20(1):839.
16-Jafari SGh, Heidari A, Asgari P & et al. The relationship between maternal self-differentiation and behavioral disorders in children with autism: The mediating role of maternal mental health. J Shahrekord Univ Med Sci. 2025;27(2): 67-72.
17-Fong VC, Shim J, Yoon A & et al. A preliminary exploration of different coping strategies used by Korean immigrant parents of autistic children in high versus low family quality of life ratings. Autism. 2023; 27(5):1307-1319.
18-Şerifali Dokuzlar S, Ozbiler S & et al. The mediating role of emotional expressivity between differentiation of self and co-dependency among couples: A common fate mediation model.Res Sq. 2024.
19-Zang X, Yang J. Dynamic facial emotional expressions in self-presentation predicted self-esteem. Behav Sci. 2025;15(5):709.
20-Zou M., Liu B, Ren L & et al. The association between aspects of expressive suppression emotion regulation strategy and rumination traits: a network analysis approach. BMC Psychol. 2024;12:501.
21-Rovane AK, Hock RM, Yang CH & et al. Parent Facilitation of Child Emotion Regulation in ASD: An Ecological Momentary Assessment Study. 2025;55(12):4197-4211.
22- Edwards E, Wupperman P. Research on emotional schemas: A review of findings and challenges. Clin Psychol. 2019;23(1):3-14.
23- Young JE, Klosko JS, Weishaar ME. Schema therapy: A practitioner’s guide. (Hamidpour H, Andouz Z, Trans.). Tehran: Arjmand; 2012. [Persian]
24-Abbady AS. The effectiveness of emotional schema therapy on improving emotion regulation and reducing neurotic perfectionism among university students. Nat Sci. 2023; 12(4): 1853-1862.
25- Le Vigouroux S, Bernat K, Charbonnier E. Risk factors and consequences of parental burnout: Role of early maladaptive schemas and emotion-focused coping. Trends in Psychology. 2023;33:518–535. https://doi.org/10.1007/s43076-023-00288-6.
26-Siadat M, Khajovand Khoshli A, Akbari H. The effectiveness of schema therapy on the psychological well-being (emotional, psychological and social) of mothers with autistic children in Gorgan city. J Soc Psychol. 2019; 13(51): 78-69.[Persian]
27-Oshima F, Shaw I, Ohtani T & et al. Individual schema therapy for high-functioning autism spectrum disorder with comorbid psychiatric conditions in young adults: Results of a naturalistic multiple case study. J Brain Sci. 2018; 48: 43-69.
28-Organi ME, Gorji Y. The Effectiveness of Schema Therapy on Differentiation of Women with Addicted Spouses. Acad J Psychol Stud. 2023; 12(1): 28-36.
29-Simpson SG, Navot L. Differentiating authentic versus pseudo vulnerability in therapeutic practice. Front Psychiatry. 2023;14(30):1200981. doi: 10.3389/fpsyt.2023.1200981.
30-Pilkington PD, Karantzas GC, Faustino B & et al. Early maladaptive schemas, emotion regulation difficulties and alexithymia: A systematic review and meta-analysis. Clin Psychol Psychother. 2024;31(1):e2914.
31-Naderiasl L, Kadkhodaee M. The Effectiveness of Emotion Regulation Training on Quality of Life, Coping Strategies, and Emotional Alexithymia of Mothers of Children with Autism Spectrum Disorder in Isfahan City. Q J Edu Psychol. 2024; 14(4): 38-52.[Persian]
32-Behnamfar K, Rajaei AR, Teymouri S. Comparison of cognitive-behavioral therapy and acceptance and commitment therapy on cognitive flexibility in mothers with autistic children. Soc Determin Health. 2022;8(1):1-9.
33-Mahjoor F, Fazeli Mehrababadi A.The Effectiveness of Lyubomirsky’s Happiness Training on Negative Emotions (Depression, Stress, and Anxiety) and Cognitive Flexibility in Mothers of Children with Autism Spectrum Disorder.Appl Fam Ther J.2025;6(3),1-8.
34-Operto FF, Pastorino GMG, Scuoppo C & et al. Adaptive behavior, emotional/behavioral problems and parental stress in children with autism spectrum disorder. Front Neurosci. 2021; 15: 751465.
35-Delavar A. Research Methods in Psychology and Educational Sciences. 5th ed. Tehran: Roshd Publications; 2016:100-99
36-Drake JR, Murdock NL, Marszalek JM & et al. Differentiation of Self Inventory—Short Form: Development and Preliminary Validation. J Contemp Fam Ther. 2015; 37(2): 101-112.
37-King LA, Emmons RA. Conflict over emotional expression: Psychological and physical correlates. J Pers Soc Psychol. 1990; 58(1): 864-77.
38-Rasouli M, Asodeh MH, Tamarchi F & et al. Factor structure and validation of Self-Differentiation Inventory Short Form (SDI-SF). J Psychom, 2016; 4(16):1-10.[Persian]
39-Shaham N, Kazemian Moghadam K, Haroon Rshidi H. The Effectiveness of Schema Therapy on Parental Stress and Psychological Hardiness of Mothers of Children with Autism Spectrum Disorder. J Except Educ. 2021; 3(163): 51-60.[Persian]
Type of Study: Applicable |
Subject:
Psychology
Received: 2025/06/1 | Accepted: 2025/09/13 | Published: 2026/03/1
Received: 2025/06/1 | Accepted: 2025/09/13 | Published: 2026/03/1
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