The Effectiveness of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders on Alexithymia of Children and their Mother’s Parental Self-Efficacy in Divorced Families during the COVID-19 Pandemic

Document Type : Original Article


Department of Educational Sciences, Islamic Azad University of Rudehen, Rudehen, Iran


Introduction: Traumatic events such as divorce play an important role in causing alexithymia in children and parental self-efficacy. A unified protocol for transdiagnostic treatment focuses simultaneously on the child’s emotions and parental effectiveness. The purpose of this study was to investigate the effectiveness of unified protocol for transdiagnostic treatment of emotional disorders on alexithymia of children and their mother’s parental self-efficacy in divorced families during the COVID-19 Pandemic
Method: The present study is a quasi-experimental design with pretest, posttest, follow-up and control group. The statistical population of this study included mothers and their children in divorced families in Tehran in 2021. A total of 24 sample (24 children and their mothers) were selected by convenience sampling and randomly assigned to experimental and control groups. Assessment was done using the Torrento’s scale of Alexithymia and the Domka’s Parental Self-efficacy scale. The experimental groups received 12 sessions of unified protocol for transdiagnostic treatment of emotional disorders but the control group did not receive any intervention. The collected data were analyzed with SPSS using ANOVA with repeated measure.
Results: Findings show that unified protocol for transdiagnostic treatment of emotional disorders improves alexithymia in children and increases their mothers' parenting self-efficacy. The results showed that between the two groups of control and experiment in the post-test and follow-up stages in the variables of alexithymia in children, including difficulty in recognizing emotions and difficulty in describing emotions (P = 0.014), F = 5.23) there was a significant difference in the component of objective thinking (P = 0.001, F = 11.53) of children and their mothers' self-efficacy (P = 0.001, F = 18.64).
Conclusion: According to findings, it can be mentioned that paying attention to this approach can be useful in treatment programs and counseling in order to reduce alexithymia in children and increase the self-efficacy of parenting in divorced families.


  1. 1. Amato, P.R., Children of divorce in the 1990s: an update of the Amato and Keith (1991) meta-analysis. Journal of family psychology, 2001. 15(3): p. 355 DOI:
  2. Connolly, M.E. and E.J. Green, Evidence-Based Counseling Interventions with Children of Divorce: Implications for Elementary School Counselors. Journal of School Counseling, 2009. 7(26): p. 1-37.
  3. Romero-Mesa, J., M.A. Pelaez-Fernandez, and N. Extremera, Emotional intelligence and eating disorders: a systematic review. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 2021. 26(5): p. 1287-1301 DOI:
  4. Barari Baziarkhili, Z. and S. Ebrahimi, Prediction of Psychological Helplessness and Fault Tolerance Based on Emotional Alexithymia in Women with Breast Cancer. Iran Journal of Nursing, 2021. 34(129): p. 96-108 DOI:
  5. Briganti, G., M. Scutari, and P. Linkowski, A machine learning approach to relationships among alexithymia components. Psychiatria Danubina, 2020. 32(suppl. 1): p. 180-187 DOI:
  6. Norman, H. and J. Borrill, The relationship between self‐harm and alexithymia. Scandinavian journal of psychology, 2015. 56(4): p. 405-419 DOI:
  7. Rasheed, A., A. Amr, and N. Fahad, Investigating the relationship between emotional divorce, marital expectations, and self-efficacy among wives in Saudi Arabia. Journal of Divorce & Remarriage, 2021. 62(1): p. 19-40 DOI:
  8. Buchanan, T. and T. LeMoyne, Helicopter parenting and the moderating impact of gender and single-parent family structure on self-efficacy and well-being. The Family Journal, 2020. 28(3): p. 262-272 DOI:
  9. Kalil, A. and R. Ryan, Parenting practices and socioeconomic gaps in childhood outcomes. The future of children, 2020. 30(1): p. 29-54.
  10. Shojarazavi, P.S., G. Askarizadeh, and M. Bagheri, The Effectiveness of Reality Therapy based on Choice Theory on General Health and Automatic Negative Thoughts of Divorced Women. Iranian Journal of Psychiatric Nursing (IJPN) Original Article, 2022. 9(6).
  11. Vance, A.J., et al., Development of parenting self-efficacy in mothers of high-risk infants. Early human development, 2020. 141: p. 104946 DOI:
  12. Haimi, M. and A. Lerner, The impact of parental separation and divorce on the health status of children, and the ways to improve it. Journal of Clinical & Medical Genomics, 2016. 4(1): p. 1-7 DOI: 1004172/2472-128x.1000127.
  13. Sakiris, N. and D. Berle, A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clinical psychology review, 2019. 72: p. 101751 DOI:
  14. Bagby, R.M., et al., The internet administration version of the 20-item Toronto alexithymia scale. Psychological Assessment, 2014. 26(1): p. 16 DOI:
  15. Besharat, M.A., Reliability and factorial validity of a Farsi version of the 20-item Toronto Alexithymia Scale with a sample of Iranian students. Psychological reports, 2007. 101(1): p. 209-220. DOI:
  16. Dumka, L.E., et al., Using qualitative methods to develop contextually relevant measures and preventive interventions: An illustration. American journal of community psychology, 1998. 26(4): p. 605-637 DOI:
  17. Dehghan Manshadi, S.M., S. Gholamrezay, and F. Ghaznanfari, The effectiveness of positive parenting skills training on parental self-efficacy and children's behavioral problems in female-headed households in city of Yazd. Quarterly journal of social work, 2016. 5(2): p. 20-27.
  18. Sbarra, D.A. and M.A. Whisman, Divorce, health, and socioeconomic status: An agenda for psychological science. Current opinion in psychology, 2022. 43: p. 75-78 DOI:
  19. Naemi, A., The Effect of Positive Thinking Training on the alexithymia and self-forgiveness of Children with learning disabilities Mother’s of Sabzevar. Psychology of Exceptional Individuals, 2018. 8(29): p. 111-145 DOI: 10.22054/JPE.2018.25734.1643.
  20. Shahhosseini, T.S., et al., The Comparison of Alexithymia and Emotional Creativity among Gifted and Normal Female Students.
  21. Elhai, J.D., J.C. Levine, and B.J. Hall, The relationship between anxiety symptom severity and problematic smartphone use: A review of the literature and conceptual frameworks. Journal of Anxiety Disorders, 2019. 62: p. 45-52 DOI:
  22. Lenton, P.L., The effectiveness of a group Theraplay and sunshine circles intervention on reducing behavioural difficulties resulting from early complex trauma. 2020 DOI:
  23. Huang, L., F. Xu, and H. Liu, Emotional responses and coping strategies of nurses and nursing college students during COVID-19 outbreak. MedRxiv, 2020 DOI:
  24. Bose, M., et al., Emotional experience in parents of children with Zellweger spectrum disorders: A qualitative study. Molecular genetics and metabolism reports, 2019. 19: p. 100459 DOI: