Volume 24, Issue 9 (12-2025)                   JRUMS 2025, 24(9): 789-806 | Back to browse issues page

Ethics code: IR/ethics.2024.82633.1196

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Mobli M, Borjali A, Sohrabi F, Isamorad A, Jalil Y. Development and Validation of an Integrated Emotion-Focused and Cognitive-Behavioral Therapy Protocol for Women Survivors of Domestic Violence with Complex Post-Traumatic Stress Disorder: A Descriptive Study. JRUMS 2025; 24 (9) :789-806
URL: http://journal.rums.ac.ir/article-1-7796-en.html
Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Allameh Tabatabai University, Tehran, Iran
Abstract:   (24 Views)
Background and Objectives: The prevalence and multidimensional consequences of domestic violence on women, the chronic symptoms of Complex Post-Traumatic Stress Disorder (CPTSD), and the limitations of current treatment protocols for this disorder all highlight the urgent need for culturally appropriate and specific interventions. This study aimed to develop and validate an integrated Emotion-Focused and Cognitive-Behavioral Therapy package for women who are victims of violence and suffer from CPTSD.
Materials and Methods: This study employed an applied, descriptive research design. The content of a 16-session therapy package was developed through a comprehensive literature review of Cognitive-Behavioral and Emotion-Focused approaches, along with thematic analysis. The package was then refined by supervising professors and evaluated for content validity by 10 psychology and counseling faculty members at Allameh Tabataba'i University, using the Content Validity Ratio (CVR) and Content Validity Index (CVI).
Results: The content validity assessment indicated that all sessions, with the exception of "Assessing Mediating Thoughts" session, achieved a CVR of over 0.62 and a CVI of over 0.79, and were therefore deemed valid by the expert panel.
Conclusion: Expert feedback confirmed that the package's key strengths lie in its structured, progressive design; its dual focus on emotional and cognitive dimensions; and its emphasis on emotional regulation, cognitive restructuring, and distressing emotions processing. The results suggest the therapy package possesses strong content validity for treating women with CPTSD resulting from domestic violence, making it a viable tool for future intervention research.
Keywords: Emotion-focused therapy, Cognitive-behavioral therapy, Domestic violence, Complex post-traumatic stress disorder

Funding: This study did not have any funds.
Conflict of interest: None declared.
Ethical considerations: The Ethics Committee of Allameh Tabataba’i University approved the study (IR/ethics.2024.82633.1196).
Authors’ contributions:
- Conceptualization: Maryam Mobli
- Methodology: Maryam Mobli, Ahmad Borjali, Jalil Younesi
- Data collection: Maryam mobli, Ahmad Borjali, Faramarz Sohrabi
- Formal analysis: Maryam Mobli
- Supervision: Ahmad Borjali, Faramarz Sohrabi
- Project administration: Ahmad Borjali
- Writing – original draft: Maryam Mobli, Ahmad Borjali
Citation: Mobli M, Borjali A, Sohrabi F, Isamorad A, Younesi J. Development and Validation of an Integrated Emotion-Focused and Cognitive-Behavioral Therapy Protocol for Women Survivors of Domestic Violence with Complex Post-Traumatic Stress Disorder: A Descriptive Study. J Rafsanjan Univ Med Sci 2025; 24 (9): 789-806. [Farsi]
- Writing – review & editing: Maryam Mobli, Ahmad Borjali, Faramarz Sohrabi, Abolghasem IsaMoradi, Jalil Younesi



 
Full-Text [PDF 372 kb]   (11 Downloads) |   |   Full-Text (HTML)  (11 Views)  
Type of Study: Research | Subject: Psychiatry
Received: 2025/08/7 | Accepted: 2025/10/25 | Published: 2025/12/19

References
1. Dvir Y, Ford JD, Hill M, Frazier JA. Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities. Harv Rev Psychiatry 2014; 22(3): 149-61.
2. Karatzias T, Brewin CR, Maercker A, Kazlauskas E, Mollica RF, MacMillan HL, et al. Complex trauma and the characteristics of emotion dysregulation: A systematic review and meta-analysis. J Trauma Stress 2017; 30(4): 355-68.
3. Knefel M, Lueger-Schuster B, Karatzias T, Shevlin M, Hyland P. From child maltreatment to ICD-11 complex post-traumatic stress symptoms: The role of emotion regulation and re-victimisation. J Clin Psychol 2018; 74(11): 1901-16.
4. Hyland P, Murphy J, Shevlin M, Vallières F, McElroy E, Elkli A, et al. Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms. Soc Psychiatry Psychiatr Epidemiol 2017; 52(6): 727-36.
5. Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatol 2017; 8(5): 1353383.
6. Dokkedahl S, Kristensen T, Murphy S, Elklit A. The complex trauma of psychological violence: cross-sectional findings from a cohort of four Danish Women's Shelters. Eur J Psychotraumatol 2021; 12(1): 1863805.
7. Soohanian Haghighi M, Feizi A. Analysis of the status of domestic violence in Iranian families. Sci Q Iran Soc Issues Res 2022; 2(4): 1-31. [Farsi]
8. Torkashwand F, Rezaeean M, Sheikhfathollahi M, Mehrabian M, Bidaki R, Garousi B, et al. The prevalence of the types of domestic violence on women referred to the healthcare centers in rafsanjan in 2012. J Rafsanjan Univ Med Sci 2013; 12(9): 695-708. [Farsi]
9. St. Vil NM, Carter T, Johnson S. Betrayal trauma and barriers to forming new intimate relationships among survivors of intimate partner violence. J Interpers Violence 2018; 36(7-8): NP3509-NP3509.
10. World Health Organization. International Classification of Diseases, Eleventh Revision (ICD-11). Geneva: WHO; 2018.
11. Danesh P, Sharbatian MH, Tavvafi P. Sociological analysis of domestic violence against women and its relationship with the sense of safety at home (Case study: Women aged 18–54 in Miyaneh city). Strateg Res Secur Soc Order 2016; 5(1): 47-77. [Farsi]
12. Karatzias T, Hyland P, Bradley A, Cloitre M, Roberts NP, Bisson JI, et al. Risk factors and comorbidity of ICD-11 PTSD and complex PTSD: Findings from a trauma-exposed population-based sample of adults in the United Kingdom. Depression Anxiety 2019; 36(9): 887-94.
13. Cloitre MG. Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. Eur J Psychotraumatol 2013; 10(1): 1562840.
14. Po BS, Lam SK, Chen YJ, Chein WT, Wong EN, Wang EK, et al. Persistence and outcomes of ICD-11 complex PTSD in the community: A nine-month longitudinal investigation in Hong Kong. Asian J Psychiatry 2023; 83: 103506.
15. Kazlauskas E, Kairyte A, Zelviene P. Complex posttraumatic stress disorder in adolescence: A two-year follow-up study. Clin Child Psychol Psychiatry 2023; 28(1): 224-35.
16. Zerach G, Shevlin M, Cloitre M, Solomon Z. Complex posttraumatic stress disorder (CPTSD) following captivity: A 24-year longitudinal study. Eur J Psychotraumatol 2019; 10(1): 1616488.
17. Gilbar O, Hyland P, Cloitre M, Dekel R. ICD-11 complex PTSD among Israeli male perpetrators of intimate partner violence: Construct validity and risk factors. J Anxiety Disord 2018; 54: 49-56.
18. Cloitre M. The “one size fits all” approach to trauma treatment: Should we be satisfied? Eur J Psychotraumatol 2015; 10(1): 1562840.
19. Kaldewaij R, Koch S, Hashemi M, Zhang W, Klumpers F, Roelofs K. Anterior prefrontal brain activity during emotion. Nat Hum Behav 2021; 5: 1055-64.
20. Holmes SE, Scheinost D, DellaGioia N, Davis T, Matuskey D, Pietrzak R, et al. Cerebellar and prefrontal cortical alterations in PTSD: Structural and functional evidence. Chronic Stress 2018; 2: 1-11.
21. Coventry P, Meader N, Melton HA, Temple M, Dale H, Wright K, et al. Psychological and pharmacological interventions for PTSD and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. PLoS Med 2020; 17(9): e1003262.
22. Sippel L, Roy A, Southwick S, Fichtenholtz H. An examination of the specific associations between facets of difficulties in emotion regulation and posttraumatic stress symptom clusters. Cogn Behav Ther 2016; 45(5): 339-50.
23. Knefel M, Lueger-Schuster B, Karatzias T, Shevlin M, Hyland P. From child maltreatment to ICD-11 complex post-traumatic stress symptoms: The role of emotion regulation and re-victimisation. J Clin Psychol 2018; 74(11): 392-403.
24. Cloitre M, Courtois CA, Ford JD, Green BL, Middleton J, Petrakis IL, et al. Describing complex trauma: Proposed diagnostic criteria for a disorder of extreme stress (DESNOS). J Trauma Stress 2012; 25(3): 1-17.
25. Greenberg LS. Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings. Washington, DC: American Psychological Association; 2015. p. 411.
26. Karami A. Familiarity with test making and psychological tests. 2nd ed. Tehran: Psychometric Publications; 2020. p. 339. [Farsi]
27. Lawshe CH. A quantitative approach to content validity. Pers Psychol 1975; 28(4): 563-75.
28. Waltz CF, Bausell RB. Nursing Research: Design, Statistics, and Computer Analysis. Philadelphia: F.A. Davis Company; 1981. p. 362.
29. Leahy RL, Holland SJ, McGinn LK. Treatment Plans and Interventions for Depression and Anxiety Disorders. 2nd ed. New York: Guilford Press; 2012. p. 490.
30. Greenberg LS. Emotion-Focused Therapy. 2nd ed. Washington, DC: American Psychological Association; 2017. p. 224.
31. Beck JS. Cognitive Behavior Therapy: Basics and Beyond. 2nd ed. New York: Guilford Press; 2011. p. 391.
32. Elliott R, Greenberg LS, Lietaer G. Research on client-centered and experiential psychotherapies. In: Lambert MJ, editor. Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. 5th ed, New York: Wiley; 2004. p. 493-539.
33. Paivio SC, Pascual-Leone A. Emotion-Focused Therapy for Complex Trauma: An Integrative Approach. Washington, DC: American Psychological Association; 2010. p. 334.
34. Jongh AD, Resick PA, Zoellner LA, Minnen AV, Lee CW, Monson CM, et al. Critical analysis of the current treatment guidelines for complex PTSD in adults. Depress Anxiety 2016; 33(5): 359-69.
35. Cloitre M. Complex PTSD: Assessment and treatment. Eur J Psychotraumatol 2021; 12(1): 1869369.
36. Thoma JA. Integrating emotion-focused therapy into cognitive-behavioral therapy. In: Thoma NC, McKay D, editors. Working with Emotion in Cognitive-Behavioral Therapy: Techniques for Clinical Practice. New York: Guilford Press; 2015. p. 239-62.
37. Ogden PM. Trauma and the Body: A Sensorimotor Approach to Psychotherapy. New York: W.W. Norton & Company; 2006. p. 345.

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