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Asvadi M, Bakhshipoor A, Razavi Tabadeghan B Z. Comparing the Effectiveness of Emotionally Focused Couple Therapy and Cognitive-Behavioral Couple Therapy on Forgiveness and Marital Intimacy of Women Affected by Infidelity in Mashhad. JCHR 2022; 11 (4) :277-286
URL: http://jhr.ssu.ac.ir/article-1-855-en.html
URL: http://jhr.ssu.ac.ir/article-1-855-en.html
1- Department of Psychology, Faculty of Humanities, Islamic Azad University of Bojnourd, Bojnourd, Iran
2- Department of Psychology, Faculty of Humanities, Islamic Azad University of Bojnourd, Bojnourd, Iran , ab8boj@gmail.com
2- Department of Psychology, Faculty of Humanities, Islamic Azad University of Bojnourd, Bojnourd, Iran , ab8boj@gmail.com
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Introduction
References
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| Comparing the Effectiveness of Emotionally Focused Couple Therapy and Cognitive-Behavioral Couple Therapy on Forgiveness and Marital Intimacy of Women Affected by Infidelity in Mashhad |
- Department of Psychology, Bojnourd Branch, Islamic, Azad University, Bojnourd, Iran
| ARTICLE INFO | ABSTRACT | |
| Original Article Received: 30 June 2022 Accepted: 19 December 2022 |
Background: The experience of infidelity is very painful and leads to serious negative consequence among couples. The aim of this study is to compare the effectiveness of emotionally focused couple therapy (EFT) and cognitive-behavioral couple therapy (CBT) on forgiveness and marital intimacy of women affected by infidelity. Methods: This was a quasi-experimental study with a pre-posttest design. The statistical population included all the infidelity-affected women referred to Andishe and Tafakor counseling center in the first quarter of 2020 in Mashhad city. The sample size was determined by Cochran formula as 15 participants for each group. From this statistical population, 45 people were selected by purposive method based on inclusion criteria and were randomly replaced in three groups of CBT (N=15), EFT (N=15), and the control group (N=15. They did not receive any intervention. All participants were assessed before, after, and two months after the intervention with the marital forgiveness and Walker and Thompson's (1983) and marital intimacy scale (MIS). The obtained data were analyzed in SPSS-20 by statistical methods of the repeated measure analysis of variance. Results: The mean age of participants was 33.11 ±5.03, and their marriage duration was 6.23±2.89. The results demonstrated forgiveness and marital intimacy were significantly increased in CBT and EFT groups compared to the control group (P <0.001). EFT showed higher effectiveness than CBT in enhancement of forgiveness and intimacy (P <0.05). Conclusion: According to the findings, CBT and EFT indicated efficacy in improvement of intimacy and forgiveness between couples. By comparing interventions, EFT showed higher effectiveness. Therefore, it is suggested to use emotion-focused techniques to improve the relationship of couple. In addition, considering the effectiveness of both treatments, an integrated approach can be used in future studies. Keywords: Forgiveness, Cognitive-Behavior Therapy, Intimacy, Emotion, Couple Therapy |
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Corresponding Author: Abolfazl Bakhshipoor ab8boj@gmail.com |
How to cite this paper:
Asvadi M, Bakhshipoor A, Razavizadeh Tabadkan BZ. Comparing the Effectiveness of Emotionally Focused Couple Therapy and Cognitive-Behavioral Couple Therapy on Forgiveness and Marital Intimacy of Women Affected by Infidelity in Mashhad. J Community Health Research 2022; 11(4): 277-286.
Introduction
People with healthy families experience higher levels of love, support, value, self-efficacy, and a better ability to cope with illness than people who live in stressful and unhealthy environments. The unhealthy atmosphere of the family is associated with psychosocial and medical problems among family members(1). Commitment and loyalty in the family are of the basic principles of maintaining the family. Marital commitment means staying with spouse even when marriage is not rewarding (2). Potentially, infidelity leads to serious damages with regard to the function of the family (3).
Regarding personal, economic, social or family reasons, a significant percentage of women choose to stay in a relationship after infidelity experience; however, they can't forgive their spouse. This causes fundamental challenges in marital intimacy (4). Intimacy provides a foundation for a person's satisfaction and dissatisfaction with marital life (5). This is because it strengthens the couple's commitment to their relationship, and is positively associated with marital happiness and compatibility (6). Forgiveness is also known as a bold factor in continued relationships (7). If after infidelity, the couple fails to find a way to heal the damaged intimacy and reduce the suffering, the whole family will be affected and may even break up despite the efforts of the couple. This is where the role of psychotherapy and counseling is highlighted (8). Failure to take timely action to use appropriate methods to manage things after infidelity condition can expose the family to collapse (9).
Among the various approaches and therapies in couple therapy, CBT have been very popular as it is well known, simple and practical with appropriate effectiveness in various fields (10). In addition to individual studies, several review studies have introduced CBT as an effective method, although it has been suggested that further studies are still needed (11). EFT, on the other hand, has gained considerable popularity among therapists as a method based on the most influential interpersonal theory of attachment. This has a fundamental role on commitment. Attachment is one of the variables severely damaged after the occurrence of infidelity. EFT follows consistent and defined steps which lead the client to recovery; therefore, review studies have evaluated this treatment method in all types of marital conflicts (12).
Several studies have examined the effectiveness of interventions on improving couples' forgiveness and intimacy. Beasley and Ager (2019) showed the effectiveness of EFT in the last 19 years, and stated that this treatment has been effective in various groups with marital problems, including infidelity (13). Dehghani et al. showed demonstrated the effectiveness of EFT on forgiveness of injured woman with infidelity (14). In another study, Alavi et al. reported EFT enhanced the marital intimacy of participants (15). Zakhirdari et al.'s findings showed effectiveness of CBT on marital intimacy (16). Khayatn et al. also indicated effectiveness of CBT on forgiveness of couples (17).
Both CBT and EFT use different techniques and theoretical bases to achieve a similar goal, which is to improve the couple's relationship (18). Review studies have confirmed the effectiveness of both methods (19). In some individual studies, CBT (17) and EFT (15) have been introduced as appropriate methods to improve marital relationships. Both methods seem to be among the most popular treatments in couple therapy approaches in the field of infidelity. However, the two methods employ different approaches. Review studies have emphasized that more studies are needed in this area to determine the sustainability and effectiveness of different couple therapies. Studies in Iran have used the usual methods of CBT and EFT. They neglected to use EFT-based infidelity method and mostly use common EFT methods. On the other hand, no study was found regarding the efficacy of CBT and EFT methods. Therefore, this study was conducted to study the effectiveness of EFT and CBT regarding marital intimacy and forgiveness of woman affected by marital infidelity.
Methods
This study used a quasi-experimental method with pretest-posttest-follow-up (30 days) and control group. Based on the Iranian psychotherapy literature (17) and considering time limitation, the follow up was considered 30 days. The study included all the women who referred to a counseling center after the experience of infidelity of spouse in the first quarter of 2020 (69 cases) in Andishe and Tafakor counseling center in Mashhad city (20). The sample size for each group was estimated based on similar studies (N=15 in each group). The first and second types of errors were considered 0.05 and 0.20, respectively. At the 5% error level, the value of z was equal to 1.96 and Z2 was equal to 3.8416.The mean and standard deviation were extracted from Zanghane- motlagh et al.'s study(21), and the sample size was calculated to be 15 participants for each group based on the following formula:
Forty-five participants who were eligible for the study were selected by purpose-based method according to the inclusion and exclusion criteria. Inclusion criteria included: experiencing spouse infidelity in the last 6 months; lack of active relationship outside the marital relationship; having no chronic mental or physical illness; minimum cycle education; not experiencing severe stress such as loss of loved ones in the last 6 months; willingness to cooperate; being available for 3 months. Exclusion criteria included; divorce in the past year, menopause, absence from counseling sessions for more than one session, having a distorted or invalid questionnaire, infertility, severe differences and physical violence between couples, drug or alcohol addiction. The samples were randomly assigned to three groups through simple randomization CBT (n = 15), EFT (n = 15) and control group (n = 15).
Research instruments
Participants were assessed before, after and one month after intervention with the following questionnaires:
The Walker and Thompson's (1983) marital intimacy scale (MIS) (22)is a 17-item tool designed to measure affection and intimacy. Scores range from 1 (never), rarely (2), sometimes (3), often (4), most often (5), almost always (6), always (7). The questionnaire has one component. Scores range from 17-119. A higher score is a sign of greater intimacy. Chan, Tu, and Wang (2015) confirmed the single factor of the questionnaire and reported a Cronbach's alpha coefficient of 0.91 for the questionnaire (23). This study was translated and validated by Sanaei's (2008). In Sanaei (2008) study, the intimacy scale was first applied to 166 undergraduate students, 68% of whom were 20 to 25 years old and 166 mothers of middle class students, most of whom were between 40 and 49 years old (63%) and 73% of them were in first marriage. Of 147 grandmothers, 40% were between 60 and 69, and 40% were between 70 and 79. 52% of the participants were married and 45% were widows (24). In this study, Cronbach's alpha was 0.71.
The marital forgiveness questionnaire (MOFS) of Fincham et al. (2007) was used. This questionnaire consists of 10 questions. The subscales include two subscales: benevolence and anger - avoidance. Each question is answered in a range of 6 points; 1 (strongly disagree) to 6 (strongly agree) with a minimum and maximum score of 10 to 60. A low score indicates no forgiveness and a high score indicates a high level of marital forgiveness. Questions 1-3-4-6-7-8 are related to the anger and avoidance subscale and questions 2-5-9-10 are related to the benevolence subscale. In study by Fincham et al. (2007) alpha coefficients of the questionnaire subscales were reported between 0.89-0.75 and 0.84 for the total score. This indicates the proper reliability of the questionnaire (25). In Iran, Rajabi et al reported a convergent validity of the questionnaire to be 0.86 and a reliability coefficient of 0.91(26). In the present study, the reliability coefficient of the questionnaire was obtained by calculating the Cronbach's alpha coefficient of 0.76.
Ethical consideration
In the implementation of the present study, ethical considerations included the following principles: conscientiousness and responsibility, usefulness and having no harm, non-discrimination, paying attention to the welfare of others, and observing the value system of the society. The participants signed a written consent before starting the study. This study was registered with the ethics code IR.IAU.BOJONURD.REC. 1399.012.
Intervention
Participants in the CBT group attended the counseling center for twelve sessions. The CBT sessions were based on the post-traumatic stress disorder for couples (27), which has been used in several studies in Iran and abroad. Meetings were held twice a week (60-90 minutes).
The sessions for the EFT group were designed based on the EFT program for infidelity (28). This program was implemented in eight sessions twice a week (60-90 minutes).
During this period, the control group did not receive any training by the research group. Before the intervention, the content of the sessions were reviewed by three psychologists for approval and the opinions of the experts were applied. After the follow-up phase, 15 cases remained in the EFT group and 14 cases remained in the control group. In the intervention group, one person was excluded from the study because of not attending all sessions. One person in the control group was removed due to unavailability.
Regarding personal, economic, social or family reasons, a significant percentage of women choose to stay in a relationship after infidelity experience; however, they can't forgive their spouse. This causes fundamental challenges in marital intimacy (4). Intimacy provides a foundation for a person's satisfaction and dissatisfaction with marital life (5). This is because it strengthens the couple's commitment to their relationship, and is positively associated with marital happiness and compatibility (6). Forgiveness is also known as a bold factor in continued relationships (7). If after infidelity, the couple fails to find a way to heal the damaged intimacy and reduce the suffering, the whole family will be affected and may even break up despite the efforts of the couple. This is where the role of psychotherapy and counseling is highlighted (8). Failure to take timely action to use appropriate methods to manage things after infidelity condition can expose the family to collapse (9).
Among the various approaches and therapies in couple therapy, CBT have been very popular as it is well known, simple and practical with appropriate effectiveness in various fields (10). In addition to individual studies, several review studies have introduced CBT as an effective method, although it has been suggested that further studies are still needed (11). EFT, on the other hand, has gained considerable popularity among therapists as a method based on the most influential interpersonal theory of attachment. This has a fundamental role on commitment. Attachment is one of the variables severely damaged after the occurrence of infidelity. EFT follows consistent and defined steps which lead the client to recovery; therefore, review studies have evaluated this treatment method in all types of marital conflicts (12).
Several studies have examined the effectiveness of interventions on improving couples' forgiveness and intimacy. Beasley and Ager (2019) showed the effectiveness of EFT in the last 19 years, and stated that this treatment has been effective in various groups with marital problems, including infidelity (13). Dehghani et al. showed demonstrated the effectiveness of EFT on forgiveness of injured woman with infidelity (14). In another study, Alavi et al. reported EFT enhanced the marital intimacy of participants (15). Zakhirdari et al.'s findings showed effectiveness of CBT on marital intimacy (16). Khayatn et al. also indicated effectiveness of CBT on forgiveness of couples (17).
Both CBT and EFT use different techniques and theoretical bases to achieve a similar goal, which is to improve the couple's relationship (18). Review studies have confirmed the effectiveness of both methods (19). In some individual studies, CBT (17) and EFT (15) have been introduced as appropriate methods to improve marital relationships. Both methods seem to be among the most popular treatments in couple therapy approaches in the field of infidelity. However, the two methods employ different approaches. Review studies have emphasized that more studies are needed in this area to determine the sustainability and effectiveness of different couple therapies. Studies in Iran have used the usual methods of CBT and EFT. They neglected to use EFT-based infidelity method and mostly use common EFT methods. On the other hand, no study was found regarding the efficacy of CBT and EFT methods. Therefore, this study was conducted to study the effectiveness of EFT and CBT regarding marital intimacy and forgiveness of woman affected by marital infidelity.
Methods
This study used a quasi-experimental method with pretest-posttest-follow-up (30 days) and control group. Based on the Iranian psychotherapy literature (17) and considering time limitation, the follow up was considered 30 days. The study included all the women who referred to a counseling center after the experience of infidelity of spouse in the first quarter of 2020 (69 cases) in Andishe and Tafakor counseling center in Mashhad city (20). The sample size for each group was estimated based on similar studies (N=15 in each group). The first and second types of errors were considered 0.05 and 0.20, respectively. At the 5% error level, the value of z was equal to 1.96 and Z2 was equal to 3.8416.The mean and standard deviation were extracted from Zanghane- motlagh et al.'s study(21), and the sample size was calculated to be 15 participants for each group based on the following formula:
Forty-five participants who were eligible for the study were selected by purpose-based method according to the inclusion and exclusion criteria. Inclusion criteria included: experiencing spouse infidelity in the last 6 months; lack of active relationship outside the marital relationship; having no chronic mental or physical illness; minimum cycle education; not experiencing severe stress such as loss of loved ones in the last 6 months; willingness to cooperate; being available for 3 months. Exclusion criteria included; divorce in the past year, menopause, absence from counseling sessions for more than one session, having a distorted or invalid questionnaire, infertility, severe differences and physical violence between couples, drug or alcohol addiction. The samples were randomly assigned to three groups through simple randomization CBT (n = 15), EFT (n = 15) and control group (n = 15).
Research instruments
Participants were assessed before, after and one month after intervention with the following questionnaires:
The Walker and Thompson's (1983) marital intimacy scale (MIS) (22)is a 17-item tool designed to measure affection and intimacy. Scores range from 1 (never), rarely (2), sometimes (3), often (4), most often (5), almost always (6), always (7). The questionnaire has one component. Scores range from 17-119. A higher score is a sign of greater intimacy. Chan, Tu, and Wang (2015) confirmed the single factor of the questionnaire and reported a Cronbach's alpha coefficient of 0.91 for the questionnaire (23). This study was translated and validated by Sanaei's (2008). In Sanaei (2008) study, the intimacy scale was first applied to 166 undergraduate students, 68% of whom were 20 to 25 years old and 166 mothers of middle class students, most of whom were between 40 and 49 years old (63%) and 73% of them were in first marriage. Of 147 grandmothers, 40% were between 60 and 69, and 40% were between 70 and 79. 52% of the participants were married and 45% were widows (24). In this study, Cronbach's alpha was 0.71.
The marital forgiveness questionnaire (MOFS) of Fincham et al. (2007) was used. This questionnaire consists of 10 questions. The subscales include two subscales: benevolence and anger - avoidance. Each question is answered in a range of 6 points; 1 (strongly disagree) to 6 (strongly agree) with a minimum and maximum score of 10 to 60. A low score indicates no forgiveness and a high score indicates a high level of marital forgiveness. Questions 1-3-4-6-7-8 are related to the anger and avoidance subscale and questions 2-5-9-10 are related to the benevolence subscale. In study by Fincham et al. (2007) alpha coefficients of the questionnaire subscales were reported between 0.89-0.75 and 0.84 for the total score. This indicates the proper reliability of the questionnaire (25). In Iran, Rajabi et al reported a convergent validity of the questionnaire to be 0.86 and a reliability coefficient of 0.91(26). In the present study, the reliability coefficient of the questionnaire was obtained by calculating the Cronbach's alpha coefficient of 0.76.
Ethical consideration
In the implementation of the present study, ethical considerations included the following principles: conscientiousness and responsibility, usefulness and having no harm, non-discrimination, paying attention to the welfare of others, and observing the value system of the society. The participants signed a written consent before starting the study. This study was registered with the ethics code IR.IAU.BOJONURD.REC. 1399.012.
Intervention
Participants in the CBT group attended the counseling center for twelve sessions. The CBT sessions were based on the post-traumatic stress disorder for couples (27), which has been used in several studies in Iran and abroad. Meetings were held twice a week (60-90 minutes).
The sessions for the EFT group were designed based on the EFT program for infidelity (28). This program was implemented in eight sessions twice a week (60-90 minutes).
During this period, the control group did not receive any training by the research group. Before the intervention, the content of the sessions were reviewed by three psychologists for approval and the opinions of the experts were applied. After the follow-up phase, 15 cases remained in the EFT group and 14 cases remained in the control group. In the intervention group, one person was excluded from the study because of not attending all sessions. One person in the control group was removed due to unavailability.
Table 1. Summary of the structure of cognitive-behavioral couple therapy sessions (27)
| Session | Subject | content |
| 1 | The rationale of psychoeducational therapy on the traumatic experience of betrayal | Establishing communication and preparation, explaining the method and goals of the meetings, describing the psychological training regarding the experiences after the trauma of betrayal |
| 2 | Communication and conflict management | Examining the sensory facilitation strategies regarding participation in careself-care Communication problems and their mutual impact on each other |
| 3 | Weakening avoidance | Investigating barriers to effective communication, focusing on recognizing emotions and thoughts, and investigating the mutual influence of emotions |
| 4 | Increasing communication | thoughts and behavior on each other, creating the skill of transferring and receiving thoughts and emotions correctly and effectively |
| 5 | anger management | Encouraging couples to participate in enjoyable activities to reduce avoidance and reduce emotional numbness; identifying the core of unrealistic beliefs and expectations which are effective in escalation and continuation |
| 6 | Communication | Using the problem solving method and practicing it in the meeting with the aim of weakening the mutual influence, experiencing damage and communication incompatibility towards each other |
| 7 | Giving meaning to the traumatic experience of betrayal | Familiarity with cognitive errors, challenging these errors, making decisions to correct cognitive errors, and replacing logical beliefs and expectations |
| 8 | Cognitive reconstruction |
Increasing and strengthening the control of one's own and others' thoughts, behavior and emotions |
| 9 | Familiarity with mutual expectations and paying attention to each other's positive characteristics | |
| 10 | Increasing trust and emotional closeness, discussing and | |
| 11 | investigating the couple's ability to create a better life and move forward, how to keep the benefits created in the treatment in future | |
| 12 | Conclusion | Feedback, discussion, post-test |
Table 2. A summary of the sessions based on the emotional-focused couple therapy treatment program for marital infidelity (28)
| Session | Aim | Content |
| 1 | Creating a therapeutic relationship | Explaining and presenting an emotionally-oriented approach; creating a therapeutic relationship, a sense of security, support, being understood and accepted by the therapist on behalf of the couple; giving feedback and providing homework |
| 2 | Investigating the incident that happened (marital infidelity) | Summarizing the previous meeting and reviewing the task of the previous meeting, discussing the incident; encouraging the injured spouse to describe it and express their feelings about the event; encouraging one's spouse not to deny his wife's feelings and not to underestimate the issue |
| 3 | Examining the effect of marital infidelity on secure attachment | Summarizing the previous session and reviewing the task of the previous session: discussing the effect of marital infidelity on secure attachment by the therapist: describing the experience by the spouse who committed marital infidelity; encouragement to fully express the injury caused by the injured spouse. 5- Access to unconscious underlying attachment-oriented emotions. |
| 4 | Reframing the problem based on attachment needs and the cycle's underlying emotions that go with it | Summarizing the previous meeting and reviewing the homework of the previous meeting; reframing the problem; increasing familiarity with attachment needs and aspects of self which have been rejected and denied; examining factors related to marital relationship in marital infidelity; receiving feedback and submitting assignments |
| 5 | Increasing the acceptance of each couple towards the experience of the other | Summarizing the previous meeting and reviewing the homework of the previous meeting; increasing the acceptance of each couple from the experience of the other couple; enhancing the feeling of closeness with rejected emotions |
| 6 | Facilitating the expression of needs and desires to reconstruct interaction based on the new understanding | Summarizing the previous meeting and reviewing the task of the previous meeting; facilitating the expression of needs and desires; creating linking events; receiving feedback and submitting assignments |
| 7 | Facilitating the development of new solutions for old problems | Summarizing the previous session and reviewing the assignment of the previous session; creating new solutions for old problems; receiving feedback and presenting the assignment |
| 8 | Consolidation of positions and new cycles of attachment behavior | Summarizing the previous meeting and reviewing the homework of the previous meeting; examining the couples' opinions on the extent to which the set goals are achieved; reviewing the interventions and summation and termination of the feedback treatment; conducting post-tests, determining time |
To analysis, data's descriptive statistics, mean, minimum, maximum, frequency, and standard deviation) were used. For inferential statistics, Chi-square test, repeated measure analysis of variance, post hoc test were used in SPSS 20 software. To compare the means with repeated measures analysis test, the assumptions were examined. The hypothesis of normality of the data was confirmed by Kolmogorov-Smirnov test. Leven test showed that variances were homogeneous. In order to check the assumption, Mauchly's sphericity test was used. Considering that the significance level in the test for the dependent variable was less than 0.05, the Green House Geisser (G-G) used. Therefore, this assumption was established.
Results
Demographic characteristics
The results showed that the majority of participants were undergraduate (60%). seven people had master's and doctoral degrees (15.4%) and the rest had high school diplomas. The majority had two children (41.8%), 26.4 % had one child and only 1.7% had three children. The rest had no children. The mean age of participants was 33.11 with a standard deviation of 5.03.The demographic characteristics of the participants are described and compared in Table (1).
Results
Demographic characteristics
The results showed that the majority of participants were undergraduate (60%). seven people had master's and doctoral degrees (15.4%) and the rest had high school diplomas. The majority had two children (41.8%), 26.4 % had one child and only 1.7% had three children. The rest had no children. The mean age of participants was 33.11 with a standard deviation of 5.03.The demographic characteristics of the participants are described and compared in Table (1).
Table 3. Comparison of demographic characteristics of participants' CBT and EFT with control group
| Variable | CBT | EFT | Control | Chi-Square | |
| N (%) | N (%) | N (%) | |||
| High school diploma and below | 5(35.7) | 2(13.3) | 5(35.7) | 𝜒2=6.97 P -value= 0.13 |
|
| Education | Undergraduate | 6(42.9) | 12(80) | 9(64.9) | |
| Graduate | 3(21.4) | 1(6.7) | 0 | ||
| Children | 1 | 5(35.7) | 5(33.73) | 2(14.3) | 𝜒2=5.91 P –value=0.43 |
| 2 | 5(35.7) | 5(33.3) | 9(64.3) | ||
| 3 | 1(7.1) | 0 | 0 |
||
| Age | Mean ±SD | 31.42±6.02 | 32.66±6.76 | 34.14±4.78 | F=0.75 P=0.47 |
| Marriage | Mean ±SD | 5.78±2.50 | 6.92±2.55 | 6.06±2.31 | F=0.80 P=0.45 |
The results of comparing the demographic status of participants in groups show that they are not significantly different in terms of age, duration of marriage, education and number of children (P <0.05).
Inferential findings
Inferential findings
Table 4. Analysis of variance and descriptive indicators of marital intimacy and forgiveness in pre-test, post-test and follow-up
| Variables | Group | Pretest | Post test | Follow-up | Result | |||||
| M | SD | M | SD | M | SD | F | P | eta | ||
| Marital intimacy | CBT | 44.53 | 4.55 | 52.00 | 4.37 | 54.07 | 4.84 | 6.29 | 0.01 | 0.18 |
| EFT | 45.26 | 4.55 | 57.60 | 4.15 | 59.80 | 4.90 | ||||
| Control | 4.50 | 44.85 | 4.26 | 44.12 | 4.66 | 43.07 | ||||
| Marital forgiveness | CBT | 23.85 | 4.22 | 31.28 | 4.54 | 34.35 | 4.30 | 9.99 | 0.01 | 0.27 |
| EFT | 26.20 | 3.46 | 37.66 | 4.25 | 41.06 | 4.36 | ||||
| Control | 24.64 | 2.89 | 25.57 | 3.08 | 26.28 | 3.22 | ||||
The mean and standard deviation of the intimacy variable in Table 4 demonstrates that the mean score of the three groups in the pretest stage does not show any difference. In the posttest stage, the scores increase in the intervention groups and no significant changes are seen in the control group. The result of repeated analysis of variance demonstrated that the difference between the groups was significant in this variable, p> 0.05; F = 6.29 and F=9.99 regarding in intimacy and forgiveness scores respectively. Based on ETA coefficients, it is determined that one of the interventions caused 17% and 27% more changes in intimacy and forgiveness scores respectively.
Table 5. Results of comparing differences between the mean scores of the two intervention groups regarding time
| Variables | ||||
| P | mean difference | Time | ||
| 0.001** | 9.98- | Post test | pretest | Marital intimacy |
| 0.001* | -2.13 | Follow up | Post test | |
| 0.001* | -12.12 | Follow up | pretest | Marital forgiveness |
| 0.001* | -4.18 | Post test | pretest | |
| 0.001* | -1.89 | Follow up | Post test | |
| 0.001* | -6.07 | Follow up | pretest | |
The findings of the above tTable (5 ) and figur1 Figure 1 show indicate that there was a significant difference between the scores of post-test and follow-up in the treated group and , while confirming the effectiveness of its stability in the follow-up.
Discussion
The aim of this study was to compare the effectiveness of EFT with CBT on marital intimacy and forgiveness in women affected by infidelity. Findings revealed that EFT was more effective on intimacy and forgiveness. This implies that those who participated in the EFT group reported more improvement in terms of intimacy and forgiveness. Consistent with the findings of the present study, Zakhirdar et al. showed that EFT was more effective than CBT in increasing the intimacy of couples (16). Beasley has also concluded in a review that emotionally-focused therapies are highly effective on emotion-related variables such as intimacy(13). This is while the study by Timulak et al. showed no difference in the effectiveness of EFT and CBT on anxiety (19). This difference in findings can be explained by the difference between the studied variable and the studied subjects. Accordingly, Beasley and Ager showed the effectiveness
of EFT on marital relation respecting the related variables (13). In another study Dehghani et al. stated the efficacy of EFT on forgiveness of woman suffering from infidelity (14). In another study, Alavi et al. reported that EFT enhanced marital intimacy of participants (15). Khayatn et al. also indicated effectiveness of CBT on forgiveness of couples (17).
These findings can be justified by the fact that EFT pays attention to the attachment style and communication patterns of individuals. It adjusts the treatment steps in such a way that it leads to a secure attachment. Therefore, after training, the individuals can be more confident in relationships. It helps them to take positive and constructive steps and enables them to express their emotions in a constructive way. Therefore, this issue is expected to increase intimacy. In fact, when attachment is damaged by infidelity, trust and intimacy are the first positive emotions that are disrupted in the relationship between the couple. The injured person feels that there has not been enough intimacy in the relationship, which has led to the concealment by the spouse. The emotionally-based therapist pays attention to the dynamics of the clients in therapy sessions, examines the family interactions of individuals, and tries to strengthen the communication which is based on sincere feelings. To achieve this goal, the therapist encourages them to look at their current emotional issues and helps them to better identify their feelings and emotions.
CBT also increases intimacy and forgiveness by reducing cognitive distortions and increasing the ability to interact. The main focus of EFT is on emotions, and intimacy is regarded a kind of emotion. Because the feeling of intimacy is among the emotions and shows a high correlation with emotional variables, it develops more under the influence of EFT. The EFT approach is to
access and reprocess the underlying emotional reactions in couples' interactions. These reactions lead to the development of safer attachment styles and different couples 'patterns, couples' empathy for each other's experiences, and the development of new interactive patterns.
During CBT sessions, the techniques of communication compatibility, and at the same time for couples, interaction trainings, reduction of bias towards negative communication behaviors and increase of positive perspectives were practiced. Couples learned strategies to facilitate participation in health, such as recognizing the early signs of anger and conflict management strategies, which results in forgiveness. Couples taught about the destructive role of avoidance in maintaining stress disorder and communication disorders and communication skills. Increasing mutual connection as a way to avoid injury-related emotional numbness led to increased forgiveness. Communication skills are trained and practiced over several sessions to help couples recognize and participate in their feelings and to pay attention
to the ways that affect their thoughts, feelings,
and behaviors. The couples, then, use these communication skills to discuss the content related to the disorder and problem-solving, which increased their intimacy and forgiveness. This is while CBT is more task-oriented, and has been more successful in treating anxiety and depression problems and less effective in improving emotions than the EFT approach. This finding shows that in addition to emotional awareness, forgiveness requires the ability to play a more highlighted role in emotional regulation, which has been considered in EFT. The results of this study can be used in the field of treatment and counseling. Since the phenomenon of infidelity causes wounds of attachment, the treatment methods of this method need to be changed and updated, and the information in this study can be used to improve the information in this field by counselors and families. The researcher in the present research process faced limitations that may have affected the quality of the research. Coinciding with the outbreak of COVID-19, this study caused problems such as lack of direct access to participants in the follow-up phase, which forced the researcher to use online questionnaires. In this study, women affected by infidelity were examined. Due to the implementation of treatment sessions by one therapist, it was possible to have skills and expertise in one treatment more than the other. This may have influenced the research findings. In this study, the level of primary mental health of the participants was not assessed. This difference may play a role in the effectiveness of treatments or the severity of the problems. Another limitation of the study was the small number of samples which was limited to a hospital in a city. Hence, caution should be exercised in generalizing the results. One of the limitations beyond the researcher's control was that random sampling was not possible. On the other hand, forgiveness and intimacy are culture-bound, while there is no questionnaire with negative content in this regard.
Conclusion
Overall, the results revealed that CBT and EFT were effective in improving the marital relationship of betrayed women. These two treatments can be used to improve couples' relationships after infidelity. Differences in the effectiveness of these approaches also show that the effectiveness of each of the treatments used can be different in different dimensions. So, different treatments can be used based on the client's condition. The therapist's experience during the research, and according to the couple's background, sexual relations played an effective role in men's tendency towards infidelity. Therefore, it is suggested that in addition to using techniques such as therapy and cognition and focusing on emotions, the process of sexual intercourse and the problems of this issue should be addressed in order to prevent future breaches in the holy bond of marriage. It is suggested that the couple under therapy use an integrated approach for people affected by infidelity according to their background problems and personal characteristics. This can make the most positive changes in clients' relationships
Acknowledgment
The authors would like to thank the couples who participated in the study and cooperated during the research. This research was derived from the doctoral dissertation of psychology.
Conflict of interest
The authors declared no conflict of interest.
Author's contribution
All authors contributed equally in this study
Ethical considerations
To implement ethical interventions in the present study, the ethical codes proposed by the APA (2003), and the Organization of the Psychological and Counseling System of the Islamic Republic of Iran (2006) were considered. Accordingly, the following components were observed for all patients:
Participating in the study (at each stage of the study): participating in each stage of the study, respect for human dignity and freedom; conscientiousness and responsibility; usefulness and having no harm; non-discrimination; paying attention to the welfare of others and to the value system of society.
Discussion
The aim of this study was to compare the effectiveness of EFT with CBT on marital intimacy and forgiveness in women affected by infidelity. Findings revealed that EFT was more effective on intimacy and forgiveness. This implies that those who participated in the EFT group reported more improvement in terms of intimacy and forgiveness. Consistent with the findings of the present study, Zakhirdar et al. showed that EFT was more effective than CBT in increasing the intimacy of couples (16). Beasley has also concluded in a review that emotionally-focused therapies are highly effective on emotion-related variables such as intimacy(13). This is while the study by Timulak et al. showed no difference in the effectiveness of EFT and CBT on anxiety (19). This difference in findings can be explained by the difference between the studied variable and the studied subjects. Accordingly, Beasley and Ager showed the effectiveness
of EFT on marital relation respecting the related variables (13). In another study Dehghani et al. stated the efficacy of EFT on forgiveness of woman suffering from infidelity (14). In another study, Alavi et al. reported that EFT enhanced marital intimacy of participants (15). Khayatn et al. also indicated effectiveness of CBT on forgiveness of couples (17).
These findings can be justified by the fact that EFT pays attention to the attachment style and communication patterns of individuals. It adjusts the treatment steps in such a way that it leads to a secure attachment. Therefore, after training, the individuals can be more confident in relationships. It helps them to take positive and constructive steps and enables them to express their emotions in a constructive way. Therefore, this issue is expected to increase intimacy. In fact, when attachment is damaged by infidelity, trust and intimacy are the first positive emotions that are disrupted in the relationship between the couple. The injured person feels that there has not been enough intimacy in the relationship, which has led to the concealment by the spouse. The emotionally-based therapist pays attention to the dynamics of the clients in therapy sessions, examines the family interactions of individuals, and tries to strengthen the communication which is based on sincere feelings. To achieve this goal, the therapist encourages them to look at their current emotional issues and helps them to better identify their feelings and emotions.
CBT also increases intimacy and forgiveness by reducing cognitive distortions and increasing the ability to interact. The main focus of EFT is on emotions, and intimacy is regarded a kind of emotion. Because the feeling of intimacy is among the emotions and shows a high correlation with emotional variables, it develops more under the influence of EFT. The EFT approach is to
access and reprocess the underlying emotional reactions in couples' interactions. These reactions lead to the development of safer attachment styles and different couples 'patterns, couples' empathy for each other's experiences, and the development of new interactive patterns.
During CBT sessions, the techniques of communication compatibility, and at the same time for couples, interaction trainings, reduction of bias towards negative communication behaviors and increase of positive perspectives were practiced. Couples learned strategies to facilitate participation in health, such as recognizing the early signs of anger and conflict management strategies, which results in forgiveness. Couples taught about the destructive role of avoidance in maintaining stress disorder and communication disorders and communication skills. Increasing mutual connection as a way to avoid injury-related emotional numbness led to increased forgiveness. Communication skills are trained and practiced over several sessions to help couples recognize and participate in their feelings and to pay attention
to the ways that affect their thoughts, feelings,
and behaviors. The couples, then, use these communication skills to discuss the content related to the disorder and problem-solving, which increased their intimacy and forgiveness. This is while CBT is more task-oriented, and has been more successful in treating anxiety and depression problems and less effective in improving emotions than the EFT approach. This finding shows that in addition to emotional awareness, forgiveness requires the ability to play a more highlighted role in emotional regulation, which has been considered in EFT. The results of this study can be used in the field of treatment and counseling. Since the phenomenon of infidelity causes wounds of attachment, the treatment methods of this method need to be changed and updated, and the information in this study can be used to improve the information in this field by counselors and families. The researcher in the present research process faced limitations that may have affected the quality of the research. Coinciding with the outbreak of COVID-19, this study caused problems such as lack of direct access to participants in the follow-up phase, which forced the researcher to use online questionnaires. In this study, women affected by infidelity were examined. Due to the implementation of treatment sessions by one therapist, it was possible to have skills and expertise in one treatment more than the other. This may have influenced the research findings. In this study, the level of primary mental health of the participants was not assessed. This difference may play a role in the effectiveness of treatments or the severity of the problems. Another limitation of the study was the small number of samples which was limited to a hospital in a city. Hence, caution should be exercised in generalizing the results. One of the limitations beyond the researcher's control was that random sampling was not possible. On the other hand, forgiveness and intimacy are culture-bound, while there is no questionnaire with negative content in this regard.
Conclusion
Overall, the results revealed that CBT and EFT were effective in improving the marital relationship of betrayed women. These two treatments can be used to improve couples' relationships after infidelity. Differences in the effectiveness of these approaches also show that the effectiveness of each of the treatments used can be different in different dimensions. So, different treatments can be used based on the client's condition. The therapist's experience during the research, and according to the couple's background, sexual relations played an effective role in men's tendency towards infidelity. Therefore, it is suggested that in addition to using techniques such as therapy and cognition and focusing on emotions, the process of sexual intercourse and the problems of this issue should be addressed in order to prevent future breaches in the holy bond of marriage. It is suggested that the couple under therapy use an integrated approach for people affected by infidelity according to their background problems and personal characteristics. This can make the most positive changes in clients' relationships
Acknowledgment
The authors would like to thank the couples who participated in the study and cooperated during the research. This research was derived from the doctoral dissertation of psychology.
Conflict of interest
The authors declared no conflict of interest.
Author's contribution
All authors contributed equally in this study
Ethical considerations
To implement ethical interventions in the present study, the ethical codes proposed by the APA (2003), and the Organization of the Psychological and Counseling System of the Islamic Republic of Iran (2006) were considered. Accordingly, the following components were observed for all patients:
Participating in the study (at each stage of the study): participating in each stage of the study, respect for human dignity and freedom; conscientiousness and responsibility; usefulness and having no harm; non-discrimination; paying attention to the welfare of others and to the value system of society.
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Review: Research |
Subject:
Health education
Received: 2022/06/30 | Accepted: 2022/12/19 | Published: 2022/12/19
Received: 2022/06/30 | Accepted: 2022/12/19 | Published: 2022/12/19
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