The Effectiveness of Emotion-Focused Transdiagnostic Therapy on Cognitive Avoidance and Psychological Hardiness in Mothers with the Experience of Child Loss

Zahra Esmaeilzadeh

Authors

Zahra Esmaeilzadeh M.A., Department of Counseling, Refah Non‑Profit College, Tehran, Iran Author https://orcid.org/0000-0001-9295-1345

Keywords:

emotion-focused transdiagnostic therapy, cognitive avoidance, psychological hardiness, grief, bereaved mothers

Abstract

Purpose: The present study aimed to examine the effectiveness of emotion-focused transdiagnostic therapy in reducing cognitive avoidance and increasing psychological hardiness in bereaved mothers.

Methods and Materials: In terms of purpose, this was an applied study, and in terms of implementation, it was a quasi-experimental study with a pretest–posttest control-group design and a two-month follow-up phase. The statistical population included all mothers with the experience of child loss residing in Tehran in 2025 who had referred to counseling centers, psychotherapy clinics, health centers, and grief-related support associations. Using purposive and convenience sampling, 30 individuals who met the inclusion criteria were selected and, after providing informed consent, were randomly assigned to an experimental group (15 participants) and a control group (15 participants). The experimental group received emotion-focused transdiagnostic therapy in twelve weekly 60-minute sessions, whereas the control group received no intervention. The research instruments included the Cognitive Avoidance Questionnaire (Sexton & Dugas, 2008) and the Psychological Hardiness Scale (Kobasa, 1979), which were administered at the pretest, posttest, and follow-up stages. The data were analyzed using repeated-measures analysis of variance and SPSS version 27.

Findings: The results showed that emotion-focused transdiagnostic therapy significantly reduced cognitive avoidance and increased psychological hardiness in the experimental group (p < .001). Moreover, the effectiveness of the therapy was maintained at the follow-up stage, and the difference between the posttest and follow-up scores was not significant.

Conclusion: Emotion-focused transdiagnostic therapy can be an effective approach for improving emotional adjustment in bereaved mothers by reducing cognitive avoidance and strengthening psychological hardiness. It is recommended that this therapeutic model be used in grief-related supportive and clinical programs.

Downloads

Download data is not yet available.

References

Akrami, R., Amini, S., Soleimani, S., & Fathi Ashtiani, A. (2021). Psychological interventions in grief: A systematic review. Journal of New Advances in Psychology, Educational Sciences and Education(38), 95-105.

Bahar, A., Nishad, S., Gupta, U., & Gupta, N. K. (2025). Bereavement Care After Stillbirth in Uttar Pradesh: A Qualitative Analysis of the Present Situation, Challenges, and Solutions. The Journal of Obstetrics and Gynecology of India. https://link.springer.com/article/10.1007/s13224-025-02221-6

Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorder. Behavior therapy, 35(2), 205-230.

Eslahkar, S., Vaziri, S., & Lotfi Kashani, F. (2020). Determining the contribution of psychological factors in the process of facilitating grief in parents of children with cancer: A mixed-methods study. Journal of Psychological Research, 37(Fall and Winter), 64-74.

Faria, M. C. (2025). Mindset and psychological hardiness for healthy aging. In Sustainability in Aging (pp. 281-295). Springer. https://doi.org/10.1007/978-3-031-77282-5_16

Haghnazari Esfahlan, A., Yousefi, R., & Abbasi Gharibe, N. (2025). The mediating role of negative emotion regulation in the relationship between avoidance and prolonged grief symptoms. Quarterly Journal of Psychological Studies, 21(1), 25-39.

Hatamian, P., Rasoulzadeh Tabatabaei, K., Azadfallah, P., & Hasani, J. (2023). Effectiveness of indigenous transdiagnostic treatment based on emotion regulation in reducing insomnia disorder: A single-case study. Iranian Journal of Nursing Research(84), 41-51.

Kobasa, S. C. (1979). Stressful life events, personality, and health: An inquiry into hardiness. Journal of personality and social psychology, 37(1), 1-11. https://doi.org/10.1037/0022-3514.37.1.1

Lang, A., & Carr, T. (2013). Bereavement in the face of perinatal loss: A hardiness perspective. In D. S. Becvar (Ed.), Handbook of Family Resilience (pp. 299-319). Springer Science + Business Media. https://doi.org/10.1007/978-1-4614-3917-2_18

Maccallum, F., Dawson, K., Azevedo, S., & Bryant, R. A. (2023). Challenges in grief-focused cognitive behavior therapy for prolonged grief disorder. Clinical psychology review, 104, 102322. https://doi.org/10.1016/j.cbpra.2023.10.002

Maddi, S. R., & Khoshaba, D. M. (1994). Hardiness and mental health. Journal of Personality Assessment, 63(2), 265-274. https://doi.org/10.1207/s15327752jpa6302_6

Mahmoudzadeh, R., & Mohammadkhani, S. (2016). The mediating role of anxiety and cognitive avoidance in the relationship between negative perfectionism and procrastination. Journal of Psychological Achievements, 23(1), 73-94.

Parchami, Z., Najafi, M., & Khosravani, V. (2025). The relations of alexithymia to unacceptable obsessional thoughts and suicidal risk in OCD: The roles of experiential avoidance, emotional suppression, cognitive reappraisal, and depression. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 43, 49. https://doi.org/10.1007/s10942-025-00610-4

Park, S., & Kim, J. (2023). The death of an adult child and trajectories of parental depressive symptoms: A gender-based longitudinal analysis. Social Science & Medicine, 331, 116544. https://doi.org/10.1016/j.socscimed.2023.116544

Shamli, S., Chalmeh, R., & Khorramdel, K. (2021). The effectiveness of cognitive emotion regulation strategies on meaning in life and grief experience in bereaved adolescents. Journal of Women Interdisciplinary Researches, 3(1), 61-74.

Shipp, L., Leigh, E., Laverton, A., Percy, R., & Waite, P. (2025). Cognitive aspects of generalised anxiety disorder in adolescents: Exploring intolerance of uncertainty, cognitive avoidance, and positive beliefs about worry. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-025-01809-3

Ssegujja, E., Ddumba, I., & Andipatin, M. (2023). An exploration of health workers' experiences in providing bereavement care to mothers following a stillbirth: Results from a subnational level health system in Uganda. BMC Pregnancy and Childbirth, 23, 588. https://doi.org/10.1186/s12884-023-05913-x

van Teunenbroek, K. C., Mulder, R. L., Verhagen, A. A. E., Kremer, L. C. M., Falkenburg, J. L., Honig-Mazer, P., van den Bergh, E. M. M., Kars, M. C., Verheijden, J. M. A., Rippen, H., Borggreve, B. C. M., Kochen, E. M., & Michiels, E. M. C. (2025). A Dutch clinical practice guideline for paediatric palliative care: A systematic review and recommendations on psychosocial care including preloss and bereavement care. BMC Palliative Care, 24, 147. https://doi.org/10.1186/s12904-025-01763-w

Waite-Jones, J. M., & Rodriguez, A. M. (2025). Bereavement experiences in adulthood. In Psychosocial Approaches to Health and Wellbeing in Adulthood (pp. 265-292). Springer. https://doi.org/10.1007/978-3-031-88177-0_10

Yavari, F., Dortaj, F., Ghaemi, F., & Delavar, A. (2022). Comparing the effectiveness of emotion regulation therapy and schema therapy on coping styles in students with grief disorder caused by COVID-19. Journal of Islamic Lifestyle Centered on Health, 6(4), 736-745.

Zheng, X., Xie, J., Cai, R., Liu, Z., & Xu, L. (2025). Why avoidance? The impact of childhood emotional abuse on social avoidance. BMC psychology, 13, 558. https://doi.org/10.1186/s40359-025-02852-4