@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2018;10(4):173-179

Background
Physical and mental disorders are as the consequences of the war for those who were directly and indirectly involved. Not only the injured person is psychologically disturbed, but also the family environment and cohesion can consequently be affected [1, 2].
Previous Studies
... [3-8]. Paying attention to the family cohesion is inevitable due to its role in the mental health of the couples and their children, as well. Precise psychological interventions and training are needed to promote this important organization, of which narrative therapy can be considered [9]. ... [10-13]. A study on the effect of group narrative therapy on the life expectancy and happiness of the elderly in Tabriz city showed that group narrative therapy sessions increased the life expectancy and happiness of the elderly in the experimental group compared with the control group [14]. In addition, the results of another study entitled “The effectiveness of narrative therapy on increasing couples intimacy and its dimensions: Implication for treatment” showed that narrative therapy significantly increases couples' intimacy as well as its three dimensions including emotional, communicative, and general intimacy in the experimental group [9]. In other words, narrative couple therapy has been effective in improving family function of the couples and its dimensions [15]. ... [16-22]. It has been shown that emotionally focused couple therapy is effective in marital satisfaction of the couples and can reduce marital conflicts among the couples [23]. The efficacy of the emotionally focused couple therapy in marital satisfaction was investigated in a study on 32 Canadian couples. The results showed that those who had higher scores in emotional control and anxiety attachment reported more significant marital satisfaction after couple therapy [24]. A study on the efficacy of emotionally focused couple therapy on increasing marital intimacy in couples entered at counseling centers in Tehran has shown that emotionally focused couple therapy techniques increases the emotional, rational, sexual, physical, communicational, socio-recreational, psychological, and spiritual intimacy as well as the overall intimacy of the couples [25]. ... [26].
Aim(s)
The aim of this study was to compare the effectiveness of narrative therapy and emotionally focused therapy on family cohesion of veterans’ wives in Khorramabad.
Research type
The present study is a semi-experimental research with pre-test and post-test design with a three-month follow-up using two experimental and one control groups.
Research society, place and time
This study was done on all veterans 'wives of the Foundation of Martyrs and Veterans Affairs in Khorramabad city in 2017.
Sampling method and number
Using available sampling method, 400 subjects were selected and following completing family cohesion questionnaire, of whom 60 subjects whose scores were lower than other participants were selected using purposive sampling method based on satisfaction and willingness to cooperate and participate in the research as the research sample. The samples were randomly divided into two experimental and one control groups (each group included 20 subjects). The inclusion criteria included at least diploma degree, the lack of participation in other therapeutic and educational program or pharmacotherapy through the intervention, no history of acute psycho-personality disorder, couples who do not live apart together or lack of bigamy in their spouses, the score lower than the average in the family cohesion questionnaire, and the willingness in participating in intervention sessions. Exclusion criteria also included being illiterate or a degree below the diploma, participation in other therapeutic and educational program or pharmacotherapy through the intervention, a history of acute psychiatric-personality disorder, couples who live apart together and bigamy in their spouses, the score above the average in the family cohesion questionnaire, and being absent for more than two sessions through the intervention.
Used devices&materials
The research tool was the family cohesion questionnaire based on a series of available documents on cohesion, adapted from the Olson combination model, by Samani in 2002. This questionnaire is a 28-item test with a Likert scale (totally agree, agree, no idea, disagree, and totally disagree) for each item. Each item is scored from 1 (totally agree) to 5 (totally disagree). The maximum score is 140 and the minimum score is 28. A preliminary study on this scale based on 8 factors, including attachment with father, mother, model of interaction, location, decision-making, emotional relationship, marital relationship, and parent-to-children relationship, indicates its effectiveness to assess the attachment between the individuals and their parents. The Cronbach's alpha coefficient obtained 0.90 and the reliability coefficient for the whole scale obtained 0.79. In another study by Samani, the internal correlation coefficient, Cronbach's alpha coefficient, and the reliability coefficient using re-test method were obtained 0.85, 0.79, and 0.80, respectively [27]. In this study, the Cronbach's alpha coefficient for the questionnaire obtained 0.84. Referring to the Foundation of Martyrs and Veterans Affairs of the Khorramabad city, the essential coordination was done with the public relations authorities and the permission letter to conduct the research was received. The subjects were informed about the confidentiality of information, and about the voluntary participation, and free therapy sessions, as well. Interventional sessions for the experimental groups were conducted by the researcher for 10 consecutive weeks and 2 hours a week. One of the experimental groups underwent narrative therapy and the other group underwent emotionally focused therapy (Table 1). Following the intervention sessions, the family cohesion questionnaire was performed as a post-test and it was re-performed three months after the intervention as a follow-up for the experimental and control groups, and the results of the three groups were compared. Intervention sessions were conducted for the control group who were willing to participate, as the ethical considerations. Data analysis was done by SPSS 20 using Shapiro-Wilk test to examine the normal distribution of scores and equality of variances in all the three groups, the Mauchly's sphericity test to examine the homogeneity assumption of variance-covariance matrix, and the repeated measures ANOVA and Bonferroni post-hoc test to examine the difference between the narrative therapy, emotionally focused therapy, and the control groups.
Findings by Text
The mean age of the veterans' wives was 49.20±3.68 years in the narrative therapy group, 48.70±3.24 in the emotionally focused therapy group, and 50.3±2.75 in the control group, and the marriage length of the subjects was between 15 and 28 years. The mean scores of the two experimental groups increased compared with the pre-test in the post-test and the follow-up, as well as compared with the post-test and follow-up of the control group (Table 2). The mean scores of family cohesion in the experimental group were significantly different in three stages: pre-test, post-test, and follow-up (F=15.41, p=0.001). The difference between the mean scores of family cohesion was not significant in the emotionally focused therapy and narrative therapy groups and the control group in the pre-test, but in the post-test and the follow-up, there was a significant difference between the narrative therapy and the control group (P=0.001), as well as the emotionally focused therapy and the control group (P=0.001), whereas there was no significant difference between the two experimental groups (Table 3).
Main comparison to the similar studies
The result of this study was consistent with the findings of Khodabakhsh et al. [9], Frost [13], Banker et al. [13], Dalgleish et al. [24], and Asadpour et al. [25]. To explain these findings, it is notable that development of alternative narratives is one of the most important elements of the narrative therapy approach that can be effective in improving family cohesion, by which individuals are more responsible about the preference of narratives of their lives [30]. To explain the efficacy of emotionally focused therapy, it can also be said that in the therapeutic sessions, accessibility and re-processing of the emotional reactions in couples' interactions, and consequently marital satisfaction and introducing reforming emotional responses are emphasized, which enhances emotional relationships and coherence in the family interactions [31].
Suggestions
It is suggested to conduct similar studies in other study population, and it is recommended to use various tools to assess family cohesion, including interviews, observing the behavior and performance of the couples at different stages of the research in order to reduce the subjects’ bias in responding and increase the internal validity. It is also suggested that the counselors and cultural planners, experts in the veterans and their families’ complications, expand couple therapy-based and narrative therapy interventions in order to raise the awareness of couples in this area and consequently to improve family function.
Limitations
The absence of the spouse at training sessions can be considered as one of the limitations of this study, since the informed couples can have an impact on reducing marital conflicts and improving family cohesion. Moreover, caution should be taken in generalizing the results, since controlling interventional variables such as age, economic status, and social status was not possible and the study population included only women.
Conclusions
Narrative therapy and emotionally focused therapy are effective in improving family cohesion in veterans’ wives.
Acknowledgments
The Foundation of Martyrs and Veterans Affairs of the Khorramabad city the veterans’ wives who participated in this study are appreciated.
Conflict of interest
None declared.
Ethical Permissions
Coordination with the Foundation of Martyrs and Veterans Affairs of the Khorramabad city was carried out and the participants’ consent was gained prior the research.
Funding Sources
This research is extracted from the Ph.D. thesis of the first author (Abbasi S.) with no financial support from any university, institute, or organization.

TABLES and CHARTS

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