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Karami K, Emami M, Noorafkan F, Pouraghaei Dizji M, arab A, Gholamipour N. (2025). Comparing the Effects of Emotion-focused Individual Therapy and Schema Therapy on PTSD, Complex Trauma, and Suicidal Ideation in Sexually Abused Adolescents. Journal of Childhood Health and Education. 6(3), 492-509. doi:10.32598/JECHE.6.3.394.1
URL: http://jeche.ir/article-1-354-en.html
URL: http://jeche.ir/article-1-354-en.html
Khadijeh Karami1 
, Masoumeh Emami2 , Fahimeh Noorafkan3 , Masoumeh Pouraghaei Dizji4 , Ali Arab *5 , Niloufar Gholamipour6
, Masoumeh Emami2 , Fahimeh Noorafkan3 , Masoumeh Pouraghaei Dizji4 , Ali Arab *5 , Niloufar Gholamipour6
1- Department of Clinical Psychology, Ilam Branch, Islamic Azad University, Ilam, Iran.
2- Department of Psychology of Assessment and Measurement, Central Tehran Branch, Islamic Azad University, Tehran, Iran.
3- Department of Psychology, Tabriz Branch, Islamic Azad University, Tabriz, Iran.
4- Department of Clinical Psychology, Research Sciences Branch, Islamic Azad University, Azerbaijan, Iran.
5- Department of Psychology, Faculty of Social Sciences and Psychology, University of Sistan and Baluchestan, Zahedan, Iran.
6- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Shahid Bahonar University, Kerman, Iran.
2- Department of Psychology of Assessment and Measurement, Central Tehran Branch, Islamic Azad University, Tehran, Iran.
3- Department of Psychology, Tabriz Branch, Islamic Azad University, Tabriz, Iran.
4- Department of Clinical Psychology, Research Sciences Branch, Islamic Azad University, Azerbaijan, Iran.
5- Department of Psychology, Faculty of Social Sciences and Psychology, University of Sistan and Baluchestan, Zahedan, Iran.
6- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Shahid Bahonar University, Kerman, Iran.
Keywords: Emotion-focused therapy, Schema Therapy, Post-traumatic Disorder, Complex Trauma, Suicidal ideation, Sexual abuse, Adolescents
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Introduction
Adolescence is a sensitive developmental stage marked by identity formation and emotional volatility. Experiencing sexual abuse during this period can have profound and everlasting psychological consequences. Given the growing prevalence of sexual violence among adolescents, identifying effective interventions is crucial to mitigate long-term harm and foster resilience. Early, structured, and empathetic psychological intervention can prevent the consolidation of maladaptive emotional and behavioral patterns.
Therapies that address both emotional and cognitive dimensions, such as emotion-focused individual therapy (EFIT) or schema therapy (ST), can help adolescents process traumatic experiences, rebuild self-worth, and restore interpersonal trust. Treatment of complex trauma and suicidal ideation in sexually abused adolescents has rarely been examined through EFIT or ST. To date, no study has directly compared these two therapeutic approaches in this vulnerable population. Hence, this research seeks to fill this important empirical and clinical gap and compare their effectiveness in reducing symptoms of post-traumatic stress disorder (PTSD), complex trauma, and suicidal ideation among sexually abused adolescents in Iran.
Research Methods
In this quasi-experimental study, the study population consisted of sexually abused adolescents in Ilam, Tehran, and Tabriz cities in 2025. Using the GPower software and considering α=0.05, and effect size=0.15, the total sample size was determined to be 60 (20 per group). The adolescents were selected via purposive sampling and randomly assigned to two intervention groups and one control group. Inclusion criteria were the experience of sexual abuse, consent to participate in the study, parental permission, and not receiving concurrent therapy. Exclusion criteria were missing two sessions or failing to complete therapeutic tasks. The assessment tools included the Mississippi scale for combat-related PTSD (MCCP), the Childhood Trauma Questionnaire (CTQ), and the Adolescent Suicidal Ideation Questionnaire (ASIQ).
The EFIT group received ten 90-minute sessions based on an emotion-focused individual approach, focused on identifying, expressing, and transforming core emotions through therapist-guided dialogue and emotion processing tasks. The ST group underwent ten 90-minute sessions based on Yang's model, focused on identifying maladaptive schemas, cognitive restructuring, and corrective emotional experiences. The control group received no intervention during the study period but was later offered counseling. Data were analyzed using ANCOVA, ANOVA, and independent t-test in SPSS sofware, version 26, considering a significance level set at 0.05.
Results
Based on the mean scores, the EFIT and ST groups showed greater reductions than the control group across all three variables, and the ST group showed a smaller reduction than the EFIT group. Findings indicated a significant difference among the EFIT, ST, and control groups in post-test scores of PTSD (F=307.77, P<0.001), complex trauma (F=66.88, P<0.001), and suicidal ideation (F=107.53, P<0.001). Effect sizes for these variables were 85.1%, 55.3%, and 66.6%, respectively, demonstrating strong intervention effects. No significant difference was found between EFIT and ST groups in reducing complex trauma or suicidal ideation; however, EFIT demonstrated a superior impact on PTSD symptoms (P<0.001).
Conclusion
The emotion-focused individual therapy has a greater effect on the PTSD symptoms of sexually abused adolescents than ST; however, their effects on suicidal ideation and complex trauma are similar; both can reduce suicidal ideation and complex trauma significantly . It seems that these two approaches can be used as an effective clinical intervention, along with other relevant methods in alleviating PTSD symptoms, suicidal ideation, and complex trauma in sexually abused adolescents in counseling centers.
Among the limitations of the present study, we can indicate the use of a convenience sampling method and a small sample size. Future studies should use a larger sample of adolescents from other cities or countries, or with other disorders, such as conduct disorder, and include a follow-up stage to obtain more reliable results.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by Farhangian University in Tehran. Informed consent was obtained from all participants. They were assured of the confidentiality of their personal information and were free to leave the study at any time.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.
Authors contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interpretation of the results, and drafting of the manuscript. Each author approved the final version of the manuscript for submission.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgments
The authors would like to thank all participants for their cooperation in this study.
Adolescence is a sensitive developmental stage marked by identity formation and emotional volatility. Experiencing sexual abuse during this period can have profound and everlasting psychological consequences. Given the growing prevalence of sexual violence among adolescents, identifying effective interventions is crucial to mitigate long-term harm and foster resilience. Early, structured, and empathetic psychological intervention can prevent the consolidation of maladaptive emotional and behavioral patterns.
Therapies that address both emotional and cognitive dimensions, such as emotion-focused individual therapy (EFIT) or schema therapy (ST), can help adolescents process traumatic experiences, rebuild self-worth, and restore interpersonal trust. Treatment of complex trauma and suicidal ideation in sexually abused adolescents has rarely been examined through EFIT or ST. To date, no study has directly compared these two therapeutic approaches in this vulnerable population. Hence, this research seeks to fill this important empirical and clinical gap and compare their effectiveness in reducing symptoms of post-traumatic stress disorder (PTSD), complex trauma, and suicidal ideation among sexually abused adolescents in Iran.
Research Methods
In this quasi-experimental study, the study population consisted of sexually abused adolescents in Ilam, Tehran, and Tabriz cities in 2025. Using the GPower software and considering α=0.05, and effect size=0.15, the total sample size was determined to be 60 (20 per group). The adolescents were selected via purposive sampling and randomly assigned to two intervention groups and one control group. Inclusion criteria were the experience of sexual abuse, consent to participate in the study, parental permission, and not receiving concurrent therapy. Exclusion criteria were missing two sessions or failing to complete therapeutic tasks. The assessment tools included the Mississippi scale for combat-related PTSD (MCCP), the Childhood Trauma Questionnaire (CTQ), and the Adolescent Suicidal Ideation Questionnaire (ASIQ).
The EFIT group received ten 90-minute sessions based on an emotion-focused individual approach, focused on identifying, expressing, and transforming core emotions through therapist-guided dialogue and emotion processing tasks. The ST group underwent ten 90-minute sessions based on Yang's model, focused on identifying maladaptive schemas, cognitive restructuring, and corrective emotional experiences. The control group received no intervention during the study period but was later offered counseling. Data were analyzed using ANCOVA, ANOVA, and independent t-test in SPSS sofware, version 26, considering a significance level set at 0.05.
Results
Based on the mean scores, the EFIT and ST groups showed greater reductions than the control group across all three variables, and the ST group showed a smaller reduction than the EFIT group. Findings indicated a significant difference among the EFIT, ST, and control groups in post-test scores of PTSD (F=307.77, P<0.001), complex trauma (F=66.88, P<0.001), and suicidal ideation (F=107.53, P<0.001). Effect sizes for these variables were 85.1%, 55.3%, and 66.6%, respectively, demonstrating strong intervention effects. No significant difference was found between EFIT and ST groups in reducing complex trauma or suicidal ideation; however, EFIT demonstrated a superior impact on PTSD symptoms (P<0.001).
Conclusion
The emotion-focused individual therapy has a greater effect on the PTSD symptoms of sexually abused adolescents than ST; however, their effects on suicidal ideation and complex trauma are similar; both can reduce suicidal ideation and complex trauma significantly . It seems that these two approaches can be used as an effective clinical intervention, along with other relevant methods in alleviating PTSD symptoms, suicidal ideation, and complex trauma in sexually abused adolescents in counseling centers.
Among the limitations of the present study, we can indicate the use of a convenience sampling method and a small sample size. Future studies should use a larger sample of adolescents from other cities or countries, or with other disorders, such as conduct disorder, and include a follow-up stage to obtain more reliable results.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by Farhangian University in Tehran. Informed consent was obtained from all participants. They were assured of the confidentiality of their personal information and were free to leave the study at any time.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.
Authors contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interpretation of the results, and drafting of the manuscript. Each author approved the final version of the manuscript for submission.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgments
The authors would like to thank all participants for their cooperation in this study.
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Received: 2025/06/29 | Accepted: 2025/10/7 | Published: 2025/12/16
Received: 2025/06/29 | Accepted: 2025/10/7 | Published: 2025/12/16
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