Comparison of the Effectiveness of Group Therapies “Emotional Freedom Techniques (EFT), Adolescent-Centered Mindfulness Therapy (ACMT) and Dialectical Behavior Therapy (DBT)” on the Emotion Regulation in Adolescents with Disruptive Mood Dysregulation Disorder (DMDD)
Keywords:
EFT, ACMT, DBT, Emotion regulation, DMDDAbstract
Background: The present study was conducted with the aim of comparison of the effectiveness of group therapies “emotional freedom techniques (EFT), adolescent-centered mindfulness therapy (ACMT) and dialectical behavior therapy (DBT)” on the emotion regulation in adolescents with disruptive mood dysregulation disorder (DMDD).
Methods: The research was semi-experimental in three stages: pre-test, post-test and two-month follow-up with the control group. The statistical population of all adolescents aged 15 to 18 years had symptoms of DMDD in the high schools of NajafAbad province in the academic years of 2023 and 2024. For this aim, using multi-stage cluster random sampling method, 600 students were screened from among the high schools of the 2nd education district by implementing the DMDD Questionnaire of Laporte et al. were randomly assigned to three experimental groups (20 each) and a control group (20). The people of the experimental groups participated in parallel and simultaneous group therapies of EFT, ACMT and DBT; But for the control group, there was no intervention. The measurement tool was Gratz and Roemer (2004) emotion regulation difficulty questionnaire. To analyze the data, the statistical method of analysis of variance with repeated measures and Bonferroni's post-hoc test was used in SPSS-26 software.
Results: In the intergroup comparison, all three therapy methods were effective in reducing the difficulty in emotions regulating of with symptoms of DMDD in the post-test stage (p<0.001) and their effectiveness remained in the follow-up stage (p<0.001). There was no significant difference between the three therapy methods (p>0.01).
Conclusion: The results of the research showed that group therapies of EFT, ACMT and DBT have the same effectiveness in reducing the difficulty in emotions regulation of adolescents with DMDD. Therefore, considering the lasting effect of all three group therapies, it is recommended to use them in medical and educational service centers for with symptoms of DMDD.
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References
Ahmadian, A., Momeni, K., & Karami, J. (2024). The Effectiveness of dialectical behavior therapy on reducing irritability and aggression in adolescents with disruptive mood dysregulation disorder. Journal of Modern Psychological Researches, 19(73), 96-106. https://psychologyj.tabrizu.ac.ir/article_17456.html?lang=en
Behan, C., & Kelly, B. (2025). Handbook of compassion in healthcare: a practical approach. Royal College of Surgeons in Ireland. https://repository.rcsi.com/articles/book/Handbook_of_compassion_in_healthcare_a_practical_approach/29581274?file=56317664
Bruno, A., Celebre, L., Torre, G., Pandolfo, G., Mento, C., Cedro, C., Zoccali, R. A., & Muscatello, M. R. A. (2019). Focus on Disruptive Mood Dysregulation Disorder: A review of the literature. Psychiatry research, 279, 323-330. https://pubmed.ncbi.nlm.nih.gov/31164249/
Bud, S., Nechita, D., & Szentagotai Tatar, A. (2023). Emotion regulation strategies in borderline personality disorder: a meta-analysis. Clinical Psychologist, 27(2), 142-159. https://psycnet.apa.org/record/2023-53526-001
Choi, Y., Kim, Y., Kwon, D.-H., Choi, S., Choi, Y.-E., Ahn, E. K., Cho, S.-H., & Kim, H. (2024). Feasibility of emotional freedom techniques in patients with posttraumatic stress disorder: a pilot study. Journal of Pharmacopuncture, 27(1), 27. https://pubmed.ncbi.nlm.nih.gov/38560335/
Debra Burdick, L. (2014). Mindfulness skills for kids & teens: A workbook for clinicians & clients with 154 tools, techniques, activities & worksheets. PESI Publishing & Media. https://books.google.co.il/books/about/Mindfulness_Skills_for_Kids_Teens.html?id=GbQ7BgAAQBAJ&redir_esc=y
Diagnostic, A. (2013). Statistical manual of mental disorders: DSM-5 (ed.) Washington. DC: American Psychiatric Association. https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
Fombouchet, Y., Pineau, S., Perchec, C., Lucenet, J., & Lannegrand, L. (2023). The development of emotion regulation in adolescence: What do we know and where to go next? Social Development, 32(4), 1227-1242. https://psycnet.apa.org/record/2023-73281-001
Goldstein, S., Brooks, R. B., Rooney, D. D., & Anthony, M. (2025a). The Eight Guideposts for Raising Emotionally Resilient Children with DMDD. In Finding the Calm Child Within: Raising Resilient Children with Disruptive Mood Dysregulation Disorder (pp. 35-49). Springer. https://link.springer.com/chapter/10.1007/978-3-031-90646-6_3
Goldstein, S., Brooks, R. B., Rooney, D. D., & Anthony, M. (2025b). Understanding DMDD. In Finding the Calm Child Within: Raising Resilient Children with Disruptive Mood Dysregulation Disorder (pp. 11-34). Springer. https://www.researchgate.net/publication/392936028_Understanding_DMDD
Goldstein, T. R., Merranko, J., Rode, N., Sylvester, R., Hotkowski, N., Fersch-Podrat, R., Hafeman, D. M., Diler, R., Sakolsky, D., & Franzen, P. (2024). Dialectical behavior therapy for adolescents with bipolar disorder: A randomized clinical trial. JAMA psychiatry, 81(1), 15-24. https://pubmed.ncbi.nlm.nih.gov/37703037/
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26(1), 41-54. https://psycnet.apa.org/record/2004-16349-005
Greenberg, L. S. (2017). Emotion-focused therapy. American Psychological Association. https://books.google.co.il/books/about/Emotion_focused_Therapy.html?id=gLYKDQEACAAJ&redir_esc=y
Gupta, M., & Gupta, N. (2022). Disruptive mood dysregulation disorder: Does variance in treatment responses also add to the conundrum? The widening gap in the evidence is a signal needing attention. CNS spectrums, 27(6), 659-661. https://pubmed.ncbi.nlm.nih.gov/34789360/
Hatchett, G. T. (2022). Treatment Planning Strategies for Youth with Disruptive Mood Dysregulation Disorder. Professional Counselor, 12(1), 36-48. https://eric.ed.gov/?id=EJ1334298
Herbein, M., Barbosa, S., Collet, O., Khalfallah, O., Navarro, M., Bailhache, M., Aouizerate, B., Sutter-Dallay, A.-L., Koehl, M., & Capuron, L. (2024). Cord serum cytokines at birth and children's trajectories of mood dysregulation symptoms from 3 to 8 years: The EDEN birth cohort. Brain, Behavior, & Immunity-Health, 38, 100768. https://pubmed.ncbi.nlm.nih.gov/38586283/
Hershkovich-Elgavi, A. (2025). Culturally Concordant DBT STEPS-A Intervention in Orthodox Jewish Schools. Montclair State University. https://digitalcommons.montclair.edu/etd/1491/
Homayoon, M. N., Samarein, Z. A., Sadeghi, M., & Hatami, M. (2024). Comparing the Efficacy of Emotion-Focused Therapy and Transcranial Direct Current Stimulation On Impulsivity, Emotion Regulation, And Suicidal Ideation In Young People With Borderline Personality Disorder. https://jrp.uma.ac.ir/article_2930.html
Joseph, R. Y. (2022). Exploring the Effect of a Sensory-Based Intervention on Occupational Participation and Anxiety in Child Victims of Trauma Within the South African Context University of the Witwatersrand, Johannesburg (South Africa)]. https://wiredspace.wits.ac.za/items/ff123dd3-0d8f-427a-9f45-6df269836438
Karbalaie, M., Yazdanbakhsh, K., & Moradi, A. (2024). Investigating the Effectiveness of Emotion-Focused Cognitive-Behavioral Therapy (ECBT) on the Worry and Anxiety Sensitivity Anxiety Children. Journal of Modern Psychological Researches, 19(73), 150-159. https://psychologyj.tabrizu.ac.ir/article_17980.html
Karimi, Z., Nourimoghadam, S., & Mazaheri, M. (2023). The Effectiveness of Mindfulness Therapy on Dysfunctional Attitudes of Covid-19. https://rjms.iums.ac.ir/article-1-8023-en.html
Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological medicine, 51(7), 1057-1067. https://pubmed.ncbi.nlm.nih.gov/33875025/
Laporte, P. P., Matijasevich, A., Munhoz, T. N., Santos, I. S., Barros, A. J., Pine, D. S., Rohde, L. A., Leibenluft, E., & Salum, G. A. (2021). Disruptive mood dysregulation disorder: Symptomatic and syndromic thresholds and diagnostic operationalization. Journal of the American Academy of Child & Adolescent Psychiatry, 60(2), 286-295. https://pubmed.ncbi.nlm.nih.gov/32004697/
Lin, Y.-J., Tseng, W.-L., & Gau, S. S.-F. (2021). Psychiatric comorbidity and social adjustment difficulties in children with disruptive mood dysregulation disorder: A national epidemiological study. Journal of affective disorders, 281, 485-492. https://doi.org/10.1016/j.jad.2020.12.039
Mancinelli, E., Cottu, M., & Salcuni, S. (2024). Validation of the Difficulties in Emotion Regulation Scale‐Short Form in a sample of Italian adolescents. Journal of Clinical Psychology, 80(11), 2209-2227. https://pubmed.ncbi.nlm.nih.gov/38970816/
Marashi, S., Bahramipour Isfahani, M., & Golparvar, M. (2023). Comparing the Effectiveness of a Package Containing Ability to Enjoy, the PERMA Well-Being Model, and the Time Perspective on the Academic Vitality of Veterans' Children. Iranian Journal of War and Public Health, 15(3), 241-247. https://ijwph.ir/browse.php?a_id=1350&sid=1&slc_lang=en
Mohammadi, M. R., Alavi, S. S., Ahmadi, N., Khaleghi, A., Kamali, K., Ahmadi, A., Hooshyari, Z., Jaberghaderi, N., Nazaribadie, M., & Farshidfar, Z. (2019). The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression. Journal of affective disorders, 247, 1-10. https://www.sciencedirect.com/science/article/abs/pii/S0165032718317981
Pashangian F, Moradi A, & A., E. (2022). Psychometric properties of the Iranian version of the DMDD questionnaire. J Psychol Behav Sci, 14(2), 87-104.
Pourjafari, P. M., Sadek, M., Paramasivam, T., & Daros, A. R. (2025). How Well Does the Difficulties in Emotion Regulation Scale Measure Emotion Dysregulation Beyond Psychopathology? A Scoping Review and Synthesis of its Construct Validity. Journal of psychopathology and behavioral assessment, 47(2), 46. https://link.springer.com/article/10.1007/s10862-025-10224-w
Quill, E. H. (2024). Attachment Theory in Practice: Practical Applications of Emotionally Focused Therapy (EFT) for Individuals, Couples, and Families. Jstone Publishing. https://books.google.com/books/about/Attachment_Theory_in_Practice.html?id=R1kdEQAAQBAJ
Shayegh Borojeni, B., Manshaee, G., & Sajjadian, I. (2019). Comparing the effects of teen-centric mindfulness and emotion regulation trining on aggression and anxiety in type II with bipolar disorder female adolescent. Psychological Achievements, 26(2), 67-88. https://psychac.scu.ac.ir/article_15226.html?lang=en
Shogren, N. P., Tirpak, J. W., Porter, N. P., Kaplan, C., Ronzio, B., Au, J. S., & Fruzzetti, A. E. (2025). Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder: Emotion Dysregulation, Abuse, and Treatment Outcomes. Evidence-Based Practice in Child and Adolescent Mental Health, 10(1), 33-45. https://pubmed.ncbi.nlm.nih.gov/40406511/
Smith, K. S., Kinsella, E. A., Moodie, S., McCorquodale, L., & Teachman, G. (2023). Mindfulness and therapeutic relationships: a phenomenological inquiry into paediatric occupational therapists’ practices. Scandinavian Journal of Occupational Therapy, 30(8), 1441-1450. https://www.tandfonline.com/doi/full/10.1080/11038128.2023.2217670
Tircuit, G. E. (2021). Disruptive Mood Dysregulation Disorder in the Classroom Walden University]. https://scholarworks.waldenu.edu/dissertations/10553/
Treier, A.-K., Döpfner, M., Ravens-Sieberer, U., Görtz-Dorten, A., Boecker, M., Goldbeck, C., Banaschewski, T., Aggensteiner, P.-M., Hanisch, C., & Ritschel, A. (2024). Screening for affective dysregulation in school-aged children: relationship with comprehensive measures of affective dysregulation and related mental disorders. European Child & Adolescent Psychiatry, 33(2), 381-390. https://pubmed.ncbi.nlm.nih.gov/36800039/
Urben, S., Ochoa Williams, A., Ben Jemia, C., Rosselet Amoussou, J., Machado Lazaro, S., Giovannini, J., Abi Kheir, M., Kaess, M., Plessen, K. J., & Mürner-Lavanchy, I. (2025). Understanding irritability through the lens of self-regulatory control processes in children and adolescents: a systematic review. European Child & Adolescent Psychiatry, 34(5), 1497-1509. https://pubmed.ncbi.nlm.nih.gov/39379596/
Van Berkel, A. S. (2023). Change is the only constant: How Dialectical Behavior Therapy (DBT) can be made more culturally responsive across treatment settings. https://encompass.eku.edu/psych_doctorals/21/
Vogl, P., Methlagl, M., & Hanfstingl, B. (2025). A systematic review of strategies, contexts and outcomes of emotion regulation in teaching. Discover Psychology, 5(1), 1-29. https://link.springer.com/article/10.1007/s44202-025-00417-5
Wei, A., Navarro, M., Yeager, V., Goubran, B., & Moran, R. A. (2023). Naltrexone as an adjunctive treatment for adolescents with deliberate self-harm behavior and cannabis use: A case series. Consultant, 63(2), e1. https://www.consultant360.com/taxonomy/term/85382
