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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 146-152

The comparative effectiveness of parental behavior management training and schema therapy on aggression and oppositional defiant in adolescents


Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran

Date of Submission17-Jan-2020
Date of Decision19-Feb-2020
Date of Acceptance03-Mar-2020
Date of Web Publication23-Jul-2020

Correspondence Address:
Dr. Parviz Askary
Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNMS.JNMS_6_20

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  Abstract 

Context: Adolescents with conduct disorder have many problems in oppositional defiant and aggressive behaviors, which can be exacerbated by not treating these problems.
Aims: The purpose of this study was to evaluate the comparative effectiveness of parental behavior management training and schema therapy on aggression and oppositional defiant in adolescents.
Settings and Design: This was a semi-experimental study with two experimental and control groups with pre- and posttest plan.
Materials and Methods: The statistical population of this study included all 63 adolescents girls and boys with conduct disorder in Ahvaz city in 2019, that using the voluntary sampling method, 45 of them were selected and randomly divided into two experimental groups and one control group (each group of 15 people). To collect the data of aggression questionnaire of Buss and Perry (1992) and oppositional defiant questionnaire of Harada et al. (2004) was used. The experimental groups underwent parental behavior management training (9 sessions 60 min) and group schema therapy (8 sessions 90 min), but the control group received no training.
Statistical Analysis Used: The collected data were analyzed using analysis of covariance using the SPSS version 24.
Results: The results showed that parental behavior management training had a greater effect than group schema therapy on the improvement of aggression and oppositional defiant (P < 0.01).
Conclusions: Parental behavior management training has more effectiveness on reducing aggression and coping disobedience and it can have practical implications for therapists.

Keywords: Aggression and oppositional defiant, Group schema therapy, Parental behavior managementtraining


How to cite this article:
Mohammad Hasani S, Askary P, Heidari A, Ehtesham Zadeh P. The comparative effectiveness of parental behavior management training and schema therapy on aggression and oppositional defiant in adolescents. J Nurs Midwifery Sci 2020;7:146-52

How to cite this URL:
Mohammad Hasani S, Askary P, Heidari A, Ehtesham Zadeh P. The comparative effectiveness of parental behavior management training and schema therapy on aggression and oppositional defiant in adolescents. J Nurs Midwifery Sci [serial online] 2020 [cited 2020 Aug 12];7:146-52. Available from: http://www.jnmsjournal.org/text.asp?2020/7/3/146/290544


  Introduction Top


Adolescence is a period of development that produces vast changes in cognitive, emotional, and behavioral spans of individuals.[1] Many behavioral problems occur in adolescents in these conditions.[2] Since behavioral and emotional patterns in adulthood are difficult to change, therapists emphasize the importance of early diagnosis and treatment of mental health problems in children and adolescents.[3] One of the common disorders of this period is conduct disorder.[4] The existence of three types of age-related behaviors such as threatening other individuals, causing panic in other persons, and returning late to home indicates the existence of conduct disorder.[5],[6] In addition, the prevalence of this disorder was higher in boys than in girls and is reported to be 13% in 8–16-year-old persons.[7] Following conduct disorder, other disorders will be developed in adolescents too. One of these disorders is aggression.[8] Aggressive behavior is one that is intended to harm oneself or other individuals.[9] In a definition by Juárez-Treviño et al.,[10] aggression is defined as the unpleasant internal feeling within each person. It is often accompanied by intensity and frequency to do verbal, nonverbal, or anti-cultural or immoral physical behaviors.[11] Some researchers attribute the failure as the main cause of aggression emergence that is resulted from annoying events in the individual,[4] and some others consider the conditionality of adolescents, which is conducted in mediation by the environment, as an important factor in aggression emergence.[12],[13] Another disorder, which gets developed in adolescence following conduct disorder, is coping disobedience disorder. This disorder is a prominent pattern of hostile behaviors against power references.[14] These persons have problems in the classroom and in relationships with peers.[15] Early childhood disobedience is associated only with pertinacity, while it occurs more intensively in adolescence,[16] so that they argue more intensively.[17],[18]

On the other hand, no single factor can justify a child's conduct disorder, but many biological, psychological, and social factors contribute to the development of the disorder.[19] One of the most fundamental problems in children with conduct disorder can be parental disability in child's correct control.[20] Tyrannical parenting without paying proper attention to children's desirable behaviors increases the child's aggressive behaviors.[21],[22] Therefore, psychological treatments such as behavior modification methods and parental behavioral training have been considered.[23] However, these interventions often emphasize on improving the relationships between caregivers and children.[24] Teaching parental behaviors to parents cause them to monitor these behaviors and reinforce affirmative behaviors by recognizing events and consequences of their children's inappropriate behaviors.[25],[26] Another treatment approach for parents is schema therapy.[27] Schemes are patterns and general motif schemes from cognitive-emotional experience of an event that can help improve the persons' life situation significantly by altering or modifying the maladaptive schemas in psychotherapy process.[28],[29] In this regard, Zeinali et al. (2016) and Shah Ali Nia showed that parents' training has an impact on reducing the symptoms of conducts disorder and aggression in adolescents.[30],[31] Hemmati Sabet et al. (2016) showed that schema therapy impacts on decreasing aggression and social anxiety in adolescents.[32] Goli et al. (2016) showed that schema therapy has an effect on aggression.[33] Bearss et al. and Kazdin et al. concluded in research that parental behavioral management training was effective in reducing their children's aggression.[34],[35] Previous studies have confirmed the efficacy of these two therapies. Therefore, in order to help the therapeutic process to determine the most therapeutic effect of each of these therapies, it is necessary to conduct this research. This can ultimately help in the treatment of adolescents with conduct disorder. Not treating the adolescents with conduct disorder can impact on creating other disorders, and conducting this research seems to be necessary considering the importance of two treating methods of parenting behavior management training and schema therapy and lack of comparison of these two intervention methods on aggression and coping disobedience in adolescents with conducts disorder. Therefore, the main question of the research is that, is there a significant difference between effect parental behavior management training and group schema therapy on aggression and coping disobedience in adolescents with conducts disorder?


  Material and Methods Top


The research methodology was a semi-experimental study with pre- and posttest plan with the control group. The statistical population of this research included 63 female and male adolescents with conduct disorder with records in the Department of Education Clinic in District 2 located in Ahvaz city in 2019. Of all the 63 individuals, 45 were selected first using the voluntary sampling method, and then randomly divided into two experimental groups and one control group (each group of 15 people).

Inclusion criteria for parents

Having adolescents with conduct disorder, at least cycling literacy, in the age group of 2–4 years.

Exclusion criteria for parents

Absence at two consecutive sessions, whenever they wish to exclude the investigation.

Inclusion criteria for adolescents

Higher-than-average grade in aggression and coping disobedience questionnaires, age between 13 and 16 years, not receiving other treatments, lack of existence of another disorder, and not consuming any drugs concurrently by psychiatrist diagnosis based on criteria DSM5.

Exclusion criteria for adolescents

Absence at two consecutive sessions, withdrawal by the diagnosis of psychologist and psychiatrist of the center based on criteria DSM5, whenever they wish to exclude the investigation.

After obtaining permission from the university and the educational organization, meetings were held at the Department of Education Clinic. Before the sampling was started, explanations of the purpose of the study and confidentiality were given to the individuals. First, consent was obtained from the parents of adolescents, and then, a pretest was received from both groups. The first experimental group was under the parental behavior management intervention and the second experimental group under the group schema therapy training but the control group received no training in parental behavior management and group schema therapy. After ending the training sessions, the experimental and control groups received the same posttest in the same circumstances. It took about 20 min to fill in the data collection form used in the study. Then, the interventions were performed by an expert psychotherapist. After collecting pre- and posttest data, the collected data were analyzed using the multivariate analysis of covariance statistical tests in the SPSS software version 24 (SPSS Inc., Chicago, Illinois, USA). Furthermore, the results were assessed within a confidence interval of 95% and at a statistical significance level of P < 0.05.

Summary of parental behavior management sessions

In accordance with the [Table 1], the parental behavior management training program was developed by Kazdin[20] and was executed on the experimental group in eight 60-min weekly sessions.
Table 1: Parental behavior management training program

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Summary of Schema therapy

In accordance with the [Table 2], Summary of group schema therapy sessions – schema-based group intervention based on Young's schema-therapy techniques and guideline[36] was executed on the experimental group in eight 60-min weekly sessions.
Table 2: Schema therapy sessions

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Research tools

Aggression questionnaire

The Buss and Perry Aggression Questionnaire[37] is composed of thirty questions. It has an overall score. The questionnaire's scoring method is in four-choice Likert style ranging from never, rarely, sometimes, and always (0, 1, 2, and 3). The construct validity of the questionnaire was confirmed by its developers and the reliability was reported to be 0.86 in Cronbach's alpha method, respectively. In Iran, Akbari Balotbangan et al.[38] confirmed the validity, and the reliability in Cronbach's alpha method was reported to be 0.85. Cronbach's alpha coefficient was 0.80 at the present research.

Coping disobedience questionnaire

Harada et al.'s[39] Coping Disobedience Questionnaire has 18 questions. It has an overall score, each question of the questionnaire has the option of “rarely, once or less per month,” “sometimes, once a week,” “often, two or three times a week,” “always, four times in a week or more” (0, 1, 2, 3). The scores range from 0 to 54. The construct validity of the questionnaire was confirmed by its developers and the reliability in Cronbach's alpha method was reported to be 0.84, respectively. In the research of Hamid et al.,[40] the validity was confirmed, and the reliability was reported to be 0.81 in Cronbach's alpha method. Cronbach's alpha coefficient was 0.78 at the present research.


  Results Top


[Table 3] shows the mean and standard deviation of the research variables of the experimental and control groups in pre- and posttest. The Shapiro–Wilk test was confirmed for the data normality investigation. In addition, Levin test, Box test, and regression line slope homogeneity were used for the homogeneity of variances assumption, and the nonsignificance of these tests indicates compliance with the homogeneity of variances assumption.
Table 3: Mean and standard deviation of research variables in the experimental and control groups in pre- and posttest

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As shown in [Table 4], the F-ratio of covariance analysis for the dependent variables shows that there is a significant difference in aggression and coping disobedience variables between the “parental behavior management” training groups, “group schema therapy,” and control group.
Table 4: Results of multivariate analysis of covariance on coping disobedience and aggression posttest marks

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With regard to the results of [Table 5], the mean difference of parental behavior management training group with the control group is more than the one between the group schema therapy group and control group, which shows that parental behavior management training method has more effectiveness on reducing the aggression and coping disobedience than the group schema therapy.
Table 5: Bonferroni follow-up test results to compare the differences in the posttest phase

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  Discussion Top


The purpose of the present research was to compare the effectiveness of parental behavior management training and group schema therapy on aggression and coping disobedience in adolescents with conduct disorder. The results of this study are in line with the findings of some researches. Zeinali et al. (2016) showed that training the parents has an effect on reducing the symptoms of conduct disorder and aggression in adolescents.[30] In another research, Shah Ali Nia showed that parental behavior management training affects the mothers of children with disobedience and pertinacity disorder.[31] Hemmati Sabet et al. (2016) showed that schema therapy impacts on decreasing aggression and social anxiety in adolescents.[32] Goli et al. (2016) showed that schema therapy has an effect on aggression.[33] Bearss et al. concluded in the research that parental behavioral management training impacted on reducing their children's aggression.[34] Kazdin et al. concluded that parenting behavioral management training impacts on changing the behavior of the involved children.[35]

In explaining the results of this research, it can be said that parental behavior management training is a preventive and effective approach to reduce aggression and coping disobedience and enables the parents to learn adaptive skills to cause a reduction in aggression and coping disobedience in their children in this way.[25] The results of this research showed that parental behavior management training is one of the most effective therapeutic methods in which the parents learn how to cope with conducts disorder in their child and to reduce conflicting behavior toward their child to prevent further deterioration of the circumstances.[41] This training causes the parents' behavioral performance to improve and their stress on their child to reduce and thereby it causes an improvement in adaptation and a reduction in the children's behavioral problems such as conducts disorder, aggression, and coping disobedience.[42]

The more effectiveness of parental behavior management training can be explained by the fact that since the parents' inability to manage the child behavior and negative parent–child interaction is among the factors influencing the children's behavioral problems[19] and with regard to the fact that psychologists believe that parenting is a complex activity and an exclusive behavior and applying it can change the child's behavior, feeling and expectations, and his/her emotional and behavioral adaptation at all stages of development.[21] It can be said that children's behavioral problems are often due to the way parents communicate with the child than to biological or hereditary factors.[43] Parental behavioral management training has enabled the parents group under this treatment to improve their relationships with children with conducts disorder and adaptation with them and to reduce aggression and coping disobedience disorder in their children more than schema therapy. The studies' results showed that there is a significant relationship between parents' misconduct and behavioral problems in children and it indicates the fact that the family factor and especially parents' behavior during childhood play an important role in the emergence of behavioral problems in childhood and adulthood.[26] Since the children have the most interaction with their parents during the childhood period, parents can certainly play a decisive role in improving their children's behavioral disorders.[34] Therefore, parents' training is one of the effective ways to treat the children's behavioral problems. On the other hand, parents' training, which is the best intervention method to reduce the symptoms of adolescent's coping disobedience disorder,[44] causes a reduction in parents' incompetency and decrease in parents' stress levels, neutralization of parents' negative feedbacks, and a reduction in conflicts between the parents and increases parents' skill levels in managing child behavior and parental use of positive disciplinary methods, and consequently, the coping disobedience behavior in the child decreases.

This research was limited to male and female adolescents with conduct disorder. The impossibility of follow-up due to lack of access to samples, Ahvaz city and time interval of 2019 were the other limitations of this research.


  Conclusions Top


The results of this research showed that both parental behavior management training and group schema therapy impacted on reducing aggression and coping disobedience. In addition, comparing the posttest results of the two experimental groups showed that the effectiveness of parental behavior management training was more than the group schema therapy. With regard to the effectiveness of two methods of parenting behavior management training and group schema therapy, especially the more effectiveness of parenting behavior management training, it is suggested to make parents familiar with these strategies and trainings in training workshops and courses to cause a reduction in aggression and coping disobedience in adolescents with conducts disorder. Other researchers are advised to increase the power of generalization of results to the target population by repeating this study and also select cognitive variables such as memory and concentration as dependent variables.

Conflicts of interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

Authors' contribution

All authors contributed equally.

Acknowledgments

This research was also registered with the institutional ethics code IR.IAU.AHVAZ.REC.1398.042 at at Islamic Azad University of Ahvaz Branch.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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