Comparing the Effectiveness of Emotion-Focused Therapy (EFT) and Cognitive-Behavioral Couple Therapy (CBT) in Reducing Anxiety, Depression, and Improving Relationship Quality Among Couples with Childhood Trauma
Keywords:
Emotion-Focused Therapy, Cognitive-Behavioral Couple Therapy, Childhood Trauma, Anxiety, Depression, Relationship QualityAbstract
Objective: The objective of this study was to compare the effectiveness of Emotion-Focused Therapy (EFT) and Cognitive-Behavioral Couple Therapy (CBT) in reducing anxiety, depression, and enhancing relationship quality in couples with a history of childhood trauma.
Methods and Materials: This randomized controlled trial included 45 couples (90 individuals) recruited from counseling centers in Tehran and Karaj, of whom 15 couples were assigned to EFT, 15 to CBT, and 15 to a no-treatment control group. Eligibility criteria required being married for at least two years and having at least one partner with documented childhood trauma. The interventions consisted of 8–12 weekly 60–90-minute sessions delivered by trained therapists. Standardized instruments—the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and Dyadic Adjustment Scale (DAS)—were administered at pretest, posttest, and a three-month follow-up. Data were analyzed using repeated-measures ANOVA and Bonferroni post-hoc tests in SPSS-27 to examine intervention effectiveness and between-group differences.
Findings: Repeated-measures ANOVA showed significant main effects of time, group, and time × group interactions for anxiety (F = 112.38, p < .001, η² = .79), depression (F = 118.57, p < .001, η² = .81), and relationship quality (F = 129.74, p < .001, η² = .82). Bonferroni post-hoc tests indicated that both EFT and CBT produced statistically significant improvements from pretest to posttest and from posttest to follow-up for all outcomes (all p < .05), whereas the control group showed no significant changes. Between-group comparisons revealed that EFT produced significantly greater improvements than CBT in anxiety (p = .031), depression (p = .028), and relationship quality (p = .017), and both interventions outperformed the control group across all variables (all p < .001).
Conclusion: The findings demonstrate that both Emotion-Focused Therapy and Cognitive-Behavioral Couple Therapy are effective in reducing anxiety and depression and enhancing relationship quality in couples with childhood trauma, with EFT showing consistently stronger and more sustained effects across emotional and relational dimensions.
Downloads
References
Ammari, S., Deyreh, E., Keykhosrovani, M., & Ganji, K. (2023). The Effectiveness of Couple Therapy on Depressive Symptoms and Sexual Function in Women Affected by Infidelity. Razi Journal of Medical Sciences, 29(7), 54-63. https://www.magiran.com/paper/2520730
Bahrami Moqadam, M., Afshariniya, K., & Kakabraee, K. (2023). The effectiveness of emotion-focused couple therapy on decrease of marital burnout and depression of couples. Journal of Adolescent and Youth Psychological Studies, 4(9), 47-62. https://doi.org/10.61838/kman.jayps.4.9.4
Durães, R. S. S., Khafif, T. C., Lotufo-Neto, F., & Serafim, A. D. P. (2020). Effectiveness of cognitive behavioral couple therapy on reducing depression and anxiety symptoms and increasing dyadic adjustment and marital social skills: An exploratory study. The Family Journal, 28(4), 344-355. https://doi.org/10.1177/1066480720902410
Fathi, A., Alipour, A., & Malekirad, A. A. (2023). Comparison of the effectiveness of emotion-focused couples therapy and Gottman couples therapy on sexual function, marital sexual satisfaction, and depression in infertile couples. Journal of Family Psychology, 9(2), 69-84. https://jams.arakmu.ac.ir
Forouzani, S., Norbakhsh Amiri, M., Abbasi, F., Akbarzadeh, N., & Jafari, Z. (2024). Effectiveness of Cognitive Behavioral Therapy on Psychological Hardiness and Marital Relationship Quality in Couples with Marital Conflicts. Journal of Assessment and Research in Applied Counseling, 6(2), 105-112. https://doi.org/10.61838/kman.jarac.6.2.13
Ghasemi, N., Aghayousefi, A., Sarsheikhzadeh, P., & Makhlooq, M. (2022). Effectiveness of Cognitive-Behavioral Stress Inoculation Training on Coping Skills and Quality of Life in Marital Discord Couples. Principles of Mental Health Journal, 24(3), 169-175. https://jfmh.mums.ac.ir/article_20350.html?lang=en
Ghasemi, N., Rezaei, F., & Sadeghi, M. (2022). The Effectiveness of Cognitive-behavioral Therapy on Sexual Function and Quality of Marital Relationships in Women with Sexual Interest/Arousal Disorder [Research]. Journal of nursing education, 10(3), 78-87. https://doi.org/10.22034/IJPN.10.3.78
Greenman, P. S., & Johnson, S. M. (2022). Emotionally focused therapy: Attachment, connection, and health. Current opinion in psychology, 43, 146-150. https://doi.org/10.1016/j.copsyc.2021.06.015
Javidan, L. (2022). The effectiveness of couple therapy with EIS model on positive and negative emotions and marital adjustment of couples. Journal of Psychological Dynamics in Mood Disorders (PDMD), 1(3), 20-30. https://ijpdmd.com/article_180410.html
Kashtmand, Z., & Parandin, S. (2023). Effectiveness of Group Training in Emotion-Focused Couples Therapy on Marital Adjustment and Quality of Life in Women with Marital Disputes in Islamabad Gharb. First International Conference on Psychology, Social Sciences, Educational Sciences, and Philosophy,
Kavitha, C., Rangan, U., & Kumar Nirmalan, P. (2024). Quality of Life and Marital Adjustment after Cognitive Behavioural Therapy and Behavioural Marital Therapy in Couples with Anxiety Disorders. JOURNAL of CLINICAL and DIAGNOSTIC RESEARCH, 8(8), WC01-WC04. https://pmc.ncbi.nlm.nih.gov/articles/PMC4190776/
Khajeh, A. H., Farhadi, H., & Aghaei, A. (2022). Investigating the Effectiveness of a Combined Emotion-Focused Therapy and Compassion-Based Therapy Package on Marital Quality of Life and Attachment Dimensions of Couples. Applied Family Therapy, 10. https://www.aftj.ir/article_142271.html
Kiani Chalmardi, A., Shahbazi, N., Jahanbakhshie, Z., & Ahmadbookani, S. (2022). Developing a Model for Predicting Women's Marital Satisfaction based on Parental Intervention, Perception of Parents' Marriage, Adverse Childhood Experiences, Depression and Communication Patterns. Journal of Family Research, 18(2), 265-285. https://doi.org/10.48308/jfr.18.2.265
MacIntosh, H. B., & Johnson, S. M. (2008). Emotionally Focused Therapy for Couples and Childhood Sexual Abuse Survivors. Journal of marital and family therapy, 34(3), 298-315. https://doi.org/10.1111/j.1752-0606.2008.00074.x
Mair, C., Cunradi, C. B., & Todd, M. (2012). Adverse childhood experiences and intimate partner violence: Testing psychosocial mediational pathways among couples. Annals of Epidemiology, 22(12), 832-839. https://doi.org/10.1016/j.annepidem.2012.09.003
Moqadam, M. B. (2023). The Effectiveness of Emotion-Focused Couple Therapy on Decrease of Marital Burnout and Depression of Couples. Jayps, 4(9), 32-42. https://doi.org/10.61838/kman.jayps.4.9.4
Pajari, M., Amiri, H., Hosseini, S. A.-S., & Afshari Nia, K. (2021). The effectiveness of group cognitive-behavioral couple therapy on marital relationship quality, marital intimacy, and marital depression in betrayed women. Applied Family Therapy, 2(4), 52-70. https://ensani.ir/fa/article/496262/
Parham, R. (2022). The effectiveness of emotion-focused couples therapy on marital happiness and quality of life in dual-income couples. Journal of Psychology Growth, 11(7), 220-209. https://www.researchgate.net
Parham, R. (2022). The Effectiveness of Emotionally-Focused Couple Therapy on Happiness and Quality of Married Life of Both Working Couples [Research]. Rooyesh-e-Ravanshenasi Journal(RRJ), 11(7), 209-220. http://frooyesh.ir/article-1-3938-en.html
Parsa Najad, F. (2024). The Effectiveness of Emotion-Focused Couples Therapy on Relationship Quality and Emotion Regulation of Couples Payame Noor University of Overseas Studies]. General Psychology.
Rahimi, A., Amiri, H., Afsharnia, K., & Arefi, M. (2022). Comparing the effectiveness of cognitive behavioral therapy with acceptance and commitment therapy on increasing marital satisfaction and reducing anxiety in couples referring to counseling centers. Disability Studies, 12.
Shahbazfar, R., Zarei, E., Hajializade, K., & Dortaj, F. (2021). Comparing the Effectiveness of Cognitive-Behavioral Couple Therapy and Couple Therapy Based on Acceptance and Commitment Therapy in Improving Marital Quality of Non-clinical Couples. Psychological Models and Methods, 12(43), 100-113. https://doi.org/10.30495/jpmm.2021.4726
Sharif Nia, M., Heshmati, R., & Hashemi, T. (2023). The Mediating Role of Schema Modes in the Relationship Between Childhood Adversities and Marital Conflicts in Individuals with Symptoms of Psychopathology. Rooyesh-e-Ravanshenasi Journal, 12(11), 11-20. https://frooyesh.ir/article-1-4781-fa.html
Timulak, L., Dailey, J., Lunn, J., & McKnight, J. (2025). Transdiagnostic Emotion-Focused Therapy for Couples with Co-Morbid Relational and Mood, Anxiety and Related Difficulties. Journal of Contemporary Psychotherapy, 55(1), 1-10. https://doi.org/10.1007/s10879-024-09645-7
Vedelago, L., Balzarini, R. N., Fitzpatrick, S., & Muise, A. (2023). Tailoring dyadic coping strategies to attachment style: Emotion-focused and problem-focused dyadic coping differentially buffer anxiously and avoidantly attached partners. Journal of Social and Personal Relationships, 40(6), 1830-1853. https://doi.org/10.1177/02654075221133575
