Jundishapur Journal of Health Sciences

Jundishapur Journal of Health Sciences

Comparing the Impact of Self-Healing Intervention and Emotion-Focused Therapy on Academic Vitality and Cognitive Distortions among Female High School Students with Depression

Document Type : Research Article

Authors
Fatemeh Mousavi
Zahra Dasht Bozorgi
Farah Naderi
Sahar Safarzadeh
Department of Psychology, Ahv.C., Islamic Azad University, Ahvaz, Iran
10.22118/jjhs.2026.240300
Abstract
Background and Objective: Depression poses a significant obstacle to academic success among high school students. It is characterized by diminished academic vitality and exacerbated by persistent cognitive distortions (maladaptive cognitive patterns). This study aimed to evaluate and compare the effectiveness of self-healing intervention (SHI) and emotion-focused therapy (EFT) in reducing these impairments among female adolescents exhibiting depressive symptoms.
 
Methods: This randomized controlled trial (registered at IRCT.ir as IRCT20250307064963N1) employed a pretest-posttest design with follow-up. Recruitment of participants was conducted in Ahvaz, Iran, from April through June 2025. A total of 45 female high school students diagnosed with depressive symptoms, confirmed via DSM‑5 clinical interviews and the Beck Depression Inventory, were selected through cluster random sampling and randomly allocated to three groups of 15: SHI intervention group, EFT intervention group, and waitlist control group. Assessments were done based on the Academic Vitality Questionnaire and the Cognitive Distortions Scale. Data were subjected to repeated-measures ANOVA for analysis.
 
Findings: Findings revealed significant improvements in academic vitality and reduced cognitive distortions in both intervention groups compared to controls at posttest and three-month follow-up (P<0.001). Although SHI yielded greater gains in academic vitality than did EFT at posttest (P=0.038), no significant between-intervention differences were observed at follow-up or on cognitive distortions, with treatment effects sustained over time.
 
Conclusion: SHI and EFT demonstrate comparable overall efficacy as therapeutic frameworks for bolstering psychological resilience and academic engagement in depressed female students. These results advocate for the incorporation of either cognitive-experiential or resource-focused strategies within educational mental health frameworks to foster enduring student well-being.
Keywords
Vitality
Depression
Self-healing
Emotion-focused therapy
Cognitive distortions
1.               Jiang MM, Gao K, Wu ZY, Guo PP. The influence of academic pressure on adolescents’ problem behavior: chain mediating effects of self-control, parent-child conflict, and subjective well-being. Front Psychol. 2022;13:954330. https://doi.org/10.3389/fpsyg.2022.954330. [PMID]
2.               Bagheri Sheykhangafshe F, Savabi Niri V, Abbasi Amiri Z, Taghavi Larmaei S, Esrafilian F. The effectiveness of metacognitive therapy on depression, emotion regulation, and self-concept in students with social anxiety disorder: a quasi-experimental study. Jundishapur J Health Sci. 2024;16(3):30–36. https://doi.org/10.5812/jjhs-145992.
3.               Franco K, Baumler E, Torres ED, Lu Y, Wood L, Temple JR. The link between school climate and mental health among an ethnically diverse sample of middle school youth. Curr Psychol. 2023;42(22):18488–18498. https://doi.org/10.1007/s12144-022-03016-y. [PMID]
4.               Askeland KG, Bøe T, Lundervold AJ, Stormark KM, Hysing M. The association between symptoms of depression and school absence in a population-based study of late adolescents. Front Psychol. 2020;11:1268. https://doi.org/10.3389/fpsyg.2020.01268. [PMID]
5.               Yan R, Jin S, Ji C, Feng C, Wang H, Lyu J, et al. Depression takes a toll on academic performance: evidence from rural students in China. Risk Manag Healthc Policy. 2024;17:2209–2227.https://doi.org/10.2147/rmhp.S469836. [PMID]
6.               Shadkam H, Zanganeh Motlagh F, Yaghoubi A, Pirani Z, Mohaghegh H. Prediction of academic vitality based on life expectancy, happiness, and meaning in students. Educ Dev Judishapur. 2022;13:128–141. https://doi.org/10.22118/edc.2022.343437.2091
7.               Khamisabadi M, Mirmehdi SR, Merati AR. Relationship of academic vitality, academic self-efficacy, and metacognitive skills with lifelong learning: mediating role of study approaches. J Res Health. 2021;11(1):1.https://doi.org/10.32598/JRH.11.1.1202.4
8.               Wang B, Zhao Y, Lu X, Qin B. Cognitive distortion-based explainable depression detection and analysis technologies for adolescent internet users on social media. Front Public Health. 2022;10:1045777. https://doi.org/10.3389/fpubh.2022.1045777. [PMID]
9.               Rnic K, Dozois DJA, Martin RA. Cognitive distortions, humor styles, and depression. Eur J Psychol. 2016;12(3):348–362.https://doi.org/10.5964/ejop.v12i3.1118 . [PMID]
10.           Zou H, Gao J, Wu W, Zhang W, Huo L. Depression, anxiety, and cognitive distortion among college students: a cross-lagged prospective network study during and after the COVID-19 pandemic. Depress Anxiety. 2024;2024:2598864. https://doi.org/10.1155/2024/2598864. [PMID]
11.           Latifi Z, Soltani M, Mousavi S. Evaluation of the effectiveness of self-healing training on self-compassion, body image concern, and recovery process in patients with skin cancer. Complement Ther Clin Pract. 2020;40:101180. https://doi.org/10.1016/j.ctcp.2020.101180. [PMID]
12.           Irani Z, Latifi Z, Soltanizadeh M. The effectiveness of self-healing training (healing codes) on psychological capital and sense of coherence in drug addicts. J Res Health. 2021;11(5):351. doi:10.32598/JRH.11.5.1598.4.https://doi.org/10.32598/JRH.11.5.1598.4
13.           Zarean F, Sheykholeslami A, Sadri Damirchi E, Rezaei Sharif A. Effectiveness of healing codes training on sexual self-esteem of infertile women. Womens Health Bull. 2024;11(2):135–143. https://doi.org/10.30476/whb.2024.102309.1286
14.           Masoudizadeh F, Hafezi F, Safarzadeh S, Dasht Bozorgi Z. Self-healing therapy for body-focused social anxiety and body management in adolescent females with body image concerns. Caspian J Health Res. 2025;10(1):47.https://doi.org/10.32598/CJHR.10.1.446.3
15.           Elliott R, Greenberg LS. The essence of process-experiential/emotion-focused therapy. Am J Psychother. 2007;61(3):241–254. https://doi.org/10.1176/appi.psychotherapy.2007.61.3.241. [PMID]
16.           Beutel ME, Greenberg L, Lane RD, Subic-Wrana C. Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP): an integrative, transdiagnostic approach. Clin Psychol Psychother. 2019;26(1):1–13. https://doi.org/10.1002/cpp.2325. [PMID]
17.           Seok JW, Kim JU. The effectiveness of emotional freedom techniques for depressive symptoms: a meta-analysis. J Clin Med. 2024;13(21):6481. https://doi.org/10.3390/jcm13216481. [PMID]
18.           Seyed Mousavi F, Talebzadeh Shoushtari M, Safarzadeh S. Effects of emotionally focused therapy on emotional autonomy and emotion regulation of students with depressive symptoms. J Clin Res Paramed Sci. 2024;13(1):e143109. https://doi.org/10.5812/jcrps-143109.
19.           Beck AT, Steer RA, Brown GK. Beck Depression Inventory–II. 2nd ed. San Antonio (TX): Psychological Corporation; 1996. https://doi.org/10.1037/t00742-000
20.           Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory–II. Depress Anxiety. 2005;21(4):185–192. https://doi.org/10.1002/da.20070[PMID]
21.           Jafari F, Salehi K, Javadipour M, Kamalimohajer R. A mixed approach to measuring school happiness of elementary school students in Tehran. J Curric Stud. 2022;17(65):245–276.
22.           Hamamci Z, Büyüköztürk Ş. The interpersonal cognitive distortions scale: development and psychometric characteristics. Psychol Rep. 2004;95(1):291–303. https://doi.org/10.2466/pr0.95.1.291-303. [PMID]
23.           Esmaeel Poor K, Bakhshi Poor Rodsari A, Mohammadzadegan R. Determining factor structure, validity, and reliability of the interpersonal cognitive distortions scale among students of Tabriz University. J Cogn Strateg Learn. 2015;2(3):53–72.
24.           Timulak L, Keogh D, McElvaney J, Schmitt S, Hession N, Timulakova K, et al. Emotion-focused therapy as a transdiagnostic treatment for depression, anxiety, and related disorders: protocol for an initial feasibility randomised controlled trial. HRB Open Res. 2020;3:7. https://doi.org/10.12688/hrbopenres.12993.1. [PMID]
25.           Zadafshar B, Sharifi T, Ahmadi R, Chorami M. Effects of emotion-focused therapy and existential group therapy on depression, anxiety, and stress in victims of child sexual harassment. J Client Cent Nurs Care. 2021;7(3):227. https://doi.org/10.32598/JCCNC.7.3.379.1
26.           Zangi M, Sadeghi M, Ghadam Poor E. The effect of emotion-focused processing strategies training on academic adjustment of female students. Iran J Learn Mem. 2018;1(2):23–28. https://doi.org/10.22034/iepa.2018.89171
27.           Dehghani Z, Al-Behbahani M. Effectiveness of emotion-focused therapy on attachment styles, anger management, and social anxiety among female secondary school students. J Adolesc Youth Psychol Stud. 2025;6(5):1–9. https://doi.org/10.61838/kman.jayps.6.5.10
28.           Kotera Y, Beaumont J, Edwards AM, Cotterill M, Kirkman A, Tofani AC, et al. A narrative review of compassion focused therapy on positive mental health outcomes. Behav Sci (Basel). 2024;14(8):643.https://doi.org/10.3390/bs14080643 . [PMID]
29.           Maloney JE, Whitehead J, Long D, Kaufmann J, Oberle E, Schonert-Reichl KA, et al. Supporting adolescent well-being at school: integrating transformative social and emotional learning and trauma-informed education. Soc Emot Learn Res Pract Policy. 2024;4:100044.https://doi.org/10.1016/j.sel.2024.100044
1.               Jiang MM, Gao K, Wu ZY, Guo PP. The influence of academic pressure on adolescents’ problem behavior: chain mediating effects of self-control, parent-child conflict, and subjective well-being. Front Psychol. 2022;13:954330. https://doi.org/10.3389/fpsyg.2022.954330. [PMID]
2.               Bagheri Sheykhangafshe F, Savabi Niri V, Abbasi Amiri Z, Taghavi Larmaei S, Esrafilian F. The effectiveness of metacognitive therapy on depression, emotion regulation, and self-concept in students with social anxiety disorder: a quasi-experimental study. Jundishapur J Health Sci. 2024;16(3):30–36. https://doi.org/10.5812/jjhs-145992.
3.               Franco K, Baumler E, Torres ED, Lu Y, Wood L, Temple JR. The link between school climate and mental health among an ethnically diverse sample of middle school youth. Curr Psychol. 2023;42(22):18488–18498. https://doi.org/10.1007/s12144-022-03016-y. [PMID]
4.               Askeland KG, Bøe T, Lundervold AJ, Stormark KM, Hysing M. The association between symptoms of depression and school absence in a population-based study of late adolescents. Front Psychol. 2020;11:1268. https://doi.org/10.3389/fpsyg.2020.01268. [PMID]
5.               Yan R, Jin S, Ji C, Feng C, Wang H, Lyu J, et al. Depression takes a toll on academic performance: evidence from rural students in China. Risk Manag Healthc Policy. 2024;17:2209–2227.https://doi.org/10.2147/rmhp.S469836. [PMID]
6.               Shadkam H, Zanganeh Motlagh F, Yaghoubi A, Pirani Z, Mohaghegh H. Prediction of academic vitality based on life expectancy, happiness, and meaning in students. Educ Dev Judishapur. 2022;13:128–141. https://doi.org/10.22118/edc.2022.343437.2091
7.               Khamisabadi M, Mirmehdi SR, Merati AR. Relationship of academic vitality, academic self-efficacy, and metacognitive skills with lifelong learning: mediating role of study approaches. J Res Health. 2021;11(1):1.https://doi.org/10.32598/JRH.11.1.1202.4
8.               Wang B, Zhao Y, Lu X, Qin B. Cognitive distortion-based explainable depression detection and analysis technologies for adolescent internet users on social media. Front Public Health. 2022;10:1045777. https://doi.org/10.3389/fpubh.2022.1045777. [PMID]
9.               Rnic K, Dozois DJA, Martin RA. Cognitive distortions, humor styles, and depression. Eur J Psychol. 2016;12(3):348–362.https://doi.org/10.5964/ejop.v12i3.1118 . [PMID]
10.           Zou H, Gao J, Wu W, Zhang W, Huo L. Depression, anxiety, and cognitive distortion among college students: a cross-lagged prospective network study during and after the COVID-19 pandemic. Depress Anxiety. 2024;2024:2598864. https://doi.org/10.1155/2024/2598864. [PMID]
11.           Latifi Z, Soltani M, Mousavi S. Evaluation of the effectiveness of self-healing training on self-compassion, body image concern, and recovery process in patients with skin cancer. Complement Ther Clin Pract. 2020;40:101180. https://doi.org/10.1016/j.ctcp.2020.101180. [PMID]
12.           Irani Z, Latifi Z, Soltanizadeh M. The effectiveness of self-healing training (healing codes) on psychological capital and sense of coherence in drug addicts. J Res Health. 2021;11(5):351. doi:10.32598/JRH.11.5.1598.4.https://doi.org/10.32598/JRH.11.5.1598.4
13.           Zarean F, Sheykholeslami A, Sadri Damirchi E, Rezaei Sharif A. Effectiveness of healing codes training on sexual self-esteem of infertile women. Womens Health Bull. 2024;11(2):135–143. https://doi.org/10.30476/whb.2024.102309.1286
14.           Masoudizadeh F, Hafezi F, Safarzadeh S, Dasht Bozorgi Z. Self-healing therapy for body-focused social anxiety and body management in adolescent females with body image concerns. Caspian J Health Res. 2025;10(1):47.https://doi.org/10.32598/CJHR.10.1.446.3
15.           Elliott R, Greenberg LS. The essence of process-experiential/emotion-focused therapy. Am J Psychother. 2007;61(3):241–254. https://doi.org/10.1176/appi.psychotherapy.2007.61.3.241. [PMID]
16.           Beutel ME, Greenberg L, Lane RD, Subic-Wrana C. Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP): an integrative, transdiagnostic approach. Clin Psychol Psychother. 2019;26(1):1–13. https://doi.org/10.1002/cpp.2325. [PMID]
17.           Seok JW, Kim JU. The effectiveness of emotional freedom techniques for depressive symptoms: a meta-analysis. J Clin Med. 2024;13(21):6481. https://doi.org/10.3390/jcm13216481. [PMID]
18.           Seyed Mousavi F, Talebzadeh Shoushtari M, Safarzadeh S. Effects of emotionally focused therapy on emotional autonomy and emotion regulation of students with depressive symptoms. J Clin Res Paramed Sci. 2024;13(1):e143109. https://doi.org/10.5812/jcrps-143109.
19.           Beck AT, Steer RA, Brown GK. Beck Depression Inventory–II. 2nd ed. San Antonio (TX): Psychological Corporation; 1996. https://doi.org/10.1037/t00742-000
20.           Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory–II. Depress Anxiety. 2005;21(4):185–192. https://doi.org/10.1002/da.20070[PMID]
21.           Jafari F, Salehi K, Javadipour M, Kamalimohajer R. A mixed approach to measuring school happiness of elementary school students in Tehran. J Curric Stud. 2022;17(65):245–276.
22.           Hamamci Z, Büyüköztürk Ş. The interpersonal cognitive distortions scale: development and psychometric characteristics. Psychol Rep. 2004;95(1):291–303. https://doi.org/10.2466/pr0.95.1.291-303. [PMID]
23.           Esmaeel Poor K, Bakhshi Poor Rodsari A, Mohammadzadegan R. Determining factor structure, validity, and reliability of the interpersonal cognitive distortions scale among students of Tabriz University. J Cogn Strateg Learn. 2015;2(3):53–72.
24.           Timulak L, Keogh D, McElvaney J, Schmitt S, Hession N, Timulakova K, et al. Emotion-focused therapy as a transdiagnostic treatment for depression, anxiety, and related disorders: protocol for an initial feasibility randomised controlled trial. HRB Open Res. 2020;3:7. https://doi.org/10.12688/hrbopenres.12993.1. [PMID]
25.           Zadafshar B, Sharifi T, Ahmadi R, Chorami M. Effects of emotion-focused therapy and existential group therapy on depression, anxiety, and stress in victims of child sexual harassment. J Client Cent Nurs Care. 2021;7(3):227. https://doi.org/10.32598/JCCNC.7.3.379.1
26.           Zangi M, Sadeghi M, Ghadam Poor E. The effect of emotion-focused processing strategies training on academic adjustment of female students. Iran J Learn Mem. 2018;1(2):23–28. https://doi.org/10.22034/iepa.2018.89171
27.           Dehghani Z, Al-Behbahani M. Effectiveness of emotion-focused therapy on attachment styles, anger management, and social anxiety among female secondary school students. J Adolesc Youth Psychol Stud. 2025;6(5):1–9. https://doi.org/10.61838/kman.jayps.6.5.10
28.           Kotera Y, Beaumont J, Edwards AM, Cotterill M, Kirkman A, Tofani AC, et al. A narrative review of compassion focused therapy on positive mental health outcomes. Behav Sci (Basel). 2024;14(8):643.https://doi.org/10.3390/bs14080643 . [PMID]
29.           Maloney JE, Whitehead J, Long D, Kaufmann J, Oberle E, Schonert-Reichl KA, et al. Supporting adolescent well-being at school: integrating transformative social and emotional learning and trauma-informed education. Soc Emot Learn Res Pract Policy. 2024;4:100044.https://doi.org/10.1016/j.sel.2024.100044