مقایسه اثربخشی درمان فراشناختی و درمان هیجان‌مدار بر تنظیم شناختی هیجان زنان سالمند مقیم سرای سالمندی

Background: With the increasing prevalence of emotional challenges in old age, identifying effective interventions to enhance emotional functioning has become particularly important. Therefore, this study aimed to compare the effectiveness of metacognitive therapy and emotion-focused therapy (EFT) in improving cognitive emotion regulation (CER) among older women residing in nursing homes.
Method: This study employed a quasi-experimental pretest-posttest design with a control group. The study population consisted of older women residing in nursing homes in 2025. A total of 57 participants were selected through convenience sampling based on the inclusion and exclusion criteria and were randomly assigned to two experimental groups (18 participants in the metacognitive therapy group and 19 participants in the EFT group) and a control group (20 participants). Garnefski et al’s Cognitive Emotion Regulation Questionnaire was used to assess CER. The metacognitive therapy group received Wells’ protocol, while the EFT group received the Greenberg and Watson protocol. Each intervention consisted of eight weekly 90-minute sessions, whereas the control group received no intervention. Data were analyzed using univariate analysis of covariance (ANCOVA) and the least significant difference (LSD) post hoc test.
Results: The results showed that both metacognitive therapy and EFT significantly improved CER among older women. However, EFT was more effective than metacognitive therapy in reducing maladaptive CER strategies and increasing adaptive strategies. No significant differences between the two interventions were found only for the positive refocusing and refocus on planning subscales.
Conclusion: The findings indicate that both metacognitive therapy and EFT can improve CER among older women and may offer promising approaches for psychological interventions in older adults. In particular, EFT may be considered an effective intervention for improving CER among older women residing in nursing homes.
EXTENDED ABSTRACT
 Introduction
Aging is accompanied by biological changes, reduced social relationships, and increased feelings of loneliness, which may contribute particularly to difficulties in emotion regulation and greater psychological vulnerability among older women. Living in nursing homes may also reduce family interactions and increase social isolation, potentially contributing to maladaptive emotional and cognitive patterns. Cognitive emotion regulation (CER) refers to the cognitive strategies individuals use to manage, modify, or change their emotional responses and plays an important role in the mental health, cognitive functioning, and social adjustment of older adults. The use of adaptive strategies is associated with better mental health, distress tolerance, and self-compassion, whereas maladaptive strategies may increase vulnerability to psychological problems. Psychological interventions such as metacognitive therapy and emotion-focused therapy (EFT) may enhance emotion regulation skills in older adults. Metacognitive therapy aims to improve psychological functioning by modifying dysfunctional metacognitive beliefs and maladaptive patterns of thinking, whereas EFT promotes emotional awareness and facilitates the processing and transformation of emotional experiences. Given the limited number of comparative studies in this area, the present study aimed to compare the effectiveness of these two approaches in improving CER among older women residing in nursing homes and to provide evidence that may inform more effective psychological interventions for this population.
Method
This applied study employed a quasi-experimental pretest-posttest design with a control group. The study population consisted of older women residing in nursing homes in Kermanshah, Iran, during 2025. The final sample included 57 participants: 18 in the metacognitive therapy group, 19 in the EFT group, and 20 in the control group. Participants were selected through convenience sampling and randomly assigned to the three groups. The inclusion criteria were: (1) scores above 12 on the maladaptive subscales and below 10 on the adaptive subscales of the CER Questionnaire, (2) being a woman aged 65 years or older, (3) having basic reading and writing literacy, (4) residing in a nursing home, and (5) willingness to participate. The exclusion criteria were acute cognitive disorders based on clinical diagnosis and simultaneous participation in other therapeutic sessions. The interventions were delivered by a specialist under the supervision of the researchers in a psychological clinic. The metacognitive therapy group received Wells' protocol, and the EFT group received the Greenberg and Watson protocol; each intervention consisted of eight weekly 90-minute sessions. Data were analyzed using SPSS version 26. Descriptive statistics included frequency, percentage, mean, and standard deviation. After checking the relevant assumptions, the inferential analyses were conducted using univariate analyses of covariance (ANCOVAs) and the least significant difference (LSD) post hoc test.
Results
Before the main analyses, the assumptions of ANCOVA were examined. Levene's tests were nonsignificant for all subscales (all ps > .05), supporting the homogeneity of variances. The interaction effects between group and pretest scores were also nonsignificant for all subscales (all ps > .05), supporting the homogeneity of regression slopes. In addition, the Shapiro-Wilk tests indicated no significant deviations from normality (all ps > .05). Therefore, univariate ANCOVAs were conducted. As shown in Table 1, after controlling for pretest scores, the effect of group was statistically significant for all nine CER subscales (all ps < .001).
The LSD post hoc comparisons showed significant pairwise differences among the three groups for all CER subscales except positive refocusing and refocus on planning. For positive refocusing and refocus on planning (p = .188), the differences between the metacognitive therapy and EFT groups were not statistically significant; however, both intervention groups differed significantly from the control group (ps < .05). Overall, both interventions were effective in improving CER. The pattern of pairwise differences further indicated that EFT was more effective than metacognitive therapy in reducing maladaptive strategies, including self-blame, rumination, catastrophizing, and other blame, and in increasing adaptive strategies, including acceptance, positive reappraisal, and putting into perspective.
Conclusion
The findings showed that both metacognitive therapy and EFT improved CER among older women residing in nursing homes. EFT demonstrated greater effectiveness than metacognitive therapy in reducing maladaptive strategies, including self-blame, rumination, catastrophizing, and other-blame, and in increasing adaptive strategies, including acceptance, positive reappraisal, and putting into perspective. However, no significant differences were observed between the two interventions for positive refocusing or refocus on planning. Metacognitive therapy may improve the management of negative thoughts and emotional responses by identifying and modifying dysfunctional metacognitive beliefs, strengthening attentional control, and reducing rumination. EFT, by emphasizing the identification, processing, and expression of emotions, may help older adults reconstruct emotional experiences and meanings and enhance emotional awareness and CER. The greater effect observed for EFT may be related to its direct focus on emotional experience and its compatibility with the emotional needs of older adults. The study was limited by its relatively small sample size, inclusion of only women residing in nursing homes, reliance on self-report measures, and lack of long-term follow-up. Consequently, the findings should be generalized cautiously to other populations. Future studies should include larger and more diverse samples, such as older men and community-dwelling older adults, and use long-term follow-up assessments to evaluate the stability and generalizability of treatment effects.
Ethical Consideration
Ethical Code
The study was conducted with the necessary authorization from the Research Deputy of Islamic Azad University, Islamabad-e Gharb Branch. Written informed consent was obtained from all participants, and confidentiality of personal information was maintained.
Funding
This study received no external funding.
Authors’ Contributions
H.V.: Methodology, data collection, software, validation, formal analysis, data curation, and writing - original draft. Sh.P.: Project administration and writing - review and editing.
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors thank all older adults who participated in the study for their time and cooperation.
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