Effectiveness of Short-Term Object Relations Group Intervention on Self-Awareness, Social Anxiety and Alexithymia in Patients with Asthma

پژوهش های روان شناسی بالینی و مشاوره

Articles in Press, Accepted Manuscript, Available Online from 30 June 2025   

Document Type: Original Article

DOI: 10.22067/tpccp.2025.88949.1671

Authors

Negar Sarlak¹; Gholamreza Talebi^{* 2}

¹MA Student in Clinical Psychology, Faculty of Medicine, Najafabad branch, Islamic Azad University, Najafabad, Iran

²Assistant Professor, Department of Health Psychology, Faculty of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran

Abstract

Introduction:
Asthma, a prevalent chronic respiratory condition, has been associated with psychological consequences such as social anxiety (Habibi et al., 2021), emotional dysregulation (e.g., alexithymia), and diminished self-awareness. These psychological factors can intensify the severity of asthma symptoms and diminish the quality of life for individuals affected by the condition (Javaheri Mohamadi et al., 2022). In recent years, object relations-based group intervention has been proposed as an effective approach for patients with asthma. The rationale behind this proposal is that, by focusing on analyzing internal relationships and promoting emotional insight, it can lead to improved psychological and social functioning and, as a result, a reduction in physical symptoms (Cohen & Hulsey, 2022). The objective of the present study was to investigate the effectiveness of short-term object relations group intervention on enhancing self-awareness and reducing social anxiety and alexithymia in patients with asthma.
Method:
The present study employs a quasi-experimental design, incorporating a pretest, posttest, control group, and follow-up design. The statistical population of this study included all hospitalized patients with asthma in Tehran hospitals in 2023, from which 40 people were selected using purposive sampling. Subsequently, the participants were randomly assigned to experimental and control groups (20 individuals for each group). During the implementation process, four individuals (two from each group) withdrew from further cooperation for various reasons, and the final analysis was conducted on the data of 36 participants. The instruments to collect data consisted of the Fenigstein Self-Consciousness Scale (FSCS) (1975), the Connor et al. Social Anxiety Questionnaire (2000), and the Toronto Alexithymia Scale (TAS-20) (Begby et al., 1994). The experimental group underwent a brief, 12-session object relations-based group therapy intervention, administered over a four-month period. In contrast, the control group did not receive any psychotherapy intervention. For the purpose of data analysis, a repeated-measures analysis of variance was employed in SPSS software, thereby enabling the examination of intragroup and intergroup changes across three phases: pretest, posttest, and follow-up.
Findings:
The findings of the repeated measures analysis of variance (with respect to statistical assumptions, including the normality of score distribution, homogeneity of variances, the covariance matrix, and sphericity) demonstrated that the therapeutic intervention resulted in a substantial enhancement in self-awareness at the post-test and follow-up stages (F (1.468, 49.915) = 36.599, P < 0.001, η² = 0.518). The results of the analysis indicate a significant decrease in alexithymia (F (1.426, 48.49) = 45.183, P < 0.001, η² = 0.618), and in social anxiety (F (1.320, 44.885) = 61.869, P< 0.001, η² = 0.702). A substantial discrepancy was identified among the intergroup levels of the intervention and control groups. The variable of self-awareness exhibited a significant result (F (1, 34) = 5.204, P= 0.029)). Similarly, a significant result was obtained for alexithymia (F (1, 34) = 5.674, P= 0.023), and a significant result was also obtained for social anxiety (F (1, 34) =8.163, P = 0.007). Due to the violation of the assumption of sphericity in some variables, such as self-awareness (Mauchly's W = 0.638, P = 0.001), the Greenhouse-Geisser correction was employed. The normality of the data distribution was confirmed based on the Shapiro-Wilk test and the homogeneity of variances according to the Levine test in all stages. The analysis of the subscales demonstrated that the object relations intervention led to a significant reduction in the components of fear, avoidance, and physiological discomfort (in cases of social anxiety) as well as a reduction in difficulty in identifying emotions, expressing feelings, and thinking with an external orientation (in Alexithymia).
 
Conclusion:
The findings of present study indicated that short-term object relations group therapy resulted in a substantial enhancement in the level of self-awareness among patients diagnosed with asthma. This result aligns with the findings of (Blum, 2010) study, which confirmed the efficacy of analytical approaches in fostering self-awareness. The therapeutic approach, which emphasizes the identification of unconscious relationships and the reconstruction of internalized objects, appears to result in an enhancement of patients' emotional and internal awareness. Consequently, it is proposed that enhancing self-awareness be regarded as a primary treatment objective in psychotherapy programs for patients afflicted with chronic diseases, such as asthma. The findings of this study indicated that the therapeutic intervention resulted in a substantial decrease in social anxiety among the patient population. This finding aligns with the research of (Devlag, 2014), which substantiated the efficacy of object relations-based therapies in mitigating social anxiety. It has been demonstrated that the provision of a secure and empathetic environment within group therapy settings is conducive to the identification of ineffectual defense mechanisms employed by patients in interpersonal relationships. This identification process facilitates the development of more adaptive communication skills among patients, thereby enhancing their ability to navigate and engage in effective interactions with others. Consequently, the utilization of object relations group therapy in interventions concerning anxiety disorders, particularly in patients with psychosomatic diseases, is strongly advised. The third finding of the study demonstrated that object relations group therapy significantly reduced alexithymia in these patients. This finding aligns with the findings of (Haji alizadeh, 2021), which demonstrated the efficacy of object relations therapy in enhancing emotion processing. The mechanism of action of this therapeutic modality can be considered to be an emphasis on increasing the capacity for emotional symbolization and analyzing unconscious defenses, which, in sum, improves the ability to process emotions in patients. Consequently, this therapeutic modality can be regarded as a promising strategy for enhancing the emotional and emotional-physical health of patients afflicted with psychosomatic ailments, such as asthma. Consequently, the implementation of this intervention in conjunction with conventional medical treatments has the potential to enhance the mental well-being and overall quality of life of individuals suffering from chronic conditions.

Keywords

short-term object relations; self-awareness; social anxiety; alexithymia; asthma

References

Batard, T., Taillé, C., Guilleminault, L., Bozek, A., Floch, V. B. L., Pfaar, O., Canonica, W. G., Akdis, C., Shamji, M. H., & Mascarell, L. (2025). Allergen immunotherapy for the prevention and treatment of asthma. Clinical & Experimental Allergy, 55(2), 111-141.  PMCID: PMC11791393  DOI: 10.1111/cea.14575          

Blum, H. P. (2010). Object relations in contemporary psychoanalysis: Contrasting views. Contemporary Psychoanalysis, 46(1), 32-47 DOI: 10.2202/1548-923X.2035.     

Carr, T. F., Fajt, M. L., Kraft, M., Phipatanakul, W., Szefler, S. J., Zeki, A. A., Peden, D. B., White, S. R., for Severe, P. I., & Group, o. E.-P. A. N. R. (2023). Treating asthma in the time of COVID. Journal of Allergy and Clinical Immunology, 151(4), 809-817. DOI: 10.1016/j.jaci.2022.12.800                   

Cohen, C. T., & Hulsey, T. L. (2022). Object relations-focused psychoanalytic psychotherapy in the treatment of narcissistic personality disorder. Clinical Case Studies, 21(5), 474-491. DOI:10.1177/15346501221098071         

Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry, 176(4), 379-386. DOI: 10.1192/bjp.176.4.379     

Devlag, S. (2014). The effectiveness of short-term object relations couples therapy on improvement of family functioning of clients filing for divorce. International Journal of Behavioral Sciences, 8(2), 123-129.   

Eassey, D., Reddel, H. K., Ryan, K., & Smith, L. (2021). Living with severe asthma: the role of perceived competence and goal achievement. Chronic Illness, 17(4), 416-432. DOI: 10.1177/1742395319884104      

Ezzati, A., Rafieinia, P., Sabahi, P., & Makvand Hosseini, S. (2021). The effectiveness of the Object Relations Brief Psychotherapy on domains of personality organization and postpartum depression symptoms. medical journal of mashhad university of medical sciences, 64(3), 3292-3312. 10.22038/mjms.2021.18890       

Figueroa, R., Taramasco, C., Pérez-Villalobos, C., Lagos, M. E., Nazar, G., Rimassa, C., Herrera, D., Pino, E., Godoy, J., & Arrieta, J. (2024). Education of Patients with Asthma Leading to the Self-management of their Condition? The primary Health Care Providers’ Approach. Revista médica de Chile, 152(7), 808-817.  DOI: 10.4067/s0034-98872024000700808 

Ghanadzadegan, F., Rahimian Boogar, I., & Pourasghar, M. (2020). Effectiveness of short-term object relation psychotherapy on interpersonal relationships, self-destruct behaviors and personality organization in patients with borderline personality disorder: A clinical trial study. Journal of Gorgan University of Medical Sciences, 22(4), 30-39. URL: http://goums.ac.ir/journal/article-1-3731-en.html                

Habibi, N., Bazzazian, S., & Ahadi, H. (2021). Effectiveness of Cognitive Behavioral Therapy and Rational Emotive Behavior Therapy in Reducing Social Anxiety among Overweight Adolescents. Razavi International Journal of Medicine, 9(1), 57-62. 10.30483/rijm.2021.254170.1023  

Haji alizadeh, K., Haji alizadeh, K., Zarei, E., & Dortaj, F. (2021). Effectiveness of Intensive Short- Term Dynamic Psychotherapy on Alexithymia in Rheumatoid Arthritis Patients  Journal of Research in Behavioural Sciences, 19(1), 139-148. https://doi.org/https://doi.org/10.52547/rbs.19.1.139

Hu, B., Mao, Y., & Kim, K. J. (2023). How social anxiety leads to problematic use of conversational AI: The roles of loneliness, rumination, and mind perception. Computers in Human Behavior, 145, 107760. DOI: 10.1016/j.chb.2023.107760          

Jaremka, L. M., & Pacanowski, C. R. (2019). Social anxiety symptoms moderate the link between obesity and metabolic function. Psychoneuroendocrinology, 110, 104425. DOI: 10.1016/j.psyneuen.2019.104425             

Javaheri Mohamadi, A., Keshavarz Afshar, H., & Bagherzadeh, S. (2022). Relationship between emotional self-control, alexithymia and educational emotional with academic burnout in students with learning disorder. Pajouhan Scientific Journal, 20(1), 57-63. 10.61186/psj.20.1.57         

Jiao, J., Terán, L., & Aubrey, J. S. (2022). Buffering an objectifying culture: Interpersonal sexual objectification, self-objectification, and attachment anxiety. Psychology of Women Quarterly, 46(4), 438-453. https://doi.org/10.1177/03616843221115335

Kalmarzi, R. N., Moradi, G., Majd, S. A., & Khanpuor, F. (2018). The effect of mindfulness-based cognitive therapy on mindfulness and quality of life for patients with asthma. Shenakht J Psychol Psychiatry, 5(5), 1-14.            

Kernberg, O. F. (2018). Treatment of severe personality disorders: Resolution of aggression and recovery of eroticism. American Psychiatric Pub.       

Levy, M. L., Bacharier, L. B., Bateman, E., Boulet, L.-P., Brightling, C., Buhl, R., Brusselle, G., Cruz, A. A., Drazen, J. M., & Duijts, L. (2023). Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ primary care respiratory medicine, 33(1), 7. doi: 10.1038/s41533-023-00330-1         

Liang, Y., Song, Z., Wang, H., & Zhang, J. (2024). Learning to trust your feelings: Leveraging self-awareness in llms for hallucination mitigation. arXiv preprint arXiv:2401.15449. https://doi.org/10.48550/arXiv.2401.15449

Mattiuzzi, C., & Lippi, G. (2020). Worldwide asthma epidemiology: insights from the Global Health Data Exchange database. International forum of allergy & rhinology, doi: 10.1002/alr.22464

Mobassem, S., Delavar, A., Karami, A., Sana'i, B., & Shafi'abadi, A. (2012). Evaluating the effectiveness of intensive short-term dynamic psychotherapy in decreasing marital conflict in women. Clinical Psychology Studies, 3(9), 81-102.               

Reddel, H. K., Bacharier, L. B., Bateman, E. D., Brightling, C. E., Brusselle, G. G., Buhl, R., Cruz, A. A., Duijts, L., Drazen, J. M., & FitzGerald, J. M. (2022). Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. American journal of respiratory and critical care medicine, 205(1), 17-35.            

Ricciardi, L., Spatari, G., Vicario, C. M., Liotta, M., Cazzato, V., Gangemi, S., & Martino, G. (2023). Clinical Psychology and Clinical Immunology: is there a link between Alexithymia and severe Asthma? Mediterranean Journal of Clinical Psychology, 11(3).                

Sheykhi, M., Pourvali, A., Ghandi, Y., Alaghmand, A., Zamanian, M., Eslambeik, T., & Tajerian, A. (2024). Exploring the relationship between asthma, its severity and anxiety symptoms in pediatric patients: a case-control study. Journal of Asthma, 61(5), 491-500. DOI: 10.1080/02770903.2023.2289158        

Silvestro, O., Ricciardi, L., Catalano, A., Vicario, C. M., Tomaiuolo, F., Pioggia, G., Squadrito, G., Schwarz, P., Gangemi, S., & Martino, G. (2023). Alexithymia and asthma: a systematic review. Frontiers in psychology, 14, 1221648. https://doi.org/10.3389/fpsyg.2023.1221648                

Soleimani, M., & Izadi, F. (2024). The effectiveness of emotion-focused therapy on emotional self-awareness, self-objectification and reduction of symptoms in girl students with symptoms of binge-eating. Rooyesh-e-Ravanshenasi Journal (RRJ), 13(7), 181-190.                

Stadter, M. (2009). Object relations brief therapy: The therapeutic relationship in short-term work. Jason Aronson.

Svrakic, D. M., & Zorumski, C. F. (2021). Neuroscience of object relations in health and disorder: A proposal for an integrative model. Frontiers in psychology, 12, 583743. https://doi.org/10.3389/fpsyg.2021.583743

Turi, E. R., Reigada, L. C., Liu, J., Leonard, S. I., & Bruzzese, J.-M. (2021). Associations among anxiety, self-efficacy, and self-care in rural adolescents with poorly controlled asthma. Annals of Allergy, Asthma & Immunology, 127(6), 661-666. e661. DOI: 10.1016/j.anai.2021.09.010   

Wang, N., Zhao, L., Liu, C., Shi, X., Wang, J., & Wu, S. (2024). Analysis of risk factors for depression and anxiety related to the degree of asthma control in children according to gender. Archives de Pédiatrie. DOI:10.1016/j.arcped.2023.09.017                

Wen, X., Zhang, Q., Liu, X., Du, J., & Xu, W. (2021). Momentary and longitudinal relationships of mindfulness to stress and anxiety among Chinese elementary school students: mediations of cognitive flexibility, self-awareness, and social environment. Journal of Affective Disorders, 293, 197-204.  https://doi.org/10.1016/j.jad.2021.06.038