Comparing the effectiveness of attention-seeking adjustment training and commitment-based training on family executive functions and narcissistic tendencies among married women with attention-seeking in Isfahan

Abstract

BACKGROUND:

The widespread use of social media has turned the healthy population into needy attention-seekers, one of the symptoms of personality and psychiatric disorders. The present research aimed to compare the effectiveness of “attention-seeking adjustment training” and “commitment-based training” on family executive function and narcissistic tendencies among attention-seeking women in Isfahan.

MATERIALS AND METHODS:

The current research used a pretest, posttest quasi-experimental design with experimental and control groups. The statistical population consisted of 60 married women with the attention-seeking disorder. All the participants were selected from the counseling centers of Isfahan in 2022 HS. They were selected using the convenience method. Then, they were non-randomly assigned to two groups: the experimental and control groups. An “executive function questionnaire” and a “researcher-made narcissistic personality inventory” were devised as measurement instruments of the present study. Both groups were assessed by the research measurement instruments before and after the training. Whereas the control group remained on the waiting list, the experimental groups received the training.

RESULTS:

All the data were analyzed by descriptive statistics (mean and standard deviation) and multivariate covariance analysis. As has been demonstrated, training improved the dependent variables (P ≤ 0/01). However, attention-seeking adjustment was more effective than commitment-based training.

CONCLUSION:

According to the results, both the attention-seeking adjustment and the commitment-based training could be applied to improve the executive functions of families, as well as the narcissistic tendencies of partners.

Introduction

The rapid increase in divorce rates has been remarkable in recent years. The family has always been a sacred institution, and the increasing divorce rates have made authorities come up with some solutions.[1] In this regard, attention-seeking is a critical factor leading to family breakdown. Today, users seek more attention on social media to attract a large number of followers.[2] In fact, social media platforms encourage people to show off and seek extreme attention, which could cause marital conflicts and leave families in turmoil. This kind of attention-seeking, referred to as social withdrawal in intergenerational theory, results in more emotional concerns for families than rational ones.[3] Individuals with excessive attention-seeking behaviors want to be the center of attention at any cost. They engage in inappropriate behaviors, such as unusual and heavily tattooed bodies, loud laughter, and heavy makeup, to gain praise or approval. Attention-seekers dress up inappropriately and weirdly. They behave as if they are on a theatrical show. Individuals with narcissistic personality disorder believe their relationships are closer and more intimate than they are. They might hurt themselves or others if not the center of attention or ignored.[4] Others and circumstances easily influence attention-seekers; that is why they end up making impulsive and irrational decisions. They are constantly seeking attention, appreciation, and intentional sexual provocation. Therefore, they display inappropriate seductive or sexually proactive behavior to feel appreciated and get the approval of others. Attention is like food or medicine that they cannot live without. Individuals with excessive attention-seeking behaviors feel validated and valuable only when they receive attention.[5] Today, the widespread use of social media has provided a platform for women prone to histrionic behaviors to respond to their need for attention. Unfortunately, such behavior has become a quasi-need, common, and expected behavior, adversely influencing other women's perspectives toward the definition of adaptive behavior.

On the other hand, men are drawn to women with histrionic behaviors that result in marital disillusionment and family disputes, respectively.[6] As a result, attention-seeking behaviors harm the executive functions of families. Executive function refers to a set of cognitive processes and mental skills that provide a framework to execute goals successfully based on purposeful behaviors. Put simply, individuals use their mental capabilities to deal with an issue that is not considered an everyday struggle. This mental capability is called an executive function. Organizing, decision-making, working memory, maintenance and shift memory, motion control, time sensation and perception, anticipation, reconstruction, internalized language, and problem-solving are among the most critical executive functions that individuals use to learn and manage daily life. The family's executive function is affected by each family member's executive function skills. According to a study, fluctuations in marital life caused by attention-seeking behaviors, boundary violations, and seductive behaviors can adversely influence the family's executive function.[7] McMaster's model of family functioning is founded on a system theory that is categorized into three dimensions: basic tasks (that are related to innate needs, such as food, shelter, love, and belonging), developmental tasks that are related to developing stages (infancy, childhood, first marriage, first pregnancy, birth of first child), and hazardous events that are related to crisis (sickness, accident, unemployment). According to studies, family executive functions and household management by family members significantly affect family performance.[8,9] Moreover, family executive functions can be related to individuals’ personalities. For instance, some researchers reported that narcissism could be related to family structures. Narcissism is one of the dark triad personality traits in relation to antisocial behaviors, problems with interpersonal communication, drug abuse, and aggression.[10] Narcissism is associated with an exaggerated sense of self-importance, arrogance, self-absorption, and self-righteousness. Narcissism interferes with interpersonal functioning since others resent narcissistic exploitative and self-centered behaviors and exaggerated self-importance.[11] According to many theorists, narcissism is a personality construct relevant to a dimension of psychological functioning that ranges from healthy narcissism to pathological, depending on psychological needs, personality and individual differences, and defense mechanisms. Therefore, healthy and pathological narcissism may be separate dimensions of personality. Put another way; healthy narcissism may lead to self-respect and well-being due to increasing personal freedom.[12,13] On the other hand, studies show narcissism can adversely affect marital relationships and is related to marital conflicts.[14,15] A term called couples’ narcissistic tendency implies the manifestation of narcissism in the relationship between couples. Couples’ narcissistic tendency is composed of two substructures: inferiority complex and superiority complex. One of the partners with narcissistic behaviors has a grandiose sense of self-importance and exaggerates their achievements and talents. In addition, they believe they are superior to their spouse in every way. Narcissistic partners ignore family boundaries and believe their partner is the one who must respect rules. Narcissistic partners behave in an arrogant or entitled manner toward their spouse and family. They expect to be admired and praised by their spouse and react poorly to perceived criticism. They are unable or unwilling to recognize their spouse's needs and feelings. They assume to be impeccable and unique and can only be understood or should associate with other unique and high-status people.

Individuals with narcissistic personality disorder lack empathy or the ability to understand or care about the feelings of others. They are also extremely sensitive to rejection. People with narcissistic behavior are interpersonally exploitative and take advantage of others to achieve their ends. In family conflicts, narcissistic partners never apologize, take responsibility for their actions, and constantly shift the blame. They believe that others are envious of them and wish for what they have.[16]

So far, many families could benefit from various counseling and therapies.[17] In a study, the effectiveness of two different therapies has been investigated to improve marital relationships: Commitment-building counseling package and emotionally focused couple therapy. The findings suggest that commitment-building counseling was effective regarding women's infidelity. Therefore, the present study could benefit from the mentioned study's results. Commitment-building counseling package helped increase family commitment and reduce the desire for risky behaviors.[18] Commitment-building counseling includes proficiency in positive and negative emotions concerning the spouse, causes and effects of emotions, how to respond to the needs, understanding emotion dysregulations, and accepting individual differences. In the present study, attention-seeking training was used to improve dependent variables. This training package is the result of quantitative research which is designed by family therapists. Attention-seeking training includes understanding the concept of attention-seeking, the effects of attention-seeking behaviors on martial relationships, understanding underlying martial beliefs of attention-seeking behavior, identifying and living values, understanding and managing cognitive distortion, and finally, learning how to achieve behavioral goals to deal with attention-seeking behaviors.[19]

Although some studies have been conducted concerning family executive functions and narcissistic behaviors, none investigated the comparison of attention-seeking adjustment and commitment-based training methods. Moreover, no research has examined the effectiveness of either the attention-seeking or commitment-based training method on executive functions of marital relationships. Thus, the current research could help specify a better way to improve attention-seeking behaviors in women, improve an intervention, and contribute to the psychological society. Therefore, the present study seeks to answer the following question: Does the attention-seeking adjustment training significantly affect family executive functions and narcissistic tendencies of attention-seeking women, compared to the commitment-based training method?

Materials and Methods

Study design and setting

The current research used a quasi-experimental design with a pretest, posttest, and follow-up after the intervention with the control group. Therefore, 60 females with the attention-seeking disorder were selected using the convenience method among the patients referred to counseling centers in Isfahan. Then, 20 individuals were randomly selected from each group (control and experimental), whereas the control group remained on the waiting list.

Study participants and sampling

The statistical population includes 60 married women with the attention-seeking disorder. According to the experts, 15 individuals for each group would suffice to fulfill experimental and quasi-experimental purposes.[20] However, the sample size was increased to 20 to provide more reliable results with greater precision. The qualified respondents were those who obtained a higher-than-average score on the researcher-made scale of the narcissistic personality inventory. Several counseling centers were informed about attention-seeking adjustment training. They were asked to identify and refer married women with the attention-seeking disorder to participate in the present study. Based on inclusion and exclusion criteria, 60 individuals were randomly selected among the volunteers. Afterward, they were divided into two groups: experimental and control. While the control group remained on the waiting list, the two experimental groups received the training.

Eligibility and inclusion criteria for all groups are as follows: married, higher-than-average score on the researcher-made scale of the narcissistic personality inventory, not separated or divorced, nonaddict (drugs, medicine, and alcohol); a diagnostic interview was performed to confirm it.

Exclusion criteria for all groups are as follows: causing disruption in meetings, such as absence, getting off-topic, irresponsibility, and no commitment and dedication to assignments.

Research tools and techniques

Family executive function questionnaire

The family executive function questionnaire was designed based on the individual executive function questionnaire.[21] Executive functions of family members could be manifested in the form of family executive functions. In addition, all the questions were family related in that respect. It is a five-point Likert scale that includes 83 items. It is a validated tool confirmed with the help of seven family therapists, in terms of content and general form. Moreover, the internal consistency was measured by Cronbach's alpha (α = 0.80). Structural validity was assessed by its correlation with individual executive function, which showed a significant correlation. In the current study, the internal consistency of this questionnaire was assessed and confirmed again (α = 0.75).

Narcissistic personality inventory

It is a five-point Likert scale from which respondents choose on a continuum from strongly agree to strongly disagree. Also, this inventory contains 22 items, with an internal consistency of α = 0.88. Test–retest reliability was assessed with a two-week interval using Pearson's correlation. The results showed a significant correlation between the two assessments. Concurrent, convergent, and divergent validities were confirmed for narcissistic personality disorder, infidelity, and family relationship (05/0 > P). The result of exploratory factor analysis confirmed construct validity; it also showed that the scale consists of two factors: inferiority complex and superiority complex. The correlation of each factor with the total score was significant according to the results, confirming this scale's construct validity. The internal consistency of this inventory was also assessed and confirmed one more time (α = 0.82).

Each group received a 90-minute training once a week by the researcher in Isfahan counseling centers. The experimental and control groups were evaluated before and after the training course using the research measurement instruments. Table 1 illustrates details of the training sessions. The experimental groups received 90-minute training for eight sessions: attention-seeking adjustment training (first group) and commitment-based training (second group). Research supervisors designed the attention-seeking adjustment training contents. Content validity ratio (CVR) was used to measure the agreement between supervisors on the mentioned training (90% = CVR). It is noteworthy that all the participants were evaluated in three stages: Pretest, posttest, and follow-up. Finally, all the data were analyzed using appropriate analytical methods.

Table 1.

Educational content of attention-seeking adjustment, and commitment-based trainings

Sessions	Attention-seeking adjustment training	Commitment-based training
1	Become acquainted with one another, and research objectives presentation Understanding the concept of attention-seeking behaviors and its consequences on marital relationships	Become acquainted with one another, research objectives presentation, and understanding emotional dysregulation
2	Familiarity with cognitive, emotional, and social causes of attention-seeking, dos and don’ts of attention-seeking behaviors	Familiarity with the effects and causes of “feelings of monotony,” understanding the importance of acceptance in everyday life (that leads to martial conflicts reduction)
3	Familiarity with cognitive techniques to deal with attention-seeking behaviors, cognitive reconstructing, and cognitive dissonance	Familiarity with concepts of conscientiousness and responsibility to improve feelings of monotony, and understanding the importance of needs in relation to emotion regulation
4	Familiarity with secure attachment and emotion regulation (by developing a secure attachment style)	Understanding how to manage and satisfy needs properly Understanding one’s and other’s role in meeting the needs
5	Learning how to manage/reduce attention-seeking behaviors by emotion regulations	Knowing the effects of needs on positive and negative emotions toward the spouse Learning how to maintain family boundaries by managing needs
6	Understanding emotion regulation using techniques in this regard Familiarity with the effects of emotion regulation on attention-seeking adjustment	Understanding the importance of adjusting expectations on the feeling of monotony Understanding the importance of managing needs in martial relationships
7	Understanding the significant influence of self-esteem on attention-seeking behaviors (by setting and keeping goals)	Learning techniques to enhance intimacy, such as managing needs and expectations
8	Familiarity with attention-seeking adjustment by changing priorities and standards that lead to marital dissatisfaction	Knowing the obstacles to needs management Familiarity with the concept of misconception, and learning how to manage it.

Ethical considerations

All participants who met the inclusion criteria received an informed consent form. The participants were fully aware of the purpose of this study, and their anonymity and confidentiality were preserved. Ethical approval was granted with the ethics code of R.IAU.KHUISF.REC.1401.025.

Result

According to the descriptive results, the ages of 25 to 30 are the most frequent, and the age of 45 or above is the least frequent among the participants. Participants with bachelor's degree had the most frequency, while associate's degree, diploma, and those who dropped out the school had the least frequency. The majority of the participants were married for less than five years and five to ten years; however, the lowest frequency belonged to the participants with less than 10-year marriage. Finally, most participants had only one child, while four children or more was reported as the least frequency of child number.

Table 2 shows a difference between the mean of family executive function and narcissistic tendencies in experimental and control groups. There is also a difference between the mean of family executive function and narcissistic tendencies of experimental groups in the pretest and posttest stages. A multivariate analysis covariance test was used to examine the differences in the mentioned mean values. Shapiro–Wilk test was applied to examine the normality of family executive function and narcissistic tendency values. The results indicate that the data (family executive function and narcissistic tendencies) significantly deviate from a normal distribution. Eventually, Levin's test was used to assess the presumption of equality of variances.

Table 2.

Mean and standard deviation of family executive functions and married women with attention-seeking tendencies based on control and experimental group

Variable	Type	Commitment-based training group		Attention-seeking adjustment training group		Control group		Number
		Mean	Standard deviation	Mean	Standard deviation	Mean	Standard deviation
Family executive functions	Pretest	8/183	37/19	1/168	27/15	6/176	8/17	20
	Posttest	8/277	94/22	2/327	91/11	1/176	57/15	20
	Pretest	8/52	66/2	8/41	82/2	8/89	41/5	20
Narcissistic tendency	Posttest	5/77	04/6	6/92	01/2	6/50	5/6	20
	Pretest	8/53	71/5	2/40	29/4	7/50	34/6	20

To check the presumption of equality of variances, Levin's test was used. In other words, Levin's test was used to assess the equality of variances in family executive functions and narcissistic tendencies. The results showed no significant difference in equality of variances regarding family executive function (F = 0/097, P = 0/957) and narcissistic tendency (F = 3/49, P = 0/260). The results indicated that the dependent variable covariances were insignificant in the two groups (Box = 2/381, P = 0.355, F = 896). A multivariate analysis covariance test was used to compare the two groups, and Table 3 presents the results of the multivariate covariance analysis.

Table 3.

The results of multivariate covariance analysis regarding the comparison of family executive functions and narcissistic tendencies

Test	Dependent variable	Sum of squares	df	Mean square	F	Significance	Eta-squared	Statistical power
Pretest	Family executive functions	863/3677	1	863/3677	766/122	000/0	854/0	000/1
	Narcissistic tendency	315/212	1	315/212	915/18	000/0	474/0	985/0
Group	Family executive functions	393/6314	2	197/3157	386/205	000/0	909/0	000/1
	Narcissistic tendency	511/490	2	256/245	850/21	000/0	675/0	000/1
Error	Family executive functions	124/629	21	958/29
	Narcissistic tendency	719/235	21	225/11

According to Table 3, there is a significant difference between the mean of the two groups regarding family executive function and narcissistic tendencies. Moreover, Eta coefficient indicates that the attention-seeking training and family executive function has changed 96.4% and 68.5%, respectively. The statistical power of family executive function, individual executive function, negative emotional experience, and narcissistic tendencies indicate a proper sample size (1.000). Finally, the Eta coefficient shows that 90.9% of changes in family executive function and 67.5% of changes in narcissistic tendency are in relation to the training. The least significant difference (LSD) post hoc test was used to determine the difference between groups, and Table 4 shows the results of this analysis.

Table 4.

An illustration of LSD test analysis indicating the difference between two means, regarding family executive function and narcissistic tendency

Variables	Group	Mean difference	Standard deviation	Significance	Lower limit	Upper limit
Family executive functions	Attention-seeking adjustment—Control group	*369/157	561/7	000/0	341/141	397/173
Attention-seeking tendency	Attention-seeking adjustment—Control group	*915/43-	466/7	000/0	699/59-	130/28-

Table 4 shows that the mean difference between family executive function and narcissistic tendency concerning attention-seeking training of the control group is significant. Based on Table 4, attention-seeking adjustment training is more effective on family executive functions than narcissistic tendencies.

Discussion

This research aimed to compare the effectiveness of attention-seeking adjustment training and commitment-based training on family executive functions and narcissistic tendencies among married women. The results indicated a meaningful difference in family executive functions and narcissistic tendencies among the three groups. According to the post hoc test, attention-seeking adjustment training was more effective than commitment-based training. Since this is the first research regarding the effectiveness of attention-seeking adjustment training, the results cannot be compared to the prior research. However, the training has been influential on the dependent variables, like other corrective and therapeutic methods. For instance, the results of narcissistic tendency were consistent with the results of other studies concerning narcissistic behaviors, including the effectiveness of empathy training on narcissistic behavior[21,22] and anger management narcissistic behavior.[23] In addition, the findings of the present research align with two other studies: the effects of dialectical behavior therapy on executive functions[24] and the effectiveness of emotion regulation on executive functions.[25] Family executive functions are associated with functions of the frontal lobes of the brain and play an important role in the survival and stability of the family.[16] Therefore, it seems attention-seeking training has the ability to improve the brain's gray matter.

Additionally, women are the key to sustainable development and quality of family. Their problem-solving ability could benefit the family in every aspect, such as maintaining peace and relieving stress and tension. In such a manner, women positively affect family executive functions. Some practical training in this regard are as follows: familiarity of married women with the types, symptoms, and effects of attention-seeking behaviors, understanding of the concept of attention-seeking, familiarity with cognitive, emotional, and social causes of attention-seeking behaviors, knowing cognitive, and emotion regulation techniques to deal with attention-seeking behaviors. It seems that the mentioned techniques, along with the practice, could greatly benefit attention-seeking behaviors. The findings showed that both trainings resulted in the reduction of narcissistic tendencies. Narcissism is one's ability to maintain a relatively positive self-image about themselves through self-regulation and self-conscious emotions.[23] Also, narcissism is characterized by grandiosity, self-importance, self-absorption, and entitlement.[23] In addition, narcissistic tendencies in marital relationships include all the mentioned characteristics. According to the results of the present study, both attention-seeking training and commitment-based training[26] had a positive influence on narcissistic tendencies. Commitment-based training helped the participants to develop empathy and ponderation, which led to a reduction of narcissistic tendencies. The participants were trained to deal with false beliefs and negative emotions. Also, they received education regarding self-esteem, the right way to fulfill their safety and security needs, and how to manage criticism. The training of the present study helped married women with attention-seeking behavior in relation to feeling contempt toward their spouse.

In this study, the techniques of attention-seeking adjustment training on married women include understanding the concept of attention-seeking, the effects of attention-seeking behaviors on martial relationships, understanding underlying martial beliefs of attention-seeking behavior, identifying and living values, understanding and managing cognitive distortion, knowing unhealthy needs that lead to attention-seeking behaviors, learning how to manage unhealthy needs, and finally learning how to achieve behavioral goals to deal with attention-seeking behaviors. All the mentioned techniques helped the participants develop self-awareness of their weaknesses and strengths, decreasing attention-seeking behaviors. The training of the present study is designed specifically for married women with the attention-seeking disorder; therefore, it could be of great benefit to them.

Limitations and suggestions

This study has some limitations. It was a cross-sectional study and the data were collected from the participants simultaneously at a specific point of time. All the participants were selected from Isfahan counseling centers; therefore, the results may not be generalized to the whole population. In the future, more longitudinal studies are needed to extend beyond a single moment in time to provide more detailed information regarding married women with the attention-seeking disorder. The results of this study provide a good starting point for discussion and further research. Therefore, future research should certainly be conducted to help family therapists with family structure development.

Conclusion

Attention-seeking behavior is a personality disorder with obvious symptoms. Today, the widespread use of social media and oversharing of personal life has turned the healthy population into needy attention-seekers that require attention. Therefore, this study aimed to investigate the effects of attention-seeking training on married women with narcissistic tendencies. In addition, the results of attention-seeking training were also compared to commitment-based training.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.