The effectiveness of addiction prevention training based on dialectical behavior therapy on family friendship and loneliness in adolescent boys

Abstract

BACKGROUND:

The ever-evolving addiction poses a serious threat to the younger generation today. Addiction mostly threatens individuals with mental vulnerabilities and poor interpersonal relationships—both within the family and among peers. Thus, having an effective communication skill serves as a critical component in addiction prevention programs. This study aims to investigate the effectiveness of the dialectical behavior therapy (DBT)-based addiction program on adolescents, focusing on its impact on family connectedness and feelings of loneliness.

MATERIALS AND METHODS:

This semi-experimental study employed a pretest–posttest–follow-up design with two experimental and control groups. The study population consists male adolescents aged 12–18 in Isfahan during 2024. Forty male adolescents were selected through a purposive sampling, considering the inclusion and exclusion criteria. The selected participants were then randomly assigned to the experimental or control groups. All participants were assessed three times during the three stages of the study, using the Family Connectedness Questionnaire and the UCLA Loneliness Scale. The control group was placed on a waiting list, while the experimental group received ten 90-min sessions of the DBT-based addiction prevention training. Data were analyzed using descriptive statistics, including mean and standard deviation, as well as the repeated-measures analysis of variance.

RESULTS:

The results indicated that the intervention significantly improved both family connectedness and reduced feelings of loneliness (P < 0.05).

CONCLUSION:

Based on the findings, the DBT-based addiction prevention program has been shown to be an effective intervention for enhancing the dependent variables of the present study.

Introduction

Adolescence is a critical stage for the onset of substance use.[1] Substance dependence is a major psychological and social challenge that can easily undermine the foundations of individual, family, and societal well-being.[2] The growing prevalence of drug use among adolescents poses a significant threat to both individual health and public safety, often leading to a range of negative consequences, such as wasted national resources, reduced workforce productivity, increased corruption, rising crime rates, and widespread violence.[3] The increasing tendency of adolescents to substance use is particularly concerning since a large number of users are adolescents who begin using drugs at a very early age and continue such behaviors later in their adulthood.[4] However, establishing a healthy and positive family connectedness is considered a key factor in addiction prevention among adolescents, offering a potential for positive change.[5]

Those adolescents who grow up in a warm, healthy, and supportive family environments are more likely to feel and experience emotional security, affection, a sense of responsibility, and commitment to the family members.[6] It should be noted that “family connectedness” refers to the emotional bonding, sacrifice, dedication of time, and physical and psychological resources to the family, as well as striving for the success of both the family and its members.[7] In contrast, adolescents who are raised in toxic and dysfunctional families and those whose emotional needs are not entirely met, lack a supportive family, which leads to a deep sense of loneliness as a result of not being able to establish a healthy family connectedness appropriately. Loneliness itself can result in anxiety, depression, a feeling of rejection, hypervigilance, intrusive thoughts, paranoia, social isolation, gloominess, and a lack of life purpose. Moreover, it is often associated with behavioral disorders, such as overeating, suicidal tendencies, alcohol abuse, and drug addiction.[8]

Studies indicate that adolescents are more likely to participate in social, friendly, and interpersonal activities when they are accepted and liked by their peers.[9] According to the biopsychosocial model, emotional dysregulation—arising from an interaction between biological predispositions and invalidating environmental conditions—can set the stage for maladaptive behaviors such as substance use and self-harm.[10] These behaviors, although temporarily relieving, are ultimately maladaptive strategies for managing emotional distress.[11] Therefore, DBT can be beneficial for those adolescents from dysfunctional families and poor interpersonal relationships.

DBT is a form of cognitive-behavioral therapy that manages extreme impulsive behaviors or emotional dysregulation. This therapy equips individuals to regulate their emotions without losing control or any self-destructive behaviors.

DBT is particularly effective for individuals who experience intense emotional pain and try to avoid it or choose to escape the pain.[12] In addition to employing standard cognitive-behavioral skills, including cognitive restructuring and crisis management, DBT targets maladaptive behaviors such as aggression and impulsivity through the cultivation of dialectical thinking ability, acceptance, emotional regulation, distress tolerance skills, and improving interpersonal relationships.[13] In general, the primary focus of DBT is the acquisition, application, and generalization of adaptive coping skills, with the ultimate goal of helping individuals break free from destructive cycles and achieve a more balanced and healthy life.[14]

Numerous studies have confirmed the effectiveness of DBT in addressing various psychological variables: aggression and anxiety,[15] emotion regulation and depressive symptoms,[16] psychological capital and academic buoyancy,[17] psychological coherence,[18] psychological stress,[19] and self-injurious behaviors.[20]

This investigation aimed to address a significant gap in the existing studies, since no published work has specifically examined the effectiveness of a DBT-based addiction prevention program on adolescents’ family connectedness and loneliness. To fill this gap, we employed a mixed-methods approach. The initial qualitative phase is focused on developing and validating a specialized DBT-based prevention package tailored for adolescents. This intervention is designed to target both internal and external risk factors linked to addiction prevention and includes four core strategies: acceptance, emotion regulation, mindfulness, and communication skills.

It is important to note that experts who specialize in the field of addiction psychotherapy validated the devised training package. The present article reports on the quantitative phase, which evaluates the effectiveness of the package on key psychological variables associated with addiction. The findings of these studies can not only contribute to the development of DBT and enrich the literature review on addiction prevention. They also provide practical tools for counselors and therapists working with adolescents. Therefore, this research provided an answer to the following question: Does the devised training program (package) effectively impact family connectedness and the feeling of loneliness among adolescents?

Study design and setting

This semi-experimental study consisted of pretest, posttest, and follow-up stages with two control and experimental groups.

Study participants and sampling

The study population also included adolescents aged 12–16 in Isfahan during 2024. Forty participants who met the inclusion criteria were selected using the continence sampling method. Then, they were all divided into two control and experimental groups, with 20 individuals in each group. The inclusion criteria are as follows: willingness to participate in the study; no severe physical problems, no severe mental disorders, and no concurrent psychological or psychiatric treatment. The exclusion criteria for the study included missing more than two sessions, irregular attendance at training, and lack of cooperation between the adolescents and the researcher.

Data collection tools and techniques

The following instruments were used to measure the variables of the study:

Family connectedness scale: We employed the Family Connectedness Questionnaire to assess the variable of family connectedness.[7] The content validity of this scale was confirmed through a review by experts in family studies. The scale includes 13 items, and its face validity was assessed and approved by a panel of 10 adolescents. The items are rated on a 5-point Likert scale, where 1 means “strongly disagree” and 5 means “strongly agree.” This scale consists of two subscales: attachment to family and detachment from family.[7] The internal consistency reliability of the scale was originally reported as 0.94. In the current study, the internal consistency for both subscales was reevaluated and found to be above 0.85.

UCLA Loneliness Scale: The UCLA Loneliness Scale is a 20-item questionnaire developed by Russell et al.[21] It is rated on a 4-point Likert scale, where 1 indicates “never” and 4 means “always.” The developers assessed the scale and reported its psychometric properties to be reliable and valid. It has been effectively used among various high-risk populations prone to loneliness, such as teenage mothers, homeless adolescents, and low-income immigrants, indicating good discriminant validity,[21] and the original Cronbach’s alpha was reported at 0.94. Moreover, the present study reassessed the reliability of this scale, yielding a Cronbach’s alpha of 0.88.

Procedure

First, the necessary approvals were obtained from the university, along with the research ethics code. Following that, we received the required permissions from the Department of Education, as well as coordinating with relevant officials to conduct the study. After the official procedures, one secondary school was randomly selected. Forty male adolescents who met the inclusion criteria were selected and then randomly assigned into two groups of control and experimental, each consisting of 20 individuals. Both groups completed the family connectedness and the UCLA loneliness scales during the pretest. Subsequently, the experimental group received the DBT-based addiction prevention training package, delivered by the researcher, throughout ten 90-min sessions twice a week.

On the other hand, the control group received no intervention, placing them on a waiting list. At the end of the training program, both groups again completed the same questionnaires as part of the posttest. Eventually, 45 days after the intervention, a follow-up session was conducted in which both groups completed the questionnaires for the third time. It is important to note that the researcher conducted the intervention sessions based on a structured protocol developed for the study. The protocol included clearly defined content and objectives for each session and was implemented under the supervision of the supervising professor. The contents of the sessions are presented in Table 1 in detail.

Table 1.

The detailed content of the DBT-based addiction prevention program

Session No.		Session Title		Session Content		Assignment
1		Getting familiar with the nature of addiction and dialectical thinking		1. Introducing adolescents to the nature, stages, and progression of addiction and challenging common misconceptions regarding addiction through a short animation called “The Nuggets” by Andreas Hykade and selected scenes from the TV series “just kidding” directed by Mehran Modiri. Eventually, they have been analyzed by an instructor. 2. Introduction to dialectical thinking		1. Completing the DBT dialectical thinking worksheet. 2. Reading a brochure on nicotine and its derivatives, including their side effects
2		Introducing the participants to the concept of mindfulness and its primary practices		1. Defining mindfulness. 2. The importance and benefits of mindfulness. 3. Primary practices: deep breathing, body scan meditation. 4. Group discussion; Q&A regarding the participants’ experience of the primary practices. 5. Summing up the session and providing a concise overview of the items discussed and the benefits of the mindfulness practices		1. Deep breathing and body scanning. 2. Taking notes on personal experiences and sharing them with other participants in the next session. Reading a brochure on cannabis, its side effects, and harms
3		Moving to advanced mindfulness practices for greater awareness		1. Getting familiar with the concepts of “reasonable mind, wise mind, and emotion mind.” 2. Getting connected to the wise mind. 3. Advanced mindfulness practices: observing thoughts without getting lost, emotional attunement. 4. Group discussion: and Q&A regarding the participants’ practices experience. 5. Providing examples and stories examples for deeper understanding		1. Reading the “Connecting with the Wise Mind” brochure and writing their own personal reflections. 2. Reading a brochure on alcohol and how it affects bodies
4		Distress tolerance skills (1)		1. Understanding the concept of distress. 2. Coping strategies for distress. 3. Addicts’ maladaptive coping strategies when faced with distress. 4. Practical skills: distraction techniques, safe emotional expression, such as screaming into a pillow, engaging in pleasurable activities, helping others, leaving distressing situations, and completing everyday tasks. 5. Group discussion: and Q&A regarding the participants’ practice experience and providing examples and stories examples for deeper understanding		1. Tracking all the practices using tracking sheets. 2. Reading a brochure on opioids and their side effects
5		Distress tolerance skills (2)		1. Reviewing the previous session: key points and the presented practices. 2. Advanced DBT skills for distress tolerance: self-soothing and radical acceptance. 3. Group discussion and Q&A regarding the participants’ practice experiences. 4. Providing examples for deeper understanding		1. Tracking all the practices using tracking sheets. 2. Reading the brochure on addictive drugs (1)
6		Emotion regulation—Part 1		1. Reviewing the previous session: key points and the presented practices. 2. Emotion regulation: Learning how to understand the relationship between thoughts, feelings, and behaviors. 3. Identifying misconceptions about emotions. 4. Group discussion and Q&A regarding the participants’ practice experiences. 5. Providing examples for deeper understanding		1. Tracking all the practices using tracking sheets. 2. Reading the brochure on addictive drugs (2)
7		Emotion regulation—Part 2		1. Reviewing the previous session: key points and the presented practices. 2. Emotion regulation: observation without attachment, opposite action, or acting opposite to emotional impulses. 3. Group discussion and Q&A regarding the participants’ practice experiences. 4. Providing examples for deeper understanding		1. Tracking all the practices using tracking sheets. 2. Reading a brochure on novel psychoactive substances (1)
8		Interpersonal effectiveness—Part 1		1. Reviewing the previous session: key points and the presented practices. 2. Mastering communication: defining relationships and communion, the art of mindful dialog, interaction styles, and identifying needs and prioritizing them. 3. Group discussion and Q&A regarding the participants’ practice experiences. 4. Providing examples for deeper understanding		1. Having participants fill out worksheets in order to explore interaction styles and identify their needs. 2. Reading a brochure on novel psychoactive substances (2)
9		Interpersonal effectiveness—Part 1		1. Reviewing the previous session: key points and the presented practices. 2. Mastering communication: communication rights, saying “no,” and the compromise skills 3. Group discussion and Q&A regarding the participants’ practice experiences. 4. Providing examples for deeper understanding		1. Having participants fill out a conflict-resolution worksheet. 2. Reading a brochure on behavioral addictions (1)
10		Taking everything into consideration (conclusion) and the application of the learned skills in everyday life		1. Summing up the sessions and providing a concise overview of the items discussed so far by the instructor. 2. Identification of learned skills by participants through viewing selected addiction-related scenes. 3. Assessing the strategies for integrating learned skills into everyday life		1. Learning “everyday planning” and applying them in everyday life. 2. Reading a brochure on behavioral addictions (2)

Ethical consideration

The present study received approval from the ethics committee under the ethics code of IR.IAU.KHUISF.REC.1403.033.

Results

The researchers employed the repeated measures analysis of variance (ANOVA) to provide an answer to the following research question: “Does the devised training package effectively impact family connectedness-attachment and detachment-and the feeling of loneliness among adolescents?”

Table 2 also presents the results of the Shapiro–Wilk test of normality, Levene’s test for homogeneity of variance across groups, testing equality of covariance matrices using Box’s M test, and Mauchly’s test of sphericity regarding the variables of family connectedness (attachment and detachment), and loneliness.

Table 2.

Results of Shapiro–Wilk, Levene’s, Box’s M, and Mauchly’s tests for the family connectedness (attachment and detachment), as well as loneliness

No.		Test		Shapiro–Wilk (Sig.)				Levene’s (Sig.)				Box’s M (Sig.)				Mauchly’s (Sig.)
Family connectedness—attachment
1		Pretest		0.96		0.44		1.56		0.22		12.20		0.08*		0.69		0.001*
2		Posttest		0.98		0.49		0.10		0.75
3		Follow-up		0.97		0.36		0.67		0.42
Family connectedness—detachment
1		Pretest		0.96		0.15		0.09		0.76		12.69		0.07		0.71		0.002*
2		Posttest		0.95		0.10		2.43		0.13
3		Follow-up		0.96		0.14		4.34		0.04
Loneliness
1		Pretest		0.96		0.17		0.78		0.38		4.27		0.69		0.53		0.001*
2		Posttest		0.95		0.11		0.38		0.54
3		Follow-up		0.96		0.13		0.69		0.41

As shown in Table 2, all three variables—attachment, detachment, and loneliness—demonstrated a normal distribution (P > 0.05), equality of error variances (P > 0.01 and P > 0.05), and equality of the variance–covariance matrix (P > 0.05). Moreover, Mauchly’s test was significant, indicating that the sphericity assumption was violated. Accordingly, the final ANOVA results were corrected using Greenhouse–Geisser estimates. Table 3 presents the means and standard deviations of family connectedness and loneliness across the pretest, posttest, and follow-up stages for the experimental and control groups.

Table 3.

Means and standard deviations of family connectedness and loneliness in the experimental and control groups across pretest, posttest, and follow-up stages

Variable		Stage		DBT-Based Addiction Prevention Training				Control Group
				Mean		SD		Mean		SD
Family connectedness—attachment		Pretest		13.15		2.03		13.80		1.47
		Posttest		22.70		2		13.60		2.16
		Follow-up		22.95		1.67		13.60		2.06
Family connectedness—detachment		Pretest		24.25		2.07		25.10		2.20
		Posttest		15.10		1.89		25.05		2.54
		Follow-up		15.20		1.88		24.90		3.06
Loneliness		Pretest		56.25		3.13		56		2.55
		Posttest		36.05		3.30		56.80		2.89
		Follow-up		36.20		2.98		57.25		2.86

As illustrated in Table 3, the DBT-based addiction prevention group showed significant changes in family connectedness and loneliness in the posttest and follow-up stages compared to the control group. The results of the repeated measures ANOVA for these variables are presented in Table 4.

Table 4.

Means and standard deviations of family connectedness and loneliness in the experimental and control groups across pretest, posttest, and follow-up stages

Source Effect				Sum of Squares		df		Mean Square		F		Significance		Eta Squared (η2)		Statistical Power
Family connectedness—attachment
Within subjects		Stage (time)		598.82		1.53		392.01		12.776		0.001*		0.77		1
		Time interaction × group		650.42		1.53		425.79		13.778		0.001*		0.78		1
		Error (Time)		178.10		5.058		3.07		–		–		–		–
Between subjects		Group		1,056.13		1		105.136		16.946		0.001*		0.81		1
		Error		240.40		38		6.33		–		–		–		–
Family connectedness—detachment
Within subjects		Stage		567.35		1.55		364.77		13.798		0.001*		0.78		1
		Time interaction × group		537.32		1.55		345.46		13.451		0.001*		0.78		1
		Error (time)		155.33		5.109		2.63		–		–		–		–
Between subjects		Group		1,400.83		1		140.830		11.267		0.001*		0.75		1
		Error		453.97		38		11.95		–		–		–		–
Loneliness
Within subjects		stage		2,433.87		13.36		178.864		13.091		0.001*		0.77		1
		Time interaction × group		2,982.60		1.36		218.277		16.640		0.001*		0.81		1
		Error (time)		705.53		5.821		13.62		–		–		–		–
Between subjects		Group		5,754.67		1		575.674		74.480		0.001*		0.95		1
		Error		295.32		38		7.77		–		–		–		–

Because the sphericity assumption was violated [Table 2], the Greenhouse–Geisser correction was applied to adjust the results [Table 3].

• (1) Family connectedness—attachment: Both the main effects of time (F = 127.76, df = 1.53, and P < 0.0.1) and the group × time interaction (F = 166.96, df = 1.53, and P < 0.01) were statistically significant in the within-subject effects. This indicates a significant difference over time and in the interaction between time and group (experimental and control) in terms of attachment to the family. Notably, the eta squared for time was 0.77, with a statistical power of 1, while the eta squared for the interaction was 0.78, also with a power of 1. These results revealed that 77% and 78% of the variance in attachment to family is explained by the independent variable—the implementation of dialectical behavior therapy (DBT)-based addiction prevention training—with full statistical power (100%). Moreover, the between-group effect was significant (F = 166.94, df = 1, and P < 0.01), with eta squared of 0.81 and statistical power of one, indicating that 81% of the variance in attachment to family between the DBT group and the control group is attributable to the intervention.

• (2) Family connectedness—detachment: In the within-subject effects, both the main effect of time (F = 138.79, df = 1.53, and P < 0.01) and the interaction time × group (F = 131.45, df = 1.53, and P < 0.01) were significant. This indicates a meaningful difference over time and in the interaction between time and group regarding family detachment. The effect size, measured by eta squared for time, is 0.78, with a power of 1. The effect size for the interaction is also 0.78, with a power of 1. Therefore, 78% of the variance in detachment from family can be explained by the intervention, which is supported by 100% statistical power. Additionally, the between-group effect was significant (F = 117.26, df = 1, and P < 0.001), with an eta squared value of 0.75 and a power of 1. This indicates a strong impact of the DBT-based intervention in reducing family detachment.

• (3) Loneliness: In the within-subjects analysis, both the effect of time (F = 131.09, df = 1.36, and P < 0.001) and the interaction between time and group (F = 160.64, df = 1.36, and P < 0.001) were significant, illustrating differences in loneliness over time and between groups. The eta squared for time is 0.77, with a power of 1, and for the interaction, it is 0.81, also with a power of 1. This means that 77% and 81% of the variance in loneliness can be attributed to the DBT-based addiction prevention program, with 100% statistical power. Furthermore, the between-group effect was highly significant (F = 740.48, df = 1.36, and P < 0.001), with an eta squared value of 0.95 and a power of 1. This demonstrates that 95% of the observed differences in loneliness between the intervention and control groups can be attributed to the impact of the training.

As shown in Table 5, there are significant differences in family connectedness—both attachment and detachment—when comparing the pretest results to those obtained in the posttest and follow-up stages. This means that participants showed notable improvements in their feelings of connectedness from the beginning to the end of the study. However, between the posttest and follow-up stages, no significant differences were found, suggesting that while there were meaningful differences from the pretest to the posttest, these improvements were maintained over time, with no additional changes observed later up to the follow-up stage.

Table 5.

Bonferroni post-hoc test results comparing time in family connectedness (attachment, detachment), as well as loneliness

Variable		No.		Reference Group		Comparison Group		Mean difference		Standard Error (SE)		Significance
Family connectedness—attachment
Time		1		Pretest		Posttest		−4.67		0.40		0.001*
		2				Follow-up		−4.80		0.37		0.001*
		3		Posttest		Follow-up		−0.12		0.23		1
Group		4		DBT-based addiction prevention training		Control		5.93		0.46		0.001*
Family connectedness—detachment
Time		1		Pretest		Posttest		4.60		0.32		0.001*
		2				Follow-up		4.62		0.39		0.001*
		3		Posttest		Follow-up		0.02		0.23		1
Group		4		DBT-based addiction prevention training		Control		−6.83		0.63		0.001*
Loneliness
Time		1		Pretest		Posttest		9.70		0.83		0.001*
		2				Follow-up		9.40		0.74		0.001*
		3		Posttest		Follow-up		−0.30		0.40		1
Group		4		DBT-based addiction prevention training		Control		13.58		0.51		0.001*

Discussion

The results indicate that the DBT-based addiction prevention package had a significant and enduring effect on adolescents’ family connectedness and feelings of loneliness. Although no previous study has directly examined this specific intervention, the current findings align with other psychological programs that similarly improve family connectedness and alleviate loneliness. For instance, Karimi et al.[6] demonstrated the effectiveness of psychological enrichment in enhancing family connectedness; Shirani et al.[22] found that compassion therapy reduced loneliness; Ahmadi et al.[23] documented mindfulness-based interventions reducing loneliness; Sadeghi Dehkordi et al.[24] showed that Seligman’s parenting style education package improved relationships; and Amiriyan Farsani et al.[25] reported that reality therapy decreased loneliness in single-parent adolescent girls.

This training package or program aims to enhance family connectedness and reduce feelings of loneliness among male adolescents. Family connectedness is characterized by expressions of love, sacrifice, and the investment of time and emotional resources into family relationships. It also involves supporting the success of family members.[7] Loneliness is a complex, adverse emotional state that stems from perceived deficiencies in our personal and social relationships. It includes a combination of negative feelings, thoughts, and distress.[23] Persistent loneliness is a major risk factor for engaging in high-risk behaviors, such as substance use. For many adolescents, loneliness often arises from low social support, isolation, and inability to form meaningful connections, which can escalate stress, anxiety, and depression. Therefore, some adolescents may engage in avoidance behaviors, such as drug or alcohol use, as a way to temporarily ease emotional pain and fill the void left by loneliness. It is crucial to understand that addiction in adolescents is often a result of maladaptive learning, a coping strategy aimed at regulating negative emotions and escaping painful realities.

The intervention was likely successful because it incorporated a variety of effective strategies. For instance, teaching dialectical thinking—embracing a “both–and” mindset rather than an “either–or” approach—helped them develop more balanced attitudes toward parents. Consequently, instead of reacting impulsively or indifferently in family interactions, they learned to engage more mindfully and respectfully, moving away from rigid black-and-white thinking.[26] Additionally, mindfulness skills such as deep breathing, body scanning, and nonjudgmental observation enhanced adolescents’ awareness of their mental and bodily states when facing daily stressors or family tension. These skills enabled them to remain calmer and respond thoughtfully rather than reactively. Through correcting problematic cognitions and applying mindfulness techniques, adolescents developed emotion regulation skills—central to the intervention. Furthermore, learning to observe their emotions without getting caught up in them and to act opposite to emotional impulses empowered them to identify and regulate their emotions accurately. This skill enabled them to make thoughtful decisions in emotionally charged situations, decreasing emotional volatility within the family and promoting more balanced, constructive interactions during future encounters.

Limitation and recommendation

The limitations of this study include the reliance on self-report measures, which may influence the interpretation of treatment outcomes. Additionally, the use of a nonrandom, all-male sample restricts the generalizability of the findings. Despite these limitations, the encouraging results suggest that it is recommended that therapists and counselors should implement this training program to improve communication skills, foster productive family interactions, and regulate emotions associated with loneliness. Furthermore, future implementations should consider repeating therapy cycles with separate follow-up periods, apart from the first follow-up, to assess the long-term effects of the intervention over time.

Conclusion

The strategies and techniques included in the training program significantly enhanced family connectedness and interpersonal relationships, ultimately decreasing adolescents’ feelings of loneliness.

Declaration of participant consent

The authors confirm that all participants filled out a consent form beforehand to ensure ethical practices. The participants have agreed to the reporting of their clinical information in the journal. They are aware of the fact that their names and initials will not be published, and efforts will be made to protect their anonymity, although complete anonymity cannot be guaranteed. We respect the participants’ privacy and will do our utmost to protect it.

AI policy statement

No AI tools were used in the conduct or writing of this study.

Ethical approval

This study has received ethical approval, and the ethics code is stated in the ethical considerations section.

Author’s contributions

NN and AA, contributed to the conceptualization and methodology of the study. YZ supervised the study and managed the project. All authors read and approved the final version of the manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflicts of interest

The present article is part of a Master’s Thesis in Clinical Psychology, which is approved under the ethics code of IR.IAU.KHUISF.REC.1403.033. The authors also declared no conflicts of interest.

Funding Statement

Nil.