Medical Journal of Mashhad university of Medical Sciences

Medical Journal of Mashhad university of Medical Sciences

The Effectiveness of Child Oriented Unified Protocol for Transdiagnostic Treatment on Grief Symptoms and Emotional Expression in 7- to 11-Year-Old Children with Grief Experience

Document Type : Research Paper

Authors
Zahra Nariman 1
Tayyebeh Sharifi 2
Mohammad Ghasemi pirbaloti 3
1 PhD student, Department of Psychology, Shk.C., Islamic Azad University, Shahrekord, Iran.
2 Full Professor, Department of Psychology, Shk.C., Islamic Azad University, Shahrekord, Iran.
3 Assistant Professor, Department of Psychology, Shk.C., Islamic Azad University, Shahrekord, Iran.
10.22038/mjms.2025.89936.5074
Abstract
The present study was conducted to investigate the effectiveness of child oriented unified protocol for transdiagnostic treatment on grief symptoms and emotional expression in 7- to 11-year-old children with grief experience. The current study was a experimental application with a pre-test-post-test design with a control group and a two-month follow-up period. The statistical population of the study included children aged 7 to 11 who had experienced grief and were studying in Isfahan during the 2024-2025 academic year. In this research, 36 children were selected by purposeful sampling and randomly assigned to experimental and control groups (18 children in the experimental group and 18 children in the control group). The children in the experimental group received the unified protocol for transdiagnostic treatment during ten weeks in ten 75-minute sessions. Children's Grief Questionnaire (CGQ), and Emotion Expression Scale for Children (EESC) were used in the present study. The data were analyzed through mixed ANOVA via SPSS23 software. The results showed that child oriented unified protocol for transdiagnostic treatment has significant effect on the grief symptoms (p<0.0001) and emotional expression (p<0.0001) in children with grief experience. According to the findings of the study it can be concluded that unified protocol for transdiagnostic treatment can be used as an efficient method to decrease grief symptoms and increase emotional expression in children with grief experience through identifying emotions, teaching emotional awareness, cognitive reevaluation, identifying emotion avoidance models and investigating behaviors resulting from emotions.
Keywords
Unified Protocol For Transdiagnostic Treatment
Emotional Expression
Grief Experience
Subjects
  1. Ouyang N, Baker JN, Ananth PJ, Knobf MT, Snaman JM, Feder SL. Parent-Clinician Communication and Prolonged Grief in Parents Whose Child Died From Cancer. Journal of Pain and Symptom Management, 2024; 68(5): 516-524.
  2. Boelen PA, Spuij M, Lenferink LIM. Comparison of DSM-5 criteria for persistent complex bereavement disorder and ICD-11 criteria for prolonged grief disorder in help-seeking bereaved children. Journal of Affective Disorders, 2019; 250: 71-78.
  3. Fitzgerald DA, Nunn K, Isaacs D. What we have learnt about trauma, loss and grief for children in response to COVID-19. Paediatric Respiratory Reviews, In Press, Corrected Proof.2021.
  4. Cohen JA, Mannarino AP. Trauma-focused cognitive behavioral therapy for childhood traumatic separation. Child abuse & neglect, 2019; 92: 179-195.
  5. Tolahunase MR, Sagar R, Chaurasia P, Dada R. Impact of yoga- and meditation-based lifestyle intervention on depression, quality of life, and cellular aging in infertile couples. Fertility and Sterility, 2018; 110(4): 67-74.
  6. Hanauer C, Telaar B, Rosner R, Doering BK. The efficacy of psychosocial interventions for grief symptoms in bereaved children and adolescents: A systematic review and meta-analysis. Journal of Affective Disorders, 2024; 350: 164-173.
  7. Pinks D, Warren-James M, Katsikitis M. Does a peer social support group intervention using the cares skills framework improve emotional expression and emotion-focused coping in paramedic students? Australasian Emergency Care, 2021; 24(4): 308-313.
  8. Yu X,  HeT, TanY, Chi P, Lin X. Intergenerational effects of childhood maltreatment: The relationships among parental childhood emotional neglect, emotional expressiveness and children's problem behaviors. Child Abuse & Neglect,  2023; 140: 1061-1066.
  9. MilojevichHM, Haskett ME. Longitudinal associations between physically abusive parents’ emotional expressiveness and children’s self-regulation. Child Abuse & Neglect, 2018; 77: 144-154.
  10. Riley TN, Sullivan TN, Hinton TS, Kliewer W. Longitudinal relations between emotional awareness and expression, emotion regulation, and peer victimization among urban adolescents. Journal of Adolescence, 2019; 72: 42-51.
  11. Brodahl K, Finset A, Storøy HE, Pedersen R. Medical students’ expressions of empathy: A qualitative study of verbal interactions with patients expressing emotional issues in a medical interview. Patient Education and Counseling. 2021; 104(12): 2936-2943.
  12. Ehrenreich-May J, Kennedy SM, Sherman P, Bielick S, Bazla J, Bent D, Barlow DH. Unified Transdiagnostic Treatment Protocols for Emotional Disorders in Children and Adolescents. Translated by Firouzeh Zarghami, Mehdi Akbari, and Fatemeh Sarvari. Arjmand Publications. 2018. (In Persian)
  13. Pan M, Liu X, Gao X, Fu X, Liu L, Li H, Wang Y, Qian Q. Feasibility, Acceptability, and Preliminary Efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents in China: A Pilot Study. Behavior Therapy, 2025; 55(1): 145-161.
  14. CaiadoB, Guiomar R,  Gomes-PereiraB, Góis AC,   Sousa B,  Canavarro MC,  Ehrenreich-May J, Moreira H. Is the Unified Protocol for Children (UP-C) Effective for the Transdiagnostic Treatment of Children’s Emotional Disorders? A Randomized Controlled Trial. Behavior Therapy, In Press, Journal Pre-proof. 2024.
  15. KennedySM, Wilkie DP,  HenryL, Moe-Hartman J,  President K, Townson K, Anthony LG, Hawks, JL. The Unified Protocols for Children and Adolescents in Partial Hospitalization: Using Implementation Science Frameworks to Guide Adaptation. Cognitive and Behavioral Practice, 2023; 30(3): 367-383.
  16. Shaw AM, Halliday ER, Ehrenreich-May J. The effect of transdiagnostic emotion-focused treatment on obsessive-compulsive symptoms in children and adolescents. Journal of Obsessive-Compulsive and Related Disorders, 2020; 26: 1005-1009.
  17. Sandín B, Julia G, Valiente M, Espinosa V. Clinical Utility of an Internet-Delivered Version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (iUP-A): A Pilot Open Trial. Int J Environ Res Public Health, 2020; 10(6): 1-17.
  18. ShermanJA, Ehrenreich-May J. Changes in Risk Factors During the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents. Behavior Therapy, 2020; 51(6): 869-881.
  19. Eckhardt S, Martell C, Lowe KD, Grange D, Ehrenreich-May J. An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children,. Journal of Eating Disorder, 2019; 34: 154-165.
  20. Kennedy SM, Bilek EL, Ehrenreich-May J. A Randomized Controlled Pilot Trial of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children. Behavior Modification, 2019; 43(3): 330-360.
  21. Gohari S, Hosseini Almadani, SA, Afkari F. Efficacy of Child-Oriented Unified Trans-Diagnostic Treatment for Alexithymia in Divorce-Engaged Children with Emotional Self-Regulation Difficulties. Journal of Applied Psychological Research, 2023; 14(2): 179-194. (In Persian)
  22. Sharafi M, Jafari D, Bahrami M. Comparison of the Effectiveness of Cognitive Behavioral Therapy and Unified Transdiagnostic Therapy on the Depression and Anxiety Symptoms of Adolescents with Generalized Anxiety Disorder. RBS, 2023; 21 (1): 138-150. (In Persian)
  23. Ghasemzadeh S, Naghsh Z, Gholami Fesharaki M, Shafiee E. The Effectiveness of Transdiagnostic Treatment Program on Improving the Quality of Life and Reducing Depression in Children with Type 1 Diabetes: An Experimental Study. Shefaye Khatam 2021; 9(4): 71-80. (In Persian)
  24. Mohammadi R, Nahang A A, Hoseini M A. The Effectiveness of Unified Transdiagnostic Therapy on Self-Concept and Psychological Disorder of the Students with Depression Symptoms. J Child Ment Health, 2020; 6(4): 108-118. (In Persian)
  25. Barrett, T.W., Scott, T.B. (1989). Development of the Grief Experience Questionnaire. Journal of Suicide and Life Threatening Behavior, 19(2), 201- 215.
  26. Jazini S, Golparvar M, Sajjadian E. Investigating the Effectiveness of "Combined Package" (Play Therapy and Story Therapy) on Bereavement and Depression Symptoms of 5-10-year-Old Children Suffering From Bereavement. JHPM, 2023; 12(6): 39-52. (In Persian)
  27. Penza-Cliyve S, Zeman J. Initial Validation of Emotion Expression Scale for Children (EESC). Journal of Clinical Child and Adolescent Psychology, 2002; 31(4): 540-547.
  28. Ariapooran S. Comparing the emotion expression, emotional literacy and social self-efficacy in children with and without learning disabilities. Journal of Learning Disabilities, 2016; 5(2): 7-26. (In Persian)

 

Medical Journal of Mashhad university of Medical Sciences
Volume 69, Issue 1
May 2026
Pages 40-52