Document Type : Research Article


Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran


Background: Marital dissatisfaction in women can lead to persistent adverse effects and psychological disorders. This study aimed to investigate the effects of Emotion-Focused Therapy (EFT) for couples on psychological distress and marital disaffection in women traumatized by their husbands’ extramarital affairs.
Methods: This semi-experimental research was conducted using a pre-test-post-test design with a control group. The study population included all women visiting the Mehravaran Counseling Center in Ahvaz, Khuzestan Province, Iran in 2022, who were dealing with their husbands’ extramarital affairs. After convenience sampling, 30 individuals were selected and subsequently divided into the experimental and control groups randomly following the pretest. In this process, the experimental group underwent nine weekly 60-minute sessions of EFT for couples, while the control group received no interventions. During the post-test phase, all participants completed research questionnaires. The research tools comprised the Marital Disaffection Scale and Psychological Distress Scale. The data obtained were analyzed using ANCOVA in SPSS version 24.
Results: The mean (±SD) of psychological distress and marital disaffection in the control group were 23.13±3.64 and 33.13±4.29 in the pretest and 23.67±3.67 and 33.53±4.17 in the post-test. Meanwhile, the mean (±SD) of psychological distress and marital disaffection were 23.40±3.71 and 33.80±4.09 in the experimental group during the pretest and 18.53±3.96 and 28.00±3.11 in the post-test. The results indicated that EFT for couples alleviated psychological distress (P=0.001) and marital disaffection (P=0.001) in women traumatized by their husbands’ extramarital affairs.
Conclusion: Given the effectiveness of EFT in reducing marital disaffection and psychological distress in women traumatized by their husbands’ extramarital affairs, it is recommended to provide couples with instruction in emotion-focused strategies to reconstruct and enhance their relationships. Engaging in such an approach can help reinforce positive beliefs and effectively address the psychological challenges experienced by women traumatized by their husbands’ extramarital involvements.


Sakineh Ameri (Google Scholar)

Fatemeh Sadat Marashian (Google Scholar), (PubMed)

How to Cite: Ameri S, Marashian FS. Effectiveness of Emotion-Focused Therapy on Marital Disaffection and Psychological Distress in Women Traumatized by Their Husbands’ Betrayal. Women. Health. Bull. 2023;10(3):182-190. doi: 10.30476/WHB.2023.99277.1236.


1. Weiss-Laxer NS, Crandall A, Hughes ME, Riley AW. Families as a Cornerstone in 21st Century Public Health: Recommendations for Research, Education, Policy, and Practice. Front Public Health. 2020;8:503. doi: 10.3389/fpubh.2020.00503. PubMed PMID: 33072687; PubMed Central PMCID: PMC7530559. ## 2. Bahmani Makvandzadeh P, Koraei A, Alavi SZ, Hashemi SE. Relationships of Attachment Behaviors with Depression and Marital Quality among Women in Ahvaz, Iran: Mediating Role of Self-esteem. Women Health Bull. 2022;9(3):142-149. doi: 10.30476/whb.2022.95594.1182. ## 3. John NA, Seme A, Roro MA, Tsui AO. Understanding the meaning of marital relationship quality among couples in peri-urban Ethiopia. Cult Health Sex. 2017;19(2):267-278. doi: 10.1080/13691058.2016.1215526. PubMed PMID: 27684713; PubMed Central PMCID: PMC5525023. ## 4. Sayehmiri K, Kareem KI, Abdi K, Dalvand S, Ghanei Gheshlagh R. The relationship between personality traits and marital satisfaction: a systematic review and meta-analysis. BMC Psychol. 2020;8(1):15. doi: 10.1186/s40359-020-0383-z. PubMed PMID: 32033583; PubMed Central PMCID: PMC7006385. ## 5. Tavakol Z, Moghadam ZB, Nasrabadi AN, Iesazadeh N, Esmaeili M. Marital satisfaction through the lens of Iranian women: a qualitative study. Pan Afr Med J. 2016;25:208. doi: 10.11604/pamj.2016.25.208.9769. PubMed PMID: 28292164; PubMed Central PMCID: PMC5326191. ## 6. Pourshahbaz A, Eftekhar Ardebili M, Dolatshahi B, Ranjbar H, Taban M. Gender role conflict: Is it a predictor of marital dissatisfaction? A cross sectional study in Tehran. Med J Islam Repub Iran. 2020;34:84. doi: 10.34171/mjiri.34.84. PubMed PMID: 33306043; PubMed Central PMCID: PMC7711028. ## 7. Lin L, Guo H, Duan L, He L, Wu C, Lin Z, Sun J. Research on the relationship between marital commitment, sacrifice behavior and marital quality of military couples. Front Psychol. 2022;13:964167. doi: 10.3389/fpsyg.2022.964167. PubMed PMID: 36267074; PubMed Central PMCID: PMC9577325. ## 8. Alipour Z, Kazemi A, Kheirabadi G, Eslami AA. Relationship Between Marital Quality, Social Support and Mental Health During Pregnancy. Community Ment Health J. 2019;55(6):1064-1070. doi: 10.1007/s10597-019-00387-8. PubMed PMID: 30847733. ## 9. Mohammadi S, Hafezi F, Ehteshamzadeh P, Eftekhar Saadi Z, Bakhtiarpour S. The Effect of Schema Therapy on Sexual Self-Esteem in the Women Involved in Marital Conflicts. Women Health Bull. 2020;7(2):49-55. doi: 10.30476/whb.2020.86498.1058. ## 10. Abreu-Afonso J, Ramos MM, Queiroz-Garcia I, Leal I. How Couple's Relationship Lasts Over Time? A Model for Marital Satisfaction. Psychol Rep. 2022;125(3):1601-1627. doi: 10.1177/00332941211000651. PubMed PMID: 33736540; PubMed Central PMCID: PMC9136471. ## 11. Javadivala Z, Allahverdipour H, Asghari Jafarabadi M, Azimi S, Gilani N, Chattu VK. Improved couple satisfaction and communication with marriage and relationship programs: are there gender differences?-a systematic review and meta-analysis. Syst Rev. 2021;10(1):178. doi: 10.1186/s13643-021-01719-0. PubMed PMID: 34148550; PubMed Central PMCID: PMC8215832. ## 12. Lefebvre AA, Dugal C, Brassard A, Lussier Y, Lafontaine MF, Godbout N, et al. The role of relationship dissatisfaction in the dyadic associations between attachment insecurity and intimate partner violence among couples seeking therapy. J Marital Fam Ther. 2021;47(4):982-998. doi: 10.1111/jmft.12537. PubMed PMID: 34190347; PubMed Central PMCID: PMC9290815. ## 13. Rokach A, Chan SH. Love and Infidelity: Causes and Consequences. Int J Environ Res Public Health. 2023;20(5):3904. doi: 10.3390/ijerph20053904. PubMed PMID: 36900915; PubMed Central PMCID: PMC10002055. ## 14. Haseli A, Shariati M, Nazari AM, Keramat A, Emamian MH. Infidelity and Its Associated Factors: A Systematic Review. J Sex Med. 2019;16(8):1155-1169. doi: 10.1016/j.jsxm.2019.04.011. PubMed PMID: 31196837. ## 15. Hou Y, Jiang F, Wang X. Marital commitment, communication and marital satisfaction: An analysis based on actor-partner interdependence model. Int J Psychol. 2019;54(3):369-376. doi: 10.1002/ijop.12473. PubMed PMID: 29318606. ## 16. Nemati M, Behmanesh F, Kheirkhah F, Geraili Z, Pasha H. Marital Commitment and Mental Health in Different Patterns of Mate Selection: A Comparison of Modern, Mixed, and Traditional Patterns. Iran J Psychiatry. 2022;17(4):418-427. doi: 10.18502/ijps.v17i4.10691. PubMed PMID: 36817815; PubMed Central PMCID: PMC9922360. ## 17. Khorramabadi R, Sepehri Shamloo Z, Salehi Fadardi J, Bigdeli I. Prediction of Extramarital Relationships Based on Executive Functions With the Mediatory Role of Marital Commitment. PCP. 2019;7(2):147-157. doi: 10.32598/jpcp.7.2.147. ## 18. Karasu F, Ayar D, Çopur EÖ. The Effect of Solution Focused Level on Marital Disaffection and Sexual Satisfaction in Married Individuals. Contemporary Family Therapy. 2023;45(1):75-84. doi: 10.1007/s10591-021-09590-w. ## 19. Taghani R, Ashrafizaveh A, Ghanbari Soodkhori M, Azmoude E, Tatari M. Marital satisfaction and its associated factors at reproductive age women referred to health centers. J Educ Health Promot. 2019;8:133. doi: 10.4103/jehp.jehp_172_18. PubMed PMID: 31463318; PubMed Central PMCID: PMC6691613. ## 20. Galati MCR, Hollist CS, do Egito JHT, Osório AAC, Parra GR, Neu C, et al. Sexual dysfunction, depression, and marital dissatisfaction among Brazilian couples. J Sex Med. 2023;20(3):260-268. doi: 10.1093/jsxmed/qdac004. PubMed PMID: 36763940. ## 21. Pourfereydoun MH, Dasht Bozorgi Z. Effectiveness of Cognitive Rehabilitation Therapy on Psychological Distress and Self-Compassion in Mastectomized Women with Depression. Women Health Bull. 2023;10(2):87-95. doi: 10.30476/whb.2023.97735.1219. ## 22. Hajihasani M, Ekhtiari Amiri R. Psychological distress in infertile women: the role of quality of marital relationships and self-compassion. Hum Fertil (Camb). 2023:1-7. doi: 10.1080/14647273.2023.2222547. PubMed PMID: 37353992. ## 23. Alimoradi Z, Bahrami N, Khodaparast S, Griffiths MD, Pakpour AH. Mediating role of psychological distress and domestic violence in the association of fear of COVID-19 with marital satisfaction and sexual quality of life among women of reproductive age: An Iranian cross-sectional study. BMJ Open. 2023;13(2):e068916. doi: 10.1136/bmjopen-2022-068916. PubMed PMID: 36746547; PubMed Central PMCID: PMC9905787. ## 24. Greenman PS, Johnson SM. Emotionally focused therapy: Attachment, connection, and health. Curr Opin Psychol. 2022;43:146-150. doi: 10.1016/j.copsyc.2021.06.015. PubMed PMID: 34375935. ## 25. Najafi M, Soleimani AA, Ahmadi K, Javidi N, Kamkar EH. The Effectiveness of Emotionally Focused Therapy on Enhancing Marital Adjustment and Quality of Life among Infertile Couples with Marital Conflicts. Int J Fertil Steril. 2015;9(2):238-46. doi: 10.22074/ijfs.2015.4245. PubMed PMID: 26246883; PubMed Central PMCID: PMC4518493. ## 26. Johnson SM. The Contribution of Emotionally Focused Couples Therapy. Journal of Contemporary Psychotherapy. 2007;37(1):47-52. doi: 10.1007/s10879-006-9034-9. ## 27. Shareh H, Ghodsi M, Keramati S. Emotion-focused group therapy among women with premenstrual dysphoric disorder: A randomized clinical trial. Psychother Res. 2022;32(4):440-455. doi: 10.1080/10503307.2021.1980239. PubMed PMID: 34556006. ## 28. Safinia G, Ebrahimi Moghadam H, Abolmaali K. Effect of Transactional Analysis Training on Communication Skills and Attribution Beliefs of Incompatible Women. Women Health Bull. 2021;8(3):170-178. doi: 10.30476/WHB.2021.90920.1116. ## 29. Johnson SM. The practice of emotionally focused couple therapy: Creating connection. 3rd ed. Routledge/Taylor & Francis Group; 2019. ## 30. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184-9. doi: 10.1001/archpsyc.60.2.184. PubMed PMID: 12578436. ## 31. Mandizadeh A, Homaei R. The casual relationship Stigma infertility and psychological distress with quality of marital relationship through the mediation of meta-emotion in infertile women. Journal of Family Research. 2020;16(1):55-76. doi: 10.29252/jfr. 16.1.4. Persian. ## 32. Kayser K. Marital Disaffection Scale (MDS). APA PsycTests; 1996. doi: 10.1037/t47903-000. ## 33. Nazari A, Falahzade H, Nazarboland N. Effectiveness of Acceptance and Commitment Therapy (ACT) on women’s marital disaffection and marital quality. Journal of Applied Psychology. 2018;11(4):433-453. Persian. ##