Investigating lived experiences of depressed students with a history of self-injury regarding effectiveness of combined emotion-focused therapy and lifestyle modification on repetitive negative thinking and clinical anger (A qualitative study)

The study aims to explore the lived experiences of students with depression and suicidal self-injury thoughts and behaviors of combination of emotion-focused therapy and lifestyle modification, with a focus on repetitive negative thinking and clinical anger. This qualitative research used an interpretive phenomenological approach and a multiple case study design. The research population included students visiting the counseling center at the Islamic Azad University, Saveh Branch, during the 2023-2024 academic year. The sample included four purposively selected students with depression and suicidal self-injury thoughts and behaviors who scored high on referential thinking and clinical anger. The research tools entailed the Beck Depression Inventory (1996), the Repetitive Negative Thinking Scale (Ehring, 2010), the Clinical Anger Scale (Snell et al., 1995), and semi-structured interviews. After 12 sessions of combined emotion-focused therapy and lifestyle modification, the interviews were analyzed using Diekelmann et al.’s method (1989). Themes indicated a reduction in repetitive negative thinking and clinical anger. Two core categories (therapeutic experiences and inhibitory factors) and eight sub-categories were identified. The therapeutic experiences for repetitive negative thinking included perceived control over behavior against negative thoughts and focus on the present moment; inhibitory factors included environmental factors, particularly friends and family. Therapeutic experiences for clinical anger included accepting shame and sorrow, behavioral non-avoidance, and a new understanding of frustrations and unpleasant events. Inhibitory factors included the difficulty of transferring learning outside of therapy sessions and others’ expectations for rapid improvement.