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Awareness Integration: An AlternativeTherapeutic Methodology to Reducing Depression, Anxiety, While Improving Low Self- Esteem and Self-Efficacy in Separated or Divorced Individuals

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Abstract

Title: Awareness Integration: An Alternative Therapeutic Methodology to Reducing Depression, Anxiety, While Improving Low Self-Esteem and Self-Ef cacy in Separated or Divorced Individuals Objective: A new method in psychotherapy, Awareness Integration (AI) Model, has been shown to be instrumental in delivering a successful and expedited path to recovery from a variety of psychological and emotional problems. The purpose of this study is to show that Awareness Integration Model positively impacts the negative characteristics of divorce such as depression and anxiety, while restoring self-esteem and self- ef cacy in divorced or separate individuals. Methods: Participants for this study were 14 volunteers, 25 to 64 years old, who consented to participate in a 6-hour workshop for the purpose of testing the Awareness Integration (AI) Model as well as completing both the pre and the post tests. Research method used in this study is based on Beck’s, 1961, 1988, and 1993 psychometric assessments, where questions were grouped to represent measurements in depression, anxiety, self esteem, and self ef cacy. Study does not use a control group as it deemed unfeasible, and sample size is relatively small comprising of 14 participants. In the analysis section, the author offers in depth explanation to the consequence of a small sample and lack of a control group. Results: As shown in the body of this paper, applying AI Model to volunteer participants showed 27.5% improvement in depressive moods, 37% less feeling of anxiousness and having anxiety, 15% increased self-esteem, and 13% boost in self-ef cacy. Conclusions: The pilot study testing the exibility of AI on divorced or separated individuals suffering from depression, anxiety, low self esteem, and self ef cacy, yielded positive outcomes. The comparison between pretest and posttest showed that the participants’ level of depression and anxiety decreased, while the degree of self esteem and self ef cacy increased. MeSh Headings/ Keywords: Awareness; Integration; Divorce; Depression; Self-help; Anxiety; Self-esteem; Self- ef cacy; Accountability; Result oriented; Goal oriented; Psychology model; Psychology interventions; Cognitive therapy; Emotional therapy; Mind-body therapy; Brief therapy; Solution focused therapy; Responsibility; Action plan
Research Article Open Access
Mental Health in Family Medicine (2017) 13: 451-458
Research Arcle
2017 Mental Health and Family Medicine Ltd
Introducon
In the recent years, particularly since the mid 1950 [1],
divorce has become a common practice and strategy for couples,
whose marital relationship have reached a disequilibrium. At this
point, couples have the option to sever the relationship, leave
problems behind, and start anew; however, the process after
divorce at times can be difcult, arduous, and even impossible
to endure. Historically, society has cast a stigma on people, who
choose divorce over making their marriage work. According
to Gerstel [1], the fact remains that being married normalizes
a person, while on the contrary, being divorced [2] leads to
feelings of inadequacy, failure, and not measuring up to normal
societal standards. Consequently, this feeling of not tting into
AbstrAct
Title: Awareness Integration: An Alternative Therapeutic
Methodology to Reducing Depression, Anxiety, While
Improving Low Self-Esteem and Self-Efcacy in Separated or
Divorced Individuals
Objective: A new method in psychotherapy, Awareness
Integration (AI) Model, has been shown to be instrumental in
delivering a successful and expedited path to recovery from a
variety of psychological and emotional problems. The purpose
of this study is to show that Awareness Integration Model
positively impacts the negative characteristics of divorce such
as depression and anxiety, while restoring self-esteem and self-
efcacy in divorced or separate individuals.
Methods: Participants for this study were 14 volunteers,
25 to 64 years old, who consented to participate in a 6-hour
workshop for the purpose of testing the Awareness Integration
(AI) Model as well as completing both the pre and the post tests.
Research method used in this study is based on Beck’s, 1961,
1988, and 1993 psychometric assessments, where questions
were grouped to represent measurements in depression, anxiety,
self esteem, and self efcacy. Study does not use a control
group as it deemed unfeasible, and sample size is relatively
small comprising of 14 participants. In the analysis section,
the author offers in depth explanation to the consequence of a
small sample and lack of a control group.
Results: As shown in the body of this paper, applying AI
Model to volunteer participants showed 27.5% improvement in
depressive moods, 37% less feeling of anxiousness and having
anxiety, 15% increased self-esteem, and 13% boost in self-efcacy.
Conclusions: The pilot study testing the exibility of AI
on divorced or separated individuals suffering from depression,
anxiety, low self esteem, and self efcacy, yielded positive
outcomes. The comparison between pretest and posttest showed
that the participants’ level of depression and anxiety decreased,
while the degree of self esteem and self efcacy increased.
MeSh Headings/ Keywords: Awareness; Integration;
Divorce; Depression; Self-help; Anxiety; Self-esteem; Self-
efcacy; Accountability; Result oriented; Goal oriented;
Psychology model; Psychology interventions; Cognitive
therapy; Emotional therapy; Mind-body therapy; Brief therapy;
Solution focused therapy; Responsibility; Action plan
society’s norm may lead to feeling less than, depressed, and
incompetent.
The progressive decline in society’s disapproval of divorce
is magnied by the fact that divorce rate is astronomically
increasing, yet marriage is still a popular social practice.
According to United States as American Psychological
Association [3] reports, even today marriage is common and
practiced, as 90% of the population marries before the age of 50,
which leads to healthier couple both physically and mentally.
The down side of marriage is that approximately 40 to 50 percent
of marriages result in divorce with subsequent divorce rate of
67% for second marriages, and 74% for thirds (APA, 2016). It
is noteworthy to mention that it would be difcult to conclude
Awareness Integration: An Alternative
Therapeutic Methodology to Reducing
Depression, Anxiety, While Improving Low Self-
Esteem and Self-Efficacy in Separated or Divorced
Individuals
Foojan Zeine, Psy.D, Ft
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Foojan Zeine, Nicole Jafari
452
an exact percentage of divorce in one region or another due to
numerous variables such as the economical conditions, current
events, and/or social occurrences. The popularity of marriage
itself leads to the perception that being married makes one
whole and acceptable, while divorce remains a taboo despite its
increase in the recent decades.
Marriage creates relational attachment and bonding in
couples seeking closeness and security. According to Bowlby
[4-7], the desire to attach to another human being for the sake
of closeness and protection is a biological inherent, which
starts early on in childhood, thus the broken bond of this union
produces a sense of loss and abandonment, and consequently
negatively impacting individual’s self of being and self worth.
As cited by Kitson [7], losing the comfort of a relationship,
may also lead to a social disconnect, while severing the comfort
zone and security that a relationship provides, ultimately creates
separation anxiety as Bowlby labeled “bereavement” [4-6].
In the trilogy of Attachment and Loss, Bowlby later on set
out to reafrm the impact of separation on the evolutionary
attachment of human beings by establishing a data-driven
theory. The trilogy above rmly made the assertion to further
understanding how these bonds once broken have a strong
implication in both children and adults [7]. Furthermore, the
separation or divorce leads to an increased degree of stress.
According to previous study [8]., both males and females have a
traumatic experience while going through divorce. As Albrecht
reports, 27% of females and 16% of males reported that they
had experienced stress as a result of divorce; although, it is
noted that part of the contributing factors was how each gender
perceives divorce and their experience of this process [8].
In a study by Steven (1990), divorce in the country of
Denmark; even though, it has a lower rate than United States
might result in suicidal thoughts and consequently committing
suicide. This drastic measure of couple attempting or committing
suicide has been contributed to isolation, loss of support, and
a deep sense of disorientation, which are characteristics of
depression. Although, as once again reported by Stack [9],
Stack’s 1980’s study of 50 American States and 3000 American
counties in addition to Trovato’s [10] analysis of Canadian
provinces, all point to the association of divorce and suicide
rate. Over all, the evidence indicated strong correlation between
divorce and suicide; therefore, it is incumbent to nd a solution
that can offer an expedient, universal, solid, and practical
strategy to address the negative side effects of divorce.
Using exibly structured questions modeling an expansive
intervention, the systematic approach of AI Model helps the
learner discover unworkable thoughts, beliefs, behaviors, and
charged up unresolved emotions. As a result, moving towards
healing and integrating the past unintegrated parts into a
healthy and more positive cognitive-emotional mapping, thus
enabling the individual to choose and apply a functional,
productive, and healthy life style. The AI Model is applicable
in a variety of psychological problems; therefore, in order to
test the broad band capabilities of this therapeutic system, the
researchers set out to test the model on separated and divorced
individuals suffering from anxiety, depression, low self esteem,
and low self efcacy. Furthermore, AI Model as a therapeutic
solution seems worthy of investigation in how it can address
and reduce the feeling of abandonment, loss of attachment,
and depressive mood, all the while, repairing and reinstating
healthy self esteem and self-efcacy. Based on previous success
oriented results, it seems that AI Model can help individuals,
who struggle with psychological challenges such as depression,
anxiety, stress, self-esteem, self-efcacy, and other related
emotional and behavioral conditions. Of course, one of the
unique characteristics of AI Model is its non- invasive, swift,
and self-guide features that help individuals walk through their
problem as it guides them in reaching an awareness in how one
views and acts upon the problem.
The Mechanism of Awareness Integration Process: The
process of AI is to foster self-awareness from past to present
and to integrate the various parts of the ‘Self’ that have been
shattered and separated as a result of psychological trauma. AI
Model offers step by step guidance on how to recognize the
broken pieces of one’s self, but also to nd a way to reunite and
reattach all the parts, so that it can once again function effectively
and productively. Through this intricate process, the participant
recognizes and identies all the unconstructive thoughts and
destructive mental strategies that reside at the core value system
of the individual; all the while, they are discovering new ways
to replace the undesirable thoughts with a positive and more
productive principles [11].
Interpersonal relationships are an important and integral part
of the Western culture as well as how individuals function in
their perspective society in regard to others. Siegel [12] refers
to the neurobiology role of interpersonal experiences and
its connection to the efciency of the brain functioning. The
author emphasizes that the left and right hemisphere work in an
integrated fashion meaning the right brain works analogically,
while the left brain functions in exerting motivation. Depending
on the individual’s life experience, the interworking mechanism
of the brain and its dependence on external events for neuro
feedback leads to either efciency in self regulation or disruption
in emotional development. Individuals, who have experienced
divorce or separation suffer from emotional distress; therefore,
may be subject to this malfunctioning or disequilibrium of
the left and right hemisphere. In accordance to Siegel’s [12]
ndings, the AI Model aims to coordinate the internal thought
processes with external events in an attempt to harmonize and
integrate disruptive thoughts, while replacing them with healthy
and efcient cognitive processes [11].
The 9 theoretical principles of AI include; 1) Recognizing
the internal experience as a perceived reality versus an absolute
external reality, 2) Potential to learn more useful and productive
capabilities and thought patterns, 3) Building skills and attitudes
to maintain a happy and enjoyable life comes from a life time
of experience, 4) The connection between man-made internal
meaning from the external events and the personal identity
that is formed for the use in external application, 5) Human’s
capability of mentally storing of experiences including
cognitively, emotionally, and somatically, 6) Integration of un-
integrated structure of belief-emotion-body, 7) Self-awareness
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453
and conscious act of making choices regarding the creation
of a positive life style, 8) Skill building on how to enhance
individual’s capabilities, experiences, results, and relationships,
9) The nal principle is based on learning how to consciously
and intentionally envision desired results, raise the probability
of attaining the result by planning and acting [11]. The AI
Model intervention goes through 6 phases in many domains of
life relevant to the participant:
Phase 1- AI as structured in multi-phases, starts with
inducing an awareness of the participant’s thoughts/perceptions,
emotion, and behaviors in relation to their external environment
and how those constructs impact their lives. Questions in this
phase include: What do you think of people? How do you feel
about people? How do you behave towards people? How does
the way you think, feel, and behave towards people affect your
life? Generalized belief systems tend to become prominent
during this phase of therapy [11].
Phase 2: This phase has 3 functions, 1) Individual becomes
aware of their own personal projections of others’ opinion and
perception of them, 2) Enhancing participant’s recognition of
the way internal meanings are assigned to these observations, 3)
Assessing how these internal projections impact life and build
skills to reality check with the outside world. Questions in this
phase include: How do you assume people think about you?
How do you assume people feel about you? How do you assume
and observe people behaving toward you? How does the way
you assume people think, feel and behave toward you affects
your life? This phase is very impactful for people with high
levels of anxiety and social phobia.
Phase 3: This phase is the most important one, since it
is geared towards the individual’s awareness of their own
identity and these questions in particular capture participant’s
core beliefs [11]. Questions in this phase include: As you see
yourself among people, looking at them while they’re looking at
you, what do you think about yourself? How do you feel about
yourself? How do you behave towards yourself? Do you judge
yourself? Are you compassionate? Are you ok? If there is no
negatively charged emotion experienced, then the individual
will proceed to Phase 5 within that area. If there are negative
core beliefs and charged up negative emotions, then continue
on Phase 4 [11].
Phase 4: In this phase, the structure of AI focuses on the
simultaneously experiencing the connection between thoughts,
formulas, and schemas with emotions and the body areas that
maintain and reconnect intense emotions with the origin of the
memory that one has decide upon the negative core belief from a
traumatic or uncomfortable experience. In this phase, irrational
thoughts, and strategy of decision makings are under scrutiny,
while the individual examines and self assesses of how negative
thoughts and emotions induce a blockage towards rational and
logical thought process. By now, the participants have gained an
awareness and capability to release the negativity, and replace
it with tolerance and effective management of emotions [11].
Questions in this phase include: When you say [negative core
belief], how do you feel about yourself? Where is the feeling
in your body? What is the intensity on a scale from 1 to 10?
Encourages the participant to go toward the original memory
from the felt sensation and the body and emotions, release,
heal and integrate the separated or dissociated part to the whole
system. A re-evaluation of the belief system about self gets
created, therefore new emotions and behaviors gets associated
with the self as the source of relatedness with the outside world.
Phase 5: This phase is a proactive step, the participants are
coached and guided through steps in visualizing and committing
themselves to a new and improved self. This phase concentrates
on building a positive attitude with the thought process of being
in control of one’s own perceptions and actions towards self
and others. Questions in this phase are phrased and structured to
explore each individual Participant’s values and beliefs. Who do
you intend to be? How do you intend to think, feel and behave?
In this phase, the participant’s response determines the degree
of success in implementing AI’s strategy towards individual
anticipation of accomplishments [11].
Phase 6: Final phase includes structuring a functional value
system including intentions, emotions and behaviors that can
assist the individual in every day life and a constructive mindset
to be the desired positive self. This designed self can be set up as
an external visual feedback through collages to create consistent
reassurance and guidance.
Methods
Design of current study
A descriptive and micro-genetic study was designed to
measure the applicability and effectivity of AI Model on
divorced and separated individuals. Previously published
study of the AI Model (2014) in the “International Journal of
Emergency Mental Health and Human Resilience” indicated a
76% decrease in depression, a 60% decrease in anxiety, a 43%
increase in self-esteem, and 20% increase in self-efcacy. The
success of AI Model on 2014 study sample offered a worthwhile
opportunity to utilize this technique on the divorced or
separated population, who suffers from depression, anxiety, low
self-esteem, and low self efcacy as a by-product of divorce.
Previous study having shown successful outcome for AI Model,
prompted the researchers to set up a clinical research study
and test the versatility of AI Model on various populations. On
that premise, a study was designed to test AI Model on these
individuals and nd the correlational factors on improving
depressive and anxious mood, while increasing self-esteem and
self-efcacy.
Objecves/Goals/Specic Aim of the Study
The goal of this research study was to educate and train the
participants on the alternative solution to combating negative
impact of divorce measured using Awareness Integration Model
to treat the symptoms, while minimizing depression and anxiety
and raising participants' self-esteem. Implementing this goal, the
study also measured the efcacy of the Awareness Integration
Model in minimizing Depression and anxiety in a short term
self help workshop setting.
Foojan Zeine, Nicole Jafari
454
Ancipated Outcomes and Goals
Recent reports from APA (2016) indicated that a negative
factorial outcome of marriage is that approximately 40 to 50
percent result in divorce with subsequent divorce rate of 67%
for second marriages, and 74% for thirds. According to other
studies as discussed previously, this astronomical rate in divorce
leads to negative psychological outcomes such as depression,
anxiety, all the while, decreasing self-esteem and self-efcacy.
Based on previous success of AI on treating depression, the
researcher anticipates a hypothetical assumption that Awareness
Integration Model correlationally decreases depression and
anxiety, while increasing self-efcacy and self-esteem.
Methodology
Participants attended a 6-hour workshop Titled “The NEW
YOU is calling YOU! Freedom from the past and a design for
the future” on a voluntary basis. The workshop was held on May
31, 2015, conducted by Dr. Foojan Zeine, Psychotherapist and
the originator of the AI Model, and facilitated by Dr. Fatemeh
Haghigatjoo from the “Nonviolent Initiative for Democracy
Organization”. The nature of this research study was based on
qualitative and correlational methodology; therefore, a pretest
was conducted before the AI application, while the study
was concluded by giving a posttest questionnaire. Based on
the qualitative nature of the study and the small sample size,
a control group would not have been feasible due to the fact
that literature review gave concrete evidence to the impact of
divorce on decreased self efcacy, self esteem, and prevalence
of depression in divorced individuals.
Populaon and Sample Populaon
To conduct this pilot study, the researchers selected a
smaller sample size based on a variety of reasons. The small
sample size provides visibility and observational values for
qualitative analysis. The premise of the study was based on a
workshop setting; therefore, a larger sample would have created
a less organized and manageable forum. Ultimately, from the
14 volunteer participants between the ages of 25 to 64, who
participated in the workshop, only 11 participants completed
both the pre-test and the post-test. The exclusion criterion was
based on the fact that the sample population must be currently
divorced or separated and complaining of negativity, low self
esteem, and lack of motivation.
Selecon of parcipants
The study had been announced in several divorce Meet-
Up groups in Boston, Massachusetts. The only condition to
register and participate was to be recently divorced or separated.
Registration had been done via Meet-Up groups’ websites.
Fourteen participants registered for the workshop. Each
individual participant was paid $30 to attend the workshop on a
voluntary basis.
Socioeconomic
All participants had some level of higher education beyond
high school with 3 holding an associate degree, 1 undergraduate,
and 7 having earned a graduate or other types of professional
degrees. Income level of the participants was that 2 claimed to
have lower than $25000/yr., where 6 put their income between
$50,000.00 to $74,999.00, One volunteer claimed to be in the
median of $75,000 to 99,999, while one participant marked the
income to be more than $200,000.
Demographic
There was no ethnicity in the exclusion criterion; therefore,
the participants, who completed the workshop identied
themselves as the following: 5 Caucasian/white, 2 Asians, and 4
Middle Eastern volunteer participants in the study.
Procedure
Each participant completed an information/consent to
participate form, a demographics form, 4 pre-tests before the
start of the workshop. The AI questionnaire was given to the
participants to use as a tool through out the workshop.
The 6-hours workshop consisted of:
1. A ½ hour lecture about the multiple phases of the divorce
process
a. Statistics
b. Shake up in Marriage
c. Pre-Divorce Process
d. Separation
e. Legal Divorce Process
f. Post Divorce Process
g. Completion with the Marriage
2. A ½ hour lecture about the AI Model 6 phases.
3. Completing Phase 1,2,3, & 4 of the AI Model in the
domain of Social Community.
4. Sharing with another participant about their experience
and their ndings.
5. Competing Phase 1,2,3 & 4 of the AI Model in the
domain of Ex-Spouse.
6. Sharing with another participant about their experience
and their ndings.
7. Competing Phase 1,2,3 & 4 of the AI Model in the
domain of Father.
8. Sharing with another participant about their experience
and their ndings.
9. Competing Phase 1,2,3 & 4 of the AI Model in the
domain of Mother.
10. Sharing with another participant about their experience
and their ndings.
11. Competing Phase 1,2,3 & 4 of the AI Model in the
domain of Parent’s Relationship.
12. Sharing with another participant about their experience
and their ndings.
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455
13. Competing Phase 1,2,3 & 4 of the AI Model in the
domain of Self.
14. Sharing with another participant about their experience
and their ndings.
15. Completing Phase 5 in the domains of ex-spouse,
Intimate relationship, Children & Social Community.
16. Sharing with another participant about their experience
and their ndings.
17. Completing Phase 6 regarding the creation of a chosen
Self-Identity.
Participants were asked to complete 4 post-tests and an
evaluation form at the conclusion of the workshop.
Data Collecon
The 4 dependent variables were measured by 4 standard
tests as pre & post tests:
1. Beck Depression Inventory BDI-II (Beck, Ward,
Mendelson, Mock & Erbaugh, 1961)
2. Beck Anxiety Inventory (Beck, 1988; Beck and Steer,
1993)
3. Rosenberg self-esteem scale (RSES) (Rosenberg, 1965;
Blascovich & Tomaka, 1993)
4. General Self-Efcacy Scale (GSES) (Schwarzer &
Jerusalem, 1995)
Data Analysis
The questionnaire sample questions were based on specic
and measurable criteria in the following categories:
* Questions 1-4 to measure Depression
* Questions 5-7 to measure Anxiety
* Questions 8-10 to measure Self-esteem
Once the data were collected, a research assistant constructed
individual excel worksheets to record each participant’s
completed pre-test and post-test values. Consequently, each
individual’s response was inputted into their perspective excel
worksheet. A separate Microsoft Excel worksheet was then
created to tally all the results for each question for the purpose
of calculating the mean average in each corresponding category
using the standard mean formula; (X1+X2+X3+….+ Xn/n)
X100 to reect overall percentages. Accordingly, the standard
deviation for each question in each category was calculated to
show proof of concept and to ensure a strong condence level.
The standard deviation for the study showed to be between +/-
2.5, which falls under a healthy bell curve standard deviation.
The calculations of standard deviation for data set is further
discussed in the ‘Results’ section of this paper.
Discussion
Regardless of being amicable or not, divorce leaves the
individual with devastating feelings of loss, depression, and
anxiety. As reported in 1981, by Peck and Manocherian [13],
going through divorce brings about a great deal of change
particularly in middle age women, who have to let go of
an accustomed life, social status, and nancial comfort.
Consequently, the feeling of abandonment, mourning, loss
of dreams, and failure in marriage may lead to depression.
Although, these negative feelings are not solely as a result of
being a middle age divorced female, but also can be seen in
younger females, who experience divorce. It is concluded from
various research studies that divorce leads to depressive moods
and thoughts.
According to Bem’s [14] Self Perception Theory, divorced
individual’s behavior is often measured by their attitude towards
divorce, and how they perceive the consequences. Furthermore,
based on longitudinal research, a person’s experience of divorce
predicts increases in pro-divorce attitudes with that individual
[9,15]. However, regardless of an individual’s own attitude,
divorce itself can be an interpersonal stressor leading to
development of depressive moods in each member of the entire
family. Divorce as a stressor impacts not only the individual, but
its effects will encompass interpersonal relationship with others
as well [16].
Bowen’s [17] Family System Theory, was developed as a
result of psychologists gaining an interest in family structure
post War War II, where there was an interest in studying
family dynamics from a different point of view. In this theory,
Bowen [17] suggests that family comprises of different systems
requiring each entity to operate in harmony and equilibrium to
gain maximum efciency as a whole emotional unit. However,
adversary factors interfering with the system’s overall operation,
such as nancial struggles, death, psychological deviance,
divorce, and other negative events may shift the unit off its
balance and thus free falling it into disequilibrium. Divorce
as a negative factor has a correlational impact to the system’s
operation, thus shifting the relationship between members into
a negative spiral. This negativity could bring about anxiety,
depression, misconduct, and other behavioral misconduct
requiring the system to receive support in order to regain the
equilibrium [17].
Divorce or separation can also impact an individual’s
interpersonal relationships and personal values in a negative
way. The individual may face a reevaluation of their cultural
beliefs and relationship with others. In doing so, through
the course of divorce, a person will consciously reexamine
their basic belief system, identities, and relationships [19],
making further growth possible. The Family Systems Theory
conrms the fact that divorce is a contributing factor in creating
disequilibrium in individual’s emotional well being; however,
Bowen believes that individuals need to nd a way to avoid
fault-nding and continue to mature through the process [19].
The ndings showed that of those, who participated in the AI
study, 36% fewer individuals blamed or criticized themselves,
which conrms the applicability and efciency of AI Model on
creating and improved emotional balance.
Traditionally, theorists have focused on two stages of
divorce: 1) Emotional or affective stage, and 2) Recovery in
terms of divorced individuals’ behavior in maintaining balance
Foojan Zeine, Nicole Jafari
456
and control. Therefore, in both stages, when grief strikes, it
would be in response to different losses, with each stage may
contain a different intensity Hagemeyer [20]. Research has
also shown a correlation between marital status and mental
disorder. Divorced individuals develop a hypersensitivity at
the time of separation and divorce; therefore, they may face six
times higher chance of needing medical attention than those of
married couples (Bloom et al., 1978; Briscoe et al., 1973), as
cited by Peck & Manocherian [13]. The AI study addresses these
emotional stages and the negative reaction to each milestone
by focusing on different emotional period, such as depression,
anxiety, low self esteem, and negative self efcacy. The result
of the study of divorced participants, who took part in AI Model
training showed 27.5% signicant improvement in depressive
moods, while a 37% revealed to be less anxious or having
anxiety. As shown through AI Model, participants were able
to show tremendous improvement in each emotional category
of depression and anxiety, thus making the transition from
emotional stage to recovery platform. Furthermore, as a result
of participants responding to questions 8 thru 10 yielded 15%
improvement in measuring posttest self-esteem of participants.
The total impact of AI Model on participants suffering from low
self efcacy was 13% increase in feeling more resourceful and
condent.
Golan [15], stated that during divorce a person may
experience psychological distortion, thus leading o pathological
problem. These problems may present themselves at different
time with different intensity. In order to better understand when
the transitional state has been reached by the divorcee, scientists
need to be able to estimate the time this transition has been
reached, and whether the person is working though problems.
This understanding was as a result of combining the psychosocial
and crisis theory that has led the scientists to an understanding
of what a normal transition may entail. These transitional stages
represent a terminated life, while spearheading to a new one. AI
Model is structured in a modular format and phase base, which
enables the therapist to address each stage of mental distortion
individually and on differentiated periodicals. This type of
structure would be benecial to the participants in addressing
problems, while seeking an optimal solution [11].
Study limitaons and recommendaons
The AI Model is a new and revolutionary concept; therefore,
the rst time research studies on novel ideas could lead to
important learning and discoveries. This particular study bears
important information in regards to future considerations
in similar research studies. In that respect, the researchers
believe this study could benet from a larger sample size of
perhaps between 30 to 40 participants, which will increase the
condence level of data generalization. Furthermore, conducting
the AI Model research study with a larger sample size could
provide additional information, such as data variation, gender
differences, which could in turn increase the data analysis
condence level.
The study type was designed to be correlational and
qualitative; therefore, no control group was set up to measure
comparative data. At the same time, lack of a control group makes
it difcult to condently ascertain the level of signicance of
AI Model and its impact on separated or divorced participants.
The researchers recommend a new study to be conducted with
a control group in place to increase the condence level of AI
Model’s efciency.
The AI Model study administered a pre-test and post-test
questionnaire to measure the impact of the workshop treatment
on the participants. However, the pre-test and post-test were
given right before and after the workshop. The timing of these
tests being so close in timing may have interfered with the true
result; therefore, to make sure the timing is not an interference
factor in the result. The recommendation is to take an appropriate
amount of time before the post-test is administered to ensure the
validity of the result.
Results
The fact that sample size was small, statistical calculations
were done using a Microsoft Excel spread sheet. Empirical data
for mean and Standard Deviation (Square Root of Variances) of
AI Model on each category such as Depression, Anxiety, Self
Esteem, and Self Efcacy, were calculated using the following
formula [22]:
σ = √ [ ∑(x-mean) ^ 2 / N]
In the formula above, the following designations were used:
σ = standard deviation
x = each value of dataset
mean = averages of each category
N = the total number of data points in each category per
participant
∑ = The sum of (xi - mean) x 2 for all data points
Measurement aws for such calculations to consider may
be ‘Time Sampling Error’, where the post test was given to the
participants immediately after the workshop not allowing for
time laps and deeper understanding of the AI Model presented
at the workshop. Examples of the ‘Time Sampling Errors’
may include changes in participants’ own characteristics (e.g.,
fatigue, illness, anxiety) and the environment of the clinic
(e.g., distractions, temperature), where the study took place. To
reduce this type of error, it is recommended that a Test-Retest
Reliability Coefcient [22] for administration of the posttest
to be considered in the future AI Model application. Based
on the standard deviation formula, the following results were
calculated as presented below.
Depression: On the pretest and posttest, questions 1- 4
were designed to measure depression. Utilizing the participants’
responses to the questions designed to measure depression
before and after the AI workshop and training, 10% fewer
participants had feelings of being punished, 36% fewer blamed
or criticized themselves, 36% were less critical of themselves,
while only 10% less blamed themselves for unfortunate events
in their life, and nally 18% fewer participants have lost interest
in other people or activities. The overall improvement in the
Aareess era A Alerae heraec ehl  Rec eress Ae hle r  elsee a elcac  earae
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457
mood of participants was that 27.5% of the sample studies
showed an improvement in depressive moods.
Anxiety: Questions 5 through 7 were designed to measure
anxiety level of participant in the pretest and posttest relevancy.
The result of the tests showed that 27% of the participants are
better able to relax, while 18% more of the individuals are able
to relax, in addition to 10% more being able to relax. Further
results showed that 18% completely feel less fearful, 10%
Mildly less fearful, and 10% Severely less fearful. In physical
improvement leading to less anxious mode, 10% mildly less
had difculty breathing in compare to10% of those, who had
noted moderately less had difculty breathing. On the whole,
the participants showed an overall 37% improvement in feeling
anxious and having anxiety.
Self-Esteem: Testing AI Model previously had shown an
improvement in individual’s self esteem; therefore, questions 8
thru 10 were designed to show pretest and posttest results in
whether AI is instrumental in lifting self worth and self value in
individuals, who have experienced loss as a result of divorce or
separation. Conrming previous AI study’s results, participants
in this test showed a reduction of 10% in individuals, who did
not have reasons to be proud of their accomplishments as well
as 10% less of sample studies showing lesser strong feelings in
being proud and 10% less feeling lack of respect for themselves.
As a result of participants responding to questions 8 thru 10
yielded 15% improvement in measuring posttest Self-Esteem
of participants.
Self-Efcacy: The study also aimed to measure self efcacy
in individuals, who have experienced divorce or separation.
Based on past study showing improvement in this area,
questions 11 through 12 were designed to assess Self- Efcacy
and whether AI also increases this criterion in individuals, who
have suffered emotional loss. As predicted, posttest showed
10% increase in remaining calm when facing difculties,
and16% increase in knowing how to handle foreseen situations.
The total impact of AI Model on participants suffering from low
self efcacy was 13% increase in feeling more resourceful and
condent.
Conclusions
Individual’s reaction towards divorce and how each person
handles such process is determined by their attitude and level of
commitment in their relationship. Furthermore, this said reaction
may also depend on the gender of the individual experiencing
separation and divorce [23]. Studies have shown that there is a
level of crisis in the divorce process, which adversely impacts
the mental balance of the individual. Regaining interpersonal
equilibrium is crucial after divorce or separation; however, if
existing problem solving mechanism is not sufcient and the
divorced individual is having difculty reaching balance, then
additional help may be required. The inter mechanism of AI
specically addresses this type of crisis by offering six phases
of in- depth soul searching. The participant in AI Model learns
to recognize and identify all the unconstructive and scattered
thoughts and destructive mental strategies. Through working on
these negative and critical cognitive processes, the individual
learns new strategies to eventually integrate positive thoughts
and constructive mental capacities. Consequently, the mental
crisis is averted, and equilibrium is achieved.
Therapy may also instrumental in restoring family system’s
structure and promoting a swifter equilibrium to be brought
back to the unit. In addition, to assist with the transition from
the accustomed life into a changed and new existence, therapists
can be inuential in helping the individual’s transition.
Brown’s [24] suggestions coincide with the functionality of
AI Model offering self guided structured therapy, while the
individual performs the therapeutic exercises [25], all the while
overcoming depression and anxiety. Research showed the
benets of psychological intervention in helping divorced or
separated individuals regain a sense of self and their eventual
transition to a new life, reafrms the positive results AI Model
offers in this study. In conclusion, the AI Model is instrumental
in reducing the negative characteristics of divorce such as
depression and anxiety [26-28], at the same time, allowing
the individuals to regain an increased level of self esteem and
self efcacy. It is noteworthy to mention that such successful
conclusion should encourage the researcher to conduct
additional pilot studies to investigate the broader application of
AI Model on other psychological and emotional challenges that
individuals may experience in a variety of situations. Further
studies would denitely be benecial to both scientic eld and
individuals, who are in need of practical and expedited methods
of therapeutic techniques.
References
1. Gerstel N. Divorce and Stigma: Social Problems, Oxford
University Press on behalf of the Society for the Study of
Social Problems. 1987; 34: 172-186.
2. Shafer K, Jensen T, Holmes E. Divorce stress, stepfamily
stress, and depression among emerging adult stepchildren.
Journal of Child and Family Studies. 2017; 26: 851-862.
3. American Psychological Association. Marriage & Divorce.
2016.
4. Bowlby J. Processes of mourning. International Journal of
Psychoanalysis. 1961; 42: 317-339.
5. Bowlby J. Attachment and Loss. Library of Congress
Catalog Number: 83-71445. 1969.
6. Bowlby J. The Origins of Attachment Theory: John Bowlby
and Mary Ainsworth Developmental Psychology. 1992;
28: 759-775. Reprinted in from R. Parke, P. Ornstein, J.
Reiser, & C. Zahn-Waxler Edtn. A century of developmental
psychology. 1994; 15: 431-471.
7. Hammen C. Stress and depression. Annual Review of
Clinical Psychology. 2005; 1: 293-319.
8. Albrecht S. Family Relations. National Council on Family
Relations. 1980; 29: 59-68.
9. Stack S. The Effect of Divorce on Suicide in Denmark,
1951-1980. The Sociological Quarterly. Wiley on behalf of
the Midwest Sociological Society. 1990; 31: 359-370.
Foojan Zeine, Nicole Jafari
458
10. Trovato F. Interprovincial migration and suicide in Canada,
1971-78. Int J Soc Psychiatry. 1986; 32: 14-21.
11. Zeine F. Awareness Integration: A new Therapeutic Model.
International Journal of Emergency Mental Health and
Human Resilience. 2014; 16: 60-65.
12. Siegel DJ. The developing mind: toward a neurobiology of
interpersonal experience. New York: Guilford Press. 1999.
13. Peck JS, Manocherian JR. Divorce in the Changing Family
Life Cycle. Changing Family Life Cycle. 1988; 15: 335-369.
14. Bem DJ. Self-perception theory. In L. Berkowitz Edtn.
Advances in experimental social psychology. 1972; 6: 1-62.
15. Amato PR, Booth A. The consequences of divorce for
attitudes toward divorce and gender roles. Journal of Family
Issues. 1991; 12: 306-322.
16. Hammen C. Stress and depression. Annual Review of
Clinical Psychology. 2005; 1: 293-319.
17. Kerr ME. One Family’s Story: A Primer on Bowen Theory.
The Bowen Center for the Study of the Family. 2000.
18. Wiseman R. Crisis theory and the process of divorce. Social
Casework. 1975; 56: 205-212.
19. Brown J. Growing Yourself Up: how to bring your best to all
of life’s relationships; p3-5; Exisle Publishing. 2012.
20. Hagemeyer S. Pastoral Psychol: Making sense of divorce
grief. 1986; 34: 237.
21. Golan N. Passing through transitions, New York: Free Press.
1981.
22. Reynolds CR, Livingston RB. Mastering Modern
Psychological Testing. Upper Saddle River, NJ: Pearson.
2012.
23. Whitton SW. Attitudes Toward Divorce, Commitment, and
Divorce Proneness in First Marriages and Remarriages.
Journal of Marriage and Family. 2013; 75: 276-287.
24. Brown MD. Creating new realities for the newly divorced: A
structural and individual. Journal of Psychotherapy and the
Family. 1985; 1: 101-120.
25. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An
inventory for measuring depression. Archives of General
Psychiatry. 1961; 4: 561-571.
26. Beck AT, Steer RA. Beck Anxiety Inventory Manual. San
Antonio: Harcourt Brace and Company. 1993.
27. Beck AT, Steer RA, Garbin MG. Psychometric properties
of the Beck Depression Inventory: Twenty-ve years of
evaluation. Clinical Psychology Review. 1988; 8: 77-100.
28. Bogolub EB. Social Work. 1991; 36: 428-433.
ADDRESS FOR CORRESPONDENCE:
a ee  er    ersal rh se
c A al aeealc
Submitted 27 February, 2017
Accepted 05 June, 2017
Chapter
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