The effectiveness of cognitive behavioral therapy on feelings of shame and guilt, impulsive behaviors, and difficulty in emotion regulation in adolescents with high-risk behaviors.

Determining the effectiveness of cognitive behavioral therapy on feelings of shame and guilt, impulsive behaviors, and difficulty in emotion regulation

The clinical trial will be a controlled, parallel-group, single-blind, randomized, controlled trial on 40 adolescents. It will be conducted using R software for block randomization (block size 4).

This quasi-experimental study will be conducted on 40 adolescents with high-risk behaviors in Ahvaz city, who will be randomly assigned to two groups of 20 (experimental and control).

Inclusion criteria: Informed consent, interest and willingness of individuals to participate in the research and their parents, ability to read, write and complete the informed consent form, age range of 14 to 17 years, symptoms of high-risk behaviors by the participant and subsequently obtaining a score higher than the average of this scale, adolescents with high-risk behaviors in Ahvaz city. Major exclusion criteria: Simultaneous participation in other training and treatments, having chronic physical disorders and inability to follow up the subject.

The intervention group will receive a structured cognitive-behavioral therapy (CBT) program consisting of 12 weekly 60-minute sessions. The intervention will focus on emotion regulation training, cognitive restructuring of shame- and guilt-related beliefs, and impulse control skills training, and will be delivered by trained therapists in a clinic or school setting. The control group will receive usual psychological services (Treatment as Usual), consisting of unstructured counseling and periodic monitoring without the CBT protocol.

Feelings of shame, guilt, impulsive behaviors, difficulty regulating emotions

In the future study, stratified randomization will be used. The unit of randomization will be the individual, and participants will be divided into strata based on key variables (such as gender and severity of risky behavior). Within each stratum, participants will be assigned to experimental and control groups using block randomization with a block size of 4. The random sequence will be generated using specialized software (such as R or SPSS) and placed in sealed envelopes or an online concealment system to reduce bias.

The assessor who measures the primary and secondary outcomes (shame, guilt questionnaires, etc.) will be kept unaware of each participant’s allocation to the intervention or control group. The allocation of participants to groups will be done by an independent collaborator who is not involved in the assessment or intervention process, and the list will be kept confidential. The raw data will be provided to the analyst for statistical analysis, with non-specific codes (e.g. Group 1 and Group 2). The true identity of the groups (experimental or control) will only be revealed to the analyst after the primary final analyses have been completed. Due to the active nature of the psychosocial intervention, participants and therapists will be aware of their group and therefore will not be blinded.