Comparing the Effectiveness of Reality Therapy and Schema Therapy on Attribution Styles in Patients with Gender Identity Disorder

Psychotherapy is the best way to reduce the complications of gender identity disorder. Therefore, the aim of the study was to compare the effectiveness of reality therapy and group schema therapy on attributional styles in patients with gender identity disorder.

This study was conducted as a semi-experimental design with pre-test-post-test and follow-up with a control group, which was approved by the code of ethics IR.IAU.YASOOJ.REC.1400.011 in Islamic Azad University, Yasouj branch. The research population is all people with gender identity disorder who referred to the Shiraz Forensic Center in 2013-2014, whose disorder was diagnosed by a forensic doctor, and due to the impossibility of reaching all of them in a targeted manner, there were 30 out of 195 people. People were selected by available sampling method and were placed in two experimental (15 people) and control (15 people) groups. The age range of the subjects was between 18 and 35 years. First, the documentary style questionnaire of Seligman et al. (1983) was taken from both groups as a pre-test. This questionnaire is a self-report tool and is used to determine people's attributional style, i.e. source of control (internal/external), degree of stability (stable/unstable), generality (general/specific) and controllability (controllable/uncontrollable) by Seligman et al. (1983) is made. This instrument measures scores for individual differences in the tendency of people to attribute the causes of pleasant and unpleasant events to internal (vs. external), stable (vs. unstable), general (vs. specific), controllable (in equals uncontrollable). Documentary styles are used to measure positive or negative thinking styles. This instrument measures scores for individual differences in the tendency of people to attribute the causes of pleasant and unpleasant events to internal (vs. external), stable (vs. unstable), general (vs. specific), controllable (in equals uncontrollable). Documentary styles are used to measure positive or negative thinking styles. This questionnaire includes 12 hypothetical situations (six positive situations and six negative situations). 4 questions are asked after each situation. The first question, which is answered descriptively, asks a major cause of the event in question, which is not considered in scoring; But it helps the examinee to answer the next 3 questions. The next 3 questions are the same for all situations and measure the dimensions of the causal documents. The second question after each internal and external situation measures the person's answer. The third question after each situation determines the stability-instability of the subject's answer, and finally the fourth question in each general situation-determines the specificity of the subject's answer. For each situation, the subject is asked to read each of the events carefully and imagine clearly in their mind that they are in such a situation, and then one reason that they believe is the most important and main. Write the most important reason for that event in the place provided. This questionnaire contains 48 questions. In this questionnaire, each item is graded from 1 to 7. For each of the 6 positive positions, 1 is the lowest rank and 7 is the highest or best option for the positive dimension. For 6 negative positions, scoring is reversed. Therefore, for negative situations, a score of 1 is considered the highest or best option and a score of 7 is considered the lowest or worst option. The reliability of the questionnaire in this research was obtained using Cronbach's alpha method as 0.89, which is an acceptable reliability.Then, the experimental group was trained in reality therapy and schema therapy by the researcher, who is a PhD student in psychology, for 8 and 9 sessions, one session per week, respectively. The main topics and content of each session are presented below. Again, the documentary styles questionnaire was administered as a post-test after reality therapy and schema therapy training on experimental and control groups, and the questionnaire was repeated in the 3-month follow-up.

The results showed that in the component of general positive attributions in the reality therapy group compared to the control group, and in the component of general negative attributions, it was significant in the schema therapy compared to the control group. In the comparison of the two treatment approaches, reality therapy was significant in the overall positive attribution component compared to schema therapy.In fact, the general achievement of these meetings was that their level of insight and control over their cognitive behaviors, including documents, increased significantly. Also, in the component of general negative attributions, schema therapy wassignificant with the control group. This finding is in line with Elahai's research (2019). In the explanation of this finding, it can be said that since the activation and stimulation of schemas produces anxiety, excitement It leads to unpleasant feelings and helpless feelings, so people use incompatible responses or coping styles since childhood in order to suppress anxiety caused by schemas. Although these coping styles lead to a short-term reduction of anxiety, in the long-term it will lead to their continuation and strengthening. Schema therapy, having a multi-dimensional perspective, besides considering the influence of cognitions and attitudes, examines the roots of the problem in the past and aims to create awareness and tension in the individual. Also, by using this method, a person can understand the cause of his communication problems and as a result, to get rid of his problems, he can focus on his personal growth and progress with more motivation. Identifying the schemas helps the person to understand and define the deep problems more accurately, and during the treatment, the therapist helps the person to identify the schemas by emphasizing the emotional relationships from childhood to time. This method makes him find out the cause of his communication problems and work with more motivation to get rid of his problems.

Since transgender people are often on the sidelines of social activities, many of their capabilities have not been developed. Efforts to make them capable in documentary styles using psychotherapy approaches can be effective in this direction.