ORIGINAL ARTICLE Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 190-197

The effects of positive thinking education for adolescent girls on their conflicts with their mothers: A randomized controlled trial

Fatemeh Nematian1, Zahra Tagharrobi2, Zahra Sooki2, Khadijeh Sharifi2
1 Department of Nursing, Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
2 Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran

Date of Submission23-Feb-2022Date of Decision21-Sep-2022Date of Acceptance01-Oct-2022Date of Web Publication18-Nov-2022

Correspondence Address:
Khadijeh Sharifi
Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan
Iran

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/nms.nms_16_22

Background: Adolescent–parent conflict (APC) has damaging effects on both adolescents and parents and hence effective strategies for its management are necessary. Objectives: The aim of this study was to evaluate the effects of positive thinking (PT) education for adolescent girls on their conflicts with their mothers. Methods: This randomized controlled trial was conducted in 2019–2020. Participants were 48 adolescent girls conveniently selected from two high schools in Kashan, Iran, and randomly allocated to a control and an intervention group through block randomization. Participants in the intervention group received PT education in eight 90 min sessions held twice weekly. A demographic questionnaire and the APC questionnaire were used for data collection. Data were analyzed through the Chi-square, Fisher's exact test, independent-sample t-tests, and the repeated measures analysis of variance. Results: There was no significant difference between the intervention and the control groups respecting the pretest mean scores of APC frequency (244.250 ± 43.353 vs. 234.042 ± 36.218) and APC intensity (24.665 ± 14.244 vs. 27.220 ± 21.829). However, the mean scores of APC frequency and intensity in the intervention group were significantly less than the control group at the end of the study intervention (155.625 ± 28.740 vs. 240.458 ± 35.234 and 13.248 ± 10.660 vs. 35.670 ± 18.998) and 1 month later (122.708 ± 12.302 vs. 241.958 ± 34.719 and 9.693 ± 7.040 vs. 40.258 ± 19.001) (P < 0.05). Conclusion: Group PT education significantly reduces APC. Nurses, midwives, and mental health specialists can use PT education to reduce APC and improve the mental health of communities.

Keywords: Adolescence, Conflict, Positive thinking

How to cite this article:
Nematian F, Tagharrobi Z, Sooki Z, Sharifi K. The effects of positive thinking education for adolescent girls on their conflicts with their mothers: A randomized controlled trial. Nurs Midwifery Stud 2022;11:190-7
How to cite this URL:
Nematian F, Tagharrobi Z, Sooki Z, Sharifi K. The effects of positive thinking education for adolescent girls on their conflicts with their mothers: A randomized controlled trial. Nurs Midwifery Stud [serial online] 2022 [cited 2022 Nov 22];11:190-7. Available from: https://www.nmsjournal.com/text.asp?2022/11/3/190/361521   Introduction 

Adolescence is the period of transition from childhood to adulthood.[1] It coincides with puberty[1],[2] and hence is associated with major physical,[2],[3] cognitive, behavioral, social,[2],[4] and emotional changes[1]. Their attempt to develop an adult identity turns adolescence into a difficult and stressful stage in life for both adolescents and their parents and may lead to conflict between them.[4],[5]

Adolescent–parent conflict (APC) is a communication challenge that often arises at the time of change and is the result of differences between adolescents and parents respecting their perceptions, expectations, and understanding of the world.[1],[5] Previous studies reported that the level of APC was moderate in Shiraz, Iran,[6] the United States,[7] and Nigeria,[8] and high in Zahedan, Iran.[9] The difference among these studies respecting APC level may be due to the level of parents' restrictions and strictness.[10] APC is acceptable to some extent. However, frequent, severe, and prolonged APC can be associated with many different destructive consequences such as substance and alcohol abuse,[11] academic failure,[3] running away from home,[5] suicide,[12] depression,[13] aggression, high-risk behaviors,[12] and delinquency.[14] Therefore, psychiatric nurses, midwives, and mental health specialists need to employ primary and secondary prevention measures to reduce APC.

Many strategies have been developed and used to manage APC. Examples of these strategies are communication enhancement,[15] psychological empowerment of mothers,[10] reality therapy,[16] problem-solving training, and anger management.[9] However, some of these strategies are costly or time-consuming, need the great engagement of parents and families, and may lead to more APC.

Positive thinking (PT) education is a strategy with potentially positive effects on APC. PT is optimistic toward the world, human being, and self-18. Education of PT skills can strengthen interpersonal relationships, promote positive emotions, cognition, perception, and behaviors, and improve well-being.[17] There are limited studies into the effects of PT on APC. Moreover, the results of the existing studies in this area are contradictory.[16],[18],[19],[20],[21],[22] For example, some studies reported that PT education for parents significantly improved the behaviors of both parents and children.[19],[22] However, some studies found that PT interventions were not effective in reducing violence and behavioral problems among adolescents.[20],[21]

The paucity of studies into the effects of PT interventions on APC and their contradictory results highlight the importance of further studies in this area. Moreover, most previous interventional studies in this area were conducted on parents.

Objectives

The aim of this study was to evaluate the effects of PT education for adolescent girls on their conflicts with their mothers.

  Methods 

Design, setting, and participants

This randomized controlled trial was conducted from November 2019 to March 2020 using a parallel design. The study population consisted of 12–16-year-old adolescents in high schools of Kashan, Iran. Participants were 48 eligible adolescent girls conveniently selected from Dehkhoda and Al-Zahra high schools, Kashan, Iran. Eligibility criteria were no self-report history of known mental illness, no physical disability, residence in Kashan, Iran, Iranian nationality, conflict with mother determined through a score of 184–368 for the conflict frequency aspects of the APC questionnaire (APCQ),[23] and living with parents. Exclusion criteria were voluntary withdrawal from the study, experience of stressful life events (such as significant loss, affliction by serious disease, or acute emotional or academic problems), and absence from at least two sessions of the study intervention. Participants were randomly allocated to a control and an intervention group through block randomization with a block size of four or eight. Six blocks with the size of four and three blocks with the size of eight were defined using the www.sealedenvelope.com website and were used to allocate participants to the groups.

The sample size was calculated with a confidence level of 0.95, a power of 0.90, and the results of a previous study that reported an APC mean of 41.17 ± 19.24 in the intervention group and 59.16 ± 14.27 in the control group.[9] The output of the sample size calculation formula showed that 19 participants per group were necessary. We increased the sample size to 24 per group to compensate for probable withdrawals from the study.

Intervention

Participants in the intervention group received PT education in two 12-person groups. The PT educational program [Table 1] was developed based on the perspective of Seligman et al.[24] and was implemented in eight 90-min sessions held twice weekly by the first author. In each session, the content of the previous session was reviewed, PT skills were taught in 20 min, strategies for the use of PT skills in daily life were discussed in 40 min, and assignments were determined in the past 10 min.[25] In the eighth session, participants were provided with explanations about follow-up assessment 1 month after the intervention. Participants in the control group received no PT intervention but were provided with PT-related educational booklets after the follow-up assessment. All participants in both groups completed APCQ at the beginning of the first session (T1), at the end of the eighth session (T2), and 4 weeks after the eighth session (T3).

Table 1: Outline of the content of the positive thinking training sessions based on the Seligman protocol

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Data collection instruments

The study instruments were a demographic questionnaire and APCQ. The demographic questionnaire had 16 items on participants' age, education level, birth rank, having a close friend, number of close friends, religious beliefs, and number of family children as well as their parents' age and education level.

APCQ has 92 items, each scored for both frequency and intensity of APC. APC frequency is scored on a five-point scale from 1 (“Almost never”) to 5 (“Usually”). Therefore, the possible total score of APC frequency is 92–460 with higher scores showing more frequent conflict. APC intensity of each item is scored on a five-point scale from 1 (“Calm”) to 5 (“Angry”). APC intensity of each item is assessed only when the response to its APC frequency is not “Almost never.” As the APC frequency of some items in the present study was “Almost never,” APC intensity scores were converted into the highest possible percentage to facilitate data analysis and make scores comparable. Asadi Younesi et al. confirmed the content validity and reliability of APCQ with a Cronbach's alpha of 0.97 for APC frequency and 0.96 for APC intensity.[23]

Ethical considerations

This study has the approvals of the Institutional Review Board and the Ethics Committee of Kashan University of Medical Sciences, Kashan, Iran (codes: 2797.1.5.29.b and IR. KAUMS.NUHEPM.REC.1398.025, respectively). It was also registered in the Iranian Registry of Clinical Trials (code: IRCT20100211003329N3). The aim of the study was explained to the authorities of the study setting, participants, and their parents. All participants were ensured of data confidentiality, anonymous data reporting, and their right to voluntarily withdraw from the study, and informed consent was obtained from them and their parents.

Data analysis

A statistical analyst who was blind to the study groups analyzed the data using the SPSS software (v. 16.0. SPSS Inc., IBM, USA). The Chi-square, Fisher's exact test, and independent-sample t-tests were used for between-group comparisons, and the repeated measures analysis of variance was used for within-group comparisons respecting the mean score of APC frequency and intensity. Data normality was assessed using skewness and kurtosis parameters (±2), and the level of significance was set at < 0.05.

  Results 

Primarily, 139 adolescent girls were assessed for eligibility and 91 adolescents were excluded due to either ineligibility (n = 87) or disagreement with participation (n = 4). The remaining 48 adolescents were included in the study and allocated to two 24-person groups [Figure 1].

There were no significant differences between the groups regarding participants' demographic characteristics and the pretest mean scores of APC frequency and intensity [P > 0.05; [Table 2]]. However, the interaction of time and group respecting APC frequency was significant [P < 0.05; [Table 3] and [Figure 2]]. Within-group comparisons also showed the significant effect of time on the mean score of APC frequency (P < 0.05). Post hoc analysis revealed significant differences between T1 and T2, T1 and T3, and T2 and T3 respecting the mean score of APC frequency (P < 0.01). The effect of time on the mean score of APC frequency was also significant in the control group (P < 0.01). Post hoc analysis revealed significant differences between T1 and T2, T1 and T3, and T2 and T3 [P < 0.01; [Table 3]]. The trend of the variations of the mean score of APC frequency across the three measurement time points was downward in the intervention group and upward in the control group.

Figure 2: The interaction of time and group positive thinking on the extent of adolescent-parent conflict

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Table 2: The frequency distribution of the demographic characteristics of the samples by group

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Table 3: The extent of conflict in the adolescent girls by the group at the three time points

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Groups did not significantly differ from each other respecting the pretest mean score of APC intensity. The interaction of time and group respecting the mean score of APC intensity was significant [P < 0.05; [Table 4] and [Figure 3]]. Within-group comparisons also showed that the effect of time on APC intensity was significant in the intervention group (P < 0.05). Post hoc analysis revealed that the mean score of APC intensity at T1 was significantly less than T2 and T3 in the intervention group (P < 0.01) but there was no significant difference between T2 and T3 (P = 0.078). The effect of time on APC intensity was also significant in the control group (P < 0.05). Post hoc analysis showed that the mean score of APC intensity at T1 was significantly more than T2 and T3 (P < 0.01) but the difference between T2 and T3 respecting the mean score of APC intensity was not significant [P = 0.226; [Table 4]].

Figure 3: The interaction of time and group positive thinking on the intensity of the adolescent-parent emotional reactions

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Table 4: The intensity of emotional reactions during conflicts in the examined adolescent girls by group at the three time points

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  Discussion 

The mean score of APC frequency in the intervention group was significantly less than the control group at the end of the intervention and 4 weeks later, implying the significant positive effects of PT education on adolescent girls' APC. This is in agreement with the findings of two previous studies.[19],[22] PT can reduce conflicts between adolescents and their mothers by modifying their attitudes and improving their understanding of the positive aspects of others.[26] Moreover, PT skills improve self-confidence, respect for others,[15] and cognitive flexibility[27] and thereby reduce APC.

Findings also showed the significant effect of time on APC frequency in the intervention group, so that APC frequency significantly decreased across the three measurement time points. This finding implies that the effects of PT education on APC frequency were significant and lasted at least 1 month. The effect of time on APC frequency was also significant in the control group so APC frequency in this group significantly increased across the three measurement time points. The significant increase in the mean score of APC frequency in the control group can be attributed to the fact that this study was conducted during the COVID-19 pandemic. Some studies reported a significant increase in the frequency of interpersonal conflicts and domestic violence during the COVID-19 pandemic.[28],[29] The COVID-19 pandemic significantly changed the life and psychological status of people globally.[30] During the pandemic period, family members needed to spend considerable time together at home which may negatively affect their interpersonal relationships and increase interpersonal conflicts through increasing behaviors such as criticism, blaming, and preaching.

We also found no significant between-group difference respecting the pretest mean score of APC intensity, whereas the mean score of APC intensity in the intervention group was significantly less than the control group both at the end of the intervention and 4 weeks later. This finding denotes the significant positive effects of PT on APC intensity which is consistent with the findings of some previous studies.[19],[22] PT education can improve interpersonal interactions, reduce anger, and improve mental health among female students.[31] A study also showed that a short online parenting program significantly improved parent–child relationships.[19] APC intensity reflects the intensity of APC-related emotions.[32] PT education can reduce APC intensity by improving emotion regulation and control,[33] increasing attention to positive emotions and capabilities,[34] and improving capabilities and capacities.[35] Study findings also showed that APC intensity significantly increased in the control group across the three measurement time points. This finding can also be attributed to the effects of home quarantine during the COVID-19 pandemic on interpersonal conflicts among family members.

Among the limitations of the present study were potential between-group information leakage and a small sample size. On the other hand, one of the strengths of the study was that none of the participants were excluded from the study.

  Conclusion 

This study concludes that group PT education is effective in significantly reducing APC. Therefore, PT education can be used to improve interpersonal relationships in families, reduce APC, and improve the mental health of families and communities. Future studies are recommended to assess the long-term effects of PT education on APC and the quality of interpersonal relationships in families.

Acknowledgment

The authors would like to thank the Research and Technology Administration of Kashan University of Medical Sciences, Kashan, Iran, for supporting this study as well as adolescent girls and their mothers who collaborated in the study.

Financial support and sponsorship

The Research Administration of Kashan University of Medical Sciences, Kashan, Iran, financially supported this study.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Mastrotheodoros S, Van der Graaff J, Deković M, Meeus WH, Branje S. Parent-Adolescent conflict across adolescence: Trajectories of informant discrepancies and associations with personality types. J Youth Adolesc 2020;49:119-35.  
    2.Das JK, Salam RA, Thornburg KL, Prentice AM, Campisi S, Lassi ZS, et al. Nutrition in adolescents: Physiology, metabolism, and nutritional needs. Ann N Y Acad Sci 2017;1393:21-33.  
    3.Willems YE, de Zeeuw EL, van Beijsterveldt CE, Boomsma DI, Bartels M, Finkenauer C. Out of control: Examining the association between family conflict and self-control in adolescence in a genetically sensitive design. J Am Acad Child Adolesc Psychiatry 2020;59:254-62.  
    4.Decarli A, Pierrehumbert B, Schulz A, Schaan VK, Vögele C. Disorganized attachment in adolescence: Emotional and physiological dysregulation during the friends and family interview and a conflict interaction. Dev Psychopathol 2022;34:431-45.  
    5.McHale JP, Talbot JA, Reisler S. Recalled coparenting conflict, paralysis of initiative, and sensitivity to conflict during late adolescence. J Womens Health Dev 2020;3:114-24.  
    6.Javidi HA, Asadi E, Ghasemi N. The relationship between adolescent-parent conflict, resiliency with adolescent psychological problems second and third level education in four areas of the city Shiraz. J Psychol Stud 2015;11:75-96.  
    7.Klahr AM, Rueter MA, McGue M, Iacono WG, Burt SA. The relationship between parent-child conflict and adolescent antisocial behavior: confirming shared environmental mediation. J Abnorm Child Psychol 2011;39:683-94.  
    8.Athanatius Ifeanyi I, Unugo LO, Oriji SA. Influence of gender, parenting style and peer pressure on adolescent conflict with parents in Ebonyi state. Int J Develop Res 2017;7:16277-85.  
    9.Farnam A. Effectiveness of problem solving and anger management on decrease of parent-adolescent conflicts among boy students. J Educ Psychol Stud 2018;15:149-76.  
    10.Badipoor M, Salimi Bajestani H, Kalantarkousheh SM. The mothers' psychology empowerment effectiveness on mother-child conflict decreasing in health room of Tehran city. Clin PsycholStud 2016;6:95-111.  
    11.Chaplin TM, Sinha R, Simmons JA, Healy SM, Mayes LC, Hommer RE, et al. Parent-adolescent conflict interactions and adolescent alcohol use. Addict Behav 2012;37:605-12.  
    12.Adrian M, Zeman J, Erdley C, Lisa L, Sim L. Emotional dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. J Abnorm Child Psychol 2011;39:389-400.  
    13.Hale WW 3rd, Nelemans SA, Meeus WH, Branje SJ. A 6-year longitudinal study of adolescents and mothers depression symptoms and their perception of support and conflict. Child Psychiatry Hum Dev 2020;51:407-15.  
    14.Riina EM, Lee JK, Feinberg ME. Bidirectional associations between youth adjustment and mothers' and fathers' coparenting conflict. J Youth Adolesc 2020;49:1617-30.  
    15.Mazhari M, Zahrakar K, Shakarami M, Davarniya R, Abdollah Zadeh A. The effect of relationship enhancement program (REP) on reducing marital conflicts of dual-career couples. Iran J Nurs 2016;29:32-44.  
    16.Hossein Panahi N, Goodarzi M. The Effectiveness of the education of the components of choice theory on reducing parent-child conflict of girl students. Shenakht J Psychol Psychiat 2018;5:43-52.  
    17.Nikmanesh Z, M Zandvakili M. The effect of positive thinking training on quality of life, depression, stress and anxiety in delinquent juveniles. J Positive Psychol Res 2015;1:53-63.  
    18.Aslani K, Varasteh M, Amanelahi A. Effectiveness of positive parenting program training on parent-child interaction quality. Couns Cult Psycother 2016;7:183-201.  
    19.Baker S, Sanders MR, Turner KM, Morawska A. A randomized controlled trial evaluating a low-intensity interactive online parenting intervention, Triple P Online Brief, with parents of children with early onset conduct problems. Behav Res Ther 2017;91:78-90.  
    20.Khodaei A, Zare H, Alipour A, Shokri O. The effectiveness of attributional retraining program based on Crick & Dodge'social information processing model on conflict solution style, optimism and reducing of parent-adolescent conflict among mothers. J Family Psychol 2016;2:27-38.  
    21.Tucker JS, Edelen MO, Huang W. Effectiveness of parent-child mediation in improving family functioning and reducing adolescent problem behavior: Results from a pilot randomized controlled trial. J Youth Adolesc 2017;46:505-15.  
    22.Westrupp EM, Northam E, Lee KJ, Scratch SE, Cameron F. Reducing and preventing internalizing and externalizing behavior problems in children with type 1 diabetes: A randomized controlled trial of the triple p-positive parenting program. Pediatr Diabetes 2015;16:554-63.  
    23.Asadi Younesi MR, Mazaheri MA, Shahidi S, Tahmasian K, Fayyaz Bakhsh MA. Construction and validation of a parentadolescent conflict questionnaire (Adolescent's Form). J Family Res 2011;8:43-70.  
    24.Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: Empirical validation of interventions. Am Psychol 2005;60:410-21.  
    25.Bekhet AK. Positive thinking training intervention for caregivers of persons with autism: Establishing fidelity. Arch Psychiatr Nurs 2017;31:306-10.  
    26.Bekhet AK, Garnier-Villarreal M. Effects of positive thinking on dementia caregivers' burden and care-recipients' behavioral problems. West J Nurs Res 2020;42:365-72.  
    27.Wang Y, Chen J, Yue Z. Positive emotion facilitates cognitive flexibility: An fMRI study. Front Psychol 2017;8:1832.  
    28.Mazza M, Marano G, Lai C, Janiri L, Sani G. Danger in danger: Interpersonal violence during COVID-19 quarantine. Psychiatry Res 2020;289:113046.  
    29.Bradbury-Jones C, Isham L. The pandemic paradox: The consequences of COVID-19 on domestic violence. J Clin Nurs 2020;29:2047-9.  
    30.Thompson T, Rodebaugh TL, Bessaha ML, Sabbath EL. The association between social isolation and health: An analysis of parent-adolescent dyads from the family life, activity, sun, health, and eating study. Clin Soc Work J 2020;48:18-24.  
    31.Mallahi M, Niknejadi F. Effectiveness of positive thinking skills on improving the situation of fathering behavior, conversation and anger in relation of daughters and their veteran fathers. Iran J War Public Health 2017;9:1-7.  
    32.Jafarnezhad K, Asadi Yoonesi MR, Rastgoomoghadam M. The relationship between family communication patterns and frequency and intensity of parent-adolescent conflict. J Family Res 2015;11:219-35.  
    33.Carver CS. Self-control and optimism are distinct and complementary strengths. Personal Indiv Differ 2014;66:24-6.  
    34.Seligman ME. Flourish: A Visionary New Understanding of Happiness and Well-Being, Publisher. New York, NY: Simon and Schuster; 2011.  
    35.Andrade G. The ethics of positive thinking in healthcare. J Med Ethics Hist Med 2019;12:18.  
    
  [Figure 1], [Figure 2], [Figure 3]
 
 
  [Table 1], [Table 2], [Table 3], [Table 4]