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Samaneh Babaei; Simin Bashardoust; Mina Mojtabaie
Abstract
Objective: Childhood cancer profoundly affects not only the diagnosed child but also the entire family system. Primary caregivers, especially parents, face persistent emotional strain, uncertainty regarding treatment outcomes, and overwhelming caregiving demands. According to the World Health Organization ...
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Objective: Childhood cancer profoundly affects not only the diagnosed child but also the entire family system. Primary caregivers, especially parents, face persistent emotional strain, uncertainty regarding treatment outcomes, and overwhelming caregiving demands. According to the World Health Organization (2023), nearly 400,000 children worldwide are diagnosed annually, most commonly with leukemia, brain tumors, and lymphomas. In Iran, the incidence rate is estimated at 12–15 per 100,000 children under fifteen (Ministry of Health, 2022). The chronic, life‑threatening nature of pediatric cancer exposes caregivers to severe psychological distress, including anxiety, depression, post‑traumatic stress, and burnout, which often persist beyond treatment and reduce caregiving effectiveness, potentially impacting child recovery (Rensen et al., 2022). Although some caregivers gradually adapt, many remain psychologically vulnerable, highlighting the need to strengthen modifiable resilience factors. One essential factor is Distress Tolerance (DT)—the capacity to endure aversive emotional states without avoidance. As a transdiagnostic construct, DT strongly relates to emotion regulation (Leyro et al., 2010). Low DT contributes to emotional exhaustion under chronic stress (Dekadt et al., 2021). Therefore, this study aimed to compare the efficacy of Transdiagnostic Treatment and Emotion Efficacy Therapy in improving caregivers’ distress tolerance through a quasi‑experimental pretest–posttest–follow‑up design. Method: This quasi-experimental study used a pretest–posttest–three-month follow-up design with three parallel groups: transdiagnostic treatment (TDT), emotion efficiency therapy (EET), and a control group. Participants were 36 primary caregivers of children with cancer (12 per group), recruited through convenience sampling from the pediatric oncology ward of Afzalipour Hospital in Kerman, Iran, during 2023–2024. Inclusion criteria were age 18–60 years, being the child’s primary caregiver, and absence of severe psychiatric disorders based on clinical interview. Exclusion criteria included withdrawal from the study, missing more than two intervention sessions, or changes in caregiving responsibility.The TDT intervention was conducted according to Frank and Davidson’s protocol and included eight weekly 90-minute group sessions focusing on emotion regulation, cognitive restructuring, and distress tolerance skills. The EET intervention also consisted of eight weekly sessions emphasizing mindfulness, emotional acceptance, and values-based behavioral strategies. The control group received no psychological intervention during the study period. Data were analyzed using multivariate analysis of variance (MANOVA) to examine between-group differences and repeated measures ANOVA to assess changes over time. Bonferroni post hoc tests were applied for pairwise comparisons. Statistical assumptions were evaluated using the Shapiro–Wilk, Mauchly’s, and Box’s M tests (P > 0.05). Results: Significant main effects of group and time, as well as group × time interactions, were found for all distress tolerance components and the total score (P ≤ 0.005). Both the transdiagnostic treatment (TDT) and emotion efficiency therapy (EET) groups showed significantly greater improvements than the control group (Bonferroni, P ≤ 0.019), with large effect sizes (partial η² = 0.20–0.64). No significant differences were observed between the two interventions (P > 0.05). Improvements achieved at post-test were maintained at the three-month follow-up, with no significant post-test–follow-up differences Conclusion: The findings indicate that both Transdiagnostic Treatment (TDT) and Emotion Efficiency Therapy (EET) significantly improve distress tolerance among caregivers of children with cancer, with effects maintained over time. Improvements across all dimensions of distress tolerance suggest enhanced emotional resilience, more adaptive coping, and greater acceptance of emotional experiences under chronic caregiving stress. The lack of significant differences between the two interventions implies that shared therapeutic mechanisms—such as increased emotional awareness, reduced experiential avoidance, and greater engagement in values-consistent behaviors—may play a central role in strengthening distress tolerance. Clinically, these results support the flexible integration of both approaches into psychosocial services in pediatric oncology settings, with intervention choice guided by therapist expertise, caregiver preferences, and contextual considerations. Enhancing caregivers’ distress tolerance may also indirectly reduce emotional exhaustion and psychological burden, thereby supporting more effective caregiving and potentially improving child-related outcomes. Overall, both TDT and EET appear to be effective and sustainable interventions for promoting emotional resilience in caregivers facing chronic stress. Future studies should employ randomized multicenter designs with larger samples and longer follow-up periods to further clarify mechanisms of change and improve generalizability.
