Premarital Education Integrating Dialectical Behavior Therapy and Acceptance-Based Approaches in a Caregiving Relationship: Impact on Premarital Patterns and Vulnerabilities in Young Adults

Yadollahi Bastani, Sogol; Atashpour, Seyed Hamid; Farhadi, Hadi

doi:10.30491/hpr.2025.528656.1495

Premarital Education Integrating Dialectical Behavior Therapy and Acceptance-Based Approaches in a Caregiving Relationship: Impact on Premarital Patterns and Vulnerabilities in Young Adults

Document Type : Original Article

Authors

Sogol Yadollahi Bastani

Seyed Hamid Atashpour

Hadi Farhadi

Department of Psychology, Isf.C., Islamic Azad University, Isfahan, Iran

10.30491/hpr.2025.528656.1495

Abstract

Background: By recognizing the profound influence of premarital patterns and vulnerabilities on long-term marital outcomes, there is a compelling need for robust premarital education programs tailored to diverse cultural contexts.
Objectives: This study aimed to assess how premarital education, specifically approaches based on Dialectical Behavior Therapy (DBT) and acceptance-based approaches in a caregiving relationship, impacted premarital patterns and reduced vulnerabilities among young adults aged 20-40 years in Isfahan, Iran.
Methods: A three-group quasi-experimental design evaluated two distinct premarital education approaches—DBT and acceptance -based approaches in a caregiving relationship—alongside a control group. Data were collected via pre-test, post-test, and a one-month follow-up from a convenience sample of 90 young adults (30 per group) approaching marriage, attending psychological centers in Isfahan during spring and summer 2023. Participants were randomly assigned, and the Premarital Patterns and Vulnerabilities Assessment Questionnaire was used. Both intervention groups received eight 90-minute sessions. Data were analyzed using SPSS 26 with descriptive statistics and repeated measures ANOVA.
Results: Both interventions significantly improved all five premarital patterns and vulnerabilities (maladaptive communication patterns, maladaptive management patterns, couples’ value system, schematic mindset, and detrimental effects of family of origin) at post-test (P<0.01). DBT outperformed acceptance-based approaches in mitigating detrimental effects of family of origin at post-test (P = 0.001, η² = 0.41). At the one-month follow-up stage, DBT showed superior efficacy in addressing maladaptive communication patterns (P = 0.009, η² = 0.12) and detrimental effects of family of origin (P = 0.001, η² = 0.41) compared to acceptance-based approaches, with moderate to large effect sizes.
Conclusion: Both DBT and acceptance-based interventions effectively reduce premarital vulnerabilities and improve relational patterns in young adults. DBT demonstrated superior and sustained efficacy, particularly in addressing maladaptive communication patterns and detrimental effects of family of origin, highlighting its potential for fostering healthier relationship foundations in the Iranian cultural context.

Keywords

Premarital Education

Dialectical Behavior Therapy

Acceptance

Marriage

Family Relations

1. Dunst CJ. Meta-analyses of the relationships between family systems practices, parents’ psychological health, and parenting quality. Int J Environ Res Public Health. 2023;20(18):6723. doi:10.3390/ijerph2018 6723

2. Weiss-Laxer NS, Crandall A, Hughes ME, Riley AW. Families as a cornerstone in 21st century public health: recommendations for research, education, policy, and practice. Front Public Health. 2020;8:503. doi:10.3389/fpubh.2020.00503

3. Eftekhari Moghaddam N, Shahbazi M, Kazemian Moghaddam K. Predicting Marital Quality Based on Emotional Empathy and Alexithymia in Nursing Students. Hosp Pract Res. 2023;8(3):325-30. doi:10.30491/hpr.2024.452346.1421

4. Zen EF, Puspitasari DN, Multisari W, Probowati D, binti Sulaiman H. Needs Analysis of Cyber Education-Based Pre-Marriage Guidance Models for Students. KnE Soc Sci. 2022:190-213. doi:10.18502/kss.v7i 1.10211

5. Karney BR, Bradbury TN. Research on Marital Satisfaction and Stability in the 2010s: Challenging Conventional Wisdom. J Marriage Fam. 2020;82(1): 100-16. doi:10.1111/jomf.12635

6. Johnson MD, Lavner JA, Mund M, Zemp M, Stanley SM, Neyer FJ, et al. Within-Couple Associations Between Communication and Relationship Satisfaction Over Time. Pers Soc Psychol Bull. 2022;48(4):534-49. doi:10.1177/01461672211016920

7. Mehrpouya F, Jajarmi M, Alizadeh Mousavi E. The Inter-Structural Relationships between Early Maladaptive Schemas and Marital Commitment of Couples: The Mediating Role of Communication Patterns. Shahroud J Med Sci. 2021;8(2):23-30. doi:10.22100/ijhs.v8i2.895

8. Jaremka LM, Kane HS, Sunami N, Lebed O, Austin KA. Romantic relationship distress, gender, socioeconomic status, and inflammation: A preregistered report. Pers Relatsh. 2020;27(3):708–27. doi:10.1111/pere.12338

9. Malik J, Heyman RE, Smith Slep AM. Emotional flooding in response to negative affect in couple conflicts: Individual differences and correlates. J Fam Psychol. 2020;34(2):145-54. doi:10.1037/fam00005 84

10. Park HG, Qin HY, Horne RM, Impett EA, Yorgason JB, Cheung F. Partner (in) congruence in gender role attitudes and relationship satisfaction. PNAS Nexus. 2025 Jan;4(1):pgae589. doi:10.1093/pnasnexus/pgae 589

11. Kaya Tezel F, Tutarel Kişlak Ş, Boysan M. Relationships between Childhood Traumatic Experiences, Early Maladaptive Schemas and Interpersonal Styles. Noro Psikiyatr Ars. 2015;52(3): 226-32. doi:10.5152/npa.2015.7118

12. Hasani H, Goudarzi M, Karimisani P. The Effectiveness of Family-Focused Therapy on the Caregiver Burden of Parents with Children Diagnosed with Bipolar II Disorder. Hosp Pract Res. 2024 ;9(4):549-55. doi:10.30491/hpr.2025.491272.1459

13. O'Hara KL, Cohen B. A call for early, effective, and scalable parent education programs for high-conflict separated/divorcing parents: A synthesized perspective from prevention science and family law. Fam Court Rev. 2024;62(1):160-75. doi:10.1111/ fcre.12771

14. Cummings EM, Koss KJ, Davies PT. Prospective relations between family conflict and adolescent maladjustment: security in the family system as a mediating process. J Abnorm Child Psychol. 2015;43(3):503-15. doi:10.1007/s10802-014-9926-1

15. D'Onofrio B, Emery R. Parental divorce or separation and children's mental health. World Psychiatry. 2019;18(1):100-1. doi:10.1002/wps.20590

16. Rady A, Molokhia T, Elkholy N, Abdelkarim A. The Effect of Dialectical Behavioral Therapy on Emotion Dysregulation in Couples. Clin Pract Epidemiol Ment Health. 2021;17:121-7. doi:10.2174/174501790211 7010121

17. Tavakoli Z, Rezaei-Jamalouei H, Kazemi-Zahrani H, Khorrami MH, Ghanaat I. A Comparative Study of Dialectical Behavior Therapy and Aripiprazole on Marital Instability of in Patients with Hypersexual. Adv Biomed Res. 2023;12:190. doi:10.4103/abr.abr_1 61_22

18. Jamshidi E, Ahmadi s, Shokrkon H, Sharifi T. Comparing the Effectiveness of Dialectical Behavior Therapy and Mindfulness based on Cognitive Therapy on Marital Satisfaction and Resilience of Women Seeking Divorce. Iran J Psychiatric Nurs. 2023;11(1): 106. doi:10.22034/IJPN.11.1.106

19. Badanfiroz A, Abolghasemi A, Khosrojavid M, Soltani Shal R. Effectiveness of Dialectical Behavior Therapy on Emotional Control, Communication Patterns, and Marital Intimacy in Women with Marital Infidelity Experience. Psychol Woman J. 2024;5(3):86-96. doi:10.61838/kman.pwj.5.3.11

20. Iri H, Makvandi B, Bakhtiarpour S, Hafezi F. The Effect of Dialectical Behavior Therapy on Divorced Women’s Psychosocial Adjustment and Cognitive Emotion Regulation. J Occup Health Epidemiol. 2020;9(2):68. doi:10.29252/johe.9.2.68

21. Halford WK, Moore E, Wilson KL, Farrugia C, Dyer C. Benefits of flexible delivery relationship education: An evaluation of the couple CARE program. Fam Relat. 2004;53(5):469-76. doi:10.1111/j.0197-6664.2004. 00055.x

22. Zemp M, Merz CA, Nussbeck FW, Halford WK, Schaer Gmelch M, Bodenmann G. Couple relationship education: A randomized controlled trial of professional contact and self-directed tools. J Fam Psychol. 2017;31(3):347. doi:10.1037/fam0000257

23. Halford WK, Wilson K, Watson B, Verner T, Larson J, Busby D, et al. Couple relationship education at home: does skill training enhance relationship assessment and feedback? J Fam Psychol. 2010;24(2): 188-96. doi:10.1037/a0018786

24. Hashemi SF, Hamzehgardeshi Z, Nataj AH, Ganji J. Factors Associated with Marital Adjustment in Couples: A Narrative Review. Curr Psychosom Res. 2024;2(2):73. doi:10.32598/cpr.2.2.193.1

25. Rostami M, Navabinejad S, Farzad VO. The construction, reliability and validation of a questionnaire for assessing the patterns and premarital injuries. Appl Psychol. 2019;13(3):453-473. doi:10.29 252/apsy.13.3.453

26. DeCou CR, Comtois KA, Landes SJ. Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. Behav Ther. 2019;50(1):60-72. doi:10.1016/j.beth.2018.03.009

27. Samadi Fard A, Sohrabi Fard MM, Valad Momen P. The effectiveness of the dialectical behavioral therapy on the cognitive and emotional strategies of couples on the verge of divorce. Fam Pathol Couns Enrich J. 2019;4(2):1-28.

28. Dell'Isola R, Durtschi J, Topham G, Gimarc C. A new approach to marriage preparation: The Attachment-Differentiation Premarital Model. J Couple Relatsh Ther. 2021;20(2):149-73. doi:10.1080/15332691.20 20.1829522