Emotion Regulation and Oppositional Defiant Disorder Symptoms in Adolescence

Document Type : Original Article


1 PhD in Clinical Psychology, Faculty of Educational Sciences and Psychology, Shiraz University, Shiraz, Iran

2 Professor, Department of Clinical Psychology, Faculty of Educational Sciences and Psychology, Shiraz University, Shiraz, Iran


Introduction: Oppositional defiant disorder (ODD) is one of the most common referrals in child and adolescent psychiatry. People with ODD have problems with emotion regulation. The aim of this study was to evaluate the effectiveness of therapy based on cognitive-behavioral emotion regulation on the symptoms of the disorder and cognitive regulation in adolescents with oppositional defiant disorder (ODD).
Method: The design of this study was a type of multiple non-concurrent baseline design. Among the girls referred to psychological centers in Shiraz in the academic year 2020-2021, three clients were selected by convenience sampling method, based on conducting the diagnostic interview, cut-off point 16 in the ODD scale reported by parents, and inclusion and exclusion criteria. An Emotion Regulation Questionnaire & Oppositional Defiant Disorder Rating Scale were used in the baseline, treatment, and follow-up steps. An intervention with the Emotion Cognitive-Behavioral Regulation Therapy for 10 individual sessions each lasting for 90 minutes was performed. Version 16 of Excel software was used to analyze the data.
Results: visual analysis (chart drawing), the index of stable change, the percentage of improvement, and the percentage of non-overlapping data (PND) indicated the therapy based on cognitive-behavioral regulation of emotion had reduced the severity of the symptoms of the disorder and suppression. Treatment had a moderate effect on the reappraisal component.
Conclusion: According to the results, Emotion Cognitive-Behavioral Regulation Therapy can reduce the symptoms of ODD and reduce suppression. Accordingly, this treatment can be used to improve ODD and better emotion regulation.


  1. منابع

    1. Mikolajewski AJ, Taylor J, Iacono WG. Oppositional defiant disorder dimensions: genetic influences and risk for later psychopathology. Journal of J Child Psychol Psychiatry. 2017; 58(6):702-710.
    2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). Fifth edition. Washington, DC: American psychiatric association. 2013; 461-466.
    3. Mohammadi MR, Salmanian M, Hooshyari Z, Shakiba A, Alavi SS, Ahmadi A, et al. Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: The National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP Braz J Psychiatry. 2020; 42(2): 162–167. [Persian]
    4. Burke JD, Loeber R, Birmaher B. Oppositional defiant disorder and conduct disorder: A review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry. 2002; 4(11): 1275‐1293.
    5. Mitchison GM, Liber JM, Hannesdottir DK, Njardvik U. Emotion dysregulation, ODD and conduct problems in a sample of five and six-year-old children. Child Psychiatry Hum Dev. 2020; 51(1): 71–79.
    6. Burke, D. An affective dimension within ODD symptoms among boys: personality and psychopathology outcomes into early adulthood. J Child Psychol Psychiatry. 2012; 53(11): 1176–1183.
    7. Cavanagh M, Quinn D, Duncan D, Graham T, Balbuena L. oppositional defiant disorder is better conceptualized as a disorder of emotional regulation. J Atten Disord. 2014; 21 (5): 381-389.
    8. Gross JJ, Thompson RA. Emotion regulation: Conceptual foundations. In JJ. Gross (Ed.), Handbook of emotion regulation. New York: Guilford Press.2007.
    9. Gross JJ. The emerging field of emotion regulation: An integrative review. Rev Gen Psychol. 1998: 2: 271-299.
    10. Sedighi M, Naziry G. The effectiveness of emotion regulation training on reducing aggressive and oppositional behaviors among children aged 4 to 6 years. JRH. 2020; 10(5): 277-286.‏ [Persian]
    11. Ferschmann L, Vijayakumar N, Grydeland H, Overbye K, Mills KL, Fjell AM, ... & Tamnes CK. Cognitive reappraisal and expressive suppression relate differentially to longitudinal structural brain development across adolescence. Cortex. 2021;136: 109-123.
    12. Calub CA, Rapport MD, Alexander K. Reducing aggression using a multimodal cognitive behavioral treatment approach: a case study of a preschooler with oppositional defiant disorder. Clin Case Stud. 2021; 20(1): 3-21.
    13. Pratiwi WA, Purnamsari A. How to Reduce Oppositional Defiant in Adolescent?‏ IJLRHSS. 2020; 3(7): 74-78.
    14. Riise EN, Wergeland JH, Njardvik U, Öst LG. Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clin Psychol Rev. 2020; 83: 1-15.
    15. Chubdari A. Kargar Barzi H, Rasuli M. Effectiveness of Emotion Regulation Training on Reduction of Symptoms in Students with Oppositional Defiant Disorder. Int J Emerg Ment Health. 2016; 18: 1081-1085.
    16. Sharifi Daramadi P, Bagian Kulehmarz M, Padervand H, Geravand F. The effect of impulse control training on impulsiveness and reduce the symptoms of students with oppositional deficit disorder. Journal of Clinical Psychology. 2013; 5(4): 29-41. [Persian]
    17. Derella OJ, Johnston OG, Loeber R, Burke JD. CBT-enhanced emotion regulation as a mechanism of improvement for childhood irritability. J Clin Child Adolesc Psychol. 2019; 48(1): 146-154.
    18. Battagliese G, Caccetta M, Luppino OI, Baglioni C, Cardi V, Mancini F, Buonanno C. Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness. Behav Res Ther. 2015; 75: 60-71.
    19. Lantrip C, Isquith PK, Koven NS, Welsh K, Roth RM. Executive function and emotion regulation strategy use in adolescents. Appl Neuropsychol Child. 2016; 5(1): 50-55.
    20. Webb, T.L., Miles, E., & Sheeran, P. Dealing with feeling: A meta-analysis of the effectiveness of strategies. Psychol Bull.2012; 138, 775-808.
    21. Javid M, Mohammadi N, Rahimi C, Hadianfard H. Comparison of Cognitive Emotion Regulation and Cold and Hot Executive Functions in Female Students with and without Oppositional Defiant Disorder. J Child Ment Health. 2021; 8 (3):87-101. [Persian]
    22. Hughes, E. K., Gullone, E., Dudley, A., & Tonge, B. A case control study of emotion regulation and school refusal in children and adolescents. J Early Adolesc. 2010; 30, 691–706.
    23. Kivity Y, Cohen L, Weiss M, Elizur J, Huppert JD. The role of expressive suppression and cognitive reappraisal in cognitive behavioral therapy for social anxiety disorder: A study of self-report, subjective, and electrocortical measures. J Affect Disord.‏ 2020; 279: 334-342.
    24. Strauss AY, Kivity Y, Huppert JD. (2019). Emotion regulation strategies in cognitive behavioral therapy for panic disorder. Behavior therapy. 2019; 50(3): 659-671.‏
    25. Preece DA, Becerra R, Hasking P, McEvoy PM, Boyes M, Sauer-Zavala S, ... & Gross JJ. The emotion regulation questionnaire: psychometric properties and relations with affective symptoms in a united states general community sample. J Affect Disord. 2021; 284, 27-30.‏
    26. Machado MR, Mosmann C. (2020). Coparental Conflict and Triangulation, Emotion Regulation, and Externalizing Problems in Adolescents: Direct and Indirect Relationships. Dev Psychol. 2020; 30: 1-9.
    27. Birmaher B, Ehmann M, Axelson DA, Goldstein BI, Monk K, Kalas C, ... & Guyer A. Schedule for affective disorders and schizophrenia for school-age children (K-SADS-PL) for the assessment of preschool children–a preliminary psychometric study. Journal of psychiatric research. 2009; 43(7): 680-686.
    28. Ghanizadeh A, Mohammadi MR, Yazdanshenas A. Psychometric properties of the Farsi translation of the kiddie schedule for affective disorders and schizophrenia-present and lifetime version. BioMed Central psychiatry. 2006; 6(10): 1-5.
    29. Hommersen P, Murray C, Ohan JL, Johnston C. Oppositional defiant disorder rating scale: preliminary evidence of reliability and validity. J Emot Behav Disord. 2006; 14(2): 118-121.‏
    30. Gross JJ, John OP. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003; 85: 348–362.
    31. Mashhadi A, Ghasempour A, Akbari E, Ilbaygi R, Hassanzadeh S. The role of anxiety sensitivity and emotion regulation in prediction of social anxiety disorder in students. Knowledge and Research in Applied Psychology. 2017; 14(52): 89-99. [Persian]
    32. Koole SL. The psychology of emotion regulation: An integrative review. Cogn Emot. 2009; 23(1): 4-41.
    33. McKay M, Wood J C, Brantley J. (2007). The dialectical behavior therapy skills. Hasan Jomehpuour and Zahra Andooz (1393). 2nd edition, Tehran, Arjmand Publication. [Persian]
    34. Southam-Gerow MA. (2013). Emotion regulation in children and adolescents: a practitioner's guide. Samaneh Shayanfard, saeedeh Shayanfard and MohammadAli Goodarzi (1398). 1st edition, Tehran, Ebnesina Publication. [Persian]
    35. Ehrenreich-May Jill, Kennedy SM, Sherman JA, Bilek EL, Buzzella, BA, Bennett SM, Barlow DH. (2018). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. Firoozeh Zarghami, Mehdi Akbari and Fatemeh Sarvari (1398). 1st edition, Tehran, Arjmand Publication. [Persian]
    36. noferesti A, Hassanabadi HR. Data analysis in single case experimental design studies. Rooyesh. 2019; 7(12): 291-306. [Persian]
    37. Javid M, Mohammadi N, Rahimi C, Hadianfard H. Comparison of Cognitive Emotion Regulation and Cold and Hot Executive Functions in Female Students with and without Oppositional Defiant Disorder. J Child Ment Health. 2021; 8 (3):87-101. [Persian]
    38. Lotfi M, Bahrampouri L, Amini M, Fatemitabar R, Birashk B, Entezari M et al. Persian Adaptation of Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA). J Mazandaran Univ Med Sci. 2019; 29 (175):117-128. [Persian]

    39. Zargarani N, Mashhadi A, Tabibi Z. The effectiveness of emotion regulation group training based on process model of Gross on behavioral and cognitive inhibition of adolescent girls with syndrome of BPD and ADHD. Journal of Clinical Psychology. 2015; 6(4): 9-19. [Persian