Jurnal UMP Social Sciences Technology Management Vol. 3, Issue. 2,2015 Models interventions of Codependency, Systematic Review Fatemeh Karimi Ahmad Abadi, Department of Social Science, University of Social Welfare Rehabilitation Sciences, Tehran, Iran Masomeh Maaref V, Department of Social Science, University of Social Welfare Rehabilitation Sciences, Tehran, Iran Hakimeh Aghaee Department of Psychology, Shahrood Branch, Islamic Azad University Shahrood, Iran Abstract Codependency is a disease which is targeted family as most important element of any community. Professionals consider it as a disease that can be cured, but is not known. In this paper, models interventions of Codependency are reviewed sorted. Methods: The study was conducted using systematic review. For this reason, articles related to models interventions of Codependency were searched in databases of PubMed, ScienceDirect, Proquest, Willy, Taylor & Francis, Scopus Cochrane Iran databases including Iranmedex, SID, Magiran, Iroce finally 14 articles with Inclusion criteria were selected for review comparison. Findings: All interventions to treat Codependency are both psychological separated into three s: rapy, family rapy cognitive rapy, respectively. Programs for rapy include most interventions to cure improve people with Codependency disorder. Conclusion: The results showed that re is significant relationship between psychological interventions during followup decreasing symptoms of Codependency Keywords: Codependency, model,, systematic review Introduction Codependency was first identified about 1970 as result of years of studying interpersonal relationships in families of alcoholics(beattie 1986).Although less than half century after introduction of Codependency concept but its extensive prevalence is so wide which is known as root of all addictions (Vaitfild, 1991). Different s are introduced with Codependency or in expose of this disorder. Influential people in life of "a person addicted to a variety of chemicals " (Gibson & Donigian, 1993; Edmundson, Byrne & Rankin, 2000; Edmundson, Byrne & Rankin, 2005), those with chronic illness (Dupree, 2009), professionals such as nurses (Biering, 1989; Ançel & Kabakçi, 2009; Williams, Bissel & Sullivan, 1991; Hopkins & Jackson, 2002), Assistance professional (Martsolf & et al., 1999; Whitfield, 1984) even alcoholic people addicted ones to or addictive chemicals are also with, probably long before chemical dependent, have been with (Beattie 1986; Cermak, 1986). Currently, prevalence of has been emphasized in stressful families (drug users, people with mental illness, with physical illness) (Fuller & Warner, 2000).According to most recent statistics (by Drug Control Headquarters, 2012) in implementation of National Plan epidemiology of addiction consumption of narcotics psychotropic substances, which have done in general population aged 15 to 64 years, approximate number of drug abusers in Iran is about 1325000 people( public relations of campaign to combat drugs, 2012,. http://www.dchq.ir) According to national survey of mental health carried out by Ministry of Health in years 20102011, it was found general prevalence of psychiatric disorders is 23.6% of population 15 to 64 years in country that is 12 574 343 people have been identified 572
Jurnal UMP Social Sciences Technology Management Vol. 3, Issue. 2,2015 with one mental disorder (Online Analytical site of ASRKHABAR, 2013, http: //www.asrkhabar.com/fa/news/18055). Anyone familiar importance of life person with problem, such as a spouse, parent, child, friend, who is related closely to same interdependent person called codependent (Bepko, 1991). If people are interdependent, only be considered with stressful families (drug abuser mentally ill) if household number is 3.6 people (Statistical Quarterly of Strategic Information Statistics Center, 2012), it can be estimated that about four million of 75 million people of Iran (Iran Statistical Center, 2012) who are subject to only in terms of drug use, 45 million people with mental illness. Morgan (1991) believes is growing in general population. Now big challenge of syndrome is lack of methods recovery of codependent people. Many of m are seeking for disorder (Hodgson, 1993).Codependency can be treated (Whitfield 1984, Cermak 1986, Miller 1994) But most studies about have ignored Codependency. concept diagnosis of Codependency has been concentrated but few professionals people are aware of this situation. Lack of awareness is a key factor to ignore diagnosis of Codependency. The growing Codependency is so fast that it is necessary writers researchers are actively engaged in clinical practice (Whitfield, 1991).Studies have shown that re is significant strong relation between in families of alcoholics drug abuse mental disorders, especially depression (Loughead, Spurlock & Ting, 1998; Roehling & Gaumond, 1996; Wells,GlickaufHughes & Bruss, 1998 ).Codependency may reduce efficacy of of people with mental disorders drug abuse after entering family environment leads to recurrence of disorder.as a result, a recovered person will enter to fault cycle of a codependent family will expose behavior of family members, so that re is no, but also patient will be disappointed to continue (Harknes et al., 2001). Codependency as a factor against stopping drug dependence, without improved will not be able to improve addictive process.in this paper, interventions models reviewed sorted. Methods In this study, using English Keywords associated with Codependency ( Codependency, Codependent, Codependent, Coalcoholic, Coalcoholic, addiction, Co Coaddiction), combined with key words related to (Treatment, Therapy, Recovery, Healing, Model) a systematic search for articles in major databases including PubMed, ScienceDirect, Proquest, Willy, Tylor & Francis, Scopus, Cochrane was done by using Persian keywords, Codependency in combination with words Treatment, recovery model databases in country, including database of articles Medical Sciences (Iranmedex), Scientific Information Database (SID), database of journals periodicals (Magiran), Institute of Scientific Information Documentation (Iroce), was searched. In first 42 articles were obtained. After Review delete unrelated ones, eventually, 14 articles, 2 in Persian 12 in English were eligible on basis of acceptation criteria were enrolled for final study. Reception criteria for study articles The accepted articles were available in full text in searched databases. They analyzed a kind of intervention in order to improve or y were become as critical components of a model intervention including purpose population, kind of intervention, methodology results f article. There was not any limitation to select m in regard to time place of research. All articles of reception criteria were investigated repeatedly were analyzed categorized interferences regarding to purpose, type of intervention its results. 375
Models interventions of Codependency, www.jsstmump.org No Author Purpose Study type 1 Nazmi, Tahereh(21 04) IRAN 2 Etefaghian, Arezoo(201 3) IRAN study of effect of rapy on codependenc y differentioanl in women who have addicted husb, Andomeshk Town study of effectiveness of family rapy based on Bowen approach of codependenc y, emotional disorder anxiety in women who asked divorce in Hamedan IN 2013 trial Romiz ed two s trial Romiz ed two s population tools Method& model of 30 individuals from among those who score 40 or higher gained Haliuk Codependen cy index (HCI) 30 women counseling centers visited Hamedan divorce divorce cases were in court. Haliuk Codepende ncy index (HCI) Their differentiati on (DSI EspEn Fisher codepende ncy Tests Toronto 20 Emotional disorder Scl90 anxiety test subscale 12 sessions of 90 minutes with content: The dependence of reasons for difference between healthy unhealthy dependence independenc e, assertiveness communicat ion skills to defend ir rights to respect mselves, to meet ir needs, feelings of emotional reactivity, concepts of creativity selfactualization Protocol 1 hour, 8 sessions once a week in form of individual counseling family rapy Bowen approach results There is significant difference between control &test in regard to differentiation &. In test, than pretest control mean of decreased but mean of differentiation increased. The results continued during two consecutive periods A significant difference in results of posttest experimental control s, respectively. Familybased to reduce dependence of Bowen emotional, emotional 375
Jurnal UMP Social Sciences Technology Management Vol. 3, Issue. 2,2015 3 Dianna L. Belyea 2011) 4 Robert Edmundso n*. Marllyn Burne Ericrakin (2000) The relationship between codependenc y level of emotional intelligence Checkdepth session on impact of a change in attitude of codependenc y on consultants. Check effect of familycentered model of rapy for of symptoms of psychological origin current communicati ons improve Psychosocial functions of interrelated dependent on chemicals trials before after trials before after 23 students graduated in counseling 69 people, both men women in 8 s (10.7 persons) open close Emotional intelligence questionnai re (EIS, Schette et al.1998) Halyvk codepende ncy questionnai re (HCI) Epidemiolo gy Depression scale (CESD) codepende ncy index(cod I) Features anxiety index(stai) Eight 2hour sessions / workshops substance abuse with family Map content, aging drug addiction, my story (use, abuse, recovery), codependen cy, alcohol fetal syndrome, introduction of cycle of addiction addiction 12 sessions of 90 minutes in 12 weeks With emphasis on content awareness, understi ng metaphors family, aware of role of communicat ion feeling accepted in family of origin, increased expression skills, understi ng of disorders anxiety divorce affected. Between smallscale manage ir emotions on outside, re is an inverse correlation. Analysis of pre posttest scores showed that holding a seminar includes an indepth meeting with on scores do not affect. A significant reduction in level of depression anxiety, as well as improve understin g of behavior on outside contributors showed. 373
Models interventions of Codependency, www.jsstmump.org 5 Robert Edmundso n*. Marllyn Burne Ericrakin (2005) 6 Gloria Jean Kirby Green (1998) use And growth model for rapy interpersonal communicati on problems associated with codependenc y Increased selfseeking behavior reduce communicati on problems its symptoms. Check psychological impact dynamiccycle (CPT) to reduce codependenc y behaviors in families with children are blind or vision impaired trials before after Case (clinical trials before after) 46 patients with mental health problems are diagnosed based on clinical symptoms. The sample included both sexes in 6 s of open close selection 4 families (N = 9 patients) had a child blind or have visual impairment (no or physical or mental challenges) Internal control index(ici) codepende ncy index (CODI) direction Of life (measured dependence on three cognitive rigidity, expressing feelings, common expectation s). responsibilit y in family of origin, shame on cognitive function of communicat ion. 12 sessions of 90 minute duration of 12 weeks (weekly sessions), use of two colleagues (male female) Awareness of role of explicit content learned, identifying origin of family metaphor, knowledge of issues related to accountabilit y communicat ion, isolation, personal growth. 12 sessions in 12 weeks perception of external control of patients on 3step test during 12 sessions after 6 months of followup was significantly improved There is Significant differences between scores of threedimensional orientation in pre posttest questionnaire 375
Jurnal UMP Social Sciences Technology Management Vol. 3, Issue. 2,2015 7 Christina Strakes. 1997) 8 Joan Gibson, Germiah Donigian (1993) 9 Katleen Veronica Prouty (1992 10 Pamela Sue Ellinger The concept is to design a program of rapy, cognitive dependence. Check effect of cognitive rapy on selfconfidence, coping skills, depression Present A for people dependent on Bowen ory. Goal of achieving a higher level of self thus reduce level of anxiety. Check effect of a 12 step program of codependent s status effects during 3 months followup program of 12 steps The focus of programs trial Romiz ed two s This research was an experimen tal study. trial Romiz Including 35 women (17 patients 18 control ) of student counseling at least once physical abuse or emotional powerless to end relationship at normal time. codependen t families in area of mental health chemical dependency 50 patients (40 women 10 men) with a family with inefficient communicat ion 40 women (20 test 20 control) Beck Depression Inventory Inventory confidence Questionna ire of coping methods codepende ncy index questionnai re (CODI) MMPI questionnai re Milon Inventory, 6 sessions during 6 weeks Check content of core beliefs of individual genealogies Monogram how identity formation, an overview of Erikson's psychosocial model, understi ng of selfdestruction how to deal with it. Three main phases of : Work with family of origin Position "I" recovery Lost emotions 12step program is based on a plan Cottonwood de Tucson`s 10 sessions 2 hour over 10 weeks. re is Significant differences between control test level of depression selfconfidence. But re is no significant difference between two s in coping skills. The three main stages of can be largest component dependency program a framework for understin g situation in area of mental health chemical dependency Effective intervention in reducing level of psychopathol ogy, as well as changes in track surface remains constant Structured counseling, 377
Models interventions of Codependency, www.jsstmump.org Dixou (1990) 11 Brown Howard Payton 12 Ronald T.patter Efron Patricias.p atter Efron, 1989 (structured counseling) is dependent on three main features: decision obediently, low selfesteem, attachment problems Check your acceptance of world around m conduct regular (daily) itself. Improving differentiatio n achieve selfworth ed two s Case study (clinical trial before after) 21 patients (15 women 6 men) with codependen cy disorders, alcoholism, drug addiction, sexual addiction, eating disorders Children, adults, couples / friends / parents of alcoholics dependent on chemicals Cooper Smith Confidence questionnai re Personality assessment form Assessment decision form The selfcontained, selfdiscovery, emotion, decisionmaking, family of origin, care alone 12 sessions in 12 weeks Treatment based on BASIcIs, consists of two phases: First, help people use twelve step Alcoholics Anonymous program. Second, life skills training 12week program including a combination of training, individual rapy rapy plan for four sections (behavioral, cognitive, emotional effective for in women is improved no significant difference between control experimental s at level of selfconfidence obedient decisionmaking Experts interviewed by target sample represents BASIcIS in psychological effectiveness of approach. Followup at 3 11 months after, indicating stability in majority of target This model, a model is effective to improve. 375
Jurnal UMP Social Sciences Technology Management Vol. 3, Issue. 2,2015 13. Richard G, Cavasina (1987) 14 Martha Elevel (1987) Structured model for women associated with identity low selfesteem improving emotionalbehavioral emotional functions use Interpersonal model for intergenerati onal transfer system is not dependent dysfunctional families trial Romiz ed two s 30 women who reported ir husbs' alcohol abuse Codependen t women Check list of behavioral problems codepende ncy questionnai re spiritual) is designed. Teaching communicat ion skills to an experimental control received stard applications clinic. Treatment model includes three basic steps: First, create a positive image Second, growth of selfdiscovery The third, interpersona l relations Teaching communicati on skills to couples rapy showed a more positive associations. Visualization (image) a powerful technique as a longterm intervention. Generally, working with mental images of women is dependent can be an effective intervention Results A total of 14 papers in field of addiction were only 2 studies (14.02 percent) in Iran 12 of anor study (85.98 per cent) have been performed abroad. The overall volume of samples was conducted in 11 clinical trial studies includes 330 patients (296 females (86.80%) 45 men (13.19 percent)), respectively.11 studies (78.57%) were clinical trial as before / after (5 studies) romized to control (6 studies), 3 studies (21.42%) in line with model of dependence were taken. In a romized study with a control of study, participants were variable between 4030 people (who were romly divided into two s: 1520). In clinical trials before after sample size varies from 59 to 9 members. The number duration of meetings were between 6 12 sessions of depend on clinical studies (1.5 to 4 months) one session each week (60 to 120 minutes) that 7 studies (63/63%) included 12 sessions of 90 minutes each week 2 studies (18%) as 8 sessions of 60120 minutes, one study (7.0%) 10 sessions of 120 minutes per week for a meeting of a study (0.7 percent) as six sessions in 375
Models interventions of Codependency, www.jsstmump.org 6 weeks. 9 studies (65 percent) were performed in period (1999 to 1987) five studies (35%) in period (20142000). Interventions Interventions about were designed performed in three methods: rapy, family rapy cognitive rapy The first category: Group Therapy It includes interventions that focus on programs in so that most interventions studies of this type were studied. The programs include rapy with approaches of breakdown, cognitive, counseling 12 steps program. (PeterEfron Peter Efron, 1989; Peyton, 1989; Elinger Dayakso, 1990, Kathleen Vronika, 1992; Astrakz, 1997; Edmsond et al., 2000; Edmsond et al., 2005, Nazmi, 2014).Group rapy is so effective to treat disorder will make social security for codependent persons who want obtain new information in Predictable appropriate space. Codependency defines as multiple relations rapy causes to forming multiple relations which can t be controlled easily is effective to recall symbolic behaviors making a space like a family. In sum, protection support of relatives, not just of Therapist is valuable in process,. This support is an emotional experience for codependent person which give a positive feedback to person lead to break down denial of himself expression his true feelings.codependent person in dissociative rapy can acquire separation bordering skills in communications problem solving so that separate his problems from addicted one. The study of genealogy, monogram belief core anticipate how to form identity, Erickson mentalsocial model, selfdestruction how to confront it in rapy intervention can lead to decrease depression increase self esteem. In addition, s which controlled by professionals experts, 12 steps s perform as based counseling s whom concentrate on increasing self awareness, self development, self esteem expression of feelings. The second category: Family Therapy Second category includes interventions stressed in effect of family rapy to treat. Only two approaches discussed Bowen family rapy to improve, a clinical survey of divorced women a model design of codependent people in area of mental health substance abuse (Gibson Donigan, 1993; Etefaghyan, 2013).Bowen believes that social psychological effects on family, especially interpersonal patterns influence on position of. An ineffective family failed to provide security good atmosphere to rear children a set of preventive factors govern in this family which lead to inconsistency of family prevent social emotional development of children. So we need to teach family members how to adjust inner realities of family increase discrimination level to establish communication with ors express ir feeling openly. The third category: Cognitive Therapy The third category includes interventions in which efficacy of cognitive rapy interventions emphasizes to treat. Including cognitive rapy interventions can be pointed out mental dynamic approach (Jane Green, 1998), a multidimensional approach to spiritual psychological (Peyton, 1989) use of image (Alvlnd, 1987).In cognitive to improve stressed on changing person cognation about him ors making new cognitions, it is believed that improvement of cognition can change improve codependent behaviors.mentaldynamic approach to treat focused on recognition of personal environment problems ( family society) which cause to obscure self change will help to recognize himself surrounding environment by active behavior interventions.using mental image is also among interventions that emphasize to treat codependent women based on three stages, making positive image, development of selfdiscovery establishment interpersonal communications. Codependency measurement In most studies conducted to measure Codependency, questionnaires were used. The Codependency questionnaire (CODI) Halivog Codependency (HCI), Espen Fisher life orientation were used, but Codependency questionnaire (CODI) is used more to measure Codependency (Nazmi, 2014; Etefaghiyan, 2013 ; Baliyeh, 2011; Edmson, 2000; Edmsond, 2005, Jane &Green, 1998; Paroti, 1992; Kavasina, 1987). 355
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Models interventions of Codependency, www.jsstmump.org Target population Regarding target population of study, more attention has been paid to of codependence in women. In 2 studies, counseling students determines as target population one of m with received intervention. In or article, counseling students taught as rapist to recognize 2 studies investigated efficacy of intervention on of family in mental health addiction as well as physical illness. In general most studies study in alcoholic drug abuse people Most studies discussed participants with problems in life only 3 studies, alcoholic drug abuse person considered as codependent person. The content of interventions The content of educational interventions for programs include a focus on ir (6 studies), problems of family origin (5 studies), ineffective communication (4 studies), express feelings (3 studies), twelvestep programs (2 studies) respectively. The effects of rapeutic interventions The expected outcomes of studies included improving selfconfidence, coping skills decisionmaking, reduce trauma (depression, anxiety, stress, heavy reliance, selflosing), change in mental status, improving conditions of based on external control, increasing differentiation communication skills. The review of studies shown interventions lead to increase self esteem decision making, changing mental status, increasing self finding differentiation improve communication skills improving behaviors incompatibility between couples. Conclusion In this paper, models intervention of were reviewed. Most of participants in studies were women. In many studies, longterm followup (11, 6, 3 2 months) after intervention, symptoms were significantly reduced. In a study was done by Gloria Jeans Kirby Green in 1998 to study impact dynamics of cycle rapy on psychological on families with children are blind or vision damage, re was no significant effect on level of that it would may be due to low sample size.methods for of can be presented in three categories of rapy, family rapy cognitive rapy classified. Group rapy over or methods was used to treat.codependency interventions have been conducted for several s, people who are mentally ill or drug abuse, those with family or Substance Abusers, or physical or mental disease or live with ir rapists or have close relationship to m.vigshaydercruz (1996) suggests that of is not a longterm maintenance rapy (in life), however, requires longterm interventions, but after a certain period ends. Most interventions for of a mediumterm or longterm is also designed in most cases ir focus was on skills training.most studies were done about this subject in 19891999 after that period, number of same studies decreased. It seems to focus more on of patients (eg drug abusers) is diminished to focus. In or h, lack of strict agreement about definition of, difficulty to measure it resistance of codependents against could be factors to prevent development of. The study also faced restrictions. When searching in databases may be articles under publishing process, but still have not been indexed or hidden from perspective of a researcher in study not entered into study. In case of a language or than English Farsi by Iranian researchers is published, were not examined. Apart from search database, or database existed where search didn t take place; re are articles that have not been studied. In IRAN, only way in which y can use to improve codependents is 12 step methods. It is necessary to design use different methods.so studies on subject of designing clinical survey of interventions can provide a sufficient ground to offer effective professional services to codependent people. References 1. Etefaghian, Arezoo(2013), study of effectiveness of family rapy based on Bowen approach of, emotional disorder anxiety in women who asked divorce in Hamedan, MA sis, Kurdestan University, social human science school 355
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