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Research Paper: The Effect of Self-Differentiation Training on Attachment Styles and Self-Esteem in Married Women

* Corresponding Author: Razieh Behjati Najafabadi, MSc. Address: Department of Guidance & Counseling, Faculty of Humanities, Khomeinishahr Branch, Islamic Azad University, Isfahan, Iran. Tel: +98 (913) 7925389 E-mail: raziye.behjati313@gmail.com Objective: The present study was done to determine the effect of self-differentiation training on attachment styles and self-esteem among married women in our center.


Introduction
amily, as the most important core of the community, plays an important role in shaping many social relationships, and the community also has some effects on family behaviors (Jafari Nadoushan & Rayati Shavazi, 2014). Mothers are one of the fundamental pillars of the family system, and as the main caregivers of children, they tend to experience much psychological stress that causes damage to their mental health. Also, to maintain the health and safety of the family system, they must identify, control, and optimize various functions of the family members to ensure the survival and safety of the family in the community (Imani & Moradi, 2012). Individuals are linked to each other by strong interests and attachments (Lee & Hankin, 2010). One of the factors that contribute to the formation and sustainability of these relationships is the attachment style of individuals. Attachment styles are one of the concepts that were first presented by John Bowlby (1969) (Naebi Nyia, Salari & Modares Gharvi, 2011). Hazan and Shaver (1987) identified three adult attachment styles based on the Ainsworth classification: secure attachment style, avoidance attachment style, and anxiousambivalent attachment style. Individuals with a secure at-tachment are known with a positive attitude to themselves and others (Karamiboldaji, Sabetzadeh, Fallahchai & Zarei, 2014). In contrast to the secure style, there are two avoidance and anxious-ambivalent styles. The main feature of avoidance attachment style is the negative attitude to yourself and others. Finally, people with anxious-ambivalent attachment style are also known to have negative attitudes toward themselves and a positive attitude to others, and also they need attention (Millikin, 2000). There is a relationship between self -esteem, sentiment, harmony, and health. People with low self -esteem will experience more negative emotions than people with high self -esteem (Du, King & Chi, 2017). Self-esteem is one of the most important factors in the growth and flourishing of humans that family plays a fundamental role in its strengthening or weakening (Naimavi, Maktabi, Tofanizadeh & Rahimi, 2015).
Self-esteem is an attitude about skills, abilities, social relationships, and future events (Snyder & Lopez, 2002). It is caused by a positive attitude to yourself through receiving feedbacks, warm and kindly relations, respect, intimacy, acceptance, and kindness from the environment, and especially the family (Hassanzadeh & Imanifar, 2010).

Highlights
• The calculated values showed a significant difference between the control and experimental groups in the mean scores of secure and anxious-ambivalent attachment styles and self-esteem.
• Self-differentiation educational intervention has increased secure attachment and improved anxious-ambivalent attachment in married women.
• Self-differentiation educational intervention has increased the self-esteem of married women.

Plain Language Summary
The family, as an essential element of society, plays a key role in the formation of different social relationships. Attachment styles are one of the concepts that are formed from early childhood and become a pattern of interpersonal relationships in adulthood so that they can predict their adjustment. Self-esteem is an individual trait that has significant effects on the context of family relationships, social interactions, and the degree of differentiation of individuals in marital relationships. Differentiation means the independent identity of the individual in the relationship and is essential for psychological adjustment. Because people in the stage of choosing a spouse tend toward a person with a similar level of differentiation, marital satisfaction is related to the levels of differentiation of couples. The present study was done to determine the effect of self-differentiation training on attachment styles and self-esteem among married women. To this aim, 30 married women who wanted to participate in the training course were selected and placed in two experimental and control (each 15 participants). The experimental group participated in a self-differentiation training course for 8 sessions, but no training was provided for the control group. The results showed that self-differentiation training increased secure attachment and self-esteem and improved anxious-ambivalent attachment.

F
Many theorists have attempted to explain family performance. Bowen (1978) was the most famous theorist who introduced the theory of family systems. In this view, the "self-differentiation" is the fundamental concept that refers to the ability of an individual to avoid the automatic obedience of emotion (Nickhah, Younesi & Borjali, 2013). The degree of self-differentiation in each individual reflects his ability to differentiate the experienced rational from the emotional process. Self-differentiation components are as follows: 1. Emotional reactivity: A situation, in which ones' emotions overcome his wisdom and logic and his decisions are based on emotional reactions; 2. "I" position: having certain beliefs in life; 3. Emotional cut-off: using different strategies to escape unsolved emotional links with others; 4. Fusion with others: have an intense mixing with others (Ghenaat Bajgirani, Ghanbari Hashem Abadi & Zarif, 2013). According to Bowen (1978) theory, the mental health of a person depends on the level of his self-differentiation; for example, people with a high degree of self-differentiation are not emotionally dependent on others and they do not need to be confirmed or rejected by others (Skowron & Friedlander, 1998).
Therefore, family therapy interventions based on the self-differentiation approach can affect marital adjustment, because according to Bowen's model, one who has reached a balanced differentiation of the family has the lowest level of anxiety and psychological syndrome (Yousefi, 2012). Other aspects of Bowen's theory include social repression, tri-angulation (a third person involved for maintenance of marital relationship), birth order, family projection system (transmission of the lowest level of differentiation by parents to the most talented child), and multigenerational and emotional system of the family (people choose couples with the same level of self-differentiation (Latifian & Fakhari, 2014).
The structure of a well-balanced family is based on true marital relationships. Couples' attachment style and their self-esteem are important factors in strengthening this relationship. According to Bowen's model, a person in a differentiated family has the lowest levels of anxiety and psychological syndrome. Some researchers have shown that self-differentiation has affected couples' life satisfaction and marital adjustment, but no similar research has been found to explore the effect of self-differentiation on self-esteem and attachment styles. For example, Rodrigues (2016) in a study showed that poor self-differentiation has effects on worry and insecure adult attachment style and their relationship. Burri, Schweitzer and O'Brien (2014) showed that relational variables of avoidance attachment and to a lesser degree, anxiety attachment were associated with fertilityspecific distress. Participants with lower levels of self-differentiation were more likely to report sexual difficulties. Beirami (2012) in a study entitled "Predicting marital satisfaction on the basis of attachment styles and differentiation components" showed that among the components of self-differentiation, I-position, and among the types of attachment styles, anxious-ambivalent attachment style (P<0.001) were the best predictors of marital satisfaction. Skowron and Dendy (2004) showed significant relationships between the dimensions of attachment and self-differentiation, and a great relationship was observed between avoidant attachment and emotional cut-off (r=-0.75), and between anxiety attachment and ER (r=-0.60).
According to the role of the family in attachment styles and self -esteem, Bowen's theory seems to be one of the strongest theories of family therapy. So far, no study has been done to investigate the effect of self -differentiation on attachment styles and self-esteem; thus, the present study was done to investigate whether self-differentiation training affects attachment styles and self-esteem of married women.

Methods
The current research was a semi-empirical study with pretest and post-test. The statistical population was married women in Najaf Abad, Isfahan in spring 2017. Cole's (1983) formula was used to estimate sample size (Cole & Black, 1983). Cole recommends using up to 30-35 subjects in most basic semi-experimental studies. Also, when the researcher intends to perform an analysis of variance with several levels of independent variables, Cole proposes 15 participants for each level. The samples were selected from married women who wanted to attend the training course.
The inclusion criteria were as follows: 1. Having a Diploma education and higher; 2. The age range of 20 to 45 years; 3. Passing at least one year from the marriage; and 4. No drug addiction and using the psychoactive substance. Exclusion criteria in this research were 1. Unwillingness to participate in the study; 2. the presence of physical, psychological, and family problems to make the women unable to continue to cooperate; and 3. Being absent for more than two sessions of the self-differentiation training.
Accordingly, 30 women who met the inclusion criteria were selected by available sampling and were randomly assigned to two groups of 15 participants: the experimental and control groups. Then, both groups were asked to complete the research questionnaires carefully. After the pre-test, the experimental group received an educational intervention consisting of eight 100-minute sessions (weekly one session), but no intervention was received by the control group. Finally, both groups were asked to respond to research questionnaires again in the post-test. Table 1 presents the framework of self-differentiation sessions based on the educational-therapeutic package for self-differentiation developed by Yousefi (2010) (?). The following ethical standards were observed in this study: All sessions were free of charge; • There was no compulsion to participate in the research, and the consent of the members to participate in the course was considered; • The confidentiality of the results of the questionnaires and participants' personal information was fully respected; • The collected information was used only for the purposes and hypotheses of the study.
To collect data, the Adult Attachment Styles Questionnaire (AAQ) developed by Hazan and Shaver and Rosenberg Self-Esteem Scale (RSES) were used. AAQ was used to measure the attachment styles of married women. This questionnaire has 15 questions and is scored on a five-point Likert scale. Five items are related to secure attachment style, five items to avoidance attachment style, and five ones to anxious-ambivalent attachment style. Hazen and Shaver (1987) obtained the total test-retest reliability of 0.81 and Cronbach's alpha of 0.78 (Aha-di, 2009) for this scale. Rahimian Bougar, Asgharnejad Farid & Rahiminejad (2008) reported the reliability of 0.75, 0.81, and 0.83 for secure, avoidance, and anxiousambivalent attachment styles, respectively, for AAQ using Cronbach's alpha equals to.
RSES was used to measure the self-esteem of married women. This scale is used more than other self-esteem scales and has ten items that are scored based on a fourpoint Likert scale, from completely agree to completely disagree. Zimprich, Perren and Hornung (2005) examined the RSES using confirmatory factor analysis and found that the one-factor model of self-esteem was more fitted to the data with orthogonal rotation with negative items. Mäkikangas, Kinnunen and Feldt (2004) obtained Cronbach's alpha coefficients of 0.87 for men and 0.86 for women. Alizadeh, Farhani, Shahraray & Alizadegan (2005) reported the reliability of 0.74 for this scale using the Cronbach's alpha coefficient and 0.82-0.88 by the test-retest method. The collected data were analyzed at descriptive (Mean±SD) and inferential (ANCOVA) levels using SPSS V. 22.

Results
The mean age of women participating in the study was 32.26. Also, 23.3% had no children, 30% had one child and 46.7% had two children or more. In terms of educational level, women with a bachelor's degree had the highest frequency (50%) and women with postgraduate education were the least frequent (10%). Table 2 pres- Introducing the method, getting acquainted with members and referrals, doing pre-test, and presenting practices related to the topic of the session.

2
Review of the previous meeting, understanding the self-differentiation concepts and its effects, explaining the relationship between non-self-differentiation and its representation in current life problems, presenting practices related to the topic of the session.

3
Review of the previous meeting, presenting the triangulation logic in the family, investigating the effects of triangulation on marital and family relationships, presenting practices related to the topic of the session.

4
Review of the previous meeting, explaining and evaluating the family's emotional system, investigating the relationship between the family's emotional system and marital conflicts, presenting practices related to the topic of the session.

5
Review of the previous meeting, presenting the family projection process, explaining the sensitivity of the transmission of parents' non-self-differentiation to their children and checking the problems caused by it, presenting practices related to the topic of the session.

6
Review of the previous meeting, presenting emotional cut-off logic, preparing a comprehensive list of specific behaviors of couples as emotional cut-off behaviors, presenting practices related to the topic of the session.

7
Review of the previous meeting, explaining the multigenerational process and genogram, presenting practices related to the topic of the session.

8
Review of the previous meeting, summing up and conclusion, doing post-test, and announcing the end of the meeting.
ents the descriptive statistic of the research variables in both groups in the pre-test and post-test phases.
The results showed that the mean scores of women participating in the experimental group in the post-test in both the avoidance attachment style (13.06) and the anxious-ambivalent style (11.53) were lower than those of the pre-test. The mean scores of women in the experimental group in the post-test in the secure attachment style (18.00) and self-esteem (29.60) increased compared with the pre-test.
The results of ANCOVA showed that among the three attachment styles, only there was a significant difference between the mean score of the experimental group in secure attachment style (F=8.56, P=0.007) and anxiousambivalent attachment style (F=7.43, P=0.012) compared with the control group (Table 3), whereas there was no significant difference between both groups in avoidance attachment style (P>0.05). Also, the experimental group showed a significant difference in the self-esteem score (F=4.60, P=0.041) compared with the control group. According to the obtained effect size, 25% of the differences between the secure attachment style, 23% of the differences between the anxious-ambivalent attachment style, and 15% of the self-esteem differences in the post-test were related to the differences between the two groups. According to the results, self-differentiation training can increase the level of self-esteem and secure attachment and decrease the anxious-ambivalent attachment in married women referred to our center.

Discussion
The present study was done to investigate the effectiveness of self-differentiation training on attachment styles and the self-esteem of married women referring to our center. The result of ANCOVA for the first hypothesis showed that self-differentiation training had a significant effect on both secure attachment and anxious-ambivalent attachment styles among married women. It increased the secure attachment style and decreased the anxious-ambivalent attachment style, whereas no significant change was observed in the avoidance attachment style. These results are consistent with those reported by Rodrigues (2016), Burri et al. (2014), Beirami (2012), and Skowron and Dendy (2004). To explain these results, it can be said that like other trans-generational perspectives, selfdifferentiation focuses on explaining the nature of interpersonal behaviors and intra-psychic structure through the past relationships within the extended family, which are transmitted from generation to generation, thus influencing the present relationships (Vancea, 2013).
Self-differentiation training makes married women informed about the harms of triangulations that they frequently create in their relationships with an emphasis on the growth of rationality. It helps them reduce their anxiety and establish deep-seated emotional relationships, be able to balance between emotional functions, and be independent in decision-making and expressing their ideas. According to Skowron and Dendy (2004), there is a high degree of convergence between the concepts of Bowen's self-differentiation and Bowlby's secure attachment; therefore, they can be used instead. People with secure attachment have positive feelings about themselves and have a positive perception of others, and are socially more confident and successful (Moazeni, Aghaei & Golparvar, 2014). They also experience less anxiety by balancing their relationships similar to selfdifferentiated individuals. In contrast to the secure style, anxious-ambivalent people tend to have a less positive view of themselves and show poor relationship patterns. They are scared of being rejected by their friends or spouses (Robyn & Evelyn, 1998).
It seems that the concept of fusion in self-differentiation is close to the theoretical conception of the anxiousambivalent attachment style. Non-differentiated people are always concerned about their feelings and others' opinions. They have the fear of losing their relatives; thus, they suffer from high psychological stress. Therefore, it can be said that educational interventions cause an increase in people's adaptability to cope with stress made by close relationships by informing non-differentiated individuals about the negative aspects of fusion, and also by trying to create greater autonomy while recognizing and keeping the boundaries of dependency. Also, the insignificance of therapeutic intervention in avoidance attachment style can be related to the presence of some features that interfere with the aspects of a high degree of self-differentiation, such as high I-position. Avoiding people by staying away from others will avoid possible conflicts, rejection, or disappointment as a result of getting too close to others. This strategy can be a mechanism to deal with the unavailability and nonresponsiveness of others and reducing the anxiety of the individual, which is consistent with the outcome of the self-differentiation training.
Therefore, considering the features of individuals with avoidance styles, the goals of self-differentiation, changes in traditional values of the family and a new definition of women's role in modern society nowadays, self-differentiation training with an emphasis on autonomy and keeping balance in intimacy and feelings in relationships has no significant impact on avoidance attachment style, which inherently follows independence. Thus, according to this contention, the ineffectiveness of the intervention on this style seems to be logical. Also, the results of ANCOVA in investigating the second hypothesis of research showed that self-differentiation training had a significant effect on self-esteem among married women. This result is consistent with the results of other studies (Nodeei, Esmaeili & Farahbakhsh, 2015;Kazemian & Kalantar Hormozi, 2013;Hea Shoon Lee, 2011;Levinger & Ronen, 2010).
To explain these results, it can be said that self-esteem is one of the most important psychosocial factors to reduce stress, which is based on the family relation fields, social interactions, and achievements (Movahed & Dastranj, 2010). According to Mogonea and Mogonea (2014), selfesteem is a method, by which individuals evaluate their values negatively or positively interrelated to the groups they belong to. It seems that the self-differentiation intervention gives married women the opportunity to create strong self-esteem by emphasizing I-position and strengthening it. Also, the women who participated in the intervention learned how to focus on their features and values in their social interactions and to apply rationality in relationships during the process of meetings (for example avoiding irrelevant and irrational adherence to relatives).
They could grow their independence to create a coherent identity to increase their sense of self-worth and self-esteem. Because as long as a person with high self-esteem, a positive attitude, and a high sense of self-worth is not dependent on the others' confirmation and behaves in an independent way, the final outcome of self-differentiation is also the creation of independence in the relationships (while keeping intimacy).
One of the limitations of the present study was that the statistical population included married women and the results should be cautiously generalized to men. Also, random sampling was not possible and the samples were selected by available sampling and randomly divided into the experimental and control groups. It is suggested that this research be done on a group of married men or groups of couples. Also, it is recommended to perform a follow-up evaluation to observe changes in relationships over time. Performing follow-up tests will determine the strengths and weaknesses and the degree of stability of treatment effects. According to the effect of self -differentiation on attachment styles and self-esteem, it is recommended that this training can be used in premarital educational programs and in couple's workshops.

Conclusion
It seems that training self-differentiation to married women could improve their attachment styles by decreasing their anxiety in relationships and this training could increase their self-esteem by improving their independent identity and I-position.

Ethical Considerations
All ethical principles were considered in this article. The study participants were informed about the purpose of the research and its implementation stages. They were also assured of the confidentiality of their information. Moreover, they were allowed to discontinue participation in the study whenever they wish. Eventually, if desired, the results of the research would be available to them.

Compliance with ethical guidelines
All ethical principles were considered in this article. The study participants were informed about the purpose of the research and its implementation stages. They were also assured of the confidentiality of their information.
Moreover, they were allowed to discontinue participation in the study whenever they wish. Eventually, if desired, the results of the research would be available to them.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.