Journal of health research in community

Introduction
Women with opioid use disorder (OUD), particularly in Iran, suffer more from its physical and psychological consequences compared to men. The evidence indicates that this group frequently experiences high levels of distress intolerance and profound feelings of loneliness, which in turn can increase the risk of relapse and disrupt the recovery process. In this regard, emotion-focused therapies have gained increasing attention as complementary interventions in addiction treatment protocols. The present study aimed to investigate the effect of emotion-focused therapy (EFT) on increasing distress tolerance and reducing loneliness in Iranian women with OUD.

Methods & Materials
This is a quasi-experimental study with a pre-test/posttest/one-month follow-up design. The study population comprised all women who visited addiction treatment centers in Ahvaz, south of Iran, in 2023. Using a purposive sampling method and based on the inclusion and exclusion criteria, 30 women were selected and randomly assigned to EFT (n=15) and control (n=15) groups. The intervention group received the EFT based on Geller & Greenberg's protocol at eight 90-minute group sessions, while the control group received no specific intervention during this period. For ethical consideration, after the follow-up phase, the EFT was provided free of charge to the control group. Data collection tools included the Distress Tolerance Scale (DTS) developed by Simons & Gaher (2005) and the Revised UCLA Loneliness Scale (R-UCLA) developed by Russell et al. (1980), which were completed at the pre-test, post-test, and follow-up stages. Data analysis was performed using mixed ANOVA with repeated measures and the Bonferroni post-hoc test in SPSS software, version 27.

Results
The results of the mixed ANOVA revealed that the main effect of the intervention on increasing distress tolerance (Effect size =0.28, P=0.003) and reducing loneliness (Effect size=0.27, P=0.003) was statistically significant. The mean DTS score in the EFT group increased by 8 units from pre-test to post-test, and the mean R-UCLA score decreased by 7.66 units. These effects remained stable at the one-month follow-up phase (P<0.001). Furthermore, pairwise comparisons using the Bonferroni test confirmed a significant difference in the EFT group between the post-test/follow-up phases and the pre-test phase, whereas no statistically significant difference was observed in the control group. 

Conclusion
According to the findings of this study, group EFT is effective in enhancing distress tolerance and reducing the feelings of loneliness in Iranian women with OUD. It seems that this therapy, by providing a safe space for emotional processing, strengthening emotional regulation skills, and responding to attachment needs, can be incorporated as an effective complementary intervention into comprehensive addiction treatment and rehabilitation programs for OUD women. It is recommended that future studies with larger sample sizes and longer follow-up periods explore the sustainability of these effects and the underlying neuro-psychological mechanisms of change.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Islamic Azad University, Ahvaz Branch (Code: IR.IAU.AHVAZ.REC.1404.052). Prior to study, written informed consent was obtained from all participants, assuring them of data confidentiality and their right to withdraw from the study at any time. 

Funding
This article was extracted from the dissertation of Maedeh Yazdanipour at Islamic Azad University, Ahvaz Branch. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors contributions
 Conceptualization, methodology, data collection and analysis, and writing the initial manuscript: Maedeh Yazdanipour; Study design, supervision, methodology, editing & review: Kobra Kazemian Moghaddam; Statistical analysis, data interpretation, editing & review: Masoud Shahbazi; All authors read and approved the final version of the manuscript.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors sincerely thank all the women participating in this study for their time and cooperation.

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