Document Type : Research Paper
Author
Associate Professor, Department of Psychology and Education of People with Special Needs, Faculty of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran.
Abstract
ABSTRACT
Given the increasing prevalence of emotional-behavioral problems in children and the challenges that mothers of these children face, helping mothers control the anxiety caused by coping with parenting challenges is becoming important. The aim of the present study was to investigate the effectiveness of the paradoxical time table on mothers' anxiety and worry, and daughters' internalized problems. This study was a quasi-experimental study with pretest, posttest, and follow-up phases with a control group. The statistical population was daughters (age 7-9) with internalizing problems in Isfahan in 1404 and their mothers. By a purposeful sampling method, 40 people from this population were selected as a sample, and 20 people were randomly assigned to the experimental group, and 20 people were randomly assigned to the control group. Mothers in the experimental group participated in six 60-minute sessions of the paradoxical time table, and the control group did not receive any intervention. Both groups completed the research instruments including: the Beck Anxiety Scale, Pennsylvania Anxiety Questionnaire, and Achenbach Behavioral Disorders Inventory (2001), before and after the intervention. The data were analyzed using repeated measures analysis of covariance. The findings showed that the values of both variables in the experimental groups in the post-test and follow-up stage were significantly different from the pretest stage (significance level less than 0.05). Therefore, this intervention had a positive and significant effect on (maternal anxiety (F = 420.587, P = 0.0001), (maternal worry (F = 231.057, P = 0.0001), and daughters' internalized problems (F = 288.629, P = 0.0001). Therefore, the paradoxical timetable is effective on maternal anxiety and worry, and daughters' internalized problems. Given the importance of maternal function in relation to children, providing education and therapeutic interventions to mothers in order to reduce mothers' negative emotions and control children's internalized problems can be effective.
Keywords: Paradoxical time table, maternal anxiety, maternal worry, internalized problems
Cite this Article: Ghamarani, A. (2025). The Effectiveness of Paradoxical Time Table on Mothers' Anxiety and Worry, and Daughters' Internalized Problems. Psychology of Exceptional Individuals, 15(60), 143-176. https://doi.org/10.22054/jpe.2026.88011.2856
© 2025 by Allameh Tabataba'i University Press
Publisher: Allameh Tabataba'i University Press
Extended Abstract
Introduction
Emotional and behavioral problems in children are considered one of the most important issues and problems in child psychology. Childhood is a very important period of a person's life because childhood experiences predict the mental health of individuals in adulthood (Lewis & McKelvey, 2025). One of the most common psychological problems in children is emotional and behavioral problems (Christopher et al., 2023). Research by Chougule et al. (2023) estimated the incidence of these disorders in adolescents to be about 13.7% to 50%. Racine et al. (2021) believe that the prevalence of internalized behavioral problems in the world has increased in recent years and have stated that the global prevalence of anxiety and depression in children is 20.5% and 25.2%, respectively. Internalized problems in children have a negative impact on the child's personal performance and prevent children from performing in line with their abilities (Dostani and Ghamarani, 2021). Therefore, internalized problems in children are debilitating problems for children. The family, as a fundamental social structure and a stable psychosocial environment for children, plays an important role in shaping their emotions and behavior (Li et al., 2025). Among all family members, the importance of the mother's role in children's mental health is an important issue that should not be ignored. Mother's mental health plays an important role in preventing children from developing behavioral problems (Shiralinia et al., 2019). By disrupting early mother-child relationships, maternal anxiety can cause emotional disorders, low levels of mental vitality, and psychological insecurity in children (Karimabadi, 2014). In general, the quality of maternal care for children is effective in preventing children's internalized behavioral problems (Shaabani and NematTavosi, 2014). Therefore, providing training and interventions that reduce mothers' negative emotions and feelings can also be effective in reducing children's behavioral problems (Li et al., 2025). Despite the existence of effective interventions for anxiety disorders, the recurrence of symptoms in the long term is one of the challenges that people with anxiety disorders face (Krijnen et al., 2022). Paradox therapy has shown its effectiveness in the treatment of anxiety disorders. Paradoxical timetable therapy (PTC) consists of two main techniques, namely paradox and time table. Given that this treatment method has shown its effectiveness in the treatment of psychological disorders, especially anxiety disorders, and problems such as recurrence of symptoms, or the persistence of symptoms after treatment, do not exist in this type of treatment. Accordingly, in the present study, an intervention was designed to treat mothers' anxiety and worry and daughters' internalized problems using paradoxical timetable therapy.
Research Questions
Does the paradoxical timetable affect mothers' anxiety and worry?
Does the paradoxical timetable affect girls' internalized problems?
Literature Review
Pardes et al. (2024) believe that exposure approaches are effective methods for the permanent treatment of stress, anxiety, and depression. One of the newest methods of exposure therapy is the Time Table + Paradox = PTC therapy, which is called paradox therapy for short. Paradox therapy has shown its effectiveness in the treatment of anxiety disorders such as death anxiety (Mardani et al., 2025), post-traumatic stress disorder (Asadiov et al., 2024), panic disorder (Najafi et al., 2024), body dysmorphic disorder in women (Mahboubi et al., 2024), social anxiety disorder (Beshart, 1398), illness anxiety (Beshart, 2019), obsessive-compulsive disorder (Ahmadi et al., 2020; Beshart, 2019), and in emotion regulation and perceived rejection (Ebrahimpour, 2024). The review goes under these subheadings.
Methodology
This research is an applied research and in terms of statistical method, it is a quantitative research of semi-experimental type with a pre-test-post-test design with a waiting list. The statistical population of the research was children with internalizing behavioral problems and their mothers were in Isfahan in 1404. Sampling was carried out purposively and students aged 7 to 9 years who had been referred to this center based on a psychiatric interview for internalizing behavioral problems and who met the inclusion criteria for the study were contacted through a counseling center in Isfahan. 30 students whose scores on the Achenbach Internalizing Behavior Problems Questionnaire were two standard deviations above the mean and who were willing to cooperate with their mothers were randomly assigned to two experimental groups and a waiting list, and the mothers in the experimental group received paradoxical timetable therapy. The inclusion criteria for the study included 1. having a child aged 7 to 9 years, 2. having a minimum education level of a high school diploma for mothers, 3. having a mother aged 30 to 40 years, 4. having a written consent form signed by the mother for the children to participate in the study, and 5. not being a single parent in the family (due to divorce or death of the spouse). The exclusion criteria also included 1. not being continuously present in the research project (absent more than two sessions), 2. using psychological services simultaneously, 3. receiving another psychiatric diagnosis within the past three years. The research instruments included the Anxiety and Worry Questionnaire for Mothers, and the Achenbach Behavioral Disorders Inventory (ASEBA).
Results
Table 1. Descriptive statistics of maternal anxiety, maternal worry and internalized problems in two groups
Variables
Experimental
Control
Test
N
M ± SD
M ± SD
maternal anxiety
Pre test
20
17.10 ± 2.22
17.85 ± 2.18
Post test
20
11.55 ± 2.08
18.15 ± 2.30
Follow up
20
12.65 ± 2.05
18.50 ± 2.16
maternal worry
Pre test
20
30.65 ± 3.86
30.95 ± 3.47
Post test
20
22.65 ± 3.78
32.15 ± 2.94
Follow up
20
21.30 ± 3.71
31.25 ± 3.40
internalized problems
Pre test
20
20.05 ± 1.90
19.65± 2.13
Post test
20
9.40 ± 1.18
20.05 ± 2.37
Follow up
20
10.35 ± 0.93
20.35 ± 2.00
Table 2. Repeated Measures ANOVA to Examine Within- and Between-Group Effects
variable
Source of Variation
Sum of Squares
df
Mean Square
F
P
Eta Squared
Anxiety
Time (Within-subject)
200.72
1
200.72
233.498
0.0001
0.860
Time × Group
130.05
1
130.05
420.587
0.0001
0.917
Group (Between-subject)
580.80
1
580.80
519.42
0.0001
0.528
Worry
Time (Within-subject)
231.20
1
231.20
126.230
0.0001
0.769
Time × Group
432.20
1
432.20
231.057
0.0001
0.859
Group (Between-subject)
1300.208
1
1300.208
37.062
0.0001
0.494
Internalizing Problems
Time (Within-subject)
405.00
1
405.00
216.152
0.0001
0.850
Time × Group
540.80
1
540.80
288.629
0.0001
0.884
Group (Between-subject)
1366.875
1
1366.875
227.099
0.0001
0.857
Discussion
The present study was conducted with the aim of investigating the effectiveness of the paradoxical time table on mothers' anxiety and worry, and children's internalized problems. The results of the study provided the necessary theoretical support for the paradoxical time table, based on which the paradoxical time table can reduce symptoms of anxiety and worry in mothers and also control children's internalized problems. The first finding of the study showed that the paradoxical timetable is effective in reducing mothers' anxiety and worry. In explaining this finding, the mechanisms of the paradoxical timetable's effectiveness can be mentioned. The artificialization of anxiety symptoms, and the experience of anxiety states prescribed by the therapist, with the help of the experience of reconstructing events, causes the person to have less anxiety about the subject of anxiety, despite the activation of worry, the principle of delayed onset, which causes the person to have less anxiety about the subject of anxiety. Another finding of the study showed that the paradoxical timetable is effective in reducing children's internalized problems. In explaining this finding, it can be said that mothers' worries and stresses are the factors that weaken the mother-child relationship, and as a result, create and perpetuate children's internalized problems (He et al., 2023). Given that in the present study, presenting a paradoxical timetable to mothers reduced their anxiety and worry, and this led to an improvement in the quality of mothers' relationships with their children (Shiralinia et al., 2019), ultimately, a reduction in internalized problems in children was expected.
Ethical Considerations
Adherence to Research Ethics Principles
This study has received the ethics code IR.UI.REC.1403.106 from the Ethics Committee of the University of Isfahan. The authors have observed all ethical principles in conducting and publishing this scientific research, and this is confirmed by all of them.
Author Contributions
First Author: Preparation of samples, conducting experiments and data collection, performing calculations, statistical analysis of data, analysis and interpretation of information and results, drafting the original manuscript, verification and validation of results, revision, review, and finalization of the manuscript.
Conflict of Interest
“The authors declare no conflict of interest.”
Funding
This article was conducted independently by the authors without any financial support.
Acknowledgements
We would like to express our gratitude and appreciation to all mothers and children who participated in this research.
Keywords
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