Effectiveness of Integrative Therapy on Psychological Hardiness Among Hard-of-Hearing Female Students

King Faisal University25 enrolled

Overview

The goal of this clinical trial (quasi-experimental study) is to learn whether an integrative therapeutic program can enhance psychological hardiness among hard-of-hearing (HOH) female students in Saudi Arabia (Al-Ahsa Governorate). The main questions it aims to answer are: 1. What is the level of psychological hardiness among DHH female students in the Kingdom of Saudi Arabia? 2. Are there statistically significant differences in the level of psychological hardiness among DHH female students attributable to the study variables (degree of hearing loss, grade level, hearing assistive device, communication method used, parents' hearing status, and type of educational environment attended)? 3. Are there statistically significant differences at the level of (α = 0.05) between the mean scores of the experimental group on the psychological hardiness scale in the pre- and post-measurements? 4. Are there statistically significant differences at the level of (α = 0.05) between the mean scores of the experimental and control groups on the post-measurement of the psychological hardiness scale? Researchers will compare students who participate in the integrative therapeutic program (experimental group) with those who do not (control group) to see if the program leads to improved psychological hardiness. Participants will: Complete a psychological hardiness scale before and after the program Participate in the integrative therapeutic training sessions (experimental group only) Continue their regular educational activities without intervention (control group)

This study was conducted to evaluate the effectiveness of an integrative therapeutic program in enhancing psychological hardiness among hard-of-hearing (HOH) female students in inclusive educational settings in Al-Ahsa Governorate, Kingdom of Saudi Arabia. HOH students often face multiple psychological and social challenges that may negatively affect their adaptive functioning and overall well-being. Therefore, this study aimed to provide an evidence-based intervention to strengthen psychological resilience and improve coping capacities within this population. A quasi-experimental design with a non-randomized experimental and control group structure was adopted. The study initially involved a broader sample of 69 deaf and hard-of-hearing (DHH) female students. All participants were assessed using a Psychological Hardiness Scale developed and validated by the researchers. Based on (pre-test) results, a purposive sample of 25 HOH students who demonstrated relatively low levels of psychological hardiness was selected to participate in the intervention phase. The selected participants were divided into two groups: an experimental group (n = 15), which received the integrative therapeutic program, and a control group (n = 10), which did not receive any intervention during the study period. The intervention program was designed to enhance key dimensions of psychological hardiness, including commitment, control, and challenge, through structured therapeutic activities and training sessions tailored to the communication abilities and learning needs of HOH students. All participants underwent pre-test and post-test assessments using the same psychological hardiness scale. The primary outcome measure was the change in psychological hardiness scores between pre-test and post-test evaluations. The effectiveness of the intervention was determined by comparing within-group changes (pre- vs. post-test) and between-group differences (experimental vs. control group). The higher the student's score on the scale, the greater the improvement in her level of psychological hardiness. The independent variable in this study was the integrative therapeutic program, while the dependent variable was psychological hardiness. Although the study design aimed to control for confounding variables, several external factors may have influenced the outcomes, including parental support, teacher preparedness, peer interactions, and the broader educational and social environment. The findings demonstrated statistically significant improvements in psychological hardiness among participants in the experimental group compared to the control group, indicating the effectiveness of the implemented program. These results support the integration of structured therapeutic interventions within educational support services for HOH students to enhance their psychological well-being and quality of life.

Interventions

Integrative Therapeutic ProgramOTHER

The therapeutic program was developed based on the integrative therapy approach, which involves combining techniques and strategies derived from multiple therapeutic schools in accordance with the characteristics of the target population, without adhering to a single theoretical framework. The integrative approach draws on contemporary integrative perspectives that emphasize flexibility in intervention according to the needs of beneficiaries. The program was also grounded in the psychological hardiness theory developed by Suzanne Kobasa, which conceptualizes hardiness through three dimensions: commitment, control, and challenge. In addition, the program incorporated techniques drawn from several therapeutic approaches, including: (Cognitive Behavioral Therapy (CBT), Rational Emotive Behavioral Therapy (REBT), Mindfulness-Based Therapy, Group Therapy, Gratitude Therapy, Reality Therapy, Supportive spiritual techniques)

Eligibility

Sex: FEMALEMin age: 13 YearsMax age: 19 Years

Medical Language ↔ Plain English

After administering the scale, a purposive sample of 25 HOH female students was selected to participate in the intervention program. These participants were divided into two groups: 15 students in the experimental group and 10 students in the control group. This selection was determined due to the sensitivity of the research topic and the practical difficulty of conducting the intervention with the entire target population. Eligibility Criteria Inclusion Criteria: 1. Female students with hearing impairment (Hard of Hearing, HOH) 2. Enrollment in inclusive schools in Al-Ahsa Governorate, Saudi Arabia 3. Within the targeted educational stage of the study 4. Low scores on the Psychological Hardiness Scale at (pre-test) 5. Ability to participate in and complete the intervention program 6. Provision of informed consent Exclusion Criteria: 1. Failure to provide informed consent 2. Incomplete participation in (pre-test) or post-intervention (post-test) assessments 3. Diagnosis of profound deafness that limits effective communication required for the intervention 4. Male students (excluded due to logistical and cultural constraints related to intervention delivery)

Outcomes

Primary Outcomes

Psychological Hardiness Scale for deaf and hard of hearing

The final version of the Psychological Hardiness Scale consisted of two sections. The first section included demographic items related to: (degree of hearing loss, grade level, type of hearing assistive device, preferred communication method, parents' hearing status, type of educational environment attended). The second section, which constitutes the main scale, consisted of 24 items distributed across three dimensions: commitment, control, and challenge. Each item was rated using a four-point Likert scale: (1 = Never, 2 = Rarely, 3 = Often, 4 = Always). Minimum value 1 Maximum value 4 Therefore, a student who scores higher on the scale will have a higher degree of psychological resilience.

Time frame: 8 weeks

Change in Psychological Hardiness Scores

This outcome measures the change in psychological hardiness among hard-of-hearing female students using a validated psychological hardiness scale developed by the researchers. The assessment evaluates key dimensions such as commitment, control, and challenge before and after the intervention. Accordingly, the higher the student's score on the psychological resilience scale between the pre-test and post-test, the more effective the implemented program is considered to be.