impact of reality therapy on alexithymia and social cognition in adolescents with blood coagulation disorders: a two-phase follow-up study

Introduction: alexithymia is a personality trait involving difficulty in identifying and expressing emotions, which can impair emotional regulation. adolescents with blood coagulation disorders may experience alexithymia due to the psychological burden of their chronic medical condition, impacting their emotional well-being and social functioning. this study aimed to evaluate the effectiveness of reality therapy on alexithymia and social cognition among adolescents diagnosed with blood coagulation disorders.method: conducted in two phases, the research first developed and validated an educational package based on reality therapy principles. in the second phase, a semi-experimental design with pre-test, post-test, and a three-month follow-up was implemented. a total of 32 adolescents aged 13–18 with hemostatic disorders, registered at the iranian hemophilia society in tehran, were selected through convenience sampling and randomly assigned to experimental and control groups. the intervention comprised eight weekly 90-minute group sessions based on reality therapy principles, including the wdep system, with active parent involvement to support adolescents' emotional and behavioral development. the data collection tools included the toronto alexithymia scale (tas-20) and the student social cognition questionnaire (shad). data were analyzed using spss version 25, employing descriptive statistics and repeated measures anova for pre-test, post-test, and follow-up comparisons.results: the intervention group showed significant reductions in total alexithymia scores and its subscales: difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking (f = 27.45, p < 0.001, η² = 0.48). additionally, improvements were observed in social cognition, including self-awareness and recognition of educational threats, sustained through the three-month follow-up period.conclusion: enhancements were also observed in social cognition, including self-awareness and recognition of educational threats. these improvements remained stable at the three-month follow-up, suggesting that reality therapy has a lasting positive effect on emotional processing and social understanding in this population.