Integrative therapy linked to higher psychological hardiness in small nonrandomized study of Saudi adolescents

A small nonrandomized controlled study found that hard-of-hearing female adolescents who received an integrative therapeutic program had higher psychological hardiness scores after the intervention than participants who did not receive it. The study, reported in BMC Psychology, involved 25 hard-of-hearing girls in Al-Ahsa Governorate, Saudi Arabia, and its authors characterized the findings as preliminary evidence of the program’s potential value.

The study had two stages. In the first, researchers administered a newly developed Psychological Hardiness Scale to 69 deaf and hard-of-hearing female adolescents recruited from middle and secondary schools in Al-Ahsa. The participants’ mean hardiness score was 2.87, described as moderate. Scores differed significantly according to degree of hearing loss, educational level, type of hearing assistive device, preferred communication method, parents’ hearing status, and educational environment. The researchers-developed scale was used to characterize psychological hardiness and examine differences associated with these characteristics.

For the intervention stage, the researchers purposively selected 25 participants with relatively low hardiness scores who met the study’s eligibility criteria. Fifteen who agreed to receive the therapeutic program formed the intervention group, while 10 who did not receive the program but agreed to complete both assessments formed the control group. The intervention took place from January 15 through March 12, 2026. The authors reported a significant pre-to-post improvement in psychological hardiness among the intervention participants, with an r of .88, while the control group showed no change. After the intervention, the intervention group’s scores were higher than the control group’s scores; the reported comparisons were r = .83 and η² = 0.61.

Several features limit how confidently these results can be interpreted. The intervention comparison included only 25 participants, groups were formed through purposive selection rather than random assignment, and the groups differed in size. The study therefore supports an association between program participation and greater measured hardiness, rather than providing strong evidence of a causal treatment effect. The trial was also registered retrospectively on ClinicalTrials.gov on March 31, 2026, because registration had not been completed before the intervention began, although the authors stated that the protocol, eligibility criteria, procedures, outcome measures, and data collection methods had been established beforehand and were not changed because of the later registration.

Subject of Research: Evaluation of an integrative therapeutic program for psychological hardiness among hard-of-hearing female adolescents in Saudi Arabia

Article Title: The effectiveness of an integrative therapeutic program in enhancing psychological hardiness among hard-of-hearing female adolescents in Saudi Arabia

Article References: Alarfaj, R. A., & Albash, N. I. (2026). The effectiveness of an integrative therapeutic program in enhancing psychological hardiness among hard-of-hearing female adolescents in Saudi Arabia. BMC Psychology. https://doi.org/10.1186/s40359-026-05811-9

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05811-9

Keywords: psychological hardiness, hard-of-hearing adolescents, integrative therapy, Saudi Arabia, nonrandomized controlled study, pre-post assessment, deaf and hard-of-hearing youth, Al-Ahsa Governorate, effectiveness, integrative, therapeutic, program