Building Emotionally Resilient Communities: Implementing the "Hold Me Tight" Program to Enhance Mental Wellbeing of Families

Last registered on September 21, 2026
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Pre-Trial

Trial Information

General Information

Title
Building Emotionally Resilient Communities: Implementing the "Hold Me Tight" Program to Enhance Mental Wellbeing of Families
RCT ID
AEARCTR-0019719
Initial registration date
September 14, 2026

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
September 21, 2026, 9:21 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country
Pakistan
Region
Islamabad

Primary Investigator

Name
Amna Hassan
Affiliation
International Islamic University Islamabad
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Nazia Iqbal
PI Affiliation
International Islamic University Islamabad
Contact Investigator
PI Name
Saira Khalil
PI Affiliation
International Islamic University Islamabad
Contact Investigator

Additional Trial Information

Status
Completed
Start date
2025-06-16
End date
2026-01-08
Keywords
Behavior, Education, Welfare
Additional Keywords
Families, Emotional Resilience, Stronger Communities, Hold Me Tight Intervention Program
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
This study was conducted to evaluate the effectiveness of the Hold Me Tight® (HMT) program in addressing relationship difficulties associated with gaslighting and triangulation among Pakistani families. The intervention was based on Emotionally Focused Therapy (EFT; Johnson, 2019). It was culturally adapted through the integration of Islamic teachings and Shariah compliant mediation principles. This was done to enhance its relevance, acceptability, and applicability within the Pakistani sociocultural context.
Two parallel randomized controlled evaluations were conducted using independent samples. Study 1 examined married couples (N = 100 individuals, 50 dyads). Study 2 examined triangulation among adolescents (N = 300). In both studies, participants were randomly assigned to an experimental or control condition. The experimental condition received two 2 hour workshops delivering the Islamically integrated HMT Seven Conversations protocol for couples, or its adolescent and family adaptation, Hold Me Tight–Let Me Go® (HMT LMG). The control condition received two 2 hour general psychoeducational workshops, matched in contact time but without the HMT protocol or Islamic integration content. Equating the two conditions on session number and duration helped isolate the active therapeutic components of the HMT protocol from the non specific benefits of therapeutic attention and social contact (Kazdin, 2017; Shadish, Cook, & Campbell, 2002).
In the couples sample, a cross sectional dyadic Actor Partner Interdependence Mediation Model (APIMeM; N = 50 dyads) showed that both husbands' and wives' couple satisfaction significantly and positively predicted their own emotional intimacy (husbands, β = .75, p < .001; wives, β = .72, p < .001). Gaslighting did not significantly mediate this relationship for either partner. After the intervention, the experimental group (n = 50) showed significant improvements across all variables: couple satisfaction (M = 59.60 to 66.84, t(49) = 5.55, p < .001), emotional intimacy (M = 53.92 to 60.74, t(49) = 6.36, p < .001), and gaslighting (M = 66.74 to 23.04, t(49) = 10.07, p < .001). The control group (n = 50) showed no significant change on any variable (all p > .15). At post test, the experimental group scored significantly higher than the control group on all variables (all p < .001).
In the adolescent sample, triangulation was significantly and negatively associated with parental bonding, r(298) = .13, p = .026, and self esteem, r(298) = .15, p = .007. Parental bonding did not significantly mediate the relationship between triangulation and self esteem (indirect effect = .012, 95% CI [.026, .001]). After the intervention, the experimental group (n = 150) showed significant reductions in triangulation (M = 77.05 to 66.91, t(149) = 19.68, p < .001), and significant increases in parental bonding (M = 77.72 to 82.56, t(149) = 16.15, p < .001) and self esteem (M = 21.70 to 26.69, t(149) = 20.12, p < .001), with large effect sizes throughout (d = 1.32 to 1.64). The control group (n = 150) showed no meaningful change on any variable (all absolute d values ≤ 0.29). Groups were statistically equivalent at baseline (all p ≥ .125). At post test, the experimental group scored significantly better than the control group on triangulation and self esteem (both p < .001). Parental bonding did not differ significantly between groups at that time point.
Together, these findings provide controlled, Pakistan specific evidence that a culturally and Islamically integrated Hold Me Tight® program improves relational and psychological outcomes for both married couples and adolescents beyond the effect of general psychoeducation alone. These results support the central premise that Islamic integrated, EFT based psychoeducation is both an effective and a culturally acceptable intervention for Pakistani families.
Keywords: Hold Me Tight, Emotionally Focused Therapy, Islamic-integrated intervention, randomized controlled evaluation, couple satisfaction, gaslighting, emotional intimacy, triangulation, parental bonding, self-esteem, actor–partner interdependence model
External Link(s)

Registration Citation

Citation
Hassan, Amna, Nazia Iqbal and Saira Khalil. 2026. "Building Emotionally Resilient Communities: Implementing the "Hold Me Tight" Program to Enhance Mental Wellbeing of Families." AEA RCT Registry. September 21. https://doi.org/10.1257/rct.19719-1.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
The experimental condition in both studies delivered EFT based Hold Me Tight® (couples) or Hold Me Tight–Let Me Go® (adolescents) content integrated with Islamic teachings. This included Quranic guidance on marital and family relationships (Surah Ar Rum 30:21; Surah An Nisa 4:19), Hadith on marital harmony (Sunan Abi Dawood 3544), and the Shariah compliant mediation principles of Tahkim, Wasatah, and Maslaha. The content was delivered through interactive lectures, guided discussion, reflective exercises drawn from the Hold Me Tight® Participant Workbook, and experiential activities. The control condition delivered general psychoeducational content on family relationships and communication. This was matched to the experimental condition in terms of structure, but it omitted the HMT protocol and the Islamic integration content. As a result, any between group difference in outcomes can be attributed to the specific content of the HMT protocols rather than to the non specific benefits of participating in a structured group activity (Kazdin, 2017).
Ethical approval and informed consent were obtained prior to data collection. The participant and guardian consent documentation and institutional ethics reference number are appended to the full project file.
Intervention (Hidden)
For the couples sample, cross-sectional relationships among couple satisfaction, gaslighting, and emotional intimacy were modeled using a distinguishable-dyad Actor–Partner Interdependence Mediation Model (APIMeM), with couple satisfaction specified as the predictor, gaslighting as the mediator, and emotional intimacy as the outcome, fit in R using the lavaan package (Rosseel, 2012).
For the adolescent sample, cross-sectional relationships among triangulation, parental bonding, and self-esteem were examined using Pearson correlations, multiple linear regression, and mediation analysis (Hayes' PROCESS macro, Model 4; Hayes, 2022), followed by t-tests.
For both intervention evaluations, paired-samples t-tests compared pre- to post-intervention scores within the experimental and control groups.
Intervention Start Date
2025-09-10
Intervention End Date
2026-01-08

Primary Outcomes

Primary Outcomes (end points)
Levels of Couple satisfaction
Levels of gaslighting - Mediator
Self esteem
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Design
Both studies used a randomized, controlled pretest posttest design. Participants in each study were randomly assigned to an experimental condition or a control condition. The experimental condition received workshops based on the culturally and Islamically integrated Hold Me Tight® protocol (Study 1, couples) or its adolescent and family adaptation, Hold Me Tight–Let Me Go® (Study 2, adolescents). The control condition received general psychoeducational workshops on family relationships that did not include the HMT protocol or the Islamic integration content. All participants completed the study measures immediately before and immediately after the sessions (posttest).
5.2 Study-1 Married Couples
Married couples (N = 50 dyads, 100 individuals) were recruited through purposive sampling and randomly assigned to the experimental (n = 50 individuals, 25 couples) or control (n = 50 individuals, 25 couples) condition. All participants completed the Couple Satisfaction Index (16 items; Funk & Rogge, 2007), the Gaslighting Scale (20 items; Stern, 2007), and the Emotional Intimacy Scale (14 items; Eukie, 2022) at both time points. Since both members of each couple were sampled, husbands' and wives' scores are statistically non independent. The cross sectional relationships among these variables were therefore modeled dyadically (Section 5.4). The pre post intervention evaluation, however, treated individuals as the unit of analysis, consistent with the paired and independent samples comparisons
5.3 Study-2 Adolescents
Adolescents (N = 300; 150 boys, 150 girls; aged 13 to 19 years) were recruited from public and private educational institutions and randomly assigned to the experimental (n = 150) or control (n = 150) condition. All participants completed the Triangulation Scale (27 items; Riaz & Iqbal, 2023), the Parental Bonding Instrument (25 items; Parker et al., 1979), and the Rosenberg Self Esteem Scale (10 items; Rosenberg, 1965) at both time points
5.4 Intervention
The experimental condition in both studies delivered EFT based Hold Me Tight® (couples) or Hold Me Tight–Let Me Go® (adolescents) content integrated with Islamic teachings. This included Quranic guidance on marital and family relationships (Surah Ar Rum 30:21; Surah An Nisa 4:19), Hadith on marital harmony (Sunan Abi Dawood 3544), and the Shariah compliant mediation principles of Tahkim, Wasatah, and Maslaha. The content was delivered through interactive lectures, guided discussion, reflective exercises drawn from the Hold Me Tight® Participant Workbook, and experiential activities. The control condition delivered general psychoeducational content on family relationships and communication. This was matched to the experimental condition in terms of structure, but it omitted the HMT protocol and the Islamic integration content. As a result, any between group difference in outcomes can be attributed to the specific content of the HMT protocols rather than to the non specific benefits of participating in a structured group activity (Kazdin, 2017).
Experimental Design Details
Randomization Method
randomization done in office by a computer
Randomization Unit
couple randomization for 1st part of study
individual randomization for 2nd part
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
100 couples
300 adolescents
Sample size: planned number of observations
400
Sample size (or number of clusters) by treatment arms
50 couples in controlled, 50 couples in Experimental, 150 adolescents in controlled, 150 adolescents in experimental
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials