Introduction
Somatic symptom disorder results in significant disruption of daily life. Emotion-focused therapy has been used as an important protocol in the treatment of somatic symptoms. The aim of the present study was to investigate the effectiveness of emotion-focused therapy on patterns of emotional processing and differentiation of self in female heads of household with somatic symptoms in Isfahan. Women who bear full responsibility for their own lives are referred to as heads of household in society. In the current era, the phenomenon of female heads of household has increased worldwide. They are among the most vulnerable social groups, facing numerous challenges in their personal, family, and social lives, and they are at increased risk for mental disorders and physical problems. Somatic symptom disorder is characterized by one or more chronic somatic symptoms (e.g., chronic bodily or head pain, abdominal symptoms, fatigue) that cause significant distress or result in significant disruption of daily life, as indicated by disproportionate and dysfunctional cognitive, emotional, and behavioral responses. Emotion processing in people with somatic symptoms is impaired and also undifferentiated individuals experience chronic high anxiety and are prone to psychological problems and symptoms of illness. They react to internal or external stressors with intense and irrational emotional activation and show limited ability to think and act independently, this function, in turn, leads to an exacerbation of psychosomatic symptoms.

Method
The method of this research was a quasi-experimental design with pretest-posttest and a control group. A purposive sampling method was used. Accordingly, from the statistical population of this study, which included all female heads of household with somatic symptoms aged 33 to 61, living in Isfahan city and its suburbs and covered by the Imam Khomeini Relief Committee (Region 2 and Region 5) and the Rah-e Zendegi (White Rose) Clinic of the Imam Khomeini Relief Committee in Isfahan from 2023 to 2024, 36 individuals were selected based on the inclusion and exclusion criteria and randomly assigned to experimental and control groups. The instruments used in this study were the Somatic Symptom Disorder- B Criteria Scale (SSD-12), the Emotional Processing Scale, and the Skowron and Schmitt (2003) Differentiation of Self Inventory. The data were analyzed using analysis of covariance with SPSS software version 23.
Results
The results of the data analysis showed that emotion-focused therapy led to the reduction of somatic symptoms (0.48) and components of somatic symptoms (cognitive (0.15), emotional (0.39) and behavioral (0.39)), as well as a reduction in emotion processing patterns (0.77) and its components ((suppression (0.30), unpleasant emotional experience (0.62), unprocessed emotional symptoms (0.35), avoidance (0.16) and emotional control (0.12)) in female heads of household with somatic symptoms. The results of the data analysis also showed that emotion-focused therapy increased differentiation of self (0.50) and its components (emotional reactivity (0.36), I-position (0.20), emotional cut off (0.18) and fusion with others (0.29)) in the experimental group at the post-test stage, and these changes were statistically significant (p < 0.05).
Discussion
According to the results, this method can be used as an interventional and therapeutic approach to reduce somatic symptoms and their components (cognitive, emotional, and behavioral), to reduce emotion processing patterns and their components (suppression, unpleasant emotional experience, unprocessed emotional symptoms, avoidance, and emotional control), and to increase differentiation of self and its components (emotional reactivity, I-position, emotional cut off, and fusion with others) in female heads of household with somatic symptoms. Due to the positive results of this research, this treatment can be used for patients with somatic symptoms in health centers, counseling and psychological and therapeutic clinics, and by the consultants in the Imam Khomeini Relief Committee, as well as by researchers in research centers and universities. The main techniques and concepts of this therapy can also be presented in the form of educational activities and workshops for individuals under the title of emotion-focused group therapy. It is recommended that these clients be referred by physicians to psychologists and psychiatrists, and that treatment be provided by the relevant specialist in order to resolve the psychological problems of these individuals with somatic symptoms.