¹ PhD Candidate, Faculty of Psychology, University of Tehran, Tehran, Iran
² Associate Professor, Faculty of Psychology, University of Tehran, Tehran, Iran *(Corresponding Author)*
³ Associate Professor, Department of Research and Evaluation, University of Tehran, Tehran, Iran
⁴ Assistant Professor, Faculty of Educational Sciences and Psychology, Shahid Beheshti University, Tehran, Iran
Corresponding author email: keshavarz1979@ut.ac.ir
Abstract
This study aims to analyze the process of insight development in Afghan refugee women with post-traumatic stress disorder (PTSD) undergoing Eye Movement Desensitization and Reprocessing (EMDR) therapy, using Charmaz’s constructivist grounded theory approach. Data were collected through semi-structured interviews with 11 participants and analyzed using constant comparative methods, including initial and focused coding. Findings revealed that the process of insight development emerged through six phases: becoming aware, becoming sensitive, becoming engaged, becoming active, awakening, and gaining insight. These stages were ultimately consolidated into three core categories—sensitization, activation, and insight realization—which collectively formed the conceptual framework of 'insight development process'.
This process interacted with various subcomponents:
- In the sensitization phase: questioning and reflection, and changes in appearance;
- In the activation phase: doubt in initial beliefs, help-seeking, and emergence of new beliefs;
- In the insight realization phase: emotional relief, reduction in psychosomatic symptoms, increased responsibility, emotional-cognitive balance, life satisfaction, socialization, assertiveness, learning, and adaptive responses to stressors.
Participants described transformations in beliefs, emotional patterns, interpersonal relationships, and overall life perspective. Sudden moments of realization (AHA phases) frequently occurred during EMDR sessions following bilateral stimulation and emotional trauma processing. The final outcome was a process model illustrating the progression from cognitive collapse to reconstruction of life meaning and metacognitive growth through the EMDR framework.
Keywords
Insight, PTSD, Trauma, EMDR, Grounded Theory
Introduction
Insight has long been considered one of the fundamental mechanisms of change in psychotherapy, especially in trauma-related disorders. Despite its centrality in psychoanalysis and cognitive-behavioral therapy, the concept remains multifaceted and ambiguous. Afghan refugee women represent a population highly affected by repeated exposure to war, forced migration, and systemic pressures, resulting in severe psychological issues such as PTSD. However, little research has explored cognitive transformations and insight processes within this group, particularly in the context of EMDR therapy.
This study seeks to fill this gap by explaining the process of insight development in Afghan women diagnosed with PTSD within the EMDR therapeutic framework, using Charmaz’s constructivist grounded theory. The goal is to present a processual and conceptual model of gradual, emotionally aware insight, grounded in the participants’ lived experiences.
Methodology
This fully qualitative research employed Charmaz’s constructivist grounded theory. The study sample consisted of 11 Afghan refugee women residing in Mashhad, Iran, all diagnosed with PTSD. Participants were selected via purposive and theoretical sampling. Data were collected using semi-structured interviews, which were recorded, transcribed, and analyzed using MAXQDA software.
Data analysis followed the stages of line-by-line initial coding, focused coding, and analytical memo writing. Codes emerged inductively through constant interaction between data and concepts. Ethical considerations including informed consent and confidentiality were strictly observed.
Findings
The process of insight development consisted of six sequential stages:
1. Becoming aware
2. Becoming sensitive
3. Becoming engaged
4. Becoming active
5. Awakening
6. Gaining insight
These phases were conceptually condensed into three core categories:
- Sensitization (with elements like questioning and self-reflection, and observable physical/behavioral changes)
- Activation (characterized by doubt in initial appraisals, help-seeking behavior, and formation of new beliefs)
- Insight Realization (marked by emotional relief, reduced psychosomatic symptoms, responsibility-taking, emotional-cognitive balance, life satisfaction, increased socialization, assertiveness, learning, and adaptive responses to stress)
Participants reported significant transformations in beliefs, emotional patterns, interpersonal interactions, and their overall perception of life. AHA moments of sudden realization were frequently observed during EMDR sessions, particularly following bilateral stimulation and emotional processing of traumatic memories.
Discussion and Conclusion
The findings indicate that EMDR can effectively facilitate the development of insight in traumatized individuals. This transformation is not instantaneous but unfolds gradually within emotional, cognitive, and social dimensions. The resulting theoretical model depicts a progression from cognitive disintegration to reconstruction of meaning and metacognitive growth within the EMDR framework.
These results are in line with neurocognitive theories of insight and emphasize EMDR’s potential in fostering cognitive-emotional transformation within culturally specific contexts. Clinicians are encouraged to integrate insight-oriented techniques into EMDR sessions, promoting metacognitive awareness and emotional integration.
Limitations and Recommendations
The study’s generalizability is limited by the small, specific sample—Afghan refugee women in Mashhad, Iran. Future research is recommended on more diverse populations, including other genders and cultural groups. Longitudinal studies are also needed to explore the long-term stability of insight gained through EMDR. Therapists should pay special attention to insight-related processes in EMDR sessions and apply strategies that foster awareness, emotional regulation, and integration.