The effectiveness of acceptance and commitment therapy on distress tolerance and cognitive emotion regulation in women with generalized anxiety disorder

Document Type : Original Article

Authors

1 PhD student, Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran

2 Department of psychology, Sari Branch, Islamic Azad University, Sari, Iran

3 Assistant Professor, Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran

10.22034/aftj.2023.332930.1450

Abstract

Aim: The present study aims to investigate the effectiveness of treatment based on acceptance and commitment on distress tolerance and cognitive regulation of emotions in women with generalized anxiety disorder. Method: It was a semi-experimental type with a pre-test-post-test design with a control group (one experimental group and one control group) and a three-month follow-up. The statistical population of women with generalized anxiety disorder referred to counseling centers and health homes in districts 1, 2, 3 and 5 of Tehran in the first half of 2021. The sample consisted of 30 women with generalized anxiety disorder who were selected in a purposeful and accessible manner with the generalized anxiety test and having the entry criteria. to collect data from tools; "Distress Tolerance Scale", "Cognitive Emotion Regulation Questionnaire" and "Pervasive Anxiety Scale" were used. The experimental group received acceptance and commitment-based treatment intervention during two months in 8 90-minute sessions. Meanwhile, the group Evidence of this intervention was not received during the research process and a follow-up period was conducted after three months. The collected data were analyzed in SPSS.27 software. Results: The results showed that the treatment of acceptance and commitment was significantly tolerated. increased distress, adaptive strategies significantly increased cognitive regulation of emotion, and non-adaptive strategies significantly decreased cognitive regulation, and there was a significant difference in both variables between pre-test and post-test, as well as between pre-test and follow-up period. Conclusion: Treatment based on acceptance and commitment affects women with generalized anxiety disorder and improves distress tolerance and cognitive regulation of emotion in them. It is recommended to use treatment based on acceptance and commitment for women with generalized anxiety disorder.

Keywords


References
Alavi, K., Modares Gharavi, M., Amin Yazdi, S. A., & Salehi Faderdi, J. (1390). The effectiveness of dialectical group behavior therapy (based on the components of comprehensive awareness, distress tolerance and emotional regulation) on depression symptoms in students. Principles of Mental Health, 13, 2, pp. 124-135. (In Persian)
Allan, Nicholas P. Macatee, Richard J. Norr, Aaron M. Schmidt, Norman B. (2014). Direct and Interactive Effects of Distress Tolerance and Anxiety Sensitivity on Generalized Anxiety and Depression. Cognitive Therapy and Reserch; 38, 350-540.
American Psychiatric Association. (2013). DSM 5 diagnostic and statistical manual of mental disorders. In DSM 5 Diagnostic and statistical manual of mental disorders (pp. 947-p).
Barlow, D. H., Ellard, K. K., Sauer-Zavala, S., Bullis, J. R., & Carl, J. R. (2014). The origins of neuroticism. Perspectives on Psychological Science, 9(5), 481-496.
Basharat, M. A., & Bazazian, S. (2013). Examining the psychometric properties of the Cognitive Emotion Regulation Questionnaire in a sample of Iranian society. Journal of the Faculty of Nursing and Midwifery. 24 (84): 61-70. (In Persian)
Cai, W. P., Pan, Y., Zhang, S. M., Wei, C., Dong, W., & Deng, G. H. (2017). Relationship between cognitive emotion regulation, social support, resilience and acute stress responses in Chinese soldiers: Exploring multiple mediation model. Psychiatry research, 256, 71-78.
Conway, C. C., Naragon-Gainey, K., & Harris, M. T. (2021). The structure of distress tolerance and neighboring emotion regulation abilities. Assessment, 28(4), 1050-1064.
Davarnia, R. (2019). Comparing the effectiveness of group counseling with compassion-focused therapy (CFT) and acceptance and commitment-based therapy (ACT) on rumination, internalized shame, and distress tolerance in women affected by marital infidelity. PhD Thesis, Khwarazmi University, Faculty of Psychology.
Delavar, A. (2012). Theoretical and practical foundations of research in humanities and social sciences. Tehran: Roshd. (In Persian)
Ezazi Bojnurdi, E., Ghadampour, S., Moradi Shakib, A., & Ghazbanzadeh, R. (2020). Prediction of corona anxiety based on cognitive emotion regulation strategies, health stubbornness and death anxiety in diabetic patients. Journal of Psychiatric Nursing. 8 (2): 34-44. (In Persian)
Fayazbakhsh E, Mansouri A. (2019). Effectiveness of acceptance and commitment therapy on intolerance of uncertainty, experiential avoidance, and symptoms of generalized anxiety disorder in individuals with Type II diabetes. International Archives of Health Sciences. 6(1): 30-35. (In Persian)
Ganji, M. (2018). Psychopathology according to DSM-5 (Vol. I). Tehran: Savalan.
Garnefski, N., & Kraaij, V. (2006). Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific samples. Personality and Individual differences, 40(8), 1659-1669.
Greenberg, L. P. (2015). The flexibility of distress tolerance through a brief Acceptance and Commitment Therapy intervention: a pilot study (Doctoral dissertation).
Gross, J. J. (2014). Emotion regulation: Conceptual and empirical foundations In Gross JJ (Ed.), Handbook of emotion regulation (pp. 3–20). New York, NY: Guilford Press.[Google Scholar].
Hacker, T., Stone, P., & MacBeth, A. (2016). Acceptance and commitment therapy–do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. Journal of affective disorders, 190, 551-565.
Hacker, T., Stone, P., & MacBeth, A. (2016). Acceptance and commitment therapy–do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. Journal of affective disorders, 190, 551-565.
Hashemi, S. (2018). The effectiveness of group therapy based on acceptance and commitment on cognitive strategies of emotion regulation, resilience and psychological distress in adolescent siblings of individuals with autism. Master's thesis. University of Rehabilitation Sciences and Social Welfare. (In Persian)
Hassanzadeh, R. (2020). Psychology of life. Tehran: Virayesh. (In Persian)
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford press.
Joormann, J., & Gotlib, I. H. (2010). Emotion regulation in depression: Relation to cognitive inhibition. Cognition and Emotion, 24(2), 281-298.
Karimi, L. (2017). The effectiveness of acceptance and commitment therapy (ACT) on anxiety, depression and cognitive emotion regulation strategies of infertile women. Master's thesis. Shahid Bahonar University. (In Persian)
Katz D. Rector NA, Laposa, JM. (2017). The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder. Cognitive Behaviour Therapy. 46(6), 459-477. 
Keshavarzafshar, H., Rafei, Z., & Mirzaei, A. (2018). The effectiveness of commitment and acceptance therapy on generalized anxiety. The publication of the research institute of academic health sciences. 17 (3): 289-296. (In Persian)
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). " Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication": Erratum.
Laposa, J. M., Collimore, K. C., Hawley, L. L., & Rector, N. A. (2015). Distress tolerance in OCD and anxiety disorders, and its relationship with anxiety sensitivity and intolerance of uncertainty. Journal of anxiety disorders, 33, 8-14.
MacKillop, J., & De Wit, H. (Eds.). (2013). The Wiley-Blackwell handbook of addiction psychopharmacology. John Wiley & Sons.Zvolensky MJ, Bernstein A, Vujanovic AA. (Eds.). (2011). Distress tolerance: Theory, research, and clinical applications. Guilford Press
Mahmoud Alilo, M., Hashemi Nosrat Abad, T., & Sohrabi, F. (2016). The effectiveness of combined intervention based on acceptance and commitment therapy (ACT) along with coping techniques on symptom severity and dimensions of anxiety sensitivity in patients with generalized anxiety disorder (GAD). Journal of Clinical Psychology, 8, 3(31), pp. 61-76.
Maleki, B. (2021). The relationship between cognitive regulation of emotion and anxiety of corona disease in the elderly: the mediating role of distress tolerance. Journal of Psychology of Aging. 7 (4): 317-330.
Moqtadaei, M. (2016). The effectiveness of treatment based on acceptance and commitment on bearing distress in veterans' wives. The first National Congress of Community Empowerment in the field of Sociology, Educational Sciences and Social and Cultural Studies, Tehran, Community Cultural and Social Skills Empowerment Center.
Morshidi, M., Davarnia, R., Zahrakar, K., Mahmoudi, M. J., Shakarami, M. (2015). The effectiveness of therapy based on acceptance and commitment on reducing marital exhaustion of couples. Journal of nursing research. 10 (4): 76-87.
Naeenian, M. R., Shaeeri, M. R., Sharifi, M., & Hadian, M. (2009). Investigating the reliability and validity of the short scale of generalized anxiety disorder. Journal of Clinical Psychology and Personality. 3 (4): 41-50.
Noushkia, M., Rasouli, M., & Zare Bahramabadi, M. (2020). Effectiveness of group-based dialectical behavior therapy training on rumination and cognitive regulation of emotion in people with generalized anxiety disorder. Quarterly Journal of Excellence in Counseling and Psychotherapy, 9, Summer 99, pp. 69-83.
Omid, A., Tabatabai, A., Sazvar, S. A., & Akasheh, G. (2003). Epidemiology of mental disorders in urban areas in Natanz, Isfahan. Iranian Journal of Psychiatry and Clinical Psychology. 8 (4): 32-38.
Rasouli, A. (2017). The effectiveness of treatment based on acceptance and commitment on feelings of loneliness and forehead tolerance of married women. Master's thesis. Al-Zahra University.
Ruiz, F. J., Peña-Vargas, A., Ramírez, E. S., Suárez-Falcón, J. C., García-Martín, M. B., García-Beltrán, D. M.,... & Sánchez, P. D. (2020). Efficacy of a two-session repetitive negative thinking-focused acceptance and commitment therapy (ACT) protocol for depression and generalized anxiety disorder: A randomized waitlist control trial. Psychotherapy, 57(3), 444.
Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and emotion, 29(2), 83-102.
Slevison, M. (2013). Effectiveness of acceptance and commitment therapy for worry and rumination (Doctoral dissertation, RMIT University).
Smith, K. E., Mason, T. B., Anderson, N. L., & Lavender, J. M. (2019). Unpacking cognitive emotion regulation in eating disorder psychopathology: The differential relationships between rumination, thought suppression, and eating disorder symptoms among men and women. Eating behaviors, 32, 95-100.
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-1097.
Padyab Z, Fayazbakhsh H. The Effectiveness of Positivism with an Emphasis on Quranic Verses in Improving Distress Tolerance and Personal Growth of Mothers with Mentally-Retarded Children. Journal of Assessment and Research in Applied Counseling 2(3): 32-48
Terrill, A. L., Hartoonian, N., Beier, M., Salem, R., & Alschuler, K. (2015). The 7-item generalized anxiety disorder scale as a tool for measuring generalized anxiety in multiple sclerosis. International Journal of MS Care, 17(2), 49-56.
Thomas N, Shawyer F, Castle DJ, Copolov D, Hayes SC,  Farhall J. (2014). A randomised controlled trial of acceptance and commitment therapy (ACT) for psychosis: study protocol. BMC Psychiatry. 14(3): 198-213.
Varasteh Kalmers H. (2019). Comparison of the effectiveness of acceptance-based therapy and group cognitive-behavioral therapy on mental endurance and distress tolerance in patients with multiple sclerosis (MS) in Bandar Abbas. [Master Thesis], Bandar Abbas: Islamic Azad University, Faculty of Humanities.
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health, 17(5), 1729.