An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study (Preprint)

A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy

The last three decades have witnessed significant advances in psychotherapy. Numerous scholarly articles and books have been devoted to pertinent topics in the field, making it difficult for the practicing clinician to keep up with this rapidly growing area. The purpose of this article is to provide some guidelines on how to evaluate the empirical literature in psychotherapy and then to explore three key areas: evidence-based psychotherapies for patients with psychiatric disorders, individual variables that predict differential outcome to treatment, and the therapeutic alliance. Finally, two case examples will be presented to illustrate how knowledge of the empirical literature can facilitate an evidence-based approach to the daily practice of psychotherapy in general psychiatry.

A structural equation model of intuitive eating with adolescents

Background: Mammography screening tends to reduce mortality rate through early detection. One of the barriers to mammography screening is fear of negative appearance evaluation(FNAE). This study investigated the impact of internal health locus of control, breast cancer worries and age on the relationship between FNAE and attitude towards mammography. Methods: A cross-sectional, questionnaire-based survey design was used. Samples were Iranian women, living in Iran, aged at least 30 years old, without any history of cancer, and had not performed mammography previously based on self-report. In total, 823 samples were collected through conducting an online survey from April to June 2016. The questionnaire consisted of several instruments including attitude toward breast cancer screening procedures scale, FNAEscale, the internal dimension of the multidimensional health locus of control, and two items to measure breast cancer worry. Using covariance-based structural equation modeling the model was tested. Results: The interaction of FNAE with internal health locus of control (β = -0.128, P<0.05,CI: -0.200, -0.056), breast cancer worry (β = 0.090, P<0.05, CI: -0.162, -0.017), and age (β =-0.095, P<0.05, CI = -0.163, -0.026) was significant. The three tested moderators dampened the positive relationship between FNAE and negative attitude towards mammography. Conclusion: More information about the screening procedure should be given to women to overcome their fear. The findings indicate the need for interventions seeking to shift women’s health locus of control from external to internal. Women with low level of cancer worry need more attention.

Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

Acceptance and Commitment Therapy (ACT) is part of the third wave of cognitive behavior therapy, and has six core components: acceptance, cognitive defusion, self as context, being present, values, and committed behavior. This study aimed to examine the efficacy of ACT for insomnia compared with cognitive behavior therapy for insomnia (CBT-I) in patients with chronic primary insomnia. The study recruited patients with chronic primary insomnia from a university hospital between August 2020 and July 2021. Thirty patients were enrolled and randomly assigned to receive either ACT (n = 15) or CBT-I (n = 15). Interventions were performed over four weeks, with four sessions of face-to-face therapy and four sessions of online therapy. The outcomes were measured using a sleep diary and a questionnaire. Post-intervention, the ACT and CBT-I groups had significantly improved sleep quality, insomnia severity, depression, beliefs about sleep, sleep onset latency (SOL), and sleep efficacy (SE) (p < 0.05). However, anxiety was significantly reduced in the ACT group (p = 0.015), but not in the CBT-I group. ACT had a significant effect on primary insomnia and secondary symptoms, especially anxiety related to insomnia. These findings suggest that ACT could be a potential intervention for individuals who do not respond to CBT-I, who have high anxiety regarding sleep problems.

Objectives To determine the effects of Acceptance and Commitment Therapy (ACT) among informal caregivers of people with dementia (PwD) on anxiety, depression, and process measures and identify the optimal characteristics of effective interventions. Method Ten electronic databases were searched from the inception of the databases to 5 April 2025. Studies were included if they used a randomized controlled trial (RCT) or quasi-experimental design to assess the effect of ACT on informal caregivers of PwD. Two researchers independently screened eligible studies. The risk of bias was assessed by the Cochrane’s and the Joanna Briggs Institute’s tool. Results Thirteen studies (six RCTs and seven quasi-experimental studies) were included in this review. Results showed that ACT modified anxiety, depression, and experiential avoidance in informal caregivers of PwD. Subgroup analyses indicated that ACT interventions lasting 8 wk, lasting >60 min per session, and implementing four or five processes were more effective in reducing anxiety and depression. Conclusion ACT may be effective in reducing anxiety, depression, and experiential avoidance in informal caregivers of PwD. Future researchers are encouraged to further explore how ACT processes affect anxiety and depression to more effectively implement ACT for informal caregivers of PwD.

Objective: This study aimed to investigate the concurrent relationships between weight self-stigma and disordered eating behaviors, mediated by weight- and body-related shame and guilt, fear of negative appearance evaluation, and eating self-efficacy, among women with overweight and obesity. Materials and Methods: This study was a cross-sectional study. The sample consisted of 228 Iranian women, aged 18-70 years, with overweight and obesity (BMI≥ 25), who were purposively selected. Participants responded to online demographic questions and research measurement tools (Dutch Eating Behavior Questionnaire, Weight Self-Stigma Questionnaire, Weight- and Body-Related Shame and Guilt Scale, Weight Efficacy Lifestyle-Short Form, Fear of Negative Appearance Evaluation Scale). Statistical methods of descriptive statistics, Pearson correlation matrix, structural equation modeling and bootstrapping mediation analysis were used to analyze the data, through SPSS 23 and AMOS 23. Results: The results showed that weight self-stigma had significant paths to all research variables in a structural model (P&lt; 0.05). Furthermore, mediation analysis showed that eating self-efficacy mediated the relationships between weight self-stigma and emotional (P&lt; 0.001), external (P&lt; 0.001), and restrained eating behaviors (P&lt; 0.002). Additionally, weight and body-related guilt mediated the relationship between weight self-stigma and restrained eating behavior (P&lt; 0.001). Totally, the research model explained 14.9% of the variance of emotional and external eating behaviors, and 36.2% of the variance of restrained eating behavior. Conclusion: The findings highlight the importance of considering weight self-stigma in obesity research. Additionally, improving eating self-efficacy and addressing guilt through psychological interventions are crucial for managing eating behaviors in this population.

IntroductionMedical school is known for high levels of anxiety, and mental health challenges. Psychological flexibility - the ability to accept difficult thoughts and emotions while acting in alignment with one’s values- can protect against these challenges. ACT has been shown to enhance psychological flexibility and reduce mental health symptoms in various populations. However, its impact on medical students has not been extensively explored.ObjectivesThis study aimed to assess whether a brief ACT intervention could improve psychological flexibility and related psychological outcomes in medical students.MethodsForty-two medical students from Istanbul Medeniyet University participated in a four-day ACT program. Inclusion criteria included active enrollment in a medical program and willingness to participate. Exclusion criteria were severe psychiatric disorders or ongoing psychiatric treatment.The intervention involved four days of ACT-based activities, including mindfulness, cognitive defusion, and value-based exercises. Each session lasted 90 minutes and was conducted in a group format. To assess the impact of the intervention, we measured psychological flexibility and related factors at baseline and after the program using the following tools: the Multidimensional Experiential Avoidance Questionnaire (MEAQ-30), AAQ-US, SF-25, Valuing Questionnaire (VQ) and the DASS-21. Paired t-tests were used to compare pre- and post-intervention scores, with statistical significance set at p < 0.05.ResultsThe ACT intervention led to significant improvements in psychological flexibility and related factors. The ACT intervention led to significant improvements in psychological flexibility and related factors. Specifically, Distress Aversion (MEAQ-30, subscale B) decreased significantly (p = 0.010), while Distress Endurance (MEAQ-30, subscale F) increased significantly (p = 0.008). Additionally, Anxiety (DASS-A) decreased significantly (p = 0.004), and Stress (DASS-S) also decreased significantly (p = 0.004). No significant changes were observed in other subscale scores, including those for SF-36, depression (DASS-D), and scores for AAQ-US and VQ. These results suggest that ACT may be particularly effective in reducing anxiety and stress while enhancing cognitive flexibility and acceptance.ConclusionsThis study suggests that even a brief, four-day ACT intervention can significantly improve psychological flexibility and reduce anxiety and stress in medical students. These findings highlight ACT’s potential as an effective tool for supporting mental health and resilience in medical students. Further research with larger sample sizes and longer follow-up periods is needed to explore the long-term impact of ACT interventions in academic settings.Disclosure of InterestNone Declared

Body talk on social networking sites and restrained eating among adolescents: A test of a multiple mediation model

The role of the acceptance and commitment therapy in the treatment of social anxiety: An updated scoping review

Hoarding is a common problem behavior worldwide and is detrimental to the physical and mental health of individuals and groups. Currently, effective interventions for hoarding are cognitive-behavioral therapies, but their post-intervention efficacy is questionable, and the available research does not examine the mediating variables of the effects of interventions on clinical outcomes. Moreover, current research on hoarding has focused on Western countries. Therefore, there is a need to investigate the efficacy of other forms of cognitive behavioral therapy on hoarding as well as other psychological outcomes related to hoarding and mediating variables that contribute to its effectiveness in different cultural contexts. One hundred thirty-nine college students with higher hoarding behaviors were randomly divided into three groups: 45 in the Acceptance and Commitment Therapy (ACT) group, 47 in the Rational Emotive Behavior Therapy (REBT) group, and 47 in the control group. They completed the Saving Inventory-Revised (SI-R), Obsessive-Compulsive Symptom Scale (OCSS), Difficulties in Emotion Regulation Scale (DERS), Experiences in Close Relationships Inventory-Attachment Anxiety Subscale (ECR), Depression Anxiety Stress Scales (DASS-21), Acceptance and Action Questionnaire II (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) before and immediately after the intervention. The results showed that ACT and REBT improved individuals' psychological flexibility, cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation compared to the control group. In addition, ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder; there were no significant differences between the two in anxiety and emotion regulation difficulties. Furthermore, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding, negative affect, attachment anxiety). Limitations were discussed.

Objective: The present study aimed to determine the effectiveness of Acceptance and Commitment Therapy (ACT) on cognitive emotion regulation and experiential avoidance in individuals with leprosy in Tabriz. Methods and Materials: The research method was a quasi-experimental design with a pretest-posttest control group. The study population consisted of all individuals with leprosy in Tabriz in 2023. After a clinical interview and considering the inclusion and exclusion criteria, 32 participants were selected through convenience sampling and randomly assigned to experimental (n=16) and control (n=16) groups. Both groups were assessed using the Cognitive Emotion Regulation Questionnaire (Garnefski et al., 2002) and the Acceptance and Action Questionnaire (Bond et al., 2011). The experimental group received eight sessions of ACT over two months, with one 90-minute group therapy session per week. At the end of the treatment, both groups completed the cognitive emotion regulation and experiential avoidance questionnaires again. The data were analyzed using multivariate covariance analysis. Findings: The results of the data analysis showed a significant difference between the experimental and control groups in terms of cognitive emotion regulation and experiential avoidance in individuals with leprosy (P&lt;0.01). After the intervention, the level of maladaptive emotion regulation and experiential avoidance in the experimental group significantly decreased compared to the pretest and control group, while adaptive emotion regulation in the experimental group significantly increased compared to the pretest and control group, leading to significant changes in cognitive emotion regulation and experiential avoidance. Conclusion: Therefore, the findings suggest that ACT affects cognitive emotion regulation and experiential avoidance in individuals with leprosy. The results of this study highlight some of the capabilities of this method in treating cognitive emotion regulation and experiential avoidance, demonstrating its potential as an effective therapy for individuals with leprosy.

Background and Aim: Children's hearing loss affects not only their speech and language dev­elopment but also their mothers’ mental health. This study aimed to determine the effect of acc­eptance and commitment therapy (ACT) on the intolerance of uncertainty and experiential avoi­dance of mothers with hearing-impaired or deaf children. Methods: This is a quasi-experimental study with the pretest-posttest design with a control group. The study population comprised all mot­hers of hearing-impaired or deaf children (2−6 years old) in Tabriz City, Iran. Using a purpo­sive sampling method, 32 mothers of hearing-impaired or deaf children were selected and then randomly assigned to control and experimental groups (each group, 16 subjects). The experim­ental group was treated with ACT in 8 sessions of 1.5 hours long in two weeks. The study data were collected by the Acceptance and Action Questionnaire-II (AAQ-II) and Intolerance of Uncertainty Scale (IUS). Results: The results showed that ACT signi­ficantly increased scores on the AAQ-II and IUS in the experimental group compared to the control group (p &lt; 0.001). Conclusion: ACT might be an efficient way to decrease intolerance of uncertainty and avoid­ance of experience in the mothers of hearing-impaired and deaf children. Also, therapists can use this approach for improving the intolerance of uncertainty and experiential avoidance in mothers of hearing-impaired or deaf children in rehabilitation centers.

SummaryObjectiveThe current study tested the efficacy of an acceptance and commitment therapy (ACT) group intervention for disinhibited eating behaviour as an adjunct to the Veterans Affairs MOVE!© weight management programme.MethodsVeterans (N = 88) with overweight or obesity who completed the MOVE! weight management programme and self‐identified as having problems with ‘stress‐related eating’ were randomized to four 2‐h weekly ACT sessions or a continued behavioural weight‐loss (BWL) intervention. Assessments were completed at baseline, post‐treatment and 3‐ and 6‐month follow‐up on outcomes of interest including measures of disinhibited eating patterns, obesity‐related quality of life, weight‐related experiential avoidance and weight.ResultsThe BWL group exhibited significantly greater reductions in binge eating behaviour at post‐treatment compared with the ACT group. Significant improvements in other outcomes were found with minimal differences between groups. In both groups, decreases in weight‐related experiential avoidance were related to improvements in binge eating behaviour.ConclusionsTaken together, the continued BWL intervention resulted in larger improvements in binge eating behaviour than the ACT intervention. The two groups showed similar improvements in other disinhibited eating outcomes. Future studies are encouraged to determine if more integrated or longer duration of ACT treatment may maximize eating outcomes in MOVE.Trial Registration Number: This trial was registered with ClinicalTrials.gov database (NCT01757847).