Volume 24, Issue 4 (3-2026)
TB 2026, 24(4): 69-83 |
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Moradi S, Ebrahimi M E. Evaluating the Effect of Acceptance and Commitment Training on Reducing Cognitive Dissonance and Marital Conflicts among Female Nurses: An Interventional Study. TB 2026; 24 (4) :69-83
URL: http://tbj.ssu.ac.ir/article-1-3809-en.html
URL: http://tbj.ssu.ac.ir/article-1-3809-en.html
Associate Professor, Department of Psychology, Hamadan Branch of Psychology, Islamic Azad University, Hamadan, Iran , lalehyari6@gmail.com
Keywords: Acceptance and Commitment Therapy, Cognitive Dissonance, Marital Conflict, Maladaptive Schemas, Nurses
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Evaluating the Effect of Acceptance and Commitment Training on Reducing Cognitive Dissonance and Marital Conflicts among Female Nurses: An Interventional Study
Soma Moradi (M.Sc.)1, Mohammad Esmaeil Ebrahimi (Ph.D.)2
1.Master of Family Counseling, Department of Psychology, Hamadan Branch, Islamic Azad University, Hamadan, Iran
2.Corresponding Author: Associate Professor, Department of Psychology, Hamadan Branch of Psychology, Islamic Azad University, Hamadan, Iran. Email: mse58_2007@yahoo.com Tel: +98 9127849470
Abstract
Introduction: Marital conflicts and cognitive dissonance are influential factors affecting mental health and can negatively impact nurses’ professional functioning. This study aimed to evaluate the effectiveness of an Acceptance and Commitment Training (ACT) program in reducing cognitive dissonance and marital conflicts among female nurses in Sanandaj.
Methods: This semi-experimental study was conducted using a pretest–posttest design with a control group and one-month follow-up. The statistical population consisted of female nurses working in hospitals in Sanandaj in 2023. A total of 32 participants were selected through purposive sampling and assigned to experimental and control groups. Participants completed questionnaires on cognitive dissonance and marital conflicts. The experimental group received eight sessions of group-based ACT, while the control group received no intervention. Data were analyzed using analysis of covariance (ANCOVA) in SPSS version 25.
Results: Group-based Acceptance and Commitment Training had a significant effect on reducing cognitive dissonance (F = 247/45, p < 0/001, η² = 0/452) and marital conflicts (F = 49/62, p < 0/001, η² = 0/463) in female nurses. These effects remained stable at follow-up.
Conclusion: Group-based CT can enhance psychological flexibility and emotion regulation, thereby improving mental health and marital relationships among female nurses.
Keywords: Acceptance and Commitment Therapy; Cognitive Dissonance; Marital Conflict; Maladaptive Schemas; Nurses
Conflict of interest: The authors declared no conflict of interest.
References
1-Cranage K, Foster K. Mental health nurses' experience of challenging workplace situations: A qualitative descriptive study. Int J Ment Health Nurs. 2022;31(3):665–676.
2-Chen YC, Wu HC, Ho JJ & et al. Exploring the association between patient-nurse ratio and nurses' occupational stressors: A cross-sectional study. J Nurs Manag. 2025;2025:6160674.
3-Tian L. Affective commitment influences occupational stressors among maternal and child health nurses via job burnout as a mediator. J Multidiscip Healthc. 2025;18:5905–5916.
4-Omeke FC, Okeke CI, Ede MO & et al. Coaching impact on work-family conflict and occupational stress among educational administrators in primary schools. Medicine. 2023;102(10):e33185.
5-Diao D , Chen X, Zhong L & et al. Sex differences in burnout and work-family conflict among Chinese emergency nurses: A cross-sectional study. Front Public Health. 2024;12:1492662.
6-Aldhafeeri NA , Abou Hashish EA, Abo Shereda HM. The effect of work-family conflict on staff nurses' job performance: the mediating role of emotional intelligence. BMC Nurs. 2025;24(1):614.
7-Hashemi S F, Hamzehgardeshi Z, Nataj A H & et al. Factors Associated With Marital Adjustment in Couples: A Narrative Review. CPR 2024; 2 (2) :73-86.
8-Montemarano V , Firasta L, Deska J & et al. Cognitive dissonance for weight stigma reduction: The development and effect of a counter-attitudinal advocacy intervention. Clin Obes. 2025;15(5):e70024.
9- Schrepel C, Jauregui J, Brown A & et al. Navigating cognitive dissonance: A qualitative content analysis exploring medical students' experiences of moral distress in the emergency department. AEM Educ Train. 2019;3(4):331–339.
10-Mahmoudpour A, Aminian A, Nowzari M & et al. The role of cognitive avoidance and emotional expression in predicting marital conflict in women in Tehran. J Psychol Sci. 2021;20(98):209–218.
11-Saffari E, Nasehi M, Yousefzadeh P. Cognitive emotion regulation strategies and marital communication patterns in married women: Investigating the mediating role of defense mechanisms. PCP. 2024;12(3):285–296.
12-Younis Sulaiman J, Al-Brwari MS. The obstacles facing women in balancing between work and home and its relationship to marital compatibility. Al-Adab J. 2023; 1(144):141-56.
13-Ahanian Moghaddam P, Atashpour SH, Golparvar M. Comparing the effectiveness of combined schema therapy and mindfulness with schema therapy and CBT on psychological flexibility. PCP. 2025;13(1):33–46.
14-Lucas JJ, Moore KA. Psychological flexibility: Positive implications for mental health and life satisfaction. Health Promot Int. 2020;35(2):312–320.
15-Mohammadi M. The effectiveness of acceptance and commitment based therapy on mental health and job satisfaction in nurses working in intensive care units of Farshchian Hospital in Hamadan. JNIP. 2022;12(16):1–14.
16-Büyüköksüz E. Effectiveness of the acceptance and commitment therapy for resilience promotion in a non-clinical sample: A randomized controlled and a pilot study. BMC Psychol. 2025;13(1):698.
17-Hadian S, Hosseinzadeh Taghvaei M, Havasi Soomar N & et al. Comparing the Effectiveness of Acceptance and Commitment Therapy and Reality Therapy on Psychological Flexibility and Responsibility in Divorced Women. Avicenna J Neuro Psycho Physiology 2023; 10 (2) :73-80
18-Latella D, Marafioti G, Formica C & et al. The role of Acceptance and Commitment Therapy in improving social functioning among psychiatric patients: A systematic review. Healthcare (Basel). 2025;13(13):1587.
19-Naderi Moghaddam N, Panah Ali A, Aghdasi AN & et al. The effectiveness of Acceptance and Commitment Therapy on marital conflict and emotional divorce of women facing divorce. Womens Health Bull. 2023;10(2):122–132.
20-Hayes SC, Luoma JB, Bond FW & et al. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25.
21-Nakagawa T, Koan I, Chen C & et al. Regular moderate- to vigorous-intensity physical activity rather than walking is associated with enhanced cognitive functions and mental health in young adults. Int J Environ Res Public Health. 2020;17:614.
22-Harmon-Jones E, Harmon-Jones C. Individual differences in dissonance arousal/reduction relate to physical exercise: Testing the action-based model. PLoS One. 2022;17(10):e0275990.
23-Mousavi Haghighi SE, Pooladi Rishehri1 A, Mousavi SA. Effectiveness of Acceptance and Commitment Therapy and Integrated Behavioral Couples Therapy on Intimacy and Family Functioning in Divorce-seeking Couples. J Research Health 2022; 12 (3) :167-176.
24-Jafarimanesh M, Zahrakar K, Taghvaei D & et al. The effectiveness of reality therapy training on marital burnout in couples with marital conflicts. RBS. 2020;18(3):288–299.
25-Asghari F, Sadeghi A, Khakdoost SZ & et al. Investigating the relationship between early maladaptive schemas with marital conflict and instability in the couples of applicants for divorce and normal couples. FPJ. 2015;1(1):46–58.
26-Zare’i A, Bakhshi Pour A, Mohammadi Pour M. The efficacy of schema therapy and Acceptance and Commitment Therapy (ACT) on cognitive flexibility and quality of life in conflicted couples. Psychol Dyn Mood Disord. 2024;3(3):129–144.
27-Forooghi F, Gholamzadeh Jofreh M, Kazemian Moghadam K & et al. Effectiveness of Acceptance and Commitment Therapy (ACT) on negative emotion regulation, distress tolerance and psychological resilience in women with migraine. J Sabzevar Univ Med Sci. 2024;31(5):733–746.
28-Mohammadi Tileh Noii S, Rahmani MA, Ghorban Shirudi S. The effect of combined couple therapy based on acceptance, commitment-schema on acceptance and practice of values in divorce applicant couples. QJCR. 2023;22(85):6.
29-Hosseini S, Tajikesmaeili A, Sanaei Zaker B & et al. Comparison of the effectiveness of couple therapy based on acceptance and commitment (ACT), and Gottman’s couple therapy on marital intimacy among conflicting couples. J Psychol Sci. 2022;21(110):4.
30-Poloee M, Yaghubi H, Saffarian Toosi M. Comparing the effectiveness of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) on the characteristics of Sternberg's love model in couples. Fundam Ment Health. 2024;26(1):3–8.
31-Rafezi Z, Keshaee M. The effectiveness of Acceptance and Commitment Therapy on increasing intimacy and marital adjustment of patients with substance use disorders. J Police Med. 2020;9(2).
Soma Moradi (M.Sc.)1, Mohammad Esmaeil Ebrahimi (Ph.D.)2
1.Master of Family Counseling, Department of Psychology, Hamadan Branch, Islamic Azad University, Hamadan, Iran
2.Corresponding Author: Associate Professor, Department of Psychology, Hamadan Branch of Psychology, Islamic Azad University, Hamadan, Iran. Email: mse58_2007@yahoo.com Tel: +98 9127849470
Abstract
Introduction: Marital conflicts and cognitive dissonance are influential factors affecting mental health and can negatively impact nurses’ professional functioning. This study aimed to evaluate the effectiveness of an Acceptance and Commitment Training (ACT) program in reducing cognitive dissonance and marital conflicts among female nurses in Sanandaj.
Methods: This semi-experimental study was conducted using a pretest–posttest design with a control group and one-month follow-up. The statistical population consisted of female nurses working in hospitals in Sanandaj in 2023. A total of 32 participants were selected through purposive sampling and assigned to experimental and control groups. Participants completed questionnaires on cognitive dissonance and marital conflicts. The experimental group received eight sessions of group-based ACT, while the control group received no intervention. Data were analyzed using analysis of covariance (ANCOVA) in SPSS version 25.
Results: Group-based Acceptance and Commitment Training had a significant effect on reducing cognitive dissonance (F = 247/45, p < 0/001, η² = 0/452) and marital conflicts (F = 49/62, p < 0/001, η² = 0/463) in female nurses. These effects remained stable at follow-up.
Conclusion: Group-based CT can enhance psychological flexibility and emotion regulation, thereby improving mental health and marital relationships among female nurses.
Keywords: Acceptance and Commitment Therapy; Cognitive Dissonance; Marital Conflict; Maladaptive Schemas; Nurses
Conflict of interest: The authors declared no conflict of interest.
References
1-Cranage K, Foster K. Mental health nurses' experience of challenging workplace situations: A qualitative descriptive study. Int J Ment Health Nurs. 2022;31(3):665–676.
2-Chen YC, Wu HC, Ho JJ & et al. Exploring the association between patient-nurse ratio and nurses' occupational stressors: A cross-sectional study. J Nurs Manag. 2025;2025:6160674.
3-Tian L. Affective commitment influences occupational stressors among maternal and child health nurses via job burnout as a mediator. J Multidiscip Healthc. 2025;18:5905–5916.
4-Omeke FC, Okeke CI, Ede MO & et al. Coaching impact on work-family conflict and occupational stress among educational administrators in primary schools. Medicine. 2023;102(10):e33185.
5-Diao D , Chen X, Zhong L & et al. Sex differences in burnout and work-family conflict among Chinese emergency nurses: A cross-sectional study. Front Public Health. 2024;12:1492662.
6-Aldhafeeri NA , Abou Hashish EA, Abo Shereda HM. The effect of work-family conflict on staff nurses' job performance: the mediating role of emotional intelligence. BMC Nurs. 2025;24(1):614.
7-Hashemi S F, Hamzehgardeshi Z, Nataj A H & et al. Factors Associated With Marital Adjustment in Couples: A Narrative Review. CPR 2024; 2 (2) :73-86.
8-Montemarano V , Firasta L, Deska J & et al. Cognitive dissonance for weight stigma reduction: The development and effect of a counter-attitudinal advocacy intervention. Clin Obes. 2025;15(5):e70024.
9- Schrepel C, Jauregui J, Brown A & et al. Navigating cognitive dissonance: A qualitative content analysis exploring medical students' experiences of moral distress in the emergency department. AEM Educ Train. 2019;3(4):331–339.
10-Mahmoudpour A, Aminian A, Nowzari M & et al. The role of cognitive avoidance and emotional expression in predicting marital conflict in women in Tehran. J Psychol Sci. 2021;20(98):209–218.
11-Saffari E, Nasehi M, Yousefzadeh P. Cognitive emotion regulation strategies and marital communication patterns in married women: Investigating the mediating role of defense mechanisms. PCP. 2024;12(3):285–296.
12-Younis Sulaiman J, Al-Brwari MS. The obstacles facing women in balancing between work and home and its relationship to marital compatibility. Al-Adab J. 2023; 1(144):141-56.
13-Ahanian Moghaddam P, Atashpour SH, Golparvar M. Comparing the effectiveness of combined schema therapy and mindfulness with schema therapy and CBT on psychological flexibility. PCP. 2025;13(1):33–46.
14-Lucas JJ, Moore KA. Psychological flexibility: Positive implications for mental health and life satisfaction. Health Promot Int. 2020;35(2):312–320.
15-Mohammadi M. The effectiveness of acceptance and commitment based therapy on mental health and job satisfaction in nurses working in intensive care units of Farshchian Hospital in Hamadan. JNIP. 2022;12(16):1–14.
16-Büyüköksüz E. Effectiveness of the acceptance and commitment therapy for resilience promotion in a non-clinical sample: A randomized controlled and a pilot study. BMC Psychol. 2025;13(1):698.
17-Hadian S, Hosseinzadeh Taghvaei M, Havasi Soomar N & et al. Comparing the Effectiveness of Acceptance and Commitment Therapy and Reality Therapy on Psychological Flexibility and Responsibility in Divorced Women. Avicenna J Neuro Psycho Physiology 2023; 10 (2) :73-80
18-Latella D, Marafioti G, Formica C & et al. The role of Acceptance and Commitment Therapy in improving social functioning among psychiatric patients: A systematic review. Healthcare (Basel). 2025;13(13):1587.
19-Naderi Moghaddam N, Panah Ali A, Aghdasi AN & et al. The effectiveness of Acceptance and Commitment Therapy on marital conflict and emotional divorce of women facing divorce. Womens Health Bull. 2023;10(2):122–132.
20-Hayes SC, Luoma JB, Bond FW & et al. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25.
21-Nakagawa T, Koan I, Chen C & et al. Regular moderate- to vigorous-intensity physical activity rather than walking is associated with enhanced cognitive functions and mental health in young adults. Int J Environ Res Public Health. 2020;17:614.
22-Harmon-Jones E, Harmon-Jones C. Individual differences in dissonance arousal/reduction relate to physical exercise: Testing the action-based model. PLoS One. 2022;17(10):e0275990.
23-Mousavi Haghighi SE, Pooladi Rishehri1 A, Mousavi SA. Effectiveness of Acceptance and Commitment Therapy and Integrated Behavioral Couples Therapy on Intimacy and Family Functioning in Divorce-seeking Couples. J Research Health 2022; 12 (3) :167-176.
24-Jafarimanesh M, Zahrakar K, Taghvaei D & et al. The effectiveness of reality therapy training on marital burnout in couples with marital conflicts. RBS. 2020;18(3):288–299.
25-Asghari F, Sadeghi A, Khakdoost SZ & et al. Investigating the relationship between early maladaptive schemas with marital conflict and instability in the couples of applicants for divorce and normal couples. FPJ. 2015;1(1):46–58.
26-Zare’i A, Bakhshi Pour A, Mohammadi Pour M. The efficacy of schema therapy and Acceptance and Commitment Therapy (ACT) on cognitive flexibility and quality of life in conflicted couples. Psychol Dyn Mood Disord. 2024;3(3):129–144.
27-Forooghi F, Gholamzadeh Jofreh M, Kazemian Moghadam K & et al. Effectiveness of Acceptance and Commitment Therapy (ACT) on negative emotion regulation, distress tolerance and psychological resilience in women with migraine. J Sabzevar Univ Med Sci. 2024;31(5):733–746.
28-Mohammadi Tileh Noii S, Rahmani MA, Ghorban Shirudi S. The effect of combined couple therapy based on acceptance, commitment-schema on acceptance and practice of values in divorce applicant couples. QJCR. 2023;22(85):6.
29-Hosseini S, Tajikesmaeili A, Sanaei Zaker B & et al. Comparison of the effectiveness of couple therapy based on acceptance and commitment (ACT), and Gottman’s couple therapy on marital intimacy among conflicting couples. J Psychol Sci. 2022;21(110):4.
30-Poloee M, Yaghubi H, Saffarian Toosi M. Comparing the effectiveness of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) on the characteristics of Sternberg's love model in couples. Fundam Ment Health. 2024;26(1):3–8.
31-Rafezi Z, Keshaee M. The effectiveness of Acceptance and Commitment Therapy on increasing intimacy and marital adjustment of patients with substance use disorders. J Police Med. 2020;9(2).
Type of Study: Research |
Subject:
Midwifery
Received: 2025/06/12 | Accepted: 2025/09/13 | Published: 2026/03/1
Received: 2025/06/12 | Accepted: 2025/09/13 | Published: 2026/03/1
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