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TB 2025, 24(6): 16-30 |
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Ethics code: IR.IAU.BOJNOURD.REC. 1404.012
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Akbari A, Mohammadzadeh Ebrahimi A, Esmaili F. A Comparison of the Effectiveness of Acceptance and Commitment Therapy and Compassion-Focused Therapy on Distress Tolerance among Women with Anxiety Symptoms. TB 2025; 24 (6) :16-30
URL: http://tbj.ssu.ac.ir/article-1-3859-en.html
URL: http://tbj.ssu.ac.ir/article-1-3859-en.html
University of Bojnord , a.mohammadzadeh@ub.ac.ir
Keywords: Acceptance and Commitment Therapy, Compassion-Focused Therapy, Women, Anxiety, Distress Tolerance
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A Comparison of the Effectiveness of Acceptance and Commitment Therapy and Compassion-Focused Therapy on Distress Tolerance among Women with Anxiety Symptoms
Azam Akbari (Ph .D. Candidate)¹, Ali Mohammadzadeh Ebrahimi (Ph .D.) ², Fateme Esmaili (Ph .D.)³
1.PhD Candidate in Psychology,Department of Psychology, Boj.C., Islamic Azad University, Bojnord, Iran
2.Corresponding Author: Associate Professor, Department of Psychology, University of Bojnord, Bojnord, Iran
E-mail:a.mohammadzadeh@ub.ac.ir. Tel: 09151872157
3.Assistant Professor, Department of Psychology, Boj.C., Islamic Azad University, Bojnord, Iran
Abstract
Introduction: Distress tolerance, as a transdiagnostic construct, plays a pivotal role in the persistence of anxiety disorders. The present study aimed to compare the effectiveness of Acceptance and Commitment Therapy (ACT) and Compassion-Focused Therapy (CFT) on distress tolerance among women with anxiety symptoms.
Methods:This was a quasi-experimental study employing a pretest–posttest control group design. The statistical population consisted of all women with anxiety symptoms referred to counseling centers in Bojnord, Iran, during 2025. A total of 45 participants were selected through convenience sampling and randomly assigned to three groups: ACT, CFT, and control (n=15 per group). The research instruments comprised the Beck Anxiety Inventory and the Distress Tolerance Scale. The experimental groups each received eight 90-minute weekly sessions of ACT and CFT, respectively, while the control group received no intervention.
Results: Analysis of covariance revealed statistically significant between-group differences in the distress tolerance (F=73/64, p=0/001) and all subscales (p<0/001). Effect sizes ranged from 0/32 to 0/78. Post-hoc comparisons indicated that both ACT and CFT produced significant improvements in the total score and all subscales of distress tolerance relative to the control group (p<0/001); however, no statistically significant difference was found between the two interventions (p>0/05).
Conclusion: ACT and CFT are equally effective and clinically viable transdiagnostic interventions for improving multiple dimensions of distress tolerance in women with anxiety symptoms. Clinicians may draw upon either protocol to enhance distress tolerance capacity in comparable clinical populations.
Keywords:Acceptance and Commitment Therapy, Compassion-Focused Therapy, Women, Anxiety, Distress Tolerance
Conflict of interest: The authors declared no conflict of interest.
References
1-American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. 5th ed. Washington, DC: American Psychiatric Publishing. 2022 ;215-216
2-Hoffman AN, Trott JM, Makridis A & et al. Anxiety, fear, panic: An approach to assessing the defensive behavior system across the predatory imminence continuum. Learning & Behavior, 2022;50(3), 339–348.
3-World Health Organization. Anxiety disorders [Internet]. Geneva: World Health Organization; 2023 [cited 2025 Sep 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
4-Byllesby BM, Palmieri PA. The association between posttraumatic stress disorder symptom severity and distress tolerance in traumatic stress treatment. J Trauma Stress. 2025;38(1):29-39.
5-Johns G, Samuel V, Freemantle L & et al. The global prevalence of depression and anxiety among doctors during the COVID-19 pandemic: Systematic review and meta-analysis. J Affect Disord. 2022;298:431-41.
6-Aguirre P, Michelini Y, Bravo AJ & et al. Association between personality traits and symptoms of depression and anxiety via emotional regulation and distress tolerance. PLoS One. 2024;19(7):e0306146.
8-Mortezavi A,InTranslation.Learning ACT (Acceptance and Commitment Therapy) A Training Manual for the Therapist on Acceptance and Commitment Therapy Skills.Luoma JB, Hayes SC, Walser RD et al.1rd ed .Tehran:public Arjmand; 2023:30-200
8-Gloster AT, Walder N, Levin ME & et al. The empirical status of acceptance and commitment therapy: A review of meta-analyses. J Contextual Behavioral Science, 2020; 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009
9-Sun Y, Tian Z, Ma Y & et al . Effectiveness of Acceptance and Commitment Therapy on reducing depression and anxiety in older adults: A systematic review and meta‐analysis. J Psychiatric and Mental Health Nursing,. 2025;32(3):643-655
10-Han A, Wilroy J D, Yuen HK. Effects of ACT on depression and anxiety: A meta-analysis. Clinical Psychologist, 2023; 27(2), 210–231.
11-Mahmoudfakhe H. The effectiveness of acceptance and commitment therapy on fear of negative evaluation and quality of life in individuals with social anxiety disorder. Prev Couns. 2022;3(3):42-53.[Persian]
12-Allen LM, Roberts C, Zimmer-Gembeck MJ & et al. Exploring the relationship between self-compassion and body dysmorphic symptoms in adolescents. J Obsessive Compuls Relat Disord. 2020;25:100535.
13-Keutler M, McHugh L. Self-compassion buffers the effects of perfectionistic self-presentation on social media on wellbeing. J Contextual Behav Sci. 2022;23:53-8.
14-Taylor A, Hodgson D. The behavioural display of compassion in radiation therapy: purpose, meaning and interpretation. J Med Imaging Radiat Sci. 2020;51(4):S59-71.
15-Hefazi Torghabeh L, Najafi M.The mediating role of self-compassion in mental health outcomes. Journal of Psychology, 2025; 113(1), 67–78.[Persian]
16-Neff KD. Self-compassion: Theory, method, research, and intervention. Annual Review of Psychology, 2023 ; 74, 193–218.
17-Mohammadi Sangachin A, Khosrojavid M, Mohammadi Kashka S & et al. The effectiveness of compassion-based intervention on depression, anxiety, and stress in mothers of children with separation anxiety disorder. J Except Educ. 2024;5(183):4-16.[Persian]
18-Saadatmand E, Mahmoudalilu M, Esmaeilpour K & et al، The relationship between early maladaptive schemas and symptoms of body dysmorphic disorder: the mediating role of self-compassion. Ravan Parastari. 2022;10(1):64-75.[Persian]
19-Foroughi A, Khanjani S, Asl EM. The relationship of concern about body dysmorphia with external shame, perfectionism, and negative affect: the mediating role of self-compassion. Iran J Psychiatry Behav Sci. 2019;13(2).[Persian]
20-Mousavi S, Mousavi Sh, Shahsavar MR. Effectiveness of compassion-focused therapy on social anxiety and rumination in female-headed households.J Clinical Research in Paramedical Sciences, 2023; 12 (2), e137456.[Persian]
21-Nekoonam Ghadirli Y, Havasi Somar N, Peyvandi P. Comparing the Efficacy of Compassion-Based Therapy and Schema Therapy Focused on Modes on Body Image Satisfaction and Resilience in Individuals with Generalized Anxiety Disorder. HPBD [Internet]. 2026 May 1 [cited 2026 Jun. 5]; 1-18. Available from: https://jhpbd.com/index.php/hpbd/article/view/242.[Persian]
22-Petrocchi N, Ottaviani, CGilbert P & et al. The impact of compassion-focused therapy on positive and negative mental health outcomes: Results of a series of meta-analyses.
Clinical Psychology: Science and Practice, 2024. 31(2), 230
23-Kleiman K, Marks DR, Block-Lerner J & et al. Feasibility and preliminary outcomes of compassion-focused acceptance and commitment therapy delivered via telehealth in a community behavioral health clinic. Frontiers in Psychology. 2025;16:1509396
24-Linardon J, Anderson C, Werthmann J & et al. The efficacy of acceptance and commitment therapy for anxiety and depressive disorders: A systematic review and meta-analysis of randomized controlled trials.J Anxiety Disorders. 2021;280:245-258.
25-Matos M, Duarte C, Pinto-Gouveia J. The effectiveness of compassion-focused therapy for anxiety and depression: A systematic review. Mindfulness, 2022 ;13(5), 1101–1115.
26-Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge;2013:502 -514.
27-Beck AT, Steer RA. Manual for the Beck anxiety inventory. San Antonio, TX: Psychological Corporation.1990.
28-Kaivani H, Mousavi AS. Psychometric properties of the Beck Anxiety Inventory across age and gender groups in the Iranian population. Tehran Univ Med J. 2008;66(2):136-40 gender groups in the Iranian population. Tehran Univ Med J. 2008;66(2):136-40.[Persian]
29-Simons JS, Gaher RM. The Distress Tolerance Scale: Development and psychometric properties. J Pers Assess. 2005; 85(2):168-78.
30-Esmaeilinasab M, Andami Khoshk A, Azarmi H & et al. The predicting role of difficulties in emotion regulation and distress tolerance in students’ addiction potential. Sci Q Res Addict. 2014;8(29):49-63.[Persian]
31-Fortes P, dos Santos-Ribeiro S, de Salles-Andrade & et al .Mindfulness interventions and quality of life in anxiety-related disorders: Asystematic review and meta-analysis.J Affective Disorders, 2025 ; 373, 383–393.
32-Ruiz FJ, Salazar JC, Suárez-Falcón JC & et al. Efficacy of acceptance and commitment therapy for depression and generalized anxiety disorder: A randomized trial. Psychotherapy. 2020;57(3):444-451
33-Sewart AR, Niles AN, Burklund LJ & et al،Examining positive and negative affect as outcomes and moderators of cognitive-behavioral therapy and acceptance and commitment therapy for social anxiety disorder. Behav Ther. 2019;50(6): 1112–1124.
34-Horwood V, Allan S, Goss K & et al. The development of the compassion focused therapy therapist competence rating scale. Psychol Psychother Theory Res Pract. 2020;93(2):387-407.
Azam Akbari (Ph .D. Candidate)¹, Ali Mohammadzadeh Ebrahimi (Ph .D.) ², Fateme Esmaili (Ph .D.)³
1.PhD Candidate in Psychology,Department of Psychology, Boj.C., Islamic Azad University, Bojnord, Iran
2.Corresponding Author: Associate Professor, Department of Psychology, University of Bojnord, Bojnord, Iran
E-mail:a.mohammadzadeh@ub.ac.ir. Tel: 09151872157
3.Assistant Professor, Department of Psychology, Boj.C., Islamic Azad University, Bojnord, Iran
Abstract
Introduction: Distress tolerance, as a transdiagnostic construct, plays a pivotal role in the persistence of anxiety disorders. The present study aimed to compare the effectiveness of Acceptance and Commitment Therapy (ACT) and Compassion-Focused Therapy (CFT) on distress tolerance among women with anxiety symptoms.
Methods:This was a quasi-experimental study employing a pretest–posttest control group design. The statistical population consisted of all women with anxiety symptoms referred to counseling centers in Bojnord, Iran, during 2025. A total of 45 participants were selected through convenience sampling and randomly assigned to three groups: ACT, CFT, and control (n=15 per group). The research instruments comprised the Beck Anxiety Inventory and the Distress Tolerance Scale. The experimental groups each received eight 90-minute weekly sessions of ACT and CFT, respectively, while the control group received no intervention.
Results: Analysis of covariance revealed statistically significant between-group differences in the distress tolerance (F=73/64, p=0/001) and all subscales (p<0/001). Effect sizes ranged from 0/32 to 0/78. Post-hoc comparisons indicated that both ACT and CFT produced significant improvements in the total score and all subscales of distress tolerance relative to the control group (p<0/001); however, no statistically significant difference was found between the two interventions (p>0/05).
Conclusion: ACT and CFT are equally effective and clinically viable transdiagnostic interventions for improving multiple dimensions of distress tolerance in women with anxiety symptoms. Clinicians may draw upon either protocol to enhance distress tolerance capacity in comparable clinical populations.
Keywords:Acceptance and Commitment Therapy, Compassion-Focused Therapy, Women, Anxiety, Distress Tolerance
Conflict of interest: The authors declared no conflict of interest.
References
1-American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. 5th ed. Washington, DC: American Psychiatric Publishing. 2022 ;215-216
2-Hoffman AN, Trott JM, Makridis A & et al. Anxiety, fear, panic: An approach to assessing the defensive behavior system across the predatory imminence continuum. Learning & Behavior, 2022;50(3), 339–348.
3-World Health Organization. Anxiety disorders [Internet]. Geneva: World Health Organization; 2023 [cited 2025 Sep 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
4-Byllesby BM, Palmieri PA. The association between posttraumatic stress disorder symptom severity and distress tolerance in traumatic stress treatment. J Trauma Stress. 2025;38(1):29-39.
5-Johns G, Samuel V, Freemantle L & et al. The global prevalence of depression and anxiety among doctors during the COVID-19 pandemic: Systematic review and meta-analysis. J Affect Disord. 2022;298:431-41.
6-Aguirre P, Michelini Y, Bravo AJ & et al. Association between personality traits and symptoms of depression and anxiety via emotional regulation and distress tolerance. PLoS One. 2024;19(7):e0306146.
8-Mortezavi A,InTranslation.Learning ACT (Acceptance and Commitment Therapy) A Training Manual for the Therapist on Acceptance and Commitment Therapy Skills.Luoma JB, Hayes SC, Walser RD et al.1rd ed .Tehran:public Arjmand; 2023:30-200
8-Gloster AT, Walder N, Levin ME & et al. The empirical status of acceptance and commitment therapy: A review of meta-analyses. J Contextual Behavioral Science, 2020; 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009
9-Sun Y, Tian Z, Ma Y & et al . Effectiveness of Acceptance and Commitment Therapy on reducing depression and anxiety in older adults: A systematic review and meta‐analysis. J Psychiatric and Mental Health Nursing,. 2025;32(3):643-655
10-Han A, Wilroy J D, Yuen HK. Effects of ACT on depression and anxiety: A meta-analysis. Clinical Psychologist, 2023; 27(2), 210–231.
11-Mahmoudfakhe H. The effectiveness of acceptance and commitment therapy on fear of negative evaluation and quality of life in individuals with social anxiety disorder. Prev Couns. 2022;3(3):42-53.[Persian]
12-Allen LM, Roberts C, Zimmer-Gembeck MJ & et al. Exploring the relationship between self-compassion and body dysmorphic symptoms in adolescents. J Obsessive Compuls Relat Disord. 2020;25:100535.
13-Keutler M, McHugh L. Self-compassion buffers the effects of perfectionistic self-presentation on social media on wellbeing. J Contextual Behav Sci. 2022;23:53-8.
14-Taylor A, Hodgson D. The behavioural display of compassion in radiation therapy: purpose, meaning and interpretation. J Med Imaging Radiat Sci. 2020;51(4):S59-71.
15-Hefazi Torghabeh L, Najafi M.The mediating role of self-compassion in mental health outcomes. Journal of Psychology, 2025; 113(1), 67–78.[Persian]
16-Neff KD. Self-compassion: Theory, method, research, and intervention. Annual Review of Psychology, 2023 ; 74, 193–218.
17-Mohammadi Sangachin A, Khosrojavid M, Mohammadi Kashka S & et al. The effectiveness of compassion-based intervention on depression, anxiety, and stress in mothers of children with separation anxiety disorder. J Except Educ. 2024;5(183):4-16.[Persian]
18-Saadatmand E, Mahmoudalilu M, Esmaeilpour K & et al، The relationship between early maladaptive schemas and symptoms of body dysmorphic disorder: the mediating role of self-compassion. Ravan Parastari. 2022;10(1):64-75.[Persian]
19-Foroughi A, Khanjani S, Asl EM. The relationship of concern about body dysmorphia with external shame, perfectionism, and negative affect: the mediating role of self-compassion. Iran J Psychiatry Behav Sci. 2019;13(2).[Persian]
20-Mousavi S, Mousavi Sh, Shahsavar MR. Effectiveness of compassion-focused therapy on social anxiety and rumination in female-headed households.J Clinical Research in Paramedical Sciences, 2023; 12 (2), e137456.[Persian]
21-Nekoonam Ghadirli Y, Havasi Somar N, Peyvandi P. Comparing the Efficacy of Compassion-Based Therapy and Schema Therapy Focused on Modes on Body Image Satisfaction and Resilience in Individuals with Generalized Anxiety Disorder. HPBD [Internet]. 2026 May 1 [cited 2026 Jun. 5]; 1-18. Available from: https://jhpbd.com/index.php/hpbd/article/view/242.[Persian]
22-Petrocchi N, Ottaviani, CGilbert P & et al. The impact of compassion-focused therapy on positive and negative mental health outcomes: Results of a series of meta-analyses.
Clinical Psychology: Science and Practice, 2024. 31(2), 230
23-Kleiman K, Marks DR, Block-Lerner J & et al. Feasibility and preliminary outcomes of compassion-focused acceptance and commitment therapy delivered via telehealth in a community behavioral health clinic. Frontiers in Psychology. 2025;16:1509396
24-Linardon J, Anderson C, Werthmann J & et al. The efficacy of acceptance and commitment therapy for anxiety and depressive disorders: A systematic review and meta-analysis of randomized controlled trials.J Anxiety Disorders. 2021;280:245-258.
25-Matos M, Duarte C, Pinto-Gouveia J. The effectiveness of compassion-focused therapy for anxiety and depression: A systematic review. Mindfulness, 2022 ;13(5), 1101–1115.
26-Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge;2013:502 -514.
27-Beck AT, Steer RA. Manual for the Beck anxiety inventory. San Antonio, TX: Psychological Corporation.1990.
28-Kaivani H, Mousavi AS. Psychometric properties of the Beck Anxiety Inventory across age and gender groups in the Iranian population. Tehran Univ Med J. 2008;66(2):136-40 gender groups in the Iranian population. Tehran Univ Med J. 2008;66(2):136-40.[Persian]
29-Simons JS, Gaher RM. The Distress Tolerance Scale: Development and psychometric properties. J Pers Assess. 2005; 85(2):168-78.
30-Esmaeilinasab M, Andami Khoshk A, Azarmi H & et al. The predicting role of difficulties in emotion regulation and distress tolerance in students’ addiction potential. Sci Q Res Addict. 2014;8(29):49-63.[Persian]
31-Fortes P, dos Santos-Ribeiro S, de Salles-Andrade & et al .Mindfulness interventions and quality of life in anxiety-related disorders: Asystematic review and meta-analysis.J Affective Disorders, 2025 ; 373, 383–393.
32-Ruiz FJ, Salazar JC, Suárez-Falcón JC & et al. Efficacy of acceptance and commitment therapy for depression and generalized anxiety disorder: A randomized trial. Psychotherapy. 2020;57(3):444-451
33-Sewart AR, Niles AN, Burklund LJ & et al،Examining positive and negative affect as outcomes and moderators of cognitive-behavioral therapy and acceptance and commitment therapy for social anxiety disorder. Behav Ther. 2019;50(6): 1112–1124.
34-Horwood V, Allan S, Goss K & et al. The development of the compassion focused therapy therapist competence rating scale. Psychol Psychother Theory Res Pract. 2020;93(2):387-407.
Type of Study: Research |
Subject:
Psychology
Received: 2025/12/6 | Accepted: 2026/02/9 | Published: 2025/09/1
Received: 2025/12/6 | Accepted: 2026/02/9 | Published: 2025/09/1
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