The effectiveness of acceptance and commitment therapy (ACT) on intolerance of uncertainty and psychological inflexibility in individuals with generalized anxiety disorder (GAD)
Journal of Research in Psychopathology
مقاله 4 ، دوره 6، شماره 3 - شماره پیاپی 21 ، 2025، صفحه 29-37 832.32 K )
نوع مقاله: Original Article
شناسه دیجیتال (DOI): 10.22098/jrp.2025.15476.1245 نویسندگان
Saeed Pourabdol* 1 Anita Azarkolah 2 Gholam Hossein Ghaedi 3 1 Assistant Professor of Clinical Psychology, Urmia University2 Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran3 Department of Psychiatry, Faculty of Medicine, Shahed University, Tehran, Iranچکیده This research aimed to investigate the effectiveness of acceptance and commitment therapy (ACT) on intolerance of uncertainty and psychological inflexibility in individuals with generalized anxiety disorder (GAD). The study utilized an experimental design with pre-test, post-test, and control groups. The population consisted of individuals diagnosed with GAD who were referred to four psychological health centers in Tehran, Iran, in 2018. The research sample comprised 30 individuals with GAD, selected through convenience sampling, and randomly assigned into two groups: experimental (n = 15) and control (n = 15). Data was collected using the Acceptance and Action Questionnaire—II (AAQ-II), the Intolerance of Uncertainty Scale, and clinical interviews. The results of the Multivariate Analysis of Covariance (MANCOVA) indicated that ACT significantly reduced both intolerance of uncertainty and psychological inflexibility among individuals with GAD (P < 0.05). The findings suggest that intolerance of uncertainty and psychological inflexibility are key factors contributing to the persistence of GAD, and ACT can be effective in reducing these cognitive patterns. کلیدواژهها
Acceptance and commitment therapy ؛ Intolerance of uncertainty ؛ Psychological inflexibility ؛ Generalized anxiety disorder
مراجع
Abasi, E., Fta, L., Molodi, R., & Zarabi, H. (2012). Psychometric properties of Persian Version of Acceptance and Action Questionnaire –II. Scientific Journal Management System, 3 (10), 65-80. doi:10.4018/jabim.2012010105
Ådnøy, T., Solem, S., Hagen, R., & Havnen, A. (2023). An empirical investigation of the associations between metacognition, mindfulness experiential avoidance, depression, and anxiety. BMC psychology , 11 (1), 281. doi: 10.1186/s12888-023-02491-1
Akbari, M., Hamidpour, H., & Anduz, Z. (2010). Investigating the Predictive Factors of Pathological Worry in Students . Paper presented at the Fifth Seminar of Students' Mental Health, Tehran University of Medical Sciences. doi: 10.4018/jabim.2012010105
Ara, B. S., Khosropour, F., & Zarandi, H. M. (2023). Effectiveness of Acceptance and Commitment Therapy (ACT) on emotional processing, irrational beliefs and rumination in patients with generalized anxiety disorder. Journal of Adolescent and Youth Psychological Studies (JAYPS) , 4 (4), 34-44. doi: 10.1186/s12888-023-02491-1
Aydın, Y. (2023). Psychological inflexibility, ruminative thinking, worry, and self-compassion about college adjustment. Bartın University Journal of Faculty of Education, 12(2), 422-434. doi:10.14686/buefad.1022706
Baussay, A., Di Lodovico, L., Poupon, D., Doublet, M., Ramoz, N., Duriez, P., & Gorwood, P. (2024). The capacity of cognitive tests to detect generalized anxiety disorder (GAD): A pilot study. Journal of psychiatric research , 174 , 94-100. doi: 10.1016/j.jpsychires.2023.12.023
Bird, S., Moid, L. A. E., Jones, C. A., & Surtees, A. D. (2024). The relationships between restrictive/repetitive behaviors, intolerance of uncertainty, and anxiety in autism: A systematic review and meta-analysis. Research in Autism Spectrum Disorders , 117 , 102428. doi: 10.1016/j.rasd.2023.102428
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., . . . Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior therapy, 42(4), 676-688. doi: 10.1016/j.beth.2011.03.007
Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour research and therapy, 40 (8), 931-945. doi: 10.1016/S0005-7967(01)00092-4
Byrne, G., & Cullen, C. (2024). Acceptance and commitment therapy for anger, irritability, and aggression in children, adolescents, and young adults: a systematic review of intervention studies. Trauma, Violence, & Abuse , 25 (2), 935-946. doi: 10.1177/15248380221143310
Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., . . . Powers, M. B. (2019). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cognitive behaviour therapy , 1-21. doi: 10.1080/16506073.2018.1560358
Casey, M. B., Takemasa, S., O'Reilly, T., Leamy, M., Mc Kearney, E., Buckley, M., ... & Doody, C. (2024). Exercise combined with Acceptance and Commitment Therapy for chronic pain: One‐year follow‐up from a randomized controlled trial. European Journal of Pain . doi: 10.1002/ejp.2024
Chung, S., Song, K., & Günlü, A. (2024). The Effect of Psychological Inflexibility on Social-Distancing Phobia Mediated by Preoccupation With Sleep and Intolerance of Uncertainty in the Elderly Population During the COVID-19 Pandemic. Psychiatry Investigation , 21 (2), 151. doi: 10.30773/pi.2023.0123
Cicek, I., Tanhan, A., & Bulus, M. (2021). Psychological inflexibility predicts depression and anxiety during COVID-19 Pandemic. i-Manager's Journal on Educational Psychology , 15 (1), 11. doi: 10.26634/jpsy.15.1.17430
Cojocaru, C. M., Popa, C. O., Schenk, A., Suciu, B. A., & Szasz, S. (2024). Cognitive-behavioral therapy and acceptance and commitment therapy for anxiety and depression in patients with fibromyalgia: a systematic review and meta-analysis. Medicine and Pharmacy Reports , 97 (1), 26. doi: 10.15386/mpr-2456
Dehghani Bidgoli, T., Mahdian, H., & Shakiba, A. (2022). The effectiveness of emotion regulation training and acceptance and commitment therapy (ACT) on psychological pain in patients with multiple sclerosis (MS). Journal of Research in Psychopathology , 3 (7), 35-46. doi: 10.22098/jrp.2022.10367.1068
Donahue, J. J., Buck, B., & Chauhan, K. (2024). A multi-sample investigation of psychological flexibility processes and reactive and proactive functions of aggression. Journal of Contextual Behavioral Science , 31 , 100721. doi: 10.1016/j.jcbs.2023.100721
Dugas, M. J., Schwartz, A., & Francis, K. (2004). Brief report: Intolerance of uncertainty, worry, and depression. Cognitive therapy and research , 28 , 835-842. doi: 10.1023/B:COTR.0000045562.66316.6
Durepos, P., MacLean, R., Ricketts, N., Boamah, S. A., Witherspoon, R., Gould, O., ... & Kaasalainen, S. (2024). Engaging care partners of persons living with dementia in acceptance and commitment therapy (ACT) programs: a scoping review. Aging & Mental Health , 28 (5), 725-737. doi: 10.1080/13607863.2023.2172991
Ercengiz, M., Yildiz, B., Savci, M., & Griffiths, M. D. (2024). Differentiation of self, emotion management skills, and nomophobia among smartphone users: The mediating and moderating roles of intolerance of uncertainty. The Social Science Journal , 61 (2), 525-539. doi: 10.1080/03623319.2023.2174496
Fang, S., & Ding, D. (2023). The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis. Journal of Contextual Behavioral Science , 28 , 149-168. doi: 10.1016/j.jcbs.2023.02.001
Garner, A. R., & Stuart, G. L. (2023). Integrating mindfulness and acceptance into traditional cognitive behavioral therapy during the covid-19 pandemic: A case study of an adult man with generalized anxiety disorder. Clinical Case Studies , 22 (2), 120-137. doi: 10.1177/15346501221137615
Gorinelli, S., Gallego, A., Lappalainen, P., & Lappalainen, R. (2023). Virtual reality acceptance and commitment therapy intervention for social and public speaking anxiety: A randomized controlled trial. Journal of Contextual Behavioral Science , 28 , 289-299. doi: 10.1016/j.jcbs.2023.04.001
Gould, R. L., McDermott, C. J., Thompson, B. J., Rawlinson, C. V., Bursnall, M., Bradburn, M., ... & Waterhouse, S. (2024). Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND): a multicentre, parallel, randomised controlled trial in the UK. The Lancet , 403 (10442), 2381-2394. doi: 10.1016/S0140-6736(24)00384-4
Hayes, A., Orsillo, S., & Roemer, L. (2010). Changes in proposed mechanisms of action during an acceptance-based behavior therapy for generalized anxiety disorder. Behaviour research and therapy, 48 (3), 238-245. doi: 10.1016/j.brat.2009.11.006
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44 (1), 1-25. doi: 10.1016/j.brat.2005.06.006
Levin, M. E., Krafft, J., & Twohig, M. P. (2024). An Overview of Research on Acceptance and Commitment Therapy. Psychiatric Clinics . doi: 10.1016/j.psc.2023.12.001
Lim, R. G., Voon, S. P., Yahya, F., Mohamad, F. S., & Ahmi, A. (2024). Global and LMIC Insights into Acceptance and Commitment Therapy (ACT): A Bibliometric Study from 1998 to 2023. Journal of Contextual Behavioral Science , 100796. doi: 10.1016/j.jcbs.2023.100796
Lin, Y., Mason, D., Zhong, S., Hirsch, C., & Happé, F. (2024). How is “intolerance of uncertainty”(IU) measured? A systematic review of assessment tools for IU and the psychometric properties of IU questionnaires. Clinical Psychology: Science and Practice . doi: 10.1111/cpsp.12515
Miron, L. R., Sherrill, A. M., & Orcutt, H. K. (2015). Fear of self-compassion and psychological inflexibility interact to predict PTSD symptom severity. Journal of Contextual Behavioral Science, 4 (1), 37-41. doi: 10.1016/j.jcbs.2015.01.002
Morina, N., Kampmann, I., Emmelkamp, P., Barbui, C., & Hoppen, T. H. (2023). Meta-analysis of virtual reality exposure therapy for social anxiety disorder. Psychological Medicine , 53 (5), 2176-2178. doi: 10.1017/S0033291722002439
Mostafazadeh, P., Sotoudehasl, N., & Ghorbani, R. (2024). Comparing the Effectiveness of Acceptance and Commitment Therapy and Metacognitive Therapy on Psychological Well-being in Women With Generalized Anxiety Disorder. doi: 10.1080/10503307.2023.2174789
Naeinian, M. R., Shaeiri, M. R., Sharif, M., & Hadian, M. (2011). To Study Reliability and Validity for A Brief Measure for Assessing Generalized Anxiety Disorder (GAD-7). Clinical Psychology & Personality, 2 (4), 41-50. doi: 10.22037/jcp.v2i4.4669
Nameni, G., Jazayeri, S., Salehi, M., Esrafili, A., Hajebi, A., & Motevalian, S. A. (2024). Association between visceral adiposity and generalized anxiety disorder (GAD). BMC psychology , 12 (1), 49. doi: 10.1186/s40359-024-00958-x
Narimani, M., Pourabdol, S., & Basahrpoor, S. (2016). The effectiveness of acceptance/ commitment training to decrease social anxiety in students with specific learning disorder. Journal of learning disabilities, 6(1), 121-140.
Nikonejad, N., Khoshli, A. K., & Hosseinaei, A. (2024). Comparison of Effectiveness of Compassion-Focused Therapy (CFT) and Acceptance and Commitment Therapy (ACT) on Affect Control (Anger, depressed mood, anxiety, positive emotion) of Women with Multiple Sclerosis (MS). Journal of Research in Psychopathology , 6 (1), 23-32. doi: 10.22098/jrp.2022.10443.1074
Ong, C. W., Barthel, A. L., & Hofmann, S. G. (2024). The relationship between psychological inflexibility and well-being in adults: a meta-analysis of the Acceptance and Action Questionnaire. Behavior Therapy , 55 (1), 26-41. doi: 10.1016/j.beth.2023.10.001
Özdemir, İ. (2021). The mediating role of mindfulness, psychological flexibility, experiential avoidance and cognitive flexibility on the relationship between childhood trauma and somatization (Master's thesis, İzmir Ekonomi Üniversitesi). doi: 10.13140/RG.2.2.22249.38241
Pourabdol, S., Sobhigharamaleki, N., Bastami, M., & Ghazanfari, H. (2016). The effect of acceptance and commitment therapy in decreasing academic procrastination among students with specific learning disorder (SLD). Biquarterly Journal of Cognitive Strategies in Learning , 4 (6), 157-170. doi: 10.22084/j.psychogy.2016.1466
Qiu, H., Lu, H., Wang, X., Guo, Z., Xing, C., & Zhang, Y. (2024). A moderated chain mediation model examining the relation between smartphone addiction and intolerance of uncertainty among master's and PhD students. Heliyon , 10 (10). doi: 10.1016/j.heliyon.2024.e04991
Roy, A., Hoge, E. A., Abrante, P., Druker, S., Liu, T., & Brewer, J. A. (2021). Clinical efficacy and psychological mechanisms of an app-based digital therapeutic for generalized anxiety disorder: randomized controlled trial. Journal of Medical Internet Research , 23 (12), e26987. doi: 10.2196/26987
Ruiz, F. J. (2014). Psychological inflexibility mediates the effects of self-efficacy and anxiety sensitivity on worry. The Spanish journal of psychology, 17. doi: 10.1017/sjp.2014.100
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. doi: 10.1037/pst0000334
Sanabria-Mazo, J. P., Colomer-Carbonell, A., Borràs, X., Castaño-Asins, J. R., McCracken, L. M., Montero-Marin, J., ... & Luciano, J. V. (2023). Efficacy of videoconference group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for chronic low back pain (CLBP) plus comorbid depressive symptoms: a randomized controlled trial (IMPACT study). The Journal of Pain , 24 (8), 1522-1540. doi: 10.1016/j.jpain.2023.04.001
Schlager, A. (2023). Examining the Relationship Between Ambiguous Situations, Intolerance of Uncertainty, and Aggression (Doctoral dissertation, Alliant International University). doi: 10.48550/arXiv.2304.01287
Shah, A. Q., Prasad, D., Caropreso, L., Frey, B. N., & de Azevedo Cardoso, T. (2023). The comorbidity between Borderline Personality Disorder (BPD) and Generalized Anxiety Disorder (GAD): A systematic review and meta-analysis. Journal of psychiatric research , 164 , 304-314. doi: 10.1016/j.jpsychires.2023.03.011
Shi, C., Chen, W., Huang, J., & Ren, Z. (2024). Cognitive Fusion and Experiential Avoidance Sequentially Mediate the Relationship Between Cyber Victimization and Depression in Adolescents. The Journal of Early Adolescence , 44 (4), 517-537. doi: 10.1177/02724316231153259
Somaini, G., Kingston, J., & Taylor, M. D. (2023). Web-based Acceptance and Commitment Therapy (ACT) for adults with type 1 diabetes: A single case experimental design (SCED). Journal of Contextual Behavioral Science , 29 , 33-45. doi: 10.1016/j.jcbs.2023.03.003
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. doi: 10.1001/archinte.166.10.1092
Wang, S., Zhang, Y., Zhang, Y., & Sun, Y. (2024). The effect of intolerance of uncertainty on smartphone addiction: a moderated mediation model of self-regulatory fatigue and feeling of the passage of time. Current Psychology , 1-13. doi: 10.1007/s12144-023-04851-1
Wetherell, J. L., Liu, L., Patterson, T. L., Afari, N., Ayers, C. R., Thorp, S. R., . . . Sorrell, J. T. (2011). Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report. Behavior therapy, 42 (1), 127-134. doi: 10.1016/j.beth.2010.02.003
Wicksell, R. K., Olsson, G. L., & Hayes, S. C. (2010). Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash. European Journal of Pain, 14 (10), 1059. e1051-1059. e1011. doi: 10.1016/j.ejpain.2010.05.001
Xiong, A., Lai, X., Wu, S., Yuan, X., Tang, J., Chen, J., ... & Hu, M. (2021). Relationship between cognitive fusion, experiential avoidance, and obsessive–compulsive symptoms in patients with obsessive–compulsive disorder. Frontiers in Psychology , 12 , 655154. doi: 10.3389/fpsyg.2021.655154
Zarei, A., Saadipour, I., Dortaj, A., & Asadzadeh, H. (2024). The effectiveness of acceptance and commitment based therapy on students' self-efficacy beliefs and academic vitality. Journal of Psychological Science , 23 (134), 287-0. doi: 10.22037/jps.v23i134.28367
Zhou, Y., Luo, Y., Zhang, N., & Liu, S. (2024). Ten years of researches on generalized anxiety disorder (GAD): a scientometric review. Current Psychology , 1-16. doi: 10.1007/s12144-023-04852-0
آمار
تعداد مشاهده مقاله: 1,278
تعداد دریافت فایل اصل مقاله: 1,194
