Volume 12, Issue 2 (June 2025)                   Health Spiritual Med Ethics 2025, 12(2): 95-104 | Back to browse issues page


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Maldar Z, Shahabizadeh F, Ahi G. Effect of Acceptance and Commitment Therapy on Emotional Flexibility and Spiritual Distress of Women With Chronic Back Pain. Health Spiritual Med Ethics 2025; 12 (2) :95-104
URL: http://jhsme.muq.ac.ir/article-1-560-en.html
1- Department of Psychology, Faculty of Psychology and Educational Sciences, Birjand Branch, Islamic Azad University, Birjand, Iran., Department of Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran
2- Department of Psychology, Faculty of Psychology and Educational Sciences, Birjand Branch, Islamic Azad University, Birjand, Iran., Department of Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran , f_shahabizadeh@yahoo.com
Abstract:   (885 Views)
Background and Objectives: Chronic back pain imposes a heavy burden on individuals, families, societies, and governments from medical, psychological, social, and economic perspectives, and is a common, recurrent, and costly problem worldwide. Therefore, the present study aimed to determine the effect of acceptance and commitment therapy on emotional flexibility and spiritual distress in women with chronic back pain. 
Methods: This quasi-experimental study used a pre-test-post-test design with a control group. The research population included all women suffering from chronic back pain who were referred to the super-specialized pain clinics of Razavi and Imam Reza hospitals in Mashhad City, Iran, in 2023, of whom 20 qualified participants volunteered to participate in the study. They were selected using convenience sampling and randomly assigned to two groups (ten in the experimental and ten in the control group). The experimental group underwent eight 90-minute face-to-face sessions over two months, and the control group received the usual intervention. The data collection tools included the Emotional Flexibility questionnaire by Rashid and Bayat (2018) and the Spiritual Distress questionnaire by Ko et al. (2010). Data were analyzed using SPSS software version 24 employing multivariate and univariate analysis of covariance at a significance level of α=0.05. 
Results: after controlling for the pre-test effect, there was a significant difference between the post-test means of emotional flexibility (positive emotional regulation, negative emotional regulation, and emotional communication) and spiritual distress (communication with self, communication with others, communication with God, and facing death) in the experimental and control groups (P<0.01). 
Conclusion: Acceptance and commitment-based treatment significantly increased emotional flexibility (positive emotional regulation, negative emotional regulation, and emotional communication) and improved spiritual distress (communication with self, communication with others, communication with God, and facing death) in women with chronic back pain. 
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Type of Study: Original Article | Subject: General
Received: 2024/01/30 | Accepted: 2025/02/1 | Published: 2025/02/28

References
1. Van Hoof W, O'Sullivan K, O'Keeffe M, Verschueren S, O'Sullivan P, Dankaerts W. The efficacy of interventions for low back pain in nurses: A systematic review. Int J Nurs Stud. 2018; 77:222-31. [DOI:10.1016/j.ijnurstu.2017.10.015] [PMID] [DOI:10.1016/j.ijnurstu.2017.10.015]
2. Edge R, Mills R, Tennant A, Diggle PJ, Young CA; TONiC study group. Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature. J Neurol. 2020; 267(3):607-15. [DOI:10.1007/s00415-019-09615-3] [PMID] [DOI:10.1007/s00415-019-09615-3]
3. Vizzotto ADB, de Oliveira AM, Elkis H, Cordeiro Q, Buchain PC. Psychosocial characteristics. In: Gellman MD, editor. Encyclopedia of behavioral medicine. New York: Springer; 2020. [Link] [DOI:10.1007/978-1-4614-6439-6_918-2]
4. Horesh D, Hasson-Ohayon I, Harwood-Gross A. The contagion of psychopathology across different psychiatric disorders: A comparative theoretical analysis. Brain Sci. 2021; 12(1):67. [DOI:10.3390/brainsci12010067] [PMID] [DOI:10.3390/brainsci12010067]
5. Martins H, Caldeira S, Dias Domingues T, Vieira M, Ku YL. Validation of the spiritual distress scale in Portuguese cancer patients undergoing chemotherapy: A methodological study. Religions. 2019; 10(11):599. [DOI:10.3390/rel10110599] [DOI:10.3390/rel10110599]
6. Silva GCN, Reis DCD, Miranda TPS, Melo RNR, Coutinho MAP, Paschoal GDS, et al. Religious/spiritual coping and spiritual distress in people with cancer. Rev Bras Enferm. 2019; 72(6):1534-40. [DOI:10.1590/0034-7167-2018-0585] [PMID] [DOI:10.1590/0034-7167-2018-0585]
7. Rogers AH, Garey L, Allan NP, Zvolensky MJ. Exploring transdiagnostic processes for chronic pain and opioid misuse among two studies of adults with chronic pain. Behav Res Ther. 2021; 136:103786. [DOI:10.1016/j.brat.2020.103786] [PMID] [DOI:10.1016/j.brat.2020.103786]
8. Spidel A, Daigneault I, Kealy D, Lecomte T. Acceptance and commitment therapy for psychosis and trauma: Investigating links between trauma severity, attachment and outcome. Behav Cogn Psychother. 2019; 47(2):230-43. [DOI:10.1017/S1352465818000413] [PMID] [DOI:10.1017/S1352465818000413]
9. Fu F, Chow A, Li J, Cong Z. Emotional flexibility: Development and application of a scale in adolescent earthquake survivors. Psychol Trauma. 2018; 10(2):246-52. [DOI:10.1037/tra0000278] [PMID] [DOI:10.1037/tra0000278]
10. Teymoorpur S, Akbari M, Hasani J. [The evaluation of mechanism of Effectiveness of Behavioral Activation Therapy (BA) through cognitive flexibility and emotional flexibility on symptoms of women with major depressive disorders (Persian)]. J Cognitive Psychol. 2019; 6(4):1-13. [DOI:20.1001.1.23455780.1397.6.4.4.1]
11. Rashid K, Bayat ABA. pConstructing, validating and identifying factor structure of emotional flexibility scale in a sample of hamedan health-care centers clients (Persian)]. Razi J Med Sci. 2019; 26(6):13-24. [Link]
12. Ghiasabadi Farahani E, Jafari Harandi R. [Predict cognitive flexibility through social adjustment and responsibility among female students (Persian)]. Soc Psychol Res. 2021; 10(40):135-50. [DOI:10.22034/spr.2021.127718]
13. Ghodrati S, Taklavi S, Kazemi R. [The effectiveness of acceptance and commitment therapy on impulsivity and co-rumination in students with suicidal thoughts (Persian)]. Rooyesh-e-Ravanshenasi J. 2023; 12(10):171-80. [Link]
14. Ferreira MG, Mariano LI, Rezende JV, Caramelli P, Kishita N. Effects of group acceptance and commitment therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord. 2022; 309:297-308. [DOI:10.1016/j.jad.2022.04.134] [PMID] [DOI:10.1016/j.jad.2022.04.134]
15. Walser RD, O'Connell M. Alliance rupture and repair in acceptance and commitment therapy. In: Eubanks CF, Samstag LW, Muran JC, editors. Rupture and repair in psychotherapy: A critical process for change. Washington: American Psychological Association; 2023. [DOI:10.1037/0000306-008] [DOI:10.1037/0000306-008]
16. Bagheri Sheykhangafshe F, Farahani H, Fathi-Ashtiani A. The effectiveness of acceptance and commitment therapy on emotional regulation and psychological distress in patients with chronic low back pain and COVID-19 anxiety. Manage Strateg Health Syst. 2023; 7(4):380-91. [DOI:10.18502/mshsj.v7i4.12180] [DOI:10.18502/mshsj.v7i4.12180]
17. Soleimani R, Mirpour ZS, Sheikholeslami F, Khiali A, Rafiee E, Gholami A, et al. [The effectiveness of acceptance and commitment group therapy on pain in patients with chronic low back pain (Persian)]. Health Syst Res. 2022; 18(1):39-45. [DOI:10.48305/jhsr.v18i1.1446]
18. Danesh-Mirkohan RA, Taklavi S, Kazemi R. [Comparing the effectiveness of acceptance and commitment therapy with mindfulness based cognitive therapy, on self-control and emotional flexibility in women with compulsive buying (Persian)]. Rooyesh-e-Ravanshenasi J. 2021; 10(5):13-24. [DOI:20.1001.1.2383353.1400.10.5.10.8]
19. Azizi S, Rasool Zade Tabatabaie K, Janbozorgi M. Comparing the efficacy of acceptance and commitment therapy (ACT) with cognitive-behavioral therapy (CBT) on depression taking into account the level of psycho-spiritual development (Case Study). Clin Psychol Stud. 2019; 9(35):147-72. [DOI:10.22054/jcps.2019.35499.1963]
20. Babaee Z, Dehghani M, Babakhani B, Najafi-mehri S. [Challenges and lived experiences of patients who suffer from chronic back pain: A phenomenological study (Persian)]. Iran J Nurs Res. 2020; 15(4):43-57. [Link]
21. Oreizy H, Farahani H. [Applied research methods in counseling and clinical psychology (Persian)]. Tehran: Danjeh; 2008. [Link]
22. Ku YL, Kuo SM, Yao CY. Establishing the validity of a spiritual distress scale for cancer patients hospitalized in southern Taiwan. Int J Palliat Nurs. 2010; 16(3):134-8. [DOI:10.12968/ijpn.2010.16.3.47325] [PMID] [DOI:10.12968/ijpn.2010.16.3.47325]
23. Ghayour Kazemi F, Shahhabizadeh F, Safara M, Shahidsales S. [Comparing the effects of transdiagnostic intervention and mindfulness-based schema therapy on spiritual distress in women with breast cancer: A clinical trial (Persian)]. Health Spirit Med Ethics J. 2022; 9(2):1-12. [DOI:10.32598/hsmej.9.2.418.1] [DOI:10.32598/hsmej.9.2.418.1]
24. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change. New York: Guilford Press; 2011. [Link]
25. Arch JJ, Fishbein JN, Ferris MC, Mitchell JL, Levin ME, Slivjak ET, et al. Acceptability, feasibility, and efficacy potential of a multimodal acceptance and commitment therapy intervention to address psychosocial and advance care planning needs among anxious and depressed adults with metastatic cancer. J Palliat Med. 2020; 23(10):1380-5. [DOI:10.1089/jpm.2019.0398] [PMID] [DOI:10.1089/jpm.2019.0398]
26. Jamshidian QalehShahi P, Aghaei A, Golparvar M. [Comparing the effect of iranian positive therapy and acceptance -commitment therapy on depression, anxiety and stress of infertile women in Isfahan city (Persian)]. J Health Promot Manage. 2017; 6(5):8-16. [DOI:10.21859/jhpm-07032] [DOI:10.21859/jhpm-07032]
27. Siyadat S, Khajevand Khoshli A, Akbari H. Effectiveness of Acceptance and Commitment Therapy on Psychological Well-being and Spiritual Attitude in Mothers with Autistic Children. Iran J Rehabil Res Nurs. 2019; 5(4):58-64. [Link]
28. Nemati M, Dokaneheeifard F, Behboodi M. [Comparing effectiveness of acceptance and commitment therapy (ACT), emotion-focused therapy (EFT) and combining ACT & EFT in the spiritual well-being of couples referring to counseling centers in Sari: An semi-experimental study (Persian)]. J Pizhūhish dar dīn va Salāmat 2020; 6(1):87-99. [Link]
29. Myler CJ. Increasing psychological flexibility regarding interpersonal conflict between religious beliefs and attitudes towards sexual minorities: An Acceptance and Commitment Therapy (ACT) intervention [doctoral dissertation]. Logan: Utah State University; 2013. [DOI:10.26076/d319-f042]
30. Razmpush M, Ramezani K, Maredpour A, Koulivand PH. [The effect of acceptance and commitment training on quality of life and resilience of nurses (Persian)]. Neurosci J Shefaye Khatam. 2019; 7(1):62-51. [DOI:10.29252/shefa.7.1.62] [DOI:10.29252/shefa.7.1.62]
31. Harris R. ACT made simple: An easy-to-read primer on acceptance and commitment therapy. Oakland: New Harbinger Publications; 2019. [Link]
32. Mohammadizadeh S, Khalatbari J, Ahadi H, Hatami HR. Effectiveness of acceptance and commitment therapy on perceived stress, body image and quality of life in women with breast cancer. Sci J Soc Psychol. 2021; 8(57):87-100. [Link]

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