The Effectiveness of Acceptance and Commitment Therapy (ACT) on Cognitive Emotion Regulation and Life Quality of Women with Prolonged Grief Disorder from Cultural Perspective

Subject Areas : Psychology

Alireza Meftahi ¹ , Susan Emamipour ² , Fariba Hasani ³ , Mahmood Shafizadeh ⁴

1 - M.A., Department of Psychology, Faculty of Psychology and Educational Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
2 - Associate Professor, Department of Psychology, Faculty of Psychology and Educational Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
3 - Associate Professor, Department of Psychology, Faculty of Psychology and Educational Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
4 - PhD. Student, Department of Candidate in Health Psychology, Faculty of Educational Sciences and Psychology, Kharazmi University, Tehran, Iran

Received: 2025-04-07 Accepted : 2025-06-14 Published : 2025-06-22

Keywords: Acceptance and commitment therapy, Cognitive emotion regulation, Quality of life, Prolonged grief disorder,

Abstract :

This study was conducted with the aim of investigating the effectiveness of acceptance and commitment therapy on cognitive emotion regulation and life quality of women with prolonged grief disorder from cultural perspective. The statistical population enfolded all the women referring to counseling and treatment centers in the west of Tehran city in year 2023. The sample encompassed 30 females whom were selected via convenient sampling procedure and randomly assigned into two experimental and control groups 15 participants each. The research method was semi-experimental with a pre-test-post-test and a control group.  All the subjects responded to Prolonged Grief Disorder Symptoms (PG-13, 2021), Quality of Life 36-Item Short Form Survey (1992) and Cognitive Emotion Regulation Questionnaire (CERQ, 2002) before and after the intervention. The experimental group was exposed to acceptance and commitment therapy for 8 sessions,90 minutes each while the control group received none. The data were analyzed by applying multi variate and univariate analysis of covariance using SPSS-26 software. The results of data analysis showed that the intervention based on acceptance and commitment caused some significant variations in the scores of cognitive emotion regulation and life quality (P<0.05) of the participants in the experimental group compared to the control group. Based on the findings of the present study, it could be concluded that acceptance and commitment therapy was effective in improving the cognitive emotion regulation and the life quality of women with prolonged grief disorder, and it should be used as an effective and appropriate cultural intervention.

References:

American Psychiatric Association (APA). (2023). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR); American Psychiatric Association Publishing: Washington. DC, USA. URL: https://seragpsych.com/wordpress/wp-content/uploads/2019/02/DSM5Update_October2018
Ashiani, H., Atadokht, A., & Kiani, A. (2024). Risk factors of complicated grief in Iran: A qualitative study. Preventive Counseling, 5(2), 54-72. URL: https://doi.org/10.22098/jpc.2024.14897.1226
Breen, L. J., Aoun, S. M., O'Connor, M., Johnson, A. R., & Howting, D. (2020). Effect of caregiving at end of life on grief, quality of life and general health: A prospective, longitudinal, comparative study. Palliative medicine, 34(1), 145–154. URL: https://doi.org/10.1177/0269216319880766
Dehghani, N. (2022). Prolonged grief in DSM-5-TR: The role of emotional intelligence in survivors of COVID-19 deaths. Second National Conference on Clinical Child and Adolescent Psychology, Stockholm, Sweden. URL: https://civilica.com/doc/1579137
Dourandish, F., Roozban, S., Ebrahimi Meymand, F., Hashemipour, F. (2022). The effect of acceptance and commitment therapy on cognitive emotion regulation, mindfulness, and self-compassion in patients with major depression. Quarterly Journal of Nursing Management, 11(3), 1-11. URL: http://ijnv.ir/article-1-959-fa.html
Eisma, M. C., & Stroebe, M. S. (2021). Emotion Regulatory Strategies in Complicated Grief: A Systematic Review. Behavior therapy, 52(1), 234–249. URL: https://doi.org/10.1016/j.beth.2020.04.004
Fang, P., Tan, L., Cui, J., & Yu, L. (2023). Effectiveness of acceptance and commitment therapy for people with advanced cancer: A systematic review and meta-analysis of randomized controlled trials. Journal of Advanced Nursing, 79(2), 519–538. URL: https://doi.org/10.1111/jan.15543
Farhadi, A., Foroughan, M., & Mohammadi, F. (2011). The quality of life among rural elderlies a cross-sectional study. Iranian Journal of Ageing, 6(2), 38-46.‏ URL: http://salmandj.uswr.ac.ir/article-1-419-fa.html
Fooladvand, K. & Zarei, S. (2022). The effectiveness of acceptance and commitment therapy on cognitive emotion regulation strategies, body image, and resilience of infertile women. Health Psychology, 11(41), 121-134. DOI: 10.30473/hpj.2022.57718.5125
Garnefski, N., Kraaij, V., & Spinhoven, P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences, 30(8), 1311–1327. URL: https://doi.org/10.1016/S0191-8869(00)00113-6
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271
Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26. URL: https://doi.org/10.1080/1047840X.2014.940781
Han, A., & Kim, T. H. (2022). The effects of internet-based acceptance and commitment therapy on process measures: Systematic review and meta-analysis. Journal of Medical Internet Research, 24(8), e39182. URL: https://doi.org/10.2196/39182
Han, J., Liu, J.-E, Su, Y.-L., & Qiu, H. (2019). Effect of a group-based acceptance and commitment therapy (ACT) intervention on illness cognition in breast cancer patients. Journal of Contextual Behavioral Science, 14, 73–81. URL: https://doi.org/10.1016/j.jcbs.2019.09.003
Hasani, J. (2010). The psychometric properties of the cognitive emotion regulation questionnaire (CERQ). Journal of Clinical Psychology, 2(3), 73-84.‏ DOI: 10.22075/jcp.2017.2031
Hayes S. C. (2016). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies-republished article. Behavior Therapy, 47(6), 869–885. URL: https://doi.org/10.1016/j.beth.2016.11.006
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639–665. DOI: 10.1016/s0005-7894(04)80013-3
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. URL: https://doi.org/10.1016/j.brat.2005.06.006
Iwakabe, S., Nakamura, K., & Thoma, N. C. (2023). Enhancing emotion regulation. Psychotherapy Research, 33(7), 918–945. URL: https://doi.org/10.1080/10503307.2023.2183155
Jones, K., Methley, A., Boyle, G., Garcia, R., & Vseteckova, J. (2022). A systematic review of the effectiveness of acceptance and commitment therapy for managing grief experienced by bereaved spouses or partners of adults who had received palliative care. Illness, Crisis, & Loss, 30(4), 596–613. URL: https://doi.org/10.1177/10541373211000175
Koohikamali, Sh., Poursharifi, H, Sodagar, Sh., & Ashayeri, H. (2022). The effectiveness of acceptance and commitment therapy (ACT) on health-related quality of life in infertile women. Journal of Community Health, 15(4), 46-57. URL: https://sid.ir/paper/992660/fa
Kraft, L., Ebner, C., Leo, K., & Lindenberg, K. (2023). Emotion regulation strategies and symptoms of depression, anxiety, aggression, and addiction in children and adolescents: A meta-analysis and systematic review.Clinical Psychology: Science and Practice, 30(4), 485–502. URL: https://doi.org/10.1037/cps0000156
Levi-Belz, Y., & Ben-Yaish, T. (2022). Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics. International Journal of Environmental Research and Public Health, 19(17), 10545. URL: https://doi.org/10.3390/ijerph191710545
Maghsoudi, Z., Razavi, Z., Razavi, M., & Javadi, M. (2019). Efficacy of acceptance and commitment therapy for emotional distress in the elderly with type 2 Diabetes: A randomized controlled trial. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 12, 2137–2143. URL: https://doi.org/10.2147/DMSO.S221245
Moayedoddin, B., & Markowitz, J. C. (2015). Abnormal grief: should we consider a more patient-centered approach?. American Journal of Psychotherapy, 69(4), 361–378. URL: https://doi.org/10.1176/appi.psychotherapy.2015.69.4.361
Mohammadi, L., Salehzade Abarghoei, M., & Nasirian, M. (2015). Effectiveness of acceptance and commitment therapy on cognitive emotion regulation in men under methadone treatment. Journal of Shahid Sadoughi University of Medical Sciences, 23(9), 853-861.‏ URL: https://sid.ir/paper/36161/fa
Musanje, K., Camlin, C. S., Kamya, M. R., Vanderplasschen, W., Louise Sinclair, D., Getahun, M., Kirabo, H., Nangendo, J., Kiweewa, J., White, R. G., & Kasujja, R. (2023). Culturally adapting a mindfulness and acceptance-based intervention to support the mental health of adolescents on antiretroviral therapy in Uganda. PLOS Global Public Health, 3(3), e0001605. URL: https://doi.org/10.1371/journal.pgph.0001605
Palitsky, R., Wilson, D. T., Friedman, S. E., Ruiz, J. M., Sullivan, D., & O'Connor, M. F. (2023). The relationship of prolonged grief disorder symptoms with hemodynamic response to grief recall among bereaved adults. Psychosomatic Medicine, 85(6), 545–550. URL: https://doi.org/10.1097/PSY.0000000000001223
Panayiotou, G., Panteli, M., & Leonidou, C. (2021). Coping with the invisible enemy: The role of emotion regulation and awareness in quality of life during the COVID-19 pandemic. Journal of Contextual Behavioral Science, 19, 17–27. URL: https://doi.org/10.1016/j.jcbs.2020.11.002
Prigerson, H. G., Boelen, P. A., Xu, J., Smith, K. V., & Maciejewski, P. K. (2021). Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 20(1), 96–106. DOI: https://doi.org/10.1002/wps.20823
Rauwenhoff, J. C. C., Bol, Y., Peeters, F., van den Hout, A. J. H. C., Geusgens, C. A. V., & van Heugten, C. M. (2023). Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases. Neuropsychological Rehabilitation, 33(6), 1018–1048. DOI: https://doi.org/10.1080/09602011.2022.2053169
Shi, J. Y., Cao, Y. M., Luo, H. Y., Liu, S., Yang, F. M., & Wang, Z. H. (2023). Effect of a group-based acceptance and commitment therapy (ACT) intervention on self-esteem and psychological flexibility in patients with schizophrenia in remission. Schizophrenia Research, 255, 213–221. URL: https://doi.org/10.1016/j.schres.2023.03.042
Twohig, M. P. (2012). Acceptance and commitment therapy. Cognitive and Behavioral Practice, 19(4), 499–507. DOI: 10.1016/j.cbpra.2012.04.003
Valizadeh, H., & Ahmadi, V. (2021). The effectiveness of acceptance and commitment-based therapy on the quality of life and death anxiety in the elderly. Aging Psychology, 7(2), 153-166.‏ DOI: 10.22126/jap.2021.6370.1528
Ware Jr, J. E., & Sherbourne, C. D. (1992). The MOS 36-ltem short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473-483.‏ URL: https://pubmed.ncbi.nlm.nih.gov/1593914/
World Health Organization. (2023). WHO health workforce support and safeguards list 2023. World Health Organization. URL: https://books.google.com/books?hl=en&lr=&id=34wOEQAAQBAJ&oi=fnd&pg=PA1&dq=World+Health+Organization+(2023)++&ots=DltKB7H-OH&sig=iTo3XpG4RefroXXpcH4QgfzH5NM#v=onepage&q=World%20Health%20Organization%20(2023)&f=false
Yaraghchi, A., Jomehri, F., Seyrafi, M., Kraskian Mujembari, A., Mohammadi Farsani, G. (2019). The Effectiveness of Acceptance and Commitment Therapy on Weight Loss and Cognitive Emotion Regulation in Obese Individuals. Iranian Journal of Health Education and Health Promotion, 7(2), 192-201. URL: http://journal.ihepsa.ir/article-1-1125-en.html