Clinical Psychology: Research and Practice Innovations

Clinical Psychology: Research and Practice Innovations"

Comparing the effectiveness of acceptance and commitment therapy with its online version on psychological flexibility and psychological distress of women affected by marital infidelity

Document Type : Original Article

Authors
Najmeh Hamid 1
Sahar Esmaeili 2
seyed Ali Marashi 3
1 Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
2 PhD student in Psychology, Faculty of Educational Sciences and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
3 Associate Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
10.22075/jcp.2025.34425.2912
Abstract
Introduction: The aim of the research was to compare the effectiveness of acceptance and commitment therapy with its online version on psychological flexibility and psychological disturbance of women affected by marital infidelity. Method: The present research was conducted as a semi-experimental study with three groups and in three phases: pre-test-post-test-follow-up. The statistical population included women affected by marital infidelity who had referred to psychological counseling centers under welfare supervision in Shiraz city in 2022. 45 people were selected as a statistical sample using the available sampling method. The control group did not receive any intervention. The face-to-face group underwent 8 sessions of therapy based on acceptance and commitment. A site was designed for the internet group, which was provided to them based on acceptance and commitment therapy in 8 sessions. Dennis and Vanderwaal (2010) cognitive flexibility and Kessler (2003) psychological distress questionnaires were used. Analysis of covariance and Bonferroni were used to analyze the findings. Resullts: Both face-to-face and online methods of therapy based on acceptance and commitment were effective on psychological flexibility and psychological disturbance of women affected by marital infidelity. No significant difference was observed between the effectiveness of face-to-face and online methods of treatment based on acceptance and commitment on psychological flexibility and psychological disturbance. Conclusion: Treatment based on acceptance and commitment can be of great help in helping couples affected by marital infidelity.
Keywords
acceptance and commitment therapy
psychological flexibility
psychological distress
marital infidelity
Subjects

  1. منابع

    1. Scheeren P, Apellániz ID, Wagner A. Marital infidelity: The experience of men and women. Trends in Psychology. 2018, 26:355-69.
    2. Dortaj F, Rajabiyan M, Fatolahi F, Dortaj F. The relationship between the rate of using virtual social networks with loneliness and marital infidelity in students. Educational Psychology. 2018 Mar 21;14(47):119-40.
    3. Vangelisti AL, Gerstenberger M. Communication and marital infidelity. InThe state of affairs 2014 Apr 8 (pp. 59-78). Routledge.
    4. Bashirpour M, ShafiAbadi A, Dokaneii F. Psychometric properties of the scale of marital infidelity. PSYCHOMETRY. 2018 May 22;6(24):37-55.
    5. Eskandari M, Parandin SH. Predicting Attitudes Toward Marital Infidelity Based on Components of Sexual Satisfaction and Intimacy in Couples. The Women and Families Cultural-Educational. 2022 Apr 21;17(58):183-99.
    6. Forster P, Hohoff C, Dunkelmann B, Schürenkamp M, Pfeiffer H, Neuhuber F, Brinkmann B. Elevated germline mutation rate in teenage fathers. Proceedings of the Royal Society B: Biological Sciences. 2015 Mar 22;282(1803):20142898.
    7. Youngblood KJ. Surviving the affair: A qualitative phenomenological case study of the strategies couples utilize to repair their marriage successfully after the occurrence of infidelity. 2022.
    8. Samadi Kashan S, Pourghnad M. Marital infidelity: Exploring views, factors and consequences. Rooyesh-e-Ravanshenasi Journal (RRJ). 2019 Jul 10;8(4):165-76.
    9. Fazel Hamedani N, Ghorban Jahromi R. Effectiveness of group therapy using transactional analysis (TA) on cognitive emotion regulation and marital intimacy of betrayed women. Journal of psychologicalscience. 2018 Dec 10;17(70):745-53.
    10. Wusu O. The Potency of Religious Influence on Marital Sexual Infidelity: Evidence from Demographic and Health Surveys in Ghana and Nigeria. Sexuality & Culture. 2022 Oct;26(5):1804-18.
    11. Fincham FD, May RW. Infidelity in romantic relationships. Current opinion in psychology. 2017 Feb 1;13:70-4.
    12. Okere RO, Ubani SN. Rapid increase of infidelity among married women in Nigeria-causes and effects: Implication for counselling. European Journal of Education Studies. 2020 Sep 18;7(10).
    13. Karbasion M, MOUSAVI SM, Shojaei M, Shabahang R, Bagheri SF. The effectiveness of group therapy based on acceptance and commitment on metacognitive beliefs and psychological flexibility of women damaged by marital infidelity. 2020. [Persian]
    14. Safa S, Noorani RA, Jalali B, Fekri ZJ, Gili S. The Role of Psychological Flexibility, Acceptance, and Commitment in Marital Adjustment Among Couples. Applied Family Therapy Journal (AFTJ). 2024 Mar 1;5(1):147-54.
    15. Zanganeh Parsa F, Hobbi MB. Testing the Mediating Role of Cognitive Flexibility in the Relationship between Psychological Capital and Distress Tolerance in Couples Suffering from Marital Infidelity. The Women and Families Cultural-Educational. 2021 Feb 19;15(53):105-23.
    16. Wolff M, Mertens LJ, Walter M, Enge S, Evens R. The Acceptance/Avoidance-Promoting Experiences Questionnaire (APEQ): A theory-based approach to psychedelic drugs’ effects on psychological flexibility. Journal of Psychopharmacology. 2022 Mar;36(3):387-408.
    17. Khazaei S, Bababei M. The role of cognitive flexibility and religious coping strategies in predicting divorce of women with betrayal experiences. Journal of Family Relations Studies. 2022 Mar 1;2(4):4-12.
    18. Khorshidi Gh, Dasht Bozorgi Z. The relationship between dark aspects of personality, sexual justice and psychological flexibility with marital burnout. Journal of Nursing Research. 2021;14(1):65-71. [Persian]
    19. Egan M, Daly M, Delaney L. Adolescent psychological distress, unemployment, and the Great Recession: Evidence from the National Longitudinal Study of Youth 1997. Social Science & Medicine. 2016 May 1;156:98-105.
    20. Narimani M, Nemati SM. The Relationship between Psychological Distress and Self-Esteem with Anthropometric Characteristics in Obese Children. SSU_Journals. 2020 Nov 15;28(9):3030-43. [Persian]
    21. Drapeau A, Marchand A, Beaulieu-Prévost D. Epidemiology of psychological distress. Mental illnesses-understanding, prediction and control. 2012 Jan 5;69(2):105-6.
    22. Arvidsdotter T, Marklund B, Kylén S, Taft C, Ekman I. Understanding persons with psychological distress in primary health care. Scandinavian journal of caring sciences. 2016 Dec;30(4):687-94.
    23. Abdul Halain A, Tang LY, Chong MC, Ibrahim NA, Abdullah KL. Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review. Journal of clinical nursing. 2022 Mar;31(5-6):497-507.
    24. Markkula N, Suvisaari J, Saarni SI, Pirkola S, Peña S, Saarni S, Ahola K, Mattila AK, Viertiö S, Strehle J, Koskinen S. Prevalence and correlates of major depressive disorder and dysthymia in an eleven-year follow-up–results from the Finnish Health 2011 Survey. Journal of affective disorders. 2015 Mar 1;173:73-80.
    25. Marchand A, Bilodeau J, Demers A, Beauregard N, Durand P, Haines III VY. Gendered depression: Vulnerability or exposure to work and family stressors?. Social science & medicine. 2016 Oct 1;166:160-8.
    26. Viertiö S, Kiviruusu O, Piirtola M, Kaprio J, Korhonen T, Marttunen M, Suvisaari J. Factors contributing to psychological distress in the working population, with a special reference to gender difference. BMC public health. 2021 Dec;21:1-7.
    27. Teymouri Z, Mojtabaei M, Rezazadeh SM. The effectiveness of emotionally focused couple therapy on emotion regulation, anger rumination, and marital intimacy in women affected by spouse infidelity. Caspian Journal of Health Research. 2020 Dec 10;5(4):78-82.
    28. Sadeghi M, Moheb N, Vafa MA. Effectiveness of Acceptance and Commitment Therapy (ACT) in Couple Burnout, Alexithymia, and Quality of Life of Women Affected by Marital Infidelity. Applied Family Therapy Journal (AFTJ). 2021 Sep 1;2(3):73-91.
    29. Biglan A, Hayes SC, Pistorello J. Acceptance and commitment: Implications for prevention science. Prevention science. 2008 Sep;9:139-52.
    30. Cristina PM, Marinella C, Tiziana M, Chiara M, De Pasquale C, Gianluca DO, Basile MS, Ezio D, Mario M, Elena C, Santo DN. Successfully aging. Choice of life or life that choices. Acta Med. 2018;34:107-11.
    31. Ramaci T, Bellini D, Presti G, Santisi G. Psychological flexibility and mindfulness as predictors of individual outcomes in hospital health workers. Frontiers in psychology. 2019 Jun 12;10:424153.
    32. Roemer L, Williston SK, Eustis EH, Orsillo SM. Mindfulness and acceptance-based behavioral therapies for anxiety disorders. Current Psychiatry Reports. 2013 Nov;15:1-0.
    33. Zangeneh A, Arefi M. Predicting the attitude towards marital infidelity based on conflict resolution styles, marital satisfaction and forgiveness of couples in Kermanshah city. Journal of Islamic-Iranian Family Studies. 2022;2(1):62-77.
    34. Hemmati M, Maddahi ME. Comparison the effectiveness of couple therapy based on schema therapy with couples therapy based on acceptance and commitment therapy on family resiliency of couples. Journal of Woman and Family Studies. 2018 Sep 23;6(2):145-63.
    35. Aminoff V, Sellen M, Sörliden E, Ludvigsson M, Berg M, Andersson G. Internet-based cognitive behavioral therapy for psychological distress associated with the COVID-19 pandemic: a pilot randomized controlled trial. Frontiers in psychology. 2021 Jun 14;12:684540.
    36. French K, Golijani-Moghaddam N, Schröder T. What is the evidence for the efficacy of self-help acceptance and commitment therapy? A systematic review and meta-analysis. Journal of Contextual Behavioral Science. 2017 Oct 1;6(4):360-74.
    37. Johnston M, Foster M, Shennan J, Starkey NJ, Johnson A. The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain. The Clinical journal of pain. 2010 Jun 1;26(5):393-402.
    38. Köhle N, Drossaert CH, Schreurs KM, Hagedoorn M, Verdonck-de Leeuw IM, Bohlmeijer ET. A web-based self-help intervention for partners of cancer patients based on Acceptance and Commitment Therapy: a protocol of a randomized controlled trial. BMC public health. 2015 Dec;15:1-3.
    39. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy. 2006 Jan 1;44(1):1-25.
    40. Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research. 2010 Jun;34:241-53.
    41. Fazeli M, Ehtshamzadeh Hashemi M, Sheikh A The effectiveness of cognitive-behavioral therapy on the cognitive flexibility of depressed people. Journal of Thought and Behavior. 2014; 9(34), 107-96. [Persian]
    42. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological medicine. 2002 Aug;32(6):959-76.
    43. Yaghubi H. Psychometric properties of the 10 questions Version of the Kessler Psychological Distress Scale (K-10). Applied Psychological Research Quarterly. 2016;6(4):45-57. [Persian]
    44. Bidaki ZZ, Jahangiri MM. Effectiveness of acceptance and commitment-based therapy on psychological flexibility among mothers with autistic children. Journal of Arak University of Medical Sciences. 2019;21(7):39-47.
    45. Shiralinia K, ABDOLLAHI MUSAVI H, KHojastemehr R. The effectiveness of of Group Acceptance and Commitment Therapy (ACT)-Based Training on Parenting Stress and Psychological Flexibility in Mothers of Children with Autism Spectrum Disorderr. Psychology of exceptional individuals. 2018 Feb 20;7(28):21-44. [Persian]
    46. Jones L, Gold E, Totsika V, Hastings RP, Jones M, Griffiths A, Silverton S. A mindfulness parent well-being course: Evaluation of outcomes for parents of children with autism and related disabilities recruited through special schools. European Journal of Special Needs Education. 2018 Jan 1;33(1):16-30.
    47. Macri JA, Rogge RD. Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review. Clinical Psychology Review. 2024 Apr 10:102432.
    48. Ghorbani V, Zanjani Z, Omidi A, Sarvizadeh M. Efficacy of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer: a pre-and post-test clinical trial. Trends in psychiatry and psychotherapy. 2021 Jul 7;43:126-33.
    49. Lewin RK, Acuff SF, Berlin KS, Berman JS, Murrell AR. Group-based acceptance and commitment therapy to enhance graduate student psychological flexibility: Treatment development and preliminary implementation evaluation. Journal of American College Health. 2023 Jan 2;71(1):162-71.
    50. García-Torres F, Gómez-Solís Á, Rubio García S, Castillo-Mayén R, González Ruíz-Ruano V, Moreno E, Moriana JA, Luque-Salas B, Jaén-Moreno MJ, Cuadrado-Hidalgo F. Efficacy of a combined acceptance and commitment intervention to improve psychological flexibility and associated symptoms in cancer patients: study protocol for a randomized controlled trial. Frontiers in Psychology. 2022 May 18;13:871929.
    51. Jansen JE, Morris EM. Acceptance and commitment therapy for posttraumatic stress disorder in early psychosis: A case series. Cognitive and Behavioral Practice. 2017 May 1;24(2):187-99.
    52. Hadian S, Hosseinzadeh Taghvaei M, Havasi Soomar N, Ebrahimi MI, Ranjbaripour T. Comparing the Effectiveness of Acceptance and Commitment Therapy and Reality Therapy on Psychological Flexibility and Responsibility in Divorced Women. Avicenna Journal of Neuro Psycho Physiology. 2023 May 10;10(2):73-80.
    53. Lee SW, Kim S, Lee S, Seo HS, Cha H, Chang Y, Lee SJ. Neural mechanisms of acceptance-commitment therapy for obsessive-compulsive disorder: a resting-state and task-based fMRI study. Psychological Medicine. 2024 Jan;54(2):374-84.
    54. Bennett R, Oliver J. Acceptance and commitment therapy: 100 key points and techniques. Routledge; 2019 Mar 27.
    55. Tyndall I, Waldeck D, Pancani L, Whelan R, Roche B, Pereira A. Profiles of psychological flexibility: A latent class analysis of the acceptance and commitment therapy model. Behavior Modification. 2020 May;44(3):365-93.
    56. Zamani Froshani Z, Dokaneifard F, Niknam M. The efficacy of acceptance and commitment therapy on psychological distress and dysfunctional attitudes. Journal of psychologicalscience. 2023 Aug 10:911-26.
    57. Evans S, Olive L, Dober M, Knowles S, Fuller-Tyszkiewicz M, Eric O, Gibson P, Raven L, Gearry R, McCombie A, Van Niekerk L. Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme. BMJ open. 2022 Jun 1;12(6):e060272.
    58. Sander AM, Clark AN, Arciniegas DB, Tran K, Leon-Novelo L, Ngan E, Bogaards J, Sherer M, Walser R. A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury. Neuropsychological rehabilitation. 2021 Aug 9;31(7):1105-29.
    59. Rahnama M, Sajjadian I, Raoufi A. The effectiveness of acceptance and commitment therapy on psychological distress and medication adherence of coronary heart patients. Iranian Journal of Psychiatric Nursing. 2017 Oct 10;5(4):34-43.
    60. Sheibani H, Sheibani KA, Amreei NN, Masrour MJ. An investigation of the effects of the acceptance and commitment therapy in groups on the cognitive strategies of emotion regulation and self-control in coronary heart disease patients. Journal of Medicine and Life. 2019 Oct;12(4):361.
    61. Flaxman PE, Blackledge JT, Bond FW. Acceptance and commitment therapy: Distinctive features. Routledge; 2010 Nov 16.
    62. Wersebe H, Lieb R, Meyer AH, Hofer P, Gloster AT. The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. International journal of clinical and health psychology. 2018 Jan 1;18(1):60-8.
    63. Hadian S, Havasi Soomar N, Hosseinzadeh Taghvaei M, Ebrahimi MI, Ranjbaripour T. THE EFFECTIVENESS OF TREATMENT BASED ON ACCEPTANCE AND COMMITMENT ON PSYCHOLOGICAL FLEXIBILITY AND SELF EFFICACY OF DIVORCED WOMEN. Studies in Medical Sciences. 2023 Aug 10;34(5):290-8. [Persian]
    64. Molander P, Hesser H, Weineland S, Bergwall K, Buck S, Jäder Malmlöf J, Lantz H, Lunner T, Andersson G. Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial. Cognitive Behaviour Therapy. 2018 4;47(2):169-84.
    65. Han A, Kim TH. Efficacy of internet-based acceptance and commitment therapy for depressive symptoms, anxiety, stress, psychological distress, and quality of life: Systematic review and meta-analysis. Journal of Medical Internet Research. 2022 Dec 9;24(12):e39727.

    Prudenzi A, Graham CD, Flaxman PE, Wilding S, Day F, O’Connor DB. A workplace Acceptance and Commitment Therapy (ACT) intervention for improving healthcare staff psychological distress: A randomised controlled trial. PloS one. 2022 Apr 20;17(4):e0266357

  • Receive Date 12 June 2024
  • Revise Date 10 January 2025
  • Accept Date 26 May 2025
  • First Publish Date 26 May 2025
  • Publish Date 21 March 2025