Transactions on Data Analysis in Social Science

Transactions on Data Analysis in Social Science

The Effect of Acceptance and Commitment Therapy (ACT) on Depression in University Students Considering Their Level of Psychospiritual Development: A Single-Case Study

Document Type : Original Article

Authors
1 Department of Psychology, Tarbiat Modares University, Tehran, Iran
2 Associate Professor, Department of Psychology, Tarbiat Modares University, Tehran, Iran
3 Associate Professor, Psychology Department, Hozeh and University Research Institute, Qom, Iran
Abstract
Depression is one of the most prevalent mental disorders, making the selection of effective treatment approaches critically important. Given the role of spirituality in depression and its treatment, this study aimed to examine the impact of individuals’ psychospiritual development on the effectiveness of Acceptance and Commitment Therapy (ACT) using a single-case study design. Four students diagnosed with major depression were selected from Tarbiat Modares University through convenience sampling. Based on the Psychospiritual Development Scale [1], participants were divided into two groups of two individuals each: high psychospiritual development and low psychospiritual development. Each participant received ACT tailored to their respective level of psychospiritual development. Depression scores were measured using the Beck Depression Inventory before, during, and after the intervention, as well as at a three-month follow-up. Changes were evaluated using improvement percentages and effect sizes. The results indicated that ACT effectively reduced depression in students; however, its impact was greater in students with lower levels of psychospiritual development. These findings suggest that considering the psychospiritual development level of clients is crucial when selecting an appropriate therapeutic approach.
Keywords

  • Jan Bozorgi, M. (2018). Multidimensional spiritual therapy: A God-centered approach (1st ed.). Qom: Research Institute of Hawzah and University.
  • Kessler, R. C., & Bromet, E. J. (2013). The epidemiology of depression across cultures. Annual Review of Public Health, 34, 119–138. https://doi.org/10.1146/annurev-publhealth-031912-114409
  • World Health Organization. (2016). Depression. http://www.who.int/mediacentre/factsheets/fs369/en/
  • Moore, R. C., & Garland, A. (2003). Cognitive therapy for chronic and persistent depression. John Wiley & Sons Ltd. https://doi.org/10.1002/9780470713495
  • Everett, L., & Worthington, Jr., E. L. (2005). Handbook of forgiveness. New York: Routledge.
  • Murphy, P. E., Ciarrocchi, J. W., Piedmont, R. L., Cheston, S., Peyrot, M., & Fitchett, G. (2000). The relation of religious belief and practices, depression, and hopelessness in persons with clinical depression. Journal of Consulting and Clinical Psychology, 68(6), 1102–1106. https://doi.org/10.1037/0022-006X.68.6.1102
  • Forootani, M. R. (2005). A study of depression in university students. Iranian Nursing Quarterly, 18(41–42), 123–130.
  • Sorajjakool, S., Aja, V., Chilson, B., Ramirez-Johnson, J., & Earll, A. (2008). Disconnection, depression and spirituality: A study of the role of spirituality and meaning in the lives of individuals with severe depression. Pastoral Psychology, 56, 521–532. https://doi.org/10.1007/s11089-008-0125-2
  • Hodges, S. (2002). Mental health, depression, and dimensions of spirituality and religion. Journal of Adult Development, 9(2), 109–115. https://doi.org/10.1023/A:1015733329006
  • McCullough, H. G. K., & Larson, D. B. (1999). Religion and depression: A review of the literature. Twin Research, 2(2), 126–136. https://doi.org/10.1375/twin.2.2.126
  • Pargament, K. (1990). God help me: Religious coping efforts as predictors of the outcomes to significant negative life events. American Journal of Community Psychology, 18, 793–824. https://doi.org/10.1007/BF00938065
  • Phillips, R. E., Pargament, K. I., Lynn, O. K., & Crossley, C. D. (2004). Self-directing religious coping: A deistic God, abandoning God, or no God at all? Journal for the Scientific Study of Religion, 43(3), 409–418. https://doi.org/10.1111/j.1468-5906.2004.00243.x
  • Knox, S., Catlin, L. A., Casper, M., & Schlosser, L. Z. (2005). Addressing religion and spirituality in psychotherapy: Clients' perspectives. Psychotherapy Research, 15(3), 287–303. https://doi.org/10.1080/10503300500090894
  • Genia, V. (1996). I, E, Quest, and fundamentalism as predictors of psychological and spiritual well-being. Journal for the Scientific Study of Religion, 35(1), 56–64. https://doi.org/10.2307/1386395
  • Genia, V. (2000). Religious issues in secularly based psychotherapy. Counseling & Values, 44(3), 213–221. https://doi.org/10.1002/j.2161-007X.2000.tb00173.x
  • Richards, P. S., Bartz, J. D., & O'Grady, K. A. (2009). Assessing religion and spirituality in counseling: Some reflections and recommendations. Counseling and Values, 54, 65–79. https://doi.org/10.1002/j.2161-007X.2009.tb00005.x
  • Williams, V. (2017). Exploring religion and spirituality in psychological therapy (Master's thesis, University of Leicester).
  • Jan Bozorgi, M. (2008). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Islamic Studies and Psychology, 2(3), 7–45.
  • Jan Bozorgi, M., Fakher, H., & Jan Bozorgi, A. (2011). Assessing spiritual-psychological development in therapists of religious clients. Islamic Studies and Psychology, 5(8), 49–70.
  • Goedde, C. (2001). A qualitative study of the client's perspectives of discussing spiritual and religious issues in therapy. Dissertation Abstracts International, 61(9), 4983B. (UMI No. 9985193)
  • Mayers, C., Leavey, G., Vallianatou, C., & Barker, C. (2007). How clients with religious or spiritual beliefs experience psychological help-seeking and therapy: A qualitative study. Clinical Psychology and Psychotherapy, 14, 317–327. https://doi.org/10.1002/cpp.542
  • Hayes, S. C., & Strosahl, K. D. (2010). A practical guide to Acceptance and Commitment Therapy. New York: Springer.
  • Robyn, D., Walser, D. W., Garvert, E., Karlin, M., Trocke, L., & Danielle, M. (2015). Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in veterans. Behavior Research and Therapy, 74, 5–31. https://doi.org/10.1016/j.brat.2015.08.012
  • Ruiz, F. (2012). Acceptance and Commitment Therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence. International Journal of Psychology and Psychological Therapy, 12(3), 333–357.
  • Azizi, A., & Ghasemi, S. (2017). Comparing the effectiveness of solution-focused therapy, cognitive-behavioral therapy, and Acceptance and Commitment Therapy on depression and quality of life in divorced women. Culture of Counseling and Psychotherapy Quarterly, 8(29), 207–236.
  • Vakili, Y., Gharraee, B., Habibi, M., Lavasani, F., & Rasoolian, M. (2014). The comparison of the effectiveness of Acceptance and Commitment Therapy with selective serotonin reuptake inhibitors and their combination in adults with obsessive-compulsive disorder. Zahedan Journal of Research in Medical Sciences, 16(Suppl 1), 10–14.
  • Twohig, M. P., & Whittal, M. L. (2008). An evaluation of mechanisms of action in ACT, CT, and RFT forced. Paper presented at the Annual Conference of the Association for Behavior Analysis, May 4–7, Chicago, IL.
  • Peterson, B. D., & Eifert, G. H. (2011). Using Acceptance and Commitment Therapy to treat infertility stress. Cognitive and Behavioral Practice, 18(4), 577–587. https://doi.org/10.1016/j.cbpra.2010.03.004
  • Alavizadeh, F., & Shakerian, A. (2017). The effectiveness of Acceptance and Commitment Therapy on reducing stress, anxiety, and depression in married women experiencing emotional-sexual infidelity. International Journal of Psychiatry and Nursing, 4(6), 8–14. https://doi.org/10.21859/ijpn-04063
  • Ogels, B. M., Lunnen, K. M. Q., & Bonesteel, K. (2001). Clinical significance: History, application, and current practice. Clinical Psychology Review, 21(3), 421–446. https://doi.org/10.1016/S0272-7358(99)00058-6
  • Ferguson, C. J. (2009). An effect size primer: A guide for clinicians and researchers. Professional Psychology: Research and Practice, 40(5), 532–538. https://doi.org/10.1037/a0015808
  • Rajabi, S., & Yazdkhasti, S. (2014). Effectiveness of group Acceptance and Commitment Therapy on anxiety and depression in women with multiple sclerosis. Clinical Psychology, 6(1), 29–38.
  • Deljo, Z., Jan Bozorgi, M., Bazazian, S., & Mousavi, E. (2013). The relationship between spiritual-psychological development, loneliness, and existential anxiety in students. Islamic Studies and Psychology, 7(13), 5–24.
  • Eifert, G. H., & Forsyth, J. P. (2011). The application of Acceptance and Commitment Therapy to problem anger. Cognitive and Behavioral Practice, 18, 41–250. https://doi.org/10.1016/j.cbpra.2010.04.004
  • Zettle, R. D. (2015). Acceptance and Commitment Therapy for depression. Current Opinion in Psychology, 2, 65–69. https://doi.org/10.1016/j.copsyc.2014.11.011
  • Har, M., Aghaei, A., Abedi, A., & Attari, A. (2013). The effect of Acceptance and Commitment Therapy on depression in patients with type 2 diabetes. Journal of Behavioral Sciences Research, 11(2), 121–128.
  • Hayes, L., Boyd, C. P., & Sewell, J. (2011). Acceptance and Commitment Therapy for the treatment of adolescent depression: A pilot study in a psychiatric outpatient setting. Mindfulness, 2, 86–94. https://doi.org/10.1007/s12671-011-0046-5
  • Tayyebi Naeini, P. N., Mohammakhani, Sh., Akbari, M., & Abedi, M. R. (2017). The effect of Acceptance and Commitment Therapy on psychological flexibility in children with obsessive-compulsive disorder. Child Mental Health Quarterly, 4(3), 91–107.
  • McCracken, L. M., & Martínez, O. G. (2011). Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy. Behaviour Research and Therapy, 49, 267–274. https://doi.org/10.1016/j.brat.2011.02.004
  • Katio, T. (2016). Relationship between coping flexibility and the risk of depression in Indian adults. Asian Journal of Psychiatry, 24, 130–134. https://doi.org/10.1016/j.ajp.2016.09.008
  • Folke, F., Parling, T., & Melin, L. (2012). Acceptance and Commitment Therapy for depression: A preliminary randomized clinical trial for unemployed on long-term sick leave. Cognitive and Behavioral Practice, 19(4), 583–594. https://doi.org/10.1016/j.cbpra.2012.01.002
  • Folke, F., & Parling, T. (2004). Acceptance and Commitment Therapy in group format for individuals who are unemployed and on sick leave suffering from depression: A randomized controlled trial. Unpublished paper, Uppsala University, Sweden.
  • Hayes, S. C., Strosahl, K. D., & Wilson, K. (2008). Measuring experiential avoidance: A preliminary test of a working model. Psychological Record, 54, 553–378.
  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. C., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological flexibility and acceptance. Behavior Therapy, 42, 676–688. https://doi.org/10.1016/j.beth.2011.03.007
  • Dennis, J. P., & Vander Wal, J. S. (2010). The development and estimates of reliability and validity of the Cognitive Flexibility Inventory: Instrument. Cognitive Therapy and Research, 34(3), 241–253. https://doi.org/10.1007/s10608-009-9276-4
Volume 4, Issue 4
Autumn 2022
Pages 164-173

  • Receive Date 04 August 2022
  • Revise Date 05 October 2022
  • Accept Date 02 November 2022