Transactions on Data Analysis in Social Science

Transactions on Data Analysis in Social Science

Effectiveness of Acceptance and Commitment Therapy on Cognitive Flexibility and Body Image Concerns in Women with Breast Cancer

Document Type : Original Article

Author
Department of Industrial Engineering, University of Rome Tor Vergata, Italy
10.22034/tdas.2025.255663
Abstract
Appropriate psychological interventions aimed at promoting psychological well-being in patients with breast cancer are of considerable importance. The present study investigated the effectiveness of Acceptance and Commitment Therapy (ACT) in increasing cognitive flexibility and reducing body image concerns among women with breast cancer. This study employed a pretest–posttest control-group design. Forty women with breast cancer who attended the Oncology and Radiotherapy Department of Imam Khomeini Hospital in Tehran were selected through convenience sampling and then randomly assigned to an experimental group and a control group (20 participants in each group). Both groups completed a demographic questionnaire, the Body Image Concern Inventory, and the Cognitive Flexibility Inventory at pretest. The experimental group then received 10 sessions of group-based ACT, whereas the control group received no psychological intervention. After the intervention, both groups completed the posttest measures. Data were analyzed using analysis of covariance (ANCOVA) in SPSS version 20, with pretest scores as the covariate. The findings indicated that ACT significantly reduced body image concerns and increased cognitive flexibility in women with breast cancer (p < 0.001; partial η² = 0.750 and 0.814, respectively). These findings suggest that ACT may be an effective psychological intervention for improving cognitive flexibility and reducing body image concerns in women with breast cancer.
Keywords

[1]      World Health Organization. (2023). Noncommunicable diseases [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
[2]      Stagl, J. M., Antoni, M. H., Lechner, S. C., Bouchard, L. C., Blomberg, B. B., Glück, S., Derhagopian, R. P., & Carver, C. S. (2015). Randomized controlled trial of cognitive behavioral stress management in breast cancer: A brief report of effects on 5-year depressive symptoms. Health Psychology, 34(2), 176–180. https://doi.org/10.1037/hea0000125
[3]      Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
[4]      Mousavi, S. M., Montazeri, A., Mohagheghi, M. A., Jarrahi, A. M., Harirchi, I., Najafi, M., & Ebrahimi, M. (2007). Breast cancer in Iran: An epidemiological review. The Breast Journal, 13(4), 383–391. https://doi.org/10.1111/j.1524-4741.2007.00446.x
[5]      Grogan, S. (2016). Body image: Understanding body dissatisfaction in men, women and children (3rd ed.). Routledge.
[6]      Rautalin, M., Färkkilä, N., Sintonen, H., Saarto, T., Taari, K., Jahkola, T., & Roine, R. P. (2018). Health-related quality of life in different states of breast cancer: Comparing different instruments. Acta Oncologica, 57(5), 622–628. https://doi.org/10.1080/0284186X.2017.1400683
[7]      Markovitz, S. E., Schrooten, W., Arntz, A., & Peters, M. L. (2015). Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients. Psycho-Oncology, 24(12), 1639–1645. https://doi.org/10.1002/pon.3834
[8]      Garlick, M. A., Wall, K., Corwin, D., & Koopman, C. (2011). Psycho-spiritual integrative therapy for women with primary breast cancer. Journal of Clinical Psychology in Medical Settings, 18, 78–90. https://doi.org/10.1007/s10880-011-9224-9
[9]      Abolghasemi, A., & Jafari, I. (2012). Effectiveness of dialectical behavior therapy on body image and self-efficacy in girls with bulimia nervosa. Journal of Clinical Psychology, 4(2), 31–42. [Persian]
[10]   Raghibi, M., & Minakhani, G. (2011). Relationship of body management with body image and self-concept. Knowledge and Research in Applied Psychology, 12(4), 72–81. [Persian]
[11]   Kruger, J., Lee, C. D., Ainsworth, B. E., & Macera, C. A. (2008). Body size satisfaction and physical activity levels among men and women. Obesity, 16(8), 1976–1979. https://doi.org/10.1038/oby.2008.311
[12]   Fredrickson, B. L., & Roberts, T.-A. (1997). Objectification theory: Toward understanding women's lived experiences and mental health risks. Psychology of Women Quarterly, 21(2), 173–206. https://doi.org/10.1111/j.1471-6402.1997.tb00108.x
[13]   Cash, T. F., & Smolak, L. (Eds.). (2011). Body image: A handbook of science, practice, and prevention (2nd ed.). Guilford Press.
[14]   Fobair, P., Stewart, S. L., Chang, S., D'Onofrio, C., Banks, P. J., & Bloom, J. R. (2006). Body image and sexual problems in young women with breast cancer. Psycho-Oncology, 15(7), 579–594.
[15]   Thompson, J. K., Heinberg, L. J., Altabe, M., & Tantleff-Dunn, S. (1999). Exacting beauty: Theory, assessment, and treatment of body image disturbance. American Psychological Association.
[16]   Younesi, S. J., & Salajegheh, A. (2001). Body image in fertile and infertile women. Journal of Reproduction and Infertility, 3(5), 14–21. [Persian]
[17]   Borzekowski, D. L. G., & Bayer, A. M. (2005). Body image and media use among adolescents. Adolescent Medicine Clinics, 16(2), 289–302. https://doi.org/10.1016/j.admecli.2005.02.010
[18]   Cañas, J. J., Quesada, J. F., Antolí, A., & Fajardo, I. (2003). Cognitive flexibility and adaptability to environmental changes in dynamic complex problem-solving tasks. Ergonomics, 46(5), 482–501. https://doi.org/10.1080/0014013031000061640
[19]   Dennis, J. P., & Vander Wal, J. S. (2010). The Cognitive Flexibility Inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy and Research, 34(3), 241–253. https://doi.org/10.1007/s10608-009-9276-4
[20]   Martin, M. M., & Rubin, R. B. (1995). A new measure of cognitive flexibility. Psychological Reports, 76(2), 623–626. https://doi.org/10.2466/pr0.1995.76.2.623
[21]   Khodaei, S., Khazaei, K., Kazemi, T., & Aliabadi, Z. (2012). Effect of group Acceptance and Commitment Therapy on anxiety and depression in patients with myocardial infarction. Modern Care Journal, 9(4), 364–370. [Persian]
[22]   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. https://doi.org/10.1016/S0005-7894(04)80013-3
[23]   Baer, R. A., Fischer, S., & Huss, D. B. (2005). Mindfulness and acceptance in the treatment of disordered eating. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23, 281–300. https://doi.org/10.1007/s10942-005-0015-9
[24]   Garavandi, S., Geram, K., Mazloumi, A., & Mazloumi, E. (2014). Effectiveness of cognitive group therapy on life expectancy and depression in women with breast cancer. Health Psychology, 3(4), 21–34. [Persian]
[25]   Rajabi, S., Hashemi, J., & Pezeshk, S. (2013). Development and evaluation of the effectiveness of Acceptance and Commitment Therapy on body image acceptance in children with cancer. Journal of Disability Studies, 4(9), 28–35. [Persian]
[26]   Khayam-Nekouei, Z., Yousefi, A. R., & Manshaei, G. R. (2010). Effect of Acceptance and Commitment Therapy training on quality of life in cardiac patients. Iranian Journal of Medical Education, 10(2), 148–154. [Persian]
[27]   Hosseinaei, A., Ahadi, H., Fati, L., Heidari, A., & Mazaheri, M. M. (2013). Effect of group training based on Acceptance and Commitment Therapy (ACT) on occupational stress and job burnout. Iranian Journal of Psychiatry and Clinical Psychology, 19(2), 109–120. [Persian]
[28]   Rezaeian, M., Ebrahimi, A., & Zargham, M. (2015). The effect of acceptance and commitment therapy on catastrophic and disabling pain in chronic pelvic pain in females. Research in Cognitive and Behavioral Sciences, 4(2), 17–30.
[29]   Bagheri, P., Saadati, N., Fathollahzadeh, N., & Darbani, S. A. (2016). Effectiveness of group Acceptance and Commitment Therapy on self-efficacy and social adjustment of retired older adults. Journal of Gerontological Nursing, 3(2), 103–117. https://doi.org/10.21859/jgn.3.2.103
[30]   Littleton, H. L., Axsom, D., & Pury, C. L. S. (2005). Development of the Body Image Concern Inventory. Behaviour Research and Therapy, 43(2), 229–241. https://doi.org/10.1016/j.brat.2003.12.006
[31]   Shareh, H., Farmani, A., & Soltani, E. (2014). Investigating the reliability and validity of the Cognitive Flexibility Inventory (CFI-I) among Iranian university students. Practice in Clinical Psychology, 2(1), 43–50.
Volume 7, Issue 4
Autumn 2025
Pages 234-241

  • Receive Date 03 March 2025
  • Revise Date 11 June 2025
  • Accept Date 09 July 2025