Comparing the effectiveness of schema therapy in comparison with acceptance and commitment therapy (ACT) on the psychological distress of women with Bulimia nervosa

پژوهش های روان شناسی بالینی و مشاوره

Article 4, Volume 14, Issue 1 - Serial Number 27, May 2024, Pages 67-84   

Document Type: Original Article

DOI: 10.22067/tpccp.2024.84361.1560

Authors

rozita goharshahi¹; Abdollah Mafakheri^{* 2}; mohammad mohammadipour³

¹PhD Candidate in Psychology, Department of Psychology, Azad University of Bojnord, Bojnord, Iran.

²Assistant Professor, Department of Psychology, PayamNoor University of Tehran, Tehran, Iran.

³Associate Professor, Department of Psychology, Azad University of Qochan, Qochan, Iran.

Abstract

Introduction The purpose of this research was to determine the effectiveness of schema therapy training in comparison to acceptance and commitment approach training (ACT) with the psychological distress of women with bulimia nervosa.

Method

The current research was a semi-experimental study with a pre-test-post-test design and a control group with a two-month follow-up. The statistical population was all women with bulimia nervosa in Mashhad city in the year of 2023 who had visited the treatment centers, 45 of whom were randomly selected and randomly assigned to schema therapy (15 people), acceptance and commitment therapy (15 people) And the control group (15 people) was divided. The experimental group of schema therapy was subjected to the intervention of Yang et al.'s educational package (2003) and the experimental group of acceptance and commitment was subjected to the therapeutic intervention of Hayes et al, (2012) for ten one-hour sessions. Data were analyzed using repeated measures analysis of variance.

Results

The results showed that the intervention of schema therapy and acceptance and commitment is effective on psychological disturbance (P=0.001), (F=49.83) and this effect is stable in the follow-up phase. The results of Shefe's follow-up test showed that there is a significant difference between the two groups of acceptance and commitment and schema therapy in the effectiveness of reducing psychological disturbance (P=0.05); Therefore, acceptance and commitment have had a greater effect on reducing women's psychological turmoil.

Discussion and Conclusion

According to the results, it can be said: by teaching psychological treatment approaches such as schema and acceptance and commitment to women, it is possible to help them lose weight and prevent their bulimia nervosa. Also, by controlling bulimia, they can be protected from the side effects of physical, psychological and social damage of bulimia, thus having healthier mothers and a healthier society.

Keywords

schema therapy; acceptance and commitment; psychological distress; bulimia nervosa

References

Abbasi Bondaragh, S., et al. (2023). "The Impact of Acceptance and Commitment Couples Therapy on Reducing the Marital Conflicts between Couples Applying for Divorce." Research in Clinical Psychology and Counseling 13(1): 25-46. 10.22067/TPCCP.2023.77768.1317 (In Persian)

AllaHayari, M. and S. Khaleghi (2021). Effectiveness of acceptance and commitment therapy in bulimia nervosa and maladaptive strategies of worry in women. The second national conference of psychopathology. Ardabil. https://civilica.com/doc/1436384/ (In Persian)

Ashrafi, S., et al. (2020). "The Effectiveness of Acceptance and Commitment Therapy on Bulimia Nervosa in Overweight Women." Journal of Research in Behavioural Sciences 18(2): 182-191.  ‎ 10.52547/rbs.18.2.182 (In Persian)

Ayar, D. and S. Sabancioğullari (2022). "The effect of a solution-oriented therapy on the depression levels and the perceived social support of depressive patients." Archives of Psychiatric Nursing 36: 62-69. 10.1016/j.apnu.2021.11.004

Boterhoven de Haan, K. L., et al. (2019). "A Schema Therapy Approach to the Treatment of Posttraumatic Stress Disorder." Journal of Psychotherapy Integration 29: 54–64.  https://doi.org/10.1037/int0000120

Chithambo, T. P. and S. J. Huey, Jr. (2017). "Internet-delivered eating disorder prevention: A randomized controlled trial of dissonance-based and cognitive-behavioral interventions." Int J Eat Disord 50(10): 1142-1151. https://doi.org/10.1002/eat.22762

Damiano, S. R., et al. (2015). "Maladaptive schemas in adolescent females with anorexia nervosa and implications for treatment." Eat Behav 16: 64-71. https://doi.org/10.1016/j.eatbeh.2014.10.016

Dehestani, m., et al. (2019). "The Effectiveness of Group Schema Therapy on Body Dysmorphic Symptoms and Early Maladaptive Schemes in Girl Students with Overweight Concerns." Thoughts and Behavior in Clinical Psychology 13(47): 47-56. https://www.sid.ir/paper/172073/fa (In Persian)

Escandón-Nagel, N., et al. (2018). "Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity." International Journal of Clinical and Health Psychology 18(1): 52-59. https://doi.org/10.1016/j.ijchp.2017.09.003

Eskandari, H. (2015). "Schema therapy: the formation of the historical evolution of the concept of bus." Clinical Psychology Studies 5(18): 15-22.               https://jcps.atu.ac.ir/article_1045.html?lang=en (In Persian)

Harris, R. and S. C. Hayes (2009). ACT Made Simple: An Easy-to-read Primer on Acceptance and Commitment Therapy, New Harbinger Publications. https://www.amazon.com/ACT-Made-Simple-Easy-Read/dp/1572247053

Hayes, S. C., et al. (2013). "Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy." Behav Ther 44(2): 180-198. doi: 10.1016/j.beth.2009.08.002

Hayes, S. C. and J. Lillis (2012). Acceptance and Commitment Therapy, American Psychological Association. https://www.apa.org/pubs/books/4317286

Hayes, S. C. and K. D. Strosahl (2013). A Practical Guide to Acceptance and Commitment Therapy, Springer US. https://link.springer.com/book/10.1007/978-0-387-23369-7#about-this-book

Hayes, S. C., et al. (2011). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, Guilford Publications. https://www.guilford.com/books/Acceptance-and-Commitment-Therapy/Hayes-Strosahl-Wilson/9781462528943

Howell, A. N., et al. (2010). "Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers." Addict Behav 35(12): 1144-1147.               https://doi.org/10.1016/j.drugalcdep.2011.09.012

Hussain, T. (2013). "Psychological distress leading to repeat HIV testing in an Integrated Counseling & Testing Centre (ICTC) at Agra, India—Case report of 10 HIV-negative clients." HIV & AIDS Review 12(2): 43-46. https://doi.org/10.1016/j.hivar.2013.05.003

Imperatori, C., et al. (2017). "The Association between Food Addiction and Early Maladaptive Schemas in Overweight and Obese Women: A Preliminary Investigation." Nutrients 9(11). DOI: 10.3390/nu9111259

Ismaili, S. and S. Khosravi (2018). The effect of treatment based on acceptance and commitment on binge eating and difficulty in regulating emotions in binge eating disorder sufferers. National conference of new ideas in psychology and educational sciences with emphasis on recent scientific researches,. Tehran.  20.1001.1.10199616.1400.23.1.6.0 (In Persian)

Kessler, R. C., et al. (2003). "Screening for serious mental illness in the general population." Arch Gen Psychiatry 60(2): 184-189. doi:10.1001/archpsyc.60.2.184

Khodabakhsh, M. and F. Kiani (2017). "The Role of Depressive Symptoms and Alexithymia in Predicting Disordered Eating Behavior Among Female Students." Community Health Journal 8(3): 27-36. https://chj.rums.ac.ir/article_45728.html?lang=en (In Persian)

Lemly, D. C., et al. (2022). "Caring for Adults With Eating Disorders in Primary Care." Prim Care Companion CNS Disord 24(1). https://doi.org/10.4088/PCC.20nr02887 DOI: 10.4088/PCC.20nr02887

Lev, A., et al. (2017). Acceptance and Commitment Therapy for Couples: A Clinician's Guide to Using Mindfulness, Values, and Schema Awareness to Rebuild Relationships, New Harbinger Publications. https://www.amazon.com/Acceptance-Commitment-Therapy-Couples-Relationships/dp/162625480X

Lillis, J. and K. E. Kendra (2014). "Acceptance and Commitment Therapy for weight control: Model, evidence, and future directions." J Contextual Behav Sci 3(1): 1-7. https://doi.org/10.1016/j.jcbs.2013.11.005

Mao, A., et al. (2022). "A qualitative inquiry into the acceptability of schema therapy in Hong Kong and Singapore: implications for cultural responsiveness in the practice of schema therapy." Clinical Psychologist 26(3): 341-350. https://doi.org/10.1080/13284207.2022.2052273

Mardani, l. and e. ahmadi (2019). "Structural relationships of dysfunctional thoughts and rumination with symptoms of eating disorder by mediating of avoidance performance." Thoughts and Behavior in Clinical Psychology 14(53): 47-56. https://www.sid.ir/paper/366487/en (In Persian)

Narimani, M. and S. M. Nemati (2020). Investigating the effect of schema therapy on bulimia nervosa and stress in obese women. The second national conference of psychopathology.  10.32592/ajnpp.2020.7.1.103 (In Persian)

Rahmani, F., et al. (2021). "The Effectiveness of Schema Therapy on Academic Enthusiasm and Body Dysmorphic Symptoms in Students." Research in School and Virtual Learning 9(2): 61-74. 20.1001.1.23456523.1400.9.2.5.4 (In Persian)

Roozeboom, W. D. (2014). Solution-Focused Counseling. Encyclopedia of Psychology and Religion. D. A. Leeming. Boston, MA, Springer US: 1679-1683. https://link.springer.com/referenceworkentry/10.1007/978-1-4614-6086-2_9220

Schaumberg, K., et al. (2021). "Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research." Clin Psychol Rev 83: 101952. https://doi.org/10.1016/j.cpr.2020.101952

Shaigian, Z. and M. Wafai (2018). "Investigating the psychometric indicators of the eating disorder beliefs questionnaire." New Journal of Cognitive Sciences 11(2): 22. 10.32598/jpcp.9.3.772.1 (In Persian)

Tashuiqi, M. and Z. Aghamiri (2019). The effectiveness of solution-oriented group therapy on the difficulty of emotion regulation and self-expression in adolescents living in centersWelfare of the city of Tehran. The second congress of new findings in the field of family, mental health, disorders, prevention and education. 10.52547/jcmh.9.3.9 (In Persian)

Trindade, I. A. and C. Ferreira (2014). "The impact of body image-related cognitive fusion on eating psychopathology." Eat Behav 15(1): 72-75. https://doi.org/10.1016/j.eatbeh.2013.10.014

Unoka, Z., et al. (2010). "Eating disorder behavior and early maladaptive schemas in subgroups of eating disorders." J Nerv Ment Dis 198(6): 425-431. 10.1097/NMD.0b013e3181e07d3d

Wheaton, M. G., et al. (2012). "Dimensions of anxiety sensitivity in the anxiety disorders: evaluation of the ASI-3." J Anxiety Disord 26(3): 401-408. https://doi.org/10.1016/j.janxdis.2012.01.002

Yaghobi, H. (2016). "Psychometric properties of the 10 questions Version of the Kessler Psychological Distress Scale (K-10)." Journal of Applied Psychological Research 6(4): 45-57. 10.22059/JAPR.2016.57963 (In Persian)

Young, J. E., et al. (2003). Schema Therapy: A Practitioner's Guide, Guilford Publications.  https://www.guilford.com/books/Schema-Therapy/Young-Klosko-Weishaar/9781593853723