The Effect of Acceptance and Commitment Therapy on Psychological Flexibility and Emotional Regulation in Patients with Spinal Cord Injuries: A Randomized Controlled Trial
Open accessAbstract
Background: Patients with spinal cord injuries suffer from some psychological problems, such as inadequate emotional regulation and flexibility for adapting to the post-injury condition. In this regard, acceptance and commitment therapy (ACT) can improve psychological flexibility and emotional regulation. Objectives: The main goal of this study was to analyze the effectiveness of ACT in improving psychological flexibility and emotional regulation in patients with spinal cord injuries. Methods: This quasi-experimental design study was based on a pretest-posttest method with a control group. The study population consisted of all patients with spinal cord injury referred to Jalaeipour Rehabilitation Center in Tehran. The study sample included 30 patients with spinal cord injury selected by the purposive sampling method. The inclusion criteria were patients aged 20 to 55 years, residing in Tehran, and with at least a high school diploma. The injury duration varied between one and five years, and the injuries were thoracic and lumbar injuries and an intermediate score of psychological flexibility and emotion regulation. The exclusion criteria were patients with cervical spinal cord injuries, as well as patients who were simultaneously receiving another psychological treatment together with the subjects who suffered from brain damage. Patients were randomly assigned to the experimental and control groups based on random numbers. There were 15 patients in each group. The intervention group received ACT during eight sessions (1.5-hour group therapy) held once a week at Jalaeipour Rehabilitation Center in Tehran (2018), while the control group received routine care. Dennis and Vander Wal’s cognitive flexibility inventory (CFI) and Gross and John’s emotion regulation questionnaire (ERQ) were completed before and one week after the intervention. The data were analyzed using multivariate analysis of covariance (MANCOVA). Results: There was a significant difference in demographic indicators between the two groups. Based on MANCOVA with the baseline score, the mean scores of psychological flexibility and emotion regulation had a significant difference regarding the results of ACT between the experimental and control groups (P < 0.05). Conclusions: According to the findings, ACT can improve psychological flexibility and emotional regulation in patients with spinal cord injuries.
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Mindfulness-based intervention significantly improved psychological well-being (p<0.01) post-intervention.
“psychological well-being ( p <0.01) post the mindfulness-based intervention [31].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [31]
The Results section reports that acceptance and commitment therapy improved psychological flexibility and emotional regulation in patients with spinal cord injuries (p = 0.005 for each). The protocol included mindfulness techniques, but the study did not report psychological well-being as an outcome, so it does not support the claimed improvement in that measure. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe included studies were conducted across four countries: the United States (n=3), Iran (n=3), China (n=2), and the United Kingdom (n=1).
“The included studies were conducted across four countries: The United States (n=3) [30, 32, 34], Iran (n=3) [15, 31, 33], China (n=2) [13, 19], and The United Kingdom (n=1) [20].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [31]
MABIs were delivered in mixed formats: face-to-face (n=4), online (n=3), hybrid (n=1), and on-site with virtual reality goggles (n=1).
“MABIs were delivered in mixed formats: face-to-face (n=4) for ACT [19, 31, 33, 34]; online (n=3) for ACT [32] and mindfulness-based interventions [13, 20] using videoconferencing or a web-based approach; hybrid (n=1) for mindfulness-based intervention [30]; and on-site with virtual reality goggles for dialectical behavioral therapy mindfulness skills training (n=1) [34].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [31]
Participants were recruited from communities (n=4), hospitals (n=2), and rehabilitation centers (n=3).
“Participants were recruited from communities (n=4) [13, 20, 30, 32]; hospitals (n=2) [15, 34]; and rehabilitation centers (n=3) [19, 31, 33].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [31]
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- Authors
- Khanjani, M. S., Kazemi, J., Younesi, J., Dadkhah, A., Biglarian, A., & Ebrahimi Barmi, B.
- Affiliations
- University of Social Welfare and Rehabilitation Sciences (IR)
- Corresponding author
- Kazemi, Javad
- Venue
- Iranian Journal of Psychiatry and Behavioral Sciences
- Publisher
- Brieflands
- Published
- 2021-04-17
- Volume
- 15
- Issue
- 2
- ISSN
- 1735-8639 (ISSN-L)
- 1735-9287
- OpenAlex
- W3156738642
- Cited by
- 17
- References
- 39
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 5
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Iranian Journal of Psychiatry and Behavioral Sciences (publishedVersion, cc-by-nc)
- Funders
- University of Social Welfare and Rehabilitation Sciences
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- acceptance and commitment therapy, spinal cord injury, psychological flexibility, emotion regulation, cognitive flexibility, group therapy, psychological rehabilitation
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