Effectiveness of acceptance and commitment therapy on interpersonal problems and difficulties in emotion regulation among university students
Open accessAbstract
Background: The acceptance and commitment therapy (ACT) is a novel method for resolving interpersonal problems. Objectives: This study aimed at determining the effectiveness of ACT on interpersonal problems and difficulties in emotion regulation among female students with interpersonal problems. Methods: In this randomized clinical trial, the study population consisted of 70 female students, who were selected via purposive sampling from Azad University of Gorgan, Iran. The study population was randomly categorized to intervention (ACT group) and control groups. The intervention group consisted of ten 90-minute ACT sessions, held by a trained clinical psychologist, according to a study by Mckay, Lev and Skeen (2012). The data collection tools included two short-form questionnaires, including the inventory of interpersonal problems (IIP-32) and difficulties in emotion regulation scale (DERS). Pre-test and post-test scores were analyzed, using covariance methods. Results: Generally, the findings showed a significant difference in the post-test scores between the control and ACT groups following the intervention. Conclusions: Based on the findings, acceptance and commitment therapy (ACT) can be effective in improvement of interpersonal problems and emotional dysregulation.
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Written from the paper’s full text.
TL;DR
In a randomized clinical trial of female Iranian university students with interpersonal problems, group acceptance and commitment therapy (ACT) significantly reduced interpersonal problems and difficulties in emotion regulation compared with a no-training control at posttest (P < 0.001). The authors conclude ACT can be effective for these outcomes.
Key findings
- Posttest scores differed significantly between the ACT and control groups for interpersonal problems and difficulties in emotion regulation (P < 0.001).
- In the ACT group, mean scores for interpersonal relations and emotion regulation difficulties decreased from pretest to posttest compared with the control group.
- The authors state that ACT improved interpersonal problems and emotional dysregulation among female university students.
Methods
- Randomized clinical trial conducted at Azad University of Gorgan, Iran, between September and November 2015; participants were female students aged 18–35 with an IIP-32 score above 40, no psychotic disorders, no psychotherapy/pharmacotherapy in the past 6 months, and no addiction or suicide history; exclusion if absent from more than 2 sessions.
- The abstract reports 70 female students; the methods report 150 screened, 80 selected and randomized; the results report that among 66 participants, 5 from the intervention group and 4 from the control group were excluded. The ACT group received ten 90-minute sessions by a trained clinical psychologist based on McKay, Lev, and Skeen (2012); the control group received no training. Measures were the IIP-32 and Difficulties in Emotion Regulation Scale (DERS) at pretest and posttest.
- Analysis used covariance, t test, and chi-square, with P < 0.05 considered statistically significant.
Limitations
- Stated by the paper: only female participants, small sample size, and lack of follow-up sessions; the authors recommend larger groups, longer follow-ups, both genders, and more diverse samples.
- Evident from the text: sample size reporting is inconsistent across the abstract, methods, and results (70 vs. 80 vs. 66 participants), and the control group received no training rather than an active comparison, so non-specific effects cannot be ruled out.
Model-written summary. Check it against the paper before relying on it.
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Cites
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Claims the paper makes
0 of 18 cited sources checked · 0 supported · 0 flagged
- Findingown data§ 4. Results
There were significant differences between the experimental and control groups in interpersonal problems in the posttest stage (P < 0.001).
“The result of covariance showed that there were significant differences between the experimental and control groups in interpersonal problems and difficulties in emotion regulation in the posttest stage (P < 0.001) (Table 4).”
Quote in the paperSubstantial claim - Findingown data§ 4. Results
There were significant differences between the experimental and control groups in difficulties in emotion regulation in the posttest stage (P < 0.001).
“The result of covariance showed that there were significant differences between the experimental and control groups in interpersonal problems and difficulties in emotion regulation in the posttest stage (P < 0.001) (Table 4).”
Quote in the paperSubstantial claim - Findingown data§ 4. Results
In the ACT group, mean interpersonal relations scores decreased from pretest to posttest.
“evaluation of the mean scores of dependant variables (interpersonal relations and emotion regulation difficulties) and comparison of pretest and posttest scores showed that the mean scores of interpersonal relations and emotion regulation difficulties decreased in the ACT group in the posttest in comparsion with the pretest.”
Quote in the paperSubstantial claim - Findingown data§ 4. Results
In the ACT group, mean emotion regulation difficulties scores decreased from pretest to posttest.
“evaluation of the mean scores of dependant variables (interpersonal relations and emotion regulation difficulties) and comparison of pretest and posttest scores showed that the mean scores of interpersonal relations and emotion regulation difficulties decreased in the ACT group in the posttest in comparsion with the pretest.”
Quote in the paperSubstantial claim - Premisecitation§ 1. Background
ACT can be used as an effective therapy to improve psychological flexibility in people with interpersonal problems through acceptance techniques and cognitive defusion of thoughts, emotions, and beliefs.
“Since people with interpersonal problems have rigid and inflexible models of behavior, ACT can be used as an effective therapy to improve their psychological flexibility through adopting acceptance techniques and cognitive defusion of thoughts, emotions, and beliefs (schemas) (3).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] McKay M, 2012, Acceptance and commitment therapy for interpersonal problems: Using mindfulness, acceptance, and schema awareness to change interpersonal behaviors.
Not checked in the free run.
- Premisecitation§ 1. Background
Various studies have revealed the effectiveness of ACT on improving psychological problems, such as depression, social anxiety, generalized anxiety disorder, obsessive compulsive disorder, and dysfunctional marital relations.
“Various studies have revealed the effectiveness of ACT on improving psychological problems, such as depression (24), social anxiety (25), generalized anxiety disorder (26), obsessive compulsive disorder (27), and dysfunctional marital relations (28).”
Quote in the paperSubstantial claim0 of 3 sources checked - Study design and conductreasoning§ 3. Materials and Methods
The minimum sample size was estimated as 24 cases per group (95% confidence level and 90% power).
“By using the Cohen’s formula, the minimum sample size was estimated as 24 cases per group (95% confidence level and 90% power).”
Quote in the paperSubstantial claim - Premisecitation§ 5. Discussion
Cognitive defusion techniques, as the core of ACT, lead to a decline in negative emotions.
“In addition, cognitive defusion techniques, as the core of ACT, lead to a decline in negative emotions (37).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Blackledge JT, 2001, J Clin Psychol. source
Not checked in the free run.
- Study design and conductcitation
The Persian version of IIP-32 had reliability of 0.82 and 0.83 using internal consistency and half-split coefficients.
“Reliability of the Persian version of IIP-32 was calculated using internal consistency and half-split coefficients, which was 0.82 and 0.83, respectively (32).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32] Fath N, 2013, J Clin Psycol.
Not checked in the free run.
- Interpretationown data§ 4. Results
ACT improved interpersonal problems of female college students.
“Therefore, the ACT group could improve the interpersonal problems and difficulties in emotion regulation of female collage students.”
- Also stated in: § 5. Discussion · hedged
“The findings of the present study showed that ACT could decrease interpersonal problems and difficulties in emotion regulation in the ACT group in comparison with the control group.”
- Also stated in: § 5. Discussion · hedged
“The present study showed that ACT could reduce interpersonal problems.”
Quote in the paperSubstantial claim - Also stated in: § 5. Discussion · hedged
- Interpretationown data§ 4. Results
ACT improved difficulties in emotion regulation of female college students.
“Therefore, the ACT group could improve the interpersonal problems and difficulties in emotion regulation of female collage students.”
- Also stated in: § 5. Discussion · hedged
“In other words, ACT could reduce difficulties in emotion regulation in the intervention group, compared to the control group.”
- Also stated in: § 5. Discussion · plain
“The findings of this study showed that DERS scores were significantly different between the intervention and control groups.”
Quote in the paperSubstantial claim - Also stated in: § 5. Discussion · hedged
- Interpretationreasoning§ 5. Discussion
Willingness to experience internal events and understanding their importance in interpersonal relations (instead of avoidance) help individuals use adaptive emotion regulation strategies and discard maladaptive methods.
“Also, willingness to experience internal events and understanding the importance of these events in interpersonal relations (instead of avoidance) help individuals use adaptive emotion regulation strategies and discard maladaptive methods.”
Quote in the paperSubstantial claim - Study design and conductnone given
The study lacked follow-up sessions.
“The limitations of this study were the inclusion of only female participants as the study sample, the small sample size, and lack of follow-up sessions.”
Quote in the paperNot a substantial claim - Study design and conductown data
The study sample included only female participants.
“The limitations of this study were the inclusion of only female participants as the study sample, the small sample size, and lack of follow-up sessions.”
Quote in the paperNot a substantial claim - Study design and conductnone given
The study had a small sample size.
“The limitations of this study were the inclusion of only female participants as the study sample, the small sample size, and lack of follow-up sessions.”
Quote in the paperNot a substantial claim
- Classified as probably not a substantial claim. 5
- May combine two claims. 12
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ 1. BackgroundAcceptance and commitment therapy (ACT) is a novel method used to overcome interpersonal issues and a wide range of psychological problems.
“Acceptance and commitment therapy (ACT) is a novel method used to overcome interpersonal issues and a wide range of psychological problems (18).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] Ruiz FJ, 2010, Revista Internacional de Psicologia y Terapia Psicologica.
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductnone given§ 3. Materials and MethodsParticipants were categorized to control and intervention groups using a table of random numbers.
“By using the table of random numbers, the participants were categorized to control and intervention groups.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductcitationThe IIP-32 subscales had internal consistency (Cronbach's alpha) of 0.60 to 0.83, and total consistency of 0.81 and 0.86.
“The IIP subscales’ internal consistency was calculated using Cronbach’s alpha coefficient, which was 0.60 to 0.83 and for the total consistency a score of 0.81 and 0.86 was determined (31).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] Barkham M, 1996, Br J Clin Psychol. source
Not checked in the free run.
May combine two claims.
Interpretationcitation§ 5. DiscussionACT techniques are useful in maladaptive emotion regulation strategies, with development of emotional awareness, and focus on different aspects of emotional regulation.
“An explanation for the mentioned finding is that ACT techniques are useful in maladaptive emotion regulation strategies, with development of emotional awareness, and focus on different aspects of emotional regulation (41, 42).”
Quote in the paperSubstantial claim0 of 2 sources checkedClassified as probably not a substantial claim. May combine two claims.
Interpretationreasoning§ 5. DiscussionACT and a combination of schema therapy formulation could help improve interpersonal relations through acceptance techniques and defusion of thoughts, emotions, and beliefs.
“To explain such findings, it can be said that ACT and a combination of scheme therapy formulation (such as maladaptive interpersonal schemes) aiming at the improvement of psychological flexibility could help improve interpersonal relations through acceptance techniques and defusion of thoughts, emotions, and beliefs.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] McKay M, 2012, Acceptance and commitment therapy for interpersonal problems: Using mindfulness, acceptance, and schema awareness to change interpersonal behaviors.
Not checked in the free run.
May combine two claims.
Study design and conductcitationThe Difficulties in Emotion Regulation Questionnaire had validity of 0.93 and reliability of 0.80 using Cronbach's alpha.
“Graz reported the validity of the questionnaire as 0.93 and its reliability was 0.80, using Cronbach’s alpha (9).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] source
Not checked in the free run.
May combine two claims.
Study design and conductcitationThe Persian version of the Difficulties in Emotion Regulation Questionnaire had reliability of 0.86 and 0.80 using Cronbach's alpha and split-half methods.
“Two methods of Cronbach’s alpha and split-half were used to calculate reliability, which was 0.86 and 0.80, respectively, proving acceptable coefficients for the emotional regulation difficulties questionnaire.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] Khanzadeh M, 2012, Int J Behav Sci.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ 5. DiscussionACT does not aim at removing or changing individuals' core schemas and beliefs, but helps them accept the pain associated with these schemas and improve behavioral flexibility.
“In fact, ACT does not aim at removing or changing the individuals’ core schemas and beliefs, yet it rather helps them accept the pain associated with these schemas through different methods (e.g. acceptance, cognitive defusion, being present, self as context, values, and committed action) and improve their behavioral flexibility to promote a principled way of life (3).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] McKay M, 2012, Acceptance and commitment therapy for interpersonal problems: Using mindfulness, acceptance, and schema awareness to change interpersonal behaviors.
Not checked in the free run.
May combine two claims.
Premisecitation§ 5. DiscussionACT focuses on acceptance techniques for dealing with maladaptive emotion regulation strategies (such as suppression) and encourages patients to accept pain instead of changing or removing unwanted thoughts and emotions such as anxiety and guilt.
“Furthermore, ACT focuses on acceptance techniques for dealing with maladaptive emotion regulation strategies (such as suppression). In this fashion, it encourages patients to accept the pain instead of changing or removing unwanted thoughts and emotions such as anxiety and guilt (20).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [20] Flaxman PE, 2010, Acceptance and commitment therapy: Distinctive features. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown data§ 4. ResultsAmong 66 participants, 5 from the intervention group and 4 from the control group were excluded because they were absent for more than 2 sessions and unwilling to complete the questionnaires.
“Among 66 participants, 5 cases from the intervention group and 4 cases from the control group were excluded, as they were absent from the intervention for more than 2 sessions and were unwilling to complete the questionnaires.”
Quote in the paperNot a substantial claimMay combine two claims.
Premisecitation§ 5. DiscussionACT strategies improve self-awareness, self-observation, emotion regulation, positive emotional reactions in interpersonal relations, and environmental control.
“In addition, ACT strategies improve self-awareness, self-observation, emotion regulation, positive emotional reactions in interpersonal relations, and environmental control (28).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [28] source
Not checked in the free run.
May combine two claims.
Interpretationown data§ 5. DiscussionPeople with interpersonal problems can overcome their poor emotional regulation and interpersonal problems through ACT.
“The present study showed that people with interpersonal problems can overcome their poor emotional regulation and interpersonal problems through ACT.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ 5. DiscussionSeveral experimental studies have shown that acceptance strategies positively affect emotion regulation, reduce physiological arousal, and promote effective responses in emotional control.
“Several experimental studies have shown that acceptance strategies positively effect emotion regulation, reduce physiological arousal, and promote effective responses in emotional control (43, 44).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [43] George B, 2015, Indian J Pos Psychol.
Not checked in the free run.
- cites [44] source
Not checked in the free run.
May combine two claims.
Interpretationown data§ 5. DiscussionAdministration of ACT leads to a decrease in interpersonal problems and difficulties in emotion regulation scores among university students.
“The results showed that administration of acceptance and commitment therapy leads to a decrease in interpersonal problems and difficulties in emotion regulation scores; therefore, intervention played an effective role in improvement of interpersonal problems and difficulties in emotion regulation among university students.”
Quote in the paperSubstantial claim
The paper relies on this without support.
Interpersonal problems are increasingly prevalent, especially among students.
“Therefore, given the increasing prevalence of these problems, especially among students, the importance of treatment is strongly felt in different communities.”
The paper relies on this without support.
The ultimate aim of ACT is to achieve emotion regulation and psychological flexibility.
“In fact, the ultimate aim of ACT is to achieve emotion regulation and psychological flexibility.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
ACT has shown preliminary evidence in improving interpersonal difficulties.
“ACT has also shown preliminary evidence in improving interpersonal difficulties [34,35,36] and PTSD symptoms [37,38,39,40].”
From A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (2022) · cites this paper as [35]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Different numbers of students reported as selected
MinorThe abstract says 70 female students were selected and randomly assigned, whereas the methods say 80 students were selected and randomly assigned. The text does not reconcile the two counts.
“the study population consisted of 70 female students, who were selected via purposive sampling from Azad University of Gorgan, Iran. The study population was randomly categorized to intervention (ACT group) and control groups.”
“In the second stage, 80 students were selected based on the inclusion criteria and their scores on the IIP-32 scale. By using the table of random numbers, the participants were categorized to control and intervention groups.”
Gratz and Tull citation year differs from reference
MinorThe discussion identifies the Gratz and Tull work as published in 2006, but the corresponding reference lists 2010.
“Gratz and Tull (2006) (37-40).”
“39. Gratz KL, Tull MT. Emotion regulation as a mechanism of change in acceptance-and mindfulness-based treatments. Assessing mindfulness and acceptance processes in clients: Illuminating the theory and practice of change. 2010.”
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“For instance, a study of a 10-session ACT intervention targeting the interpersonal problems of university students in Iran (n = 66) showed a significant reduction in interpersonal problems and emotion regulation difficulties [35].”
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- Authors
- Norouzi, M., Zargar, F., & Norouzi, F.
- Affiliations
- Kashan University of Medical Sciences (IR)
- Isfahan University of Medical Sciences (IR)
- Islamic Azad University, Tehran (IR)
- Corresponding author
- Norouzi, Mohadeseh
- ORCID
- Zargar, Fatemeh
- Venue
- Iranian Journal of Psychiatry and Behavioral Sciences
- Publisher
- Brieflands
- Published
- 2017-05-21
- Volume
- 11
- Issue
- 3
- ISSN
- 1735-8639 (ISSN-L)
- 1735-9287
- OpenAlex
- W2614606592
- Semantic Scholar
- a5e2b681f8333a669a3dc8016bdb4a9a8ad02adc
- Cited by
- 21
- References
- 40
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 6 · 2020: 2
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc
- Locations
- Iranian Journal of Psychiatry and Behavioral Sciences (publishedVersion, cc-by-nc)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Keywords
- acceptance and commitment therapy, interpersonal problems, emotion regulation, emotional dysregulation, female university students, psychological intervention, Inventory of Interpersonal Problems, Difficulties in Emotion Regulation Scale
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