Comparing the Effects of Acceptance and Commitment Therapy and Cognitive Rehabilitation Treatment on Stress and Anxiety in Female High Schoolers

Increased stress and anxiety in adolescents is critical and may cause health issues, dysfunctions, educational and professional problems, and risky behaviors. Cognition and anxiety are interrelated. Cognition can affect anxiety and anxiety may reduce cognitive performance by affecting working memory capacity and executive functions. Working memory is a complex limited–capacity system of cognition that simultaneously stores and processes data. An approach used for controlling stress and anxiety is Acceptance and Commitment Therapy (ACT). Additionally, another novel treatment method with examinable effectiveness is Cognitive Rehabilitation Treatment (CRT) which attempts to repair cognitive deficits. Thus, this study aimed to compare the effects of ACT and CRT in reducing stress and anxiety among female high schoolers.

This was a quasi–experimental study with a pretest–posttest–follow–up and a control group design. The statistical population included all female high school students (age range: 14–16 y) in District 20 of Tehran City, Iran, in the academic year of 2018–2019. Sampling was performed in two stages. Initially, the Depression, Anxiety, Stress Scale (DASS–21; Lovibond & Lovibond, 1995) was purposively distributed among the students of one of the selected high schools. Next, among those who obtained higher scores in the subscales of anxiety and stress, 45 students were randomly selected. The selected samples were randomly placed into two experimental groups, including ACT and CRT and one control group (n=15/group). The inclusion criteria were the willingness and cooperation of students to participate in the sessions; signing the commitment letter of continuous participation in therapy sessions; the ability to participate in sessions respecting the number and timing of the sessions; being a student in the secondary high school, and not consuming any psychiatric medications for 3 months before the first treatment session. The exclusion criteria included absence from >2 training sessions and unwillingness to continue cooperation. For one experimental group, the ACT intervention was applied based on the protocol provided by Hayes et al. (1999); this intervention was performed in eight 90–minute sessions two days a week. The other experimental group underwent CRT for working memory. This group received training based on Captain's Log cognitive rehabilitation software version 2018 for eight 90–minute sessions and two days a week. The control group received no intervention. The required data were collected using DASS–21. The obtained data were analyzed by repeated–measures Analysis of Variance (ANOVA) and Bonferroni post–hoc test in SPSS at the significance level of p<0.05.

Regarding stress, the main effect of time (F=64.21, p<0.001) and the effect of group (F=9.45, p=0.011) and concerning anxiety, the main effect of time (F=76.82, p<0.001) and group effect (F=11.43, p=0.008) were significant. In other words, changes in the control group were different from those of the two experimental groups; both experimental groups achieved significantly lower scores in stress and anxiety in the posttest and follow–up stages. Moreover, there was a significant difference between the ACT and control groups in stress and anxiety (p<0.001); there was also a significant difference in stress and anxiety between the CRT and control groups (p<0.001). However, there was no significant difference between the test groups respecting reducing stress (p=0.726) and anxiety (p=0.942); both treatment methods presented desirable effectiveness in this respect.

Both ACT and CTR methods are effective in reducing anxiety and stress in students; therefore, they could be considered as useful methods in the field.