Comparing the Effectiveness of Acceptance and Commitment Therapy based on Self-compassion and Schema Therapy on Perceived Stress in Women Suffering Chronic Fatigue Syndrome due to Intimate Partner Violence

Chronic fatigue syndrome (CFS) poses a complex and debilitating challenge, with violence from a partner identified as one of the important causes of this syndrome. Women are nearly twice as likely as men to be affected by this syndrome. Women who have experienced intimate partner violence are at risk of this disease. Stress is one of the most critical aggravating factors of CFS. Today, one widely–used treatment to reduce stress is third–wave cognitive behavioral therapy. Acceptance and Commitment Therapy (ACT) belongs to these approaches. Researchers and therapists of ACT investigate the role of self–compassion in psychotherapy. Self–compassion is one of the essential variables in adulthood. Schema Therapy is another treatment approach that has a notable impact on psychological improvement. This research aimed to compare ACT's effectiveness based on self–compassion versus Schema Therapy on perceived stress in women suffering chronic fatigue syndrome caused by intimate partner violence.

This quasi–experimental research employed a pretest–posttest and follow–up design with a control group. The study population comprised all women living in Tehran, Iran, suffering from CFS due to intimate partner violence from 2021 to 2022. Three hundred women of this population were evaluated using the Revised version of the Conflict Tactics Scale (Straus & Douglas, 2004) and Chronic Fatigue Syndrome (CFS) questionnaire (Jason et al., 2011). Then, among them, 80 women suffering from CFS and experienced violence from their husbands were identified. In the next stage, according to the inclusion criteria, 60 qualified volunteers were included in the study. They were randomly assigned to two intervention groups and one control group (20 people in each group).
One of the experimental groups received 8 sessions of ACT based on self–compassion therapy, and the other experimental group received 12 sessions of Schema Therapy. However, the control group received no intervention. All sessions were held for 90 minutes once a week via Skype application. In both groups, in the pretest, posttest, and follow–up stages, the perceived stress variable was measured using the Perceived Stress Scale (Cohen et al., 1983). The content of the ACT intervention focused on self–compassion was prepared based on Yadavaia's (2013) dissertation and Gilbert's (2010) guidelines. This intervention was conducted in eight 90–minute group training sessions (once a week) for the first experimental group. The schema–based intervention was prepared based on instructions and techniques of Schema Therapy (adapted from Young et al., 2003). This intervention was conducted in twelve 90–minute group sessions (once a week) for the second experimental group. Data analysis was carried out in two parts: descriptive statistics and inferential statistics. The mean and standard deviation were used at the descriptive statistics level. At the inferential statistics level, we used variance analysis with repeated measures and the Bonferroni post hoc test in SPSS version 23. The significance level of the tests was 0.05.

Both time and the interactive effect of time and group on perceived stress variables were significant (p<0.001), but the group effect was not significant (p=0.091). In the intervention groups, the differences between the mean scores of the perceived stress variable in the pretest, posttest, and follow–up were significant (p<0.001). However, the differences between the mean scores of the mentioned variable in the posttest with follow–up stages in the groups of Schema Therapy (p=0.181) and ACT based on self–compassion (p=0.284) were not significant, which showed the stability of the treatment effects over time.

Based on the research findings, both treatment methods reduced perceived stress in women with chronic fatigue syndrome caused by intimate partner violence. So, psychologists and mental health professionals can choose either approach based on their preferences to treat these women.