The Effects of Acceptance and Commitment Group Therapy on Rumination and Emotional Processing in Women With Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is among the most prevalent anxiety disorders. GAD is characterized by excessive, chronic, and uncontrolled anxiety about multiple activities or events associated with experiencing physical symptoms. A feature of this disorder is the presence of negative repetitive thoughts or ruminations that aggravate and persist the condition. Numerous psychological interventions have emerged over the past decades to treat this disorder. Accordingly, Acceptance and Commitment Therapy (ACT), as the third generation of these interventions is among the newest forms of cognitive–behavioral therapy. The goal of ACT is to eliminate experimental avoidance and increase psychological flexibility. Due to the high prevalence, chronic episodes, and prolonged course of GAD; the comorbidity of this disorder with other psychiatric disorders, and its multiple effects on the lives of affected individuals, ACT seems to be an appropriate option to manage their conditions. Thus, this study aimed to investigate the effects of group–based ACT on rumination and emotional processing in women with GAD.

This was a quasi–experimental study with pretest–posttest–follow–up and a control group design. The statistical population of the study included all women with GAD referring to counseling and psychological services centers in the west of Tehran City, Iran, in 2018–2019. Of them, 30 were selected using the convenience sampling method based on the inclusion and exclusion criteria of the study, as the research sample. The inclusion criteria of the study included voluntarily completing the informed consent form to participate in the research; a minimum of secondary education; presenting the characteristics of GAD as per the Generalized Anxiety Disorder Scale–7 (GAD–7) (Spitzer et al., 2006) and the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), and not participating in similar studies. The exclusion criteria of the study consisted of the presence of any bio psychological illnesses affecting the process of intervention; absence from >2 intervention sessions, and dissatisfaction with participating in the research. The research data were collected in the pretest, posttest, and one–month follow–up phases using the Ruminative Response Scale (Nolen–Hoeksema & Morrow, 1991) and the Emotional Processing Scale (Baker et al., 2007). ACT was administered to the experimental group for 12 sessions (one session per week for an average of 90 minutes); however, no intervention was provided to the controls. The protocol used in the present investigation was based on a study by Steven Hayes, developed by Orsillo et al. (2004) for anxiety disorders. The obtained data were analyzed using descriptive statistics (mean & standard deviation) and inferential statistics, i.e., repeated–measures Analysis of Variance (ANOVA) in SPSS at the significance level of 0.05.

The obtained data suggested significant differences in the mean pretest-posttest–follow–up scores of distraction (F=60.96, p<0.001), reflection (F=30.41, p<0.001), brooding (F=24.07, p<0.001), total rumination score (F=70.40, p<0.001), and total emotional processing score (F=29.68, p<0.001) between the experimental and control groups. In other words, the provided group-based ACT reduced rumination and improved emotional processing in the explored women with GAD in the posttest and follow–up phases. The Eta–squared value also revealed that the effect of group-based ACT on distraction was measured as 0.68, the same for reflection was calculated as 0.52, the score of brooding was 0.46, total rumination score equaled 0.72, and the same for emotional processing was computed as 0.51.

The present study results indicated the beneficial effects of group ACT on rumination and emotional processing in women with GAD. Thus, implementing short–term, group–based, and evidence–based therapies, such as ACT may alleviate the signs and symptoms of GAD, leading to improved mental health status in this population.