The Effectiveness of Combining Commitment and Acceptance Group Counseling with Reality Therapy on Resilience and Body Image in Infertile Women

The one of problem that infertile women face is negative social messages about their bodies. (Your body is not able to reproduce). So, people try to control a part of their body to avoid unpleasant emotions and annoying thoughts. This control is achieved through diet, extreme exercise, surgery, makeup, and avoiding social situations. In commitment-based counseling, control is not the solution but the problem itself. Exactly when a person wants to control something, he is not accepting it. Reality-based counseling also suggests that instead of blaming and criticizing one's body (external control), one accepts and respects one's body and does not seek to change it (internal control). Both counseling methods express the concept of control and try not to do it, so the combination of these two methods can be related to creating a favorable body image in infertile women and have a significant effect on their body image. Body image is the perception or mental belief about the appearance and the body in general. Infertile women with poor body image are more likely to have mental health problems, which can affect all aspects of their lives, and cause them to worry about physical attractiveness, overall self-esteem and general health. They suffer from mental disorders, especially emotional problems. Given the importance of mental health and its role in fertility, researchers suggest that the infertility treatment program be accompanied by psychological therapy. Counseling programs include a wide range of counseling approaches, including commitment-based counseling and reality therapy. Act treatment includes exposure-based exercises, language metaphors, and methods such as mental care. The ultimate goal of this treatment is to increase the abundance of valuable living. The main goal in this treatment is to establish the ability to make practical choices between different choices that are more appropriate. Research has also emphasized the effectiveness of group intervention in acceptance and commitment therapy and its important applications on adaptation, stress, anxiety, depression, resilience and psychosocial well-being. On the other hand, group therapy provides an opportunity for patients to come together in a supportive meeting to deal with the impact that the disease has on them. Studies have shown that some psychological interventions improve the health of infertile women. Common therapies that may affect these individuals include group therapy with acceptance and commitment therapy and group therapy with a reality therapy approach.Research has also been done in this area. Among them are Narimani, Alamdari and Abolghasem,,who studied the effectiveness of acceptance and commitment-based therapy on infertile women's quality of life. Cognitive attachment and flexibility in infertile women, Yaghoubi and Shahabizadeh, who studied the effectiveness of reality therapy training on cognitive emotion regulation strategies of women with experience of infidelity, Rahmanian, Nejad Ali and Oraki. The Effectiveness of Acceptance and Commitment Therapy on Cognitive Regulation of Emotion and Body Image Concern in Women with Overeating, Peterson and Efert , who in their study exposed 217 students to the theory of group therapy selection and counseling, Prinzella,  who in his study examined the interventional effect of reality therapy based on selection theory on PTSD patients, Hoggs, Clark, Klaklo, Dahl and McMillan, who in their research on the effectiveness of commitment-based therapy and acceptance on Examined chronic pain in women. Due to the prevalence and frequency of infertility and chronic infertility, a range of psychological problems for such women in various areas such as body image and resilience. The present study seeks to answer the question of whether the combination of group counseling based on commitment and acceptance with reality therapy is effective on body image and resilience in infertile women?

The present study is a quasi-experimental type of intra-subject - between subject and quarterly follow-up with an experimental group and a control group. According to this plan, the subjects were randomly assigned to an experimental group and a control group and then an experimental operation was performed. First, they were pre-tested and then for the experimental group, a combination of acceptance and commitment group counseling program (ACT) was performed, while the control group did not receive any training. Then, at the end of the training course, post-test was taken from both groups to compare the effect of the combination of acceptance and commitment group therapy (ACT) with reality therapy on the performance of the groups. The statistical population of the present study was all infertile women in Shiraz who had referred to one of the infertility clinics and treatment centers in Shiraz in a period of three months (summer 1398). Among infertile women referred, 30 were selected by convenience sampling. In order to control the effects of demographic, the two groups were matched based on age of 20-45 years. These groups included two experimental groups (combination of act therapy and reality therapy) and a control group. The measuring instruments were Connor and Davidson’s Resilience Questionnaire and Fisher’s Body image questionnaire. The validity of the questionnaires was calculated through face validity and their reliability was calculated using Cronbach's alpha coefficient, whose reliability was 0.89 and 0.86, respectively. Descriptive statistics methods were used to estimate the distribution of participants and research variables and inferential statistics such as analysis of covariance were used to compare the means of the experimental and control groups.

The results showed that the combination of group counseling based on commitment and acceptance with reality therapy is effective on resilience and body image in infertile women.

Due to the fact that infertility causes destructive psychological effects and various social reactions and many psychological problems, adverse social and psychological conditions for infertile women in society are formed. Therefore, using a combination of group counseling based on commitment and acceptance with reality therapy on resilience and body image in infertile women is important.