Comparing the Effectiveness of Reality Therapy, Acceptance and Commitment Therapy, and Group-Based Positive Approach on Marital Conflicts in Women with Multiple Sclerosis

 Multiple sclerosis (MS) is the most common neurocognitive disorder among middle–aged individuals and a chronic, progressive disease of the central nervous system that negatively affects various aspects of relationships, including sexual relationships. Constandinidis et al. (2019) found a relationship between MS, marital conflicts, and sexual dysfunction. Marital conflict refers to physical and verbal/psychological aggression between spouses. Reality therapy and choice theory are popular options for couple therapy, aiming to increase sexual satisfaction and reduce sexual conflicts. Another potentially effective treatment for marital conflicts is acceptance and commitment therapy, which helps individuals by increasing psychological flexibility and mindfulness, clarifying values, breaking free from unhelpful thoughts, and engaging in intelligent actions. According to some studies, positive behavior therapy, which Seligman and colleagues developed, is another treatment that has been effective in reducing some components of marital conflict. The present study was conducted to evaluate and compare the effectiveness of reality therapy, acceptance and commitment therapy, and positivist approach in a group manner on marital conflicts in female patients with multiple sclerosis living in Hamadan City, Iran.

 The current quasi–experimental research employed a pretest–posttest design with a control group. The study's statistical population included all women with multiple sclerosis living in Hamadan in 2020. Of these, 63 were selected using available sampling and randomly assigned to three experimental groups (reality therapy with 16 people, acceptance and commitment therapy with 15 people, and positivist approach with 15 people) and a control group with 17 people. The therapy program consisted of one 90–minute weekly session in 8 sessions for three experimental groups (one therapeutic intervention for each group). In the case of the control group, there was no intervention at that time. In addition, the present study used the Marital Conflict Questionnaire (Sanayi Zaker et al., 1992) to collect information. The questionnaire has 54 questions scored on a 5–point scale from 1 to 5. The reliability and validity of the questionnaire were confirmed by calculating the Cronbach alpha equal to 0.96. Analysis of the research data was done using the analysis of the covariance using SPSS–25 software.

 Univariate analysis of covariance after adjusting pretest score showed significant differences between MS women participating in reality therapy, acceptance and commitment therapy, and positive approach regarding the average posttest scores of marital conflicts (p<0.001) with the effect size of 0.526. Based on the Bonferroni post hoc test results, the average posttest scores of marital conflicts in the reality therapy group (p<0.001), acceptance and commitment therapy group (p<0.001), and positive approach group (p<0.001) were significantly lower than the control group. Also, the average scores of marital conflicts in the reality therapy group (p<0.031) and acceptance and commitment therapy group (p<0.001) were significantly lower than those in the positive approach group (p<0.001). However, there was no significant difference between the reality therapy group and the acceptance and commitment therapy group. All three interventions of reality therapy, acceptance and commitment, and positive approach therapies were significantly effective in reducing the marital conflicts of MS women. In addition, no difference was observed between the effectiveness of reality therapy and acceptance and commitment therapy.

 Comparing the efficacy of three intervention approaches showed that all three treatment methods effectively reduced marital conflicts. However, acceptance and commitment therapy was more effective than the other two interventions. Therefore, we suggest that all three methods of reality therapy, acceptance and commitment therapy, and the positivist approach can be used to reduce marital conflicts. Of course, based on the results of the present study, it is better to use acceptance and commitment therapy as the first choice of therapists.