Comparison of the Effectiveness of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy (BAT) on Quality of Life and Self-Care Behaviors in Patients with Type 2 Diabetes
Keywords:
Acceptance and Commitment Therapy (ACT), Behavioral Activation Therapy (BAT), Type 2 Diabetes, Quality of Life, Self-Care Behavior, Psychological InterventionsAbstract
Purpose: This study aimed to compare the effectiveness of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy (BAT) on quality of life and self-care behaviors in patients with type 2 diabetes.
Methods and Materials: The research employed a quasi-experimental design with pre-test, post-test, and three-month follow-up, using a three-group format (ACT, BAT, and control). A total of 60 patients with type 2 diabetes from Tehran health centers were selected through convenience sampling and randomly assigned to one of the three groups, with 20 participants in each. Both intervention groups received eight two-hour sessions administered face-to-face by the researcher. The ACT protocol was based on Hayes' model, emphasizing psychological flexibility, mindfulness, and value-driven behavior, while the BAT protocol followed Levenson’s structure focused on re-engagement with rewarding activities. Data were collected using the Quality of Life Questionnaire (SF-36) and the Diabetes Self-Care Behavior Questionnaire. Descriptive statistics and mixed ANOVA, along with Bonferroni post-hoc tests, were used for data analysis via SPSS.
Findings: Results indicated that both ACT and BAT significantly improved quality of life and self-care behaviors compared to the control group (p < .001). However, ACT was significantly more effective than BAT in enhancing both outcome variables at post-test and follow-up. Within-subject analyses showed significant changes over time for both interventions, and between-subject effects confirmed group-based differences. Post-hoc tests revealed sustained improvements in the ACT group, while BAT showed moderate but less stable effects.
Conclusion: Both ACT and BAT are effective psychological interventions for improving self-care and quality of life in type 2 diabetic patients, with ACT demonstrating stronger and more lasting outcomes.
Downloads
References
Al Yassin, S. A., Davoodi, H., & Nematollahi, M. (2020). The Effectiveness of Acceptance and Commitment-Based Therapy on the Psychological Well-Being and Resilience of Type 2 Diabetic Women. medical journal of mashhad university of medical sciences, 62(5.1), -. https://doi.org/10.22038/mjms.2020.18950
Alho, I., Lappalainen, P., Muotka, J., & Lappalainen, R. (2022). Acceptance and commitment therapy group intervention for adolescents with type 1 diabetes: A randomized controlled trial. Journal of Contextual Behavioral Science, 25, 153-161. https://doi.org/10.1016/j.jcbs.2022.08.002
Bass, C., van Nevel, J., & Swart, J. (2014). A comparison between dialectical behavior therapy, mode deactivation therapy, cognitive behavioral therapy, and acceptance and commitment therapy in the treatment of adolescents. International journal of behavioral consultation and therapy, 9(2), 4-8. https://doi.org/10.1037/h0100991
Behzadi, S., Tajeri, B., Sodagar, S., & Shariati, Z. (2021). The comparison of the effectiveness of acceptance, commitment, and reality therapy on life satisfaction and self-care behaviors of the elderly with type II diabetes. Applied Family Therapy Journal (AFTJ), 2(4), 483-501. https://journals.kmanpub.com/index.php/aftj/article/view/827
Enayati Shabkolai, M., Enayati Shabkalai, M., & Bagheri Dadokolai, M. (2023). The Effectiveness of Treatment based on Acceptance and Commitment on Social Adaptation, Academic Self-Regulation and Cognitive Flexibility of Students with Specific Learning Disorders. International Journal of Education and Cognitive Sciences, 4(1), 33-41. https://doi.org/10.61838/kman.ijecs.4.1.5
Fernández-Rodríguez, C., Coto-Lesmes, R., Martínez-Loredo, V., González-Fernández, S., & Cuesta, M. (2023). Is Activation the Active Ingredient of Transdiagnostic Therapies? A Randomized Clinical Trial of Behavioral Activation, Acceptance and Commitment Therapy, and Transdiagnostic Cognitive-Behavioral Therapy for Emotional Disorders. Behavior Modification, 47(1), 3-45. https://doi.org/10.1177/01454455221083309
Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of consulting and clinical psychology, 75(2), 336-343. https://doi.org/10.1037/0022-006X.75.2.336
Ismailian, Z., Rahmani, M. A., & Tizdast, T. (2023). The Effectiveness of Acceptance and Commitment Therapy on Self-Care and Glycated Hemoglobin in Female Patients with Type 2 Diabetes. New Advances in Cognitive Sciences, 25(1), 1-14. https://icssjournal.ir/article-1-1458-fa.html
Keikha, H., Farnam, A., & Jenaabadi, H. (2019). Comparing the Effectiveness of Group Therapy Based on Acceptance-Commitment Therapy on Cognitive Fusion, Quality of Life, and Anxiety in Students with Diabetes. Psychological Sciences Journal, 18(83), 2193-2201. https://psychologicalscience.ir/article-1-438-fa.html
Khalatbari, A., Ghorbanshiroudi, S., Zarbakhsh, M., & Tizdast, T. (2021). Comparison of the Effectiveness of Compassion-Focused Therapy and Treatment based on Acceptance and Commitment to Craving, Quality of Life and Psychological Distress in Patients with Type 2 Diabetes. Health Psychology, 9(36), 7-24. https://doi.org/10.30473/hpj.2020.53961.4884
Khalatbari, A., Ghorbanshiroudi, S., Zarbakhsh, M. R., & Tizdast, T. (2020). Comparison of the Effectiveness of Compassion-based Therapy and Acceptance-based Therapy and Commitment to Self-care Behavior and Glycosylated Hemoglobin in Patients With Type 2 Diabetes. gums-med, 29(3), 34-49. https://doi.org/10.32598/JGUMS.29.3.1584.1
Kharaii, K., & Azizi, M. (2021). The Effectiveness of Behavioral Activation Therapy in a Group Setting on Depression, Anxiety, and Increased Quality of Life in Female-Headed Households in Ghale Ganj County. Quarterly Journal of New Ideas in Psychology, 10(14), 1-8. https://jnip.ir/article-1-580-fa.html
Nicolescu, S., Secară, E.-C., Jiboc, N. M., & Băban, A. (2024). Oncovox: A randomised controlled trial of a web-based acceptance and commitment therapy for breast cancer patients. Journal of Contextual Behavioral Science, 32, 100729. https://doi.org/10.1016/j.jcbs.2024.100729
Parhoon, H., Moradi, A., Hatami, M., & Parhoon, K. (2013). Comparison of the brief behavioral activation treatment and meta-cognitive therapy in the reduction of the symptoms and in the improvement of the quality of life in the major depressed patients. https://www.sid.ir/paper/134003/en
Saeidi, A., Jabalameli, S., Gorji, Y., & Ebrahimi, A. (2021). The Effectiveness of Acceptance and Commitment Therapy on Self-Care and Psychological Capital in Patients with Diabetes. Zabol Diabetes Nursing, 9(3), 1633-1647. https://civilica.com/doc/1301407/
Shayeghian, Z., Amiri, P., Aguilar-Vafaie, M. E., & Besharat, M. A. (2016). Effectiveness of acceptance and commitment group therapy on improvement of glaycated hemoglobin and self-care activities in patients with type II diabetes. Contemporary Psychology, Biannual Journal of the Iranian Psychological Association, 10(2), 41-50. https://bjcp.ir/browse.php?a_id=897&sid=1&slc_lang=en
Staley, C., & Lawyer, S. R. (2010). Behavioral Activation and CBT as an Intervention for Coexistent Major Depression and Social Phobia for a Biracial Client With Diabetes. Clinical Case Studies, 9(1), 63-73. https://doi.org/10.1177/1534650109355187
Susanne, A., Ingrid, W., Fredrik, L., Eva, T., Unn-Britt, J., & Therese, A. (2018). Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: study protocol for a randomised controlled trial. BMJ open, 8(11), e022234. https://doi.org/10.1136/bmjopen-2018-022234
Zandi, A., Dinpanah-Khoshdarehgi, H., Ebrahim-Madahi, M., & Jamehri, F. (2023). Comparison of the effect of acceptance and commitment therapy and reality therapy on the self-care of diabetes type II patients. J Educ Health Promot, 12, 364. https://doi.org/10.4103/jehp.jehp_1174_22
Zandi, M., Mohammadi Khani, S., & Hatami, M. (2024). Comparing the Effectiveness of Acceptance and Commitment Therapy and Emotion-Focused Therapy on the Quality of Life of Patients with Type 2 Diabetes. Journal of Psychological Achievements, 1, 1-10. https://psychac.scu.ac.ir/article_19434.html
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 Reza Ahmadi (Author); Lida Leilabadi; Mahdieh Salehi (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
