International Journal of Behavioral Sciences

International Journal of Behavioral Sciences

Effectiveness of Emotion-Focused Therapy Compared to Acceptance and Commitment Therapy on Health-Promoting Behaviors and Psychological Flexibility in Patients with Autoimmune Diseases: Investigating the Moderating Role of Age

Document Type : Original Article

Authors
Mojgan Omidbakhsh 1
Afra Shahrabi Farahani 2
Seyedeh Neda Amirnia 3
Kazem Rad 4
Masoumeh Alizadeh 5
1 1. Department of Psychology, Refah University, Tehran, Iran. Email address: mojiomid3@gmail.com. Phone Number:09124716747
2 2. Department of Psychology, University of Tehran, Tehran, Iran. ORCID code: 0009-0008-5643-236X. Email address: afra.shahrabi@gmail.com. Phone number: 09106987112
3 3. Department of Psychology, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran. Email: n.amirniya@gmail.com. ORCID ID: 0009-0007-5199-3304. Phone: +989197713623.
4 4. Department of Psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran.
5 5. Department of Psychology, Urmia Branch, Islamic Azad University, Urmia, Iran. https://orcid.org/0009-0002-9103-8655. 0922749710. abinehdarman1400@gmail.com
10.30491/ijbs.2026.564961.2293
Abstract
Introduction: The condition of patients with autoimmune diseases is critically influenced by the interaction between emotions, health-related behaviors, and psychological flexibility. This study aimed to compare the effectiveness of Emotion-Focused Therapy (EFT) and Acceptance and Commitment Therapy (ACT) on health-promoting behaviors and psychological flexibility in patients with autoimmune diseases, while examining the role of age as a moderator of change trajectories.
Method: This semi-experimental study employed a pre-test, post-test, and three-month follow-up design with three groups. The statistical population consisted of all patients aged 20 years and above with a confirmed diagnosis of autoimmune disease in Tehran between July and November 2024. The sample consisted of 45 participants selected purposively. The ACT group received eight 90-minute sessions and the EFT group received ten 90-minute sessions, twice a week. Instruments included the Health Promoting Lifestyle Profile (HPLP) and the Psychological Flexibility Questionnaire (PFQ). For statistical analyses, Kruskal-Wallis H test and repeated measures analysis of covariance were used.
Results: For psychological flexibility, the main group effect was non-significant (p = 0.998), showing no significant differences between the three groups. The time × group interaction was significant (F = 4.25, p = 0.023, η² = 0.20), indicating that changes in psychological flexibility over time varied according to treatment type. For health-promoting behaviors, the time × group interaction was highly significant (F = 8.05, p = 0.001, η² = 0.32), demonstrating greater efficacy of EFT and ACT compared to the control group. The time × age interaction was also significant (F = 10.67, p = 0.003, η² = 0.24).
Conclusion: Both EFT and ACT effectively induced meaningful changes in the trajectories of patients with autoimmune diseases, although the speed and nature of their effects differed.
Keywords
Emotion-Focused Therapy
Acceptance and Commitment Therapy
Health-Promoting Behaviors
Psychological Flexibility
Autoimmune Patients
Age
1.      Silva-Ribeiro S, Godinho CA, Camilo C, Marques MM, Chisari C, Segura Ú, Bernardes SF. Psychological, social and behavioural factors associated with disease/illness activity and adjustment to Lupus: a systematic review and meta-analysis. Health Psychology Review. 2025 Mar 26:1-35.
2.      Klettner A, Luo S, Coyle LD, Liu N. A review of the link between psychological stress and inflammatory bowel disease exacerbation. Academia Mental Health and Well-Being. 2025 Mar 26;2(1).
3.      Banafshi Z, Dehghan Nayeri N, Moghimi N, Khatony A. Exploring the self-care experiences of patients with rheumatoid arthritis through qualitative content analysis. Scientific Reports. 2025 Aug 26;15(1):31430.
4.      Di Giuseppe M, Spatola C, Merlo EM, Silvestro O, Giorgianni CM, Juli G, Catalano A, Martino G. RESEARCH ADVANCES IN CLINICAL PSYCHOLOGY OF CHRONIC DISEASES. Psychiatria Danubina. 2025 Sep;37(Suppl 1):56-62.
5.      Roberts MZ, Scheiber FA, Moskovich AA, Merwin RM. A Scoping Review of the Relationship Between Psychological (In) flexibility and Living with and Managing Type 1 and Type 2 Diabetes. Behavioral Sciences. 2025 Jun 9;15(6):792.
6.      Li P, Li Y, He C, Wang H, Yin X, Jiang Y, Yin T. The Mediating Role of Patient Activation on the Relationship Between Social Support and Health-Promoting Behavior in Patients with Thyroid Cancer: A Cross-Sectional Study. J Multidiscip Healthc. 2025 Apr 16;18:2131-2140. doi: 10.2147/JMDH.S510415. PMID: 40260224; PMCID: PMC12010070.
7.      Stout R, Reichert D, Kelly R, editors. Lifestyle Medicine and the Primary Care Provider: A Practical Guide to Enabling Whole Person Care. CRC Press; 2025 Jul 30. https://doi.org/10.1201/9781032675794
8.      Zarbo C. “In health and sickness”: the psychological distress of partners of women with a diagnosis of Endometriosis. The Project PRENDOTE. MEDITERRANEAN JOURNAL OF CLINICAL PSYCHOLOGY. 2024;12(S2):690-1. https://boa.unimib.it/handle/10281/547517
9.      Bagheri M, Lotfi Kashani F, Ebrahimi MI. Comparing the Effects of Acceptance and Commitment Therapy and Reality Therapy on Improving Illness Perception in Women with Multiple Sclerosis. Avicenna Journal of Neuro Psycho Physiology. 2024 Sep 10;11(3):117-25. 10.32592/ajnpp.2024.11.3.117
10.   Eisazadeh F, Rahimian-Boogar I. Effectiveness of Acceptance and Commitment Therapy on Physiological Measures in Patients with Type 2 Diabetes in Iran: A Systematic Review and Meta-Analysis: Systematic Review and Meta-Analysis of Acceptance and Commitment Therapy in Type 2 Diabetes. International Journal of Applied Behavioral Sciences. 2024;11(3):26-36. https://doi.org/10.22037/ijabs.v11i3.46328
11.   Rahelić V, Perković T, Romić L, Perković P, Klobučar S, Pavić E, Rahelić D. The Role of Behavioral Factors on Chronic Diseases-Practice and Knowledge Gaps. Healthcare (Basel). 2024 Dec 12;12(24):2520. doi: 10.3390/healthcare12242520. PMID: 39765947; PMCID: PMC11675894.
12.   Agarwal U, Tonk RK. A Review of Mental Health: Epidemiology, Interventions, and Treatment Modalities. Current Social Sciences. 2025 Jan;3(1):E2772316X373662. DOI: 10.2174/012772316X373662250324051043
13.   Wang Z, Song Y, Ou L, Liao D, He L, Ning Q, Chen Y, Chen H. Factors affecting patient activation among patients with systemic lupus erythematosus. Scientific Reports. 2024 Jan 18;14(1):1632.
14.   Kang H. Sample size determination and power analysis using the G* Power software. Journal of educational evaluation for health professions. 2021 Jul 30;18.10.3352/jeehp.2021.18.17
15.   Greenberg LS. Emotion–focused therapy. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice. 2004 Jan;11(1):3-16. https://doi.org/10.1002/cpp.388
16.   Mostajeran M, Jazayeri RS, Fatehizade M. The Effect of integrated Emotion-focused therapy (Grinbeerg's) and Compassion focused Therapy on Marital quality of Life and married women. Research in Cognitive and Behavioral Sciences. 2021 Aug 23;11(1):85-106. https://doi.org/10.22108/cbs.2022.130801.1576
17.   Hayes SC, Pistorello J, Levin ME. Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist. 2012 Oct;40(7):976-1002. https://doi.org/10.1177/0011000012460836
18.   Walker SN, Sechrist KR, Pender NJ. The health-promoting lifestyle profile: development and psychometric characteristics. Nursing research. 1987 Mar 1;36(2):76-81. https://pubmed.ncbi.nlm.nih.gov/3644262/
19.   Sehati M, Ashayeri H, Doulatabadi S. Effectiveness of Cognitive-Behavioral Intervention on Adherence to Health Promotion Behaviors and Psychological Flexibility in Autoimmune (Psoriasis) Patients. Medical Journal of Mashhad university of Medical Sciences. 2020 Jul 22;63(3):2428-40. https://doi.org/10.22038/mjms.2021.17838
20.   Ben-Itzhak S, Bluvstein I, Maor M. The psychological flexibility questionnaire (PFQ): Development, reliability and validity. 2014.
21.   Safarzaei M, Ameri F, Mehrinejad SA, Peivastegar M, Khodabakhsh Pirkalani R. Psychometric properties of the Psychological Flexibility Questionnaire among students. Journal of Research in Psychological. 2020. URL: http://rph.khu.ac.ir/article-1-3787-fa.html
22.   Khayyat-Abuaita U, Paivio S, Pascual-Leone A, Harrington S. Emotional processing of trauma narratives is a predictor of outcome in emotion-focused therapy for complex trauma. Psychotherapy. 2019 Dec;56(4):526.
23.   Noorali Z, Khakpour R, Jahangir P. Comparison of the Effects of Acceptance and Commitment Therapy and Emotion-Focused Therapy on Mental Vitality in Caregivers of Elderly Parents. Elderly Health Journal 2024; 10 (2) :111-121. http://ehj.ssu.ac.ir/article-1-330-en.html
24.   Folkertsma TS, Bos R, Vodegel RM, Bloem S, Liefveld AR, Tack GJ. Personalizing supportive healthcare for patients with immunological disorders. medRxiv. 2024 Apr 27:2024-04. https://www.medrxiv.org/content/10.1101/2024.04.25.24306403v1.full.pdf
25.   Niño de Guzmán Quispe E, Martínez García L, Orrego Villagrán C, Heijmans M, Sunol R, Fraile-Navarro D, Pérez-Bracchiglione J, Ninov L, Salas-Gama K, Viteri García A, Alonso-Coello P. The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews. Patient. 2021 Nov;14(6):719-740. doi: 10.1007/s40271-021-00514-2.
26.   Clark PG, Greene GW, Blissmer BJ, Lees FD, Riebe DA, Stamm KE. Trajectories of Maintenance and Resilience in Healthful Eating and Exercise Behaviors in Older Adults. J Aging Health. 2019 Jun;31(5):861-882. doi: 10.1177/0898264317746264. Epub 2017 Dec 12. PMID: 29254440.
Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease - strategies for optimizing treatment outcome. J Eur Acad Dermatol Venereol. 2019 Dec;33(12):2253-2263. doi: 10.1111/jdv.15913. Epub 2019 Nov 14. PMID: 31454113.
International Journal of Behavioral Sciences
Volume 20, Issue 1
Spring 2026
Pages 10-18