Comparing the Effectiveness of Cognitive Behavioral Therapy and Emotion-Focused Therapy on Mindfulness and Psychological Flexibility in Generalized Anxiety Disorder

Alireza Ahangaran; Hasan  Fathi; Negin Sadat  Azimi; Aliyeh  Ghorbani

doi:10.61838/

Authors

Alireza Ahangaran Ms.C in General Psychology, Department of Psychology, Faculty of Economics and Social Sciences, Bu-Ali Sina University, Hamedan, Iran

Hasan Fathi * Department of Psychology, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran Hasanfathi26@gmail.com

Negin Sadat Azimi M.S. in Clinical Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran

Aliyeh Ghorbani M.S. in Clinical Psychology, Islamic Azad University, Lahijan Branch, Lahijan, Iran

https://doi.org/10.61838/

Abstract

Objective: This study compared the effectiveness of cognitive behavioral therapy (CBT) and emotion-focused therapy (EFT) for improving mindfulness and psychological flexibility in women with generalized anxiety disorder (GAD). Method: A quasi-experimental pretest-posttest design with a control group and follow-up assessment was used. Forty-five women with GAD who attended counseling and psychological service centers in Tehran in 2025 were selected through purposive sampling and then randomly assigned to three groups (n = 15 per group): CBT, EFT, and control. Interventions were delivered online in 12 weekly 90-minute sessions. Measures included the Generalized Anxiety Disorder Scale (GAD-7), the Five Facet Mindfulness Questionnaire (FFMQ-15), and the Acceptance and Action Questionnaire-II (AAQ-II). Data were analyzed using repeated-measures analysis of variance in SPSS version 26. Results: Both active treatments produced significant improvements compared with the control group, but CBT showed the strongest effects. For mindfulness, the CBT group increased from M = 31.46 (SD = 5.12) at pretest to M = 54.06 (SD = 5.00) at posttest and M = 55.53 (SD = 8.41) at follow-up, whereas the EFT group increased from M = 32.73 (SD = 4.51) to M = 47.73 (SD = 4.72) and M = 47.20 (SD = 4.75). For AAQ-II scores, where lower scores indicate greater psychological flexibility, the CBT group improved from M = 33.80 (SD = 3.23) to M = 17.60 (SD = 4.08) and M = 18.26 (SD = 4.31), while the EFT group improved from M = 36.06 (SD = 3.43) to M = 23.40 (SD = 3.45) and M = 22.93 (SD = 4.69). The repeated-measures ANOVA showed significant time, group, and time × group effects for both mindfulness and psychological flexibility (all p < .001). Conclusion: Both CBT and EFT were effective in women with GAD, but CBT yielded greater gains in mindfulness and psychological flexibility and maintained these gains at follow-up.