Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy Educational-Therapeutic Packages on Anxiety and Alexithymia in Students with Self-Harming Behaviors

Fatemeh Fathi; Niloufar Tahmouresi; Mahtab Morveji

Authors

Fatemeh Fathi Department of Clinical Psychology, Ki.c., Islamic Azad University, Kish, Iran. Author https://orcid.org/0009-0007-0859-1561
Niloufar Tahmouresi Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran. Corresponding Author https://orcid.org/0000-0002-2962-375X
Mahtab Morveji Department of Nursing & midwifery, Za.c., Islamic Azad University, Zanjan, Iran. Author https://orcid.org/0000-0003-3150-0836

Keywords:

Self-Harming Behaviors, Anxiety, Alexithymia, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Students

Abstract

Objective: This study aimed to compare the effectiveness of educational-therapeutic packages based on Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) in reducing anxiety and alexithymia among students with self-harming behaviors.

Methodology: This quasi-experimental study employed a pretest-posttest design with two intervention groups and a control group. The statistical population consisted of upper-secondary school students in Kermanshah, Iran. Using convenience sampling and screening with the Sansone et al. (1998) Self-Harm Inventory, 45 eligible students were selected and assigned to CBT, ACT, and control groups. Participants completed the Beck Anxiety Inventory (1990) and the Toronto Alexithymia Scale (1994) at pretest and posttest. The two experimental groups received educational-therapeutic interventions based on CBT and ACT, whereas the control group received no intervention during the study period. Data were analyzed using univariate and multivariate analyses of covariance (ANCOVA and MANCOVA) in SPSS version 26, with pretest scores controlled in the inferential analyses.

Findings: Univariate ANCOVA indicated a statistically significant group effect on posttest anxiety after controlling for pretest scores, with group membership accounting for approximately 78% of the variance in anxiety. A significant intervention effect was also found for total alexithymia, indicating a substantial reduction attributable to the therapeutic interventions. Multivariate covariance analysis of alexithymia dimensions revealed significant between-group differences in difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking, with the largest effect observed for externally oriented thinking. Bonferroni post-hoc comparisons demonstrated that both CBT and ACT significantly reduced anxiety, total alexithymia, and its dimensions compared with the control group. However, no statistically significant differences were observed between CBT and ACT in their effects on anxiety or alexithymia.

Conclusion: Both CBT- and ACT-based educational-therapeutic packages appear to be effective interventions for reducing anxiety and alexithymia among students exhibiting self-harming behaviors. The absence of significant differences between the two approaches suggests that either intervention may be incorporated into school-based psychological and counseling programs according to students’ needs and available clinical resources.

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