Examining the Effectiveness of Compassion-Based Acceptance and Commitment Integrated Therapy on Cortisol Hormone Levels and Mindfulness in Infertile Women Undergoing Hormone Therapy

Authors

    Sanaz Pourgoli Department of Clinical Psychology, kho.C., Islamic Azad University, Khomeinishahr, Iran
    Maryam Dehghan Department of Clinical Psychology, kho.C., Islamic Azad University, Khomeinishahr, Iran
    Kamran Pourmohammad Ghouchani * Department of psychology, Kish International Branch, Islamic Azad University, Kish island, Iran Kamran.pourmohammadghouchani@gmail.com
    Elham Naghshineh Associate Professor, Department of Obstetrics and Gynecology, Isfahan Branch, Isfahan University of Medical Sciences, Isfahan, Iran.
https://doi.org/10.61838/

Keywords:

Compassion-Based Acceptance and Commitment Integrated Therapy (ACT-CFT), infertility, cortisol, mindfulness

Abstract

Objective: The purpose of this study was to investigate the effect of compassion-based acceptance and commitment integrated therapy on reducing cortisol hormone levels and improving mindfulness in infertile women undergoing hormone therapy.

Methods and Materials: This study employed a quasi-experimental design with a pretest–posttest control group. The statistical population consisted of infertile women undergoing hormone therapy in Isfahan, Iran, in 2023, from which 40 participants were selected using purposive sampling and randomly assigned to the experimental group (n = 20) and the control group (n = 20). The therapeutic intervention was conducted for the experimental group in 10 sessions. Research instruments included the Five Facet Mindfulness Questionnaire (FFMQ) and a salivary cortisol assessment test. Data were analyzed using multivariate analysis of covariance (MANCOVA) and multivariate analysis of variance (MANOVA).

Findings: The results indicated that compassion-based acceptance and commitment therapy had a significant effect on reducing cortisol levels (P < .001) and improving various dimensions of mindfulness (P < .01). In the experimental group, the mean cortisol level decreased significantly in the posttest (a 2.2-unit reduction), while the control group showed a minimal, non-significant decrease. Moreover, overall mindfulness in the experimental group increased by 13.3 units; dimensions such as acceptance of negative emotions, present-moment focus, and non-judgmental awareness also demonstrated positive changes. MANOVA results further revealed that the difference between groups regarding the combination of dependent variables was significant (Wilks’ Lambda = 0.712, P < .001).

Conclusion: The findings suggest that compassion-based acceptance and commitment integrated therapy is effective not only in reducing physiological stress (cortisol) but also in enhancing mindfulness skills.

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References

Aghasi, M. (2021). Comparison of Self-Compassion and Self-Efficacy in Individuals With and Without Cosmetic Surgery. Quarterly Journal of Health Psychology and Social Behavior, 1(2), 89-104. https://journals.iau.ir/article_685150.html

Amirpour, F., Seddighi, A., Jarrahi, A., & Soltani, H. (2024). A Review of Factors Affecting Infertility and Its Prevention. The 12th International Conference on Women, Obstetrics, Infertility, and Mental Health,

Asadollah Salmanpour, F., & Pasha, G. R. (2023). The Effect of Acceptance and Commitment Therapy (ACT) on the Happiness, Mental Health, and Quality of Life of Childless Women. Quarterly Journal of Women Psychology, 4(1). https://doi.org/10.61838/kman.pwj.4.1.9

Balsom, A. A., Klest, B., Sander, B., & Gordon, J. L. (2024). Acceptance and commitment therapy adapted for women with infertility: a pilot study of the Infertility ACTion program. Reproductive Health, 21(1), 43. https://doi.org/10.1186/s12978-024-01766-5

Barbosa, C., Santos, S., & Pedro, J. (2024). Mapping acceptance and commitment therapy outcomes in the context of infertility: a systematic review. Current Psychology, 43(16), 14634-14644. https://doi.org/10.1007/s12144-023-05294-6

Cervoni, E. (2025). Disparity in hormone therapy acceptance between genders. Andrology. https://doi.org/10.1111/andr.70024

Cesta, C. E., Johansson, A. L., Hreinsson, J., Rodriguez‐Wallberg, K. A., Olofsson, J. I., Holte, J., & Nyman Iliadou, A. (2018). A prospective investigation of perceived stress, infertility‐related stress, and cortisol levels in women undergoing in vitro fertilization: influence on embryo quality and clinical pregnancy rate. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 258-268. https://doi.org/10.1111/aogs.13280

Costa, R. A., Vilcu, A. M., Cairat, M., Olivier, E., Thiébaut, A. C., & Fournier, A. (2025). Trends in the use of menopausal hormone therapy in France, 2001-2023. Maturitas, 108270. https://doi.org/10.1016/j.maturitas.2025.108270

Fard, T. R., Kalantarkousheh, M., & Faramarzi, M. (2018). Effect of mindfulness-based cognitive infertility stress therapy on psychological well-being of women with infertility. Middle East Fertility Society Journal, 23(4), 476-481. https://doi.org/10.1016/j.mefs.2018.06.001

Fata, S., & Tokat, M. A. (2021). Does hypnofertility-based nursing care affect cortisol levels, fertility preparedness, and pregnancy outcomes in women undergoing in vitro fertilization? a randomized controlled trial. Biological Research For Nursing, 23(3), 418-429. https://doi.org/10.1177/1099800420976916

Ferreira, C., Pereira, J., Skvarc, D., Oliveira, S., Galhardo, A., Ferreira, N. B., & Trindade, I. A. (2024). Randomized controlled trial of an Acceptance and Commitment Therapy and compassion-based group intervention for persons with inflammatory bowel disease: the LIFEwithIBD intervention. Frontiers in psychology, 15, 1367913. https://doi.org/10.3389/fpsyg.2024.1367913

Jalali Fard, K. (2023). The Effectiveness of Acceptance and Commitment Therapy (ACT) on Academic Self-Efficacy and Motivation in Female Students https://ensani.ir/fa/article/463838/

Järvelä-Reijonen, E. (2020). Stress, eating behavior, diet, and the effects of acceptance and commitment therapy: among adults with psychological distress and overweight https://erepo.uef.fi/items/d9b745db-bf30-414e-882c-9a5c1273f1dd

Järvelä-Reijonen, E., Puttonen, S., Karhunen, L., Sairanen, E., Laitinen, J., Kolehmainen, M., & Kolehmainen, M. (2020). The effects of acceptance and commitment therapy (ACT) intervention on inflammation and stress biomarkers: a randomized controlled trial. International Journal of Behavioral Medicine, 27, 539-555. https://doi.org/10.1007/s12529-020-09891-8

Karunyam, B. V., Abdul Karim, A. K., Naina Mohamed, I., Ugusman, A., Mohamed, W. M., Faizal, A. M., & Kumar, J. (2023). Infertility and cortisol: a systematic review. Frontiers in Endocrinology, 14, 1147306. https://doi.org/10.3389/fendo.2023.1147306

Malina, A., Głogiewicz, M., & Piotrowski, J. (2019). Supportive social interactions in infertility treatment decrease cortisol levels: experimental study report. Frontiers in psychology, 10, 2779. https://doi.org/10.3389/fpsyg.2019.02779

Malina, A., & Piotrowski, J. (2024). The role of social support for hormonal regulation for couples treated due to infertility. General Medicine & Health Sciences/Medycyna Ogólna i Nauki o Zdrowiu, 30(4). https://doi.org/10.26444/monz/197734

Miller, N., Herzberger, E. H., Pasternak, Y., Klement, A. H., Shavit, T., Yaniv, R. T., & Wiser, A. (2019). Does stress affect IVF outcomes? A prospective study assessing cortisol levels and stress questionnaires for women undergoing through IVF treatments. Reproduc Biomed Online, 30062-30068. https://pubmed.ncbi.nlm.nih.gov/31085094/

More, D., Chimurkar, V., & Bhandekar, B. (2022). Effectiveness of mind-body intervention on oocyte quality and serum cortisol level in sub-fertile women undergoing IVF treatment in Wardha region: A Study Protocol. Journal of Pharmaceutical Negative Results, 13(3). https://doi.org/10.47750/pnr.2022.13.03.172

Mousavi, E., Hosseini, S., Bakhtiyari, M., Abasi, I., Mohammadi, A., & Masjedi Arani, A. (2020). The effects of mindfulness-based stress reduction group therapy on anxiety, depression, stress, and the intolerance of uncertainty in infertile women. Iranian Rehabilitation Journal, 18(2), 137-144. https://doi.org/10.32598/irj.18.2.862.1

Nery, S. F., Paiva, S. P., Vieira, É. L., Barbosa, A. B., Sant'Anna, E. M., Casalechi, M., & Reis, F. M. (2019). Mindfulness‐based program for stress reduction in infertile women: Randomized controlled trial. Stress and Health, 35(1), 49-58. https://doi.org/10.1002/smi.2839

Pourgoli, S., & Rezaei, A. (2023). The Combined Effectiveness of Acceptance and Commitment Therapy and Compassion on Psychological Hardiness in Patients with Multiple Sclerosis (MS). The 3rd International Conference on Educational Sciences, Counseling, Psychology, and Social Sciences, Hamadan.

Rahimi, E., Attarha, M., & Majidi, A. (2019). Effect of acceptance and commitment therapy on the quality of life in infertile women during treatment: a randomized control trial. International Journal of Women's Health and Reproduction Sciences, 7(4), 483-489. https://doi.org/10.15296/ijwhr.2019.80

Rezaie, A. M. (2021). Effectiveness of treatment based on acceptance and commitment, compassion-based therapy and combination therapy on anxiety and dysfunctional attitudes in patients with systemic lupus. J Health Psychol, 10, 189-206. https://hpj.journals.pnu.ac.ir/article_7775.html?lang=en

Roncati, L. (2025). Adjuvant Metronomic Chemotherapy After Surgery in pT1-T2 N0 M0 HER2-Positive and ER/PR-Positive Breast Cancer Plus Targeted Therapy, Anti-Hormonal Therapy, and Radiotherapy, with or Without Immunotherapy: A New Operational Proposal. Cancers, 17(8), 1323. https://doi.org/10.3390/cancers17081323

Sharma, A., Shrivastava, D., & Sharma Iv, A. (2022). Psychological problems related to infertility. Cureus, 14(10). https://doi.org/10.7759/cureus.30320

Swift, A., Reis, P., & Swanson, M. (2021). Infertility stress, cortisol, coping, and quality of life in US women who undergo infertility treatments. Journal of Obstetric, Gynecologic & Neonatal Nursing, 50(3), 275-288. https://doi.org/10.1016/j.jogn.2020.12.004

Tarway, N. K., & Kumari, P. (2024). Navigating infertility care: the impact of the ART (regulation) act 2021. Journal of Marine Medical Society, 26(2), 301-312. https://www.semanticscholar.org/paper/Navigating-Infertility-Care%3A-The-Impact-of-the-Art-Manisha-Tarway/c24d1e1f82fcaa6fba17e3198e018465476df9f2

Wang, G., Liu, X., & Lei, J. (2023). Effects of mindfulness-based intervention for women with infertility: a systematic review and meta-analysis. Archives of Women's Mental Health, 26(2), 245-258. https://doi.org/10.1007/s00737-023-01307-2

Wdowiak, A., Raczkiewicz, D., Janczyk, P., Bojar, I., Makara-Studzińska, M., & Wdowiak-Filip, A. (2020). Interactions of cortisol and prolactin with other selected menstrual cycle hormones affecting the chances of conception in infertile women. International journal of environmental research and public health, 17(20), 7537. https://doi.org/10.3390/ijerph17207537

Wen, Y., Li, X., Shu, W., Zhang, H., Shen, Z., & Huang, Z. (2024). The effects of mindfulness therapy on infertile female patients: A meta-analysis. Technology and Health Care, 32(6), 4983-4997. https://doi.org/10.3233/THC-240174

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Published

2026-01-01

Submitted

2025-07-03

Revised

2025-10-01

Accepted

2025-10-08

Issue

Section

Articles

How to Cite

Pourgoli, S., Dehghan, M., Pourmohammad Ghouchani, K., & Naghshineh, E. . (2026). Examining the Effectiveness of Compassion-Based Acceptance and Commitment Integrated Therapy on Cortisol Hormone Levels and Mindfulness in Infertile Women Undergoing Hormone Therapy. Psychology of Woman Journal. https://doi.org/10.61838/