A Comparison of the Effectiveness of Schema Therapy and Acceptance and Commitment Therapy on Experiential Avoidance in Women with Multiple Sclerosis
Keywords:
Multiple sclerosis, experiential avoidance, schema therapy, acceptance and commitment therapy, womenAbstract
Objective: The present study aimed to compare the effectiveness of schema therapy and acceptance and commitment therapy in reducing experiential avoidance among women diagnosed with multiple sclerosis.
Methods and Materials: This applied, quasi-experimental study employed a pretest–posttest–follow-up design with a control group. The statistical population consisted of women with multiple sclerosis who attended the Tehran Multiple Sclerosis Society during 2024–2025. Forty-five eligible participants were selected using accessible sampling and randomly assigned to three groups: schema therapy, acceptance and commitment therapy, and a control group, each comprising fifteen participants. The two intervention groups received ten group-based sessions of 90 minutes according to standardized therapeutic protocols, while the control group received no psychological intervention. Experiential avoidance was assessed at pretest, posttest, and follow-up using the Acceptance and Action Questionnaire–II. Data were analyzed using descriptive statistics and repeated-measures analysis of covariance, controlling for baseline scores, with post hoc comparisons conducted using Tukey’s HSD test.
Findings: Inferential analyses demonstrated a statistically significant effect of group on experiential avoidance at posttest after controlling for pretest scores, as indicated by ANCOVA results (F = 69.44, p < 0.001, η²p = 0.77), confirming a large effect of the interventions. Post hoc Tukey HSD comparisons showed that the acceptance and commitment therapy group had significantly lower experiential avoidance scores than the schema therapy group (mean difference = −4.44, p < 0.001) and the control group (mean difference = −7.98, p < 0.001), and the schema therapy group also differed significantly from the control group (mean difference = −3.54, p < 0.001). At follow-up, the group effect remained statistically significant (F = 51.31, p < 0.001, η²p = 0.72), indicating sustained treatment effects over time. Pairwise comparisons at follow-up revealed that acceptance and commitment therapy continued to show significantly lower experiential avoidance compared with the control group (mean difference = −7.28, p < 0.001) and schema therapy (mean difference = −5.45, p < 0.001), while schema therapy also maintained a significant advantage over the control group (mean difference = −1.84, p = 0.041). These results indicate that both interventions produced significant and lasting reductions in experiential avoidance, with acceptance and commitment therapy demonstrating the strongest and most durable effects.
Conclusion: Both schema therapy and acceptance and commitment therapy are effective interventions for reducing experiential avoidance in women with multiple sclerosis; however, acceptance and commitment therapy appears to yield superior and more durable outcomes. These findings support the use of acceptance-based and schema-focused psychological interventions as part of comprehensive psychosocial care for women with multiple sclerosis.
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