Comparing Effectiveness of the Cognitive-behavioral Therapy, Reality Therapy, and Acceptance and Commitment Therapy on Quality of Life, General Health, and Coping Strategies of Chronic Patient’s Caregivers

Document Type : Original Article


1 Doctor of Health Psychology, Kharazmi University, Tehran, Iran

2 Associate Professor, Kharazmi University, Tehran, Iran

3 Associate Professor،Department of clinical Psychology،kharazmi University،Tehran،Iran

4 Associate Professor, William Glaser Institute, Australia


Introduction: The chronic diseases has long been great challeng in the healthcare system worldwide, with huge financial, psychological and physical costs. Given the persistence of these diseases and increased  patients tendency for non-hospital care, the care processes may impact the quality of life and general health of family members, particularly the primary caregiver. The  aim of this study then was  to compare the effectiveness of Congnitive-behavioral Therapy, Reality Therapy and Acceptance and Commitment Therapy on quality of life, general health and coping strategies of chronic patient caregivers.
Method: This study was designed and conducted as a semi-experimental study (pre-test and post-test with control group). The statistical population of this study included caregivers of people with cancer in Shohada Hospital of Tajrish and caregivers of patients with MS registered in the Tehran MS Association. A total sample of 60 subjects were selected on a voluntary basis and divided into 3 exprimental groups and a control group. All subjects were completed the General Health Questionnaire, the  Coping Response Inventory , and the Quality of Life Questionnaire in the pretest and post test occations.
Results: The results of this study showed that all three interventions of cognitive behavioral therapy, reality therapy and acceptance and commitment therapy could significantly impact the means of the study dependent variables compared to the control group. Cognitive-behavioral therapy interventions compared to other methods revealed more robust changes in the general health scores, quality of life, and coping strategies in caregivers.
Conclusion: The effectiveness of all three interventions in cognitive-behavioral therapy, reality therapy, and acceptance and commitment therapy on caregivers public health, quality of life and coping strategies, are confirmed. The cognitive-behavioral therapy intervention is prefered compared to the other two methods, and reality therapy showed the minimum effect.


1. Page, Timothy F.; Palmer, Richard C. Cost Analysis of Chronic Disease Self-Management Programmes Being Delivered in South Florida. Health Education Journal,. (2014), v73 n2 p228-236.
2. Bopp, Trevor; Stellefson, Michael; Weatherall, Brittany; Spratt, Susannah. Promoting Physical Literacy for Disadvantaged Youth Living with Chronic Disease. American Journal of Health Education, (2019). v50 n3 p153-158.
3. Hall, Michael; Elise, Eifert. Theory in Chronic Disease Prevention and Health Promotion. American Journal of Health Education, (2016). v47 n4 p202-203.
4. Kumar, Chandrika; Bensadon, Benjamin A.; Van Ness, Peter H.; Cooney, Leo M. Curriculum on Resident Education in Care of Older Adults in Acute, Transitional and Extended Care Settings. Journal of Education and Training Studies, (2016). v4 n9 p247-252.
5. Beighton, Carole; Victor, Christina; Carey, Iain M.; Hosking, Fay; DeWilde, Steve; Cook, Derek G.; Manners, Paula; Harris, Tess. 'I'm Sure We Made It a Better Study…': Experiences of Adults with Intellectual Disabilities and Parent Carers of Patient and Public Involvement in a Health Research Study. Journal of Intellectual Disabilities, (2019).v23 n1 p78-96.
6. Safaeian, Zohreh; Sadat Hejazi, Sima; Delavar, Elahe; Hosseini Azizi, The relationship between care pressure, stress, anxiety and depression in caregivers of cancer patients in Imam Reza Hospital in Bojnourd. journal of Psychiatry. (2017), 5(3), Pp. 7-14. [Persian]
7. Nasiri Zarrin Qabaei, Davood; Talibpour Amiri, Fereshteh; Hosseini Volshkalaei, Seyed Mohammad Reza and Rajabzadeh, Rezvan. Quality of life and its relationship with job stress in nurses working in hospitals in Sari in 1394. Nursing education. (2015), 5(2). Pp. 40-48. [Persian]
8. Khanjani, Zeinab. Predicating public Based on body image, stress and research in applied psychology. (2014), 15(58). Pp. 40-47. [Persian]
9. Hosseini, Amin; Zahtakar, Kianoosh; Davarnia, Reza and Shakermi, Mohammad. Predicating vulnerability to stress based on social support, resilience, coping strategies, and personality traits in students. Cognitive and Behavioral Sciences Research. (2016). 6(2). Pp. 27-42. [Persian]
10. Radovanovic, Ivica; Bogavac, Dragana; Cvetanovic, Zorica; Kovacevic, Jasmina. Quality of Life--Lifelong Education Platform. Universal Journal of Educational Research, (2017). v5 n12A p188-195.
11. Bishop-Fitzpatrick, Lauren; Mazefsky, Carla A.; Eack, Shaun M. The Combined Impact of Social Support and Perceived Stress on Quality of Life in Adults with Autism Spectrum Disorder and without Intellectual Disability. Autism: The International Journal of Research and Practice, (2018). v22 n6 p703-711.
12. Van Heijst, Barbara F. C.; Geurts, Hilde M. Quality of Life in Autism across the Lifespan: A Meta-Analysis. Autism: The International Journal of Research and Practice, (2015). v19 n2 p158-167.
13. Gil, Iris. A New Educational Program to Improve Posture and Quality of Life among Students by Means of the Feldenkrais Method and a New Program: MAP-Motion and Posture. Journal of Education and Training Studies, (2018). v6 n11 p1-11.
14. Valerio, Teresa D.; Kim, Myoung Jin; Sexton-Radek, Kathy. Association of Stress, General Health, and Alcohol Use with Poor Sleep Quality among U.S. College Students. American Journal of Health Education, (2016). v47 n1 p17-23.
15. Bazazian, Saeedeh and Besharat, Mohammad Ali, Comparison of emotional intelligence, mental and journal of Applied Psychology. (2009), 3(1). Pp. 7-26. [Persian]
16. Adejumo, Adebayo O. Influence of Social Support, Self-Efficacy, and Personality on the General Health of Retirees in Lagos, Nigeria. Educational Gerontology, (2010), v36 n10-11 p907-918.
17. Zhou, Mingming; Kam, Chester Chun Seng. Trait Procrastination, Self-Efficacy and Achievement Goals: The Mediation Role of Boredom Coping Strategies. Educational Psychology, (2017), v37 n7 p854-872.
18. Amiri, M. Agha Mohammadian Sharabaf, H.and Kimiaei, A. The effectiveness of the reality-froup approach to group control and coping strategies. Thought and Behavior, (2012), 24, Pp. 59-68. [Persian]
19. Skaalvik, Einar M. Mathematics Anxiety and Coping Strategies among Middle School Students: Relations with Students' Achievement Goal Orientations and Level of Performance. Social Psychology of Education: An International Journal, (2018). v21 n3 p709-723.
20. Nedayi, Ali; Paghosh, Atta Allah; Sadeghi Hasanijeh, Amir Hossein, Relationship between quality of life coping strategies: The mediating role of cognitive emotion regulation skills. Clinical Psychology. (2016(,4 (8). Pp. 35-48. [Persian]
21. Rahimi, Elham; Abyar, Zolfaghar; Hammam Zakeri Langroudi, Arezoo and Zamani, Narges. Comparison of general health, mental health, and coping strategies in patients with type 1 and type 2 diabetes with patients with multiple sclerosis. Health Research. (2016), 2 (1). Pp. 33-41. [Persian]
22. Mohammadi, Seyed Younes and Rahimzadeh Tehrani, Katayoun, The effectiveness of meaningful therapy on spiritual health and quality of life of women with AIDS in Tehran. health Psychology. (2018), 7 (25). Pp. 106-120. [Persian]
23. Amini, Mahnoosh; Nouri, Abolghasem and Samavatian, Hossein.The effect of communication skills training on nurses' general health. Health Information Management. (2013). 101. Pp. 109-117. [Persian]
24. Ramzi, Leila; Sepehri Shamloo, Zohreh; Alipour, Ahmad and Zare, Hossein,The effectiveness of group reality therapy on family psychology coping strategies. (2014), 1(2). Pp. 19-30. [Persian]
25. Trenike, Nicholas. RFT learning. Frienly translation, covenant. (1398) Amin Negar Publications: Tehran. (2010). [Persian]
26. Vernon, Ann, Ed.; Doyle, Kristene A., Ed. Cognitive Behavior Therapies: A Guidebook for Practitioners. American Counseling Association. (2017).
27. Crumb, Loni. Haskins, Natoya. An Integrative Approach: Relational Cultural Theory and Cognitive Behavior Therapy in College Counseling. Journal of College Counseling, (2017). v20 n3 p263-277.
28. Mabeus, Danielle; Rowland, Karen D. Reality Therapy in a Middle School Setting: Altering a Student's Perception. Georgia School Counselors Association Journal, (2016). v23 p48-52.
29. Hale, Jane V. An Examination of Reading and Mathematic Achievement among Second Grade Students Who Have Received Instruction from Either Teachers Who Have Been Trained in Choice Theory/Reality Therapy Methods or Teachers Who Have Not Been Trained. ProQuest LLC, Ph.D. Dissertation, Duquesne University. (2011).
30. Glasser, W. Reality therapy in action. HarperCollins: Publishers. (2000).
31. Harris, Ross. Treat acceptance and commitment with love. Friendly translation, covenant. Hedayati Hamedani, Seyedeh Sepideh. Researcher, Hussein. (1398(min Negar Publications. Fourth Edition: Tehran. (2009). [Persian]
32. Hayes, Steven C, Acceptance and Commitment Therapy: Cognitive Fault. Friendly translation, covenant. Ahmadi, Fatemeh. (1395). Hegmataneh Inclusive Publications: Hamedan. (2013). [Persian]
33. Mohagheghi, Hossein; Dosti, Peyman and Jafari, Davood. The effect of acceptance and commitment therapy on transgenderism, social anxiety and students' health concerns. Journal of Clinical Psychology Studies. (2016). (23)6. Pp. 81-94. [Persian]
34. Hayes, S. C., & Strosahl, K. D. A practical guide to acceptance and commitment therapy. Springer Science & Business Media. (2004).
35. Hayes, S. C. Strosahl, K.D. Wilson, K.G. Acceptance and Commitment Therapy: The process and practice of mindful change. New York: Guilford Press. (2012).
36. Cohen, Research Methods in Behavioral Sciences, Zohreh Sarmad, Abbas Bazargan, Elahe Hejazi, (2018), if published. [Persian].
37. Nejat, Saharnaz; Montazeri, Ali; Holakouee Naeini, Cyrus; Mohammad, Kazem and Majdzadeh, Seyed Reza, Standardization of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF): Iranian translation and psychometrics. Journal of the School of Health and the Institute of Health Research,, (2006), 4, 12-1. [Persian]
38. Taghavi, Seyed Mohammad Reza, The validity and validity of the General Health Questionnaire (G.H.Q), Journal of Psychology, (2001), Volume 5, Number 4, 381-398. [Persian].
39. Shah Beyk, Soroush; Taghavi Jourabchi, Fatemeh; Roshan, Farzaneh and Naseri, Maryam, The effectiveness of group cognitive therapy based on mindfulness on family performance and marital adjustment of couples with type 2 diabetes. Nursing Journal, (2018) 13 (6): 68-75. [Persian]
40. Hosseini Ghadmagahi. The quality of social relationships, stress levels and coping strategies in coronary heart patients. Master Thesis in Clinical Psychology, Iran University of Medical Sciences and Health Services, Tehran Institute of Psychiatry.vol., (1997). [Persian]
41. Emery G. Overcomming depression: a cognitive- behavior protocol for the treatment of depression. Translated by: Mohammadkhani P, Rezaee Dogahe E. 1st ed. Tehran: Faradid publication; 2004. pp: 18-90. [Persian]
42. Omidi. Abdullah; Mohammadi. Abolfazl, Zargar. Fatemeh, Akasheh. Goodarz, Comparison of the effectiveness of cognitive therapy based on integrated mindfulness, With cognitive therapy and classical cognitive-behavioral therapy, in reductionIneffective attitudes of patients with major depressive disorder. Scientific Journal of Birjand University of Medical Sciences. Volume 20, Number 4, (2013). [Persian]
43. Glasser, W. (2008). Station of the mind: new direction for reality therapy. New York.
44. Namkhani Akbari Nejad. H; Trust. A and Nasirnejad, F. The effectiveness of group reality therapy on women's anxiety. Al-Zahra Journal of Psychological Studies, 10 (2), 73-87. (2013). [Persian]
45. Soleimani. A & Babaei. A. The effectiveness of group reality therapy training based on the theory of choice on anxiety and hope of drug addicts during withdrawel. journal of addiction Research on Substance Abuse. 10(37), 137-150. (2016). [Persian]
46. Khaleghi. N; Amiri. M. and Taheri, A.The effectiveness of group reality therapy on social anxiety, interpretation bias and interpersonal relationships in adolescents. Journal of Mental Health Principles. 19(2), 77-83. (2016). ). [Persian]
47. Peterson BD, Eifert GH, Feingold T, Davidson S. Using acceptance and commitment therapy to treat distressed couples: a case study with two couples. Cognitive and Behavioral Practice; 16(4), 430-42. (2009).
48. Kavousian. Javad; Harifi. Hosnieh. and Karimi, Kambiz. Effectiveness of Acceptance and Commitment-Based Therapy on Couples' Marital Satisfaction, Journal of Health and Care Year 18, Issue 4, (2016).
49. Azizi, Arman & Ghasemi, Simin, Comparison the Effectiveness of Solution-Focused Therapy, Cognitive-Behavior Therapy and Acceptance and Commitment Therapy on Depression and Quality of Life in Divorced Women 2017, 8(29):207-236. [Persian]
50. Robyn, D., Walser, D. W., Garvert, E., Karlin, M., Trocke, l., & Danielle, M. Effectiveness of acceptance and commitment therapy in treating depression and suicidal ideation in veterans. Behavior Research and Therapy,(2015), 74, 05-31.
51. Ebrahimi, Amrullah; Rezaian, Masoumeh; Khorvash, Mehdi and Zargham, Mahtab.Evaluationof the effectiveness of Acceptance and Commitment Therapy (ACT) on pain acceptance, quality of life and reduction of pain-related anxiety in patients with chronic pelvic pain. Fifth Psychosomatic Congress, Chaharmahal and Bakhtiari University of Medical Sciences and Health Services (2013). [Persian]
52. Hor M, Aghaei A, Abedi A, Attari A. The effectiveness of acceptance and commitment therapy on depression in patients with type 2 diabetes. J Res Behav Sci (2013); 11(2): 121-8. [Persian]
53.Ejei, Javad; Sayadshirazy, Maryam; Gholamali Lavasani, Masoud & Kasaei Esfahani, Abdolrahim. Compare the Effectiveness of Group Therapy Based on Acceptanc and Commitment and Cognitive-Behavioral Therapy on Reducing Anxiety of Mothers of Autistic Children. Journal of Psychology, (2018), 22 (Spring) 3-21. [Persian]
54. Eilenberg, T., Frostholm, L. & Kronstrand, L. (2014). Acceptance and Commitment Group Therapy (ACT-G) for severe health anxiety . The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital.
55. Rafiee, M., Sedrpoushan, N., & Abedi, M. Study and investigate the effect of acceptance and commitment therapy on reducing anxiety symptoms and body image dissatisfaction in obese women in Isfahan (2012-13). Journal of Social Issues & Humanities , (2014). 2(1), 187-190.
56. Niles, A. N., Burklund, L. J., Arch, J. J., Lieberman, M. D. ,Saxbe, D., & Craske, M. G. Cognitive mediators of treatment for social anxiety disorder: Comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behavior Therapy, (2014). 45 , 664–677.
57. Arch, J.J., Eifert, G.E., Plumb, J., Rose, R., Davies, C., & Craske, M.G. Randomized clinical trial of Cognitive Behavioral Therapy (CBT) versus Acceptance and Commitment Therapy (ACT) in the treatment of mixed anxiety disorders. Journal of Consulting and Clinical Psychology, (2012), 80(5), 750-765.
58. Lappalainen, R., Lehtonen, T., Skarp, E., Taubert, E., Ojanen, M., & Hayes, S.C. The impact of CBT and ACT models using psychology trainee therapists: A Preliminary Controlled Effectiveness Trial. Behavior Modification , (2007), 31, 488-511.
59. Blackledge, J, & Hayes. S.C. Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child and Family Behavior Therapy; (2006), 18–28:1 .
60. Zettle, R. D. Acceptance and Commitment Therapy (ACT) vs. Systematic Desensitization in Treatment of Mathematics Anxiety,” The Psychological Record, (2003), 53(2), 197-215.
61. Gholami Haidarabadi, Zahra; Navabi Nejad, Shokooh; Delavar, Ali & Shafiabadi, Abdullah. The effectiveness of positivity training on increasing happiness and hardness Mothers with blind children. Quarterly Journal of Exceptional People, Fourth Year, No. 69, 2014.