Comparing the Effectiveness of Reality Therapy and Acceptance and Commitment Therapy on Distress Tolerance and Anxiety Sensitivity in Male Upper Secondary Students
Keywords:
Reality Therapy, Acceptance and Commitment Therapy, Tolerance of District, anxiety Sensitivity and Metacognitive BeliefsAbstract
Objective: This study aimed to compare the effectiveness of Reality Therapy and Acceptance and Commitment Therapy (ACT) on distress tolerance and anxiety sensitivity among male upper secondary school students.
Methodology: This quasi-experimental study employed a pretest–posttest–follow-up design with a nonequivalent control group. The population consisted of male upper secondary students in Sabzevar, from whom 45 participants were selected through one-stage cluster sampling and randomly assigned to two experimental groups (Reality Therapy and ACT) and one control group (15 participants per group). The Reality Therapy group received ten 90-minute sessions, while the ACT group received eight 90-minute sessions; the control group received no intervention. Distress Tolerance and Anxiety Sensitivity questionnaires were administered at pretest, posttest, and follow-up stages. Data were analyzed using multivariate repeated-measures ANOVA and Bonferroni post hoc tests.
Findings: The results indicated a significant main effect of time for both distress tolerance and anxiety sensitivity (P<0.01). Participants in both intervention groups showed a significant increase in distress tolerance and a significant decrease in anxiety sensitivity from pretest to posttest, with effects maintained at follow-up. Neither the main effect of group membership nor the time×group interaction was significant (P>0.05), indicating no statistically significant difference between the two therapeutic approaches in terms of effectiveness.
Conclusion: Both Reality Therapy and Acceptance and Commitment Therapy are effective interventions for enhancing distress tolerance and reducing anxiety sensitivity in male upper secondary students, with no significant difference observed between their levels of effectiveness.
Downloads
References
Asli Azad, M., Khaki, S., & Farhadi, T. (2021). Efficiency of Online Reality Therapy on Anxiety and psychological Distress in the Covid-19 Improved. Psychological Achievements, 28(2), 1-20. https://doi.org/10.22055/psy.2021.35651.2620
Babaei Motlagh, F., & Tanha, Z. (2023). Comparing the Effectiveness of Mindfulness-Based Parenting with Choice Theory-Based Parenting on Psychological Distress in Mothers with Children with Oppositional Defiant Disorder. Research in Child and Adolescent Psychotherapy, 2(2), 21-36. https://doi.org/10.22098/rcap.2023.2406
Baniasadi, K., Gerdooie, R., Gorji, M., Shahbazi, G., Babaahmadi, F., Ghafourian, G., & Pourmohammad Ghouchani, K. (2025). Comparison of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy on Enhancing Resilience, Cognitive Flexibility, and Distress Tolerance in Adolescents with Obsessive-Compulsive Disorder. Journal of Adolescent and Youth Psychological Studies (JAYPS), 6(6), 1-10. https://doi.org/10.61838/kman.jayps.6.6.6
Ebn-Nasir, S., & Khaleghipour, S. (2018). The effectiveness of acceptance and commitment therapy on anxiety sensitivity and quality of life in hypertensive patients with avoidant personality trait. Behavioral Sciences Research, 16(2), 198-205. https://rbs.mui.ac.ir/browse.php?a_id=600&sid=1&slc_lang=en
Ebrahimi, M., & Ebrahimi, S. (2021). The Effectiveness of the Reality Therapy on the Rumination, Concern and Tolerance of Distress in Mothers of Autistic Children. JPEN, 7(2), 11-20. http://jpen.ir/files/site1/user_files_4397d4/eng/moshak-A-10-420-3-203fcd6.pdf
Forouzanfar, A., Lavasani, G., & Shuae Kazemi, M. (2017). The Effectiveness of Group Counseling Based on Acceptance and Commitment on Distress Tolerance and Anxiety Sensitivity in Women Dependent on Substance Abuse. Addiction Research Quarterly, 11, 135-154. https://etiadpajohi.ir/browse.php?a_id=1290&slc_lang=en&sid=1&printcase=1&hbnr=1&hmb=1
Ghajari, E., Toozandehjani, H., & Nejat, H. (2020). The Effectiveness of Marital Relationship Enrichment Training Based on Choice Theory, on Distress Tolerance of Women Recovered from Addiction (Persian). Quarterly of "The Horizon of Medical Sciences", 26(4), 316-331. https://doi.org/10.32598/hms.26.4.3237.1
Hoseini, M., & Kiyani, R. (2019). The Effectiveness of Group Reality Therapy on Anxiety Sensitivity Patients with Irritable Bowel Syndrome (IBS). Health Psychology, 8(31), 7-22. https://hpj.journals.pnu.ac.ir/article_6312.html?lang=en
Jiang, X., Sun, J., Song, R., Wang, Y., Li, J., & Shi, R. (2024). Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials. Front. Psychol., 14, 1253266. https://doi.org/10.3389/fpsyg.2023.1253266
Lipsett, M., & Berkman, E. (2025). A randomized controlled trial of an acceptance and commitment therapy-informed diabetes prevention program reduces body shame and distress. Health Psychology, 44(5), 549. https://doi.org/10.1037/hea0001434
Madani, F., & Ebrahimzadeh, S. (2024). Effectiveness of acceptance and commitment therapy on depression, anxiety, and distress in children with diabetes: A systematic review. Quarterly Journal of Child Mental Health, 11(4), 18-33. https://doi.org/10.61186/jcmh.11.4.18
Manapour, M., & Afkaneh, S. (2023). The Effectiveness of Online Reality Therapy on Post-Traumatic Growth and Psychological Distress in Bereaved Individuals During the COVID-19 Pandemic. Journal of Psychology Growth(8), 87-96. http://frooyesh.ir/article-1-4707-en.html
Najarnasab, S., Dasht Bozorgi, Z., Safarzadeh, S., & Talebzadeh Shoushtari, M. (2024). The Efficacy of Acceptance and Commitment Therapy (ACT)-Based Couples Therapy on Marital Quality of Life and Emotion Regulation in Distressed Couples. Avicenna Journal of Neuro Psycho Physiology. https://ajnpp.umsha.ac.ir/article-1-500-fa.html
Sarabadani, A., Hasanzadeh, R., & Ghanadzadegan, H. (2023). The Effectiveness of Acceptance and Commitment Therapy on Distress Tolerance and Cognitive Emotion Regulation in Women With Generalized Anxiety Disorder. Aftj, 4(2), 96-114. https://doi.org/10.61838/kman.aftj.4.2.6
Sasaki, N., Imamura, K., Nishi, D., Watanabe, K., Asaoka, H., Sekiya, Y., Tsuno, K., Kobayashi, Y., Obikane, E., & Kawakami, N. (2023). The effect of internet-based acceptance and commitment therapy (iACT) on psychological well-being among working women with a pre-school child: A randomized controlled trial. Journal of Contextual Behavioral Science, 28, 33-47. https://doi.org/10.1016/j.jcbs.2023.03.002
Sepas, L., Shaker Dolaq, A., & Khademi, A. (2022). Comparing the effectiveness of Acceptance and Commitment Therapy and Reality Therapy on reducing anxiety sensitivity in women with Multiple Sclerosis (MS). Counseling and Psychotherapy Culture, 13(51), 85-113. https://qccpc.atu.ac.ir/article_14119.html?lang=en
Shahidi, S., Hasanzadeh, R., & Mirzaian, B. (2023). The effectiveness of metacognitive therapy on psychological toughness and distress tolerance in female patients with psoriasis. Journal of Applied Family Therapy, 3(5), 374-388. https://doi.org/10.22034/aftj.2022.331799.1422
Sierra, M. A., & Ortiz, E. (2023). Feasibility and effect of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking for Colombian young women. Journal of Contextual Behavioral Science, 28, 127-138. https://doi.org/10.1016/j.jcbs.2023.03.010
Sohrabnejad, S., Mehrabaninasab, M., Nazari, H., Sohrabnejad, A., & Nazari, G. (2025). The Effectiveness of Acceptance and Commitment Therapy on Suicidal Thoughts, Sensation Seeking and, Distress Tolerance among Substance Users. Journal of Basic Research in Medical Sciences, 12(2), 1-10. https://doi.org/10.61186/jbrms.12.2.1
Toope, M., Mirzamani Bafghi, S. M., & Hatami, M. (2025). The Effectiveness of Reality Therapy and Emotion-Focused Therapy on Cognitive Avoidance in Women with Marital Distress. Iranian Journal of Educational Research, 4(2), 0-0. https://ijer.hormozgan.ac.ir/article-1-389-en.pdf
Yaghoubi, M., Ebrahimi, F., Pour Mohammad Ghochani, K., & Noorouziani, Z. (2026). A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy on Referential Thoughts, Cognitive Flexibility, and Distress Tolerance in Patients with Major Depression. Psychological Dynamics in Mood Disorders, 1-18. https://doi.org/10.1002/da.22878
Zaemi, H., Rajayi, A. R., Safarian Tosi, M. R., & Najat, H. (2023). Comparing the Effectiveness of Emotion-focused Therapy and Acceptance and Commitment Therapy on the Distress Tolerance of Disaffected Couples. Rehabilitation Nursing Research Journal, 9(3), 55-66. https://ijrn.ir/article-1-762-en.pdf
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 Mahdi Yousefi, Hossein Mahdian, Ali Jahangiri (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
