The Effects of Acceptance and Commitment Therapy on Cognitive Evaluation, Death Anxiety, Experimental Avoidance, and Emotional Expression in Nurses

Nurses are always exposed to anxiety–induced harms. Their work environment and activities are threatening to the general population, causing anxiety. In hospitals, recruiting and retaining staff is vital. Recently, the position of nurses to increase the efficiency of hospitals has been considered by managers. However, disregarding the conditions of nurses can lead to frustration, the loss of motivation to work, and a deeper impact on the socioeconomic development of a country. It is necessary to help nurses to solve job–related problems. Recognizing factors affecting the cognitive assessment, death anxiety, experimental avoidance, and emotional expression can improve nurses’ conditions using different approaches. The present study aimed to determine the effects of Acceptance and Commitment Therapy (ACT) on cognitive assessment, death anxiety, experimental avoidance, and emotional expression in nurses.

This was an applied and quasi–experimental research with a pretest–posttest–follow–up and a control group design. The statistical population of this study included all nurses of Ayatollah Rouhani Hospital in Babol City, Iran, in 2019 (N=388). The study sample included 40 nurses who were selected using the convenience sampling method. They were assigned to the experimental and control groups (n=20/group). The inclusion criteria of the study were the age range of 30 to 50 years; having ≥5 years of work experience; no history of participation in ACT workshops; no history of mental disorders, and specific and chronic physical illnesses. The exclusion criteria of the research included non–compliance with the group rules stated in the first session and absence from >2 sessions. The required data were obtained using the Cognitive Appraisal Questionnaire (Peacock & Wong, 1990), the Death Anxiety Questionnaire (Templer, 1970), the Acceptance and Action Questionnaire–II (Bond et al., 2011), and the Emotional Expression Questionnaire (King & Emmons, 1990). The test group received eight 90–minute weekly sessions of ACT according to Hayes’s educational package (2010). To describe the obtained data, central and dispersion indices, e.g., mean and standard deviation were used; for data analysis, repeated–measures Analysis of Variance (ANOVA) and Bonferroni post–hoc test were used in SPSS at the significance level of 0.05.

Repeated–Measures ANOVA data concerning cognitive evaluation, death anxiety, experimental avoidance, and emotional expression were significant for intragroup (time) (p<0.001), interaction (time & group) (p<0.001), and intergroup (p<0.001) factors. Respecting cognitive evaluation, the rate of intergroup effect was equal to 0.24. Regarding death anxiety, the rate of intergroup effect equaled 0.23. Concerning experimental avoidance, the intergroup effect was measured as 0.37. Respecting emotional expression, the intergroup effect was calculated as 0.25. The posttest scores of cognitive assessment in the experimental group were lower than those of the pretest (p<0.001). The cognitive evaluation values of the follow–up stage were significantly different from the pretest stage ones (p<0.001); however, no significant difference was observed between the scores of posttest and follow–up steps (p=0.105). Furthermore, the posttest scores of death anxiety in the experimental group were lower than those of the pretest (p<0.001), and the follow–up values of death anxiety were significantly different from the pretest scores (p<0.001); however, there was no significant difference between the values of posttest and follow–up (p=0.457). The experimental avoidance posttest scores were lower than those of the pretest values in the experimental group (p<0.001). Besides, the experimental avoidance scores of the follow–up stage were significantly different from those of the pretest stage (p<0.001); however, no significant difference was observed between the posttest and follow–up stages (p=0.721). The posttest scores of emotional expression were higher than those of the pretest in the experimental group (p<0.001). Furthermore, the emotional expression scores of the follow–up stage were significantly different from those of the pretest (p<0.001); however, there was no significant difference between the posttest and follow–up steps (p=0.569). The obtained results highlighted that the effectiveness of ACT lasted until the follow–up phase for all studied variables.

The obtained data suggested the effectiveness of group ACT on cognitive assessment, death anxiety, experimental avoidance, and emotional expression in nurses.