The Effects of Acceptance and Commitment Group Therapy on Perceived Stress, Emotion Regulation, and Self-Care Behaviors in Patients with Hypertension

Hypertension is among the most common and chronic diseases with increasing global prevalence, which leads to other health issues, and causes extensive long–term changes in lifestyle. Mostly, individuals with hypertension encounter stress, which increases their blood pressure level. High blood pressure is crucial in survival prediction in Iran and globally. A compelling psychological approach for patients with hypertension is Acceptance and Commitment Therapy (ACT). ACT emphasizes the awareness of the present moment and its acceptance and is based on the theory that psychological trauma attempts to control or escape from negative thoughts and emotions. This study aimed to investigate the effects of group ACT on perceived stress, emotion regulation, and self–care behaviors in patients with hypertension.

This was a quasi–experimental study with pretest–posttest, a two–months follow–up, and a control group design. The statistical population included all patients diagnosed with hypertension in 2020 who were referred to one of the medical centers in Kish Island, Iran. In total, 32 patients who met the inclusion criteria were selected by the purposive sampling method and randomly assigned to the experimental and control (n=16/group) groups. The inclusion criteria were being diagnosed with primary hypertension according to the patient's medical record, being non–diabetic, having no history of heart attack or stroke, having no history of neuroleptic pharmacotherapy, no physical disability, no underlying diseases which lead to hypertension, such as alcohol poisoning, atherosclerosis, adrenal tumors or using birth control pills. Patients who did not participate in all therapy sessions or were under other interventions and those not willing to cooperate were excluded from the study. Perceived Stress Scale (Cohen et al., 1983), Emotional Cognitive Regulation Questionnaire (Garenfeski et al., 2001), and Self–Care Behaviors of Patients with Hypertension (Han et al., 2014) were used for data collection. The group ACT was presented to the experimental group in 10 sessions based on the Forman and Herbert training package (2009); however, no intervention was provided to the control group. Descriptive statistics, including frequency, percentage, mean, and standard deviation, described the collected data. Inferential statistics, including repeated–measures Analysis of Variance (ANOVA), Independent Samples t–test, and Bonferroni post hoc tests, were also used to analyze the obtained data in SPSS. The significance level of the tests was considered 0.05.

The effect of group on negative emotion (p<0.001), diet (p=0.008), medication (p<0.001), and disease management (p=0.018) was significant; however, on positive perceived stress (p=0.587), negative perceived stress (p=0.479), positive emotion (p=0.091) and food labeling (p=0.053) it was not significant. The effect of time and time and group interaction on positive and negative perceived stress, positive and negative emotions, diet, medication diet, food labeling, and disease management was significant (p<0.001). Concerning positive perceived stress (p=0.999), positive emotions (p=0.999), negative emotions (p=0.092), diet (p=0.668), medication (p=0.668), food labeling (p=0.602), and disease management (p=0.999), no significant difference was observed between the mean scores of the posttest and follow–up stages, which indicates the persistence of the intervention over time.

Considering the effectiveness of group ACT on negative emotion, diet, medication, and disease management in patients with hypertension, it is better to pay attention to the psychological components in individuals with chronic diseases along with physical features.