Comparing the Effects of Cognitive-Behavioral Therapy and Acceptance and Commitment Group Therapy on the Fear of Negative Evaluation in Women with Major Depressive Disorder

Depression is a disorder associated with despair, sadness, lack of motivation and hope, and low self–esteem and pessimism that can affect people's thoughts, behavior, feelings, happiness, and health. Research indicated that individuals with depression are more vulnerable than others because of the fear of negative evaluation; accordingly, this condition increases the severity of the disease. Cognitive–Behavioral Therapy (CBT) can effectively reduce depression. Acceptance and Commitment Therapy (ACT) enhances the impact of CBT. Unlike cognitive–behavioral approaches, which reinforce the dynamic interaction between cognition and behavior, ACT replaces incompatible thought processes with healthier cognitions. Therefore, this study aimed to compare the effects of CBT and ACT on the fear of negative evaluation in women with Major Depressive Disorder (MDD).

This was a quasi–experimental study with pretest–posttest and a control group design. The study's statistical population included all women with MDD referring to psychiatric clinics in Sari City, Iran, to receive psychiatric services. Of them, 36 individuals diagnosed with MDD by a psychiatrist and per Beck Depression Inventory (BDI; Beck et al., 1961) were selected. The study participants were determined by voluntary sampling method and randomly assigned to two experimental groups and one control group (n=12/group). The inclusion criteria included MDD and fear of negative evaluation based on the DSM–5 diagnostic criteria by a psychiatrist, obtaining a score of above 23 in the BDI, the age range of 25–45 years, and not using other psychotherapy services. The exclusion criterion of the study was absence from 3 treatment sessions. One experimental group underwent 12 ninety–minute ACT sessions, and the other experimental group underwent 9 ninety–minute CBT sessions. No intervention was performed in the control group. Descriptive statistics (mean & standard deviation) and inferential statistics, including Analysis of Variance (ANOVA), Chi–squared test, univariate Analysis of Covariance (ANCOVA), and Bonferroni post hoc test were used in SPSS to analyze the research data at the significance level of 0.05.

The obtained results suggested that the mean score of fear of negative evaluation was significantly different between the three groups at post–test (p<0.001) by controlling the pretest effect. Furthermore, based on the results of Benferroni post hoc test, there was no significant difference between the CBT and ACT groups concerning the fear of negative evaluation; however, there was a significant difference between the two experimental groups and the control group in this regard (p<0.001).

According to the present study findings, CBT and ACT can be suggested as effective clinical interventions to reduce the fear of negative evaluation in women with MDD.