Comparing the Effects of Acceptance and Commitment Therapy and Emotional Schema Therapy on Attentional Bias, Uncertainty Intolerance, and Cognitive Avoidance in Females with Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is a pervasive condition in which a subject is constantly worried and afraid about future events. Pervasive anxiety disorder is a common and debilitating disorder that rises to a level of pathological anxiety and interferes with daily life; however, it is of poor cognitive etiquette. Moreover, current interventions are associated with numerous adverse effects and delays in treatment, and impaired therapeutic outcomes. The structures of intolerance, cognitive avoidance, and attention bias play a major role in GAD. Developing biopsychological therapies to reduce these symptoms can help these patients with treatment. Therapies include Acceptance and Commitment Therapy (ACT) and Emotional Schema Therapy (EST). Therefore, this study aimed to evaluate and compare the effects of ACT and EST on the attentional bias, intolerance, and cognitive avoidance in women with GAD.

This was a quasi–experimental study with a pretest–posttest and a control group design. The statistical population was women with GAD in District 22 of Tehran City, Iran, in 2019. Overall, 45 individuals voluntarily enrolled in the study based on the inclusion and exclusion criteria. They were randomly divided into two experimental groups (ACT & EST) and a control group. The inclusion criteria included a diagnosis of GAD and no clinical diagnosis associated with GAD or biological diseases, not receiving concurrent pharmacotherapy, no history of hospitalization and medication use for chronic psychological problems, no attendance of other therapy sessions simultaneously, providing consent to participate in the study, and completing the study course. The study's exclusion criteria were unwillingness to cooperate, having severe physical conditions, providing incomplete questionnaires, and participating in other psychological interventions concurrently. The interventions were performed in the test groups for 8 ninety–minute sessions; the control group received no intervention. In the pretest and posttest, to collect the necessary data, the Attention Bias Questionnaire (Woody et al., 1997), Uncertainty Intolerance Questionnaire (Freeston et al., 1994), and Cognitive Avoidance Questionnaire (Sexton & Dugas, 2008) were employed. Descriptive statistics (frequency, mean, & standard deviation indices) and inferential statistics, including Analysis of Covariance (ANCOVA) and Bonferroni post hoc test, were applied in SPSS to analyze the collected data at the significance level of 0.05.

The present study results indicated that by controlling the pretest effect, the scores of attention bias (p<0.001), cognitive avoidance (p<0.001), and uncertainty intolerance (p<0.001) in ACT and EST groups were significantly reduced, compared to the controls (p<0.001). Additionally, no significant difference was observed between the effects of EST and ACT in reducing the symptoms of attention bias (p=0.101), uncertainty intolerance (p=0.928), and cognitive avoidance (p=0.825).

ACT and EST are effective treatment methods to reduce the symptoms of uncertainty intolerance, attention bias, and cognitive avoidance. Therefore, therapists can use the present study findings to reduce the symptoms of individuals with GAD.