The Effectiveness of Acceptance and Commitment Group Therapy on the Self-esteem of Girls With Visual Impairment

Students with visual impairments have built negative attitudes towards their abilities due to difficulties in achieving social skills, orientation, and independent mobility. Their negative attitude towards blindness puts them at high-risk developing loneliness, social isolation, depression, anxiety, decreased life expentancy, no participation in group activities, and low levels of social support. Lack or no social skill reduces social acceptance and real feeling about themselves, which in turn reduces self-esteem in students with visual impaiments. Using appropriate therapeutic intervention with the aim of ensuring mental health as well as promoting self-esteem can prevent many psychological problems in these people. The acceptance and commitment therapy (ACT) is one of the third wave approaches to behavioral therapy that aims to control effectively the pain, suffering and stress that a person faces in the life. The acceptance and commitment therapy helps the person increases her psychological relations with herself and her feelings, trying to adapt to the environment and community instead of changing her cognition. The present study aimed to determine the effectiveness of the acceptance and commitment group therapy on self-esteem of students with visual impairment in Tehran City. 

The present study was a quasi-experimental study in which a pretest-posttest design with a control group used along with a two-month follow-up. The sample was consisted of twenty-eight 14-20 year old female students who was selected from the population of students with visual impairment studying in the schooling year of 2019-2020 in Narjes day-and-night school for the blind individuals. In Tehran, there is only one school for female blind students and the sample purposefully selected according to the probability of sample’s dropout. At first, 50 students completed the Cooper Smith Self-Esteem Questionnaire (CSSEQ) and after scoring the CSSEQ, twenty-eigth students selected according to receiving a score of 23 or lower in the CSSEQ. All subjects matched based on their age and grade, then randomly assigned to the experimental and the control group. The experimental group (two subgroups consisted of seven people in each) participated in eight therapeutic sessions (twice a week and 75 minutes for per session) and received the acceptance and commitment group therapy while the control group participated only in the mainstream programs at the school. At the end of the therapeutic sessions all subjects completed the CSSEQ again and the experimental group completed CSSEQ after two months follow-up.The multiple analysis of covariance (MANCOVA) used for analyzing the obtained data. Furthermore, for comparing the posttest and follow-up situations in the experimental group the related t-test used. 

 The results of multiple analysis of covariance for the data obtained from the self-esteem questionnaire showed that the participation of female students with visual impairment in the acceptance and commitment group therapy sessions led to significant increase (P<0.001) in self-esteem (general, family, social, and educational) of them. In fact, according to Eta quotient, 71%, 78%, 78%, and 72% of variation in self-esteem (general, family, social, and educational respectively) of the experimental group can be explained by participating in the acceptance and commitment group therapy sessions. The results of the related t-test for comparing the self-esteem of the experimental group in post test and follow-up situations showed that the effectiveness of group therapy based on acceptance and commitment has been lasted on the self-esteem (general, family, social, and educational) of the experimental group after two months follow-up later (P>0.05). 

 We conclude according to the findings of the present study that the acceptance and commitment group therapy can use for planning and policy making instructional courses suitable for students with visual impairments. Furthermore, the specialists who are working with these children can use the ACT as a practical technique for improving self-esteem and the adaptation in many areas such as family, social and educational areas in students with visual impaiments. Additionally, the ACT recommend improving self-esteem and positive performance of students with visual impairment in social, educational and family areas along side the routin instructional couses. However, the acceptance and commitment group therapy helps the students with visual impairment know how to control their thoughts and feelings in order to prevent problems from getting worse. This therapeutic method helpls them to accept their behavioral changes through accepting the unpleasant thoughts and feelings.