Comparing the Effectiveness of Couple Therapy Based on Acceptance and Commitment ACT and Schema Therapy ST in Improving Emotional Literacy, Emotional Expression and Differentiation in Couples with Marital Distress

Conflicts between individuals are a common and unavoidable issue. One of the most important reasons for couples seeking counseling is their decision to divorce (1). An unhealthy family environment caused by conflicts, hypocrisy, and arguments between spouses can lead to negative consequences for the children's lives, which may manifest as defiance and disobedience to social norms in the future (3). Empathy is a crucial factor in creating or preventing marital intimacy, as it can reduce the emotional distance between spouses. Studies show that awareness of emotions and the impact of this awareness on interpersonal relationships in married life is effective (12). Couples who possess a certain level of self-awareness can maintain their individuality and independence while also having strong, genuine, and non-threatening emotional intimacy (13). Expressing emotions is related to some marital processes, including marital satisfaction; competent individuals in terms of emotions can identify and understand their feelings, recognize the underlying meanings of those feelings, and express their emotional states more effectively to others (17). Marital therapy is an important component of healthcare services, and research has shown that therapy based on acceptance and commitment is a type of effective treatment for reducing marital conflicts (19). The healing cycle is a combined treatment that integrates cognitive-behavioral therapy, object relations theory, psychodrama therapy, and attachment theory into a systematic treatment model (22). Therefore, the present study aimed to investigate whether marital therapy based on acceptance and commitment and the healing cycle can have a significant impact on improving emotional empathy, emotional expression, and self-awareness in couples with marital distress.

In this study, a semi-experimental design was used. The research design was of the applied type and semi-experimental (with a pre-test and post-test with a control group) and was approved by the university's Ethics Committee with the code IR.IAU.BOJNOURD.REC.1401.016 in the ethics system. The statistical population consisted of all couples who sought treatment at the Astane Mehr Center in Mashhad in the spring of 1401. From this population, 30 couples were selected using convenience sampling. They were randomly assigned to three groups: commitment-based therapy and acceptance (15 couples), healing cycle therapy (15 couples), and the control group (15 couples). The inclusion criteria included being between the ages of 25 and 45, having no signs of primary depression or anxiety disorders, and no mental or sexual disorders, which were identified through a screening interview conducted by the researcher and a trained assistant in clinical psychology.Additionally, participants had to score above the cutoff point of the marital distress scale (the cutoff point for this scale is 84), and couples had to have at least 5 years of cohabitation. Participants had to have a minimum of a diploma and no substance dependence. The exclusion criteria included seeking other treatments or counseling services simultaneously or having more than three consecutive absent sessions and participants not wanting to continue treatment. In this study, the following instruments were used: the Couples Burnout Measurement, Emotional Expression Questionnaire, Self-Awareness Questionnaire, and Emotional Awareness Questionnaire.

The findings showed that the mean differences in the research variables (emotional expression, self-awareness, and emotional empathy) in the two measurement stages were statistically significant (P<0.01). The interaction between the repeated measure and the experimental variable (acceptance-based and commitment therapy and healing cycle therapy): The mean differences between the research variables in the experimental and control groups in the three measurement stages were statistically significant (P<0.01). The experimental variable (acceptance-based and commitment therapy and healing cycle therapy): The mean differences of the research variables in the experimental and control groups were statistically significant (P<0.01). The purpose of presenting the above hypothesis was to examine the impact of the experimental variables. Since the calculated F value for acceptance-based and commitment therapy and healing cycle therapy is greater than the critical F value at a degree of freedom of 2 and 57 and a significant level of P<0.05, the null hypothesis is rejected. Based on the rejection of the null hypothesis, it can be concluded that acceptance-based and commitment therapy and healing cycle therapy had a more significant impact on improving the research variables (emotional expression, self-awareness, and emotional empathy) in the married couples of the experimental groups compared to the control group.

The results showed that the mean scores of emotional empathy, emotional expression, and self-awareness in the members of the experimental groups were significantly higher than those in the control group in the post-test. Additionally, the effect size indicated that providing acceptance-based and commitment therapy and healing cycle therapy had a significant impact on improving the levels of emotional empathy, emotional expression, and self-awareness in the married couples of the experimental groups.In conclusion, the provided therapies were able to have a meaningful impact on improving the levels of emotional empathy, emotional expression, and self-awareness in the members of the experimental groups, and it was determined that there was no significant difference in the impact of acceptance-based and commitment therapy and healing cycle therapy on the research variables among the members of the experimental groups.