The effectiveness of commitment-based acceptance therapy on flexibility and perfectionism of physical appearance in body deformity disorder

Document Type : Research Paper


1 PhD student General Psychology , Department of Psychology , Tonekabon Branch , Islamic Azad University, Tonekabon , Iran.

2 Associate Professor، Department of Psychology , Tonekabon Branch, Islamic Azad University, Tonekabon, Iran. )Corresponding author(

3 Associate Professor ، Department of Psychology , Tonekabon Branch , Islamic Azad University, Tonekabon , Iran.

4 Assistant Professor، Department of Psychology , Tonekabon Branch, Islamic Azad University, Tonekabon, Iran


Introduction & Objective: Body deformity disorder is a chronic and distressing condition that can lead to severe social, occupational, educational and family problems. The aim of this study was to determine the effectiveness of commitment-based acceptance treatment on flexibility and perfectionism of physical appearance in body deformity disorder. Method: In a quasi-experimental study of pre-test-post-test-follow-up designs with a control group, 30 female students with deformity who are studying at the Islamic Azad University of Tehran University of Medical Sciences during the months of November to January 2017 were selected by available sampling method. Subjects were then randomly assigned to the experimental and control groups through Excel Office software. The experimental group (n = 15) underwent commitment-based admission treatment for 8 weekly sessions of 90 minutes each session. The flexibility questionnaire and the Physical Appearance Perfectionism Questionnaire (PAPS) were collected in three baseline stages after quarterly intervention and follow-up. Data were entered in SPSS statistical software version 21 and analyzed using repeated measures multivariate analysis of variance. Results: The results showed that the group undergoing commitment-based acceptance treatment, the mean score of flexibility and perfectionism of physical appearance was significantly lower than the control group (P <0.001). Conclusion: The results of this study showed that commitment-based acceptance therapy can be effective in improving the perfectionism of physical appearance and flexibility in students with deformity.


  1. Azadi, M.; Origin, G; Gol Paror, Mohsen. Comparing the effectiveness of mindfulness interventions based on mobile phone social networks with acceptance and commitment group therapy (ACT) and mindfulness group interventions on depression, anxiety and stress in patients with type 2 Diabetes Nursing Quarterly. 2017; (2): 775-792
  2. Amanzad, Z; Hosseinian, S. Effectiveness of group counseling based on existential approach on life attitude and spiritual health of patients with type 2 Women and family studies. 2017; 6(1): 67-49
  3. Taghizadeh, M.; Bigley, Z; Mohteshmi, T. The effectiveness of behavior modification program training in the lifestyle of type 2 diabetic patients. Scientific-Research Quarterly of Health Psychology. 2013; 3(9): 30-45
  4. Hor; Aghaei, A; Abedi, A; Golparvar, M. The effectiveness of the integrated treatment package (health lifestyle based on acceptance and commitment therapy) with mindfulness-based treatment on self-care and glycosylated hemoglobin of patients with type 2 Islamic lifestyle with a focus on health. 2017;2 (2): 57-65
  5. hor; Manshey, G. The effectiveness of treatment based on acceptance and commitment on the mental health of patients with type 2 diabetes in Isfahan city. Iranian Journal of Diabetes and Metabolism. 2016;16 (6): 316-309
  6. Saifullahi, M.; Monfardi, A; Mohteshmi, J.; Mohammadi, H. The effectiveness of group therapy based on acceptance and commitment on reducing anxiety, depression and increasing the quality of life and self-efficacy of patients with multiple sclerosis. Journal of Principles of Mental Health, 18 (Special Issue of the Third International Conference on Psychology and Educational Sciences), 2015; 596-605
  7. Shaygian, Z; Amiri, P; Aguilar Vafai, M.; Basharat. M.A. The effectiveness of group therapy based on acceptance and commitment on improving glycosylated hemoglobin and self-care activities in type 2 diabetes patients. Journal of Contemporary Psychology. 2014;(2) 10: 50-41
  8. Taheri, N; Qajri, H; Shahbazi, H. Relationship between health literacy and self-efficacy and self-care in patients with type 2 Iranian Journal of Endocrine and Metabolism. 2017; (3):135-141
  9. Sabour, S; Kakabrai, Kivan. The effectiveness of acceptance and commitment group therapy on depression symptoms, stress and pain indicators in women with chronic pain. Journal of rehabilitation research in nursing. 2015;2 (4): 1-9
  10. Mirmehdi, S; Reza Ali, M. Effectiveness of cognitive therapy based on mindfulness on resilience, emotion regulation and life expectancy in women with type 2 Scientific-Research Quarterly of Health Psychology, 2017; 7(28): 167-183.
  11. Bogusch, L. M., & O'Brien, W. H. The effects of Mindfulness-based interventions on diabetes-related distress, quality of life, and metabolic control among persons with diabetes: A meta-analytic review. Behavioral Medicine,2019; 45(1): 19-29.
  12. Cherrington, A., Wallston, K. A., & Rothman, R. L. Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. Journal of behavioral medicine,2015; 33(1): 81-89.
  13. Dong, C., Kou, T., Liu, Y., Zou, Y., Sun, L., Tian, H., & Wang, Q. Study on the effect of smoking on the risk of active pulmonary tuberculosis in patients with type 2 diabetes mellitus. Chronic Diseases Prevention Review. 2019;10 (6): 36-41.
  14. Ellis, D. A., Carcone, A. I., Slatcher, R., Naar‐King, S., Hains, A., Graham, A., & Sibinga, E. Efficacy of Acceptance and Commitment Therapy (ACT) in emerging adults with poorly controlled, type 1 diabetes: A pilot randomized controlled trial. Pediatric diabetes,2019; 20(2): 226-234.
  15. Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL.Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. J Consult Clin Psychol. 2007; 75(2):336-43.
  16. Harrington, C., Carter-Templeton, H., & Appel, S. Diabetes self-management education and self-efficacy among African American women living with type 2 diabetes in rural primary care. Journal of Doctoral Nursing Practice, 2017;10(1): 11-16.
  17. Hasker SM. Evaluation of the Mindfulness-Acceptance-Commitment (MAC) Approach for Enhancing Athletic Performance. Theses and Dissertations (All). 2010;913.


  1. Hayes SC and Duckworth MP. Acceptance and Commitment Therapy and Traditional Cognitive Behavior Therapy Approaches to Pain. Cognitive and Behavioral Practice. 2006;13:185–187.
  2. Kamody, R. C., Berlin, K. S., Rybak, T. M., Klages, K. L., Banks, G. G., Ali, J. S., ... & Diaz Thomas, A. M. Psychological flexibility among youth with type 1 diabetes: Relating patterns of acceptance, adherence, and stress to adaptation. Behavioral Medicine, 2018;44(4): 271-279.
  3. Jan, S. M. The effect of non-surgical phase on fasting sugar level in type 2 diabetic patients with generalized chronic periodontitis. Paripex-Indian Journal of Research, 2019;8(4): 32-39
  4. Jesse, C. D., Creedy, D. K., & Anderson, D. J. Effectiveness of psychological interventions for women with type 2 diabetes who are overweight or obese: a systematic review protocol. JBI database of systematic reviews and implementation reports, 2019;17(3):281-289.
  5. Lin, L. Y., Hsu, C. Y., Lee, H. A., Wang, W. H., Kurniawan, A. L., & Chao, J. C. J. Dietary patterns in relation to components of dyslipidemia and fasting plasma glucose in adults with dyslipidemia and elevated fasting plasma glucose in Taiwan. Nutrients, 2019;11(4): 845-851
  6. Lappalainen R, Lehtonen T, Skarp E, Taubert E, Ojanen M, & Hayes SC. The impact of CBT and ACT models using psychology trainee therapists. Behavior Modification, 2007;31(4): 488-511.
  7. Lustman PJ and Gavard JA. Chapter 24; Psychosocial Aspects of Diabetes in Adult Diabetes in America, 2nd Edition Table of Contents. Washington University School of Medicine, St. Louis, MO, 2012; 507-517.
  8. Messina, R., Rucci, P., Sturt, J., Mancini, T., & Fantini, M. P. Assessing self-efficacy in type 2 diabetes management: validation of the Italian version of the Diabetes Management Self-Efficacy Scale (IT-DMSES). Health and quality of life outcomes, 2018;16(1): 71.
  9. Patton, K., Connor, J. P., Rundle-Thiele, S., Dietrich, T., Young, R. M., & Gullo, M. J. Measuring adolescent drinking-refusal self-efficacy: Development and validation of the Drinking Refusal Self-Efficacy Questionnaire-Shortened Adolescent version (DRSEQ-SRA). Addictive behaviors,2018; 81:70-77.
  10. Pain, W. I. C. Accept Pain for a Vital Life: Acceptance and Commitment Therapy for the Treatment of Chronic Pain. Somatoform and Other Psychosomatic Disorders: A Dialogue between Contemporary Psychodynamic Psychotherapy and Cognitive Behavioral Therapy Perspectives, 2018;163.
  11. Rosen, G. M., & Lilienfeld, S. O. On the failure of psychology to advance self-help: Acceptance and commitment therapy (ACT) as a case example. Journal of Contemporary Psychotherapy, 2016;46(2): 71-77.
  12. Sherer, M., Maddux, J. E., Mercandante, B., & Rogers, R. W. The Self-Efficacy Scale: Construction and validationPsychological Reports, 1982;51(2):663-671.
  13. Xing, L., Liu, S., Tian, Y., Yan, H., Jing, L., Chen, K., & Sun, Y. Relationship between Fasting Plasma Glucose and Unfavorable Outcomes in Patients of Ischemic Stroke without Diabetes. Journal of Stroke and Cerebrovascular Diseases, 2019;28(5): 1400-1408.
  14. Witkiewitz K, Marlatt GA, Walker D. Mindfulness based relapse prevention for alcohol and substance use disorders. J Cognit Psychother. 2005;19(3):221-8.