Comparing the Effectiveness of Schema Therapy and Acceptance and Commitment Therapy on Alexithymia in Women with Multiple Sclerosis
Keywords:
Multiple sclerosis, Alexithymia, Schema therapy, Acceptance and commitment therapy, WomenAbstract
The present study aimed to compare the effectiveness of schema therapy and acceptance and commitment therapy in reducing alexithymia among women diagnosed with multiple sclerosis. This applied, semi-experimental study employed a pretest–posttest–follow-up design with a control group. The statistical population consisted of women with multiple sclerosis who referred to the Tehran Multiple Sclerosis Society during 2024–2025. Using an available sampling method, 45 eligible participants were selected and randomly assigned to three groups: schema therapy, acceptance and commitment therapy, and a control group, each comprising 15 participants. The two experimental groups received ten 90-minute group intervention sessions based on standardized protocols, while the control group received no psychological intervention. Data were collected using the Toronto Alexithymia Scale. Descriptive statistics and repeated-measures analysis of covariance were conducted using SPSS version 26, with pretest scores entered as covariates. Inferential analyses revealed a statistically significant main effect of group on alexithymia scores at posttest and follow-up. Both schema therapy and acceptance and commitment therapy resulted in significant reductions in alexithymia compared with the control group (p < 0.001). Post-hoc comparisons indicated that schema therapy led to significantly greater reductions in alexithymia than acceptance and commitment therapy at follow-up (p < 0.001). The group-by-time interaction was significant, demonstrating differential patterns of change over time. Effect size estimates indicated a large effect for the group factor, and robust HC3 estimates confirmed the stability of the results. Both schema therapy and acceptance and commitment therapy were effective in reducing alexithymia in women with multiple sclerosis; however, schema therapy demonstrated superior and more sustained effects, suggesting its particular suitability for addressing deep-seated emotional processing deficits in this population.
Downloads
References
1. Capet N, Joly H, Suply C, Mondot L, Cohen M, Lebrun-Frenay C. Alexithymia in multiple sclerosis: Clinical and radiological correlations. Revue Neurologique. 2021;177(3):302-11. doi: 10.1016/j.neurol.2020.06.008.
2. Poulios A, Pavlopoulos V. The relationship between dimensions of mental health and alexithymia in multiple sclerosis patients. Multiple Sclerosis and Related Disorders. 2020;46:1025-9. doi: 10.1016/j.msard.2020.102525.
3. Hasan Larijani M, Hossein Sabet F, Borjali A. Effects of Acceptance and Commitment Therapy on Alexithymia in Patients with Multiple Sclerosis. Middle Eastern Journal of Disability Studies. 2020;10:124.
4. Javadi THS, Masjedi MA, Hamzehloo E, Chehraghi MJ, Razavi L, Rahmani S, et al. Effectiveness of Group Therapy Based on Acceptance and Commitment on the Severity of Fatigue and Depression with the Moderating role of Alexithymia in Multiple Sclerosis Patients. International Clinical Neurosciences Journal. 2021;8(1):37-43. doi: 10.34172/icnj.2021.08.
5. Vakilian L, Tarkhan M, Khalatbari J. Predicting Alexithymia Based on Early Maladaptive Schemas and Emotional Expressiveness with the Mediating Role of Cognitive Flexibility in Patients with Chronic Pain. Knowledge & Research in Applied Psychology. 2021;22(3):32-46.
6. Feyzioğlu A, Taşlıoğlu Sayıner AC, Özçelik D, Tarımtay Altun F, Budak EN. The mediating role of early maladaptive schemas in the relationship between early childhood trauma and alexithymia. Current Psychology. 2023;42(21):17851-61. doi: 10.1007/s12144-022-02988-1.
7. Pilkington PD, Karantzas GC, Faustino B, Pizarro-Campagna E. Early maladaptive schemas, emotion regulation difficulties and alexithymia: A systematic review and meta-analysis. Clinical Psychology & Psychotherapy. 2024;31(1):e2914. doi: 10.1002/cpp.2914.
8. Karjouh K, Azzaoui F-Z, Boulbaroud S, Samlali WI, Ahami A. Role of Early Maladaptive Schemas and Alexithymia in the Relationship Between Perceived Parenting Styles in Moroccan Psychoactive Substance Users. International Journal of Nutrition, Pharmacology, Neurological Diseases. 2022;12(3):170-9.
9. Faramarzi Rad B, Robatmili S, Abolmali K, Zarehbaramabadi M. A structural model for predicting alexithymia based on early maladaptive schemas with the mediation of emotional self-disclosure. Journal of Psychological Science. 2023;22(123):539-56.
10. Ghanbari Z, Mohseni Nasab Z, Taati M, Mohbi Aria M, Torabi A. Comparing the effectiveness of schema therapy and mindfulness-based stress reduction on alexithymia, self-control, and psychological well-being in women victims of domestic violence. Research in Psychological Health. 2023;17(4):50-65.
11. Malekimajd M, Ameri F, Pivastehgar M, Farahbijari A. Examining the effectiveness of schema therapy on alexithymia, dysfunctional relationship beliefs, and sexual intimacy in married women with persistent depressive disorder. Disability Studies. 2024;13(1):1-10.
12. Almardani Se. Comparing the effectiveness of acceptance and commitment therapy and schema therapy on alexithymia of divorced women referring to welfare organization. Journal of Family Relations Studies. 2023;4(12):4-14.
13. Asadi M, Vali-Zadeh M. The effectiveness of acceptance and commitment therapy on alexithymia and self-differentiation in married women. The First Conference on Psychopathology Studies and New Treatment Methods. 2021.
14. Karimi Z. Effectiveness of acceptance and commitment therapy on alexithymia in women experiencing infidelity. PWJ. 2023;4(4):48-54. doi: 10.61838/kman.pwj.4.4.6.
15. Naseri SS, AliMehdi M. The effectiveness of acceptance and commitment therapy (ACT) on alexithymia, concern about body image and negative spontaneous thoughts in patients with diabetes in Gorgan city. Journal of Adolescent and Youth Psychological Studies. 2023;4(9):1-15.
16. Tahmasebi Zadeh B, Kooshki S, Nemat Tavousi M, Oraki M. The Effectiveness of Acceptance and Commitment Therapy on Alexithymia and Interpersonal Problems of Men with Substance Use Disorder. Journal of Research in Behavioural Sciences. 2021;18(4):510-8. doi: 10.52547/rbs.18.4.510.
17. Sadeghi M, Naeimeh M, Alivandvafa M. Effectiveness of Acceptance and Commitment Therapy (ACT) in Couple Burnout, Alexithymia, and Quality of Life of Women Affected by Marital Infidelity. Journal of Applied Family Therapy. 2021;2(3):73-91. doi: 10.22034/AFTJ.2021.296762.1146.
18. Sadeghi M, Moheb N, Alivandi Vafa M. The Effectiveness of Group Acceptance and Commitment Therapy and Cognitive Therapy on Alexithymia and Marital Boredom, Case study: Women Affected by Marital Infidelity in Mashhad, Iran. Journal of Community Health Research. 2022;10(4):316-27.
19. Kermanshahi F, Navabi Nezhad S, Ahmadi Noudeh K. Comparing the effectiveness of Emotion Focused, acceptance and commitment and positive interventions on marital boredom and Alexithymia in women affected by infidelity. Medical Journal of Mashhad University of Medical Sciences. 2023;66(5).
20. Mardani F, Yousefi SA, Ghorbani E, Mirzaei Z. The Effectiveness of Reality-Guided Acceptance and Commitment Therapy (RACT) on Marital Burnout and Alexithymia in Couples. Measurement and Research in Applied Counseling. 2023;5(1):10-20. doi: 10.61838/kman.jarac.5.1.2.
21. Roshandel Z, Ghaffari A, Kazemi R, Nadermohammadi M. Effectiveness of Acceptance and Commitment based Therapy on Pain Severity, Fatigue, and Alexithymia in Female Patients with Rheumatic Diseases. Applied Family Therapy Journal (AFTJ). 2022;3(5):84-100. doi: 10.61838/kman.aftj.3.5.6.
22. Tayebi M, Ouraki M. Investigating the Effectiveness of Acceptance and Commitment Therapy on Anxiety, Alexithymia, and Treatment Adherence in Adolescent Girls with Gastroesophageal Reflux Disease. Psychological Sciences Quarterly. 2023:273-88.
23. Asari S. The effectiveness of commitment and acceptance training on emotional stability and alexithymia in gifted female high school students 2024.
24. Noroozi Mehmandoost Z, Gholami Heydarabadi Z. Education Acceptance- Commitment Therapy on Dyfunctional Attitudes,Alexithymia of Depressed Women. Middle Eastern Journal of Disability Studies. 2019;9(0):115-.
25. Mehmandoost ZN, Heydarabadi ZG. Education Acceptance- Commitment Therapy on Dyfunctional Attitudes,Alexithymia of Depressed Women. Middle Eastern Journal of Disability Studies. 2019;9:115-.
26. Rostami Torznogh M, Mahmoudi Nia S, Bahrami M, Rostami Torznogh M. Predicting Students' Addiction to Social Networks Based on Academic Procrastination and Early Maladaptive Schemas, Considering the Mediating Role of Alexithymia. Educational Innovations. 2025;24(1):25-46.
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2026 Fatemeh Gholizadeh (Author); Firoozeh Zangeneh Motlagh; Mohammad Reza Bayat (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
