Comparison of the Effectiveness of Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Therapy (CBT) on Reducing Pathological Worry and Generalized Anxiety in Patients with Generalized Anxiety Disorder (GAD)
DOI:
https://doi.org/10.63053/ijhes.200Keywords:
Generalized Anxiety Disorder, Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, Pathological Worry, Psychological FlexibilityAbstract
Background: Generalized Anxiety Disorder (GAD) is a chronic and debilitating condition characterized by excessive, uncontrollable worry. Both Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Therapy (CBT) have demonstrated efficacy for GAD, but their comparative effectiveness on pathological worry and generalized anxiety remains unclear. This study aimed to compare the effectiveness of ACT and CBT on reducing pathological worry and generalized anxiety in patients with GAD.
Methods: This quasi-experimental study employed a pretest-posttest design with a control group. The statistical population included all patients aged 18–50 years diagnosed with GAD attending psychiatric clinics and counseling centers in Babol city during 2024–2025. A total of 45 participants were selected using purposive sampling and randomly assigned to ACT (n = 15), CBT (n = 15), and control (n = 15) groups. The ACT group received 10 weekly 90-minute sessions, and the CBT group received 10 weekly 90-minute sessions. Data collection instruments included the Penn State Worry Questionnaire (PSWQ), Generalized Anxiety Disorder Scale (GAD-7), and Acceptance and Action Questionnaire-II (AAQ-II). Data were analyzed using multivariate analysis of covariance (MANCOVA) with SPSS-26.
Results: Both ACT and CBT significantly reduced pathological worry and generalized anxiety compared to the control group (P < 0.001). ACT showed significantly greater improvement in pathological worry (F = 28.45, P < 0.001, η² = 0.61) and generalized anxiety (F = 26.73, P < 0.001, η² = 0.58) compared to CBT. ACT also demonstrated significantly greater improvement in psychological flexibility (F = 32.18, P < 0.001, η² = 0.64). Effect sizes for ACT were large (d = 2.45 for worry; d = 2.38 for anxiety), while CBT showed moderate to large effects (d = 1.86 for worry; d = 1.72 for anxiety).
Conclusion: Both ACT and CBT are effective interventions for reducing pathological worry and generalized anxiety in patients with GAD. However, ACT demonstrated superior outcomes, likely due to its emphasis on psychological flexibility and acceptance-based strategies. ACT should be considered a preferred treatment for GAD, particularly when pathological worry is prominent.
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