The Effectiveness of Integrated ACT with Emotion Regulation Training on Distress Tolerance and Stress Symptoms in Individuals with Post-Traumatic Stress Disorder (PTSD) Symptoms
DOI:
https://doi.org/10.63053/ijhes.201Keywords:
Post-Traumatic Stress Disorder, Acceptance and Commitment Therapy, Emotion Regulation, Distress Tolerance, Stress SymptomsAbstract
Background: Post-Traumatic Stress Disorder (PTSD) is a debilitating condition characterized by intrusive re-experiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Both Acceptance and Commitment Therapy (ACT) and emotion regulation training have demonstrated efficacy for PTSD, but their combined effects on distress tolerance and stress symptoms remain unclear. This study aimed to investigate the effectiveness of integrated ACT with emotion regulation training on distress tolerance and stress symptoms in individuals with PTSD symptoms.
Methods: This quasi-experimental study employed a pretest-posttest-follow-up design with a control group. The statistical population included all individuals aged 18–50 years with PTSD symptoms 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 integrated ACT (n = 15), ACT-only (n = 15), and control (n = 15) groups. The integrated group received 12 weekly 90-minute sessions combining ACT with emotion regulation training, while the ACT-only group received 12 weekly 90-minute sessions of standard ACT. Data collection instruments included the Distress Tolerance Scale (DTS), Post-Traumatic Stress Disorder Checklist (PCL-5), and Acceptance and Action Questionnaire-II (AAQ-II). Data were analyzed using repeated-measures ANOVA with SPSS-26.
Results: The integrated ACT with emotion regulation training showed significantly greater improvement in distress tolerance (F = 34.52, P < 0.001, η² = 0.62) compared to ACT-only (F = 22.18, P < 0.001, η² = 0.48). Stress symptoms showed significantly greater reduction in the integrated group (F = 38.45, P < 0.001, η² = 0.66) compared to ACT-only (F = 26.73, P < 0.001, η² = 0.52). Psychological flexibility improved significantly more in the integrated group (F = 40.12, P < 0.001, η² = 0.68). Improvements were maintained at two-month follow-up (P < 0.001). Effect sizes for the integrated group were large (d = 2.56 for distress tolerance; d = 2.78 for stress symptoms).
Conclusion: Integrated ACT with emotion regulation training is a highly effective intervention for improving distress tolerance and reducing stress symptoms in individuals with PTSD symptoms. The combination of acceptance-based and emotion regulation strategies appears to produce superior outcomes compared to ACT alone. This integrated approach should be considered a preferred treatment for PTSD when distress tolerance deficits are prominent.
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