Community Health Journal

Community Health Journal

Comparing the Effects of Paradoxical Treatment and Acceptance and Commitment Therapy on Distress Tolerance in Women with Health Anxiety

Document Type : Original Article

Authors
A Madhi 1
F Farshbaf Manisefat 2
M Etemadi-Nia 2
1 PhD Student, Dept. of Psychology, Urmia Branch, Islamic Azad University, Urmia, Iran.
2 Assistant Prof., Dept. of Psychology, Urmia Branch, Islamic Azad University, Urmia, Iran.
10.22123/chj.2025.485414.2134
Abstract
Introduction: Distressed people complain more about symptoms of physical illness, and the frequency of physical illness is a strong predictor of damage in psychosocial and physical functions. Therefore, this research was conducted with the aim of comparing the effectiveness of paradox therapy and therapy based on acceptance and commitment on distress tolerance indicators in patients with health anxiety.
Materials and Methods: This was a semi-experimental study with a pre-test, post-test, and control group design with a 2-month follow-up. The statistical population of the research included all women with health anxiety who referred to Shahid Shirazi Hospital in Gorgan in 2023. Among these, 60 people were selected by purposeful sampling and were randomlyassigned into experimental and control groups (20 people in each group). Participants completed the Salkovskis’ Health Anxiety Inventory and the Simons’ Distress Tolerance Scale at different measurement stages. Acceptance and commitment therapy and paradox therapy were applied to the experimental groups during 8 and 6 sessions of 90 minutes, respectively, with the frequency of one session per week. The control group did not receive any intervention. Data were analyzed by two-way repeated measures ANOVA.
Results: Paradox therapy and acceptance and commitment therapy improved the components of tolerance (η=0.408 & F=19.634), absorption (η=0.350 & F=15.372), evaluation (η=0.407 & F=19.570), regulation (η=0.304 & F=12.442) and, distress tolerance (η=0.566 & F=59.543) in women with health anxiety compared to the control group (p<0.05). Also, no significant difference was observed in terms of the usefulness of the two treatment approaches in improving distress tolerance (p<0.05).
Conclusion: It seems that paradox therapy and acceptance and commitment therapy can improve distress tolerance in health anxiety sufferers and are not superior to each other.
Keywords
Paradoxical treatment
Acceptance and commitment therapy
Distress tolerance
Health anxiety
  1. Vallée A, Ceccaldi PF, Carbonnel M, Feki A, Ayoubi JM. Pollution and endometriosis: a deep dive into the environmental impacts on women's health. BJOG: Int J Gynaecol Obstet 2024; 131(4):401-14.
  2. Mazzoni D, Amadori R, Sebri V, Tosi M, Pregnolato S, Surico D, et al. Health anxiety and oppressive support: their impact on decisions for non-urgent use of the emergency department of obstetrics and gynecology. Curr Psychol 2024; 43(12):10904-13.
  3. Garey L, Smit T, Clausen BK, Redmond BY, Obasi EM, Businelle MS, et al. Anxiety sensitivity and distress tolerance in relation to smoking abstinence expectancies among Black individuals who smoke. J Stud Alcohol Drugs 2024; 85(2):244-53.
  4. Tanguy WJ, Kaur K, Asnaani A. Using a transdiagnostic approach to examine the associations among internalizing symptoms, emotion regulation, and distress tolerance. J Exp Psychopathol 2024; 15(2):20438087241249682.
  5. Simons JS, Gaher RM. The distress tolerance scale (DTS): Development and validation of a self-report measure. Motivation and Emotion 2005; 29(2):83-102.
  6. Besharat MA. Evaluating the effectiveness of paradox therapy for the treatment of social anxiety disorder: A case study. JPS 2019; 18(76):383-96. [Persian]
  7. Mohammadpour M, Aslami E. Evaluating the effectiveness of paradox therapy on components of psychological well-bing of conflicting couples. JNIP 2022; 14(18):1-24. [Persian]
  8. Nikan A, Lotfi Kashani F, Vaziri S, Mojtabaie M. Comparison of paradoxical timetable and cognitive behavioral therapy on worry and rumination of individuals with social anxiety. RRJ 2021; 10(1):1-14. [Persian]
  9. Chitgar-zadeh MJ, Asayesh MH, Besharat MA, Hakak F. Investigating the effectiveness of paradoxical couple therapy (PTC) on marital conflicts and emotion regulation in conflicting couples. RRJ 2023; 12(2):40-51. [Persian]
  10. Domschke K, Seuling PD, Schiele MA, Bandelow B, Batelaan NM, Bokma WA, et al. The definition of treatment resistance in anxiety disorders: A delphi method‐based consensus guideline. World Psychiatry 2024; 23(1):113-23.
  11. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change. 2nd Guilford Press; 2012.
  12. Keenan E, Morris R, Vasiliou VS, Thompson AR. A qualitative feasibility and acceptability study of an acceptance and commitment-based bibliotherapy intervention for people with cancer. J Health Psychol 2024; 29(5):410-24.
  13. Tavakoli MR, Amini N, Keikhosravani M. Comparison of the effectiveness of couple therapy based on self-regulation and acceptance and commitment on perspective-taking and marital target orientation of married women. CHJ 2024; 17(4):1-14. [Persian]
  14. Salkovskis PM, Rimes KA, Warwick HM, Clark D. The health anxiety inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med 2002; 32(5):843-53.
  15. Nargesi F, Izadi F, Kariminejad K, Rezaii Sharif A. The investigation of the reliability and validity of Persian version of health anxiety questionnaire in students of Lorestan university of medical sciences. Quarterly of Educational Measurement 2017; 8(27):147-60. [Persian]
  16. Tofangchi M, Raeisi Z, Ghamarani A, Rezaei H. The psychometric properties of distress tolerance scale (DTS) in women with tension-type headaches. JAP 2021; 12(4):34-43. [Persian]
  17. Morris EM, Johns LC, Gaudiano BA. Acceptance and commitment therapy for psychosis: Current status, lingering questions and future directions. Psychology and Psychotherapy: Theory, Research and Practice 2024; 97(1):41-58.
  18. Byrne G, Cullen C. Acceptance and commitment therapy for anger, irritability, and aggression in children, adolescents, and young adults: a systematic review of intervention studies. Trauma, Violence, & Abuse 2024; 25(2):935-46.
  19. Romano D, Chesterman S, Fuller-Tyszkiewicz M, Evans S, Dober M, Gearry R, et al. Feasibility, acceptability, and preliminary efficacy of acceptance commitment therapy for adults living with inflammatory bowel disease and distress. Inflammatory bowel diseases 2024; 30(6):911-21.
  20. SaeediNejad N, Foroozandeh E, Besharat MA, Nikvarz M, Bani Taba SM. The effectiveness of paradox therapy on the anxiety and ego strength of mothers with premature babies. RRJ 13(7):61-70. [Persian] 
  21. Babaie V, Abolmaali Alhosseini K, Hobbi MB. Investigating the efficacy of paradoxical time table therapy on anxiety sensitivity and focused–attention in people with social anxiety disorder. Journal of Psychological Science 2023; 22(125):967-983. [Persian]
  22. Azadi H, Ghazangari A, Chorami M, Sharifi T. Comparing the effectiveness and durability of the treatment based on acceptance and commitment and the time schedule of the paradoxical recovery of emergency department nurses. Journal of Hospital 2022; 21(3):55- 64. [Persian]
  23. Taghilo L, Azizi-Ziabari L S, Khajevand-Khoshli A, Damgani-Mirmahaleh M. Comparing the effectiveness of acceptance and commitment therapy and paradox therapy on the ego strength of nurses. NPWJM 2023; 11(38):12-19. [Persian]
Community Health Journal
Volume 18, Issue 4
Spring 2025
Pages 62-75