Community Health Journal

Community Health Journal

Comparing the Effects of Cognitive-Behavioral Therapy with Acceptance and Commitment Therapy on Pain Perception and Treatment Adherence in Women with Chronic Musculoskeletal Pain Syndrome

Document Type : Original Article

Authors
A Sadighi 1
A Shokrgozar 2
SH Sodagar 2
M Bahrami-Hidahi 3
SA Raeissadat 4
1 PhD Student, Dep of Health & Clinical Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
2 Assistant Professor, Dep of Health & Clinical Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
3 Assistant Professor, Dep of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
4 Professor, Dep of Physical Medicine and Rehabilitation, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.22123/chj.2026.553915.2227
Abstract
Introduction: Chronic musculoskeletal pain syndrome is a disorder characterized by pain at various levels, for which there is no specific treatment. Therefore, this study aimed to compare the effectiveness of CBT with ACT on pain perception and treatment adherence in women with chronic musculoskeletal pain syndrome.
Materials and Methods: This is a semi-experimental study with a pre-test, post-test, and control group design with a 3-month follow-up. The statistical population of the study comprised all female patients with chronic musculoskeletal pain syndrome referred to the rehabilitation clinic of Modarres Hospital in Tehran in 2024. Out of 112 subjects, 45 were selected through purposive sampling; they were randomly assigned to three equal groups of 15 participants. Data were collected using a pain perception questionnaire and a treatment adherence questionnaire. CBT was applied for 10 sessions, and ACT was applied for 8 sessions for experimental groups. The control group did not receive any intervention. Data were analyzed using a two-way ANOVA with repeated measures through SPSS version 26.
Results: CBT and ACT, compared to the control group, reduced pain perception (F=47.95, η2=0.49) and improved overall treatment adherence (F=169.76, η2=0.58) and its dimensions in women with chronic musculoskeletal pain syndrome (p<0.05). Bonferroni post hoc test also showed that the two approaches had the same effectiveness in treatment adherence, but CBT was more beneficial for pain perception.
Conclusion: According to the results, specialists active in the field of fibromyalgia patients can use the above-mentioned treatments in addition to conventional drug therapy methods to increase treatment adherence in these patients.
Keywords
Cognitive-behavioral therapy
Acceptance and commitment therapy
Pain perception
Treatment adherence
Fibromyalgia
1.       Baykal GÖ, Ayduran S, Arık SD, Baba O, Tunçez S, Sönmez HE, et al. Prevalence of juvenile fibromyalgia syndrome in Turkish patients with juvenile idiopathic arthritis: A multicenter study. ARP rheumatology 2025; 4(2):138-44.
2.       Häuser W, Fitzcharles MA, Henningsen P. Fibromyalgia syndrome-a bodily distress disorder/somatic symptom disorder? Pain reports 2025; 10(1):e1223.
3.       Ghorbanzade BorBor A, Soleimani E, Esazadeghan A. Effect of exposure therapy and cognitive behavioral therapy for insomnia on psychological distress in women with fibromyalgia. Avicenna J Clin Med 2025; 32(1):28-36. [Persian]
4.       Raev S, Aloush V, Gilam G, Elkana O. The Mediating role of depression in the relationship between perceived injustice and pain intensity among fibromyalgia patients. Journal of Pain Research 2025; 31:3077-85.
5.       Lee J, Lazaridou A, Paschali M, Loggia ML, Berry MP, Ellingsen DM, et al. A Randomized controlled neuroimaging trial of cognitive behavioral therapy for fibromyalgia pain. Arthritis & Rheumatology 2024; 76(1):130-40.
6.       Nhu NT, Wong CZ, Chen IY, Jan YW, Kang JH. Telehealth-delivered cognitive behavioral therapy-a potential solution to improve sleep quality and normalize the salience network in fibromyalgia: A pilot randomized trial. Brain Imaging and Behavior 2024; 18(6):1376-84.
7.       Pontes-Silva A, de Castro GF, Avila MA. Examining clinical and sociodemographic variables and social support on exercise adherence in women with fibromyalgia: a cohort study. Sport Sciences for Health 2025; 21(3):1683-92. 7
8.       Brea-Gómez B, Pérez-Gisbert L, Fernandez-Castro I, Valenza MC, Torres-Sánchez I. Effects of virtual reality-based rehabilitation in the treatment of patients with fibromyalgia syndrome: A systematic review and meta-analysis of randomized clinical trials. Games for Health Journal 2025; 14(2):79-102.
9.       Téllez M, García Y. Enhancing medication adherence, depression, and values-based behaviors in HIV-positive individuals through acceptance and commitment therapy: A pilot study. Journal of Contextual Behavioral Science 2025.
10.    Moore A, Bidonde J, Fisher E, Häuser W, Bell RF, Perrot S, et al. Effectiveness of pharmacological therapies for fibromyalgia syndrome in adults: An overview of Cochrane Reviews. Rheumatology 2025; 64(5):2385-94.
11.    Rubio-Fidel L, Cotaina-Berto M, Pérez-Turleque L, García-Palacios A, Suso-Ribera C. Feasibility of an app-supported monitoring system for cognitive-behavioral interventions in fibromyalgia patients in public settings. Cyberpsychology, Behavior, and Social Networking 2025; 28(6):432-39.
12.    Thorn BE. Cognitive therapy for chronic pain, second edition: A step-by-step guide. The Guilford Press 2017.
13.    Jennings MB, Kalmbach DA, Reffi AN, Miller CB, Roehrs T, Drake CL, et al. Prevention of pain interference in insomnia patients via digital cognitive-behavioral therapy for insomnia. Behavioral Sleep Medicine 2025; 15(5):1-13.
14.    Sanabria-Mazo JP, Royuela-Colomer E, Navarrete J, Rodríguez-Freire C, Robles B, McCracken LM, et al. Predicting adherence and clinical response of cognitive behavioral therapy among individuals with chronic low back pain plus depressive symptoms: A secondary analysis of a randomized controlled trial. Pain Medicine 2025; 26:459-467.
15.    Burns JW, Lumley MA, Vowles KE, Jensen MP, Day MA, Schubiner H, et al. Comparative main effects, mediators, and moderators of cognitive behavioral therapy, acceptance and commitment therapy, and emotional awareness and expression therapy for chronic spinal pain: Randomized controlled trial rationale and protocol. Contemporary Clinical Trials Communications 2025.
16.    Ottergard ML, Pretzmann L, Lundgren T, McCracken L, Buhrman M, Molander P, et al. Patient-reported unwanted events and deterioration rates during acceptance and commitment therapy: A brief report of group therapy for fibromyalgia. Journal of Contextual Behavioral Science 2025.
17.    Hayes SC, Pistorello J, Levin ME. Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist 2012; 40(7):976-1002.
18.    Liu JQ, Mak YW, Tang AL, Kwan C, Al Zoubi F, Wong TK, et al. Effects of acceptance and commitment therapy plus exercise for older adults with chronic low back pain: A preliminary cluster randomized controlled trial with qualitative interviews. The Journal of Pain 2025; 30:105350.
19.    Tajally R, Bahrami Hidaji M, Tajeri B, Hossein-Zadeh Taghvaie M, Goodarzi A. Comparing the effects of mindfulness-based cognitive therapy and metacognitive therapy on emotional self-regulation in patients with alopecia areata. Community Health Journal 2024; 18(2):1-12. [Persian]
20.    Jahan AM, Rwaiha AE, Anaiba SM, Alghoul RA. Cross-cultural validation of the arabic short-form McGill qain Questionnaire (SF-MPQ): Libyan version in patients with musculoskeletal pain. Advances in Rehabilitation Science and Practice 2024.
21.    Shaghaghi F, Smkhani Akbarinejhad H. The Effectiveness of acceptance and commitment therapy on intensity pain and pain catastrophizing in women with chronic pain. Medical Science Journal of Islamic Azad University 2025; 35(1):56-64. [Persian]
22.    Seyed Fatemi N, Rafii F, Hajizadeh E, Modanloo M. Psychometric properties of the adherence questionnaire in patients with chronic disease: A mix method study. Koomesh 2018; 20(2):179-91. [Persian]
23.    Akbari N, Pashmdarfard M, Manuchehri M, Amini M, Mirzakhani Araghi N. Predicting adherence to treatment in the elderly with type 2 diabetes based on interpersonal conflicts and self-compassion. SJRM 2024; 13(3):664-75. [Persian]
24.    Ziaee H, Yosefi E, Khajehpoor L. Comparing the effectiveness of CBT and acceptance and commitment therapy on the temptation of patients undergoing addiction treatment in Khorramshahr. Iranian Evolutionary Educational Psychology Journal 2024; (2):107-122.
25.    Hayatloo S, Farshbaf Manisefat F, Etemadi-Nia M. Comparing the effects of acceptance and commitment therapy and brief cognitive-behavioral therapy on sleep quality of adolescents with gastrointestinal disorders. Community Health Journal 2025; 18(4):39-51. [Persian]
26.    Wells‐Di Gregorio S, Flowers S, Peng J, Marks DR, Probst D, Zaleta A, et al. Combined treatment with cognitive behavioral therapy for insomnia and acceptance and commitment therapy enhances objective and subjective reports of sleep in patients with advanced cancer. Psycho‐Oncology 2025; 34(4):e70141.
27.    Homaie Mojaz Z, Saif AA, Kordnoghabi R. Comparison of the effectiveness of cognitive behavioral therapy and acceptance and commitment on the insomnia disorder in the middle-aged. Journal of Psychological Science 2024; 23(135):139-56. [Persian]
28.    Delasas GE, Delgado NM, Mojica IK, Ragasa S, Dones III V, Manlapaz D. Effectiveness of cognitive behavioral therapy vs conservative pain management for occupational performance in patients with low back pain: A systematic review protocol. JBI Evidence Synthesis 2025; 23(2):365-71.
29.    Hasani B, Tajeri B, Meschi F, Shokrgozar A, Razavianzadeh N. Comparing effectiveness of cognitive behavioral therapy group and cognitive therapy based on mindfulness on life expectancy of dialysis patients. Journal of Psychological Science 2025; 24(149):181-96. [Persian]
30.    Cojocaru CM, Popa CO, Schenk A, Suciu BA, Szasz S. Cognitive-behavioral therapy and acceptance and commitment therapy for anxiety and depression in patients with fibromyalgia: A systematic review and meta-analysis. Medicine and Pharmacy Reports 2024; 97(1):26-35.
31.    Hertenstein E, Trinca E, Schneider CL, Fehér KD, Johann AF, Nissen C. Acceptance and commitment therapy, combined with bedtime restriction, versus cognitive behavioral therapy for insomnia: A randomized controlled pilot trial. Psychotherapy and psychosomatics 2024; 93(2):114-28.
Community Health Journal
Volume 19, Issue 4
Spring 2025
Pages 67-80