Document Type : Research Article


1 Faculty of Educational Sciences and Psychology, University of Sistan and Baluchestan, Zahedan, Iran

2 Department of Psychology, Faculty of Educational Sciences and Psychology, University of Sistan and Baluchestan, Zahedan, Iran


Background: Fertility phenomenon holds great importance in almost all cultures; therefore, failures in this matter can turn into a harmful sensation. This study aimed to study the efficacy of acceptance and commitment therapy on anxiety, depression, and stress in women with frequent miscarriage records.
Methods: The research design of this study was quasi-experimental, including post-test and pre-test types with experiment and control groups. The population of this study consisted of all applicants from Alzahra hospital of Rasht, Iran with frequent miscarriage records in summer 2019. The research sample size comprised 30 women who were chosen through convenience method sampling and were randomly assigned into two groups of control group (15 participants) and experiment group (15 participants). Eight sessions of acceptance and commitment therapy were performed on the experiment group. Lovibond and Lovibond’s (1995) scale of depression, anxiety, and stress was applied to collect the data. To analyze the data, one-way ANCOVA was used.
Result: Results revealed that acceptance and commitment therapy was significantly reduced (P=0.001). The mean scores of anxiety (M=27.73±0.79), depression (M=26.73±1.22), and stress (M=27.06±0.59) in the experimental group as compared with control group that were anxiety (28.26±0.96), depression (28±0.75), and stress (28.13±0.83), respectively.
Conclusion: The findings of present study indicated that acceptance and commitment therapy increased the psychological flexibility and led to committed action toward personal values. Therefore, this therapy is applicable for those women with frequent miscarriages to decrease their anxiety, depression, and stress levels.


  1. Sharifi-Shaki S, Aakhte M, Alipor A, Fahimi-Far A, Taghadosi M, Karimi R, et al. The effectiveness of mindfulness-based cognitive therapy in reducing anxiety and meta-worry in women with recurrent miscarriages. Feyz. 2015;19(4):334-40. Persian. ##
  2. Cunningham FG LK, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, et al. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2014. ##
  3. Hachem HEI, Crepaux V,May-Panloup P, Descamps P, Legendre G, Bouet PE. Recurrent pregnancy loss: current perspectives. Int J Womens Health. 2017;9:331-345. doi: 10.2147/IJWH.S100817. PubMed PMID: 28553146; PubMed Central PMCID: PMC5440030. ##
  4. Tulandi T, Al-Fozan HM. Spontaneous miscarriage: Risk factors, etiology, clinical manifestations, and diagnostic evaluation. In Rose B, editor. UpToDate. Wellesley, MA: UpToDate; 2017. pp. 1–23. ##
  5. Nynas J, Narang P, Kolikonda MK, Lippmann S. Depression and anxiety following early pregnancy loss: recommendations for primary care providers. Prim Care Companion CNS Disord. 2015;17(1):10.4088/PCC.14r01721. doi: 10.4088/PCC.14r01721. PubMed PMID: 26137360; PubMed Central PMCID: PMC4468887. ##
  6. Nikcevic AV, Kuczmierczyk AR, Nicolaides KH. The influence of medical and psychological interventions on women's distress after miscarriage. J Psychosom Res. 2007;63(3):283-90. doi: 10.1016/j.jpsychores.2007.04.004. PubMed PMID: 17719366. ##
  7. Bellieni CV, Buonocore G. Abortion and subsequent mental health: Review of the literature. Psychiatry Clin Neurosci. 2013;67(5):301-10. doi: 10.1111/pcn.12067. PubMed PMID: 23859662. ##
  8. Stratton K, Lloyd L. Hospital-based interventions at and following miscarriage: literature to inform a research-practice initiative. Aust N Z J Obstet Gynaecol. 2008;48(1):5-11. doi: 10.1111/j.1479-828X.2007.00806.x. PubMed PMID: 18275565. ##
  9. Curley M. An Explanatory Model to Guide Assessment, Risk and Diagnosis of Psychological Distress after Abortion. Open Journal of Obstetrics and Gynecology. 2014;4(15):944-953. doi: 10.4236/ojog.2014.415133. ##
  10. Topal CA, Terzioglu F. Assessment of depression, anxiety, and social support in the context of therapeutic abortion. Perspect Psychiatr Care. 2019;55(4):618-623. doi: 10.1111/ppc.12380. PubMed PMID: 31004351. ##
  11. Brier N. Anxiety after miscarriage: a review of the empirical literature and implications for clinical practice. Birth. 2004;31(2):138-42. doi: 10.1111/j.0730-7659.2004.00292.x. PubMed PMID: 15153134. ##
  12. Lundell IW, Öhman SG, Frans Ö, Helström L, Högberg U, Nyberg S, et al. Posttraumatic stress among women after induced miscarriage: a Swedish multi-centre cohort study. BMC Womens Health. 2013;(13):52. doi: 10.1186/1472-6874-13-52. PubMed PMID: 24364878; PubMed Central PMCID: PMC3879178. ##
  13. Sadock BJ, Sadock VA. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry , 10th edition. Indian J Psychiatry. 2009;51(4):331. PubMed Central PMCID: PMC2802389. ##
  14. Janssen HJ, Cuisinier MC, de Graauw KP, Hoogduin KA. A prospective study of risk factors predicting grief intensity following pregnancy loss. Arch Gen Psychiatry. 1997;54(1):56-61. doi: 10.1001/archpsyc.1997.01830130062013. PubMed PMID: 9006401. ##
  15. Selye H. The Stress Concept Today. In Kutash IL, editors. Handbook on Stress and Anxiety. San Francisco; 1980. ##
  16. Campillo ISL, Meaney S, McNamara K, O'Donoghue K. Psychological and support interventions to reduce levels of stress, anxiety or depression on women’s subsequent pregnancy with a history of miscarriage: an empty systematic review. BMJ Open. 2017;7(9):e017802. doi: 10.1136/bmjopen-2017-017802. PubMed PMID: 28882928; PubMed Central PMCID: PMC5595175. ##
  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. doi: 10.1177/0011000012460836.
  18. Hayes SC. Acceptance and coomitment thrapy, relation fram theory, and the third wave of behavioral and cognitive therapies. Behav Ther. 2016;47(6):869-885. doi: 10.1016/j.beth.2016.11.006. PubMed PMID: 27993338. ##
  19. Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013;44(2):180-198. doi: 10.1016/j.beth.2009.08.002. PubMed PMID: 23611068; PubMed Central PMCID: PMC3635495. ##
  20. Dixon M, Hayes S, Stanley CR, Law S, Al-Nasser T. Is Acceptance and Commitment Training or Therapy (ACT) a method that applied behavior analysts can and should use? Psychological Record. 2020;70(4):559-79. doi: 10.1007/s40732-020-00436-9. ##
  1. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25. doi: 10.1016/j.brat.2005.06.006. PubMed PMID: 16300724. ##
  2. Grégoire S, Lachance L, Bouffard T, Dionne F. The Use of Acceptance and Commitment Therapy to Promote Mental Health and School Engagement in University Students: A Multisite Randomized Controlled Trial. Behav Ther. 2018;49(3):360-372. doi: 10.1016/j.beth.2017.10.003. PubMed PMID: 29704966. ##
  3. Monteiro F, Fonseca A, Pereira M, Alves S, Canavarro MC. What protects at-risk postpartum women from developing depressive and anxiety symptoms? The role of acceptance-focused processes and self-compassion. J Affect Disord. 2019;246:522-529. doi: 10.1016/j.jad.2018.12.124. PubMed PMID: 30599377. ##
  4. Ossman WA, Wilson KG, Storaasli RD, McNeill JW. Preliminary Investigation of the use of Acceptance and commitment therapy in-group Treatment for social phobia. International Journal of Psychology and Psychological Therapy. 2006;6(3):397-416. ##
  5. Afshari A. Comparison of the Efficacy of Acceptance and Commitment Therapy and Mind-Fullness Therapy on Women's Resilience in repeated Abortions. IJPN. 2018;6(4):11-18. Persian. ##
  6. Chen SL, Chang SM, Kuo PL, Chen CH. Stress, anxiety and depression perceived by couples with recurrent miscarriage. Int J Nurs Pract. 2020;26(2):e12796. doi: 10.1111/ijn.12796. PubMed PMID: 31713284. ##
  7. Wang Y, Meng Z, Pei J, Qian L, Mao B, Li Y, et al. Anxiety and depression are risk factors for recurrent pregnancy loss: a nested case–control study. Health Qual Life Outcomes. 2021;19(1):78. doi: 10.1186/s12955-021-01703-1. PubMed PMID: 33685488; PubMed Central PMCID: PMC7938475. ##
  8. Fertl KI, Bergner A, Beyer R, Klapp BF, Rauchfuss M. Levels and effects of different forms of anxiety during pregnancy after a prior miscarriage. Eur J Obstet Gynecol Reprod Biol. 2009;142(1):23-9. doi: 10.1016/j.ejogrb.2008.09.009. PubMed PMID: 18986753. ##
  9. Kolte AM, Olsen LR, Mikkelsen EM, Christiansen OB, Nielsen HS. Depression and emotional stress is highly prevalent among women with recurrent pregnancy loss. Hum Reprod. 2015;30(4):777-82. doi: 10.1093/humrep/dev014. PubMed PMID: 25662810; PubMed Central PMCID: PMC4359400. ##
  10. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43. doi: 10.1016/0005-7967(94)00075-u. PubMed PMID: 7726811. ##
  11. Samani S; Joukar B. A Study on the Reliability and Validity of the Short Form of the Depression, Anxiety and Stress Scale. Journal of Social Sciences and Humanities of Shiraz University. 2007;26(3):65-77. Persian. ##
  12. Sahebi A, Asghari MJ, Salari R. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Psychology. 2005;1(4). ##
  13. Alipour M, Ghahremani L, Amooee S, Keshavarzi S. The effectiveness of relaxation techniques on depression, anxiety and stress in pregnant women: based on self-efficacy theory. SJKU. 2017;22(3):20-30. doi: 10.22102/22.3.20. Persian. ##
  14. Kanter JW, Baruch DE, Gaynor ST. Acceptance and commitment therapy and behavioral activation for the treatment of depression: Description and comparison. Behav Anal. 2006;29(2):161-85. doi: 10.1007/BF03392129. PubMed PMID: 22478462; PubMed Central PMCID: PMC2223147. ##
  15. Feros DL, Lane L, Ciarrochi J, Blackledge JT. Acceptance and Commitment Therapy (ACT) for improving the lives of cancer patients: a preliminary study. Psychooncology. 2013;22(2):459-64. doi: 10.1002/pon.2083. PubMed PMID: 23382134. ##
  16. Bloy S, Oliver JE, Morris E. Using acceptance and commitment therapy with people with psychosis: A case study. Clinical Case Studies. 2011;10(5):347-59. doi: 10.1177/1534650111420863. ##
  17. Tunnell NC, Suterwala M, Meuret AE. Brief acceptance-based therapy for women with high-risk pregnancies: Uncontrolled pilot of an intervention for inpatients. Journal of Contextual Behavioral Science. 2019;14:127-135. doi: 10.1016/j.jcbs.2019.10.004. ##