Research Article

The effects of the acceptance and commitment therapy on the experiential avoidance and intolerance of uncertainty of mothers with hearing-impaired children


Background and Aim: Children's hearing loss affects not only their speech and language development but also their mothers’ mental health. This study aimed to determine the effect of acceptance and commitment therapy (ACT) on the intolerance of uncertainty and experiential avoidance of mothers with hearing-impaired or deaf children.
Methods: This is a quasi-experimental study with the pretest-posttest design with a control group. The study population comprised all mothers of hearing-impaired or deaf children (2−6 years old) in Tabriz City, Iran. Using a purposive sampling method, 32 mothers of hearing-impaired or deaf children were selected and then randomly assigned to control and experimental groups (each group, 16 subjects). The experimental group was treated with ACT in 8 sessions of 1.5 hours long in two weeks. The study data were collected by the Acceptance and Action Questionnaire-II (AAQ-II) and Intolerance of Uncertainty Scale (IUS).
Results: The results showed that ACT significantly increased scores on the AAQ-II and IUS in the experimental group compared to the control group (p < 0.001).
Conclusion: ACT might be an efficient way to decrease intolerance of uncertainty and avoidance of experience in the mothers of hearing-impaired and deaf children. Also, therapists can use this approach for improving the intolerance of uncertainty and experiential avoidance in mothers of hearing-impaired or deaf children in rehabilitation centers.

CorrectionThe effects of the acceptance and commitment therapy on the experiential avoidance and intolerance of uncertainty of mothers with hearing-impaired children

1. Kirk S, Gallagher J, MR Coleman. Educating exceptional children. 14ed en. Stamford, USA Publisher: Cengage Learning; 2014.
2. World Health Organization. Newborn and infant hearing screening: Current issues and guiding principles for action. 2009. Available from: and Infant Hearing Screening Report.pdf.
3. Schorr EA, Roth FP, Fox NA. A comparison of the speech and language skills of children with cochlear implants and children with normal hearing. Commun Disord Q. 2008;29(4):195-210. doi: 10.1177/1525740108321217
4. Pipp-Siegel S, Sedey AL, Yoshinaga-Itano C. Predictors of parental stress in mothers of young children with hearing loss. J Deaf Stud Deaf Educ. 2002;7(1):1-17. doi: 10.1093/deafed/7.1.1
5. Gharashi K, Sarandi P, Farid A. [The comparison of stress and marital satisfaction status of parents of hearing-impaired and normal children]. Audiol. 2013;22(1):18-24. Persian.
6. Gharashi K, Moheb M. The effect of cognitive-behavioral therapy on reducing the anxiety and depression of children with hearing loss . Aud Vestib Res. 2018;27(1):31-7.
7. McConnell D, Savage A. Stress and resilience among families caring for children with intellectual disability: expanding the research agenda. Curr Dev Disord Rep. 2015;2(2):100-9. doi: 10.1007/s40474-015-0040-z
8. Clark DA, Taylor S. The transdiagnostic perspective on cognitive-behavioral therapy for anxiety and depression: New Wine for Old Wineskins? J Cogn Psychother. 2009;23(1):60-6. doi: 10.1891/0889-8391.23.1.60
9. Lee JK, Orsillo SM, Roemer L, Allen LB. Distress and avoidance in generalized anxiety disorder: exploring the relationships with intolerance of uncertainty and worry. Cogn Behav Ther. 2010;39(2):126-36. doi: 10.1080/16506070902966918
10. Bardeen JR, Tull MT, Stevens EN, Gratz KL. Exploring the relationship between positive and negative emotional avoidance and anxiety symptom severity: the moderating role of attentional control. J Behav Ther Exp Psychiatry. 2014;45(3):415-20. doi: 10.1016/j.jbtep.2014.04.006
11. Dugas MJ, Schewartz A, Francis K. Intolerance of uncertainty, worry, and depression. Cognit Ther Res. 2004;28(6):835-42. doi: 10.1007/s10608-004-0669-0
12. Mansouri A, Korozhde N. [The effectiveness of the acceptance and commitment therapy on the intolerance of uncertainty, worry and insomnia in mothers of children with autism spectrum disorder]. Journal of Research in Behavioural Sciences. 2017;15(3):347-53. Persian.
13. Dugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther. 1998;36(2):215-26.
14. Arfaei A, Besharat gharamlaki R, Gholizadeh H, Hekmati E. [Intolerance of uncertainty: comparision between individuals with Major depressed disorder with obsessive-compulsive disorder]. J Tabriz Univ Med Sci. 2011; 33(5): 17-22. Persian.
15. van der Heiden C, Melchior K, Muris P, Bouwmeester S, Bos AE, van der Molen HT. A hierarchical model for the relationships between general and specific vulnerability factors and symptom levels of generalized anxiety disorder. J Anxiety Disord. 2010;24(2):284-9. doi: 10.1016/j.janxdis.2009.12.005
16. Biglan A, Hayes SC, Pistorello J. Acceptance and commitment: implications for prevention science. Prev Sci. 2008;9(3):139-52. doi: 10.1007/s11121-008-0099-4
17. Bloy S, Oliver JE, Morris E. Using acceptance and commitment therapy with people with psychosis: A case study. Clin Case Stud. 2011;10(5):347-59. doi: 10.1177/1534650111420863
18. Jones L, Gold E, Totsika V, Hastings RP, Jones M, Griffiths A, et al. A mindfulness parent well-being course: evaluation of outcomes for parents of children with autism and related disabilities recruited through special schools. Eur J Spec Needs Educ. 2018;33(1):16-30. doi: 10.1080/08856257.2017.1297571
19. Gould ER., Tarbox J, Coyne L. Evaluating the effects of acceptance and commitment training on the overt behavior of parents of children with autism. Journal of Contextual Behavioral Science. 2017. doi: 10.1016/j.jcbs.2017.06.003
20. Shiralinia K, Abdollahi Mousavi H, Khojastemehr R. [The effectiveness of of group acceptance and com¬mitment therapy (act)-based training on parenting stress and psychological flexibility in mothers of children with autism spectrum disorder]. Psychology of Exceptional Individuals. 2017;28(7):21-44. Persian. doi: 10.22054 / jpe.2018.26885.1695
21. Pak R, Abdi R, Chalbianloo G. [Effectiveness of acceptance and commitment therapy (ACT) on disease acceptance and experiential avoidance in patients with multiple sclerosis (MS)]. Contemporary Psychology.2017;12(1):63-72. Persian.
22. Mesbah I, Hojatkhah SM, Golmohammadian M. [Effectiveness of group therapy based on acceptance and commitment on resilience mothers of children with mental retardation]. Psychology of Exceptional Individuals. 2018;8(29):85-109. Persian. doi: 10.22054 / jpe.2018.24311.1613
23. Hughes LS, Clark J, Colclough JA, Dale E, McMillan D. Acceptance and commitment therapy (ACT) for chronic pain: a systematic review and meta-analyses. Clin J Pain. 2017;33(6):552-568. doi: 10.1097/AJP.0000000000000425
24. Murrell AR, Scherbarth AJ. State of the research and literature address: ACT with children, adolescents and parents. Int J Behav Consult Ther. 2006;2(4):531-43.
25. Ost LG. Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behav Res Ther. 2008;46(3):296-321. doi: 10.1016/j.brat.2007.12.005
26. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. 2nd en. New York: Guilford Press; 2012.
27. Hayes SC. Acceptance and commitment therapy and the new behavior therapies: mindfulness, acceptance and relationship. In: Hayes SC, Follette VM, Linehan MM, editors. Mindfulness and acceptance: expanding the cognitive-behavioural tradition. 1st ed. New York: The Guilford Press; 2011. p. 1-29.
28. Villatte M, Villatte JL, Hayes SC. Mastering the clinical conversation. Language as intervention. 1st ed. New York: Guilford Press; 2016.
29. 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):180-98. doi: 10.1016/j.beth.2009.08.002
30. Kashdan TB, Morina N, Priebe S. Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: experiential avoidance as a contributor to distress and quality of life. J Anxiety Disord. 2009;23(2):185-96. doi: 10.1016/j.janxdis.2008.06.006
31. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK. et al. Preliminary psychometric properties of the acceptance and action questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther. 2011;42(4):676-88. doi: 10.1016/j.beth.2011.03.007
32. Abbasi E, Fata L, Moloudi R, Zarabi H. [Psychometric properties of persian version of acceptance and action questionnaire-II]. Journal of psychological models and methods. 2013;3(10):65-80. Persian.
33. Beck AT, Steer RA, Brown GK. Beck Depression Inventory manual. 2nd ed. San Antonio, TX: Psychological Corporation. 1996.
34. Beck AT, Clark DA. Anxiety and depression: An infor¬mation processing perspective. Anxiety Research. 1998;1(1):23-36. doi: 10.1080/10615808808248218
35. Freeston MH, Rheauma J, Litarte H, Dugas MJ, Ladouceur R. Why do people worry? Pers Individ Dif. 1994;17(6):791-802. doi: 10.1016/0191-8869(94)90048-5
36. Buhr K, Dugas MJ. The role of fear of anxiety and intolerance of uncertainty in worry: an experimental manipulation. Behav Res Ther. 2009;47(3):215-23. doi: 10.1016/j.brat.2008.12.004
37. Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol. 1996;64(6):1152-68.
38. Kowalkowski JD. The impact of a group-based acceptance and commitment therapy intervention on parents of children diagnosed with an autism spectrum disorder. [Dissertation]. Ypsilanti (MI): Eastern Michigan University; 2012. 512.
39. Avdagic E, Morrissey SA, Boschen MJ. A randomized controlled trial of acceptance and commitment therapy and cognitive-behaviour therapy for generalised anxiety disorder. Behav Change 2014;31(2):110-30. doi: 10.1017/bec.2014.5
40. .Behrouz B. [The effectiveness of group-based acceptance and commitment therapy on post-traumatic stress disorder, coping styles, and self-efficacy in girls with abnormal grief]. J Clin Psychol. 2016;7(4):81-91. Persian.
41. Narimani M, Alamdari E, Abolghasem A. [The study of the efficiency of acceptance and commitment-based therapy on the quality of infertile women’s life]. Family Counseling and Psychotherapy. 2014;4(3):387-405. Persian.
42. Gharashi K, Moheb N, Abdi A. Effects of acceptance and commitment therapy on decreasing anxiety and depression symptoms in mothers of hearing-impaired or deaf children. Aud Vestib Res. 2019;28(2):116-23. doi: 10.18502/avr.v28i2.866
IssueVol 28 No 4 (2019) QRcode
SectionResearch Article(s)
Hearing impairment; experiential avoidance; intolerance of uncertainty; acceptance and commitment therapy

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How to Cite
Gharashi K, Moheb N, Abdi R. The effects of the acceptance and commitment therapy on the experiential avoidance and intolerance of uncertainty of mothers with hearing-impaired children. Aud Vestib Res. 2019;28(4):256-264.