Abstract
Background & Objectives: Major depressive disorder is one of the most common mental disorders in the field of mental health, affecting 12% of adults worldwide. Depressed individuals often do not adequately confront issues and emotions, leading to avoidance. Instead of experiencing the desired unpleasant feeling, they engage in other tasks, a phenomenon referred to in recent studies as experiential avoidance. Schema therapy is a very effective method for improving emotional experience. Also, acceptance and commitment therapy is effective for the symptoms of depressed individuals and the experiential avoidance of depressed individuals. Given the high prevalence of depressive disorder and since this disorder is considered a very debilitating psychological disorder and can have serious consequences for the individual, family, or society, it is important to identify the treatment with the best effect on improving the symptoms of the disorder and its related variables. So, this study compared the effectiveness of emotional schema therapy and acceptance and commitment therapy on the severity of depressive symptoms and experiential avoidance in individuals with major depressive disorder.
Methods: The current research was quasi–experimental, utilizing a pretest–posttest design with a control group. The statistical population consisted of all patients with major depressive disorder who had referred to psychological centers (including psychiatrists' offices, psychologists' clinics, neuropsychiatric hospitals, and welfare clients) in Zanjan City, Iran, in 2023. Among the participants, 45 eligible volunteer patients suffering from major depressive disorder were selected through convenience sampling and randomly assigned to two experimental groups (15 individuals each) and one control group (15 individuals). The inclusion criteria were as follows: subject's consent, not receiving other psychological interventions, not suffering from any psychotic disorder, not suffering from substance abuse, not participating in a therapeutic intervention in the past two years, participants' consent and agreement in emotional schema therapy and acceptance and commitment therapy sessions, and a minimum of ninth–grade literacy. The exclusion criteria included severe disturbances that prevented communication with the patient, absence from more than two sessions, receiving drug treatment or any psychotherapy simultaneously, unwillingness to continue treatment, referral for drug treatment if necessary, and exclusion from the study. To select the sample and obtain the necessary permits for implementing the intervention, arrangements were made with officials from private and public medical centers (neuropsychological and welfare hospitals). Patients diagnosed with major depressive disorder based on the assessment of the center's psychiatrist and psychologist were introduced to the researcher and therapist for participation in the study if they wished. Ultimately, 45 eligible individuals willing to participate were included in the study and assigned to three groups of 15 individuals each, consisting of two experimental groups and one control group, using a simple random method. One experimental group received emotional schema therapy interventions, consisting of nine sessions of 90 minutes each, once a week for two months, based on the Leahy (2002) therapy package. The other experimental group underwent acceptance and commitment therapy in eight sessions of 90 minutes each, once a week for two months, based on the Hayes et al. (2007) treatment package. The control group did not receive any therapeutic interventions.
Results: The results of the analysis of covariance indicated that both emotional schema therapy and acceptance and commitment therapy were effective in reducing depressive symptoms (p<0.001) and reducing experiential avoidance and its components (behavioral avoidance, maladaptive distress, procrastination, distraction/suppression, denial/suppression, distress tolerance) (p<0.001). Based on the results of the Bonferroni post hoc test, emotional schema therapy and acceptance and commitment therapy did not differ significantly in reducing depressive symptoms, experiential avoidance, and its components, and both were equally effective (p=1.000).
Conclusion: Based on the findings of the present study, both emotional schema therapy and acceptance and commitment therapy, without any superiority over each other, are effective and beneficial new interventions focused on non–avoidance of emotions and feelings. They can serve as efficient and effective treatments for reducing symptoms of depression and experiential avoidance.