Archives of

1. Introduction
Marriage is the most exciting and stressful experience for every individual although it is quite normal to have arguments and disagreements [1]. Marital relationships are one of the deepest human pleasures, as well as one of the greatest sources of suffering in couples; however, relationship turmoil is diagnosed through mental evaluation of the relationship by couples. Persistent turmoil in a relationship often leads to divorce and separation. Some couples decide to separate despite having minor relationship problems, while others stay together despite having serious relationship problems and experience emotional divorce [2,3]. Divorce rates in Iran have sharply risen in this decade, and one in three marriages ends in divorce [4]. There is a stage before legal divorce called emotional divorce when couples live together, but there is little or no verbal and emotional connection between them [5].
Domestic violence is a common cause of emotional divorce which starts from simple arguments and spreads to verbal conflicts, quarrels, and violent actions [6]. During the coronavirus disease 19 pandemic, domestic violence has increased as couples spend more time together. Domestic violence against women is a major global human right concern and a major social and public health concern. In addition, it is a major cause of death and illness in women around the world [7]. Hurting women is a problem of global proportions that transcends cultural, geographical, religious, social, and economic boundaries. Violence against women is gender-based violence in which women are subjected to coercion and abuse of rights by the opposite sex; if this type of behavior is within the family and between husband and wife, it is referred to as domestic violence [8].
Attitude to life decreases in women exposed to domestic violence. Attitude to life is defined as the ability to better see the world and what happens in it and the ability to deal with the realities of life [9]. Scheier and Carver [10] define attitude to life as an individual difference variable that reflects the scope in which individuals retain desirable generalized experiences for the future. A dispositional attitude or the tendency to believe that a good thing will
Effectiveness of Acceptance and Commitment Therapy on Domestic Violence and Attitude to Life of Women With Emotional Divorce
Fatemeh Khosravi Saleh Baberi1ID, Reza Pasha1*ID, Alireza Heidari1ID, Sasan Bavi1ID
1Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
*Corresponding Author: Reza Pasha, Email : pashaires@gmail.com
Abstract
Background & Aims: Many couples never refer to a therapist or counseling centers in courts while they suffer from various degrees of marital dissatisfaction and experience emotional divorce. The impacts of marital dissatisfaction are more lasting than divorce and extend to people who are close to couples and their acquaintances, especially children. The present study aimed to investigate the effectiveness of acceptance and commitment therapy (ACT) on domestic violence and the attitude to life of women with emotional divorce.
Materials and Methods: This quasi-experimental study was conducted using a pretest-posttest control group design. Forty women experiencing emotional divorce visiting the counseling centers of Ahvaz in 2021 were selected using convenience sampling and randomly divided into intervention (n = 20) and control (n = 20) groups. Participants completed the Domestic Violence Questionnaire and life orientation test in the pretest and posttest. The intervention group received eight 90-minute sessions of ACT. Data were analyzed using univariate analysis of covariance.
Results: The means ± standard deviations of post-test scores related to domestic violence and attitude to life in the experimental group were 48.90 ± 6.99 and 25.65 ± 3.31, respectively, which improved compared to the post-test of the control group. The results suggested that ACT improved domestic violence (F = 421.04, P < 0.001) and attitude to life (F = 172.37, P < 0.001) in the posttest.
Conclusion: This study achieved promising results concerning the applicability of ACT. ACT was effective in reducing domestic violence and improving attitudes to life in women with emotional divorce.
Keywords: Emotions, Divorce, Domestic violence, Acceptance and commitment therapy, Women
Received: January 21, 2022, Accepted: April 4, 2022, ePublished: December 29, 2022
https://jhygiene.muq.ac.ir/
10.34172/AHS.11.4.381.1
Vol. 11, No. 4, 2022, 279-285
Original Article
Khosravi et al
280 Arch Hyg Sci. Volume 11, Number 4, 2022
happen in life is defined as a relatively persistent personal
trait that determines a person’s behavior. The growing
trend of marital conflicts and emotional divorce and
their negative impact on the mental health of couples,
their children, and society encouraged researchers to
develop strategies to strengthen marital relations and
the foundation of the family [11]. One of the major
strategies is acceptance and commitment therapy (ACT),
which aims to help individuals strive to create a rich
and meaningful life and accept their suffering in life
[12]. While being open to older clinical traditions and
emphasizing the patient’s behavioral performance rather
than the causation and psychological resilience, the ACT
has shown why it is detrimental to fuse empirical and
cognitive avoidance [13]. ACT is a behavioral therapy
aiming at practicing empirical avoidance and attempting
to control disturbing experiences [14].
Glassman et al [15] believed that ACT teaches clients to
accept their thoughts and emotions, choose new paths in
life, and take committed action. Six underlying processes
are defined as the major ingredients of ACT, including
expansion and acceptance, cognitive defusion, the
observing self, contact, and connection with the present
moment, values clarification, and committed action [16].
Various studies have pointed out the effectiveness of
ACT in improving interpersonal forgiveness and distress
tolerance in female victims of domestic violence; In
addition, ACT could improve social anxiety and attitude
to life in female-headed households, as well as the meaning
of life, life satisfaction, cognitive resilience, and suicidal
thoughts of individuals with depression. Further, this
method improved psychological capital and neuroticism
in mothers of children with Down syndrome. Moreover,
it could improve marital turmoil, marital conflict, and
optimism in married women, as well as life satisfaction in
mothers of children with cancer [17-19].
Although religious traditions and beliefs in Iranian
society condemn divorce in most marriages, statistics
show that the divorce rate is on the rise in recent years, and
experts state various reasons for it. Many couples never
refer to a therapist or counseling centers in courts while
they suffer from different degrees of marital dissatisfaction
and experience emotional divorce. The effects of marital
dissatisfaction are more lasting than divorce and extend
to individuals who are in close connection with couples
and their acquaintances, particularly children. This
study sought to prevent domestic violence and improve
the attitude to life in women experiencing emotional
divorce. Considering that mothers play a major role in
maintaining the psychosocial balance of the family and
given the various problems and issues they face, the need
is felt to address the problems they face in this regard.
Accordingly, this study aimed to evaluate the effectiveness
of ACT on domestic violence and the attitude to life of
women with emotional divorce.
2. Materials and Methods
2.1. Design and participants
This quasi-experimental study was conducted using a
pretest-posttest control group design. The statistical
population consisted of all women experiencing
emotional divorce visiting the counseling centers of
Ahvaz in 2021. A sample of 40 women (20 per group) was
selected using convenience sampling from among those
who met the inclusion criteria, and they were randomly
divided into intervention and control groups (Figure 1).
In the present study, 20 women with an emotional divorce
were included in each group by the use of G-power
software with an effect size of 1.81, a test power of 0.90,
and α = 0.05.
2.2. Inclusion and exclusion criteria
The inclusion criteria were diagnosing emotional divorce
by the therapist, giving informed consent to participate in
the study, having a minimum secondary education, and
being in the age range of 20-45 years. The other criteria were
obtaining a higher-than-average score on the Domestic
Violence Questionnaire and a score lower than average
on the Attitude to Life Scale, not being a divorcee, and
not participating in other therapy programs at the same
time. On the other hand, the exclusion criteria included
receiving concomitant psychological therapies, taking
psychiatric drugs, showing unwillingness to cooperate
and continue the study, facing a severely stressful event,
and missing more than two therapeutic sessions.
At the end of the study, to observe ethical considerations,
a summary of therapy sessions was provided to the
control group. Moreover, to take ethical considerations,
the authors received written consent from the women for
participation in the study.
2.3. Instruments
Domestic Violence Questionnaire: To investigate violence
against women, the Haj-Yahia’s Violence Against Women
Questionnaire [20] was used, which is adapted from several
other questionnaires, including the Conflict Tactics Scale
(CTS) Questionnaire, the Psychological Maltreatment of
Women Inventory, the Composite Abuse Scale (CAS), and
the Index of Spouse Abuse (ISA). The 32-item Violence
Against Women Questionnaire measures psychological
violence, physical violence, sexual violence, and economic
violence. In this inventory, never, once, twice, and more
responses are scored 1, 2, and 3, respectively, and the
scores range from 32 to 96. Ghazanfari [21] reported the
reliability of this questionnaire to be equal to 0.89 based
on Cronbach’s alpha coefficient. In the present study, this
coefficient was 0.87.
Life Orientation Test: Attitude to life was measured
using the Life Orientation Test developed by Scheier and
Carver [22]. They developed this scale to validate the
efficiency of optimistic and pessimistic explanatory styles,
Arch Hyg Sci. Volume 11, Number 4, 2022 281
Attitude to life of women with emotional divorce
and individuals responded to them according to life
outcomes. They believed that the questionnaire is highly
valid and evaluates the individual’s overall expectations
and consequences for the desirable future consequences
of their actions. Khodaei et al [23] reported the reliability
of this questionnaire as 0.88 based on Cronbach’s alpha
coefficient. In the present study, the mentioned coefficient
was equal to 0.91.
2.4. Intervention program
ACT: The content of eight 90-minute ACT sessions
according to Hayes et al [24] is provided in Table 1.
Following therapy sessions, the intervention and control
groups completed the posttest under the same conditions.
2.5. Statistical Analyses
Quantitative data were analyzed using the mean and
standard deviation. One-way analysis of covariance
(ANCOVA) was used to examine the effect of ACT
on research variables. Kolmogorov-Smirnov test and
Levene’s test were also applied to indicate the normal
distribution of data, and finally, data were analyzed by
SPSS, version 27.0.
3. Results
In this study, 38% and 62% of participants were within
the age range of 20-31 and 32-45 years old, respectively.
The mean age of the intervention and control groups
was 32.77 ± 7.21 and 33.19 ± 6.68, respectively. Table 2
presents the indicators of central tendency and dispersion
and results of the Kolmogorov-Smirnov test for domestic
violence and attitude to life.
As shown in Table 2, the mean of variables in the
intervention group changed in the posttest compared to
the pretest, while no significant changes were reported in
the control group. A univariate ANCOVA was used to
find the significant difference between the two groups.
The assumptions of ANCOVA were measured before
analysis. First, the absence of outliers was confirmed
given the skewness and kurtosis indices provided in
Table 1 (in general, then data are not normally distributed
if the skewness and kurtosis are not in the range of -2 to
2). The results of the Kolmogorov-Smirnov test (Table 2)
indicated the normal distribution of data in the pretest
and posttest for domestic violence and attitude to life
(P > 0.05), and data were normally distributed when
analyzing covariance. In addition, Levene’s test was
employed to examine the homogeneity of variances
(equality of variances in the intervention and control
groups), which was F = 1.40 and P = 0.992, as well as
F = 2.26 and P = 0.141 for domestic violence and attitude
to life, respectively. Further, the regression line slope
for domestic violence (F = 2.86, P = 0.071) and attitude
to life (F = 0.862, P = 0.431) was calculated to verify the
homogeneity assumption. The one-way ANCOVA after
controlling the effect of the pretest was used to compare
Figure 1. Flowchart of participant selection
Khosravi et al
282 Arch Hyg Sci. Volume 11, Number 4, 2022
the intervention and control groups using posttest scores
and to determine the effect of ACT on domestic violence
and attitude to life in women experiencing emotional
divorce (Table 3).
Based on data in Table 3, there was a significant
difference in the pretest and posttest scores of participants
in domestic violence when eliminating the influence of
the pretest results (F = 421.04, P < 0.001). Therefore, the
ACT proved effective in improving domestic violence.
Additionally, there was a significant difference in the
pretest and posttest scores of attitude to life when
eliminating the influence of the pretest results (F = 172.37,
P < 0.001). Thus, the ACT could improve attitude to life.
4. Discussion
The present study sought to investigate the effectiveness
of ACT on domestic violence and attitude to life in
women with emotional divorce. The results revealed
the effect of ACT on improving domestic violence and
attitude to life, which is consistent with the results of
previous studies [25,26]. To explain this issue, marital
conflicts cause verbal and physical conflict, reduced
social capital, and ultimately emotional neglect and
divorce. The findings of this study are in line with the
functionalist perspective; according to functionalists,
there are different and contradictory ideas in the family,
and violence is occasionally used to resolve them. It
seems that different dimensions of domestic violence
can be effective in shaping emotional divorce between
couples by disrupting the family structure and balance
and distancing of couples. Some family problems are
rooted in behaviors that are not widely addressed in the
Iranian culture for some reasons, but research has shown
that many of these problems can be rooted in hidden
family realities. Unfortunately, some separations and
cold family relationships are closely related to violence
against women, and many women complain about it [25].
Violence occurs when a spouse does not value the
relationship as much as the other one does or when the
essential needs of a spouse are ignored. Here, emotionalmarital
satisfaction and intimacy fade, and they do not
want each other. Healthy relationships promote men’s
and women’s health in marital life. On the other hand, the
ACT encourages women to connect with and be fascinated
by the real values of their lives. This strategy helps women
to imagine a more rewarding life despite unpleasant
thoughts and feelings; this mindset leads to a reduction
in marital problems such as domestic violence. The ACT
helps women detach themselves from their thoughts and
emotions in order to modify negative cognitions such as
depression and reduce domestic violence [26].
In this therapy, experiential avoidance creates a
traumatic process that contributes to the development
and spread of marital and family conflicts. When a spouse
Table 1. The content of acceptance and commitment therapy sessions
Sessions Content
1
Communicating and building good relations, concluding a medical contract and therapeutic alliance with clients, stating the rules, goals, and
number of treatment sessions, and conducting a pretest in the first session
2
Calling and discovering, trying to promote re-reading of couples’ experiences consciously, encouraging clients to abandon ineffective strategies,
and measuring and giving feedback
3
Demonstrating conflict-inducing and distressing issues and focusing on resolving them, listening to and discovering clients’ narratives of extant
problems, as well as collecting information about the history of original attachment style and their current relationship and controlling them
4
Increasing knowledge about underlying emotions and desire positions, identifying negative interaction cycles and painful aspects of participants’
experiences, observing emotional processing style, and identifying intrapersonal and interpersonal issues, as well as practicing the metaphor of
bus passengers and the mindful bus metaphor and reviewing defusion construction
5
Reviewing previous assignments, weakening conceptualized self-reliance, distinguishing the conceptualized self from the observing self, and
creating awareness about the observing self
6 Reviewing assignments, facilitating the wants and needs for reconstruction, interacting new perceptions, and creating new essential solutions
7 Expressing the concept of values, objectives, and dreams
8 Summarizing and concluding with the help of clients and performing posttest
Table 2. Mean ± SD and results of Kolmogorov-Smirnov test of variables in experimental and control groups
Variables Group Phases Mean ± SD Skewness Kurtosis z P
Domestic violence
ACT
Pre-test 89.85 ± 4.70 0.40 -0.97 0.19 0.064
Post-test 47.90 ± 6.99 0.27 1.06 0.18 0.078
Control
Pre-test 90.10 ± 4.83 -0.12 1.39 0.15 0.200
Post-test 90.25 ± 6.33 -0.31 -0.63 0.12 0.200
Attitude to life
ACT
Pre-test 15.00 ± 2.99 0.51 0.42 0.18 0.085
Post-test 25.65 ± 3.31 0.59 -0.22 0.14 0200
Control
Pre-test 15.30 ± 3.51 0.73 -0.78 0.17 0.128
Post-test 14.15 ± 2.58 -0.25 -0.46 0.16 0.170
Note. SD: Standard deviation; ACT: Acceptance and commitment therapy.
Arch Hyg Sci. Volume 11, Number 4, 2022 283
Attitude to life of women with emotional divorce
experiences domestic violence, he/she makes continuous
and fruitless efforts to get rid of the situation. The ACT
targets these avoidances in order to create a fundamental
reopening to experience rather than to control or change
the negative assessments of domestic violence in one’s
life. Therefore, in the ACT, women not only have a full
experience of thoughts and emotions but also allow their
spouses to have such an experience in order to reduce their
marital burnout and domestic violence [27]. In addition,
through acceptance and defusion practices, women learn
to accept their spouse the way he is without judging,
humiliating, insulting, or comparing him. Teaching a
new concept of curiosity used in the ACT makes spouses’
relationships take on a new form; hence, the treatment
is effective in improving marital relations and reducing
domestic violence. The mechanism of change is such that
when defined for participants, values become important
and personal to them, and they resolve conflicts and avoid
domestic violence in more adaptively, thus experiencing
a better view of the relationship with their spouse [25,28].
The results indicated that the ACT improved the attitude
to life in women experiencing emotional divorce. This
finding is consistent with the results of previous research
[18]. Women who receive ACT can improve their hope
and resilience by promoting their problem-solving skills
and self-awareness, increasing their meaning of life, and
improving their level of adjustment, resulting in fewer
marital conflicts. On the other hand, studies suggest
that people who experience positive emotions exhibit
unusual, flexible, and creative patterns of thinking.
Positive emotions increase the desire to have multiple
choices in life, and they create multiple behavioral choices
for individuals. In addition, positive emotions build a
flexible and extensive cognitive structure in individuals
and improve their ability to integrate broad topics [18].
On the other hand, using this practice, women realized
that many sufferings occur because individuals see people
through their thoughts and feelings and consider those
thoughts true. Through acceptance, the individual tends to
move in the direction of his/her values; they turn to solutionbased
behaviors instead of focusing on unsuccessful
solutions. The negative thought and judgment cycle is
broken, leading to an improvement in their performance.
Maintaining value-based behavior significantly improves
the attitude to life in these women [29].
It is claimed that through awareness-based exercises,
the ACT builds the grounds for creative helplessness
towards solutions used by the person in relation to his/
her unpleasant thoughts and feelings. These situations
pave the way for introducing acceptance as an alternative
solution, and through acceptance, an opportunity
is provided to the individual to pay attention to the
important and valuable matters in life [30]. Based on the
results, when women try to avoid or get rid of unwanted
thoughts and feelings, they not only fail but also suffer
a lot due to experiencing marital conflicts. This helped
clients to feel unpleasant thoughts and feelings instead
of trying to control them, which made those experiences
seem less threatening. Expressing pure and impure
suffering helped women blame themselves less and be
kinder to themselves. By ACT, researchers aim not to
create the feeling of helplessness or belief in helplessness,
but rather give up one’s previous strategies used to control
these thoughts and feelings.
This study was conducted on women experiencing
emotional divorce visiting counseling centers in Ahvaz;
therefore, caution should be exercised when attempting
to generalize these results to other centers and cities.
Convenience sampling and self-report were the other
limitations of this study.
5. Conclusion
ACT was effective in reducing domestic violence and
improving attitudes to life in women with emotional
divorce. By providing optimistic concepts of life to women
with emotional divorce, the therapeutic and educational
ACT raises hope and resilience in them in the face of
marital conflicts. It reduces domestic violence and boosts
their attitude to life. It is therefore recommended that this
intervention be provided, along with other psychological
interventions to reduce the psychological and physical
burden of caring for women with emotional divorce.
Acknowledgments
This article was extracted from part of the PhD dissertation
submitted by Fatemeh Khosravi Saleh Baberi in the Department of
Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran.
The researchers wish to thank all the individuals who participated
in the study.
Author Contributions
Conceptualization: Fatemeh Khosravi Saleh Baberi, Reza Pasha.
Data curation: Fatemeh Khosravi Saleh Baberi.
Formal Analysis: Alireza Heidari.
Funding acquisition: Fatemeh Khosravi Saleh Baberi.
Investigation: Fatemeh Khosravi Saleh Baberi, Sasan Bavi.
Methodology: Reza Pasha, Sasan Bavi.
Project administration: Reza Pasha, Alireza Heidari.
Table 3. Results of one-way analysis of covariance on post-test scores
Variables SS df MS F P η2 Power
Domestic violence 17019.94 1 17019.94 421.04 0.001 0.92 1.00
Attitude to life 1344.39 1 1344.39 172.37 0.001 0.82 1.00
Note. SS: Sum of squares; df: Degree of freedom; MS: Mean squares.
Khosravi et al
284 Arch Hyg Sci. Volume 11, Number 4, 2022
Resources: Fatemeh Khosravi Saleh Baberi.
Software: Reza Pasha, Sasan Bavi.
Supervision: Reza Pasha.
Validation: Alireza Heidari.
Visualization: Reza Pasha, Sasan Bavi.
Writing – original draft: Fatemeh Khosravi Saleh Baberi, Reza
Pasha.
Writing – review & editing: Fatemeh Khosravi Saleh Baberi, Reza
Pasha.
Conflict of Interests
All the authors declare that they have no conflict of interests.
Ethical Approval
The study was approved by the Ethics Committee of Islamic Azad
University, Ahvaz Branch (code: 950517294).
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