The Effectiveness of Acceptance and Commitment Therapy on Distress Tolerance, Pain Perception and Interleukin-12 in patients with Multiple Sclerosis

Document Type : Original Article


1 Payam Noor university of Tehran

2 medical University Tehran


Aim: The aim of this research was to assess the effectiveness of Acceptance and Commitment Therapy (ACT) on distress tolerance, pain perception and interleukin 12 in patients with Multiple Sclerosis (MS). Method: The present study was a quasi-experimental design with pretest-posttest and a three-month follow-up with control group. The statistical population included female patients with Relapsing–Remitting MS who had referred to Multiple Sclerosis Research Center of Tehran University of Medical Sciences in Sina Hospital in 2019. 20 patients were selected by target-based sampling and randomly assigned into experimental and control groups. The experimental group received the ACT in 8 weekly sessions (90 minutes each session) and the control group was placed in the waiting list. Participants completed the Distress Tolerance Scale (DTS) Simons & Gahr (2005) and the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Kerns, Turk & Rudy (1985). Also, the Enzyme-Linked Immunosorbent Assay (ELISA) was used to measure interleukin-12. The data were analyzed using mixed varience repeated measure and Bonferroni post-hoc test. Results: The results showed that ACT increased distress tolerance and improved pain perception in post-test and follow-up (p<0.001), but this intervention had no significant effect on interleukin-12. Conclusion: ACT can be a good treatment to improve the psychological factors of distress tolerance and pain perception in patients with MS, but not an appropriate treatment for reducing biomarkers such as interleukin 12 in these patients.


برادران، مجید؛ زارع، حسین؛ علی­پور، احمد؛ فرزاد، ولی­الله. (1395). اثربخشیدرمانمبتنیبرتعهدوپذیرش برهمجوشیشناختیوشاخصهایسلامت جسمانیبیمارانمبتلابهفشارخوناساسی. فصلنامه روانشناسی شناختی، 4(1-2): 9-1. ]پیوند[
ثناگویمحرر، غلامرضا؛ حسین زاده، محدثه. (1396). بررسیرابطهخودتنظیمیهیجانیباتحملپریشانیوکیفیتزندگیانجمنبیماریام اس (مطالعهموردیبیماراناماساستانسیستانوبلوچستان). فصلنامه مطالعات علوم اجتماعی، 3(2): 203-196. ]پیوند[
زواری زارع، پروانه؛ زواری زارع، آذر؛ ابراهیمی پاکیزه، بهروز. (1395). اثربخشی درمان مبتنی بر پذیرش و تعهد بر هیجانات منفی بیماران مبتلا به ام اس. چهارمین کنفرانس ملی توسعه پایدار در علوم تربیتی و روانشناسی، مطالعات اجتماعی و فرهنگی، 8-1. ]پیوند[
شاکرنژاد، سپیده؛ نسرین، موذن؛ حمیدی، معصومه؛ هاشمی، رها؛ بزاززاده، نیلوفر؛ بداقی، مظاهر. (1396). اثربخشیدرمانمبتنیبرپذیرشوتعهدبرپریشانیروانشناختی،رضایت زناشوییوکیفیتزندگیدرزنانمبتلابهبیماریاسکلروز متعدد. مجله سلامت و مراقبت، 19(1): 17-8. ]پیوند[
شمس، جمال؛ عزیزی، علیرضا؛ میرزایی، آزاده. (1389). بررسی رابطه تحمل آشفتگی و تنظیم هیجانی با میزان وابستگی دانشجویان به سیگار. مجله تحقیقات نظام سلامت حکیم، 13(1): 18-11. ]پیوند[
شیدایی ­اقدم، شوان؛ شمس الدینی لری، سلوی؛ عباسی، سمیه؛ یوسفی، سارا؛ عبداللهی، صفیه؛ مرادی جو، محمد. (1393). اثربخشیدرمانمبتنیبر پذیرشوتعهدبرکاهشپریشانی ونگرشهایناکارآمددربیمارانمبتلابه .M.Sاندیشه و رفتار، 9(34): 66-57. ]پیوند[
فروزانفر، آزاده؛ لواسانی، مسعود غلامعلی؛ شعاع کاظمی، مهرانگیز. (1396). اثربخشی مشاوره گروهی مبتنی بر پذیرش و تعهد بر تحمل پریشانی و حساسیت اضطرابی زنان وابسته به سوءمصرف مواد. اعتیاد پژوهی، 11(44): 154-135. ]پیوند[
مقتدایی، مسعود. (1395). اثربخشی درمان مبتنی بر پذیرش و تعهد برتحمل پریشانی درهمسران جانبازان. اولین کنگره ملی توانمندسازی جامعه در حوزه جامعه شناسی، علوم تربیتی و مطالعات اجتماعی و فرهنگی، 10-1. ]پیوند[
میرزمانی، سید محمود؛ صفری، اکبر؛ حلی ساز، محمد تقی؛ سدیدی، احمد. (1386). ارزیابیاعتبارپرسشنامهچندبعدیدردوستهاون-ییلدربینبیمارانمبتلابهدردمزمن. مجله دانشگاه علوم پزشکی قم، 1(3): 25-13. ]پیوند[
نیکوگفتار،منصوره؛خانعلیلو،رویا. (1396). مقایسهاثربخشیدرمانشناختیرفتاریودرمانمبتنیبرپذیرشوتعهدبرکاهشنشانههایافسردگیبیمارانزنمبتلا به Multiple Sclerosis (MS).مجلهتحقیقاتعلومرفتاری، 15(1): 66-59. ]پیوند[
Bennett, R., & Oliver, J. E. (2019). Acceptance and Commitment Therapy: 100 Key Points and Techniques. Routledge.
Broglio, S. P., Kontos, A. P., Levin, H., Schneider, K., Wilde, E. A., Cantu, R. C., ... & Giza, C. (2018). National Institute of neurological disorders and stroke and department of defense sport-related concussion common data elements version 1.0 recommendations. Journal of Neurotrauma, 35(23), 2776-2783. [Link]
Burkill, S., Montgomery, S., Kockum, I., Piehl, F., Strid, P., Hillert, J., & Bahmanyar, S. (2019). The association between multiple sclerosis and pain medications. Pain, 160(2), 424-432. [Link]
Craig, A.W. (2001). Cognitive behaviour therapy for chronic medical problems: a guide to assessment and treatment in practice. 1st ed. Wiley.
De Oliveira, J.F., Wiener, C.D., Jansen, K., Portela, L.V., Lara, D.R., de Mattos Souza, L.D., da Silva, R.A., Moreira, F.P., & Oses, J.P. (2018). Serum levels of interleukins IL-6 and IL-10 in individuals with posttraumatic stress disorder in a population-based sample. Psychiatry Research, 260, 111-115. [Link]
Del Vecchio, M., Bajetta, E., Canova, S., Lotze, M. T., Wesa, A., Parmiani, G., & Anichini, A. (2007). Interleukin-12: biological properties and clinical application. Clinical Cancer Research, 13(16), 4677-4685. [Link]
Dennison, L., Moss-Morris, R., & Chalder, T. (2009). A review of psychological correlates of adjustment in patients with multiple sclerosis. Clinical Psychology Review, 29(2), 141-153. [Link]
Gardner, C. M. (2018). Exploring the effects of Acceptance and Commitment Therapy (ACT) on biomarkers of stress in breast cancer survivors (Doctoral dissertation, University of Southern Queensland). [Link]
Greeson, J. M. (2009). Mindfulness research update: 2008. Complementary Health Practice Review, 14(1), 10-18. [Link]
Hann, K. E., & McCracken, L. M. (2014). A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. Journal of Contextual Behavioral Science, 3(4), 217-227. [Link]
Harris, R. (2009). ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
Harrison, A. M., McCracken, L. M., Jones, K., Norton, S., & Moss-Morris, R. (2017). Using mixed methods case-series evaluation in the development of a guided self-management hybrid CBT and ACT intervention for multiple sclerosis pain. Disability and Rehabilitation, 39(18), 1785-1798. [Link]
Hayes, S. C. (2008). Climbing our hills: A beginning conversation on the comparison of acceptance and commitment therapy and traditional cognitive behavioral therapy. Clinical Psychology: Science and Practice, 15(4), 286-295. [Link]
Hayes, S. C. (2019). Acceptance and commitment therapy: towards a unified model of behavior change. World Psychiatry, 18(2), 226-227. [Link]
Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behavior Research and Therapy, 44(1), 1-25. [Link]
Heesen, Ch., Sieverding, F., Schoser, B. G. H., Hadji, B., & Kunze, K. (1999). Interleukin‐12 is detectable in sera of patients with multiple sclerosis—association with chronic progressive disease course? European Journal of Neurology, 6(5), 591-596. [Link]
Järvelä-Reijonen, E., Puttonen, S., Karhunen, L., Sairanen, E., Laitinen, J., Kolehmainen, M. & Lappalainen, R. (2020). The Effects of Acceptance and Commitment Therapy (ACT) Intervention on Inflammation and Stress Biomarkers: a Randomized Controlled Trial. International Journal of Behavioral Medicine, 1-17. [Link]
Kahraman, T., Özdoğar, A. T., Ertekin, Ö. & Özakbaş, S. (2019). Frequency, type, distribution of pain and related factors in persons with multiple sclerosis. Multiple Sclerosis and Related Disorders, 28, 221-225. [Link]
Kangas, M., & McDonald, S. (2011). Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury. Neuropsychological Rehabilitation, 21(2), 250-276. [Link]
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30 (7), 865-878. [Link]
Kerns, R.D., Turk, D.C., Rudy, T.E. (1985). The west haven-yale multidimensional pain inventory (WHYMPI). Pain. 23: 345-356. [Link]
Kim, Y. K., Suh, I. B., Kim, H., Han, C. S., Lim, C. S., Choi, S. H., & Licinio, J. (2002). The plasma levels of interleukin-12 in schizophrenia, major depression, and bipolar mania: effects of psychotropic drugs. Molecular Psychiatry, 7(10), 1107. [Link]
Losy, J., & Michałowska‐Wender, G. (2002). In vivo effect of interferon‐β 1a on interleukin‐12 and TGF‐β1 cytokines in patients with relapsing–remitting multiple sclerosis. Acta Neurologica Scandinavica, 106(1), 44-46. [Link]
Martin, K. J. (2018). Effectiveness of Acceptance and Commitment Therapy self-help for carers of people with multiple sclerosis: A feasibility randomised controlled trial (Doctoral dissertation, University of Nottingham). [Link]
Melzack, R., & Wall, P. D. (2016). Interaction of fast and slow conducting fibre systems involved in pain and analgesia. Proc. 3rd Int. Pharm. Meet, 9, 231-242.
Murray, E.D., Buttner, E.A., Price, B.H. (2012). Depression and Psychosis in Neurological Practice. In Daroff R, Fenichel G, Jankovic J, Mazziotta J. Bradley's neurology in clinical practice (6th ed.). Philadelphia, PA: Elsevier/Saunders.
Özenci, V., Pashenkov, M., Kouwenhoven, M., Rinaldi, L., Söderström, M., & Link, H. (2001). IL-12/IL-12R system in multiple sclerosis. Journal of Neuroimmunology, 114(1), 242-252. [Link]
Pakenham, K. I., Scott, T., & Uccelli, M. M. (2018).Short Report: Evaluation of Acceptance and Commitment Therapy Training for Psychologists Working with People with Multiple Sclerosis. International Journal of MS Care, 20(1), 44-48. [Link]
Sheppard, S. C., Forsyth, J. P., Hickling, E. J., & Bianchi, J. (2010). A novel application of acceptance and commitment therapy for psychosocial problems associated with multiple sclerosis: Results from a half-day workshop intervention. International Journal of MS Care, 12(4), 200-206. [Link]
Simons, J. S & Gaher, R.M. (2005). The distress tolerance scale: Development & validation of a self report measure. Motivation & Emotion, 20(9), 83- 102. [Link]
Song, C., Li, X., Leonard, B. E., & Horrobin, D. F. (2003). Effects of dietary n-3 or n-6 fatty acids on interleukin-1β-induced anxiety, stress, and inflammatory responses in rats. Journal of Lipid Research, 44(10), 1984-1991. [Link]
Sun, L., He, C., Nair, L., Yeung, J., & Egwuagu, C. E. (2015). Interleukin 12 (IL-12) family cytokines: Role in immune pathogenesis and treatment of CNS autoimmune disease. Cytokine, 75(2), 249-255. [Link]
Thompson, A. J., Banwell, B. L., Barkhof, F., Carroll, W. M., Coetzee, T., Comi, G., & Fujihara, K. (2018). Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology, 17(2), 162-173. [Link]
Trinchieri, G. (1993). Interleukin-12 and its role in the generation of TH1 cells. Immunology Today, 14(7), 335-338. [Link]
Trinchieri, G., & Scott, P. (1994). The role of interleukin 12 in the immune response, disease and therapy. Immunology Today, 15(10), 460-463. [Link]
Van Boxel-Dezaire, A. H. H., van Trigt-Hoff, S. C. J., Killestein, J., Schrijver, H. M., Van Houwelingen, J. C., Polman, C. H., & Nagelkerken, L. (2000). Contrasting responses to interferon β-1 b treatment in relapsing-remitting multiple sclerosis: Does baseline interleukin-12p35 messenger RNA predict the efficacy of treatment? Annals of Neurology, 48(3), 313-322. [Link]
Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A. J., & Atkinson, J. H. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain, 152(9), 2098-2107. [Link]
Zhang, M., Li, X., Li, J., Sun, H., Zhang, X., & Bao, J. (2017). Effects of confinement on physiological and psychological responses and expression of interleukin 6 and brain derived neurotrophic factor mRNA in primiparous and multiparous weaning sows. Asian-Australasian Journal of Animal Sciences, 30(9), 1350. [Link]