Comparison of the Effectiveness of Acceptance and Commitment Therapy With and Without Compassion-Based Intervention on Psychological Symptoms in Patients With Chronic Tension-Type Headache

Abstract

The aim of this study was to compare the effectiveness of Acceptance and Commitment Therapy with and without a compassion-based component on anxiety, stress, and depression in patients with chronic tension-type headache. This quasi-experimental study employed a pretest–posttest design with a control group and a three-month follow-up. The study population consisted of patients diagnosed with chronic tension-type headache who referred to a neurology clinic in Mashhad. Forty-five eligible patients were purposively selected and randomly assigned to three groups: ACT with compassion-based intervention, ACT without compassion, and a control group (15 participants each). Both interventions were delivered in group format over sixteen 60-minute sessions. Psychological symptoms were assessed at pretest, posttest, and follow-up using a standardized self-report measure. Multivariate analysis of covariance indicated a significant group effect on anxiety, stress, and depression (p<0.001). Bonferroni post hoc tests revealed that both intervention groups showed significantly greater reductions in psychological symptoms compared to the control group, while the ACT with compassion group demonstrated significantly larger improvements than the ACT-only group. These effects remained significant at follow-up. Acceptance and Commitment Therapy is effective in reducing psychological symptoms in chronic tension-type headache, and its integration with compassion-based intervention enhances and sustains therapeutic outcomes.