Uncorrected Proof Iran J Psychiatry Behav Sci. 2022 December; 16(4):e127590. Published online 2022 October 29. doi: 10.5812/ijpbs-127590. Systematic Review The Eﬀectiveness of Cognitive-Behavioral, Mindfulness and Acceptance and Commitment Therapies to Improving the Psychological Symptoms of Patients with Multiple Sclerosis in Iran (Systematic Review and Meta-analysis) Bahman Bahmani 1 , Shaﬁgh Mehraban 1, * , Manoochehr Azkhosh 1 , Mohammad Saeed Khanjani 1 and Mojtaba Azimian 2 1 Department of Counselling , University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 2 Department of Clinical Science, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran * Corresponding author: Department of Counselling , University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Email: sf.mehraban@yahoo.com Received 2022 May 10; Revised 2022 September 08; Accepted 2022 October 06. Abstract Context: Multiple sclerosis (MS) is a neurological disease in which the myelin lining the central nervous system is damaged and often occurs between the ages of 20 and 40. In addition to loss of motor, sensory, and cognitive function, patients with MS also experience related symptoms such as depression, anxiety, stress, fatigue, and pain. Objectives: The aim of this study was to systematically and meta-analyze the eﬀectiveness of cognitive-behavioral, mindfulness and acceptance and commitment (CMAC) therapies to improving the psychological symptoms of patients with multiple sclerosis in Iran. Methods: The study was conducted using preferred reporting items for systematic reviews and meta-analysis. This study examined articles published from the beginning until November 20, 2021 in Persian and English on cognitive and behavioral interventions performed in Iran, in order to inﬂuence psychological symptoms for people with multiple sclerosis. Articles relevant to research were screened in external (Google Scholar, PubMed, Scopus, Science Direct, Web of Science) and internal databases (Sid, Magiran, Ganj, Irandoc, Civilica). The quality of the included RCTs was assessed using the Cochrane guideline risk of bias tool. The results were expressed in terms of mean diﬀerence (MD) and the corresponding 95% conﬁdence interval. Data analyses were performed by RevMan5.4. Results: In the ﬁrst stage of the search, 792 articles were obtained. After reviewing the titles of the articles, 701 articles were dis- carded due to irrelevance and duplication and 91 articles remained. Finally, 21 studies were selected by reviewing the abstracts and considering the inclusion criteria. Compared with the control group, the standardized mean diﬀerence (SMD) estimate depression was 1.60 (2.27, 0.93), for anxiety 0.49 (0.80, 0.19), for stress 0.97 (1.70, 0.23) and for fatigue 0.19 (2.75, 1.25) had a positive eﬀect; But no signiﬁcant eﬀect on pain reduction equal to 0.49 (2.21, 1.23) was not found. Conclusions: The meta-analysis in the posttest showed that the eﬀects of CMAC were considerable on reducing depression, anxiety, stress, and fatigue, but the eﬀects were not notable for pain mitigation. Future high quality studies with follow-up evaluations are needed to support the eﬀects of CMAC on reducing symptoms in people with multiple sclerosis and to evaluate the interventional features that enhance and maintain the eﬀects. Keywords: Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, Meta-analysis, Mindfulness, Multiple Sclerosis, Systematic Review 1. Context Multiple sclerosis (MS) is a neurological disease in which the CNS-covering myelin is damaged. Based on the data obtained from the Iranian MS Association, around 50,000 patients, i.e. 60 to 70 patients per every 100,000 people in Iran’s population have this disease (1). Persons with MS (PwMS) in addition to losing motor, sensory, and cognitive functions, also experience associ- ated symptoms including depression, anxiety, stress, fa- tigue, and pain (2, 3). Thus, PwMS confront numerous phys- ical, mental, and emotional problems on a daily basis (4). Although in the initial stages of the disease, the physical Copyright © 2022, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.