IJHS 28 | International Journal of Health Studies 2021;7(1) IJHS 2021;7(1):28-32 ijhs.shmu.ac.ir doi:10.22100/ijhs.v7i1.827 Original Article International Journal of Health Studies The Effectiveness of Acceptance and Commitment Therapy on Depression, Anxiety, and Stress in Patients with Chronic Pain in Ahvaz Mandana Yadavari 1 , Farah Naderi 2* , Behnam Makvandi 3 1 PhD Student, Department of Health Psychology, Khorramshahr-Persian Gulf International Branch, Islamic Azad University, Khorramshahr, Iran. 2 Professor, Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran. 3 Associate Professor, Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran. Received: 3 January 2021 Accepted: 25 January 2021 Abstract Background: Chronic pain causes various problems and agonies including emotional disorders as well as limited personal, social, and occupational functioning. The present study aimed to investigate the effectiveness of acceptance and commitment therapy (ACT) on depression, anxiety, and stress in patients with chronic pain. Methods: The research method was experimental with a pre-test, post- test, and follow-up design and a control group. The study population comprised all patients with chronic pain who were referred to the medical centers of Ahvaz in 2018. Using convenience sampling, we selected 30 patients willing to participate in the study and randomly divided them into experimental (n=15) and control (n=15) groups. Both were groups tested at the beginning and end of the intervention program with the depression, anxiety, and stress scale (DASS-21). The experimental group underwent nine sessions (90-minute sessions per week) of acceptance and commitment therapy. The follow-up was performed after 60 days. Data analysis was done using SPSS version 23. Results: The mean±SD of the post-test scores of depression, anxiety, and stress was (12.03±2.82), (10.50±2.34), and (12.50±1.72) in the experimental group and (21.33±1.84), (19.20±4.12), and (26.71±1.18) in the control group, which had significant differences with each other. The results showed that acceptance and commitment therapy effectively decreased depression, anxiety, and stress in patients with chronic pain in the experimental group (Pvalue<0.05). Conclusions: Acceptance and commitment therapy can be used as an effective intervention program to reduce depression, anxiety, and stress in patients with chronic pain. Keywords: Acceptance and commitment therapy (ACT), Depression, Anxiety, Stress, Chronic pain. * Corresponding to: F Naderi, Email: naderifa2@gmail.com Please cite this paper as: Yadavari M, Naderi F, Makvandi B. The effectiveness of acceptance and commitment therapy on depression, anxiety, and stress in patients with chronic pain in Ahvaz. Int J Health Stud 2021;7(1):28-32 Introduction Pain warns people to steer away from dangerous and unpleasant stimuli thus playing an important role in human survival. 1 Although often a transient feeling, it persists for some people past the point where it contributes to emotional distress and increased use of healthcare system resources. 2 Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is divided into two forms of acute and chronic. Acute pain serves as a warning signal with protective and adaptive function and warns people of a problem in their body. Chronic pain is defined as persistent or recurrent pain lasting longer than three months. 3,4,5 Although pain serves as a warning signal that is an indispensable part of living, chronic pain no longer serves as a warning sign and hurts various aspects of life (e.g., quality of life). Therefore, most people experiencing chronic pain suffer from negative emotions including depression, anxiety, stress, anger, and inability to undertake daily activities. 6 People with chronic pain no longer pursue their previous pleasant activities and might be at the risk of depression. The bio-psycho-social model suggests that chronic pain interferes with social, occupational, or recreational activities. 7,8 People with highly severe emotional distress often complain of physical illness, which is a strong predictor of physical, psychological, and social dysfunction. 9 Depression, anxiety, and stress are the most important risk factors for many diseases including heart failure and cancer. 10 The third generation of psychological therapies and widespread studies have acknowledged the effectiveness of these therapies in chronic physical diseases. 11,12 ACT is one of the third-generation psychological interventions, which can reduce the symptoms of anxiety, stress, and depression in autoimmune diseases. 13,14 Steven Hayes, an American psychologist, designed this therapy in the 1980s and offered growing empirical studies and evidence on its effectiveness, especially in those with high psychological flexibility. 15 ACT has six core processes for establishing psychological flexibility. These processes are acceptance, cognitive defusion (self-as context), contact with the present (values), and committed action. 16,17 ACT aims to reduce experiential avoidance and increase psychological flexibility by accepting unavoidable and distressing unpleasant emotions (e.g., anxiety), fostering mindfulness, and identifying those personal values associated with behavioral goals. 18,19,20 ACT was found to be effective in a variety of clinical conditions including depression, obsessive-compulsive disorder, workplace stress, end-stage cancer stress, anxiety, post-traumatic stress disorder, mental anorexia, heroin use, and even schizophrenia. EzzatPanah and Latifi 21 showed the effectiveness of ACT in reducing the psychological distress of patients with fibromyalgia syndrome and improving their quality of life. Dereix-Calonge et al. 22 showed the effectiveness of ACT in overcoming negative thoughts. Mohammadi and Soufi 23 also showed that ACT enhanced the quality of life and reduced perceived stress in cancer patients. Kemani et al. 24 also