Volume 10, Issue 4 (12-2021)                   JCHR 2021, 10(4): 306-315 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Shahabi A, Rahmati A, Khezri Moghadam N. The Effectiveness of training the acceptance, commitment and problem-solving skills on reducing the emotional divorce and the marital frustration. JCHR. 2021; 10 (4) :306-315
URL: http://jhr.ssu.ac.ir/article-1-694-en.html
1- MA in family counseling, Department of Psychology, Faculty of Literature and Humanities, Shahid Bahonar University of Kerman , shahabi.ailin2018@gmail.com
2- professor of family counseling, Department of Psychology, Faculty of Literature and Humanities, Shahid Bahonar University of Kerman
3- Associate Professor Psychology Department, Faculty of Literature and Humanities, Shahid Bahonar University of Kerman, Kerman, Iran
Full-Text [PDF 462 kb]   (261 Downloads)     |   Abstract (HTML)  (573 Views)
Full-Text:   (134 Views)
Abstract
Introduction:
This study aimed to investigate the effectiveness of the acceptance, commitment and problem-solving skills training on reducing the emotional divorce and the marital frustration.
Method: The research method, with regard to the quasi-experimental nature of the subject, was selected with a pre-test post-test design with a control group. The statistical population was the couples attending the Family counseling centers in Kerman city in 2019. The study sample involved 30 participating couples who were selected using convenience sampling and were divided into two experimental and control groups. Training the acceptance, commitment and problem-solving was presented to the couples in the experimental group during eight two-hour sessions. The educational content was about couples' problems in marital relationships, choosing a common marital value and offering a solution based on it, and identifying internal and external barriers to action based on values. To assess the subjects in both groups, the Emotional divorce questionnaire, and the Marital Frustration questionnaire Completed before and after the intervention. In order to analyze the data, mean value, standard deviation (SD), and multivariate analysis of covariance (MANCOVA) were used. SPSS version 22 was further used. The significance level of the study was considered to be p=0.05.
Results: The results of the covariance analysis for the participants who were 30-60 years old couples with at least five years of marital experience showed that training the acceptance, commitment and problem-solving was effective on reducing the emotional divorce and frustration. While the mean value of emotional divorce for the pre-test was (M=14.33), the results for the post-test changed to (M=11.80). Marital frustration was also changed from (M=48.93) in the pre-test to (M=44.60).
Conclusions: According to the results, maybe we need to consider a more serious role for training the acceptance, commitment and problem-solving in the educational and therapeutic interventions related to reducing the emotional divorce and the marital frustration of the couples.
Introduction

The family is the most basic social unit that is the source of creating the human emotions and the center of the most intimate inter-personal relationships and interactions (1).
Creating and maintaining intimate relationships and satisfying the emotional and psychological needs during the marriage is an art and skill that added to the mental health and early healthy experiences, requires having and acquiring the rational attitudes, life skills and performing their individual behaviors and tasks (2). Most people have over-expectation of love and marriage and these over expectations pave the way for boredom and emotional frustration (3). According to Guttmann (1994), the marital relationship is the core of the family system and its disruption is a serious threat to the rest of the family (4).
In the literature of the psychology, the rupture or the emotional divorce refers to a kind of silent separation that has not occurred legally and religiously, and the man and the woman live under the same roof inevitably for some considerations; but, due to the coldness of the relationships and the lack of exchanging the feelings and emotions have a feeling of dissatisfaction with frustration (5). In addition to the emotional divorce, the marital frustration is also a painful state of the physical, emotional and psychological exhaustion and affects the expectant couples (3). When the family functions, such as the biological, social, cognitive and emotional ones are damaged one after another, the members gradually lose their sense of satisfaction. The gradual decrease in member’s satisfaction leads to a kind of frustration and eventually to the emotional divorce (6).
Perhaps, it can be said one of the reasons for this emotional coldness and frustration in the marital relationships is the unrealistic view of various life events. It can be said that the more the couples deal with the problems in a dream-like state, the more problems they will face. When the romantic expectations are not met, the feeling of the frustration is directly attributed to the spouse and causes the loss of love and commitment and the frustration replaces the love (3). In other words, the lack of the realistic understanding of each other’s behavior and speech, the lack of sufficient knowledge of the other spouse’s spirits, and apathy and the coldness towards the partner contribute to an emotional coldness and deep emotional distance in the couples’ lives (7).
Many skills are taught to the couples by the marital therapists to modify and improve the problems. One of the most important skills in the area is the acceptance and commitment skill, the main assumption of which is that when a marital problem occurs that is not changeable, the best solution is to accept it, and this does not imply the passive surrender, rather it is the real acceptance without enduring suffering, regardless of how painful the thoughts and feelings have been for us (8).
The aim of the acceptance and commitment therapy is to help the clients to create a rich, complete and meaningful life while accepting the suffering that life inevitably brings with it (9). Acceptance and commitment therapy helps the clients to recognize what is really important to them and then asks them to use these values to guide and make the behavioral changes in life. A conscious action is one that is done with full awareness and presence. In other words, being open to experience and full participation in what is being done (10). Research has shown that the acceptance and commitment based therapy reduces the symptoms of anxiety and stress by altering the psychological flexibility and valuable life constraints (11), reducing the tendencies of depression and anxiety (12), relieving the persistent pain of the patients referred to the primary care clinics (13), improving the depressive symptoms, anxiety, health status and valuable life constraints (14), improving the mental disorder, psychological flexibility, self-confidence in the couples with children with acquired brain injury (15), reducing the couples’ distress (16), and facilitating the  resolution of the marital conflicts in the women with incompatibility (17).
Also, the problem-solving as one of the basic skills in life is actually teaching the cognitive and behavioral skills that help the person to identify the most effective solution to the problem and to deal effectively with the present and future problems (18). Studies have shown that problem-solving methods for family members are effective in reducing dissatisfaction. Problem-solving training by empowering the couples to solve the problems in participatory way can reduce neurosis and stress (19, 20), reduce the marital conflicts (21), promote the communication and increase the marital satisfaction (22). Given the importance of the family and its functions in society, it is necessary to early detect and solve possible problems and difficulties of the couples. To address the increasing rate of the emotional divorce between couples and the couples' increasing referrals to counseling centers, to facilitate the process of establishing healthier and more stable relationships in the marital relations, to reduce injuries in the marital life, and to prevent the family breakdown, this study aimed to investigate the effectiveness of training the acceptance and commitment skills on reducing the emotional divorce and the marital frustration in couples in Kerman.
Method
Study design and setting
This study conducts a quasi-experimental pre-test post-test with a control group. The study’s statistical population included all 30-60-year-old couples referred to counseling centers in Kerman in 2019. Based on the rule expressed by Delavar (23), the study population consisted of 30 subjects where each subject was a couple composed of one female and one male.  Then, these subjects were divided into two equal groups of intervention and control -each consisting of 15 couples- using a random allocation method. According to the inclusion and exclusion criteria, all the subjects were selected using available and simple random sampling method.
At the first stage, five counseling centers in Kerman, including Raha, Ordibehesht, Damoon, Mahan, and Farashenakht were selected. Forty couples (twenty couples for each group) referred to these counseling centers were purposefully evaluated for inclusion criteria: the couples with symptoms of emotional divorce and marital frustration, who were not attending psychotherapy sessions at the same time, had at least five years of marital relationship, and were willing to participate in the sessions. The exclusion criteria included the couples absent in more than three sessions and those with incomplete questionnaires. After evaluating and filling out the questionnaires, 30 couples from these 40 were selected, including nine from Ordibehesht, seven from Mahan, six from Damon, four from Raha, and four from Farashenakht.
No part of this research has been performed without ethical consideration. Obtaining informed consent in written form from each participant, retention of participants’ confidential information, and the option of withdrawing from the study in case of any discomfort were among these considerations. After a pre-arranged coordination, subjects were referred to counseling centers for assessment and completion of the questionnaires. The study and its significance in detecting, preventing, and intervening has been explained to participants promptly. To maintain confidentiality, each couple has been given a different code with an F prefix for the female and an M for the male. These codes were identified for the tools completed.
In the pre-test stage, each individual was presented with two questionnaires individually and asked to complete all of them carefully. It took about an average of 40 minutes for each participant to complete the questionnaires. After the completion of each questionnaire, the participants were convinced of the terms of their information data security. In the next stage, couples from the intervention group took training sessions for about two months. In the final stage, a post-test had been conducted on all participants.
Measurement
The data collection tools are the questionnaires of marital frustration and emotional divorce.
The Questionnaire of Marital Frustration: This scale was developed by Neihuis and Bartell (2006) and is consisted of 16 items, each rated on a 7-point Likert scale. According to the report by Neihuis and Bartell, this scale enjoys a high internal consistency and its Cronbach’s alpha was reported to equal 0.96. This scale, in Iran, was investigated in a study by Sayed Ali Tabar et al. (23), who tested the factor structure of the marital frustration using the confirmatory factor analysis so that its factor structure was confirmed. Its retest coefficient was calculated to be 0.85. The analysis of the correlation coefficients showed that the marital frustration scale has a positive and significant correlation with the scale of the tendency to extramarital relationships and the subscales of avoidance or resentment, avoidance attachment, and ambivalence, which indicates the convergent validity had a significant negative correlation with Kanzas’ marital consent and the subscale of forgiveness, which is indicative of its divergent validity. To verify the validity of the questionnaire, the factor analysis and the internal consistency methods were used, which showed desirable results. The reliability of the tool by using Cronbach’s alpha method and retest were reported to be 0.89 and 0.73, respectively.
The Questionnaire of the Emotional Divorce: This scale of the emotional divorce was developed by Guttmann (1994), which consists of 24 items used to assess the dissatisfaction level of the marital life and the emotional divorce. The scores of the scale range from 0.49 to 0.80 and the questions are yes/no questions. Its reliability in Iran has been reported to be 0.93 (24). To obtain the validity of the structure, the factor analysis by Varimax’s rotation method and Scary’s test were used. Its artificial validity was also confirmed by the experts. In this study, the validity of the questionnaire was calculated by using content validity was reported to be 0.89, and its consistency coefficient was calculated by Cronbach’s alpha to be 0.95; which, they show that the questionnaire enjoys acceptable psychometric properties.
Intervention and Data Collection
The control group only completed the questionnaire of marital frustration and emotional divorce.
Participants in the intervention group were trained in eight two-hour sessions per week. At the end of each session, participants were given assignments to use the educational materials in practice according to the topics raised in each session. Then, at the beginning of the next session, they had to explain how they did their assignments and why they did not do them. The protocol was used to determine the effect of training of acceptance, commitment, and problem solving skills on reducing emotional divorce and frustration. The researcher conducted the educational sessions. The educational content was as follows. Session 1: introducing and establishing a good relationship, concluding initial contracts, taking a pre-test, introducing the nature of both skills. Session 2: recognizing the general situation of married life and its issues, training mindfulness and contact with the present. Task: practicing conscious observation and listening. Session 3: helping subjects think of the problem as part of life, discussing methods for dealing with the problem (acceptance, coping, and avoidance). Task: a list of ineffective problem-solving practices. Session 4: defining and formulating the problem, considering the couple's problems as the toxins of marital relations and the solutions as antidotes, finding the solution without evaluation. Task: identifying wrong beliefs in marriage and trying to weaken unreasonable expectations. Session 5: generating alternative solutions, brainstorming, explaining values. Task: recognizing and determining values and expectations in married life. Session 6: selecting couple’s common value and presenting a solution, evaluating the proposed solutions and predicting the possible consequences. Task: determining the three proposed solutions to the existing problem based on the priority of short- and long-term consequences. Session 7: identifying internal and external barriers to value-based practices, taking committed action and reviewing the outcome and, if necessary, returning to the problem solving process and choosing the best solution. Task: how do I want to behave in relationship with my spouse? Session 8: answering the subjects' questions, appreciating them, receiving feedback for future work and conducting a posttest.
Data analysis
The data from both intervention and control group were analyzed in this study. Tables, mean, and standard deviation (SD) were used as descriptive statistics, and multivariate analysis of covariance (MANCOVA) was used for the inferential statistics. The data were analyzed with SPSS version 22 and the significance level was considered to be (p=0.05).
Results
The participants were 30 couples of 30-60 years old. 26.66% of the samples were about 30-40 years old, 36.67% about 41-50 years old, and 36.67% about 51-60 years old. The experimental and control groups showed no significant difference regarding demographic characteristics.
The experimental group's mean and standard deviation for emotional divorce was (M=14.33; SD=5.11) for pre-test and (M=11.80; SD=3.73) for the post-test. In the control group, the mean and standard deviation was (M=14.07; SD=4.54) for the pre-test and (M=13.93; SD=3.84) for the post-test. Also, the experimental group's mean and standard deviation for marital frustration was (M=48.93; SD=11.99) for pre-test and (M=44.60; SD=10.81) for the post-test. In the control group, the mean and standard deviation was (M=49.53; SD=10.19) for the pre-test and (M=50.07; SD=11.17) for the post-test.
The results of Shapiro-Wilk test showed that the assumption of the variables distribution homogeneity is established (P>0.05). Also, the study of the assumption of the variances equality by Levens Test (Table 1) did not show a significant difference between the variances of the groups (P>0.05).
Table 2 shows the results of the reciprocal study between the subjects for the variables of the emotional divorce and the marital frustration. According to the results, the reciprocal effect of the pretest and groups was not significant for all variables (P<0.05). It can be said that the reciprocal vectors are not significant and the regression slopes in all variables are not significantly different between the two groups.
To test the homogeneity assumption of the covariance of the dependent variables in the group the Box's M test was used. According to the reported results (Table 3) the zero Box's M test was confirmed and it can be said the homogeneity assumption of dependent variables covariance in the group is established (P<0.05).
To test the intervention effect, MANCOVA was performed on post-test scores. (Table 4) shows the MANCOVA analysis results on the post-test scores of the emotional divorce and the marital frustration.
According to the obtained results (Table 4), Pillai’s trace, as the most conservative indicator of the covariance analysis, shows that the training of the acceptance, commitment and problem-solving skills has been effective on the dependent variables. The results also showed that there was a significant difference between the experimental and control groups in terms of at least one of the dependent variables (P<0.05). To test the more specific hypotheses, the variance difference in MANCOVA context was used to compare the dependent variables’ post-tests.
As it can be seen, the results (Table 5) shows that the covariance analysis for the emotional divorce variable (P=0.004, F=10.176) and the marital frustration (P=0.0002, F=11.549) is significant. According to the obtained results it can be said that in the two experimental groups, there was a significant change in the mentioned variables in the post-test compared to the control group under the intervention influence. According to Etta coefficients, the strongest effect was on the variable of the marital frustration.
Discussion
This study aimed to investigate the effectiveness of training the acceptance, commitment and problem-solving skills on reducing the emotional divorce and the marital frustration. Observation of the results showed the confirmation of the effectiveness of the training intervention on reducing the emotional divorce. Subjects’ scores in the emotional divorce variable decreased from pretest to posttest and were statistically significant. The study results in this section were in line with study of Din Dar et.al (2018) who also showed
that problem solving skill and the effective communication and apathy had the greatest effect on predicting the emotional divorce (25). Also, in a study by Fakhri, Mahdavian Fard and Kimiaee (2017), the problem-solving skill was reported to be an important predictor of the possibility of divorce or emotional separation in the population of women (7, 26, 27). In the findings by Katzler et al (2018), Brassington et al (2016), and Brown et al. (2015) the acceptance and commitment-based group therapy have shown a significant effect on improving the symptoms of depression, anxiety, health status limitations and the valuable life
(13-15).
The results of the present study and the review of studies conducted in this field show that the training of acceptance, commitment and problem solving improves the relationship between couples and reduces their emotional divorce. The positive effect of acceptance, commitment and problem-solving skills on reducing the problem of the emotional divorce can be indicative of that these two skills reduce helplessness, marital conflict, depression and the couples’ incompatibility on one hand, and increase the intimacy and marital happiness and strengthen the behavioral reforms and adjust the unrealistic expectations of the couples, on the other hand, can enhance the couples’ family functioning and improve their quality of married life. In addition, it can be said that perhaps these two skills by creating positive behaviors, such as mindfulness and acceptance of what is considered painful for human beings, flexibility, re-evaluation, goal setting, engaging in a participatory activity and reducing negative behaviors, such as blame, irony and criticism that causes spouses to accept problems without hesitation and to seek new committed action to improve their relationship; and also sometimes to solve their problems and feel good about themselves and their relationship with their spouses.
It should also be noted that the skills of acceptance, commitment and problem-solving while improving interactions and communications in general, since they emphasize both the cognitive and the behavioral aspects by modifying the view and beliefs of the individuals on the marital issues and problems, can increase communication, improve the couples’ roles by emphasizing the efficient behaviors and interactions, unconditional acceptance of the annoying problems and behaviors, and committed action to continue positive behaviors and solve the existing problems, increase the spouses’ family functioning and reduce their emotional separation. In short, these two skills help couples accept unresolved issues and problems to take steps to take committed action, and to use problem-solving to reduce their communication problems and to prevent the emotional separation from their spouses.
The results of this study showed, the training intervention led to a reduction in the couples’ emotional frustration. Subjects’ scores on the variable of the marital frustration decreased from the pre-test to the post-test and were statistically significant. This part of the results was in line with the results of some previous research, such as Arien Far and Rasouli (2019), who showed in their study that couple therapy based on acceptance and commitment is more effective in reducing marital burnout compared to the solution-oriented way (28); Nazari, Fallahzadeh. And Nazarboland (2017) based on their research to this conclusion, they found that acceptance and commitment therapy is an effective-way to reduce marital frustration and increase the marital quality of the married women by using metaphors, emotion regulation techniques, and value-based practices (29); Dehghani et al (2016) based on their research concluded that training these skills, in particular the problem-solving skills, reduces marital boredom and increase women’s marital satisfaction (30). Finally, Tsaplasoo et.al (2009) conducted study in the field of marital burnout and concluded that the couple therapy interventions and learning the counteracting skill and problem-solving in particular the acceptance of what is not changeable have an effective role on the sexual functioning and the marital consent (31).
According to the results of the present study and previous studies, this type of educational intervention can have a positive effect on couples' frustration and reduce their sense of hopelessness. In explaining this research finding, it can be said that considering that the training of the acceptance and commitment includes the cognitive-behavioral problem solving, moment-to-moment awareness of emotions (mindfulness) and unconditional acceptance of the problem, and at the same time the commitment to the purposeful action to find solutions for the problems ahead, so it makes people reinforce the skills needed to solve the problems. Because the frustrated couples have a variety of cognitive disorders and dysfunctional thoughts, activating these thoughts not only focuses them on self-worth and frustration with the future of the marriage, but also has a strong effect on exacerbating the symptoms of frustration.
In addition, training the life skills, such as the problem-solving can help to establish and maintain a good relationship, reduce the creation or persistence of destructive and negative feelings during the course of the marital relationship, and prevent the couples from becoming frustrated by reducing tensions and resolving conflicts.
As we know it, the family as an emotional and social unit can either be the center of growth and development, healing, change and transformation, or in certain circumstances pave the background to annihilate the relationship between its members, causing some damages to occur such as, marital frustration and the emotional divorce. Since the emotional divorce and the marital frustration are both important structures in the women’s marital life and play an important role in maintaining the marriage and the marital health, it was important to properly understand these two structures and the factors affecting them and to observe the effect of training the acceptance and commitment skills, and the problem-solving skill on these two structures in line with previous research, make it the more obvious to pay more attention to the educational and preventive interventions in this field.
Given that research is a continuous and endless activity and the findings of each research always raise new questions, so it is suggested that researchers, who are interested in the field of the marital life, conduct further research instead of using quantitative methods, such as questionnaires from other methods and tools, such as participatory observation, content analysis, and group interview methods to give more validity to the data in situations where the survey method is not able to accurately measure the variables in question; therefore, repetition of the research using other methods and tests in wider samples is recommended.
Limitations
The present study, like other researches in the field of humanities had limitations, including lack of cooperation of all subjects, especially due to repeated requests of the researcher from them to complete questionnaires and attend training sessions, and their frequent dropouts. The sample studied in this study included all couples who referred to counseling centers in Kerman; therefore, the findings of this study to other communities and groups should be generalized with caution. Data collection is based on self-report questionnaire, which may be the source of one-dimensional bias in the use of methods. Therefore, further methodological efforts are necessary to measure the rate of emotional divorce and marital frustration in future studies. Since achieving the desired subjects was difficult, it was not possible to control the confounding variables such as limited age range, level of education, number of children, etc.
Conclusion
The results of the present study showed that training of acceptance, commitment and problem solving skills could influence emotional divorce and frustration of couples.
The educational and prevention centers in the sub-branches of the organizations such as Welfare, medical sciences, Education, etc. should take actions in acquainting couples with different concepts and dimensions of the marital issues with emphasis on the acceptance, commitment and problem-solving skills. The evidences suggest that, it helps couples to adopt the correct and effective method of dealing with the problems and challenges of the married life and prevents the occurrence and continuation of the damages, such as frustration and the emotional divorce, as well as teaching treatment strategies and measures based on the two skills of acceptance and commitment and problem-solving skills to the families affected by the marital relationships in order to develop the couples’ mental health and prevent the collapse of the family foundation; and, to counselors and mental health professionals to be able to take more effective interventions in the field of family and the marital damages.
Acknowledgement
This research was conducted after acquisition of the necessary permissions from Bahonar University of Kerman and the informed consent of the subjects. The researcher had to adhere to Islamic law, especially respect for human rights. A letter of introduction was taken from Bahonar University of Kerman and given to the counseling centers. The purpose of the research was explained to the authorities of the centers to attract their cooperation.
This article was part of a master’s thesis written by the first author in the field of educational sciences with tracking code 2596807 of Iranian Research Institute for Information Science and Technology (IRANDOC).
Conflict of interest
The authors declare that there is no conflict of interest.
Author contribution
A.R and N.K contributed to the research, and A.S wrote the article.
Review: Research | Subject: General
Received: 2020/10/19 | Accepted: 2021/12/29 | Published: 2022/01/10

References
1. 1. Copello A, Templeton L, Powell J. Adult family members and carers of dependent drug users: prevalence, social cost, resource savings and treatment responses. London: UK Drug Policy Commission. 2009;50(12):45-52.
2. Bahram Nia M, Falah Chai SR, Mohammadi K. A study of comparing the dimensions of marital conflict in couples with marital conflict and women with emotional divorce in Bandar Abbas. Master Thesis. Faculty of Psychology and Educational Sciences. Hormozgan University. 2013.
3. Paynes A. Boredom of marital relationships. Shadab Translation, (Published in the original language 1996). Tehran: Rad Mehr Publications. 2015.
4. Adli M. The effectiveness of Alice's couple therapy on changing the style of documents and reducing conflicts and marital boredom of couples in Bandar Abbas. . Master thesis, Hormozgan University. 2013.
5. Carr SN, Francis AJ. Do early maladaptive schemas mediate the relationship between childhood experiences and avoidant personality disorder features? A preliminary investigation in a non-clinical sample. . Cognitive therapy and research. 2010;34(4):343-58. [DOI:10.1007/s10608-009-9250-1]
6. Bernardi F, Martínez-Pastor JI. Divorce risk factors and their variations over time in Spain. Demographic Research. 2011;24:771-800. [DOI:10.4054/DemRes.2011.24.31]
7. Rajaee A, Kimiaee A, Mashhadi A. Evaluation of the effectiveness of couple therapy by Guttman's method on reducing emotional divorce, improving verbal relationships and interpersonal cognitive distortions of conflicting couples. . Master Thesis and Educational Sciences Mashhad Ferdowsi University. 2015.
8. Zaree A. Family Mental Health, Publisher: Hormozgan University. 2014.
9. Izadi R, Abedi M. Acceptance and Commitment Therapy, Second Edition, Tehran: Jangal Publishing. 2014.
10. Qaderi A. the effectiveness of acceptance and commitment approach on marital boredom and forgiveness of couples referring to the Social Services and Counseling Center of Tehran Prisons Organization, Master Thesis, Marvdasht Azad University. 2014.
11. Eilenberg T, Kronstrand L, Fink P, Frostholm L. Acceptance and commitment group therapy for health anxiety-Results from a pilot study. . Journal of Anxiety Disorders. 2013;27(5):461-8. [DOI:10.1016/j.janxdis.2013.06.001]
12. Zhang A, Park S, Sullivan JE, Jing S. The effectiveness of problem-solving therapy for primary care patients' depressive and/or anxiety disorders: A systematic review and meta-analysis. . The Journal of the American Board of Family Medicine. 2018;31(1):139-50. [DOI:10.3122/jabfm.2018.01.170270]
13. Kanzler KE, Robinson PJ, McGeary DD, Mintz J, Potter JS, Muñante M, et al. Rationale and design of a pilot study examining Acceptance and Commitment Therapy for persistent pain in an integrated primary care clinic. Contemporary clinical trials. 2018;66:28-35. [DOI:10.1016/j.cct.2018.01.004]
14. Brassington L, Ferreira NB, Yates S, Fearn J, Lanza P, Kemp K, et al. Better living with illness: A transdiagnostic acceptance and commitment therapy group intervention for chronic physical illness. . Journal of Contextual Behavioral Science. 2016;5(4):208-14. [DOI:10.1016/j.jcbs.2016.09.001]
15. Brown FL, Whittingham K, Boyd RN, McKinlay L, Sofronoff K. Does Stepping Stones Triple P plus Acceptance and Commitment Therapy improve parent, couple, and family adjustment following paediatric acquired brain injury? A randomised controlled trial. . Behaviour research and therapy. 2015;73:58-66. [DOI:10.1016/j.brat.2015.07.001]
16. Aman Allahi A, Heydari N, Khojasteh Mehr R, Imani M. the effectiveness of acceptance and commitment based therapy in the treatment of couples' anxiety. . Bi-Quarterly Journal of Applied Counseling. 2014;4(1):103-19.
17. Farahanifar M, Haidari H, Davoodi H, Al-Yassin SA. Comparison of the effectiveness of systematic motivational counseling and acceptance and commitment treatment on conflict resolution styles of martially incompatible women. . Journal of Behavioral Science Research. 2019;17(1):44-55.
18. Davis KD, Winsler A, Middleton M. Students' perceptions of rewards for academic performance by parents and teachers: Relations with achievement and motivation in college. . The Journal of genetic psychology. 2006;167(2):211-20. [DOI:10.3200/GNTP.167.2.211-220]
19. Woszidlo A, Segrin C. Direct and indirect effects of newlywed couples' neuroticism and stressful events on marital satisfaction through mutual problem solving. . Marriage & Family Review. 2013;49(6):520-45. [DOI:10.1080/01494929.2013.772933]
20. Pakravan A, Haghayegh SA, Neshat Doost HT, Molavi H. the effectiveness of problem solving training method on marital satisfaction and psychological profile of couples in Borujen. Journal of Counseling Culture and Psychotherapy. 2013;16(4):32-15.
21. Rasouli Y, A. FA. The effect of active problem solving method on marital conflicts in Yasuj. . Journal of the Armaghan Danesh. 2015;18(10):859-68.
22. Khodabakhsh M, Kiani F, Nouri Tirtashi A, Khastohashjin H. the effectiveness of narrative therapy on increasing couples' intimacy and its dimensions: Implications for treatment. Family Counseling and Psychotherapy. 2014;4(4):607-23.
23. Sayed Ali Tabar SH, Mohammad Alipour Z, Habibi F, Sarvestani A, Javanbakht AR. Reliability, Validity and Factor structure of the Marital Frustration Scale. Researcher Journal. 2015;20(6):342-3495.
24. Mousavi F, Rahimi A. The Comparison of Interpersonal Identity Statuses in Married People with Regards to Emotional Appl Psychol Res. 2015;6(10):11-23.
25. Din Dar A, Mahdavi MS, Sayed Mirzaee MS. Investigating the Relationship between Life Skills and Emotional Divorce (Case Study: Married People in Shiraz). . Journal of Women and Society. 2018;9(4):153-76.
26. Fakhri M, Mahdavian Fard R, Kamikaee SA. Predicting the probability of divorce of women based on avoidant attachment, anxiety attachment and family problem solving skills. . Journal of Counseling and Psychotherapy Culture; Allameh Tabatabai University. 2017;9(33):207-22.
27. Mahdavian Fard R. Evaluation of the effectiveness of teaching the concepts of rational-emotional-behavioral approach on improving communication and reducing marital boredom, M.Sc. Thesis, Ferdowsi University of Mashhad. 2012.
28. Arienfar N, Rasouli R. Comparison of the effect of short-term solution-oriented couple therapy with acceptance and commitment-based couple therapy on marital burnout. . Journal of Knowledge and Research in Applied Psychology 2019;1(75):pp. 47-60.
29. Nazari A, Fallahzadeh H, Nazar Boland N. the effectiveness of acceptance and commitment therapy on women's frustration and marital quality. . Journal of Applied Psychology. 2017;3(43):433-53.
30. Dehghan F, Piri Kamrani M, Goli R, Rahmani H. the effect of life skills training on marital satisfaction, Marital boredom and women's mental health. . Journal of Women and Society 2016;4(7):1-11.
31. Tsapelas I, Aron A, Orbuch T. Marital boredom now predicts less satisfaction 9 years later. . Psychological Science. 2009;20(5):543-5. [DOI:10.1111/j.1467-9280.2009.02332.]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2022 CC BY-NC 4.0 | Journal of Community Health Research

Designed & Developed by : Yektaweb