Effectiveness of Acceptance and Commitment Therapy on Psychological Distress and Rumination among Colostomy Patients

Document Type : Original Article


1 PhD student, Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran

2 Assistant Professor, Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran

3 Professor of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran


Background and Aim: The most common conditions leading to a stoma (abdominal surgery) include colorectal bowel cancers and inflammatory diseases. This study aimed to determine the effectiveness of acceptance and commitment therapy (ACT) on psychological distress and rumination in colostomy patients.
Methods: This study was a quasi-experimental study with pre-test, post-test, and follow-up with the control group. The statistical population of this study included colostomy patients referred to the psychosomatic ward of Imam Khomeini hospital in Sari in 2019, of which 50 were selected by convenience sampling method based on inclusion and exclusion criteria and were divided into experimental and control groups (each group consisted of 25 people). The experimental group was placed weekly in 8 sessions of 120 minutes. Data were collected using a demographic questionnaire, psychological distress scale (Kessler et al., 2002), and rumination response questionnaire (Nolen-Hoeksema and Marrow, 1993) and analyzed by covariance analysis SPSS.22 software. The significance level of the tests was 0.05.
Results: The results of this study showed that acceptance and commitment therapy (ACT) was effective on psychological distress (p <0.001) and rumination (p <0.001) in colostomy patients.
Conclusion: Considering the positive effect of acceptance and commitment therapy (ACT) on psychological distress and rumination of colostomy patients, it is recommended to use these capacities and training in planning mental health programs, especially in colostomy patients.


  1. Karakus SC, User IR, Akcaer V, Ceylan H, Ozokutan BH. Posterior sagittal anorectoplasty in vestibular fistula: with or without colostomy. Pediatric Surgery International. 2017 Jul 1;33(7):755-9. https://doi.org/10.1007/s00383-017-4102-7 
  2. Jin Y, Ma H, Li Y, Zhang Y, Jiménez‐Herrera M. Development and psychometric evaluation of the colostomy disgust scale in patients with colostomy. European Journal of Cancer Care. 2020 Sep 5:e13323. https://doi.org/10.1037/t78502-000 
  3. Pierce L, Hocking MC, Schwartz LA, Alderfer MA, Kazak AE, Barakat LP. Caregiver distress and patient health‐related quality of life: psychosocial screening during pediatric cancer treatment. Psycho‐oncology. 2017 Oct;26(10):1555-61. https://doi.org/10.1002/pon.4171 
  4. El-Jawahri A, Traeger L, Greer JA, VanDusen H, Fishman SR, LeBlanc TW, Pirl WF, Jackson VA, Telles J, Rhodes A, Li Z. Effect of inpatient palliative care during hematopoietic stem-cell transplant on psychological distress 6 months after transplant: results of a randomized clinical trial. Journal of Clinical Oncology. 2017 Nov 10;35(32):3714. https://doi.org/10.1200/JCO.2017.73.2800 
  5. Troy JD, de Castro CM, Pupa MR, Samsa GP, Abernethy AP, LeBlanc TW. Patient-reported distress in myelodysplastic syndromes and its association with clinical outcomes: a retrospective cohort study. Journal of the National Comprehensive Cancer Network. 2018 Mar 1;16(3):267-73. https://doi.org/10.6004/jnccn.2017.7048 
  6. Elsner K, Naehrig D, Halkett GK, Dhillon HM. Reduced patient anxiety as a result of radiation therapist‐led psychosocial support: A systematic review. Journal of Medical Radiation Sciences. 2017 Sep;64(3):220-31. https://doi.org/10.1002/jmrs.208 
  7. Dempsey AE, O'Brien KD, Tiamiyu MF, Elhai JD. Fear of missing out (FoMO) and rumination mediate relations between social anxiety and problematic Facebook use. Addictive Behaviors Reports. 2019 Jun 1;9:100150. https://doi.org/10.1016/j.abrep.2018.100150 
  8. Rosmarin DH. Spirituality, religion, and cognitive-behavioral therapy: A guide for clinicians. Guilford Publications; 2018 May 28. https://doi.org/10.1007/s10826-018-1259-1
  9. Feliu-Soler A, Montesinos F, Gutiérrez-Martínez O, Scott W, McCracken LM, Luciano JV. Current status of acceptance and commitment therapy for chronic pain: a narrative review. Journal of pain research. 2018;11:2145. https://doi.org/10.2147/JPR.S144631 
  10. Yilmaz E, Celebi D, Kaya Y, Baydur H. A descriptive, cross-sectional study to assess quality of life and sexuality in Turkish patients with a colostomy. Ostomy Wound Manage. 2017 Aug 1;63(8):22-9. https://doi.org/10.25270/owm.2017.08.2229 
  11. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological medicine. 2002 Aug;32(6):959-76. https://doi.org/10.1017/S0033291702006074 
  12. Rahnama M, Sajjadian I, Raoufi A. The Effectiveness of Acceptance and Commitment Therapy on Psychological Distress and Medication Adherence of Coronary Heart Patients. IJPN. 2017; 5 (4) :34-43. https://doi.org/10.21859/ijpn-05045 
  13. Heidari F, Asgari P, Heidari A, Pasha R, Makvandi B. The Effectiveness of acceptance and commitment therapy on psychological flexibility and rumination in patients with non-cardiac chest pain. mejds. 2018; 8 :46-46.
  14. Burckhardt R, Manicavasagar V, Batterham PJ, Hadzi-Pavlovic D. A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology. Journal of school psychology. 2016 Aug 1;57:41-52. https://doi.org/10.1016/j.jsp.2016.05.008 
  15. Kelson J, Rollin A, Ridout B, Campbell A. Internet-delivered acceptance and commitment therapy for anxiety treatment: systematic review. Journal of medical Internet research. 2019;21(1):e12530. https://doi.org/10.2196/12530 
  16. Thompson EM, Destree L, Albertella L, Fontenelle LF. Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes. Behavior Therapy. 2020 Jul 16. https://doi.org/10.1016/j.beth.2020.07.002 
  17. Kemani MK, Kanstrup M, Jordan A, Caes L, Gauntlett-Gilbert J. Evaluation of an intensive interdisciplinary pain treatment based on acceptance and commitment therapy for adolescents with chronic pain and their parents: a nonrandomized clinical trial. Journal of pediatric psychology. 2018 Oct 1;43(9):981-94.  https://doi.org/10.1093/jpepsy/jsy031