The Effectiveness of Acceptance and Commitment Therapy on Distress Tolerance and Character Strengths in Older People

Old age is a sensitive period in which examining different dimensions of mental health becomes very important. Tolerating distress and character strengths is one of the factors that can have a significant impact on people’s mental health in old age. Therefore, this study was conducted with the aim of determining the effectiveness of acceptance and commitment therapy (ACT) on distress tolerance and character strengths on older adults of Dezful, Iran. The research method was quasi-experimental with a pretest-posttest design with a control group. The statistical population included all the older adults living in Dezful in 2023. The sample of the research included 30 older adults (65 to 75 years old) selected by the convenience sampling method and based on the inclusion and exclusion criteria and randomly assigned to two experimental and control groups. The experimental group received Hayes et al.’s package of ACT in eight weekly 90-minute sessions. The scales used in this research included Peterson and Seligman’s character strengths scale and Simmons and Gaher’s distress tolerance scale. Data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS-22 software. The results revealed that by controlling the effect of the pre-test in the post-test stage, there was a significant difference between the control and experimental groups in terms of distress tolerance and character strengths (p<.001). Based on the findings of this study, ACT increases the distress tolerance and character strengths in older adults and represents new horizons in clinical interventions and can be used as an effective intervention in improving the distress tolerance and character strengths in older adults.
EXTENDED ABSTRACT
 Introduction
Due to psychological distress and negative emotions during old age, such as feelings of failure amidst life's turmoil, stress, and pressures, older adults face greater challenges. Consequently, this higher perception of stress leads to a decrease in their quality of life and relationships. Among the constructs that help individuals to cope with and manage unpleasant life experiences are distress tolerance and character strengths. Studies have shown that distress tolerance is related to higher psychological well-being, improved quality of life, reduced death anxiety, and better sleep quality in older adults. Furthermore, research has indicated that character strengths are associated with lower physical and psychological symptoms of stress, higher psychological well-being, maintaining and enhancing life satisfaction, and improved psychological and social functioning. One of the treatments that has gained attention in recent years for addressing the psychological issues of older adults is Acceptance and Commitment Therapy (ACT). The effectiveness of ACT on distress tolerance and character strengths has been confirmed. Although this therapy has been conducted on different age groups and many variables, it has not been specifically applied to older adults. This underscores the necessity of conducting the current research. Therefore, the aim of this study was to investigate the effectiveness of ACT on distress tolerance and character strengths in older adults.
Method
This was an applied study in terms of its objective and quasi-experimental with a pretest-posttest and control group design in terms of its method. The statistical population included all individuals aged 65 to 75 years old living in Dezful, Iran during the second half of 2023, among whom 30 people who met the eligibility criteria were selected using convenience sampling and randomly assigned to experimental and control groups in an equal proportion. The inclusion criteria were (1) scoring below the average on distress tolerance and character strengths scales, (2) being over 65 years old, and (3) having at least a middle school diploma. The exclusion criteria included (1) participation in concurrent therapeutic sessions and (2) severe cognitive disorders. Data were collected using the Simons and Gaher’s Distress Tolerance Scale and Peterson and Seligman’s Character Strengths Scale. The content of the therapy sessions was adapted from Hayes et al.’s ACT manual. The protocol was conducted by the first author of the article in form of eight 90-minute sessions for the experimental group. Each session included the introduction of goals and topics related to that session and in-session exercises. Ethical considerations of this research included obtaining written consent for participation in the study, maintaining the confidentiality of personal information, and implementing ACT for the control group as well. Data analysis was performed using univariate covariance analysis (ANCOVA). The data were analyzed using SPSS-22 at a significance level of .05.
Results
According to the research method, ANCOVA was used to analyze the results. Levene’s test for the research variables was not statistically significant, confirming the assumption of homogeneity of variances. Moreover, the key assumption of ANCOVA, namely the homogeneity of regression slopes, was tested by examining the interaction effect of the independent variable and the pre-test of each dependent variable on their respective post-test scores. The results indicated that the F-value was not significant at the .05 level for the research variables. Additionally, to assess the normality of the variables, the Shapiro-Wilk test was used. The Shapiro-Wilk test showed that the distribution of the variables was normal, as the obtained Z-value was not significant at the .05 level.
As shown in Table 1, there is a significant difference between the experimental and control groups in terms of distress tolerance. In other words, ACT, considering the mean distress tolerance of the experimental group compared to that of control group, significantly increased distress tolerance in the experimental group. The effect size is 0.715, meaning that 71% of the individual differences in distress tolerance scores are related to the effect of ACT.
Additionally, as shown in Table 1, there is a significant difference between the experimental and control groups in terms of character strengths. In other words, ACT, considering the mean character strengths of the experimental group compared to that of control group, significantly increased character strengths in the experimental group. The effect size or difference is 0.646, meaning that 65% of the individual differences in character strengths scores are related to the effectiveness of ACT. Therefore, the research hypotheses were confirmed.
Conclusion
The results indicated that ACT is effective in increasing distress tolerance and character strengths in older adults. This finding can be explained by the likelihood that ACT enhances distress tolerance by reducing pathological expectations, rapidly decreasing negative emotions and distressing thoughts, and accepting them as natural human experiences. Additionally, it allows individuals to cognitively absorb, evaluate, and regulate events, thereby increasing distress tolerance and character strengths in older adults. Based on the findings of this study, ACT leads to improved distress tolerance and character strengths in older adults, presenting new horizons in clinical interventions. It can be utilized as an effective intervention method for enhancing distress tolerance and character strengths in older adults. Moreover, the results of this research could have practical implications for families with older members, counseling and psychological service centers, elder care homes, relevant associations, and health and welfare centers. It is recommended that this study be conducted on older adults in other cities and the results be compared with those of the current study. To enhance external validity, various social groups should be included.
Ethical Consideration
Ethical Code
This article has been extracted from the master’s thesis of the first author in the field of Personality Psychology at the Islamic Azad University, Dezful Branch.
Financial Support
This study received no financial support.
Authors’ Contributions
M.K: Conceptualization, software, validation, formal analysis, data curation, visualization; D.R: Methodology, writing-review & editing, project administration; H.H: Conceptualization, methodology, writing-original draft
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors express their gratitude to all participants of this study.
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