The Effectiveness of Acceptance and Commitment Therapy on Death Anxiety, Loneliness, and Rumination in Single Older Women

Background: Later life represents a significant developmental stage during which individuals encounter a wide range of physiological and psychological changes. Among these changes, issues such as death anxiety, feelings of loneliness, and rumination become particularly salient. Accordingly, the present study aimed to determine the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing death anxiety, loneliness, and rumination among single older women in Dezful.
Method: The present study employed a quasi-experimental design with a pretest–posttest control group. The statistical population consisted of all single older women residing in Dezful in 2025. The sample included 30 participants aged 65–75 years who were selected through convenience sampling based on the study’s inclusion criteria and were randomly assigned to experimental and control groups. Participants in the experimental group received ACT across eight weekly sessions lasting 90 minutes each. The instruments used in this study included Templer’s Death Anxiety Scale, the UCLA Loneliness Scale developed by Russell and colleagues, and the Ruminative Response Scale by Nolen-Hoeksema and Morrow. Data were analyzed using one-way analysis of covariance (ANCOVA) in SPSS version 23.
Results: The findings indicated significant differences between the experimental and control groups in death anxiety, loneliness, and rumination (p<.001).
Conclusion: The findings suggest that ACT reduces death anxiety, loneliness, and rumination among older women. These results highlight promising directions for psychological interventions and suggest that ACT can be considered an effective therapeutic approach for reducing death anxiety, loneliness, and rumination in single women in later life.
EXTENDED ABSTRACT
 Introduction
Later life represents a significant stage of human development during which individuals experience a wide range of physiological and psychological changes. Among these changes, issues such as death anxiety, loneliness, and rumination become increasingly salient. Addressing the mental health of older adults and identifying factors that promote their psychological well-being is therefore of considerable importance. In this regard, the use of effective therapeutic approaches may serve as a valuable means of improving psychological functioning in later life.
In recent years, various therapeutic interventions have been employed to alleviate death anxiety, loneliness, and rumination among older adults; however, Acceptance and Commitment Therapy (ACT) has received substantial attention. Given the growing population of older adults and the necessity of implementing educational and intervention programs aimed at promoting their mental health and equipping them with psychological resources for coping with age-related stressors, further investigation of effective interventions is warranted. Moreover, the effectiveness of ACT in relation to death anxiety, loneliness, and rumination among single older women has received limited empirical attention, or at least has not been adequately documented in the available literature. Therefore, the present study aimed to determine the effectiveness of Acceptance and Commitment Therapy on death anxiety, loneliness, and rumination among single older women.
Method
In terms of purpose, this study was applied research, and methodologically it employed a quasi‑experimental design with a pretest–posttest control group. The statistical population consisted of all single older women aged 65–75 years residing in Dezful during the first half of 2025. Using convenience sampling, 30 eligible participants were selected from this population and randomly assigned in equal numbers to an experimental group and a control group. The inclusion criteria were: scoring above the mean on the death anxiety, loneliness, and rumination scales; age between 65 to 75 years; being female; being single; and having at least a high school diploma. Exclusion criteria included simultaneous participation in other psychological interventions and the presence of severe cognitive disorders. Data were collected using Templer’s Death Anxiety Scale (1970), the Revised UCLA Loneliness Scale developed by Russell et al. (1978), and the Ruminative Responses Scale by Nolen‑Hoeksema and Morrow (1991). The therapeutic content was adapted from the Acceptance and Commitment Therapy protocol developed by Hayes et al. (1999). The intervention was delivered by a psychotherapy specialist to the experimental group in eight weekly sessions lasting 90 minutes each. Each session included the introduction of session objectives and topics, group discussion, and in‑session exercises. The session contents are presented in Table 1. Data were analyzed using one‑way analysis of covariance (ANCOVA). Statistical analyses were conducted using SPSS version 23.
Results
Based on the study design, one‑way analysis of covariance (ANCOVA) was used to analyze the primary outcomes. Prior to conducting the main analysis, Levene’s test was applied to examine the homogeneity of variances between the two groups at the posttest stage. The results indicated that Levene’s test for death anxiety, loneliness, and rumination was not statistically significant, confirming the assumption of homogeneity of variances. Another key assumption of ANCOVA, homogeneity of regression slopes, was tested by examining the interaction between the independent variable and the pretest scores for each dependent variable on the corresponding posttest scores. The results showed that the F values were not significant at the .05 level for death anxiety, loneliness, and rumination, indicating that this assumption was satisfied. In addition, the normality of the dependent variables was assessed using the Shapiro–Wilk test. The results suggested that the variables were normally distributed, as the obtained Z values were not significant at the 0.05 level. Since all assumptions for ANCOVA were met, one‑way ANCOVA was conducted to examine the effectiveness of Acceptance and Commitment Therapy on the total scores of death anxiety, loneliness, and rumination. The results are presented in Table 1.
 The findings indicated significant differences between the experimental and control groups in death anxiety, loneliness, and rumination. In other words, compared with the control group, participants in the experimental group who received Acceptance and Commitment Therapy showed significant reductions in death anxiety, loneliness, and rumination.
Conclusion
The findings may be explained by the mechanisms of Acceptance and Commitment Therapy. ACT utilizes metaphors and experiential exercises aimed at cognitive defusion, such as observing thoughts, labeling thoughts, distancing from thoughts, and allowing them to pass without attempting to change them. Rather than attempting to modify the content of thoughts and emotions, ACT seeks to alter individuals’ relationships with these internal experiences. Through techniques that emphasize acceptance of thoughts and feelings rather than avoidance, as well as mindfulness practices designed to enhance awareness of thoughts, emotions, and internal experiences, ACT promotes psychological flexibility. This increased psychological flexibility can facilitate more adaptive behavior, greater engagement in individual and social activities, and consequently reductions in death anxiety, loneliness, and rumination.
Several limitations should be considered when interpreting the results of the present study. These include the use of non‑random convenience sampling, the absence of a follow‑up assessment, and the focus on older women residing in Dezful, which may limit the generalizability of the findings. Future studies are recommended to employ structured interviews and observational methods for data collection and variable assessment. Additionally, examining outcomes in both short‑term and long‑term follow‑up phases would provide a more comprehensive understanding of the durability of treatment effects. It is also suggested that mental health professionals working in the field of aging incorporate ACT into their practice to help older adults adopt a more flexible perspective toward the challenges and limitations associated with later life and to promote a sense of purpose and meaningful engagement throughout later life.
Ethical Consideration
Ethical Code
This article was derived from the first author’s master’s thesis in personality psychology at the Islamic Azad University, Dezful Branch.
Financial Support
This study did not receive financial support.
Authors’ Contributions
N.A: Conceptualization, methodology, data curation, software, formal analysis, writing - original draft; H.H.R: Conceptualization, methodology, validation, writing - review & editing, supervision
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors would like to express their sincere gratitude to all participants who took part in this study.
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