Examining the Effectiveness of Acceptance and Commitment Therapy on the Cognitive Functions of Patients with Systemic Lupus Erythematosus
-
Suleiman Ibrahim Mohammad
,
Asokan Vasudevan
,
Zhanna Gardanova
,
Hamza Fadhel Hamzah
,
Bahira Abdulrazzaq Mohammed
,
KDV Prasad
Abstract
Objective: This study was administrated with the goal of examining the efficacy of acceptance and commitment therapy (ACT) on cognitive functions of patients with systemic lupus erythematosus.
Method: In a single-blind experimental research, 90 adult patients with lupus were randomly divided into the three ACT (n = 30), general health education (GHE) (n = 30) and waitlist (n = 30) groups. Both treatment groups received individual treatment with a specific protocol for four weeks. Before and after treatment, all participants were assessed using the Wisconsin Card Sorting Test (WCST) and the Stroop Color Word Test (SCWT).
Results: Both ACT and GHE groups had a significantly better post-intervention cognitive performance compared to the waitlist group in terms of WCST and SCWT scores (P < 0.05). Cohen’s d for the effects of ACT on WCST total errors and completed categories were 0.86 and 0.80, respectively. Cohen’s d for the effect of ACT on SCWT was 0.70. Furthermore, Cohen’s d for the effects of GHE on WCST total errors and completed categories were 0.65 and 0.58, respectively. Also, Cohen’s d for the effect of GHE on SCWT was 0.55. The ACT and GHE interventions differed significantly only in total errors on WCST, with the ACT group demonstrating significantly better cognitive functioning at post-intervention (P = 0.04).
Conclusion: The ACT approach has a large effect on the cognitive performance of lupus patients, while the GHE has a moderate effect on these functions. Therefore, these intervention methods, especially ACT, could be considered alongside usual treatment methods as suitable options to improve the daily affairs of people with lupus.
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2. Jolly M, Pickard SA, Mikolaitis RA, Rodby RA, Sequeira W, Block JA. LupusQoL-US benchmarks for US patients with systemic lupus erythematosus. J Rheumatol. 2010;37(9):1828-33.
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7. Palagini L, Mauri M, Faraguna U, Carli L, Tani C, Dell'Osso L, et al. Insomnia symptoms, perceived stress and coping strategies in patients with systemic lupus erythematosus. Lupus. 2016;25(9):988-96.
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10. Sweet JJ, Doninger NA, Zee PC, Wagner LI. Factors influencing cognitive function, sleep, and quality of life in individuals with systemic lupus erythematosus: a review of the literature. Clin Neuropsychol. 2004;18(1):132-47.
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16. Beygi Z, Tighband Jangali R, Derakhshan N, Alidadi M, Javanbakhsh F, Mahboobizadeh M. An Overview of Reviews on the Effects of Acceptance and Commitment Therapy (ACT) on Depression and Anxiety. Iran J Psychiatry. 2023;18(2):248-57.
17. van de Graaf DL, Trompetter HR, Smeets T, Mols F. Online Acceptance and Commitment Therapy (ACT) interventions for chronic pain: A systematic literature review. Internet Interv. 2021;26:100465.
18. Sahebari M, Asghari Ebrahimabad MJ, Ahmadi Shoraketokanlo A, Aghamohammadian Sharbaf H, Khodashahi M. Efficacy of Acceptance and Commitment Therapy in Reducing Disappointment, Psychological Distress, and Psychasthenia among Systemic Lupus Erythematosus (SLE) Patients. Iran J Psychiatry. 2019;14(2):130-6.
19. Akhtar Z, Majeed S. Efficacy of Acceptance and Commitment Therapy for Psychological Distress in Patients with Systemic Lupus Erythematous. Pakistan Journal of Medical & Health Sciences. 2022;16(09):96-.
20. Arjol D, Barbero-Rubio A. A brief acceptance and commitment therapy group intervention on systemic lupus erythematosus. Revista de Psicoterapia. 2022;33(122):105-27.
21. Zhang CQ, Leeming E, Smith P, Chung PK, Hagger MS, Hayes SC. Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach. Front Psychol. 2017;8:2350.
22. Sarihi N, Manavipour D, Sdaghatifard M. Comparing the effectiveness of ISTDP intervention program, awareness training, and its application on executive functions. Psychol Sci. 2020;19(87):339-48.
23. Liu H, Liu N, Chong ST, Boon Yau EK, Ahmad Badayai AR. Effects of acceptance and commitment therapy on cognitive function: A systematic review. Heliyon. 2023;9(3):e14057.
24. Cuevas H, Heitkemper E, Kim J. Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis. West J Nurs Res. 2024;46(9):708-24.
25. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25.
26. Kohli A, Kaur M. Wisconsin Card Sorting Test: Normative data and experience. Indian J Psychiatry. 2006;48(3):181-4.
27. Singh S, Aich TK, Bhattarai R. Wisconsin Card Sorting Test performance impairment in schizophrenia: An Indian study report. Indian J Psychiatry. 2017;59(1):88-93.
28. Rao A, Rao AR, Painkra B, Kiruthika S, Kumar S, Thakral M, et al. Cognitive assessment across normal aging and subjective cognitive decline using PGIMS and Stroop color-word test: A cross-sectional study. Arch Gerontol Geriatr Plus. 2025;2(2):100133.
29. Fidell LS, Tabachnick BG. Preparatory data analysis. Handbook of psychology. 2003:115-41.
30. Shari NI, Zainal NZ, Ng CG. Effects of brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy. J Psychosoc Oncol. 2021;39(6):695-714.
31. Rahbar Karbasdehi F, Hosseinkhanzadeh AA, Shakerinia I. The Efficacy of Acceptance and Commitment Therapy on Cognitive Emotion Regulation and Social Self-Efficacy in Adolescents with Epilepsy. Journal of Applied Psychological Research. 2022;13(2):1-16.
32. Amiri S, Ehtesham Zadeh P, Hafezi F, Borna MR. Comparison of the Effectiveness Behavioral Activation Treatment Therapy and Acceptance and Commitment Therapy on Executive Functions of Learning the Rules, Inhibiting Impulsivity, and Flexibility in Patients with Depression. Shefaye Khatam. 2021;9(2):68-78.
33. Alizadeh S, Taklavi S, Mahmoud Alilou M. Effectiveness of Online Existential Therapy on Attitude toward Life and Perplexities related to Death in Recovered Patients of Covid-19. Research in Cognitive and Behavioral Sciences. 2021;11(1):145-62.
34. Twohig MP, Levin ME. Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. Psychiatr Clin North Am. 2017;40(4):751-70.
35. Khaleghi A, Mohammadi MR, Shahi K, Nasrabadi AM. Computational Neuroscience Approach to Psychiatry: A Review on Theory-driven Approaches. Clin Psychopharmacol Neurosci. 2022;20(1):26-36.
36. Khaleghi A, Shahi K, Saidi M, Babaee N, Kaveh R, Mohammadian A. Linear and nonlinear analysis of multimodal physiological data for affective arousal recognition. Cogn Neurodyn. 2024;18(5):2277-88.
37. Kelson J, Rollin A, Ridout B, Campbell A. Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. J Med Internet Res. 2019;21(1):e12530.
38. Kozora E, Zell JL, Baraghoshi D, Smith RM, Strand M. Improved executive function in patients with systemic lupus erythematosus following interactive digital training. Lupus. 2022;31(8):910-20.
39. Zahiri S, Jahani S, Sayadi N, Cheraghian B, Rajaei E. The effects of an educational intervention on fatigue and activities of daily living in patients with systemic lupus erythematosus. Nurs Midwifery Stud. 2022;11(1):24-30.
40. Tsoi A, Gomez A, Boström C, Pezzella D, Chow JW, Girard-Guyonvarc'h C, et al. Efficacy of lifestyle interventions in the management of systemic lupus erythematosus: a systematic review of the literature. Rheumatol Int. 2024;44(5):765-78.
41. Tajik E, Mohammadi MR, Rahmanian H. A Randomized Controlled Trial of a Healthy Lifestyle Intervention to Improve Mental Health among School-Going Adolescents. Iran J Psychiatry. 2025;20(3):289-303.
42. Cai H, Li G, Hua S, Liu Y, Chen L. Effect of exercise on cognitive function in chronic disease patients: a meta-analysis and systematic review of randomized controlled trials. Clin Interv Aging. 2017;12:773-83.
2. Jolly M, Pickard SA, Mikolaitis RA, Rodby RA, Sequeira W, Block JA. LupusQoL-US benchmarks for US patients with systemic lupus erythematosus. J Rheumatol. 2010;37(9):1828-33.
3. Akbarian M, Faezi ST, Gharibdoost F, Shahram F, Nadji A, Jamshidi AR, et al. Systemic lupus erythematosus in Iran: a study of 2280 patients over 33 years. Int J Rheum Dis. 2010;13(4):374-9.
4. Fatoye F, Gebrye T, Mbada C. Global and regional prevalence and incidence of systemic lupus erythematosus in low-and-middle income countries: a systematic review and meta-analysis. Rheumatol Int. 2022;42(12):2097-107.
5. Seet D, Allameen NA, Tay SH, Cho J, Mak A. Cognitive Dysfunction in Systemic Lupus Erythematosus: Immunopathology, Clinical Manifestations, Neuroimaging and Management. Rheumatol Ther. 2021;8(2):651-79.
6. Kakati S, Barman B, Ahmed SU, Hussain M. Neurological Manifestations in Systemic Lupus Erythematosus: A Single Centre Study from North East India. J Clin Diagn Res. 2017;11(1):Oc05-oc9.
7. Palagini L, Mauri M, Faraguna U, Carli L, Tani C, Dell'Osso L, et al. Insomnia symptoms, perceived stress and coping strategies in patients with systemic lupus erythematosus. Lupus. 2016;25(9):988-96.
8. Ceccarelli F, Perricone C, Pirone C, Massaro L, Alessandri C, Mina C, et al. Cognitive dysfunction improves in systemic lupus erythematosus: Results of a 10 years prospective study. PLoS One. 2018;13(5):e0196103.
9. Petri M, Naqibuddin M, Carson KA, Wallace DJ, Weisman MH, Holliday SL, et al. Depression and cognitive impairment in newly diagnosed systemic lupus erythematosus. J Rheumatol. 2010;37(10):2032-8.
10. Sweet JJ, Doninger NA, Zee PC, Wagner LI. Factors influencing cognitive function, sleep, and quality of life in individuals with systemic lupus erythematosus: a review of the literature. Clin Neuropsychol. 2004;18(1):132-47.
11. Garcia RJ, Francis L, Dawood M, Lai ZW, Faraone SV, Perl A. Attention deficit and hyperactivity disorder scores are elevated and respond to N-acetylcysteine treatment in patients with systemic lupus erythematosus. Arthritis Rheum. 2013;65(5):1313-8.
12. Barraclough M, McKie S, Parker B, Jackson A, Pemberton P, Elliott R, et al. Altered cognitive function in systemic lupus erythematosus and associations with inflammation and functional and structural brain changes. Ann Rheum Dis. 2019;78(7):934-40.
13. Watson P, Storbeck J, Mattis P, Mackay M. Cognitive and emotional abnormalities in systemic lupus erythematosus: evidence for amygdala dysfunction. Neuropsychol Rev. 2012;22(3):252-70.
14. Benedict RH, Shucard JL, Zivadinov R, Shucard DW. Neuropsychological impairment in systemic lupus erythematosus: a comparison with multiple sclerosis. Neuropsychol Rev. 2008;18(2):149-66.
15. Ghazagh M, Vazir S, Zareh H. A Review of the Effect of Acceptance and Commitment Therapy (ACT) and Intensive Short-Term Dynamic Psychotherapy (ISTDP) on Executive Cognitive Functions in Lupus Patients. Clinical Schizophrenia & Related Psychoses. 2022;16.
16. Beygi Z, Tighband Jangali R, Derakhshan N, Alidadi M, Javanbakhsh F, Mahboobizadeh M. An Overview of Reviews on the Effects of Acceptance and Commitment Therapy (ACT) on Depression and Anxiety. Iran J Psychiatry. 2023;18(2):248-57.
17. van de Graaf DL, Trompetter HR, Smeets T, Mols F. Online Acceptance and Commitment Therapy (ACT) interventions for chronic pain: A systematic literature review. Internet Interv. 2021;26:100465.
18. Sahebari M, Asghari Ebrahimabad MJ, Ahmadi Shoraketokanlo A, Aghamohammadian Sharbaf H, Khodashahi M. Efficacy of Acceptance and Commitment Therapy in Reducing Disappointment, Psychological Distress, and Psychasthenia among Systemic Lupus Erythematosus (SLE) Patients. Iran J Psychiatry. 2019;14(2):130-6.
19. Akhtar Z, Majeed S. Efficacy of Acceptance and Commitment Therapy for Psychological Distress in Patients with Systemic Lupus Erythematous. Pakistan Journal of Medical & Health Sciences. 2022;16(09):96-.
20. Arjol D, Barbero-Rubio A. A brief acceptance and commitment therapy group intervention on systemic lupus erythematosus. Revista de Psicoterapia. 2022;33(122):105-27.
21. Zhang CQ, Leeming E, Smith P, Chung PK, Hagger MS, Hayes SC. Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach. Front Psychol. 2017;8:2350.
22. Sarihi N, Manavipour D, Sdaghatifard M. Comparing the effectiveness of ISTDP intervention program, awareness training, and its application on executive functions. Psychol Sci. 2020;19(87):339-48.
23. Liu H, Liu N, Chong ST, Boon Yau EK, Ahmad Badayai AR. Effects of acceptance and commitment therapy on cognitive function: A systematic review. Heliyon. 2023;9(3):e14057.
24. Cuevas H, Heitkemper E, Kim J. Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis. West J Nurs Res. 2024;46(9):708-24.
25. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25.
26. Kohli A, Kaur M. Wisconsin Card Sorting Test: Normative data and experience. Indian J Psychiatry. 2006;48(3):181-4.
27. Singh S, Aich TK, Bhattarai R. Wisconsin Card Sorting Test performance impairment in schizophrenia: An Indian study report. Indian J Psychiatry. 2017;59(1):88-93.
28. Rao A, Rao AR, Painkra B, Kiruthika S, Kumar S, Thakral M, et al. Cognitive assessment across normal aging and subjective cognitive decline using PGIMS and Stroop color-word test: A cross-sectional study. Arch Gerontol Geriatr Plus. 2025;2(2):100133.
29. Fidell LS, Tabachnick BG. Preparatory data analysis. Handbook of psychology. 2003:115-41.
30. Shari NI, Zainal NZ, Ng CG. Effects of brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy. J Psychosoc Oncol. 2021;39(6):695-714.
31. Rahbar Karbasdehi F, Hosseinkhanzadeh AA, Shakerinia I. The Efficacy of Acceptance and Commitment Therapy on Cognitive Emotion Regulation and Social Self-Efficacy in Adolescents with Epilepsy. Journal of Applied Psychological Research. 2022;13(2):1-16.
32. Amiri S, Ehtesham Zadeh P, Hafezi F, Borna MR. Comparison of the Effectiveness Behavioral Activation Treatment Therapy and Acceptance and Commitment Therapy on Executive Functions of Learning the Rules, Inhibiting Impulsivity, and Flexibility in Patients with Depression. Shefaye Khatam. 2021;9(2):68-78.
33. Alizadeh S, Taklavi S, Mahmoud Alilou M. Effectiveness of Online Existential Therapy on Attitude toward Life and Perplexities related to Death in Recovered Patients of Covid-19. Research in Cognitive and Behavioral Sciences. 2021;11(1):145-62.
34. Twohig MP, Levin ME. Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. Psychiatr Clin North Am. 2017;40(4):751-70.
35. Khaleghi A, Mohammadi MR, Shahi K, Nasrabadi AM. Computational Neuroscience Approach to Psychiatry: A Review on Theory-driven Approaches. Clin Psychopharmacol Neurosci. 2022;20(1):26-36.
36. Khaleghi A, Shahi K, Saidi M, Babaee N, Kaveh R, Mohammadian A. Linear and nonlinear analysis of multimodal physiological data for affective arousal recognition. Cogn Neurodyn. 2024;18(5):2277-88.
37. Kelson J, Rollin A, Ridout B, Campbell A. Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. J Med Internet Res. 2019;21(1):e12530.
38. Kozora E, Zell JL, Baraghoshi D, Smith RM, Strand M. Improved executive function in patients with systemic lupus erythematosus following interactive digital training. Lupus. 2022;31(8):910-20.
39. Zahiri S, Jahani S, Sayadi N, Cheraghian B, Rajaei E. The effects of an educational intervention on fatigue and activities of daily living in patients with systemic lupus erythematosus. Nurs Midwifery Stud. 2022;11(1):24-30.
40. Tsoi A, Gomez A, Boström C, Pezzella D, Chow JW, Girard-Guyonvarc'h C, et al. Efficacy of lifestyle interventions in the management of systemic lupus erythematosus: a systematic review of the literature. Rheumatol Int. 2024;44(5):765-78.
41. Tajik E, Mohammadi MR, Rahmanian H. A Randomized Controlled Trial of a Healthy Lifestyle Intervention to Improve Mental Health among School-Going Adolescents. Iran J Psychiatry. 2025;20(3):289-303.
42. Cai H, Li G, Hua S, Liu Y, Chen L. Effect of exercise on cognitive function in chronic disease patients: a meta-analysis and systematic review of randomized controlled trials. Clin Interv Aging. 2017;12:773-83.
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| Issue | Vol 21 No 1 (2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Acceptance and Commitment Therapy Attention Cognitive Function Lupus Erythematosus Disseminatus Psychotherapy | ||
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How to Cite
1.
Ibrahim Mohammad S, Vasudevan A, Gardanova Z, Fadhel Hamzah H, Abdulrazzaq Mohammed B, Prasad K. Examining the Effectiveness of Acceptance and Commitment Therapy on the Cognitive Functions of Patients with Systemic Lupus Erythematosus. Iran J Psychiatry. 2025;21(1):32-42.
