The Effectiveness of Acceptance and Commitment Therapy on Intolerance of Uncertainty and Cognitive Flexibility in Students with Symptoms of Generalized Anxiety
Keywords:
Acceptance and commitment therapy, intolerance of uncertainty, cognitive flexibility, generalized anxiety, University StudentsAbstract
Introduction and Aim: Generalized anxiety is characterized by persistent worry, heightened sensitivity to uncertain situations, and difficulty modifying cognitive perspectives and coping strategies, potentially impairing students’ academic functioning and psychological adjustment. This study aimed to determine the effectiveness of acceptance and commitment therapy on intolerance of uncertainty and cognitive flexibility among university students with symptoms of generalized anxiety.
Methodology: This applied study employed a quasi-experimental pretest–posttest design with a control group. The statistical population consisted of students with generalized anxiety symptoms at Ayandegan University in 2025. Thirty eligible students were recruited through convenience sampling and randomly assigned to an acceptance and commitment therapy group or a control group, with 15 participants in each group. Data were collected using the Intolerance of Uncertainty Scale developed by Freeston et al. and the Cognitive Flexibility Inventory developed by Dennis and Vander Wal. The experimental group received eight weekly 90-minute sessions of acceptance and commitment therapy, whereas the control group received no intervention. The data were analyzed using repeated-measures analysis of variance and Bonferroni post-hoc comparisons.
Findings: The time-by-group interaction was significant for the components of intolerance of uncertainty, with effect sizes of 0.243 for self-referential uncertainty and 0.405 for perceived unfairness (p<0.001). Significant between-group differences were also observed for self-referential uncertainty (F=7.948, p=0.009) and perceived unfairness (F=11.599, p=0.002). Bonferroni comparisons indicated that, in the intervention group, self-referential uncertainty and perceived unfairness scores decreased by 4.467 and 5.333 points, respectively (p<0.001). The time-by-group interaction for cognitive flexibility was also significant (Pillai’s trace=0.886, F=14.578, p<0.001). In the intervention group, scores for alternatives, control, and alternatives for human behaviors increased by 5.533, 6.000, and 2.933 points, respectively (p<0.001), whereas no significant pretest–posttest changes were observed in the control group.
Conclusion: Acceptance and commitment therapy was effective in reducing intolerance of uncertainty and improving cognitive flexibility among students with generalized anxiety symptoms. By promoting acceptance of internal experiences, cognitive defusion, present-moment awareness, values clarification, and committed action, this intervention may help students respond more adaptively to worry, ambiguity, and anxiety-provoking circumstances.
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