The Effectiveness of Acceptance and Commitment Therapy (ACT) on Attachment to God in High School Students with Self-Injurious Behavior

Document Type : Research Paper

Authors

1 PhD Student in Educational Psychology, Ard.C., Islamic Azad University, Ardabil, Iran.

2 . Professor, Department of Counseling, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

3 . Associate Professor, Department of Psychology, Ard.C., Islamic Azad University, Ardabil, Iran.

4 Associate Professor, Department of Psychology, Ard.C., Islamic Azad University, Ardabil, Iran.

10.30471/psy.2025.11310.2355

Abstract

Extended Abstract
 
Introduction and Objectives: self-injury is a common and concerning behavior, often employed to regulate negative emotions or cope with psychological distress (Burke et al., 2023). As a maladaptive strategy for managing emotional distress, it is associated with disorders such as depression and anxiety (Liu et al., 2019). In this context, the relationship with God, which can be conceptualized as an attachment bond, is effective in promoting mental health and preventing self-harming behaviors (Beck & McDonald, 2004). Attachment to God is defined as an individual’s emotional bond with God, wherein God serves as a secure base and a safe haven in times of difficulty (Kirkpatrick, 2005). Accordingly, Acceptance and Commitment Therapy (ACT), with its emphasis on values, appears to be a suitable option for strengthening this spiritual bond.
Today, self-injury is increasingly prevalent among adolescents (Laughlin et al., 2024). Numerous studies estimate the global prevalence of self-injury among adolescents to be as high as 22% (Cheng et al., 2025). Although extensive research has highlighted the link between religiosity and mental health (Rosmarin & Koenig, 2020; Schieman et al., 2013), specific dimensions such as the subjective perception of God have been less explored (Kent et al., 2020). Given that the quality of this attachment is linked to adolescent mental health and ACT is recognized as effective in enhancing emotional acceptance and focus on values, the present study was conducted to investigate the effectiveness of this therapy on attachment to God in students engaging in self-injurious behavior.
Method: This study employed a quasi-experimental design with repeated measures and a control group. The statistical population comprised all senior high school students in Parsabad city (N = 5,851) during the 2023-2024 academic year. Initially, using a multi-stage cluster sampling method, 612 students from various schools and classrooms were screened with the Self-Harm Inventory (Sansone et al., 1998). From this pool, 40 individuals with scores ranging from 18 to 24 were randomly selected as the sample. These participants were then matched and assigned to an experimental group (n = 20) and a control group (n = 20). Data were collected using the Self-Harm Inventory (Sansone et al., 1998) and the Attachment to God Inventory (Beck & MacDonald, 2004). The experimental group received the Acceptance and Commitment Therapy (ACT) program over eight 90-minute group sessions, held twice a week for one month. Data were collected at three stages pre-test, post-test and a 28-day follow-up and were analyzed using repeated measures analysis of variance (RM-ANOVA) in SPSS software, version 28.
Results: Descriptive results showed that the mean scores for attachment to God in the intervention group significantly decreased from pre-test (107.45) to post-test (73.95) and follow-up (73.15), which indicates an increase in attachment to God, while the control group showed no significant change. The results of multivariate analysis of variance showed that the linear combination of the dependent variable after the intervention had a significant difference between the groups (Pillai’s Trace = 0.99, F=4728.84, p<0.01). Furthermore, the results of the within-subjects test (time-group interaction), with the Greenhouse-Geisser correction, were significant (F=2120.41, p<0.01), confirming the effect of the intervention on attachment to God. The Bonferroni post-hoc test in the intervention group showed a significant difference between the pre-test and post-test (mean difference = 33.50, p<0.01) and between the pre-test and follow-up (mean difference = 34.30, p<0.01). The lack of a significant difference between the post-test and follow-up indicated the durability of the treatment’s effect.
Discussion and Conclusion: The results indicated that ACT was effective in enhancing attachment to God among students with self-injurious behavior. This effectiveness is attributed to how ACT helps individuals accept unpleasant internal experiences and move toward a values-driven life (Hayes et al., 2011). For these adolescents, attachment to God serves as a supportive resource, providing an alternative to self-injury when facing challenges and acting as a source of security (Kirkpatrick, 2005). Through mechanisms such as emotional acceptance, commitment to behaviors aligned with spiritual values (e.g., prayer) and present-moment awareness, ACT enables adolescents to turn to God rather than resorting to unhealthy coping strategies. Ultimately, this integrated approach reduces the propensity for self-injury by increasing psychological flexibility, as the perceived support from God leads to an overall improvement in their mental health (Hayes et al., 2004).
Acknowledgments: The authors would like to thank the supervisors and advisors of this research, the management and educational staff of the participating schools and the students and their parents for their participation in this study.
Conflict of interest: the authors declare no conflict of interest for this study.

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References

منابع
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