The Effectiveness of Acceptance and Commitment Therapy on Cognitive Flexibility, Rumination and Negative Automatic Thoughts in Students with Self-Harming Behaviors

Abbasi-Ghahramanloo, A., Khodadoust, B., Adham, D., Gholami, A., Farokhi, R., Maghsodlou-Nejad, V., & Afrashteh, S. (2024). Non-suicidal self-injury and its risk factors among Iranian high school and university students. Frontiers in Psychiatry, 15, 1425411. https://doi.org/10.3389/fpsyt.2024.1425411

Anusuya, S. P., & Gayatridevi, S. (2025). Acceptance and Commitment Therapy and Psychological Well-Being: A Narrative Review. Cureus, 17(1), e77705. https://doi.org/10.7759/cureus.77705

Azar, S. K., Naeim, M., & Arjmand, H. (2025). Socio-cultural erosion and the mental health crisis in iranian youth: root causes, challenges, and culturally aligned interventions. Asian Journal of Psychiatry, 103, 104350. https://doi.org/10.1016/j.ajp.2024.104350

Barraca, J., Polanski, T., Duarte-Diaz, A., & Perestelo-Perez, L. (2025). Acceptance and commitment therapy for couples: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 35, 100867. https://doi.org/10.1016/j.jcbs.2024.100867

Bektaş-Aydın, C., & Yüksel-Şahin, F. (2025). Effectiveness of Acceptance and Commitment Therapy on Post-Traumatic Stress Symptoms, Psychological Inflexibility, and Self-Compassion in IPV Survivor University Women. Journal of Interpersonal Violence, 08862605251318283. https://doi.org/10.1177/08862605251318283 

Chung, J. J., Heakes, M., & Kaufman, E. A. (2024). The role of cognitive flexibility in self-injurious thoughts and behaviors: A systematic review. Clinical Psychology: Science and Practice, 31(1), 42–56. https://doi.org/10.1037/cps0000163

Dennis, J. P., & Vander-Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity, Cognitive therapy and research, 34(3):241-53. https://doi.org/10.22070/cpap.2025.19843.1637

Gratz KL. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. J Psychopathol Behav Assess; 23(4):253-63. https://doi.org/10.22126/jap.2025.11478.1821

Hollon, S. D., & Kendall, P. (1980). Development of an Automatic Thoughts Questionnaire. Cognition Therapy and Research. 4, 383-395. https://doi.org/10.22089/spsyj.2025.18326.2596

Ji-hoon, K. (2024). Stress and coping mechanisms in South Korean high school students: academic pressure, social expectations, and mental health support. Journal of Research in Social Science and Humanities, 3(5), 45-54. https://www.pioneerpublisher.com/jrssh/article/view/808

 Kolahkaj, F., & Bakhshi Sooreshjani, L. (2025). The Effectiveness of" Acceptance and Commitment Therapy" on Anger Rumination and Multidimensional Body-Self Relations of Female Students of the Secondary Level with Social Phobia. Journal of Health Promotion Management, 14(2), 102-115.  http://jhpm.ir/article-1-1791-en.html

Kpeno, A., Sahoo, S., Sahu, A. K., & Sahu, P. K. (2024). Problem-solving and coping skills training for youth with deliberate self-harm behaviors: a scoping review. Journal of Indian Association for Child and Adolescent Mental Health, 20(4), 304-313. https://doi.org/10.1177/09731342241278964

Lakani  N,  Akbari  B.  (2021). The Effectiveness of Cognitive Emotion Regulation on Emotional Regulation, Cognitive Flexibility, and Mental Happiness among Students with Internet-addicted: A Pilot Study. Salāmat-i ijtim(Community Health). 8(3):453-467. https://doi.org/10.22098/jpc.2024.15112.1236

Le, G. H., Wong, S., Au, H., Badulescu, S., Gill, H., Vasudeva, S., & McIntyre, R. S. (2025). Association between rumination, suicidal ideation and suicide attempts in persons with depressive and other mood disorders and healthy controls: A systematic review and meta-analysis. Journal of Affective Disorders, 368, 513-527. https://doi.org/10.1016/j.jad.2024.09.118

Mansouri, A., Mansouri, M., & Mansouri, N. (2015). The Relation between Schizotypay and Depression Symptom According to Mediator Role of Rumination. Clinical Psychology and Personality, 12(2), 99-108. https://doi.org/10.30476/whb.2024.103315.1300

Murali, R., & Avudaiappan, V. (2024). Unveiling the invisible struggles: Exploring student perspectives on mental health in universities. IEEE Potentials. https://doi.org/10.1109/MPOT.2024.3486902

Naghashzadeh, S. and Amani, A. (2025). The Effectiveness of Group Therapy based on Acceptance and Commitment on Emotional Eating, Body Image and Rumination of Overweight Female Students. Journal of Psychological Studies, 20(4), 57-71. doi: 10.22051/psy.2024.47505.2977

Nawaz, R.F., Anderson, J.K., Colville, L., Fraser-Andrews, C. and Ford, T.J. (2024), Review: Interventions to prevent or manage self-harm among students in educational settings – a systematic review. Child Adolesc Ment Health, 29: 56-69. https://doi.org/10.1111/camh.12634

Noroozi Homayoon, M., Almasi, M. , Sadri Damirchi, E. and Hatami Nejad, M. (2023). Comparing the Effectiveness of Transcranial Direct Current Stimulation and Repeated Transcranial Magnetic Stimulation Treatment on Working Memory, Impulsivity and Self-Harm Behaviors in People with Borderline Personality. Neuropsychology, 8(31), 1-19. doi: 10.30473/clpsy.2023.65222.1678

Noroozi Homayoon, M., Nasiri, A., Sadri Damirchi, E., & Narimani, M. (2025). The Comparison of the Effectiveness of Emotional Cognitive Regulation Training and Transcranial Direct Current Stimulation on Resilience, Cognitive Flexibility, and Rumination in Older Women with Major Depressive Disorder. Aging Psychology, 11(1), 42-21. doi: 10.22126/jap.2025.11478.1821

Patil, S. V., Srinivas, S. B., Tussing, D. V., & Rhee, J. (2025). Addressing the flexible use of cognitive flexibility constructs: toward a multifaceted approach. Academy of Management Annals, 19(1), 74-131. https://doi.org/10.5465/annals.2023.0078

Rad, Y., Prudenzi, A., Zernerova, L., Gerson, J., & Flaxman, P. E. (2025). Effects of workplace acceptance and commitment therapy (ACT) programs on psychological flexibility’s subprocesses: A systematic review. Journal of Contextual Behavioral Science, 100915. https://doi.org/10.1016/j.jcbs.2025.100915

Radunz, M., Johnson, C., O’Dea, B., & Wade, T. D. (2025). Interventions for self-harm and suicidality in paediatric emergency departments: a meta-review. European child & adolescent psychiatry, 1-10. https://doi.org/10.1007/s00787-025-02706-9 

Rahman Nia, M., Sepah Mansour, M., & Khalili, M. (2025). Effectiveness of Acceptance and Commitment Therapy on cognitive flexibility of Psychiatric Nurses: A Quasi-Experimental Study. Iranian Journal of Organizational psychology. https://doi.org/10.22111/ijop.2025.52386.1049

Sevilla-Liu, A. (2022). Acceptance and commitment therapy and narrative practice: A practically grounded examination of theories and worldviews. Journal of Systemic Therapies, 41(2), 17-39. https://doi.org/10.1521/jsyt.2022.41.2.17

Richardson, R., Connell, T., Foster, M., Blamires, J., Keshoor, S., Moir, C., & Zeng, I. S. (2024). Risk and protective factors of self-harm and suicidality in adolescents: an umbrella review with meta-analysis. Journal of youth and adolescence, 53(6), 1301-1322.  https://doi.org/10.1038/s41598-025-87394-w

Rogers, M. L., Law, K. C., Lawrence, O. C., & Mandel, A. A. (2024). Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens. Behaviour research and therapy, 177, 104524. https://doi.org/10.61882/jrums.24.5.438 

Sadri Damirchi E, Noroozi Homayoon M, Hatami Nejad M. (2025). Developing a Model of Social Anxiety in Students Based on Insecure Attachment Styles and Fear of Failure with the Mediating Role of Rumination: A Descriptive Study. JRUMS; 24 (5) :438-451. http://dx.doi.org/10.61882/jrums.24.5.438

Shahani, S., & Mansouri, A. (2023). The mediating role of cognitive emotion regulation in  the relationship between borderline personality traits and non-suicidal self-injury in students. Clinical Psychology and Personality, 21(1), 33-42.  https://doi.org/10.22098/jfrs.2025.17642.1249

Sun, F., Chen, Y., Li, H., Wei, S., Wang, S., & Zhao, H. (2025). Developmental trajectories of interpersonal stress in school and psychological pain contributing to self‐harm in adolescents. Suicide and Life‐Threatening Behavior, 55(2), e13144. https://doi.org/10.30476/whb.2025.105249.1333  

Tabatabei, F. (2011). The Comparison of Perceived Stress and Negative  Automatic Thoughts in Addicted and Non-addicted Individuals, M. A. Dissertation, Mash-had Ferdosi University. https://doi.org/10.22054/jem.2025.82349.3576

Thompson, B., Moghaddam, N., Evangelou, N., Baufeldt, A., & Das Nair, R. (2022). Effectiveness of acceptance and commitment therapy for improving quality of life and mood in individuals with multiple sclerosis: A systematic review and meta-analysis. Multiple Sclerosis and Related Disorders, 63, 103862. https://doi.org/10.1016/j.msard.2022.103862

Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis, Cognit Ther Res, 27(3):247-59. https://doi.org/10.22126/jap.2025.11026.1801

Turrell, S. L., Bell, M., & Wilson, K. G. (2016). ACT for adolescents: Treating teens and adolescents in individual and group therapy. Context Press. https://doi.org/10.32598/jpcp.13.3.1049.1

Wang, D., Lin, B., Du, J., Liu, W., Sun, T., Li, Q., & Xiao, L. (2025). Acceptance and commitment therapy for nurses’ sleep, rumination, psychological flexibility, and it's neural mechanism: A randomized controlled fNIRS study. International Journal of Clinical and Health Psychology, 25(1), 100543. https://doi.org/10.1016/j.ijchp.2025.100543

Westhoff, M., Heshmati, S., Siepe, B., Vogelbacher, C., Ciarrochi, J., Hayes, S. C., & Hofmann, S. G. (2024). Psychological flexibility and cognitive-affective processes in young adults’ daily lives. Scientific Reports, 14(1), 8182. https://doi.org/10.1016/j.brat.2024.104638

Wu, O., Zhu, M., Yeo, K. J., Xu, W., Wu, Y., & Lu, X. Navigating Emotions: The Role of Self-Talk in Preventing Adolescent Self-Injury. Health Education & Behavior, 10901981251363168. https://doi.org/10.22059/japr.2024.375061.644904 

Zou, Y., Wang, R., Xiong, X., Bian, C., Yan, S., & Zhang, Y. (2025). Effects of acceptance and commitment therapy on negative emotions, automatic thoughts and psychological flexibility for depression and its acceptability: a meta-analysis. BMC psychiatry, 25(1), 602. https://doi.org/10.22098/jpc.2022.1733