A pilot randomized controlled trial of culturally-adapted, telehealth group acceptance and commitment therapy for iranian adolescent females reporting symptoms of anxiety

While the efficacy of internet-based acceptance and commitment therapy (ACT) has been examined for different mental health concerns in high-income countries, evidence for the potential efficacy of culturally-adapted ACT in non-Western, low-and middle-income countries is scarce. The present study is a randomized, waitlist-controlled trial of culturally-adapted, online, manualized group ACT for anxiety in Iranian adolescent females. To partic-ipate, adolescents had to identify as female, report interfering anxiety symptoms, be currently attending high school, and be within the age range of 15-18 years old. Individuals in the active condition (n = 24) participated in eight group sessions delivered over the Shad platform, the largest technological application in the Iranian school system. All individuals in the active condition participated in the same ACT group sessions in a class-like format. Multilevel models were used to test between-group differences for primary and secondary outcomes over time. Participants in the ACT group reported a significant reduction in anxiety and depression, along with im-provements in worry, emotion regulation, and intolerance of uncertainty. Treatment gains were maintained over a one-month follow-up period. The effect sizes for the main outcome measures were small to large (d = .39-1.56) and comparable to other online ACT interventions for youth with anxiety disorders in Western countries. In sum, this pilot study provides preliminary evidence that culturally-adapted, online ACT is effective for the treatment of anxiety symptoms in Iranian female youth.