دانشگاه اصفهان پژوهش های علوم شناختی و رفتاری 2251-7642 15 1 2025 08 23 The Effectiveness of Acceptance and Commitment Therapy (ACT) on Rumination and Cognitive Confusion in Injured Athletes اثربخشی درمان پذیرش و تعهد ACT بر نشخوار فکری و آشفتگی شناختی ورزشکاران آسیب‌دیده 123 142 30050 10.22108/cbs.2025.145706.2035 FA فرشته ایزدخواه استادیار،گروه رفتار حرکتی و روانشناسی ورزشی، دانشکده علوم ورزشی، دانشگاه شهید چمران اهواز، اهواز، ایران پیمان هنرمند دکتری روانشناسی ورزش، گروه روانشناسی ورزش، دانشکده علوم ورزشی، دانشگاه تهران، تهران، ایران. حسین احمدی نیا دانشجوی کارشناسی تربیت‌بدنی و علوم ورزشی، دانشکده علوم ورزشی، دانشگاه شهید چمران اهواز، اهواز، ایران. مصطفی جلیلی دانشجوی کارشناسی تربیت‌بدنی و علوم ورزشی، دانشکده علوم ورزشی، دانشگاه شهید چمران اهواز، اهواز، ایران. Journal Article 2025 06 17 Rumination and cognitive confusion are common challenges among injured athletes. This study aimed to examine the effectiveness of Acceptance and Commitment Therapy (ACT) on rumination and cognitive confusion in injured athletes. In this semi-experimental study, 40 injured athletes were randomly assigned to two groups: an experimental group and a control group. The experimental group received ACT for 8 weeks, with two 90-minute sessions per week, while the control group received no intervention. Both groups were assessed at three stages: pre-test (one day before the intervention), post-test (one day after the intervention), and follow-up (two weeks after the post-test). Data were collected using the Ruminative Responses Scale (RRS) and the Mason Cognitive Confusion Questionnaire (MCQ) and analyzed using mixed-design repeated measures ANOVA in SPSS version 23, with a significance level of 0.05. Results indicated that ACT significantly reduced rumination (F = 7.973, p = 0.001, η² = 0.296) and cognitive confusion (F = 46.278, p = 0.001, η² = 0.709) in the experimental group, and these positive effects were maintained during the follow-up period. ACT is suggested as an effective therapeutic approach to reduce rumination and cognitive confusion in injured athletes. By helping athletes accept unpleasant thoughts and feelings and enhancing psychological flexibility, this therapy can contribute to improving their quality of life.<br /><strong>Introduction</strong><br />Sports are not only a platform for physical development and skill improvement but also an important environment for shaping personal identity, boosting self-confidence, and experiencing positive emotions. However, athletic injuries are an unavoidable part of sports and often lead to significant physical and mental effects. After an injury, many athletes face not just physical limitations but also notable psychological pressures, including rumination and cognitive confusion (Borders, 2020).<br />Rumination, as a maladaptive cognitive style, involves repetitive and persistent focus on negative thoughts and unpleasant past experiences (Borders, 2020). This pattern of thinking not only diminishes athletes’ concentration and psychological energy but also disrupts their adaptation to injury and return to sports activities (Lundgren et al., 2021). On the other hand, cognitive confusion, characterized by difficulties in processing information, organizing thoughts, and making decisions, may intensify during periods of injury and significantly impair athletes’ psychological functioning (White et al., 2023). The interaction between these two variables threatens athletes’ mental health and has negative effects on rehabilitation quality, motivation, and self-confidence (Van Vugt  et al., 2018).<br />In this regard, Acceptance and Commitment Therapy (ACT), as one of the third-wave behavioral and cognitive-behavioral therapies, has received considerable attention (Borders, 2020). ACT emphasizes acceptance of internal experiences instead of avoidance, and prioritizes living in accordance with personal values rather than merely reducing symptoms (Lundgren et al., 2021). By focusing on processes such as acceptance, mindfulness, cognitive confusion, and committed action, ACT helps individuals establish a healthier relationship with their thoughts and emotions. Therefore, ACT can play a crucial role in reducing rumination and alleviating the adverse effects of cognitive confusion in injured athletes (Amouzadeh & Bahrami., 2024).<br />Research in the fields of clinical and sport psychology has demonstrated that ACT-based interventions can effectively improve psychological well-being, enhance quality of life, and reduce symptoms of anxiety and depression (Amouzadeh & Bahrami, 2024; Borders, 2020; Lundgren et al., 2021; White et al., 2023). Nevertheless, only a limited number of studies have specifically examined the effectiveness of ACT on rumination and cognitive confusion in populations of injured athletes (Amouzadeh & Bahrami, 2024). Given that athletic injuries represent a highly challenging condition both physically and psychologically, implementing effective psychological interventions may facilitate the rehabilitation process, increase motivation, and promote a successful return to sports participation (Lundgren et al., 2021).<br />Accordingly, the present study aims to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing rumination and cognitive confusion among injured athletes. The findings of this study are expected to enrich the existing body of knowledge, provide practical guidelines for sport psychologists, coaches, and rehabilitation specialists, and underscore the importance of integrating psychological interventions with medical and physiotherapeutic treatments.<br /><strong>Materials and Methods</strong><br />This semi-experimental study was conducted to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) on rumination and cognitive confusion in injured athletes. A total of 40 injured athletes were recruited and randomly assigned to two groups: an experimental group and a control group, each consisting of 20 participants. The random assignment ensured that baseline characteristics were balanced across the two groups, minimizing potential selection bias.<br />The experimental group underwent an ACT-based intervention program lasting eight weeks, with two 90-minute sessions per week. These sessions were structured according to established ACT protocols, emphasizing core processes such as acceptance, cognitive confusion, mindfulness, values clarification, and committed action. The control group did not receive any psychological intervention during the study period, allowing for a clear comparison of the treatment effects.<br />Data were collected at three time points: pre-test (one day before the intervention), post-test (one day after the completion of the intervention), and follow-up (two weeks after the post-test). To assess the key variables, the study employed two standardized questionnaires: the Ruminative Response Scale (RRS), designed to evaluate repetitive and reflective thinking patterns, and the Mason Cognitive Confusion Questionnaire (MCQ), measuring levels of cognitive confusion and difficulty in processing information. Both instruments have demonstrated adequate reliability and validity in prior Iranian studies, ensuring the appropriateness of their use in this context.<br />The collected data were analyzed using mixed-design analysis of variance (ANOVA) with repeated measures in SPSS version 23. This statistical approach allowed for examination of within-group changes over time as well as between-group differences, providing a comprehensive understanding of the intervention’s effectiveness. The significance level was set at 0.05 for all statistical tests. Effect sizes were also calculated to estimate the magnitude of ACT’s impact on rumination and cognitive confusion, enhancing the interpretability and practical relevance of the findings.<br />This methodological design, combining a randomized control framework, standardized measurement tools, and repeated assessments, aimed to rigorously evaluate the causal effects of ACT while accounting for temporal changes in psychological outcomes.<br /><strong>Results</strong><br />The findings indicated that Acceptance and Commitment Therapy (ACT) had a significant effect on reducing rumination and cognitive confusion in injured athletes. Mixed-design ANOVA showed a significant difference between the experimental and control groups in rumination (F = 7.973, η² = 0.296, <em>p</em> < 0.001), with the experimental group exhibiting a substantial decrease in rumination after the intervention.<br />Similarly, the analysis for cognitive confusion revealed a significant effect of ACT; the experimental group showed a significant reduction compared to the control group (F = 46.278, η² = 0.709, <em>p</em> < 0.001). This reduction was maintained during the follow-up period, indicating the persistence of the intervention effects shortly after the completion of the therapy sessions.<br />Overall, the findings emphasize that ACT can be an effective intervention for reducing rumination and cognitive confusion in injured athletes, with its effects remaining stable at least two weeks after the intervention.<br /><strong>Conclusion</strong><br />In summary, this study demonstrated that Acceptance and Commitment Therapy (ACT) effectively reduces rumination and cognitive confusion in injured athletes. The structured eight-week ACT intervention produced significant improvements in participants’ psychological and cognitive outcomes, and these effects were maintained during the follow-up period, indicating short-term stability of the intervention effects. Considering the importance of mental health and cognitive functioning in injured athletes, and the limitations of pharmacological interventions, ACT-based psychotherapy provides a practical and accessible approach to support psychological and cognitive well-being in this population. Implementing these programs in sports centers, psychological clinics, or even individually can complement existing support methods. Future research should explore the underlying mechanisms of ACT, optimize session duration and frequency, and evaluate the long-term effects on other cognitive functions and daily performance of athletes.<br /><strong>Ethical Considerations</strong><br /><strong>Compliance with ethical guidelines</strong><br />This study was approved by the Ethics Committee of Shahid Chamran University of Ahvaz with the ethical code IR.SCU.REC.1403.122.<br /><strong>Funding</strong><br />There is no funding support.<br /> <br /><strong>Authors’ Contribution</strong><br />The first author was responsible for implementing the study procedures, data collection, data analysis and interpretation, and manuscript writing. The second author contributed to study design, data analysis and interpretation, as well as revisions and approval of the final version. The third author was responsible for revisions and approval of the final version. The fourth author also contributed to revisions and approval of the final version<br /><strong>Conflict of Interest</strong><br />Authors declared no conflict of interest.<br /><strong>Acknowledgments</strong><br />We are grateful to all the athletes who participated in this study.<br /><strong> </strong>  <br />نشخوار فکری و آشفتگی شناختی از چالش‌های شایع در ورزشکاران آسیب‌دیده محسوب می‌شوند. این مطالعه با هدف بررسی اثربخشی درمان پذیرش و تعهد (ACT) بر نشخوار فکری و آشفتگی شناختی ورزشکاران آسیب‌دیده انجام‌ شده است. در این پژوهش نیمه‌آزمایشی، 40 ورزشکار آسیب‌دیده به‌ صورت تصادفی در دو گروه (یک گروه آزمایش و یک گروه کنترل) قرار گرفتند. گروه‌ آزمایش به مدت 8 هفته، هر هفته دو جلسۀ 90دقیقه‌ای، درمان ACT دریافت کردند. گروه کنترل هیچ مداخله‌ای دریافت نکرد. هر دو گروه در سه مرحلۀ پیش‏آزمون (یک روز قبل از مداخله)، پس‌آزمون (یک روز بعد از مداخله) و پیگیری (دو هفته بعد از پس‌آزمون) بررسی شدند. داده‌ها با استفاده از پرسشنامه‌های نشخوار فکری (RRS) و آشفتگی شناختی ماسون (MCQ) جمع‌آوری شدند. داده‌ها با استفاده از تحلیل واریانس آمیخته با اندازه‌گیری‌های مکرر در نرم‌افزار SPSS نسخۀ 23 تحلیل شدند و سطح معنا‌داری ۰٫۰۵ در نظر گرفته شد. نتایج نشان داد درمان ACT به طرزی معنادار باعث کاهش نشخوار فکری (296/0= η2، 001/0=sig، 973/7=F) و آشفتگی شناختی (709/0=η2، 001/0=sig، 278/46=F) در گروه آزمایش شد و این اثر مثبت در طول دورۀ پیگیری نیز حفظ‌ شده است. درمان ACT به ‌عنوان یک رویکرد درمانی مؤثر برای کاهش نشخوار فکری و آشفتگی شناختی در ورزشکاران آسیب‌دیده پیشنهاد می‌شود. این درمان با کمک به ورزشکاران در پذیرش افکار و احساسات ناخوشایند و افزایش انعطاف‌پذیری روان‌شناختی، می‌تواند به بهبود کیفیت زندگی آنها کمک کند.<br />  https://cbs.ui.ac.ir/article_30050_dc241f4083f1fc896601ae60b0cae2e8.pdf