Introduction
Multiple sclerosis (MS) is a chronic disease of the central nervous system that affects the brain and spinal cord [1]. The disease most often occurs between the ages of 20 and 40. According to the World Health Organization (WHO), the disease prevalence in Iran is 20-60 per 100000 people, and the incidence in women is 3 to 4 times higher than in men [2]. The quality of life of patients with MS is more affected by psychological factors, such as coping, mood, self-efficacy, and perceived support, than biological factors. So, interventional studies should focus on psychological factors concerning the health of these patients and extend beyond social harm and their physical disability [5]. Given the increased number of patients with MS and the psychological factors affecting them, this study was conducted to compare the effectiveness of acceptance and commitment therapy (ACT) and compassion-focused therapy (CFT) for these patients.
Materials and Methods
This research was a quasi-experimental study with a pretest-posttest design and a control group. The statistical population included all patients with MS under treatment by MS clinics in Tehran City, Iran, in the second half of 2019. The patients included 2500 people. Of whom, 45 patients were randomly assigned to ACT, CFT, and control groups. Participants completed the Connor-Davidson resilience scale (CD-RISC) and the Pennsylvania state worry questionnaire (PSWQ) in both the pretest and posttest phases. The groups received eight sessions of ACT and ten sessions of CFT, respectively. The control group received no intervention. The posttest was performed at the end of the treatment sessions. At the inferential statistics level, multivariate analysis of variance (MANOVA) and multivariate analysis of covariance (MANCOVA) was used to eliminate the effect of pretest to test the study hypotheses. Questionnaires were reviewed to determine and extract outliers before performing descriptive and inferential analyses. Data were analyzed by descriptive and inferential statistics in SPSS v. 24 software.
Results
The study sample consisted of 45 patients with MS, of whom 15 were randomly assigned to the first experimental group (ACT), 15 to the second experimental group (CFT), and 15 to the control group. The sample’s age range was 20 to 40 years, with an average of 28.84 years. The number of females was 0.33 times higher than males. There was no significant difference between the subjects by age and level of education when analyzing qualitative data through descriptive statistics using measures of central tendency, dispersion, and frequency distribution.
Three groups had equal resilience and worry scores before intervening and in the pretest. The resilience and worry scores of the experimental group decreased compared to the control group after the intervention. Thus, there was a significant difference between the experimental and control groups in terms of ACT (P<0.05) and CFT (P<0.05). The effectiveness of these two treatments is compared in Tables 1 and 2.




According to the results of MANCOVA at the statistical level of P<0.05, F=5.88 for resilience and F=42.60 for worry, ACT was more effective than CFT.
Discussion
Since self-compassion increases the secretion of oxytocin in the body, the immune system becomes more active and relieved. As a result, people become more aware of their difficult emotions, better manage them, and achieve higher resilience [41]. Because patients experience changes in their physical abilities, and these changes may lead them to self-blame and, consequently, worry and rumination about their physical condition, CFT can reduce patients’ rumination and worry by affecting self-criticism. Self-compassion includes taking care of oneself in the face of difficulties. High self-compassion is associated with psychological well-being and protects the individual against stress [46]. The ACT approach suggests that human suffering results from psychological inflexibility reinforced by cognitive fusion and experiential avoidance [47]. The first goal of this treatment is to neutralize avoidant behaviors, and the second is to promote psychological resilience. However,  a high-quality and healthy life depends on accepting negative and positive emotions in the first step and the commitment to reduce negative emotions in a balanced and calm way in the second step (reduced worry originates from this process). Thus, ACT can be expected to effectively reduce the severity of patients’ worries [48]. In this treatment, people learn that stressors and anxieties are not problematic alone but that trying to cope with them is the main problem. The goal of this treatment is to increase a person’s behavior repertoire in the presence of stressful behaviors, i.e., psychological resilience. Centralized processes of ACT teach participants how to abandon problem-solving avoidance strategies, break free from annoying thoughts, strengthen the observing self instead of the conceptualized self, accept internal events instead of control, and address their stated values [49].

Compliance with ethical guidelines
This study has been approved by Islamic Azad University of Torbetjam with the code of ethics IR.IAU.TJ.REC.1399.012.

Funding
This article is the result of a doctoral student thesis of the Mir Moeini campus in the field of health psychology and has not received any financial aid from government, private or non-profit organizations.

Authors' contributions
All authors contributed equally in preparing all parts of the research.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We are grateful for the continuous presence of Dr. Amirreza Azimi Sain, MS Clinic MS Fellowship, who favored us in all stages of implementation and scientific research.
 

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