Document Type : Scientific Research

Authors

• Saman Nonahal ¹
• shahram mohammadkhani ²
• Jafar Hasani ²
• mehdi akbari ³

¹ Ph.D. in Health Psychology, Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran .

² Professor, Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran

³ Associate Professor, Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran .

Abstract

Objective: Given cultural differences, therapies that prove effective in one context may not be equally effective in others. Therefore, our study aimed to culturally adapt the acceptance and commitment therapy matrix protocol for health behaviors (eating and exercise) in the Iranian population with obesity. Method: The cultural adaptation study was conducted in five stages: Protocol Translation, Information Gathering, Preliminary Adaptation, Preliminary Test, and Final Adaptation. In stage 2, three professionals specializing in third-wave behavior therapy, one nutritionist, and one bodybuilding coach participated. In stage 4, five individuals with obesity were involved, and, in stage 5, seven professionals in third-wave behavior therapy participated. Data were analyzed quantitatively (mean and content validity index) and qualitatively. Results: A protocol consisting of 12 sessions was developed, assigning two sessions to each of the six steps of the acceptance and commitment therapy matrix. The adapted protocol differed from the original protocol in terms of metaphors, exercises, and materials. We added three metaphors: The Compass, the Noticing Muscle, and the Monsters on the Bus. Additionally, Matrix cards were introduced, including Goals & Directions, The Magic Wand, Who Is Important, Important, Stuff That Shows Up, Behavior, Toward Moves, Toward & Away, Surfing The Waves, Am I Important, Choosing My Life, Psychological Flexibility, Noticing Muscle, Practice, Stuck Loops, Monster Tug-Of-War, Don't Think of It, Don't Feel It, The 2 Rules, Dead Person's Goals, Hooks, Catch & Release, Verbal Aikido, U-Turn, Monsters on the Bus, Two Friends, Texting My Future Self. We also included four worksheets: The Compass, Who or What Is Important, Two Friends, and Texting My Future Self. Excluded items were The Hooky Words Game and Sorting Five-Senses and Inner Experience. The Monster Tug-Of-War metaphor was used instead of the Man in The Hole metaphor; for an experiential exploration of controlling thoughts, the term “pink elephant” was used instead of “purple unicorn;” the new version of the Verbal Aikido Worksheet was used instead of the existing one; and the Two Friend metaphor was replaced with the Mother Cat Exercise. Furthermore, a short video about physical aikido was added, and the perspective-taking dialogue shifted from verbal format to writing format. The content validity index for each session in the adapted protocol, as well as for the entire adapted protocol, was excellent. Conclusion: The study provides valuable insights into the use of the acceptance and commitment therapy matrix in the Iranian population with obesity. It underscores the importance of considering cultural nuances during intervention design.

Keywords

• Acceptance and Commitment Therapy
• Cultural Adaptation
• Health Behavior
• Obesity

Main Subjects

• A