effectiveness of acceptance and commitment therapy compared to compassion-focused therapy in improving distress tolerance and cognitive flexibility in women with migraine

Background: migraine, a chronic neurological disorder, significantly impacts women's quality of life through psychological distress. acceptance and commitment therapy (act) enhances distress tolerance and cognitive flexibility by promoting acceptance and value-driven action. compassion-focused therapy (cft) fosters self-compassion, reducing self-criticism to alleviate distress and support cognitive flexibility.objectives: the objective of this study was to compare the effectiveness of act and cft in enhancing distress tolerance and cognitive flexibility in women with migraine.methods: this quasi-experimental study employed a pre-test-post-test design with a 3-month follow-up and a control group. the statistical population included women diagnosed with migraine in ahvaz, iran, in 2023. a sample of 108 participants was selected via convenience sampling from patients attending the labkhande zendegi counseling center and randomly assigned to three groups (act, cft, and waitlist control; n = 36 per group) using computer-generated random numbers. the experimental groups received 8 weekly 90-minute sessions of either act or cft, while the control group remained on a waitlist. data were collected using the distress tolerance scale (dts) and cognitive flexibility inventory (cfi) and analyzed using repeated measures analysis of variance with a significance level of 0.05.results: both act and cft significantly improved distress tolerance (act: from 29.70 ± 4.13 to 50.40 ± 4.72; cft: from 30.00 ± 3.99 to 49.35 ± 4.25) and cognitive flexibility (act: from 46.06 ± 5.28 to 78.12 ± 5.88; cft: from 46.60 ± 4.92 to 68.00 ± 5.43) compared to the control group (p < 0.001), with effects maintained at follow-up. the act showed a significantly greater improvement in cognitive flexibility compared to cft (mean difference: 10.12, p < 0.001), but no significant difference was observed for distress tolerance (p = 0.325).conclusions: the findings indicate that both act and cft are effective in improving distress tolerance and cognitive flexibility in women with migraine, with act showing a relative advantage in enhancing cognitive flexibility. these results suggest that clinicians can select either approach based on patient needs, potentially improving psychological management of migraine-related distress.