Comparative Effectiveness of Acceptance and Commitment Therapy and Short-Term Psychodynamic Psychotherapy on Sexual Intimacy and Marital Silence in Women with Marital Burnout
Objective: This study compared the effectiveness of ACT and short-term psychodynamic psychotherapy in improving sexual intimacy and reducing marital silence among women experiencing marital burnout.
Methods: In a quasi-experimental design with pre-test, post-test, and follow-up, 45 married women meeting criteria for marital burnout were selected through purposive sampling and randomly assigned to three groups: ACT (n = 15), short-term psychodynamic psychotherapy (n = 15), and a wait-list control group (n = 15). The intervention groups received eight weekly 90-minute sessions based on standard ACT and short-term psychodynamic protocols. All participants completed validated measures of sexual intimacy and marital silence at pre-test, post-test, and eight-week follow-up. Data were analyzed using repeated-measures ANOVA and ANCOVA, controlling for baseline scores.
Results: Both ACT and short-term psychodynamic psychotherapy produced significant improvements in sexual intimacy and reductions in marital silence compared with the control group at post-test (p < .01). These gains were largely maintained at follow-up. Between the two active treatments, ACT showed slightly greater effects on reducing marital silence, whereas improvements in sexual intimacy were comparable across approaches. Effect sizes for both interventions were in the moderate-to-large range.
Conclusions: ACT and short-term psychodynamic psychotherapy are both effective for enhancing sexual intimacy and reducing marital silence in women with marital burnout, with ACT showing a relative advantage for breaking maladaptive patterns of silence. Integrating these approaches into couple-focused services may improve relational outcomes for distressed women.
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Azimi, S., Javadivala, Z., Alizadeh Mizani, M., Pourrazavi, S., Fathifar, Z., Chattu, V. K., et al. (2023). A glance at the efficiency of marital sexual intimacy interventions: The different outcomes on couples and women. The Family Journal. Advance online publication. https://doi.org/10.1177/10664807231174220
Azimi, S., Torkzahrani, S., Moslemi, A., Azin, S. A., Ozgoli, G., & Joulaee Rad, N. (2025). A qualitative exploration of declining sexual intimacy among married men and women. [Journal name], [volume], [pages]. (PMCID: PMC12680515).
Ghasemi, M., [co-authors]. (2023). Effect of Acceptance and Commitment Therapy (ACT) on the quality of life of Iranian women at post-menopause ages. [Journal of Mid-life Health / similar], [volume], [pages].
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
International Society for Sexual Medicine (ISSM). (2024). The role of acceptance and mindfulness in sexual health. Sexual health headlines.
Khodadad, F., Agah Heris, M., Rahmanian, M., & Kordmirza Nikoozadeh, E. (2025). Effectiveness of short-term psychodynamic therapy on negative meta-emotion and marital burnout in betrayed women. Psychology of Woman Journal, 6(3), 1–9. https://doi.org/10.61838/kman.pwj.6.3.11
Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: A meta-analysis. Archives of General Psychiatry, 61(12), 1208–1216.
Minoosepehr, Z., [co-authors]. (2022). A structural equation modeling to explain marital burnout: Pornography consumption and perfectionism with the mediating role of sexual self-concept. Practice in Clinical Psychology, 10(1), 59–70.
Najibzadegan, A., Bahrainian, S. A., & Shahabizadeh, F. (2024). Efficacy of Acceptance and Commitment Therapy on intimacy, marital forgiveness, and marital burnout in women affected by extramarital relationships. Applied Family Therapy Journal, 5(3), 102–112. http://dx.doi.org/10.61838/kman.aftj.5.3.11
Nejatian, M., Rahmani, M., Parizad, N., Dehghan, A., Heydari, H., & Asghari Jafarabadi, M. (2021). Investigating the status of marital burnout and related factors in married women referred to health centers. Journal of Education and Health Promotion, 10, 1–9.
Nezhad, M. Z., & Goodarzi, A. M. (2011). Sexuality, intimacy, and marital satisfaction in Iranian first-time parents. Journal of Sex & Marital Therapy, 37(2), 77–88.
Papp, L. M., Kouros, C. D., & Cummings, E. M. (2009). Demand–withdraw patterns in marital conflict in the home: Links with conflict, emotions, and partners’ depression. Journal of Family Psychology, 23(3), 351–360.
Pines, A. M. (1996). Couple burnout: Causes and cures. Routledge.
Pines, A. M. (2002). A psychoanalytic–existential view of burnout: From individual stress to existential crisis. In W. Schaufeli, C. Maslach, & T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 55–76). Taylor & Francis.
Rosen, N. O., et al. (2024). Demand–withdrawal communication during sexual conflict discussions and its associations with couples’ sexual and relationship well-being: An observational and prospective study. [Manuscript / Journal of Sex Research].
Saremi Nezhad, M., et al. (2017). The effect of Acceptance and Commitment Therapy on sexual satisfaction of couples in Shiraz. International Journal of Medical Research & Health Sciences, 6(1), 58–65.
Schrodt, P., Witt, P. L., & Shimkowski, J. R. (2014). A meta-analytical review of the demand/withdraw pattern of interaction and its associations with individual, relational, and communicative outcomes. Communication Monographs, 81(1), 28–58.
Ziapour, A., Hajiazizi, A., Ahmadi, M., & Dehghan, F. (2023). Effect of short-term dynamic psychotherapy on sexual function and marital satisfaction in women with depression: Clinical trial study. Health Science Reports, 6(6), e1370. https://doi.org/10.1002/hsr2.1370
Azimi, S., Javadivala, Z., Alizadeh Mizani, M., Pourrazavi, S., Fathifar, Z., Chattu, V. K., et al. (2023). A glance at the efficiency of marital sexual intimacy interventions: The different outcomes on couples and women. The Family Journal. Advance online publication. https://doi.org/10.1177/10664807231174220
Azimi, S., Torkzahrani, S., Moslemi, A., Azin, S. A., Ozgoli, G., & Joulaee Rad, N. (2025). A qualitative exploration of declining sexual intimacy among married men and women. [Journal name], [volume], [pages]. (PMCID: PMC12680515).
Ghasemi, M., [co-authors]. (2023). Effect of Acceptance and Commitment Therapy (ACT) on the quality of life of Iranian women at post-menopause ages. [Journal of Mid-life Health / similar], [volume], [pages].
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
International Society for Sexual Medicine (ISSM). (2024). The role of acceptance and mindfulness in sexual health. Sexual health headlines.
Khodadad, F., Agah Heris, M., Rahmanian, M., & Kordmirza Nikoozadeh, E. (2025). Effectiveness of short-term psychodynamic therapy on negative meta-emotion and marital burnout in betrayed women. Psychology of Woman Journal, 6(3), 1–9. https://doi.org/10.61838/kman.pwj.6.3.11
Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: A meta-analysis. Archives of General Psychiatry, 61(12), 1208–1216.
Minoosepehr, Z., [co-authors]. (2022). A structural equation modeling to explain marital burnout: Pornography consumption and perfectionism with the mediating role of sexual self-concept. Practice in Clinical Psychology, 10(1), 59–70.
Najibzadegan, A., Bahrainian, S. A., & Shahabizadeh, F. (2024). Efficacy of Acceptance and Commitment Therapy on intimacy, marital forgiveness, and marital burnout in women affected by extramarital relationships. Applied Family Therapy Journal, 5(3), 102–112. http://dx.doi.org/10.61838/kman.aftj.5.3.11
Nejatian, M., Rahmani, M., Parizad, N., Dehghan, A., Heydari, H., & Asghari Jafarabadi, M. (2021). Investigating the status of marital burnout and related factors in married women referred to health centers. Journal of Education and Health Promotion, 10, 1–9.
Nezhad, M. Z., & Goodarzi, A. M. (2011). Sexuality, intimacy, and marital satisfaction in Iranian first-time parents. Journal of Sex & Marital Therapy, 37(2), 77–88.
Papp, L. M., Kouros, C. D., & Cummings, E. M. (2009). Demand–withdraw patterns in marital conflict in the home: Links with conflict, emotions, and partners’ depression. Journal of Family Psychology, 23(3), 351–360.
Pines, A. M. (1996). Couple burnout: Causes and cures. Routledge.
Pines, A. M. (2002). A psychoanalytic–existential view of burnout: From individual stress to existential crisis. In W. Schaufeli, C. Maslach, & T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 55–76). Taylor & Francis.
Rosen, N. O., et al. (2024). Demand–withdrawal communication during sexual conflict discussions and its associations with couples’ sexual and relationship well-being: An observational and prospective study. [Manuscript / Journal of Sex Research].
Saremi Nezhad, M., et al. (2017). The effect of Acceptance and Commitment Therapy on sexual satisfaction of couples in Shiraz. International Journal of Medical Research & Health Sciences, 6(1), 58–65.
Schrodt, P., Witt, P. L., & Shimkowski, J. R. (2014). A meta-analytical review of the demand/withdraw pattern of interaction and its associations with individual, relational, and communicative outcomes. Communication Monographs, 81(1), 28–58.
Ziapour, A., Hajiazizi, A., Ahmadi, M., & Dehghan, F. (2023). Effect of short-term dynamic psychotherapy on sexual function and marital satisfaction in women with depression: Clinical trial study. Health Science Reports, 6(6), e1370. https://doi.org/10.1002/hsr2.1370
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