Evaluating the Effectiveness of Acceptance and Commitment Therapy on Alexithymia and White Blood Cell Counts in Women with Breast Cancer

Abstract

Background: Alexithymia, defined as difficulty in identifying and expressing feelings, is a common psychological problem among patients undergoing cancer treatment. White blood cell (WBC) counts may also decrease during treatment, creating additional clinical challenges. Objectives: This study evaluated whether Acceptance and Commitment Therapy (ACT) could reduce alexithymic symptoms and modify WBC counts in women with a confirmed diagnosis of breast cancer. Methods: This randomized controlled trial included pretest, posttest, and 1-month follow-up assessments, as well as a control group. Participants were randomly assigned to either an ACT group or a control group that continued standard medical care without additional psychological support. The study population comprised women with breast cancer who were referred to Baqaei Super-Specialty Hospital and a specialized cancer treatment center in Ahvaz during the 2025 - 2026 calendar year. The sample size was determined to be 42 participants using G*Power software. Study instruments included an alexithymia questionnaire and a complete blood count test. The psychotherapeutic intervention was ACT. Data were analyzed using descriptive statistics and inferential methods, particularly mixed analysis of variance, in SPSS version 25. Before conducting repeated-measures analysis of variance, key statistical assumptions were evaluated. The Shapiro-Wilk test was used to assess normality, and Mauchly's test was used to evaluate the sphericity assumption. Results: Acceptance and Commitment Therapy effectively reduced alexithymia levels, and this reduction was maintained over time. However, the observed changes in WBC counts did not achieve statistical significance. Conclusions: These findings suggest that ACT may reduce alexithymia in female patients with cancer by addressing disease-related emotional difficulties. Understanding this effect may help improve care and support programs for individuals undergoing cancer treatment.