Conflicts in marital life occur in case of disagreement, maladjustment, or difference between couples. In addition, marital conflicts can be attributed to couples’ disagreement on personal goals, motivations, values, or behavioral preferences. The importance of handling marital conflicts will be only perceived when their effects on physical, mental, and family health are taken into account [1].
Couples’ behaviors during conflicts include a wide range. Some couples get caught up in a cycle of increasingly negative interactions. In the long term, this situation causes marital dissatisfaction and is associated with a higher rate of physical aggression [2]. Marital conflicts and marital disturbances are widespread issues in many families, not only leading to the increased rates of divorce in developing countries but also causing psychosocial and psychological disorders in couples and their children [3].
Bohler et al. [4] define marital conflicts as disagreement, stressful and hostile interactions between a husband and wife, and disrespect and insult that may be accompanied by profanity [5]. For Glasser [6], marital conflicts are the results of a couple’s disharmony on the type of needs and the way they are satisfied, self-centeredness, difference in desires, behavioral schemas, and irresponsible behaviors in the marital relationship and marriage [7].
The first signs of conflict include talking ironically, finding flaws, maintaining heavy silence, or criticizing and screaming [8]. Marital conflicts can also be manifested in various forms, such as wife-beating, spousal misconduct, sexual abuse, lack of responsibility, illegitimate relationships, sexual assaults, and subtle controversies among husbands and wives [9]. Among the consequences of marital conflicts are no psychological well-being [10], insecure attachment style, severe psychiatric disorders (e.g., depression, anxiety disorders, and sexual abuse disorders), physical health problems [11], high tension, chronic pains, and ischemic heart diseases [10].
It seems that many variables can contribute to reducing couples’ conflicts, including the quality of interpersonal relationships. One of the most important and stable elements in strengthening the marital relationship and marital satisfaction is the quality of interpersonal communication [12]. Intimate relationships, such as relationships between couples, are the foundation stone of marital success and communication quality [13]. The quality of couples’ interpersonal relationships is a multidimensional concept that encompasses various aspects of relationships in couples, such as adjustment, satisfaction, happiness, cohesion, commitment, communication, and dialogue [13].
In a review with multiple systematic principles, Lawrence et al. referred to five dimensions of interpersonal relationship quality, including emotional intimacy, quality of the sexual relationship, interpersonal support, ability to share the power of communication, and conflict management [14]. People with poorer relationship quality have more depression and stress than individuals with better relationship quality; accordingly, both stress and depression impair a person’s immune function. Couples with better marital quality are more likely to use couples’ health care services [15]. These couples will more frequently participate in housing, parenting, and financial issues. However, couples with poorer interpersonal communication quality exhibit higher levels of emotional violence, including behaviors, such as the humiliation of wife in public, threats, and insults [14].
Changing couples' interactions and dialogues are important goals for most couple and family therapies. Many approaches have developed specific sets of interventions to bring partners into contact to change negative interactions into positive ones [16]. Some types of couple therapy, such as structural couple therapy, emphasizing family structure rather than changing individuals to change families and creating inflexible :union:s (e.g., the presence of boundaries, such as a defined boundary, a strict boundary, and an uncertain boundary) result in a lack of flexibility in the quality of marital relationships [17].
Bowenian couple therapy model has focused
on concepts, such as differentiation, triangles, emotional systems, and emotional triangles [18]. Moreover, psychoanalytic attitude-based therapists, such as Freud, Firburn, and Winnicott, emphasized the unconscious, early memories, and internalized experiences with loved ones in relationships. In addition, the linear analysis model with an emphasis on the causal relationship in interactions [19] has caused the aforementioned approaches not to be as effective as acceptance and commitment therapy (ACT) and emotionally-focused couple therapy (EFCT) in enhancing the quality of interpersonal relationships among couples with marital conflicts.
Almost all previous studies have analyzed the behavioral, cognitive, and emotional dimensions of variables in an analytic and one-dimensional way, and these three dimensions, considering the circular causality between them, have not been simultaneously and systematically studied regarding the relationships of distressed couples. The EFCT and ACT investigate all behavioral, cognitive, and emotional dimensions. The EFCT is a type
of short-term couple therapy (including 8-20 sessions) aimed at modifying spouse interactions by assisting spouses to identify and accept early unconscious emotions and resolve the conflicting patterns of marital conflicts. 
Multiple studies have confirmed the effectiveness of EFCT. This type of couple therapy is based on the attachment theory, in which temporary insecure attachments (e.g., the fear of abandonment) and negative emotions, such as anger and aggression, can stem from challenges among spouses [3]. Based on this therapeutic model developed by Dr. Sui Johnson and Leslie Greenberg in the 1980s and later popularized in the United States and around the world, firstly, the damaged cycles of the couple's relationships stop, and then new cycles are formed. Finally, the therapist deals with reinforcing new interactive cycles [20].
The EFCT offers clinicians a technique to reduce conflicts by the establishment of a secure emotional connection. The theoretical basis of EFCT is rooted in the humanistic empirical perspectives of Roger and Pearl. The EFCT encompasses Guttmann’s empirical work on healthy communications versus unhealthy communications, each one showing a destructive interplay of the interactive cycles of criticism, defensiveness, and complaint among others so that women tend to criticize and complain, and men tend to be deterred and inhibited [21]. A meta-analysis study of the four precise results of the EFCT approach showed 70-73% efficiency in the improvement of troubled relationships as well as a significant 90% improvement [22]. Based on the EFCT approach, the emotional experiences of couples are identified and eventually improved by processing and reorganizing the interactive patterns that lead to couples' helplessness in marital relationships [23].
Among the effective therapeutic interventions to improve the quality of interpersonal relationships in couples with marital conflicts, ACT therapists interpret love as a valued object. If spouses act on the basis of values according to which they marry, dialogue becomes easier in the ups and downs of life. In addition, value-based behaviors make couples happier in their relationships. The marital relationship in nature causes couples to encounter many ups and downs, and this is why flexibility in a relationship is so important. Furthermore, psychological flexibility, which is one of the goals of couples' therapy based on ACT, helps couples maintain marital intimacy.
From the perspective of treatment, psychological flexibility is based on acceptance and commitment that is the ability to communicate fully with the present and change or maintain behaviors in the service of important values of life [24]. Furthermore, EFCT emphasizes increasing the interactive needs (i.e., the reconstruction of interactive patterns) of couples, achieving safe interpersonal relationships patterns and empathy, and enhancing flexibility and growth in couples with marital conflict [21]. Therefore, both ACT and EFCT are utilized which are rooted in the third wave of behavioral therapies and can help enhance the quality of interpersonal relationships with better lives and feelings in couples with marital conflicts.
According to the literature, ACT led to a decrease in psychological inflexibility, self-criticism, increase in marital satisfaction, reduction of interpersonal psychological anxiety [25], reduced infertility stress and psychological distress [26], depression and suicidal thoughts [27], and obsessive-compulsive disorder [28]. Therefore, it seems that this therapeutic approach can be effective in the adjustment of couples' satisfaction. It is worth noting that multiple studies have shown that mindfulness techniques in ACT lead to observing and accepting emotions and escaping negative events (i.e., empirical avoidance) as they occur [29]. Consequently, ACT help couples consciously increase their cognition and acceptance, use metaphors to experience negative thoughts and reactions related to marriage in new ways, provide an opportunity to clarify values and commitment to enhance the quality of couples' interpersonal relationships, and reduce psychological and interpersonal sufferings [29].
According to the above-mentioned investigations and limited number of studies carried out on the effectiveness of ACT in the quality of interpersonal relationships in couples with marital conflict, the present study demonstrated that ACT was effective in improving the quality of interpersonal relationships among couples with marital conflicts. The ACT was developed and recognized by Steven Hayes (1987) at the University of Nevada, United States, in the 1980s. This therapeutic procedure is a form of cognitive-behavioral therapy based on functional contextualism and is rooted in a new theory about language and cognition which is a theory of mental relations framework [30].
The ACT teaches couples to embrace their thoughts and feelings, choose new lifestyles, and take committed actions. The ACT includes six central processes leading to psychological flexibility. These six processes are acceptance versus avoidance, mindfulness (i.e., the consideration of self as the context) versus conceptualized self, relation of the present versus overcoming of the past and conceptualized future, dissonance versus cognitive blending, emphasis on values versus lack of clarity of values and their relation to them, and committed action versus isolation [30-32]. The ACT is a therapeutic approach based on the evidence that combines mindfulness and acceptance procedures with commitment and behavioral changing techniques to enhance the goals of psychological flexibility [33].
The ACT has the best evaluation with regard to its goals. This type of treatment with a knowledge development strategy is called contextual behavioral knowledge [34]. The goal of this treatment is to provide a meaningful and productive life by effectively controlling the pain, suffering, and stress that life has brought about. The ACT changes the relationship between troubled thoughts and feelings; accordingly, individuals do not consider them morbid symptoms and even learn that they are harmless [35]. With this background in mind, the present study aimed to compare the effectiveness of two ACT and EFCT approaches in the quality of interpersonal relationships among couples with marital conflicts.
According to the literature, it seems that the strength of this study is that the effectiveness of ACT and EFCT in the quality of interpersonal relationships among couples with marital conflicts has not been studied and compared to date. Therefore, it is necessary to carry out further studies in this regard because many couples annually experience conflicts and they have to adapt to a great number of life changes and new emotional adjustments.
 
Objectives
The present study aimed to investigate the effectiveness of emotionally-focused couple therapy (EFCT) and acceptance and commitment therapy (ACT) in the quality of interpersonal relationships among couples with marital conflicts.
 
Materials and Methods
This was a semi-experimental study with a pretest-posttest design, follow-up test, and control group. The statistical population included all the conflicting couples referring to counseling centers of Tayebad, Iran, in the second half of 2017. At first, among the four counseling centers in Tayebad, two centers were randomly selected, and then 60 couples with marital conflict were referred for initial evaluation and completion of the marital conflicts questionnaire. With regard to the cut-off score (i.e., a minimum of 42 and maximum of 168), 15 couples did not meet the criteria for entry into the study, and 45 couples (i.e., 15 couples in the ACT, 15 couples in the EFCT, and 15 couples in the control groups) were chosen through convenient sampling and randomly assigned to the experimental and control groups. Since 6 couples were unable to participate in therapeutic sessions, the data on 39 couples were statistically analyzed.
The inclusion criteria were marital conflicts, physical and mental health, minimum of diploma literacy, at least 2 years and a maximum of 10 years of living together, both couples attending the treatment sessions, living together and no decision on divorce, and no psychological disorders. The exclusion criteria were a wife or husband with no addictive or alcoholic spouse,  with the use of psychiatric and psychoactive drugs, with a history of infidelity or extramarital affairs, with a physical disability or mental retardation, and identified during the treatment as not meeting the requirements of the study. Then, the first and second experimental groups received ACT and EFCT, respectively. In addition, the third group was placed on the waiting list.
After the end of the study in Mehraz Omid Behravan Consulting Center, all the three groups were subjected to a posttest, and the follow-up test was performed 2 months following the posttest. According to the obtained results of the present study, ACT was more effective in enhancing the quality of interpersonal relationships than EFCT. Therefore, the control group received the ACT intervention at the end of the study with ethical considerations. The current study was not registered in the Iranian Registry of Clinical Trials.
 
Marital Conflicts Questionnaire
Marital Conflicts Questionnaire is a 42-item self-report instrument designed to measure the dependent variable of marital conflict based on a clinical experience by Sanaei. The seven dimensions of this questionnaire are decreased cooperation, decreased sexual relationships, increased emotional reactions, increased children support, increased personal relationships with own's relatives, decreased family relationships with spouses' relatives and friends, and financial separation from each other. Questionnaire scoring is based on a 5-point Likert scale, including 1) never to 5) always. In this questionnaire, the minimum and maximum scores are considered 42 and 168, respectively. As the score increases, the conflicts increase and as the score decreases, the relationship has a higher quality. Dehghan Sefid kooh has reported the reliability of this questionnaire with a Cronbach's alpha coefficient of 0.71.
 
Interpersonal Relationships Quality
Interpersonal Relationships Quality (IRQ) was developed by Pierce et al. to measure the independent variable of interpersonal relationships quality in order to assess the quality of relationships with important people in life (i.e., parents, friends, and spouse). The IRQ consists of 25 items with three subscales, including perceived social support (7 items), interpersonal conflicts (12 items), and depth of relationships (6 items). It is rated based on a 4-point Likert scale with 1) no, 2) low, 3) average, and 4) high. In addition, the items 8-19 are inversely scored. In IRQ, the scores are within the range of 25-50 (i.e., couples with poor relationship quality), 50-62 (i.e., couples with moderate relationship quality), and 62 or higher (i.e., couples with high relationship quality). The content validity of IRQ has been confirmed by several psychology specialists. Pierce et al. has reported the test-retest reliability of IRQ within the range of 0.75-0.92.
 
Emotionally-Focused Couple Therapy
This treatment was firstly proposed by Johnson [36]. Nine treatment sessions were held for EFCT twice a week for 90 min. The content of each treatment session is presented in Table 1.
 
Acceptance and Commitment Couple Therapy
This treatment has been proposed by Hayes et al. [37]. Eight treatment sessions were held for ACT twice a week for 90 min. The content of each treatment session is shown in Table 2.
 

Content	Session
Feeling empathy with couples; creating therapeutic unity between the couple and therapist about therapeutic goals and how the treatment is performed; assessing the nature of the problem and relationship; identifying a clear understanding of the problem	1st
Evaluating the participant intimacy and attachment history; making hypothesis about the vulnerability of each couple in the relationship; identifying internal and external barriers to intimacy and emotional track in each of the couples; familiarizing couples with the negative cycles of interaction	2nd
Accessing known emotions lying in interactive situations; identifying the primary and secondary emotions of each couple; reframing the problem and couples' interactive cycle	3rd
Intensifying the emotional experience; increasing the tendency to involvement and emotional confrontation; increasing responsiveness to each other in terms of latent emotions and need for couples' attachment; deeply describing couples' emotions and interactive cycles	4th
Increasing the identification of needs and helping couples to raise awareness; engaging the spouses with each other and accepting the ownership of vulnerabilities; identifying the injuries and fears of attachment; helping the spouse to hear and accept his wife's fears; deepening emotional involvement and evoking dreams	5th
Accept responsibility for your position and its role in relation to the couples expressing their expectations from the opposite side; facilitating the adoption of a person by the spouse	6th
Changing interactive patterns and rebuild interactions; facilitating the expression of needs and desires; creating emotional involvement between couples	7th
Finding new solutions to old problems; redefining the relationship by each couple; nurturing a safe environment and building trust	8th
Identifying and supporting healthy interactive patterns; providing couples access to safe patterns in their relationships; increasing the availability and accountability; consolidating and integrating new interactive situations; reviewing changes made by couples and terminating the treatment	9th

Content	Session
Establishing a therapeutic relationship; familiarizing couples with the research topic; answering a questionnaire; making therapeutic contract	1st
Discovering therapeutic methods and evaluating their impacts; talking about temporary and ineffective treatments using the allegory; receiving feedback and assigning tasks	2nd
Helping the participants to identify inefficient strategies; controlling and realizing their futility; accepting the painful personal events without conflict with the use of allegory; receiving feedback and assigning tasks	3rd
Explaining how to avoid painful experiences and knowledge of its consequences; teaching acceptance steps, changing language concepts using allegory; training relaxation; receiving feedback and assigning tasks	4th
Introducing three-dimensional behavioral model to express the common relation of behaviors-emotions, psychological functions, and observable behaviors; talking about trying to change behaviors based on feedbacks and assignments	5th
Explaining the concepts of role and context; viewing the self as a bed and making contact with yourself using the allegory; informing of different sensory perceptions and training how to separate from the senses that are part of mental content; receiving feedback and assigning tasks	6th
Explaining the concept of values; motivating change; empowering participants for a better life; focusing exercises and assignments and providing feedback	7th
Training commitment to action; identifying behavioral patterns in accordance with the values and having the commitment to behave based on them; summing up sessions; implementing posttest	8th

Results
In this section, firstly, the underlying assumptions of repeated measures analysis of variance (ANOVA) are examined. Repeated measure ANOVA was used with the confirmation of variance analysis assumptions, including distance, linearity, and normality of variances (i.e., the Kolmogorov-Smirnov test). The statistical analysis of the data was performed using SPSS software (version 23).
The mean values of females and males age were reported as 20.8±5.8 and 25.3±6 years, respectively. The educational level of 67% and 76.5% of the male and female participants was higher than the diploma, respectively. Furthermore, the rest of the subjects were reported with the educational level of below the diploma. In addition, 31% of the couples were forced to marry, and the marriage was optional in 69% of the subjects. The mean values of interpersonal relationships quality (i.e., with the components of parents, friends, and the spouse) in the ACT group were 40.2±7.67, 50.73±8.03, and 56.5±7.1 in the pretest, posttest, and follow-up, respectively. The mean scores of interpersonal relationships quality (i.e., with the components of parents, friends, and the spouse) in the EFCT group were 41.56±7.13, 51.6±6.86, and 56.83±5.7 in the pretest, posttest, and follow-up, respectively. The mean values of interpersonal relationships quality in the control group were 38.93±7.06, 41.96±6.26, and 42.36±6.26 in the pretest, posttest, and follow-up, respectively (P<0.001).
The results of Table 3 showed that the single-sample Kolmogorov-Smirnov index and F Levine index were not significant for the variable of interpersonal relationships quality at the baseline. Therefore, the distribution of the scores on the baseline was normal. Moreover, the results of one-way ANOVA were only significant for the quality of the relationships with parents indicating that there was a significant difference in the quality of relationships with parents among the mean scores of the pretest of the three groups. As a result, the variance of the experimental and control groups was homogeneous at the baseline.
The results of the Bonferroni test (Table 4) showed that the pretest and posttest averages were different between the two groups; accordingly, the short-term effect of ACT on improving the relationships with the parents was greater with the effect size of 0.71. However, the long-term effect of ACT on the improvement of the relationships with parents with an effect size of 0.44 or at a moderate level was reported. In relation to friends, the short-term and long-term effects of ACT on the improvement of the relationships with friends were not effective. In relation to the spouse, both the short-term and long-term effects sizes of ACT were reported to be 0.32 and 0.33, respectively. Regarding the effectiveness of EFCT in interpersonal relationships quality, it can be said that this type of therapeutic model had a short-term effect with an average effect size of 0.59 on the improvement of the relationships with parents. In addition, its long-term effect on the improvement of the relationships with parents was reported to be at a low level of 0.14.
In relation to friends, the short-term and long-term effect sizes of EFCT were reported as 0.08 and 0.45 at a medium level, respectively. In relation to the spouse, the short-term effect of EFCT with an effect size of 0.33 at a medium level and its long-term effect with an effect size of 0.14 at a low level were reported indicating that EFCT had a minor long-term effect on the improvement of the relationship with the spouse. Based on the data of the Bonferroni test in Table 4, it can be said that there was no significant difference between the short-term and long-term effects of ACT and EFCT in relationships with the spouse and friends, and both treatments had similar effectiveness in this regard. Therefore, EFCT and ACT were reported with a short-term effect and better long-term effect on the relationships with parents.
The results of repeated measures ANOVA in Table 5 show that the group effect is significant, indicating that there is a significant difference between the means of the two groups of ACT and EFCT. In other words, ACT with a larger effect size of 0.71 was more effective in interpersonal relationships quality (i.e., the relationship with parents) than EFCT with an average effect size of 0.53. However, the effectiveness of both ACT and EFCT in other variables of interpersonal relationships quality was reported at a low level.

Assumption of homogeneity variances		Comparison of means in pretest		Normality		Interpersonal relationships quality
p	F	p	F	p	z
0.049	3.15	0.025	3.9	0.200	0.08	Relationships with parents
0.712	0.34	0.963	0.04	0.200	0.07	Relationships with friends
0.615	0.49	0.216	1.57	0.200	0.09	Relationships with spouse

Repeated analysis of variance (Bonferroni)			Effect	Interpersonal  relationships quality	Type of couple therapy
Eta coefficient	p	F
0.71	0.001	121.71**	Short-term	Parents	Acceptance and commitment couple therapy
0.44	0.001	39.85**	Long-term
0.02	0.366	0.83	Short-term	Friends
0.04	0.168	1.96	Long-term
0.32	0.001	23.26**	Short-term	Spouse
0.33	0.01	24.74**	Long-term
0.59	0.001	73.11**	Short-term	Parents	Emotionally-focused couple therapy
0.14	0.007	8.01**	Long-term
0.08	0.040	4.47*	Short-term	Friends
0.45	0.001	41.4***	Long-term
0.33	0.001	24.74**	Short-term	Spouse
0.14	0.006	8.19**	Long-term
0.11	0.018	5.94*	Short-term	Parents	Acceptance and commitment couple therapy and  Emotionally-focused couple therapy
014	0.006	8.4**	Long-term
0.01	0.398	0.73	Short-term	Friends
0.35	0.000	26.77**	Long-term
0.001	0.786	0.07	Short-term	Spouse
0.03	0.208	1.63	Long-term

Effect size	p	F	MS	df	SS	Source of changes	Interpersonal relationships quality	Acceptance and commitment couple therapy
0.071	0.001	121.71**	1757.77	1.74	3053.17	Group	Parents
-	-	-	14.44	86.85	1254.26	Error
0.04	0.167	1.88	28.71	1.55	44.58	Group	Friends
-	-	-	15.23	77.62	1182.1	Error
0.44	0.001	38.97**	802.7	1.71	1371.01	Group	Spouse
-	-	-	20.6	85.4	1759.13	Error
0.53	0.001	59.94**	750.68	1.76	1320.17	Group	Parents	Emotionally-focused couple therapy
-	-	-	13.18	87.93	1159.18	Error
0.35	0.001	26.7**	374.03	1.52	569.09	Group	Friends
-	-	-	14.01	76.07	1065.6	Error
0.35	0.001	26.68**	620.85	1.76	1094.5	Group	Spouse
-	-	-	23.27	88.15	2051.44	Error

1. Mohsenzadeh F, Keshvarzafshar H, Jehanbakhshi Z, Hajhosseini M. The quality of marital relationship in conflict resolution style couple profiles. The Women and Family Cultural Education. 2018; 10(32):29-40.
2. Pahlavan M, Mootabi F, Mazaheri M. Reaction to marital conflict: an intergenerational study. Iranian Journal of Psychiatry and Clinical Psychology. 2015; 21(3):202-14.
3. Rathgeber M, Burkner PC, Schiller EM, Holling H. the efficacy of emotionally focused couples therapy and behavioral couples therapy: a meta-analysis. Journal of Marital and Family Therapy. 2018; 45(3):447-63. [DOI:10.1111/jmft.12336] [PMID]
4. Buehler C, Krishnakumar A, Stone G, Anthony C, Pemberton S, Gerard J, et al. Interparental conflict styles and youth problem behaviors: a two-sample replication study. Journal of Marriage and the Family. 1998; 60:119-32. [DOI:10.2307/353446]
5. Mohsenzadeh F, Khoshkonesh A, Safari F, Afsahr HK, Arefi M. Conflict resolution types in profile of marital relationship quality. Journal of Academic Research. 2014; 6(6):316-20. [DOI:10.7813/2075-4124.2014/6-6/B.49]
6. Glasser W. Choice theory: a new psychology of personal freedom. London: Harper Perennial; 1999. P. 352.
7. Amani A, Isanejad O, Alipour E. Effectiveness of acceptance and commitment group therapy on marital distress, marital conflict and optimism in married women visited the counseling center of Imam Khomeini Relief Foundation in Kermanshah. Shenakht Journal of Psychology and Psychiatry. 2018; 5(1):42-64. [DOI:10.29252/shenakht.5.1.42]
8. Young M, Wilmott P. Family and kinship in East London. London: Routledge; 2013.
9. Osarenren N. The impact of marital conflicts on the psychosocial adjustment of adolescents in Lagos Metropolis, Nigeria. Journal of Emerging Trends in Educational Research and Policy Studies. 2013; 4(2):320-6.
10. Galinsky AM, Waite LJ. Sexual activity and psychological health as mediators of the relationship between physical health and marital quality. The Journal of Gerontology Series B: Psychological Sciences and Social Sciences. 2014; 69(3):482-92. [DOI:10.1093/geronb/gbt165] [PMID] [PMCID]
11. Wang Q, Wang D, Li C, Miller RB. Marital satisfaction and depressive symptoms among Chinese older couples. Aging & Mental Health. 2014; 18(1):11-8. [DOI:10.1080/1360
    7863.2013.805730] [PMID]
12. Wedgeworth M, LaRocca MA, Chaplin WF, Scogin F. The role of interpersonal sensitivity, social support, and quality of life in rural older adults. Journal of Geriatric Nursing. 2017; 38(1):22-6. [DOI:10.1016/j.gerinurse.2016.07.001] [PMID]
13. Ahmadikhoei S, Mahdad A, KeshtiAraye N. Developing of prevention of divorce training package and detemination of its effectiveness on marital satisfaction and emotional divorce on employess of education organization of Urmia city. Nursing and Midwifery Journal. 2018; 16(5):335-45.
14. Ruark A, Chase R, Hembling J, Davis VR, Perrin PC, Brewster-Lee D. Measuring couple relationship quality in a rural African population: validation of a couple functionality assessment tool in Malawi. PloS One. 2017; 12(11):
    e0188561. [DOI:10.1371/journal.pone.0188561] [PMID] [PMCID]
15. Jaremka LM, Derry HM, Kiecolt-Glaser JK. Psychoneuroimmunology of interpersonal relationships: both the presence/absence of social ties and relationship quality matter. Washington, DC: American Psychological Association; 2014. 
16. Tilley D, Palmer G. Enactments in emotionally focused couple therapy: shaping moments of contact and change. Journal of Marital and Family Therapy. 2013; 39(3):299-313. [DOI:10.1111/j.1752-0606.2012.00305.x] [PMID]
17. Finney N, Tadros E. Integration of structural family therapy and dialectical behavior therapy with high-conflict couples. The Family Journal. 2019; 27(1):31-6. [DOI:10.1177/
    1066480718803344]
18. Brown J. Bowen family systems theory and practice: Illustration and critique. Australian and New Zealand Journal of Family Therapy. 1999; 20(2):94-103. [DOI:10.1002/j.1467-8438.1999.tb00363.x]
19. Cooklin A. A psychoanalytic framework for a systemic approach to family therapy. Journal of Family Therapy. 1979; 1(2):153-65. [DOI:10.1046/j..1979.00489.x]
20. Palmer‐Olsen L, Gold LL, Woolley SR. Supervising emotionally focused therapists: a systematic research‐based model. Journal of Marital and Family Therapy. 2011; 37(4):411-26. [DOI:10.1111/j.1752-0606.2011.00253.x] [PMID]
21. Beasley CC, Ager R. Emotionally focused couples therapy: a systematic review of its effectiveness over the past 19 years. Journal of Evidence-Based Social Work. 2019; 16(2):144-59. [DOI:10.1080/23761407.2018.1563013] [PMID]
22. Zanganeh MF, Banijamali SA, Hasan A, Reza HH. The impact of coupletherapy based on acceptance, commitment and emotions on the improvement of couples’adjustment and MARITAL Commitment. The Women and Family Cultural Education. 2018; 11(38):49-70.
23. Gurman AS, Lebow JL, Snyder DK. Clinical handbook of couple therapy. New York: Guilford Publications; 2015. P. 729.
24. Veshki SK, Shafiabady A, Farzad V, Fatehizade M. A comparison of the effectiveness of cognitive–behavioral couple therapy and acceptance and commitment couple therapy in the couple’s conflict in the city of Isfahan. Jundishapur Journal of Health Sciences. 2017; 9(3):e43085. [DOI:10.17795/jjhs-43085]
25. Gamefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences. 2001; 30(8):1311-27. [DOI:10.1016/S0191-8869(00)00113-6]
26. Peterson BD, Eifert GH. Using acceptance and commitment therapy to treat infertility stress. Cognitive and Behavioral Practice. 2011; 18(4):577-87. [DOI:10.1016/j.cbpra.2010.
    03.004]
27. Kraaij V, Garnefski N. The behavioral emotion regulation questionnaire: development, psychometric properties and relationships with emotional problems and the cognitive emotion regulation questionnaire. Personality and Individual Differences. 2019; 137:56-61. [DOI:10.1016/j.paid.2018.
    07.036]
28. Tangney JP, Baumeister RF, Boone AL. High self‐control predicts good adjustment, less pathology, better grades, and interpersonal success. Journal of Personality. 2004; 72(2):271-324. [DOI:10.1111/j.0022-3506.2004.00263.x] [PMID]
29. Akhavan Bitaghsir Z, Sanaee Zaker B, Navabinejad S, Promotion H. Comparetive of emotional focused couple therapy and acceptance and commitment therapy on marital adjustment and marital satisfaction. Iranian Journal of Health Education Promotion. 2017; 5(2):121-8. [DOI:10.30699/
    acadpub.ijhehp.5.2.121]
30. Samadi H, Mohsen D. Investigating the effectiveness of Acceptance and Commitment Therapy (ACT) on marital compatibility and life expectancy in infertile women. International Academic Journal of Sosial Sciences. 2014; 3(5):16-27.
31. Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Journal of Behavior Therapy. 2013; 44(2):180-98. [DOI:10.1016/j.beth.2009.08.002] [PMID] [PMCID]
32. Hayes SC, Pistorello J, Levin ME. Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist. 2012; 40(7):976-1002. [DOI:10.1177/0011000012460836]
33. Biglan A, Zettle R, Hayes S, Barnes-Holmes D. The future of the human sciences and society. The Wiley handbook of contextual behavioral science. New Jersey: John Wiley & Sons; 2016. 
34. Elahifar H, Ghamari M, Zahrakar K. Comparison of the effectiveness between treatment based on improving quality of life and acceptance and commitment therapy (ACT) on increasing happiness of female teachers. Quarterly of Applied Psychology. 2019; 13(1):141-62.
35. Dessaulles A, Johnson SM, Denton WH. Emotion-focused therapy for couples in the treatment of depression: a pilot study. The American Journal of Family Therapy. 2003; 31(5):345-53. [DOI:10.1080/01926180390232266]
36. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: an experiential approach to behavior change. Cognitive and Behavioral Practice. 2002; 9(2):164-6. [DOI:10.1016/S1077-7229(02)80009-8]
37. Fallahzade H, Sanai ZB. Effectiveness of emotionally focused couple therapy and integrated systemic couple therapy. Womens Studies. 2013; 10(4):87-110.
38. Saadati N, Rostami M, Darbani SA. Comparing the effectiveness of Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy (CFT) on improving self-esteem and post-divorce adaptation in women. Journal of Family Psychology. 2017; 3(2):45-58.
39. Schade LC, Sandberg JG, Bradford A, Harper JM, Holt‐Lunstad J, Miller RB. A longitudinal view of the association between therapist warmth and couples' in‐session process: an observational pilot study of emotionally focused couples therapy. Journal of Marital & Famiy Therapy. 2015; 41(3):292-307. [DOI:10.1111/
    jmft.12076] [PMID]
40. Weissman N, Batten SV, Rheem KD, Wiebe SA, Pasillas RM, Potts W, et al. The effectiveness of emotionally focused couples therapy with veterans with PTSD: a pilot study. Journal of Couple & Relationship Therapy. 2018; 17(1):25-41. [DOI:10.1080/15332691.2017.1285261]
41. Halchuk RE, Makinen JA, Johnson SM. Resolving attachment injuries in couples using emotionally focused therapy: a three-year follow-up. Journal of Couple Relationship Therapy. 2010; 9(1):31-47. [DOI:10.1080/153326909034
    73069]
42. Babaei GM, Rasouli M, Davarniya R. The effect of emotionally-focused couples therapy (EFCT) on reducing marital stress of married couples. Zanko Journal of Medical Sciences. 2017; 18(56):56-69.
43. Nameni E, Mohammadipoor M, Noori J. The effectiveness of emotion-focused group therapy on interpersonal forgiveness and hope in divorced women. Counseling Culture and Psychotherapy. 2017; 8(29):57-78.
44. Wiebe SA, Johnson SM. A review of the research in emotionally focused therapy for couples. Journal of Family Process. 2016; 55(3):390-407. [DOI:10.1111/famp.12229] [PMID]
45. Badihi ZB, Mousavi R. Efficacy of emotion-focused couple therapy on the change of adult attachment styles and sexual intimacy of couples. Counseling Culture and Psychotherapy. 2016; 7(25):71-90.
46. Botlani S, Ahmadi A, Bahrami F, Shahsiah M, Mohebbi S. Effect of attachment-based couple therapy on sexual satisfaction and intimacy. Journal of Fundamentals of Mental Health. 2010; 12(46):496-505.
47. Peluso PR. Infidelity: a practitioner’s guide to working with couples in crisis. London: Routledge; 2007.
48. Omidi A, Mohammadkhani P, Mohammadi A, Zargar F. Comparing mindfulness based cognitive therapy and traditional cognitive behavior therapy with treatments as usual on reduction of major depressive disorder symptoms. Iranian Red Crescent Medical Journal. 2013; 15(2):142-6. [DOI:10.5812/ircmj.8018] [PMID] [PMCID]
49. Azimifar S, Fatehizade M, Bahrami F, Ahmadi A, Abedi A. Comparing the effects of cognitive-behavioral couple therapy and acceptance and commitment therapy on marital happiness of dissatisfied couples. Shenakht Journal of Psychology and Psychiatry. 2016; 3(2):56-81.
50. Morshedi M, Davarniya R, Zahrakar K, Mahmudi M, Shakarami M. The effectiveness of acceptance and commitment therapy (ACT) on reducing couple burnout of couples. Iranian Journal of Nursing Research. 2016; 10(4):76-87.
51. Hacker T, Stone P, MacBeth A. Acceptance and commitment therapy–do we know enough? Cumulative and sequential meta-analyses of randomized controlled
    trials. Journal of Affective Disorders. 2016; 190:551-65. [DOI:10.1016/j.jad.2015.10.053] [PMID]
52. Lanza PV, Garcia PF, Lamelas FR, González‐Menéndez. Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women. Journal of Clinical Psychology. 2014; 70(7):644-57. [DOI:10.1002/jclp.22060] [PMID]