The Effect of ACT-Based Nursing Interventions on Social Cognition, Emotion Regulation and Psychological Flexibility in Patients With Schizophrenia

Schizophrenia is a chronic psychiatric disorder associated with significant impairmentsin social cognition, emotion regulation, and psychological flexibility. These impairmentscontribute to social withdrawal, functional decline, and reduced quality of life. Whilepharmacological treatments address positive symptoms, psychosocial interventionstargeting functional outcomes remain underdeveloped, especially those delivered within anursing framework.Acceptance and Commitment Therapy (ACT) is a third‐wave cognitive behavioral approachcentered on psychological flexibility, defined as the ability to contact the presentmoment fully and to persist in or change behavior in the service of chosen values. ACT'score processes ‐ cognitive defusion, acceptance, present‐moment contact, self‐as‐context,values clarification, and committed action ‐ offer a theoretically coherent interventionframework for addressing the functional deficits seen in schizophrenia.This study integrates ACT principles into nursing practice through structured groupsessions. The intervention program was developed based on a review of the literature andwill be evaluated for content validity by at least twelve experts in psychiatric nursing,psychology, and psychiatry prior to implementation. The program consists of 8 weeklysessions (45‐60 min each), covering the following themes: 1. Introduction and ACTpsychoeducation; 2. Present‐moment contact and mindfulness; 3. Emotion awareness andacceptance; 4. Cognitive defusion; 5. Self‐as‐context and social cognition; 6. Valuesclarification; 7. Committed action and flexible coping; 8. Consolidation and relapseprevention.Sample size was determined by G*Power 3.1 power analysis based on three outcomevariables. The largest required sample (n = 58) was drawn from the emotion regulationvariable (mean scores: 28.06 ± 11.58 vs. 19.08 ± 16.23; effect size d = 0.82; 95% CI;alpha = 0.05; power = 85%). Adding a 10% buffer for attrition yields a total sample of 64(32 experimental + 32 control). Randomization will be performed using acomputer‐generated randomization sequence by an independent researcher to preventselection bias.Blinding: Due to the nature of psychosocial interventions, participant and investigatorblinding is not possible. Outcome assessors will not be involved in the intervention toreduce performance bias. Data will be analyzed using SPSS 22.0; paired comparisons willuse Dependent t‐Test or Wilcoxon Signed‐Rank Test; between‐group comparisons will useIndependent t‐Test or Mann‐Whitney U Test. Statistical significance is set at p < 0.05.After data collection is complete, control group participants will receive a condensed2‐session version of the ACT‐based program as an ethical courtesy.