Introduction
Marriage is a pivotal life stage that profoundly influences mental and physiological health [1]. The quality of marital relationships and emotional empathy are critical factors in reducing conflicts and enhancing marital satisfaction. Lack of these elements can increase discord and divorce, resulting in serious social and economic repercussions [2]. Statistics indicate a rising divorce rate in Iran, with communication problems stemming from environmental issues contributing to anxiety and distrust among couples [3]. Emotional empathy, adaptability, alexithymia, and couple functioning are recognized as fundamental components for fostering stable marriages; their absence can lead to significant challenges within marital relationships [4-7]. Acceptance and commitment therapy (ACT) has emerged as an effective method for improving emotional empathy, adaptability, and couple functioning. Research demonstrates that ACT can reduce emotional dysregulation and enhance couples’ conflict management skills [8, 9]. By emphasizing the acceptance of emotions and focusing on the present moment, ACT helps strengthen intimacy and compatibility between partners. Furthermore, couples’ ability to employ problem-solving strategies is contingent upon properly understanding the conditions and emotions in their situations, a process that ACT can effectively facilitate [10, 11].

Methods
This randomized controlled clinical trial investigated the effectiveness of ACT on emotional empathy, adaptability, alexithymia, and couple functioning among incompatible young couples in Yazd City, Iran. We employed a two-group study with a pre-test, post-test and a 6-month follow-up design. The participants were recruited from counseling and divorce centers in 2023, and after identifying the experimental and control groups, separate online introductory meetings were held. The experimental group discussed marital incompatibility and related issues, while the control group engaged in unrelated topics to avoid bias. Participants provided informed consent and completed the emotional empathy scale, the adaptability and cohesion evaluation scales, the Toronto alexithymia scale, and the ENRICH couple scales. The ACT protocol was delivered over eight weekly sessions lasting 60 to 90 minutes each, while the control group remained on a waiting list with weekly follow-ups. Ethical considerations ensured the control group received the ACT protocol after the study’s conclusion. Participants completed questionnaires at the end of treatment and then six months later to evaluate study outcomes.
The study excluded participants suffering from severe mental disorders, such as depression, anxiety, and psychotic disorders, assessed using the symptom checklist-90 at the treatment’s onset. The inclusion criteria required couples to have cohabited for at least one year, be aged 20 to 35, participate in meetings together, have no legal divorce actions pending, and have no history of marital infidelity in the early years of marriage. The exclusion criteria included any psychiatric or medical conditions requiring hospitalization during treatment (as reported by clients), failure to attend more than three sessions, incomplete joint treatment tasks, and concurrent psychotherapy or psychiatric medication use. 

Results
In this study, 104 individuals (52 couples) from a pool of approximately 120 incompatible young couples in Yazd were selected through simple random sampling during the spring and summer of 2023. After verifying the inclusion criteria, the participants were divided into two groups of 26 couples each, with no dropouts during treatment; however, three men attended fewer than two sessions, which did not breach exit criteria. Statistical analyses were conducted on all 104 individuals, with an equal gender distribution (50% men and 50% women). The average age was 28.15 years in the experimental group and 28.36 years in the control group. Regarding cohabitation duration, the experimental group’s mean and standard deviation were 3.48 and 1.55 years, ranging from 1 to 7 years. In the control group, these figures were 3.11 and 1.35 years, with cohabitation lasting between 1 and 6 years. Educationally, in the experimental group, 57.7% had a bachelor’s degree or lower, while in the control group, this figure was 60.5%. Statistical analysis revealed no significant differences between the groups regarding gender, age, education level, or cohabitation duration (P >0.05), indicating that both groups were comparable on these variables (Table 1).



The data in the Table are reported as frequency (percentage) or average. 
Table 2 presents information regarding the research variables and the effects of ACT on them. The findings indicate that, based on the intergroup ANCOVA results, there are significant differences in the mean scores of emotional empathy, adaptability, alexithymia, and couple functioning between the experimental and control groups (P<0.01).




Conclusions
The present research investigates the impact of ACT on emotional empathy, adaptability, alexithymia, and couple functioning among incompatible young couples. The results indicate that ACT significantly enhances emotional empathy and improves a couple’s functioning with 95% confidence while reducing emotional dysregulation. Specifically, ACT accounted for 74% of the variance in post-test scores of emotional empathy [12]. By emphasizing the acceptance of emotions and thoughts, these findings align with previous research and suggest that ACT aids couples in enhancing their emotional empathy and mitigating emotional avoidance [13].
Research has demonstrated that ACT enhances adaptability and alleviates emotional distress. With a 95% confidence level, ACT has accounted for 76% of the variance in post-test adaptability scores. This therapeutic approach helps couples identify their and their partners’ needs, facilitating appropriate responses [14]. Additionally, through mindfulness exercises, couples gain a deeper understanding of their emotions and learn to avoid avoidant behaviors. Ultimately, ACT has also contributed to improved couple functioning, predicting 77% of the variance in post-test couple functioning scores [15]. 

 Ethical Considerations

Compliance with ethical guidelines
The research was conducted with approval from the Ethics Committee of Shahid Beheshti University of Medical Sciences in Tehran (IR.SBMU.MSP.REC.1402.143).

Funding
This study was financially supported by the Vice-chancellor for Research and Technology of Shahid Beheshti University of Medical Sciences, Tehran.

Authors contributions
Conceptualization: All authors; Methodology: Amir Masoud Mirbagheri and , Amir Sam Kiani Moghaddam; Writing and Original Draft: Amir Masoud Mirbagheri; Review and Editing: Abbas Masjedi Arani and, Amir Sam Kiani Moghaddam; Funding and Resources: Abbas Masjedi Arani and, Amir Masoud Mirbagheri.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
 We want to express our heartfelt gratitude and appreciation to all the esteemed professors and staff at Shahid Beheshti University of Medical Sciences, the distinguished couples who participated in this research, and the individuals who contributed to the design and implementation of this study. Your invaluable support and collaboration have been crucial to our work, and we are deeply thankful for your commitment and dedication.



 

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