Efficacy of Acceptance and Commitment Therapy on Anxiety, Self-Criticism, and Body Image in Adolescent Female Athletes: A Randomised Controlled Trial

This randomised controlled trial evaluated an eight-session, school-adapted Acceptance and Commitment Therapy (ACT) intervention among 62 adolescent female athletes from vocational high schools in Ahvaz, Iran. Participants with high competitive anxiety and low body image satisfaction were randomly assigned to the ACT group ( n = 31) or a waitlist control group ( n = 31). A pretest-posttest design with 3-month follow-up was used. Measures included the Sport Anxiety Scale-2, Forms of Self-Criticising/Attacking and Self-Reassuring Scale (short form), Multidimensional Body-Self Relations Questionnaire Appearance Scales, and Avoidance and Fusion Questionnaire for Youth. Repeated-measures ANOVA showed significant group × time interactions for all primary outcomes ( p < .001, partial η 2 = .33–.44). The ACT group exhibited reductions in competitive anxiety and self-criticism and improvements in body image satisfaction at posttest and follow-up. Exploratory mediation analyses indicated that intervention-related changes in psychological inflexibility were associated with changes in the outcomes; however, temporal precedence cannot be established and these findings should not be interpreted as demonstrating a causal mechanism. These results provide preliminary evidence that a brief, contextually adapted ACT programme was associated with improved psychological flexibility, reduced sport-related distress, and enhanced body image. Practical implications for school-based interventions are discussed.