Acceptance and Commitment Therapy versus Expressive Writing Therapy for Emotional Regulation and Emotional Numbing among Nursing Students

Authors

  • Rafi Jachra Adam , Universitas Pendidikan Indonesia
  • Sri Sumartini Universitas Pendidikan Indonesia
  • Nadia Sintia Wardany Universitas Pendidikan Indonesia
  • Slamet Rohaedi Universitas Pendidikan Indonesia
  • Amelia Febrianti Universitas Pendidikan Indonesia

DOI:

https://doi.org/10.51143/jksi.v11i1.1023

Keywords:

Acceptance and Commitment Therapy Expressive Writing Therapy Emotion Regulation Emotional Numbing Nursing Students

Abstract

Emotional numbing among nursing students can impair emotional regulation and increase vulnerability to psychological distress. This study aimed to compare the effectiveness of ACT and EWT in enhancing emotional regulation and reducing emotional numbing. A quasi-experimental pretest–posttest two-group design was conducted, involving 52 nursing students selected through purposive sampling and subsequently assigned to intervention groups primarily through random allocation. Emotional regulation was measured using DERS, while emotional numbing was assessed with the ERNS-G. Data were analysed using paired t-tests and ANCOVA to compare posttest outcomes while controlling for pretest scores. Both ACT and EWT significantly improved emotional regulation and reduced emotional numbing within groups (p < .05). However, ANCOVA revealed no statistically significant differences between ACT and EWT in emotional regulation (F = 1.373, p = .247, ?² = .027) or emotional numbing (F = 0.791, p = .378, ?² = .016) after controlling for pretest scores. Both ACT and EWT were effective in improving emotional regulation and reducing emotional numbing among nursing students. Nevertheless, no statistically significant difference in effectiveness was found between the two interventions.

Author Biography

Rafi Jachra Adam, , Universitas Pendidikan Indonesia

Rafi Jachra Adam is a nursing researcher specializing in psychiatric nursing. His academic interests include emotional regulation, mental health interventions, and clinical nursing education.

References

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Asari, M. N. L., Ni’mah, M., Damayanti, N., & Utami, L. H. (2023). The Effectiveness of Expressive Writing Therapy in Improving Student Academic Resilience. Philanthropy: Journal of Psychology, 7(2), 144. https://doi.org/10.26623/philanthropy.v7i2.7232

Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., Hasking, P., Murray, E., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Stein, D. J., Vilagut, G., Zaslavsky, A. M., & Kessler, R. C. (2018). WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638. https://doi.org/10.1037/abn0000362

Blackledge, J. T., & Hayes, S. C. (2001). Emotion Regulation in Acceptance and Commitment Therapy. In J Clin Psychol/In Session (Vol. 57).

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Cahart, M. S., Giampietro, V., Naysmith, L., Muraz, M., Zelaya, F., Williams, S. C. R., & O’Daly, O. (2024). Anhedonia severity mediates the relationship between attentional networks recruitment and emotional blunting during music listening. Scientific Reports, 14(1), 1–16. https://doi.org/10.1038/s41598-024-70293-x

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Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224–237. https://doi.org/10.1037//0022-3514.74.1.224

Gross, J. J., & John, O. P. (2003). Individual Differences in Two Emotion Regulation Processes: Implications for Affect, Relationships, and Well-Being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348

Guendelman, S., Medeiros, S., & Rampes, H. (2017). Mindfulness and emotion regulation: Insights from neurobiological, psychological, and clinical studies. In Frontiers in Psychology (Vol. 8, Number MAR). Frontiers Research Foundation. https://doi.org/10.3389/fpsyg.2017.00220

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2026-07-04

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Rafi Jachra Adam, Sri Sumartini, Nadia Sintia Wardany, Slamet Rohaedi, & Amelia Febrianti. (2026). Acceptance and Commitment Therapy versus Expressive Writing Therapy for Emotional Regulation and Emotional Numbing among Nursing Students. JURNAL KEPERAWATAN SUAKA INSAN (JKSI), 11(1), 1–15. https://doi.org/10.51143/jksi.v11i1.1023

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Vol. 11 No. 1 (2026): Jurnal Keperawatan Suaka Insan (JKSI)

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References

Abouzaid, A. M. G., & Abdelhamid, H. G. (2023). The Factorial Structure of the Anhedonia List and its mediating role between Mindfulness and both Anxiety and Depression among University Students. Sohag University International Journal of Educational Research, 8(8), 319–387. https://doi.org/10.21608/suijer.2023.305894

Albagawi, B. S., Alsalamah, Y. S., Nashwan, A. J., Rawili, R. M. AL, Babkair, L. A., Alkharji, S. A., Alslamah, T., & Fawaz, M. (2024). The mediating role of learning motivation in the relationship among perceived stress and emotional regulation among Saudi nursing students in clinical practice. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-01893-1

Asari, M. N. L., Ni’mah, M., Damayanti, N., & Utami, L. H. (2023). The Effectiveness of Expressive Writing Therapy in Improving Student Academic Resilience. Philanthropy: Journal of Psychology, 7(2), 144. https://doi.org/10.26623/philanthropy.v7i2.7232

Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., Hasking, P., Murray, E., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Stein, D. J., Vilagut, G., Zaslavsky, A. M., & Kessler, R. C. (2018). WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638. https://doi.org/10.1037/abn0000362

Blackledge, J. T., & Hayes, S. C. (2001). Emotion Regulation in Acceptance and Commitment Therapy. In J Clin Psychol/In Session (Vol. 57).

Bennet, R., & Oliver, J. E. (2025). Acceptance and Commitment Therapy 100 Key Points and Techniques (Second Edi). Taylor & Francis.

Cahart, M. S., Giampietro, V., Naysmith, L., Muraz, M., Zelaya, F., Williams, S. C. R., & O’Daly, O. (2024). Anhedonia severity mediates the relationship between attentional networks recruitment and emotional blunting during music listening. Scientific Reports, 14(1), 1–16. https://doi.org/10.1038/s41598-024-70293-x

Chen, X., Huang, Z., & Lin, W. (2022). The effect of emotion regulation on happiness and resilience of university students: The chain mediating role of learning motivation and target positioning. Frontiers in Psychology, 13(December), 1–10. https://doi.org/10.3389/fpsyg.2022.1029655

Cheung, R. Y. M., Chung, H. S., & Ng, M. C. Y. (2021). Expressive Writing and Well-Being in Chinese Emerging Adults: Is Emotion Regulation an Underlying Mechanism? Emerging Adulthood, 9(6), 679–689. https://doi.org/10.1177/2167696818824719

Dyball, D., Maqsood, R., Schofield, S., Bennett, A. N., Cullinan, P., Bull, A. M. J., Boos, C. J., & Fear, N. T. (2025). Post-traumatic stress disorder (PTSD) symptom clusters associated with an indicator of heart rate variability: The ADVANCE cohort study. Journal of Affective Disorders, 375(January), 86–92. https://doi.org/10.1016/j.jad.2025.01.087

Easdale-Cheele, T., Parlatini, V., Cortese, S., & Bellato, A. (2024). A Narrative Review of the Efficacy of Interventions for Emotional Dysregulation, and Underlying Bio–Psycho–Social Factors. Brain Sciences, 14(5). https://doi.org/10.3390/brainsci14050453

Flack, W. F., Milanak, M. E., & Kimble, M. O. (2005). Emotional numbing in relation to stressful civilian experiences among college students. Journal of Traumatic Stress, 18(5), 569–573. https://doi.org/10.1002/jts.20066

Ford, J. D., Grasso, D. J., Levine, J., & Tennen, H. (2017). Emotion Regulation Enhancement of Cognitive Behavior Therapy for College Student Problem Drinkers: A Pilot Randomized Controlled Trial. Journal of Child and Adolescent Substance Abuse, 27(1), 47–58. https://doi.org/10.1080/1067828X.2017.1400484

Forster, M., & Kuhbandner, C. (2022). The promotion of functional expected teaching-related emotions through expressive writing. PLoS ONE, 17(5 May), 1–15. https://doi.org/10.1371/journal.pone.0267905

Gadassi-Polack, R., Paganini, G., Zhang, A. K., Christine, D., Silk, J. S., Kober, H., & Joormann, J. (2020). It’s a balancing act: The ratio of maladaptive (vs. all) emotion regulation strategies is associated with depression. Journal of Youth and Adolescence, 2507(February), 1–9.

GBD Mental Disorders Collaborators. (2022). Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry, 9(2), 137–150. https://doi.org/10.1016/S2215-0366(21)00395-3

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 1(26), 41–54.

Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224–237. https://doi.org/10.1037//0022-3514.74.1.224

Gross, J. J., & John, O. P. (2003). Individual Differences in Two Emotion Regulation Processes: Implications for Affect, Relationships, and Well-Being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348

Guendelman, S., Medeiros, S., & Rampes, H. (2017). Mindfulness and emotion regulation: Insights from neurobiological, psychological, and clinical studies. In Frontiers in Psychology (Vol. 8, Number MAR). Frontiers Research Foundation. https://doi.org/10.3389/fpsyg.2017.00220

Guzmán-González, M., Mendoza-Llanos, R., Garrido-Rojas, L., Barrientos, J., & Urzúa, A. (2020). Propuesta de valores de referencia para la Escala de Dificultades de Regulación Emocional (DERS-E) en población adulta chilena. In Rev Med Chile (Vol. 148).

Harris, R. (2021). Trauma-Focused ACT. A practitioner’s guide to working with mind, body & emotion using acceptance & commitment therapy. www.newharbinger.com

Hansen, W. B., Pankratz, M. M., & Bishop, D. C. (2014). Differences in Observers’ and Teachers’ Fidelity Assessments. Journal of Primary Prevention, 35(5), 297–308. https://doi.org/10.1007/s10935-014-0351-6

Harrington, S. J., Morrison, O. P., & Pascual-Leone, A. (2018). Emotional processing in an expressive writing task on trauma. Complementary Therapies in Clinical Practice, 32, 116–122. https://doi.org/10.1016/j.ctcp.2018.06.001

Hayat, A. A., Shateri, K., Amini, M., & Shokrpour, N. (2020). Relationships between academic self-efficacy, learning-related emotions, and metacognitive learning strategies with academic performance in medical students: A structural equation model. BMC Medical Education, 20(1), 1–11. https://doi.org/10.1186/s12909-020-01995-9

Hoyt, M. A., Darabos, K., & Llave, K. (2021). Emotional processing writing and physiological stress responses: understanding constructive and unconstructive processes. Cognition and Emotion, 35(6), 1187–1194. https://doi.org/10.1080/02699931.2021.1929083

Kementrian Kesehatan RI. (2019). Laporan Riskesdas 2018 Nasional. Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan (LPB).

Korem, N., Duek, O., Ben-Zion, Z., Kaczkurkin, A. N., Lissek, S., Orederu, T., Schiller, D., Harpaz-Rotem, I., & Levy, I. (2022). Emotional numbing in PTSD is associated with lower amygdala reactivity to pain. Neuropsychopharmacology, 47(11), 1913–1921. https://doi.org/10.1038/s41386-022-01405-2

Lakens, D. (2022). Sample size justification. In Collabra: Psychology (Vol. 8, Number (1)). https://doi.org/10.1525/collabra.33267

Litz, B. T., & Gray, M. J. (2002). Emotional numbing in posttraumatic stress disorder: Current and future research directions. Australian and New Zealand Journal of Psychiatry, 36(2), 198–204. https://doi.org/10.1046/j.1440-1614.2002.01002.x

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