Shahroud University of Medical siences Shahroud Journal of Medical Sciences 2423-6594 12 6 2026 10 17 Efficacy of Online Shame-Based Acceptance and Commitment Group Therapy on Marital Adjustment in Women Experiencing Infertility and Moderate-to-Severe Depression 22 30 eng Najmeh Amiri Ph.D. Student in Clinical Psychology, Department of Clinical Psychology, Faculty of Education and Psychology, Shiraz University, Shiraz, Iran.. n-amiri@shirazu.ac.ir Mahdi Imani Associate Professor, Department of Clinical Psychology, Faculty of Education and Psychology, Shiraz University, Shiraz, Iran.. mimani@shirazu.ac.ir Nurallah Mohammadi Professor, Department of Clinical Psychology, Faculty of Education and Psychology, Shiraz University, Shiraz, Iran.. nmohamadi@shirazu.ac.ir Mohammad Ali Goodarzi Professor, Department of Clinical Psychology, Faculty of Education and Psychology, Shiraz University, Shiraz, Iran.. mgoodarzi@rose.shirazu.ac.ir 2025 08 20 2025 12 29 Background: Infertility poses a profound psychological and social challenge for Iranian women, significantly impairing their mental health and marital adjustment. This study aimed to investigate the efficacy of an online shame-based acceptance and commitment therapy (ACT) group intervention on marital adjustment and its components among women experiencing infertility and moderate-to-severe depression. Methods: A randomized controlled clinical trial with a pretest-posttest design, including a control group and follow-up phase, was conducted. The study population comprised infertile women attending infertility treatment centers in Tehran in 2023. A purposive sample of 40 infertile women was randomly allocated to intervention and control groups (20 participants each). Data were collected using a demographic questionnaire, the Dyadic Adjustment Scale (DAS), and the Beck Depression Inventory-II (BDI-II). The intervention consisted of 10 weekly online ACT sessions based on the 10-session shame-focused ACT protocol by McKay et al. (2020). Data were analyzed using repeated-measures analysis of variance in SPSS version 25. Results: The results demonstrated that online shame-based ACT group therapy significantly improved overall marital adjustment and its components—satisfaction, cohesion, consensus, and affection- in women experiencing infertility and moderate-to-severe depression. (P-value<0.05). These improvements were sustained at follow-up. Conclusion: Online shame-based ACT group therapy proved effective in enhancing marital adjustment among women experiencing infertility and moderate-to-severe depression. It is recommended as a complementary intervention alongside other mental health services to improve the quality of marital relationships in this population.