1. Introduction
ype 2 diabetes is a chronic metabolic disorder in the body, in which the speed and capability in metabolism and robust mechanism of lowering the sugars. Intracellular reactions are also reduced, and insulin's effectiveness in stimulating glucose uptake by tissues decreases [1]. Despite many efforts, no definitive treatment has been found so far [2]. Self-care is one of the most critical factors that can control the diabetes mellitus [2]; CFT can affect diabetic patients [4]; in the third wave treatment, the ACT is considered an important field of psychological therapy [5].
This research aimed to answer whether there is a relationship between the effectiveness of the ACT and the CFT on self-care behavior and glycosylated hemoglobin in patients with type II diabetes.
2. Materials and Methods
In this clinical trial study, 200 patients with type II diabetes were selected using the single-stage cluster sampling method in Tonekabon city. Simultaneously, the scale of Tubert, Glasco, and Humphson's Self-Care Behavior (2002) was presented to them. Forty-five patients were randomly selected and divided into 3 groups, including two interventions and one control group. Twelve sessions on the ACT and 12 sessions for CFT were specified. Each session's duration was 45 min—two sessions for each intervention per week with a time interval of 3 days. At the end of treatment, all three groups were retested.
3. Results
Due to the comparison of the mean differences between the two treatment groups for self-care and glycosylated hemoglobin (5.012) (-2.145), the Octopus Treatment was more effective than CFT.
4. Conclusion
According to the results, patients who were treated by ACT have a more sustainable self-care behavior and glycosylated hemoglobin level than people treated by CFT. 

Ethical Considerations
Compliance with ethical guidelines
All ethical principles are considered in this article. The participants were informed of the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them. Also, all ethical principles are approved by the Ethics Committee of Islamic Azad University, Tonekabon branch (IR.IAU.TON.REC.1399.019).

Funding
The paper was extracted from the PhD. dissertation of the first author, Department of Psychology of Islamic Azad University, Tonekabon Branch.

Authors' contributions
Conceptualization, methodology, validation, and data analysis: Mohammad Reza Zarbakhsh and Tahir Tizdast; Performing therapeutic and evaluation interventions, data collection, writing – original draft: Ameneh Khalatbari; Visualization, supervision, writing – review & editing: Shohreh Ghorban Shiroodi; Funding acquisition and resources: Tahir Tizdast.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We would like to thank all the the people and patients with type 2 Diabetes who referred to Dr. Barghi Clinic in Ramsar, as the samples of the research, and the workers of the clinic.


References

1. Miri A, NaderiyanFar F. [The effects of olive oil consumption on symptoms and metabolic factors of diabetes: A review of clinical trials (Persian)]. Journal of Diabetes Nursing. 2018; 6(3):584-95. http://jdn.zbmu.ac.ir/article-1-301-en.html
2. Smeltzer SC, Brunner LS, Suddarth DS. Liver, glands, diabetets and bile channals [A. Dabirian, M. Shaban, Persian trans.]. Tehran: Andishe Rafi; 2010. http://opac.nlai.ir/opac-prod/bibliographic/2027663
3. Baji Z, Zamani Alavijeh F, Nouhjah S, Haghighizadeh MH. [Self-care behaviors and related factors in women with type 2 diabetes (Persian)]. Iranian Journal of Endocrinology and Metabolism. 2015; 16(6):393-401. http://ijem.sbmu.ac.ir/article-1-1772-en.html
4. Davari L, Eslami AA, Hassanzadeh A. [Underlying factors influencing self-care quality in type 2 diabetic patients in Khoram Abad city, Iran (Persian)]. Journal of Research Development in Nursing and Midwifery. 2014; 11(2):77-85. http://nmj.goums.ac.ir/article-1-630-en.html
5. Setoodeh N, Aghamolaei T, Bushehri E, Abedini S. [Explaining the concept of self-care from the viewpoints of patients with diabetes type II: A qualitative research (Persian)]. Journal of Preventive Medicine. 2016; 3(3):21-30. http://jpm.hums.ac.ir/article-1-183-en.html
6. Mazlom SR, Firooz M, Hasanzade F, Kimiaee SA, Raoufsaeb AA. [The effect of group counseling on physiological aspect of self-care and HbA1C level of patients with diabetes type II (Persian)]. Evidence Based Care Journal. 2015; 5(2):25-36. [DOI:10.22038/EBCJ.2015.4500]
7. Bigdeli MA, Hashemi Nazari SS, Khodakarim S, Brodati H, Mafi H, Gafari Z, et al. [Factors associated with self-care behavior in patients with type II diabetes (Persian)]. Journal of Mazandaran University of Medical Sciences. 2015; 25(125):61-72. http://jmums.mazums.ac.ir/article-1-5718-en.html
8. Shahbodaghi Z, Borhani F. [The effect of empowerment program on hemoglobin A1C in type 2 diabetes patients (Persian)]. Medical - Surgical Nursing Journal. 2013; 1(2):e87580. https://sites.kowsarpub.com/msnj/articles/87580.html
9. Zarei F. [The effectiveness of compassion-focused therapy in treating depression and controlling blood sugar in patients with type 2 diabetes (Persian)] [MA. thesis]. Sanandaj: University of Kurdistan; 2014. https://ganj.irandoc.ac.ir//#/articles/a2445c9e96fdc4e45f9ae4823acf91e1
10. Gilbert P. The compassionate mind: A new approach to life’s challenges. Oakland, CA: New Harbinger Publications; 2009. https://books.google.com/books?id=krNPL6xCVL0C&dq
11. Irons C, Lad S. Using compassion focused therapy to work with shame and self-criticism in complex trauma. Australian Clinical Psychologist. 2017; 3(1):006. https://acp.scholasticahq.com/article/1743
12. Leaviss J, Uttley L. Psychotherapeutic benefits of compassion-focused therapy: An early systematic review. Psychological Medicine. 2015; 45(5):927-45. [DOI:https://doi.org/10.1017/S0033291714002141]
13. Esmali Kooraneh A, Alizadeh M, Ghanizadeh Balderlou K. [The effectiveness of group psychotherapy based on acceptance and commitment on quality of life in women with breast cancer (Persian)]. Studies in Medical Sciences. 2016; 27(5):365-74. http://umj.umsu.ac.ir/article-1-3549-en.html
14. Izadi R, Neshatdust HT, Asgari K, Abedi MR. [Comparison of the efficacy of acceptance and commitment therapy and cognitive-behavior therapy on symptoms of treatment of patients with obsessive- compulsive disorder (Persian)]. Journal of Research in Behavioural Sciences. 2014; 12(1):19-33. http://rbs.mui.ac.ir/article-1-358-en.html
15. Smout MF, Longo M, Harrison S, Minniti R, Wickes W, White JM. Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behavior therapy and acceptance and commitment therapy. Substance Abuse. 2010; 31(2):98-107. [DOI:10.1080/08897071003641578] [PMID]
16. Fathi Ahmadsaraei N, Neshat Doost HT, Manshaee GR, Nadi MA. [The effectiveness of acceptance and commitment therapy on quality of life among patients with type 2 diabetes (Persian)]. Iranian Journal of Health Education and Health Promotion. 2016; 4(1):31-9. [DOI:10.18869/acadpub.ihepsaj.4.1.31]
17. Shayeghian Z, Amiri P, Aguilar-Vafaie ME, Besharat MA. [Effectiveness of acceptance and commitment group therapy on improvement of glaycated hemoglobin and self-care activities in patients with type II diabetes (Persian)]. Contemporary Psychology, Biannual Journal of the Iranian Psychological Association. 2016; 10(2):41-50. http://bjcp.ir/browse.php?a_id=897
18. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care. 2000; 23(7):943-50. [DOI:10.2337/diacare.23.7.943] [PMID]
19. Nouhi E, Khandan M, Mirzadeh A. [Effective of electronic education on knowledge attitude and self-care in patient’s diabetic type 2 refer to diabetic center of Kerman University of Medical Science (Persian)]. Iranian Journal of Nursing Research. 2011; 6(22):73-80. http://ijnr.ir/article-1-884-en.html
20. Rahimian Boger E, Mohajeri Tehrabi MR, Besharat MA, Talepasand S. [Psychological, social and structural determinants of diabetes self-management (Persian)]. Iranian Journal of Endocrinology and Metabolism. 2012; 13(5):467-78. http://ijem.sbmu.ac.ir/article-1-1115-en.html
21. Coaston SC. Self-care through self-compassion: A balm for burnout. The Professional Counselor. 2017; 7(3):285-97. https://tpcjournal.nbcc.org/self-care-through-self-compassion-a-balm-for-burnout/
22. Hor M, Aghaei A, Abedi A, Golparvar M. [Effect of combined treatment package (ACT-based healthy lifestyle) with mindfulness-based therapy on self-care and glycated hemoglobin in patients with diabetes mellitus, type 2 (Persian)]. Islamic Life Style. 2018; 2(2):65-70. http://islamiclifej.com/article-1-181-en.html
23. Ebadi Fard Azar F, Hedari H, Solhi M. [Relationship between self-care behavior and health locus of control in patients with type II diabetes (Persian)]. Razi Journal of Medical Sciences. 2016; 23(146):84-92. http://rjms.iums.ac.ir/article-1-3805-en.html
24. Peveler RC, Davies BA, Mayou RA, Fairburn CG, Mann JI. Self-care behaviour and blood glucose control in young adults with type 1 diabetes mellitus. Diabetic Medicine. 1993; 10(1):74-80. [DOI:10.1111/j.1464-5491.1993.tb02000.x] [PMID]
25. Ahangari M, Kamali M, Arjmand Hesabi M. [The study of quality of life in the elderly with hypertension who are member of Tehran senile culture house clubs (Persian)]. Salmand: Iranian Journal of Ageing. 2008; 3(1):26-32. http://salmandj.uswr.ac.ir/article-1-80-en.html
26. Witkiewitz K, Marlatt GA, Walker D. Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy. 2005; 19(3):211-28. [DOI:10.1891/jcop.2005.19.3.211]
27. Abdollahi S, Hatami M, Moradi Manesh F, Askari P. The effectiveness of acceptance and commitment therapy on the self-care and adherence to treatment in patients with type 2 diabetes. International Archives of Health Sciences. 2020; 7(2):78-83. http://www.iahs.kaums.ac.ir/article.asp?issn=2383-2568;year=2020;volume=7;issue=2;spage=78;epage=83;aulast=Abdollahi