| Summary: | Objective: To compare the effectiveness of Internet‐based acceptance and commitment therapy (iACT) and bibliotherapy‐based ACT (bACT) in reducing anxiety and depression among women with breast cancer. Methods: In this three‐arm randomized controlled trial, 99 participants were recruited from three oncology centers in Iran and randomly assigned to iACT, bACT, or a control group (n = 33 each). Interventions lasted 6 weeks with a 4‐week follow‐up. The Beck Anxiety Inventory and Beck Depression Inventory‐Short Form were used to assess outcomes at baseline, post‐intervention, and follow‐up. Data were analyzed using generalized estimating equations (GEE). Results: The iACT group showed significantly greater reduction in depression and anxiety than the control group at post‐intervention and follow‐up (all p < 0.001, except for post‐intervention anxiety in iACT group was p = 0.001). The bACT group showed delayed but significant improvement in anxiety at follow‐up (p > 0.001), but not in depression. Between‐group comparisons revealed superior outcomes for iACT over bACT in both anxiety and depression post‐intervention, though the difference in anxiety diminished by follow‐up. Conclusions: Internet‐based ACT was more effective than bACT or standard care in reducing anxiety and depression in breast cancer patients. These results support the broader use of guided Internet‐based ACT interventions in oncology settings. Trial Registration: Iranian Registry of Clinical Trials: IRCT20231209060301N1
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