en مامائی Midwifery پژوهشي Original Article <div style="text-align: justify;"><span style="font-size:14px;"><span style="font-family:Tahoma;"><span style="line-height:2;"><b>Background:</b> Secondary tokophobia, or the fear of subsequent pregnancy and childbirth often linked to postnatal post-traumatic stress symptoms (P-PTSS), can result from a negative prior experience and lead to avoidance of childbearing. Given the importance of maintaining a young population in Iran, this study aimed to compare the effectiveness of acceptance and commitment<span style="color:black"> therapy</span> (ACT) versus motivational counseling (MC) via telemedicine on P-PTSS in single-child women with tokophobia.<br> <b>Methods:</b> This three-arm randomized controlled trial was conducted from January 2024 to March 2025 in Mashhad, Iran, and enrolled 102 single-child women with secondary tokophobia diagnosed by the Fear of Childbirth Prior Pregnancy (FOCPP) and assessed with the Impact of Event Scale (IES). Participants were randomly assigned using six blocks to an ACT group, a MC group, or a control group. The primary outcome was P-PTSS severity, measured at baseline, 4 weeks post-intervention, and 6&ndash;8 weeks post-intervention. After attrition, 94 participants were analyzed (ACT = 33, MC = 32, control = 29). Data were entered into a computer, and analyzed using SPSS version 25 software. One-way analysis of variance and chi-square tests were performed with a significance level of 0.05.<br> <b>Results:</b> Among 102 single-child women with secondary tokophobia (mean age: 31.28 &plusmn; 5.08 years), 34 were randomized to each of the three groups. Four weeks post-intervention, P-PTSS scores significantly decreased in the ACT (24.36&plusmn;4.07) and MC (26.59&plusmn;3.2) groups, while increasing in the control group (34.13&plusmn;6.11). This difference between groups was statistically significant (p < 0.001), suggesting a positive effect of the interventions. At the eight-week follow-up, the improvement continued in the ACT (22.36&plusmn;3.30) and MC (23.62&plusmn;2.58) groups, while the control group remained high (33.65&plusmn;5.84), with a significant difference between groups (p < 0.001). however, no statistically significant differences were observed between the ACT and MC counseling at either follow-up assessment.<br> <b>Conclusion:</b> Telemedicine-based MC and ACT counseling effectively and significantly reduces postnatal PTSS scores in single-child women with secondary tokophobia at two follow up time points. Telemedicine‑based ACT and MC appear promising for re‑pregnancy counseling in women with secondary tokophobia, but longer follow‑up and broader settings are needed.</span></span></span></div> Secondary tokophobia, P-PTSS, commitment-acceptance therapy, motivational counseling, childbearing 6 6 http://jhs.mazums.ac.ir/browse.php?a_code=A-10-1248-1&slc_lang=en&sid=1 Maryam Ramezani ramezanim4012@mums.ac.ir 100319475328460015974 0009-0000-1390-9460 No Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran Mohsen Dehghani dehghanimhs@mums.ac.ir 100319475328460015975 100319475328460015975 No Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran Somaye Minaei Moghadam moghadam95@gmail.com 100319475328460015976 100319475328460015976 No Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Sedigheh Abdollahpour abdollahpourts2@yahoo.com 100319475328460015977 100319475328460015977 Yes Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran