An Overview of Reviews on the Effects of Acceptance and Commitment Therapy (ACT) on Depression and Anxiety
-
Zahra Beygi
,
Reyhane Tighband Jangali
,
Nafiseh Derakhshan
,
Mina Alidadi
,
Farzane Javanbakhsh
,
Mahdieh Mahboobizadeh
Abstract
Objective: Emotional disturbances are the most common mental health problems in different populations and societies. We intend to provide the latest evidence related to the effectiveness of Acceptance and Commitment Therapy (ACT) on depression and anxiety by reviewing systematic review and meta-analysis studies published in the last three years.
Method: PubMed and Google Scholar databases were systematically searched between January 1, 2019 and November 25, 2022 with relevant keywords for English systematic review and meta-analysis articles reviewing the utilization of ACT to reduce anxiety and depression symptoms.
Results: 25 articles were included in our study: 14 systematic review and meta-analysis studies and 11 systematic reviews. These studies have investigated the effects of ACT on depression and anxiety in populations of children or adults, mental health patients, patients with different cancers or multiple sclerosis, people with audiological problems, parents or caregivers of children with mental or physical illnesses as well as normal people. Furthermore, they have examined the effects of ACT in individual, group, Internet, computerized, or combined delivery formats. Most of the reviewed studies reported significant effect sizes (small to large effect sizes) of ACT, regardless of the delivery method, compared to passive (placebo, waitlist) and active (treatment as usual and other psychological interventions except cognitive behavioral therapy (CBT)) controls for depression and anxiety.
Conclusion: Recent literature mainly agrees on the small to moderate effect sizes of ACT on depression and anxiety symptoms in different populations.
1. Mohammadi MR, Ahmadi N, Khaleghi A, Mostafavi SA, Kamali K, Rahgozar M, et al. Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents. Iran J Psychiatry. 2019;14(1):1-15.
2. Kircanski K, LeMoult J, Ordaz S, Gotlib IH. Investigating the nature of co-occurring depression and anxiety: Comparing diagnostic and dimensional research approaches. J Affect Disord. 2017;216:123-35.
3. Mohammadi MR, Salehi M, Khaleghi A, Hooshyari Z, Mostafavi SA, Ahmadi N, et al. Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities. J Affect Disord. 2020;263:450-7.
4. Mohammadi MR, Alavi SS, Ahmadi N, Khaleghi A, Kamali K, Ahmadi A, et al. The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression. J Affect Disord. 2019;247:1-10.
5. Mohammadi MR, Pourdehghan P, Mostafavi SA, Hooshyari Z, Ahmadi N, Khaleghi A. Generalized anxiety disorder: Prevalence, predictors, and comorbidity in children and adolescents. J Anxiety Disord. 2020;73:102234.
6. Mohammadi MR, Zarafshan H, Khayam Bashi S, Mohammadi F, Khaleghi A. The Role of Public Trust and Media in the Psychological and Behavioral Responses to the COVID-19 Pandemic. Iran J Psychiatry. 2020;15(3):189-204.
7. Khaleghi A, Mohammadi MR, Pirzad Jahromi G, Zarafshan H. New Ways to Manage Pandemics: Using Technologies in the Era of COVID-19: A Narrative Review. Iran J Psychiatry. 2020;15(3):236-42.
8. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann N Y Acad Sci. 2021;1486(1):90-111.
9. Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, et al. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35(3):195-208.
10. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, et al. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry. 2017;210(2):119-24.
11. Farzadfar F, Naghavi M, Sepanlou SG, Moghaddam SS, Dangel WJ, Weaver ND, et al. Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;399(10335):1625-45.
12. Swain J, Hancock K, Hainsworth C, Bowman J. Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clin Psychol Rev. 2013;33(8):965-78.
13. Twohig MP. Acceptance and commitment therapy: Introduction. Elsevier; 2012. p. 499-507.
14. Pears S, Sutton S. Effectiveness of Acceptance and Commitment Therapy (ACT) interventions for promoting physical activity: a systematic review and meta-analysis. Health Psychol Rev. 2021;15(1):159-84.
15. Plumb JC, Vilardaga R. Assessing treatment integrity in acceptance and commitment therapy: Strategies and suggestions. Int J Behav Consult Ther. 2010;6(3):263.
16. Hayes SC. Acceptance and commitment therapy: towards a unified model of behavior change. World Psychiatry. 2019;18(2):226-7.
17. Levin ME, Herbert JD, Forman EM. Acceptance and commitment therapy: a critical review to guide clinical decision making. Treatments for psychological problems and syndromes. 2017:413-32.
18. Twohig MP, Levin ME. Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. Psychiatr Clin North Am. 2017;40(4):751-70.
19. Hacker T, Stone P, MacBeth A. Acceptance and commitment therapy - Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. J Affect Disord. 2016;190:551-65.
20. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. Bmj. 2017;358:j4008.
21. Ferreira MG, Mariano LI, Rezende JV, Caramelli P, Kishita N. Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord. 2022;309:297-308.
22. Chua JYX, Shorey S. The Effect of Mindfulness-Based and Acceptance Commitment Therapy-Based Interventions to Improve the Mental Well-Being Among Parents of Children with Developmental Disabilities: A Systematic Review and Meta-Analysis. J Autism Dev Disord. 2022;52(6):2770-83.
23. Haller H, Breilmann P, Schröter M, Dobos G, Cramer H. A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders. Sci Rep. 2021;11(1):20385.
24. Han A, Yuen HK, Jenkins J. Acceptance and commitment therapy for family caregivers: A systematic review and meta-analysis. J Health Psychol. 2021;26(1):82-102.
25. Li Z, Li Y, Guo L, Li M, Yang K. Effectiveness of acceptance and commitment therapy for mental illness in cancer patients: A systematic review and meta-analysis of randomised controlled trials. Int J Clin Pract. 2021;75(6):e13982.
26. Parmar A, Esser K, Barreira L, Miller D, Morinis L, Chong YY, et al. Acceptance and Commitment Therapy for Children with Special Health Care Needs and Their Parents: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(15).
27. Thompson EM, Destree L, Albertella L, Fontenelle LF. Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes. Behav Ther. 2021;52(2):492-507.
28. Bai Z, Luo S, Zhang L, Wu S, Chi I. Acceptance and commitment therapy (ACT) to reduce depression: A systematic review and meta-analysis. J Affect Disord. 2020;260:728-37.
29. Fang S, Ding D. A meta-analysis of the efficacy of acceptance and commitment therapy for children. J Contextual Behav Sci. 2020;15:225-34.
30. Jansen JE, Gleeson J, Bendall S, Rice S, Alvarez-Jimenez M. Acceptance-and mindfulness-based interventions for persons with psychosis: A systematic review and meta-analysis. Schizophr Res. 2020;215:25-37.
31. Li H, Wu J, Ni Q, Zhang J, Wang Y, He G. Systematic Review and Meta-Analysis of Effectiveness of Acceptance and Commitment Therapy in Patients With Breast Cancer. Nurs Res. 2021;70(4):E152-e60.
32. Wang B, Gould RL, Kumar P, Pikett L, Thompson B, Gonzalez SC, et al. A Systematic Review and Meta-Analysis Exploring Effects of Third-Wave Psychological Therapies on Hearing-Related Distress, Depression, Anxiety, and Quality of Life in People With Audiological Problems. Am J Audiol. 2022;31(2):487-512.
33. Sun Y, Ji M, Zhang X, Chen J, Wang Y, Wang Z. Comparative effectiveness and acceptability of different ACT delivery formats to treat depression: A systematic review and network meta-analysis of randomized controlled trials. J Affect Disord. 2022;313:196-203.
34. Thompson B, Moghaddam N, Evangelou N, Baufeldt A, das Nair R. Effectiveness of acceptance and commitment therapy for improving quality of life and mood in individuals with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord. 2022;63:103862.
35. Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M. The empirical status of acceptance and commitment therapy: A review of meta-analyses. J Contextual Behav Sci. 2020;18:181-92.
36. Knight L, Samuel V. Acceptance and commitment therapy interventions in secondary schools and their impact on students' mental health and well-being: A systematic review. J Contextual Behav Sci. 2022.
37. Li H, Wong CL, Jin X, Chen J, Chong YY, Bai Y. Effects of Acceptance and Commitment Therapy on health-related outcomes for patients with advanced cancer: A systematic review. Int J Nurs Stud. 2021;115:103876.
38. Coto-Lesmes R, Fernández-Rodríguez C, González-Fernández S. Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. J Affect Disord. 2020;263:107-20.
39. Byrne G, Ghráda Á N, O'Mahony T, Brennan E. A systematic review of the use of acceptance and commitment therapy in supporting parents. Psychol Psychother. 2021;94 Suppl 2:378-407.
40. Kelson J, Rollin A, Ridout B, Campbell A. Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. J Med Internet Res. 2019;21(1):e12530.
41. Yıldız E. The effects of acceptance and commitment therapy in psychosis treatment: A systematic review of randomized controlled trials. Perspect Psychiatr Care. 2020;56(1):149-67.
42. Mathew A, Doorenbos AZ, Jang MK, Hershberger PE. Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model. J Cancer Surviv. 2021;15(3):427-51.
43. Stockton D, Kellett S, Berrios R, Sirois F, Wilkinson N, Miles G. Identifying the Underlying Mechanisms of Change During Acceptance and Commitment Therapy (ACT): A Systematic Review of Contemporary Mediation Studies. Behav Cogn Psychother. 2019;47(3):332-62.
44. Caletti E, Massimo C, Magliocca S, Moltrasio C, Brambilla P, Delvecchio G. The role of the acceptance and commitment therapy in the treatment of social anxiety: An updated scoping review. J Affect Disord. 2022;310:174-82.
45. Harris E, Samuel V. Acceptance and Commitment Therapy: A Systematic Literature Review of Prevention and Intervention Programs for Mental Health Difficulties in Children and Young People. J Cogn Psychother. 2020;34(4):280-305.
46. JG AT, Davis ML, Morina N, Powers MB, Smits JA, Emmelkamp PM. A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychother Psychosom. 2015;84(1):30-6.
47. Jiménez FJR. Acceptance and commitment therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence. Int J Psychol Psychol Ther. 2012;12(3):333-58.
2. Kircanski K, LeMoult J, Ordaz S, Gotlib IH. Investigating the nature of co-occurring depression and anxiety: Comparing diagnostic and dimensional research approaches. J Affect Disord. 2017;216:123-35.
3. Mohammadi MR, Salehi M, Khaleghi A, Hooshyari Z, Mostafavi SA, Ahmadi N, et al. Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities. J Affect Disord. 2020;263:450-7.
4. Mohammadi MR, Alavi SS, Ahmadi N, Khaleghi A, Kamali K, Ahmadi A, et al. The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression. J Affect Disord. 2019;247:1-10.
5. Mohammadi MR, Pourdehghan P, Mostafavi SA, Hooshyari Z, Ahmadi N, Khaleghi A. Generalized anxiety disorder: Prevalence, predictors, and comorbidity in children and adolescents. J Anxiety Disord. 2020;73:102234.
6. Mohammadi MR, Zarafshan H, Khayam Bashi S, Mohammadi F, Khaleghi A. The Role of Public Trust and Media in the Psychological and Behavioral Responses to the COVID-19 Pandemic. Iran J Psychiatry. 2020;15(3):189-204.
7. Khaleghi A, Mohammadi MR, Pirzad Jahromi G, Zarafshan H. New Ways to Manage Pandemics: Using Technologies in the Era of COVID-19: A Narrative Review. Iran J Psychiatry. 2020;15(3):236-42.
8. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann N Y Acad Sci. 2021;1486(1):90-111.
9. Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, et al. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35(3):195-208.
10. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, et al. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry. 2017;210(2):119-24.
11. Farzadfar F, Naghavi M, Sepanlou SG, Moghaddam SS, Dangel WJ, Weaver ND, et al. Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;399(10335):1625-45.
12. Swain J, Hancock K, Hainsworth C, Bowman J. Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clin Psychol Rev. 2013;33(8):965-78.
13. Twohig MP. Acceptance and commitment therapy: Introduction. Elsevier; 2012. p. 499-507.
14. Pears S, Sutton S. Effectiveness of Acceptance and Commitment Therapy (ACT) interventions for promoting physical activity: a systematic review and meta-analysis. Health Psychol Rev. 2021;15(1):159-84.
15. Plumb JC, Vilardaga R. Assessing treatment integrity in acceptance and commitment therapy: Strategies and suggestions. Int J Behav Consult Ther. 2010;6(3):263.
16. Hayes SC. Acceptance and commitment therapy: towards a unified model of behavior change. World Psychiatry. 2019;18(2):226-7.
17. Levin ME, Herbert JD, Forman EM. Acceptance and commitment therapy: a critical review to guide clinical decision making. Treatments for psychological problems and syndromes. 2017:413-32.
18. Twohig MP, Levin ME. Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. Psychiatr Clin North Am. 2017;40(4):751-70.
19. Hacker T, Stone P, MacBeth A. Acceptance and commitment therapy - Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. J Affect Disord. 2016;190:551-65.
20. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. Bmj. 2017;358:j4008.
21. Ferreira MG, Mariano LI, Rezende JV, Caramelli P, Kishita N. Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord. 2022;309:297-308.
22. Chua JYX, Shorey S. The Effect of Mindfulness-Based and Acceptance Commitment Therapy-Based Interventions to Improve the Mental Well-Being Among Parents of Children with Developmental Disabilities: A Systematic Review and Meta-Analysis. J Autism Dev Disord. 2022;52(6):2770-83.
23. Haller H, Breilmann P, Schröter M, Dobos G, Cramer H. A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders. Sci Rep. 2021;11(1):20385.
24. Han A, Yuen HK, Jenkins J. Acceptance and commitment therapy for family caregivers: A systematic review and meta-analysis. J Health Psychol. 2021;26(1):82-102.
25. Li Z, Li Y, Guo L, Li M, Yang K. Effectiveness of acceptance and commitment therapy for mental illness in cancer patients: A systematic review and meta-analysis of randomised controlled trials. Int J Clin Pract. 2021;75(6):e13982.
26. Parmar A, Esser K, Barreira L, Miller D, Morinis L, Chong YY, et al. Acceptance and Commitment Therapy for Children with Special Health Care Needs and Their Parents: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(15).
27. Thompson EM, Destree L, Albertella L, Fontenelle LF. Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes. Behav Ther. 2021;52(2):492-507.
28. Bai Z, Luo S, Zhang L, Wu S, Chi I. Acceptance and commitment therapy (ACT) to reduce depression: A systematic review and meta-analysis. J Affect Disord. 2020;260:728-37.
29. Fang S, Ding D. A meta-analysis of the efficacy of acceptance and commitment therapy for children. J Contextual Behav Sci. 2020;15:225-34.
30. Jansen JE, Gleeson J, Bendall S, Rice S, Alvarez-Jimenez M. Acceptance-and mindfulness-based interventions for persons with psychosis: A systematic review and meta-analysis. Schizophr Res. 2020;215:25-37.
31. Li H, Wu J, Ni Q, Zhang J, Wang Y, He G. Systematic Review and Meta-Analysis of Effectiveness of Acceptance and Commitment Therapy in Patients With Breast Cancer. Nurs Res. 2021;70(4):E152-e60.
32. Wang B, Gould RL, Kumar P, Pikett L, Thompson B, Gonzalez SC, et al. A Systematic Review and Meta-Analysis Exploring Effects of Third-Wave Psychological Therapies on Hearing-Related Distress, Depression, Anxiety, and Quality of Life in People With Audiological Problems. Am J Audiol. 2022;31(2):487-512.
33. Sun Y, Ji M, Zhang X, Chen J, Wang Y, Wang Z. Comparative effectiveness and acceptability of different ACT delivery formats to treat depression: A systematic review and network meta-analysis of randomized controlled trials. J Affect Disord. 2022;313:196-203.
34. Thompson B, Moghaddam N, Evangelou N, Baufeldt A, das Nair R. Effectiveness of acceptance and commitment therapy for improving quality of life and mood in individuals with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord. 2022;63:103862.
35. Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M. The empirical status of acceptance and commitment therapy: A review of meta-analyses. J Contextual Behav Sci. 2020;18:181-92.
36. Knight L, Samuel V. Acceptance and commitment therapy interventions in secondary schools and their impact on students' mental health and well-being: A systematic review. J Contextual Behav Sci. 2022.
37. Li H, Wong CL, Jin X, Chen J, Chong YY, Bai Y. Effects of Acceptance and Commitment Therapy on health-related outcomes for patients with advanced cancer: A systematic review. Int J Nurs Stud. 2021;115:103876.
38. Coto-Lesmes R, Fernández-Rodríguez C, González-Fernández S. Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. J Affect Disord. 2020;263:107-20.
39. Byrne G, Ghráda Á N, O'Mahony T, Brennan E. A systematic review of the use of acceptance and commitment therapy in supporting parents. Psychol Psychother. 2021;94 Suppl 2:378-407.
40. Kelson J, Rollin A, Ridout B, Campbell A. Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. J Med Internet Res. 2019;21(1):e12530.
41. Yıldız E. The effects of acceptance and commitment therapy in psychosis treatment: A systematic review of randomized controlled trials. Perspect Psychiatr Care. 2020;56(1):149-67.
42. Mathew A, Doorenbos AZ, Jang MK, Hershberger PE. Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model. J Cancer Surviv. 2021;15(3):427-51.
43. Stockton D, Kellett S, Berrios R, Sirois F, Wilkinson N, Miles G. Identifying the Underlying Mechanisms of Change During Acceptance and Commitment Therapy (ACT): A Systematic Review of Contemporary Mediation Studies. Behav Cogn Psychother. 2019;47(3):332-62.
44. Caletti E, Massimo C, Magliocca S, Moltrasio C, Brambilla P, Delvecchio G. The role of the acceptance and commitment therapy in the treatment of social anxiety: An updated scoping review. J Affect Disord. 2022;310:174-82.
45. Harris E, Samuel V. Acceptance and Commitment Therapy: A Systematic Literature Review of Prevention and Intervention Programs for Mental Health Difficulties in Children and Young People. J Cogn Psychother. 2020;34(4):280-305.
46. JG AT, Davis ML, Morina N, Powers MB, Smits JA, Emmelkamp PM. A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychother Psychosom. 2015;84(1):30-6.
47. Jiménez FJR. Acceptance and commitment therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence. Int J Psychol Psychol Ther. 2012;12(3):333-58.
| Files | ||
| Issue | Vol 18 No 2 (2023) | |
| Section | Short Communication(s) | |
| DOI | https://doi.org/10.18502/ijps.v18i2.12373 | |
| Keywords | ||
| Acceptance and Commitment Therapy Systematic Review Depression Anxiety | ||
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How to Cite
1.
Beygi Z, Tighband Jangali R, Derakhshan N, Alidadi M, Javanbakhsh F, Mahboobizadeh M. An Overview of Reviews on the Effects of Acceptance and Commitment Therapy (ACT) on Depression and Anxiety. Iran J Psychiatry. 2023;18(2):248-257.
