Efficacy of ACT for self-injurious thoughts and behaviours: a systematic review and meta-analysis

Brief summary

This study systematically evaluates the effectiveness of acceptance and commitment therapy (ACT) in reducing self-injurious thoughts and behaviours (SITBs), such as suicide ideation, suicide attempts, self-harm, and non-suicidal self-injury (NSSI). Through a meta-analysis of 48 studies with a total of 4,719 participants, the research provides comprehensive insights into the short- and long-term impacts of ACT as a therapeutic intervention for SITBs, while also examining factors that may enhance its efficacy.

Key findings

1. Effectiveness of ACT: ACT significantly reduced suicide ideation (g = -0.64), suicide attempts (g = -0.66), self-harm (g = -1.53), NSSI (g = -0.59), and overall SITBs (g = -0.99) at post-treatment. At follow-up, ACT maintained its effectiveness, particularly for suicide ideation (g = -2.15), NSSI (g = -1.18), and overall SITBs (g = -1.52).
2. Comparison to other therapies: ACT demonstrated effectiveness comparable to dialectical behaviour therapy (DBT) and exceeded the efficacy of cognitive behavioural therapy (CBT) and mindfulness-based interventions (MBI) for SITBs.
3. Moderators of effectiveness: Group-based ACT was found to be more effective than individual formats; interventions in Eastern countries showed greater efficacy compared to those in Western contexts. Direct interventions targeting SITBs were more effective than indirect interventions addressing broader issues.
4. Cultural relevance: ACT’s alignment with Eastern philosophies, such as mindfulness and acceptance, may enhance its effectiveness in those regions.

Practice recommendations

• ACT should be considered a viable and effective therapeutic option for reducing SITBs.
• Group-based delivery of ACT could maximise its benefits, and its implementation in culturally diverse settings shows promise.
• Direct interventions focusing specifically on SITBs should be prioritised where possible.
• Training practitioners in ACT principles and adapting interventions to specific cultural contexts can improve outcomes for individuals experiencing SITBs.
• Further high-quality, large-scale, and long-term research is necessary to refine these findings and ensure robust application in clinical practice.

Reference

Zhang, T., et al. (2025). Efficacy of acceptance and commitment therapy for self-injurious thoughts and behaviours: a systematic review and meta-analysis. Psychotherapy and Psychosomatics. https://doi.org/10.1159/000548398