ACT for adolescent anxiety: a systematic research review

Anxiety in young people is both incredibly common and can be incredibly debilitating. It can interrupt key developmental tasks related to establishing social connections, undertaking academic requirements, and developing a healthy sense of self.

Although many young people report experiencing anxiety, a subgroup describes their anxiety as very restrictive. They need some help and assistance with it. Acceptance and commitment therapy provides both a toolkit for approaching anxiety and a method to help young people develop a healthy relationship with anxiety, which allows them to be anxious at times but not let their anxiety define them. Alongside this, the beauty of a group intervention is that it helps adolescents connect with each other, normalise their anxiety experience in a healthy way, and do this without necessarily having adults dictate to them the terms of their relationship with anxiety.

That’s what makes this systematic review so exciting. It looks into the current research for ACT for helping young people with their anxiety within a group setting. The review covered nine different studies, with over 1,000 participants included in all the studies.

The interventions ranged from three sessions delivered over 12 weeks to 16 30-minute sessions twice weekly.

Efficacy of group-based ACT for adolescent anxiety

The review uncovered compelling evidence supporting the effectiveness of group-based ACT in reducing anxiety symptoms among adolescents. Post-treatment assessments revealed a significant decrease in anxiety symptoms, with indications that the benefits may continue to grow over time. Despite variations in follow-up data availability across the studies, the overall findings suggest that group-based ACT holds promise in alleviating anxiety symptoms both immediately after treatment and potentially in the long term.

Effectiveness based on symptom severity

Subgroup analyses revealed an intriguing pattern: participants with clinical levels of anxiety experienced the most substantial reduction in symptoms following group-based ACT. These findings align with previous research conducted with adult populations, highlighting the consistent effectiveness of ACT in addressing clinical symptoms. Surprisingly, the review also found that group-based ACT appeared to have a greater impact on adolescents with nonclinical symptoms compared to those with subclinical symptoms. This unexpected finding warrants further investigation to better understand the complex relationship between ACT and different levels of symptom severity among adolescents.

Impact on psychological inflexibility

The review also examined the impact of group-based ACT on psychological inflexibility, a key component of anxiety. By targeting experiential avoidance and cognitive fusion, ACT aims to reduce psychological inflexibility. The analysis revealed that group ACT effectively reduced avoidance and fusion outcomes, suggesting a reduction in psychological inflexibility among adolescents. These findings align with previous meta-analyses conducted with adult populations, providing support for the hypothesised processes of change in ACT when used with adolescents. However, further research is needed to explore the intricate relationship between psychological inflexibility and anxiety symptoms in this population.

Implications

First of all, it’s important to keep in mind these conclusions are based on small samples and only nine studies. As always, further research is needed. Having said that, the data is exciting and shows a lot of promise for helping young people who are experiencing anxiety. The most intriguing finding is that ACT appears to be most useful for those young people with more severe levels of anxiety. This may perhaps be because they’re more willing to experiment with different strategies that they have not previously used. It may also be an interaction with a group intervention. They get to meet and talk with other young people experiencing anxiety which would likely have the added benefit of normalising their experiences.

Key points

  • Group-based Acceptance and Commitment Therapy (ACT) shows promise in treating adolescent anxiety.
  • A systematic review and meta-analysis examined nine studies with over 1,000 participants.
  • Group-based ACT led to a significant decrease in anxiety symptoms.
  • ACT was particularly effective for adolescents with clinical levels of anxiety.
  • It also reduced psychological inflexibility, a key component of anxiety.
  • Group intervention allowed for connection and normalisation of anxiety experiences.
  • Further research is needed to validate these findings and explore the nuances of ACT for adolescent anxiety.

Burley, J., & McAloon, J. (2023). Group acceptance and commitment therapy for adolescent anxiety: A systematic review and meta-analysis. Journal of Contextual Behavioral Science. Advance online publication. https://doi.org/10.1016/j.jcbs.2023.11.003

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