An overview review of the systematic reviews of ACT for chronic pain

Martinez-Calderon, J., García-Muñoz, C., Rufo-Barbero, C., Matias-Soto, J., & Cano-García, F. J. (2023). Acceptance and commitment therapy for chronic pain: An overview of systematic reviews with meta-analysis of randomized clinical trials. The Journal of Pain. DOI:


Key findings from study

  • Post-treatment: ACT can reduce depression, anxiety, inflexibility, catastrophising.
  • Post-treatment: ACT can improve mindfulness, pain acceptance, flexibility.
  • Three-month: ACT can improve depression, inflexibility, functioning, flexibility.
  • Six-month: ACT can improve mindfulness, functioning, acceptance, flexibility.
  • Six-twelve-month: ACT can improve catastrophising and functioning.


Background to the study

Chronic pain affects a large number of people worldwide, with around 27.5% of the population experiencing it. The financial impact of chronic pain is significant, with billions of dollars spent on medical costs and lost productivity. Dealing with chronic pain can be complex, requiring a collaborative approach that addresses various symptoms and physical limitations.

Psychological interventions, particularly cognitive-behavioural therapies (CBT), have shown promise in managing chronic pain. Acceptance and Commitment Therapy (ACT), a type of CBT, focuses on improving psychological flexibility and emphasizes six core processes to help individuals engage in meaningful activities despite negative thoughts and emotions. By valuing personal growth and purpose, people can better cope with pain, fear, and other difficult experiences.

Clinical trials have demonstrated the effectiveness of ACT in treating chronic pain, both through online and face-to-face sessions, either as a standalone treatment or as part of a comprehensive pain management plan. The number of trials and reviews exploring the benefits of ACT for chronic pain has been increasing. This summary of systematic reviews aims to provide an overview and critical analysis of the benefits of ACT for pain intensity, functioning, psychological factors, and quality of life in adults with chronic pain. Such summaries help pain clinicians and researchers identify gaps in knowledge and shape future directions for ACT in managing chronic pain.

Summary of findings

The findings from various studies showed positive outcomes after ACT treatment. People experienced a reduction in symptoms of depression, anxiety, psychological inflexibility, and pain catastrophising. They also reported improvements in mindfulness, pain acceptance, and psychological flexibility.

The benefits of ACT were observed not only immediately after treatment but also at follow-up periods. At the three-month mark, ACT was found to reduce depression symptoms and increase psychological flexibility, while improving pain-related functioning. After six months, participants showed improvements in mindfulness, pain-related functioning, pain acceptance, psychological flexibility, and overall quality of life. Even at the six to twelve-month follow-up, ACT continued to reduce pain catastrophising and enhance pain-related functioning.

On the whole, randomised clinical trials and systematic reviews have consistently demonstrated that ACT can enhance outcomes associated with chronic pain, such as improvements in pain-related functioning.


If you’re interested in finding out more about how to use ACT with people experiencing chronic pain, you might be interested in our on-demand training with Professor Lance McCracken. You can find more information about this training event here.