Brief summary
This systematic review and meta-analysis examined the use of single-session acceptance and commitment therapy (ACT) interventions for adults with chronic health conditions (CHCs).
Fourteen manuscripts reporting outcomes from 13 unique studies (N = 793) were identified through searches of PsycINFO, PubMed, and Web of Science. Interventions were typically delivered as a single-day workshop (modal length: 5 hours) in medical or hospital settings. Ten of the 13 studies were pilot or feasibility trials. Conditions studied included migraine, type 2 diabetes, irritable bowel syndrome, inflammatory bowel disease, multiple sclerosis, functional somatic syndromes, and post-surgical pain risk.
Outcomes were reviewed across four domains: (1) functioning and quality of life, (2) mental health, (3) physical health, and (4) ACT processes (e.g., psychological flexibility, acceptance). A random-effects meta-analysis of between-group effects on functioning-related outcomes was conducted across five controlled studies.
Key findings
Across all four outcome domains, 69% of outcomes showed results favouring single-session ACT (significant effects in randomised controlled trial or medium-to-large effect sizes in pilot trials). Results by domain:
- Functioning & quality of life: 88% of outcomes favoured ACT (24/27)
- ACT process outcomes (e.g., acceptance, psychological flexibility): 73% (8/11)
- Mental health (depression, anxiety, stress): 67% (16/24)
- Physical health (e.g., HbA1c, pain severity, GI symptoms): 31% (4/13)
Practice recommendations
Based on the findings and the authors’ recommendations for future research, the following implications are relevant for clinicians working with chronic health populations:
- Single-session ACT workshops (~5 hours) are feasible and generally well-accepted by patients with chronic health conditions, including those with significant psychiatric comorbidity such as depression or anxiety.
- Functioning and quality of life are the most responsive outcomes. Clinicians should set realistic expectations: physical symptom reduction is less consistently achieved than improvements in disability, daily functioning, and engagement in valued activities.
- ACT is particularly appropriate where symptom elimination is not a viable goal. Its transdiagnostic focus on psychological flexibility makes it applicable across diverse CHC presentations without requiring condition-specific adaptations beyond psychoeducation components.
- Dropout can be significant, especially for patients with multiple comorbidities or high disability. Practical barriers (time, distance) and emotional overwhelm were the most commonly reported reasons for non-participation. Virtual delivery may improve reach.
- Booster contact (e.g., a follow-up phone call or bibliotherapy) after a single-session workshop may enhance effects. Two studies that included supplementary components demonstrated robust findings.
- Condition-specific acceptance measures (e.g., diabetes acceptance, IBS acceptance) appear more sensitive to change than generic functioning measures, and should be used alongside general outcome tools.
- Single-session ACT may be best positioned as a low-intensity first-line option within a stepped-care framework, with non-responders receiving additional intervention (e.g., full-length ACT) as indicated.
Limitations to note
The evidence base remains preliminary. Clinicians should interpret positive outcomes cautiously, as most evidence comes from small pilot trials and the meta-analysis did not reach significance.
Reference
Dochat, C., Wooldridge, J. S., Herbert, M. S., Lee, M. W., & Afari, N. (2021). Single-session acceptance and commitment therapy (ACT) interventions for patients with chronic health conditions: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 20, 52–69. https://doi.org/10.1016/j.jcbs.2021.03.003
