Systematic review and meta-analysis of ACT in working with chronic health conditions

This systematic review and meta-analysis offers some valuable insights into the application of ACT for treatment of chronic pain.

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Konstantinou, P., Ioannou, M., Melanthiou, D., Georgiou, K., Almas, I., Gloster, A.T., Kassianos, A.P., & Karekla, M. (2023). The impact of acceptance and commitment therapy (ACT) on quality of life and symptom improvement among chronic health conditions: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 29, 240-253. https://doi.org/10.1016/j.jcbs.2023.08.004


Study overview

Chronic health conditions (CHCs) affect millions of individuals worldwide. One promising intervention for managing CHCs is acceptance and commitment therapy (ACT). However, the current literature on ACT’s efficacy in CHCs is limited, as there is no uniform definition of CHCs being used across studies, despite existing definitions provided by organisations like the World Health Organisation.

To address this gap, a systematic review and meta-analysis was conducted to examine the efficacy of ACT compared to other treatment groups (both active and inactive) in well-defined CHCs. The researchers screened databases and included 57 studies in the systematic review. Out of these, 33 studies were included in the meta-analysis for quality of life (QoL) outcomes, and 45 studies were included for symptom improvement outcomes.

Key findings

  • Acceptance and commitment therapy (ACT) shows promise for managing chronic health conditions (CHCs).
  • A systematic review and meta-analysis examined the efficacy of ACT compared to other treatments in well-defined CHCs.
  • ACT was found to be superior to inactive groups and some active treatments in improving quality of life and symptom management.
  • Moderators such as CHC type, treatment setting, and format influenced the effectiveness of ACT.
  • More research is needed to fully understand the potential benefits of ACT for CHC management.

Summary

The overall quality of the included studies was found to be mostly low, with some criteria lacking important information, such as attrition rates. Despite this, the meta-analyses showed that ACT was superior to comparison groups in terms of both QoL and symptom improvement. Specifically, subgroup analyses revealed that ACT was more effective than inactive groups (such as waitlist and treatment-as-usual) and some active groups (such as yoga, expressive writing, and standardised talking) in improving overall QoL, psychological health, and symptoms of anxiety and depression.

The researchers also identified several moderators that influenced the efficacy of ACT. These included the type of CHC (such as breast cancer), treatment setting (such as outpatient), and treatment format (such as group therapy). These findings suggest that ACT is an effective treatment option for various CHCs, leading to improved QoL and symptom management.

However, it is important to note that the quality of the included studies was generally low, and there were limitations in terms of study design and sample sizes. Therefore, further research is needed to strengthen the evidence base for ACT in CHC management. The discussion section of the paper proposes areas where ACT can have an impact, highlights the need for future research, and provides recommendations for stakeholders involved in CHC management.

You may also find our knowledge hub post Chronic Pain and ACT useful for background reading on this topic.

 

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