The Effects of Internet-Based Acceptance and Commitment Therapy on Process Measures: Systematic Review and Meta-analysis

Objective This systematic review and meta-analysis aimed to examine the effects of acceptance and commitment therapy (ACT) on depressive symptoms, anxiety, pain intensity, quality of life, acceptance, and functional impairment in individuals with neurological disorders. Method A comprehensive search was conducted within four databases to identify relevant randomised controlled trials (RCTs). The quality of the included RCTs was assessed using the Cochrane Collaboration risk of bias tool. Either a random effects model or fixed effects model was used. Subgroup analyses were conducted according to the types of control groups. Results Twenty-four RCTs met the eligibility criteria. This meta-analysis found that ACT had medium-to-large effects in the immediate post-test and follow-up on reducing depressive symptoms, anxiety, pain intensity, and perceived functional impairment and improving quality of life and acceptance in individuals with neurological disorders. The overall risk of bias was unclear. Conclusions Relatively fewer studies were conducted to compare the effects of ACT to active control groups compared to studies involving passive control conditions. Future high-quality studies that compare ACT to active control conditions in individuals with neurological disorders are needed to determine whether practitioners should be routinely providing ACT for this population instead of other evidence-based treatments.

As incarcerated populations report significantly higher prevalence rates for psychological distress than community populations, it is important to have an evidence-based perspective on what reduces psychological distress among people in prison or jail. To examine effects of mindfulness-based interventions (MBIs) on psychological distress, including anxiety, depressive symptoms, stress and overall psychological distress, and on mindfulness in incarcerated populations. This systematic review and meta-analysis of randomised controlled trials (RCTs) involved a comprehensive search within the PubMed, CINAHL, PsycINFO, and SCOPUS databases to identify relevant RCTs. The quality of the included RCTs was assessed using the Cochrane Collaboration risk of bias tool. Depending on I2 statistic values for heterogeneity, either a random effects model or fixed effects model was used. Subgroup analyses for each outcome were conducted to see whether effects differed when compared MBIs to active control groups, provided with other comparable interventions, or passive control groups, provided with no intervention (i.e., treatment as usual [TAU] control groups or waiting list controls). Thirteen RCTs met the eligibility criteria. Meta-analyses showed moderate effects of MBIs on depressive symptoms and overall psychological distress, large effects on stress, and small effects on anxiety and mindfulness. The overall risk of bias across studies was unclear. Fewer studies were conducted to compare effects of MBIs to other interventions than TAU. Future high-quality studies comparing MBIs to other active interventions are needed to understand better whether the former are comparable or superior to other evidence-based treatments in decreasing distress and improving mindfulness in incarcerated populations and/or in which circumstances one may be preferable to the other.

Acceptance and commitment therapy (ACT) is one of the so called "third-wave" cognitive behavioral therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT is based on a model of general human functioning called the psychological flexibility (PF) model. Most facets of the PF model have been examined in chronic pain. However, a potential key facet related to "self" appears underappreciated. Indeed, a positive or healthy sense of self seems essential to our well-being, and there have been numerous studies of the self in chronic pain. At the same time, these studies are not currently well organized or easy to summarize. This lack of clarity and integration creates barriers to progress in this area of research. PF with its explicit inclusion of self-related therapeutic processes within a broad, integrative, theoretical model may help. The current review summarizes the PF model in the context of chronic pain with a specific emphasis on the parts of the model that address self-related processes.

Purpose: Within the framework of Acceptance and Commitment Therapy, the study aimed to examine the extent to which psychological flexibility predicted future anxiety among university students and whether core components of psychological flexibility, which are mindfulness, valuing (progress and obstruction), and cognitive defusion, explained additional variance in future anxiety beyond the psychological flexibility. Method: A correlational research design was used in this study. The sample consisted of 336 undergraduate students (213 females, 119 males, and four who did not disclose their gender) enrolled at universities in Ankara, Türkiye, with ages ranging from 18 to 29 years. Hierarchical regression analysis was conducted to test the proposed model. Findings: The results indicated that the final model accounted for 32% of the variance in future anxiety. Individuals with higher levels of psychological flexibility, mindfulness, and cognitive defusion reported lower levels of future anxiety, whereas those with greater value-related obstruction reported higher levels of future anxiety. Progress in values did not significantly predict future anxiety. Conclusion: The findings underscore the critical role of Acceptance and Commitment Therapy in understanding and addressing future anxiety among emerging adults.

Introduction A growing body of research has demonstrated the positive effects of Acceptance and Commitment Therapy (ACT) delivered in the workplace on employees’ well-being and psychological flexibility. Delivering ACT in the workplace aims to enhance employee performance and reduce stress levels by promoting psychological flexibility, a skill to consciously live in the present, observing thoughts and emotions, and engaging in value-driven actions. Objectives The short-term effects of a 5-week ACT-based psychological flexibility training program were tested. Methods Participants were 21 corporate employees (62 % women, M age = 43.9 years, SD = 9.5) recruited from a large company in the financial sector. The six core processes of psychological flexibility were examined before the first training session and after the fifth training session of the 5-week training. Psychological flexibility, value-driven living, thought suppression, five facets of mindfulness and cognitive fusion were assessed. Results Results showed a statistically significant difference in one core process of psychological flexibility, namely Contact with the present moment. Acting with awareness , Describing and Nonjudge showed significant difference before and after the training. Presumably, changes in Cognitive defusion and Non-reactivity are also evident, however results did not show significant difference. Conclusions The present research has provided further empirical evidence for the effectiveness of ACT-based psychological flexibility training with regard to three aspects of Contact with the present moment , which is a core process of psychological flexibility ( Acting with awareness, Describing, and Nonjudge ). The findings provide a basis for future research to investigate longer-term effects, including monitoring how participants in the research program practice the learnt techniques in their everyday lives. Disclosure of Interest Á. Magyary Grant / Research support from: ÁM was supported by the ÚNKP-23-2 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund., Z. Demetrovics: None Declared, Á. Zsila: None Declared, N. Mészáros: None Declared

IntroductionMedical school is known for high levels of anxiety, and mental health challenges. Psychological flexibility - the ability to accept difficult thoughts and emotions while acting in alignment with one’s values- can protect against these challenges. ACT has been shown to enhance psychological flexibility and reduce mental health symptoms in various populations. However, its impact on medical students has not been extensively explored.ObjectivesThis study aimed to assess whether a brief ACT intervention could improve psychological flexibility and related psychological outcomes in medical students.MethodsForty-two medical students from Istanbul Medeniyet University participated in a four-day ACT program. Inclusion criteria included active enrollment in a medical program and willingness to participate. Exclusion criteria were severe psychiatric disorders or ongoing psychiatric treatment.The intervention involved four days of ACT-based activities, including mindfulness, cognitive defusion, and value-based exercises. Each session lasted 90 minutes and was conducted in a group format. To assess the impact of the intervention, we measured psychological flexibility and related factors at baseline and after the program using the following tools: the Multidimensional Experiential Avoidance Questionnaire (MEAQ-30), AAQ-US, SF-25, Valuing Questionnaire (VQ) and the DASS-21. Paired t-tests were used to compare pre- and post-intervention scores, with statistical significance set at p < 0.05.ResultsThe ACT intervention led to significant improvements in psychological flexibility and related factors. The ACT intervention led to significant improvements in psychological flexibility and related factors. Specifically, Distress Aversion (MEAQ-30, subscale B) decreased significantly (p = 0.010), while Distress Endurance (MEAQ-30, subscale F) increased significantly (p = 0.008). Additionally, Anxiety (DASS-A) decreased significantly (p = 0.004), and Stress (DASS-S) also decreased significantly (p = 0.004). No significant changes were observed in other subscale scores, including those for SF-36, depression (DASS-D), and scores for AAQ-US and VQ. These results suggest that ACT may be particularly effective in reducing anxiety and stress while enhancing cognitive flexibility and acceptance.ConclusionsThis study suggests that even a brief, four-day ACT intervention can significantly improve psychological flexibility and reduce anxiety and stress in medical students. These findings highlight ACT’s potential as an effective tool for supporting mental health and resilience in medical students. Further research with larger sample sizes and longer follow-up periods is needed to explore the long-term impact of ACT interventions in academic settings.Disclosure of InterestNone Declared

Further validation of the Chronic Pain Values Inventory in a Swedish chronic pain sample

Clients who present to psychotherapy reporting diffuse and/or sub-clinical concerns may provide a puzzling treatment decision for providers of evidence-based practice. The current case study illustrates the implementation of an evidence-based treatment, Acceptance and Commitment Therapy (ACT), for a client diagnosed with adjustment disorder with mixed anxiety and depressive symptoms. ACT targets a dimensional, transdiagnostic construct known as psychological flexibility, currently conceptualized as involving six inter-related behavioral repertoires. The client was a Caucasian woman in her 30s who self-referred to therapy. She reported feeling anxious and depressed, especially in regard to interpersonal difficulties with her mother and her ex-husband. Fourteen sessions of an ACT protocol emphasizing a modular approach to the repertoires emphasized by the psychological flexibility model were provided. Each modular session consisted of psychoeducation, metaphors, experiential exercises, and daily practice assignments for one of the repertoires. The client completed pre-treatment, post-treatment, and 6-month follow-up outcome measures and weekly process measures to track change throughout treatment. One process measure assessed each of the six repertoires. The client’s data revealed substantial increases in psychological flexibility and decreases in psychological distress from pre- to post-treatment, which remained stable at follow-up. This case report suggests that ACT may be a desirable treatment option for clients bearing ambiguous or sub-clinical presentations, including interpersonal conflicts. The report also provides a model for monitoring change with individual psychological flexibility repertoires with respect to a modular approach to teaching those repertoires.

Sleep improvement is a promising target for preventing and modifying many health problems. Hypnosis is considered a cost-effective and safe intervention with reported benefits for multiple health conditions. There is a growing body of research assessing the efficacy of hypnosis for various health conditions in which sleep was targeted as a primary or secondary outcome. This review aimed to investigate the effects of hypnosis interventions on sleep, to describe the hypnotic procedures, and to evaluate potential adverse effects of hypnosis. We reviewed studies (prior to January 2017) using hypnosis in adults for sleep problems and other conditions comorbid with sleep problems, with at least one sleep outcome measure. Randomized controlled trials and other prospective studies were included. One hundred thirty-nine nonduplicate abstracts were screened, and 24 of the reviewed papers were included for qualitative analysis. Overall, 58.3% of the included studies reported hypnosis benefit on sleep outcomes, with 12.5% reporting mixed results, and 29.2% reporting no hypnosis benefit; when only studies with lower risk of bias were reviewed the patterns were similar. Hypnosis intervention procedures were summarized and incidence of adverse experiences assessed. Hypnosis for sleep problems is a promising treatment that merits further investigation. Available evidence suggests low incidence of adverse events. The current evidence is limited because of few studies assessing populations with sleep complaints, small samples, and low methodological quality of the included studies. Our review points out some beneficial hypnosis effects on sleep but more high-quality studies on this topic are warranted.

BackgroundBehavioral activation is recognized as a stand-alone, evidence-based therapy for depression. Internet-delivered psychological interventions are easy to access and low cost. Therefore, it is important to determine whether internet-delivered behavioral activation (iBA) is an effective option for improving depressive symptoms and other health-related outcomes. This systematic review and meta-analysis aimed to examine the effects of iBA on individuals with depressive symptoms. MethodsA comprehensive search was conducted within four databases to identify randomized controlled trials (RCTs) that involved iBA for people with depressive symptoms. The quality of the included RCTs was assessed using the Cochrane Collaboration risk-of-bias tool. Depending on I2 statistic values for heterogeneity, either a random effects model or fixed effects model was used. Subgroup analyses were conducted according to the type of control groups. ResultsTwenty RCTs met the eligibility criteria. Meta-analyses showed iBA had small to medium effects on depressive symptoms, anxiety, quality of life, functioning, perceived social support, and behavioral activation (BA) in people suffering from depressive symptoms at the immediate posttest and follow-up compared to control conditions. LimitationsRelatively fewer studies were conducted to compare effects of iBA on outcomes other than depressive symptoms and BA process measures compared to comparison or control conditions. The overall risk of bias across the included RCTs was unclear. ConclusionsFurther high-quality studies are needed to verify the effects of iBA on varied health outcomes and BA process measures for individuals with depressive symptoms.

Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis

While the growth of Acceptance and Commitment Therapy and its underlying construct, psychological flexibility, has been supported by numerous studies, it has received little attention from sociocultural disciplines. With the aim of considering the transdiagnostic Psychological Flexibility Model from a cultural perspective and from an interdisciplinary approach combining both Psychology and Anthropology, this article proposes an interpretative theoretical analysis of two Native American healing rituals: sweat lodge ceremonies and peyote ceremonies. Drawing from the fieldwork of Calabrese among the Navajo and Wilson among the Lakota Sioux, both healing rituals are interpreted and compared in light of the six processes of psychological flexibility. While recognising the adaptability of the model outside the cultural sphere of Western mental health sciences, the article concludes with two remarks: the relevance of the sociocultural construction of values and a potential connection between psychological flexibility and altered states of consciousness.

ObjectiveTo quantify bias related to specific methodological characteristics in child-relevant randomized controlled trials (RCTs).DesignMeta-epidemiological study.Data SourcesWe identified systematic reviews containing a meta-analysis with 10–40 RCTs that were relevant to child health in the Cochrane Database of Systematic Reviews.Data ExtractionTwo reviewers independently assessed RCTs using items in the Cochrane Risk of Bias tool and other study factors. We used meta-epidemiological methods to assess for differences in effect estimates between studies classified as high/unclear vs. low risk of bias.ResultsWe included 287 RCTs from 17 meta-analyses. The proportion of studies at high/unclear risk of bias was: 79% sequence generation, 83% allocation concealment, 67% blinding of participants, 47% blinding of outcome assessment, 49% incomplete outcome data, 32% selective outcome reporting, 44% other sources of bias, 97% overall risk of bias, 56% funding, 35% baseline imbalance, 13% blocked randomization in unblinded trials, and 1% early stopping for benefit. We found no significant differences in effect estimates for studies that were high/unclear vs. low risk of bias for any of the risk of bias domains, overall risk of bias, or other study factors.ConclusionsWe found no differences in effect estimates between studies based on risk of bias. A potential explanation is the number of trials included, in particular the small number of studies with low risk of bias. Until further evidence is available, reviewers should not exclude RCTs from systematic reviews and meta-analyses based solely on risk of bias particularly in the area of child health.

The relationship between psychosis and psychological flexibility and other acceptance and commitment therapy processes: A systematic review and meta-analysis

Death anxiety, defined as the distress associated with the awareness of mortality, has profound psychological and cultural impacts. Western societies often respond to death salience through avoidance and medicalization, reinforcing defensive strategies described by Terror Management Theory. This project aimed to investigate whether mindfulness can serve as a buffer against death anxiety. A structured literature review was conducted using PsycINFO, PubMed, the Portland State University Library, and Google Scholar between January 2025 and April 2025. One study found that mindfulness moderated the effects of death anxiety on health-related quality of life in people living with HIV. Two experiments linked mindfulness to reduced negative affect and defensive reactions following mortality salience. Six additional studies conducted with cancer patients found that mindfulness-based interventions improved mood, stress, psychological flexibility, spiritual well-being, and even blood pressure, and immune and endocrine function. Psychological mechanisms such as cognitive defusion, emotional regulation, acceptance of impermanence, reduced rumination, and psychological flexibility are proposed to mediate these effects. Mindfulness offers a non-defensive framework for engaging with existential realities, aligning with existential theories such as Frankl's logotherapy and operationalized through approaches like Acceptance and Commitment Therapy. Mindfulness-based interventions, including MBSR and ACT, show promise for application in hospice, palliative care, and grief contexts. While mindfulness may not eliminate death anxiety, it provides a means of experiencing existential fears with greater openness and resilience. Future research should focus on longitudinal studies, cultural generalizability, clarification of mindfulness constructs, and clinical trials specifically targeting death anxiety outcomes.