Acceptance and commitment therapy – Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials

Abstract

Acceptance and Commitment Therapy (ACT) has accrued a substantial evidence base. Recent systematic and meta-analytic reviews suggest that ACT is effective compared to control conditions. However, these reviews appraise the efficacy of ACT across a broad range of presenting problems, rather than addressing specific common mental health difficulties. Focussing on depression and anxiety we performed a meta-analysis of trials of ACT. We incorporated sequential meta-analysis (SMA) techniques to critically appraise the sufficiency of the existing evidence base. Findings suggest that ACT demonstrates at least moderate group and pre-post effects for symptom reductions for both anxiety and depression. However using SMA findings are more qualified. There is currently insufficient evidence to confidently conclude that ACT for anxiety is efficacious when compared to active control conditions or as primary treatment for anxiety. Similarly, using SMA, there is currently insufficient evidence to suggest a moderate efficacy of ACT for depression compared to active control conditions. To stimulate further research we offer specific estimates of additional numbers of participants required to reach sufficiency to help inform future studies. We also discuss the appropriate strategies for future research into ACT for anxiety given the current evidence suggests no differential efficacy of ACT in the treatment of anxiety compared to active control conditions.

Cost-Utility of Group Acceptance and Commitment Therapy for Fibromyalgia Versus Recommended Drugs: An Economic Analysis Alongside a 6-Month Randomized Controlled Trial Conducted in Spain (EFFIGACT Study)

“…There is considerable evidence regarding the effectiveness of ACT, 9,13,37,40 but to our knowledge, the present work is the second published cost-effectiveness study for ACT in patients with chronic longstanding pain. 15,18 Although some studies that are in Compared with the advice alone condition, the intervention was associated with significant benefits in nearly all outcomes at one-year follow-up.…”

The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Systematic reviews and meta-analyses of the evidence for the efficacy of third-wave treatments in improving a range of mental health outcomes have yielded support for ACT (A-Tjak et al, 2015;Bluett, Homan, Morrison, Levin, & Twohig, 2014;Hacker, Stone, & MacBeth, 2016;Lee, An, Levin, & Twohig, 2015), DBT (Kliem, Kröger, & Kosfelder, 2010;Panos, Jackson, Hasan, & Panos, 2014), MCT (Normann, van Emmerik, & Morina, 2014), MBCT (Chiesa & Serretti, 2011;Piet & Hougaard, 2011), schema therapy (Jacob & Arntz, 2013), CBASP (Negt et al, 2016), CFT, and CMT (Leaviss & Uttley, 2015). These prior reviews examined outcomes including personality disorders, substancerelated disorders, anxiety disorders, and mood disorders, such as major depressive disorder and chronic depression, as well as process measures and satisfaction with life.…”

Innovative Psychological Treatments for Depression

“…A recent meta-analysis found nearly 40 trials that assessed depression across the course of treatment in samples with a variety of different disorders; in those trials, Acceptance and Commitment Therapy produced large withingroup reductions in symptoms and moderate reductions relative to minimal treatment controls (but not active controls). 30 For example, only one study (conducted in Iran) focused on the treatment of patients who met criteria for major depressive disorders and cell sizes in that trial were quite small. 31 Although not as often studied as the other interventions with respect to diagnosed depression, it would appear that existing findings are promising with respect to efficacy if not specificity.…”