Efficacy of Internet-Based Acceptance and Commitment Therapy for Depressive Symptoms, Anxiety, Stress, Psychological Distress, and Quality of Life: Systematic Review and Meta-analysis

Abstract

Background Acceptance and commitment therapy (ACT) is an empirically supported transdiagnostic approach that involves mindfulness processes and behavior change processes for valued living. Objective This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of internet-based ACT (iACT) for depressive symptoms, anxiety, stress, psychological distress, and quality of life (QoL). Methods PubMed, CINAHL, PsycINFO, and SCOPUS databases were searched to identify relevant RCTs published up to June 5, 2021. The included RCTs were assessed using the Cochrane Collaboration risk-of-bias tool. The use of either a random effects model or fixed effects model was determined using I2 statistic values for heterogeneity. Subgroup analyses were conducted according to the type of control group, the use of therapist guidance, delivery modes, and the use of targeted participants, when applicable. Results A total of 39 RCTs met the inclusion criteria. Meta-analyses found small effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL at the immediate posttest and follow-up. There was no significant effect of iACT on stress at follow-up. Subgroup analyses showed small to medium effects of iACT on all the outcomes at the immediate posttest and follow-up compared with the passive control groups. In contrast, subgroup analyses that compared iACT with active control groups found no differences between groups on stress, psychological distress, and QoL at the immediate posttest or on depressive symptoms, anxiety, and stress at follow-up. In addition, subgroup analyses conducted according to the use of therapist guidance, delivery modes, and the use of targeted participants found no statistically significant subgroup differences among studies in all the outcomes, except for the subgroup difference among studies according to the use of targeted participants for depressive symptoms at the immediate posttest (ie, a statistically significant, larger effect of iACT when studies targeted people with depressive symptoms). The overall risk of bias across the studies was unclear. Conclusions The findings of this study contribute to the body of evidence regarding the effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL and may be applicable in any population, as ACT is a transdiagnostic approach. Few studies have compared iACT with active control conditions, especially for stress and psychological distress at the immediate posttest and follow-up. In addition, the active control conditions varied among the included studies. Further high-quality studies are needed to better understand whether iACT is comparable or superior to other evidence-based interventions, such as cognitive behavioral therapy, in decreasing depressive symptoms, anxiety, stress, and psychological distress and improving QoL.

The feasibility and preliminary effects of a pilot randomized controlled trial: Videoconferencing acceptance and commitment therapy in distressed family caregivers of people with dementia

“…When participants with at least mild depressive symptoms were included for the additional secondary analyses only ( N = 12; six per group), results showed more positive findings even with this smaller sample size, including small to medium effects of ACT on decreasing depressive symptoms ( r = 0.37), anxiety ( r = 0.40), stress ( r = 0.42), grief ( r = 0.63), and psychological inflexibility ( r = 0.51) and increasing engagement in meaningful activities ( r = 0.72) compared to the control group. A recent meta-analysis found a statistically significant larger effect of internet-based ACT on decreasing depressive symptoms when studies targeted people with depressive symptoms in particular (Han and Kim, 2022b). These findings suggest ACT may be most effective in varied mental health outcomes when caregivers are screened to target the subpopulation with depressive symptoms in particular.…”

Interventions Based on Acceptance and Commitment Therapy for Stress Reduction in Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…In a meta-analysis on the effects of ACT in adults with chronic conditions, most of the included studies showed improvements in distress (including anxiety and depressive symptoms) following ACT compared to control conditions [78]. Han and Kim [79] investigated in the efficacy of internet-based ACT in adults on various outcomes, including stress. Like the present study, they conclude that more high-quality studies are necessary to make a firm statement.…”

Coping and emotion regulation: A conceptual and measurement scoping review.

“…Reappraisal (reinterpreting an event’s meaning to alter emotional responses) and suppression (inhibiting emotional behaviour) are among the most commonly studied ones (Hu et al, 2014; Troy et al, 2023; Webb et al, 2012). Acceptance, which is the willingness to experience specific emotions/situations (Carver et al, 1989), and its opposite, experiential avoidance (Boulanger et al, 2010; Gratz & Roemer, 2004), are somewhat less studied in the general population but have been largely examined among clinical samples, in part via psychotherapy research based on mindfulness as well as acceptance and commitment therapies (Han & Kim, 2022). Other strategies, like distraction, have been investigated as well, notably in the context of emotion regulation choice and goals (Millgram et al, 2019; Webb et al, 2012).…”