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

Abstract

Chronic health conditions (CHCs) afflict millions of individuals worldwide. One promising intervention for CHC management is Acceptance and Commitment Therapy (ACT). Current literature is limited on examining ACTs' efficacy in CHCs without following a uniform definition of CHCs, even though such definitions exist (e.g., World Health Organization). This systematic review and meta-analysis aimed to: (a) collate evidence on the efficacy of ACT vs. comparison groups (active and inactive) in well-defined CHCs on symptoms and quality of life (QoL) outcomes, and (b) identify moderators of treatment efficacy. PubMed, PsycINFO, and Scopus databases were screened, and 57 studies included in the systematic review whereas 33 studies were included in QoL meta-analysis and 45 studies in symptom improvement meta-analysis. Study quality was mostly low, with some quality criteria lacking (e.g., attrition information). Random-effects meta-analyses showed that ACT was superior to comparison groups on both QoL and symptom improvement. Specifically, subgroup analyses showed that ACT was superior to inactive (i.e., waitlist, treatment-as-usual) and some active groups (i.e., yoga, expressive writing, standardized talking, supportive treatment) on improving overall and psychological health QoL domains, and on anxiety and depression symptoms. Significant moderators of treatment efficacy included CHC type (e.g., breast cancer), setting (e.g., outpatient) and treatment format (e.g., group). Findings suggest that ACT is an efficacious treatment compared to inactive groups and some active groups, leading to improved QoL and symptoms for various CHCs. Discussion proposes areas of ACTs’ impact, suggestions for future research needs and recommendations for stakeholders.