Acceptance and commitment therapy for psychological and physiological illnesses: a systematic review for social workers

Authors:
MONTGOMERY Katherine L., KIM Johnny S., FRANKLIN Cynthia
Journal article citation:
Health and Social Work, 36(3), August 2011, pp.169-181.
Publisher:
Oxford University Press

Acceptance and commitment therapy (ACT) is one of the ‘third wave’ cognitive-behavioural therapies offering flexibility and effectiveness in treating challenging cases. The goal of ACT is for the client to change their response to their thinking and feelings. The purpose of this review is to provide social work researchers and practitioners with an explanation of the ACT approach and of the efficacy of ACT with various illnesses. A literature search of multiple databases was conducted for ACT intervention studies with either psychological or physiological illness outcomes. A total of 18 articles were identified that met the inclusion criteria. Effect sizes were calculated for all outcome measures. The results are presented on 2 main outcome constructs: psychological illness and physiological illness. The findings indicate that ACT is a promising intervention for those with anxiety disorders, depression, psychosis, trichotillomania, epilepsy, chronic skin picking, and diabetes. The article concludes that research on ACT provides social workers with a promising alternative for tackling challenging illnesses.

Extended abstract:
Author

MONTGOMERY Katherine L.; KIM Johnny S.; FRANKLIN Cynthia;

Acceptance and commitment therapy for psychological and physiological illnesses: a systematic review for social workers.

Journal citation/publication details

Health and Social Work, 36(3), August 2011, pp.169-181.

Summary

Seventeen intervention studies examining the efficacy of acceptance and commitment therapy (ACT) were included in the systematic review. The results were mixed probably due to the weak study designs and small sample sizes used. Promising results were reported for a range of disorders but further research is required. 

Context

Acceptance and commitment therapy has been used with some success with a range of challenging clients including those with psychotic features, generalised anxiety disorder, chronic pain, depression, and trichotillomania. The aim of this study was to systematically review the growing literature on the effectiveness of ACT.

Methods

What sources were searched?
Searches were carried out on the PsycINFO, Medline, ERIC, and CINAHL databases, and the website of the Association for Contextual Behavioural Science.

What search terms/strategies were used?
The search term used was ‘acceptance and commitment therapy’. It is not clear when the searches were carried out.

What criteria were used to decide on which studies to include?
Randomised controlled trials, quasi-experimental studies, and pre-test post-test intervention studies investigating the impact of ACT on psychological or physiological outcomes were eligible for inclusion.

Who decided on their relevance and quality?
Details of the selection process are not included in the report, and there is no indication that study quality was formally assessed.

How many studies were included and where were they from?
A total of 368 articles was identified; 239 from PsycINFO, 68 from Medline, 40 from ERIC, and 21 from CINAHL. Eighteen studies are quoted in the text as being included in the review, although only seventeen are summarised in Table 1. Study settings are not reported.

How were the study findings combined?
Effect sizes, expressed as Hedges’ g, were calculated for all outcome measures using Meta-Analysis software and analysed using the methods of Cohen. The review is narrative in nature and the results are presented separately for the psychological and physiological outcomes.

Findings of the review

There were three studies on anxiety, six on depression, six on general mental health, one of psychosis, and two of substance abuse. All of the three studies examining anxiety outcomes reported a significant improvement in symptoms but none of the studies were randomised and all had small sample sizes. All of the studies of depression, five of which were randomised controlled trials, reported non-significant small to medium effect sizes. Four randomised controlled studies measuring mental health outcomes found no significant benefit related to ACT intervention although two pre-test post-test studies did. No significant effects were reported for the substance abuse trials and most of the outcomes in the study of the effect on psychotic symptoms were non-significant.

The efficacy of ACT in physical illness was investigated in five separate studies each focusing on diabetes, epilepsy, smoking cessation, trichotillomania and skin picking, and weight loss, respectively. Beneficial effects were observed in the diabetes study and the epilepsy study, both of which were randomised and controlled, and in the study of trichotillomania and skin picking, which was quasi-experimental. Small, non-significant effects were reported in the weight loss, and smoking cessation trials.

Authors' conclusions

The results suggest that ACT ‘can assist clients with psychosis, anxiety disorders, pain management, trichotillomania, chronic skin picking, and epilepsy and may provide social workers with newer methods for approaching these challenging disorders’.

Implications for policy or practice

None are discussed.

Subject terms:
mental health problems, physical illness, behaviour therapy;
Content type:
systematic review
Link:
Journal home page
ISSN online:
1545-6854
ISSN print:
0360-7283

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