Technology-supported Acceptance and Commitment Therapy for chronic health conditions: A systematic review and meta-analysis

Matthew S Herbert, Cara Dochat, Jennalee S Wooldridge, Karla Materna, Brian H Blanco, Mara Tynan, Michael W Lee, Marianna Gasperi, Angela Camodeca, Devon Harris, Niloofar Afari, Matthew S Herbert, Cara Dochat, Jennalee S Wooldridge, Karla Materna, Brian H Blanco, Mara Tynan, Michael W Lee, Marianna Gasperi, Angela Camodeca, Devon Harris, Niloofar Afari

Abstract

Chronic health conditions (CHCs) are common and associated with functional limitations. Acceptance and commitment therapy (ACT) shows promise in improving functioning, quality of life, and distress across several CHCs. The purpose of this study was to conduct a systematic review of technology-supported ACT for CHCs and perform a meta-analysis on functioning and ACT process outcomes. Multiple databases were systematically searched for randomized controlled trials. A total of 20 unique studies with 2,430 randomized participants were included. CHCs addressed in these studies were chronic pain (k = 9), obesity/overweight (k = 4), cancer (k = 3), hearing loss (k = 1), HIV (k = 1), multiple sclerosis (k = 1), and tinnitus (k = 1). Internet and telephone were the most used technology platforms. All studies included therapist contact with considerable heterogeneity between studies. Random effects meta-analyses found medium effect sizes showing technology-supported ACT outperformed comparator groups on measures of function at post-treatment (Hedges' g = -0.49; p = 0.002) and follow-up (Hedges' g = -0.52; p = 0.02), as well as ACT process outcomes at post-treatment (Hedges' g = 0.48; p < 0.001) and follow-up (Hedges' g = 0.44; p < 0.001). Technology-supported ACT shows promise for improving function and ACT process outcomes across a range of CHCs. Recommendations are provided to optimize technology-supported ACT for CHCs. PROSPERO registration number: CRD42020200230.

Keywords: Acceptance; Chronic disease; Chronic illness; Disability; Functioning.

Conflict of interest statement

Disclosure statement: None of the authors have any conflicts of interest to disclose.

Declaration of Interest Statement: All authors declare no conflicts of interest

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Figure 1:
Figure 1:
Flow diagram
Figure 2:
Figure 2:
Risk of bias domains
Figure 3a.
Figure 3a.
Between-group meta-analysis results and forest plot for function outcomes at post-treatment.
Figure 3b.
Figure 3b.
Between-group meta-analysis results and forest plot for function outcomes at follow-up.
Figure 3c.
Figure 3c.
Between-group meta-analysis results and forest plot for ACT process outcomes at post-treatment.
Figure 3d.
Figure 3d.
Between-group meta-analysis results and forest plot for ACT process outcomes at follow-up. Note: Error bars are 95% confidence intervals; dashed line is pooled effect size; red line is prediction interval. SD = standard deviation. SMD = standardized mean difference, calculated as Hedges’ g. For function outcomes, negative SMD values indicate greater functional improvement/less functional impairment. For ACT process outcomes, positive SMD values indicate greater indicators of psychological flexibility. Unadjusted means and SDs were obtained for Mosher et al. (2018, 2019) and Scott et al. (2018).

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