Single-Session Acceptance and Commitment Therapy (ACT) Interventions for Patients with Chronic Health Conditions: A Systematic Review and Meta-Analysis

Abstract

Rationale: Chronic health conditions (CHCs) are costly and difficult to manage. Patients often struggle with behavioral adherence to complex treatment regimens and experience psychiatric distress. Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral approach that aims to improve functioning and quality of life (QoL), which are important treatment outcomes for this population. Preliminary efficacy of multi-session ACT in patients with CHCs has been demonstrated, and single-session ACT interventions have since been developed to increase feasibility, acceptability, and accessibility. The purpose of this systematic review and meta-analysis was to describe the literature on single-session ACT intervention studies in CHC populations with regards to (1) study design and methodology, (2) patient characteristics and conditions targeted, and (3) efficacy for outcomes across various domains, using narrative and quantitative methods.

Methods: PsycINFO, PubMed, and Web of Science were systematically searched in August 2020. Studies of single-session ACT interventions in adult patients with CHCs that reported quantitative outcomes in any of the following domains were included: (a) functioning and related domains (e.g., disability, QoL, well-being); (b) mental health; (c) physical health; (d) ACT processes. Both controlled and uncontrolled studies were included. Study quality was assessed using the Psychotherapy Outcome Study Methodology Rating Scale (POMRF). Between-group random effects meta-analysis was conducted on general functioning outcomes.

Results: Fourteen manuscripts reporting outcomes from 13 studies (N = 793) met inclusion criteria. Ten studies were identified by their authors as pilot or feasibility trials. Eight studies used comparison or control groups. Twelve studies delivered the ACT content in workshop format. Studies recruited for a variety of conditions. Narrative review found that between- and within-group effect sizes showed generally positive results favoring single-session ACT overall (69%), especially for measures of functioning and related domains (88%), mental health (67%), and ACT processes (73%). Meta-analysis found that ACT did not significantly outperform comparison groups on measures of general functioning (Hedges' g: -0.51, 95% confidence interval: [-1.19, 0.16]; I 2 = 86%; K = 5) despite a medium-sized pooled effect.

Discussion: Use of single-session ACT interventions in CHC populations is an emergent field. There is preliminary evidence for the acceptability, feasibility, and efficacy of these interventions, which provides support for further testing in fully-powered RCTs. Additional RCTs will enable larger meta-analyses and stronger conclusions about efficacy. Recommendations for future trials are provided.

Keywords: ACT; acceptance and commitment therapy; brief; chronic health conditions; meta-analysis; systematic review; workshop.

Conflict of interest statement

None of the authors have any conflicts of interest to disclose.

Figures

Figure 1.

Study screening and selection flowchart (adapted from Moher et al., 2009).

Figure 2.

Between-group meta-analysis results and forest plot for functioning-related outcomes at follow-up. Functioning-related outcomes included measures of functioning and well-being. Where studies reported more than one relevant outcome, the general (rather than condition-specific) measure was selected to reduce heterogeneity. 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.

Figure 3.

Within-group effect sizes and forest plot for functioning-related outcomes at follow-up. Functioning-related outcomes included measures of disability, symptom interference, well-being, and quality of life. Where studies reported more than one relevant outcome, the general (rather than condition-specific) measure was selected to reduce heterogeneity. Error bars are 95% confidence intervals. TE = Hedges’ g; seTE = standard error of Hedges’ g.