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ACT for Reducing Attrition and/or Improving Adherence

Given that therapy can only be effective when clients are attending sessions and are actively engaging with the treatment, it is crucial to determine ways to increase adherence and reduce attrition. The following is a list of studies that determine the effectiveness of ACT in reducing drop out and/or increasing adherence or engagement in treatment (list gathered by Brandon Gaudiano).

If you are aware of similar research that is not listed here, please add it as a comment at the bottom of the page and it will be added to the list.

  • Bricker, J., Miao, Z., Mull, K., Santiago-Torres, M., & Vock, D.M. (2023). Can a Single Variable Predict Early Dropout From Digital Health Interventions? Comparison of Predictive Models From Two Large Randomized Trials. Journal of Medical Internet Research, 25, e43629.
  • Klimczak, K.S., Twohig, M.P., Peacock, G.G., & Levin, M.E. (2023). Using peer-support coaching to improve adherence to online ACT self-help for college mental health: A randomized controlled trial. Behaviour Research and Therapy, 160, 104228. DOI: 10.1016/j.brat.2022.104228
  • Masjedi, M. A., Khalatbari, J., Abolghasemi, S., Tizdast, T., & Khah, J. K. (2020). Comparison of the effectiveness of Acceptance and Commitment-based Therapy and Emotion-Focused Therapy on adherence to treatment in cardiac patients. International Journal of Applied Behavioral Sciences, 7(1), 33-45.
  • Abdollahi, S., Hatami, M., Manesh, F. M., & Askari, P. (2020). The effectiveness of acceptance and commitment therapy on the self-care and adherence to treatment in patients with type 2 diabetes. International Archives of Health Sciences, 7(2), 78-83.
  • Malins S, Biswas S, Rathbone J, Vogt W, Pye N, Levene J, Moghaddam N, Russell J. (2020) Reducing dropout in acceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy for chronic pain and cancer patients using motivational interviewing. Br J Clin Psychol. 59(3):424-438. doi: 10.1111/bjc.12254
  • Rahnama, M., Sajjadian, I., & Raoufi, A. (2017). The effectiveness of acceptance and commitment therapy on psychological distress and medication adherence of coronary heart patients. Iranian Journal of Psychiatric Nursing, 5, 34-43.
  • Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2012). Slow and steady wins the race: A randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology, 80(1), 43–53. Found that those in an inpatient substance abuse program receiving ACT showed higher rates of treatment attendance following discharge compared to treatment as usual.
  • White, R., Gumley, A., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., & Mitchell, G. (2011). A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis. Behaviour Research and Therapy, 49(12), 901–907. Found that those receiving ACT for emotional dysfunction following psychosis had a lower attrition rate compared with treatment as usual.
  • Branstetter-Rost, A., Cushing, C., & Douleh, T. (2009). Personal Values and Pain Tolerance: Does a Values Intervention Add to Acceptance? The Journal of Pain, 10(8), 887–892.
  • Páez-Blarrina, M., Luciano, C., Gutiérrez-Martínez, O., Valdivia, S., Ortega, J., & Rodríguez-Valverde, M. (2008). The role of values with personal examples in altering the functions of pain: Comparison between acceptance-based and cognitive-control-based protocols. Behaviour Research and Therapy, 46(1), 84–97.
  • McMullen, J., Barnes-Holmes, D., Barnes-Holmes, Y., Stewart, I., Luciano, C., & Cochrane, A. (2008). Acceptance versus distraction: Brief instructions, metaphors and exercises in increasing tolerance for self-delivered electric shocks. Behaviour Research and Therapy, 46(1), 122–129.
  • Marcks, B. A., & Woods, D. W. (2007). Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: An analog to obsessive–compulsive disorder. Behaviour Research and Therapy, 45(11), 2640–2651.
    Masedo, A. I., & Rosa Esteve, M. (2007). Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behaviour Research and Therapy, 45(2), 199–209.
  • Levitt, J. T., & Karekla, M. (2005). Integrating acceptance and mindfulness with cognitive behavioral treatment for panic disorder. In S. M. Orsillo & L. Roemer (Eds.), Acceptance and mindfulness-based approaches to anxiety (pp. 165-188). New York: Springer.
  • Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35(4), 747–766.

Meta-Analyses and Systematic Reviews

  • Karekla, M., Konstantinoua, P., Ioannoua, M., Kareklas, I., & Gloster, A. T. (2019). The phenomenon of treatment dropout, reasons and Moderators in Acceptance and Commitment Therapy and other active treatments: A meta-analytic review. Clinical Psychology in Europe, 1(3), 1-36. doi: 10.32872/cpe.v1i3.33058
  • Ong, C. W., Lee, E. B. & Twohig, M. P. (2018). A meta-analysis of dropout rates in acceptance and commitment therapy. Behaviour Research and Therapy, 104, 14-33. DOI: 10.1016/j.brat.2018.02.004

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