ACT for Reducing Attrition and/or Improving Adherence

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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.



  • Mike Twohig has a grant from the International OCD Foundation (IOCDF) to compare ACT+Exposure and Response Prevention (ERP) versus ERP alone to test whether ACT promotes better engagement in exposures (in progress).
  • Maria Karekla’s dissertation showed that those receiving ACT for panic disorder had a different pattern of attrition compared to those receiving Panic Control Therapy (where most drop outs occurred following initiation of exposure).



  •  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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.