ACT Self-help Studies including those Based on Computers, Phones, SmartPhones, and Books

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Here is a partial list of studies of ACT or ACT components delivered as self-help, including especially those done by books, websites, phone calls, apps, or other media.

N = 32 as of April 2019

Paganini, S., Lin, J., Kählke, F., Buntrock, C., Leiding, D., Ebert, D. D., & Baumeister, H. (2019). A guided and unguided internet- and mobile-based intervention for chronic pain: Health economic evaluation alongside a randomised controlled trial. BMJ Open, 9, e023390. doi: 10.1136/bmjopen-2018-023390. This study is based on Lin J, Paganini S, Sander L, Lüking, M., Ebert, D. D., Buhrman, M., Andersson, G., & Baumeister, H. (2017). An internet-based intervention for chronic pain: a three-arm randomized controlled study of the effectiveness of guided and unguided acceptance and commitment therapy. Deutsches Ärzteblatt International, 114, 681–688.

Wersebe, H., Lieb, R., Meyer, A. H., Hofer, P., & Gloster, A. T. (2018). The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. International Journal of Clinical and Health Psychology, 18, 60-68. DOI: 10.1016/j.ijchp.2017.09.002

Levin, M. E., Haeger, J., & Cruz, R. A. (2018). Tailoring acceptance and commitment therapy skill coaching in the moment through smartphones: Results from a randomized controlled trial. Mindfulness, 10(4),  DOI: 10.1007/s12671-018-1004-2

Hofer, P. D., Waadt, M., Aschwanden, R., Milidou, M., Acker, J., Meyer, A. H., Lieb R., & Gloster, A. T. (2018). Self-help for stress and burnout without therapist contact: An online randomised controlled trial. Work & Stress, 32, 189-208. DOI: 10.1080/02678373.2017.1402389

Tol, W. A., Augustinavicius, J., Carswell, K., Leku, M. R., Adaku, A., Brown, F. L., García-Moreno, C., Ventebogel, P., White, R. G., Kogan, C. S., Bryant, R., & Van Ommeren, M. (2018). Feasibility of a guided self-help intervention to reduce psychological distress in South Sudanese refugee women in Uganda. World Psychiatry, 17, 234-235. DOI: 10.1002/wps.20537

Proctor, B. J., Moghaddam, N. G., Evangelou, N. & das Nair, R. (2018). Telephone-supported acceptance and commitment bibliotherapy for people with multiple sclerosis and psychological distress: A pilot randomised controlled trial. Journal of Contextual Behavioral Science, 9, 103-109. 

Eustis, E. H., Hayes-Skelton, S. A., Orsillo, S. M., & Roemer, L. (2018). Surviving and thriving during stress: A randomized clinical trial comparing a brief web-based therapist assisted acceptance-based behavioral intervention versus waitlist control for college students. Behavior Therapy, 49(6), 889-903. DOI: 10.1016/j.beth.2018.05.009

Davis, E. L., Deane, F. P., Lyons, G. C. B., Barclay, G. D., Bourne, J., & Connoly, V. (2017). Feasibility randomised controlled trial of a self-help acceptance and commitment therapy intervention for grief and psychological distress in carers of palliative care patients. Journal of Health Psychology. DOI: 10.1177/1359105317715091

Levin, M. E., Haeger, J., Pierce, B. G. & Twohig, M. P. (2017). Web-based acceptance and commitment therapy for mental health problems in college students: A randomized controlled trial. Behavior Modification, 41, 141-162. DOI: 10.1177/0145445516659645

Hara, K. W., Bjørngaard, J. H., Brage, S., Borchgrevink, P. C., Halsteinli, V., Stiles, T. C., Johnsen, R., & Woodhouse, A. (2017). Randomized controlled trial of adding telephone follow-up to an occupational rehabilitation program to increase work participation. Journal of Occupational Rehabilitation, 1-14. DOI: 10.1007/s10926-017-9711-4

Fiorillo, D., McLean, C., Pistorello, J., Hayes, S. C., & Follette, V. M. (2017). Evaluation of a web-based Acceptance and Commitment Therapy program for women with trauma related problems: A pilot study. Journal of Contextual Behavioral Science, 6, 104-113. doi:10.1016/j.jcbs.2016.11.003

Levin, M. E., Hayes, S. C., Pistorello, J., & Seeley, J. R. (2016). Web-based self-help for preventing mental health problems in universities: Comparing acceptance and commitment training to mental health education. Journal of Clinical Psychology, 72, 207-225. DOI: 10.1002/jclp.22254

Ivanova, E., Lindner, P., Ly, K. H., Dahlin, M., Vernmark, K., Andersson, G., & Carlbring, P. (2016). Guided and unguided acceptance and commitment therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial. Journal of Anxiety Disorders, 44, 27-35. DOI: 10.1016/j.janxdis.2016.09.012

Ritzert, T., Forsyth, J. P., Berghoff, C. R., Boswell, J., & Eifert, G. H. (2016).  Evaluating the effectiveness of ACT for anxiety disorders in a self-help context: Outcomes from a randomized wait-list controlled trial.  Behavior Therapy, 47, 431-572.
Large international RCT (N = 503) of an ACT self-help workbook for anxiety (the Mindfulness and Acceptance Workbook for Anxiety; N = 256) vs wait list (N = 247). Crossover design. Workbook use produced improvements in anxiety, quality of life, and ACT processes. Outcomes were replicated in the wait-list group following crossover to workbook. All improvements were maintained at 9 mo. follow-up.

Pots, W.T.M. , Fledderus, M., Meulenbeek, P.A.M., ten Klooster, P.M. , Schreurs, K.M.G. & Bohlmeijer, E.T. (2016). Acceptance and Commitment Therapy as a web-based intervention for depressive symptomatology: A randomised controlled trial. British Journal of Psychiatry, 208(1), 69-77. doi: 10.1192/bjp.bp.114.146068.. RCT (N = 236) finding that a guided web-based Acceptance and Commitment Therapy (ACT) intervention for adults with mild to moderate depression, was better pre to post than a credible expressive writing comparison (Cohen’s d = 0.36) and a wait list (Cohen’s d = 0.56). Effects were sustained at 6- and 12-month follow-up. Related article: Pots, W. T. M., Trompetter, H. R., Schreurs, K. M. G., & Bohlmeijer, E. T. (2016). How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms. BMC Psychiatry, 16, 158. DOI: 10.1186/s12888-016-0841-6

Trompetter, H. R., Bohlmeijer, E. T., Veehof, M. M., & Schreurs, K. M. G. (2015). Internet-based guided self-help intervention for chronic pain based on Acceptance and Commitment Therapy: A randomized controlled trial. Journal of Behavioral Medicine, 38, 66-80. doi: 10.1007/s10865-014-9579-0

RCT with persons suffering from chronic pain (N = 238) comparing internet-delivered, guided self-help based on ACT) (n = 82), an internet-based expressive Writing (n = 79) or a wait list (n = 77); measure at baseline, posttreatment (3 months) and at a 3-month follow-up. Better outcomes for pain interference, esp. among those who adhered to the intervention; also superior improvement on depression, pain intensity, psychological inflexibility and pain catastrophizing (d: .28–.60). 28 % of ACT-participants showed general clinically relevant improvement vs. 5% for the other groups.

Bricker, J. B., Mull, K. E., Kientz, J. A., Vilardaga, R. Mercer, L. D., Akiokaa, K. J., & Heffner, J. L. (2014). Randomized, controlled pilot trial of a smartphone app for smoking cessation using Acceptance and Commitment Therapy. Drug and Alcohol Dependence, 143, 87–94. http://dx.doi.org/10.1016/j.drugalcdep.2014.07.006 Double-blind RCT (N = 196) comparing smartphone-delivered ACT for smoking cessation application (SmartQuit) with the National Cancer Institute’s application for smoking cessation (QuitGuide). More use of ACT app. Quit rates of 13% in SmartQuit vs. 8% in QuitGuide (OR = 2.7; 95% CI = 0.8–10.3).

Ly, K. H., Asplund, K., & Andersson, G. (2014). Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial. Internet Interventions, 1, 95–101. ACT-based smartphone treatment for middle managers at medium- and large-sized companies (> 50 employees) in Sweden. A total of 73 participants were randomized to either receive the six-week stress intervention (n = 36) or to a waitlist control group (n = 37). Results showed small to moderate within-group effect sizes (Cohen's d range 0.37–0.62) for the treatment group, and small to moderate between group effects (Cohen's d range 0.41–0.50).

Lappalainen, P., Granlund, A., Siltanen, S., Ahonen, S., Vitikainen, M., Tolvanen, A., & Lappalainen, R. (2014). ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: An 18-month follow-up. Behaviour Research and Therapy, 61, 43-54. DOI: 10.1016/j.brat.2014.07.006 RCT comparing face to face with internet based ACT for outpatients experiencing mild or worse depression. 6 weekly therapy sessions versus 6 weeks of access to an ACT-based Internet program. Pre-treatment to 18-month follow-up within-group effect sizes for all symptom measures in the iACT treatment group (1.59-2.08), were similar or larger than for the face-to-face ACT group (1.12-1.37).

Johnston, M., Foster, M., Shennan, J., Starkey, N. J., & Johnson, A. (2010). The effectiveness of an Acceptance and Commitment Therapy self-help intervention for chronic pain. Clinical Journal of Pain, 26, 393-402. Very small RCT (N = 14) showing that ACT bibliotherapy (Dahl & Lundgren, 2006 – see self help books above) helps with chronic pain.

Muto, T., Hayes, S. C., & Jeffcoat, T. (2011). The effectiveness of Acceptance and Commitment Therapy bibliotherapy for enhancing the psychological health of Japanese college students living abroad. Behavior Therapy, 42, 323–335. RCT on the impact of Get Out of Your Mind and Into Your Life on the mental health of international students (N = 70). Better general mental health at post and follow up. Moderately and above depressed or stressed, and severely anxious students showed improvement compared to those not receiving the book. Outcomes mediated and moderated by psychological flexibility.

Jeffcoat, T. & Hayes, S. C. (2012). A randomized trial of ACT bibliotherapy on the mental health of K-12 teachers and staff. Behaviour Research and Therapy, 50, 571-579. ACT RCT with K – 12 school personnel (N = 236; 91% female; 30 - 60 years old) in a wellness program compared to wait list. Three-fourths were above clinical cutoffs in general mental health, depression, anxiety, or stress. Participants read the book for two months, completed exercises and quizzes, and after post assessment were followed for 10 weeks; wait list participants were then also given the book with two months to complete it. Overall, participants showed significant improvement in psychological health. Significant preventive effects for depression and anxiety were observed along with significant ameliorative effects for those in the clinical ranges of depression, anxiety and stress. Follow up general mental health, depression, and anxiety outcomes were related to the manner in which participants used the workbook and to post levels of psychological flexibility.

Levin, M. E., Pistorello, J., Hayes, S. C. & Seeley, J. (2014). Feasibility of a prototype web-based Acceptance and Commitment Therapy prevention program for college students. Journal of American College Health, 62, 20-30. doi:10.1080/07448481.2013.843533 RCT (N = 76) comparing ACT web program to wait list. Better anxiety and depression outcomes in ACT.

Chase, J. A., Houmanfar, R., Hayes, S. C., Ward, T.A., Vilardaga, J. P. & Follette, V. (2013). Values are not just goals: Online ACT-based values training adds to goal setting in improving undergraduate college student performance. Journal of Contextual Behavioral Science, 2, 79-84.  RCT (N = 132) comparing wait list, goal setting, or goal setting plus ACT values work with college students. Higher GPA at post in the values plus goal setting condition over next semester. After one semester, the wait list was then given values plus goal setting and the same effect was seen, over the next semester.

Ljótsson, B., Atterlöf, E., Lagerlöf, M., Andersson, E., Jernelöv, S., Hedman, E., Kemani, M. & Wicksell, R.K. (2014). Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: A pilot study. Cognitive Behaviour Therapy, 43, 93-104. doi: 10.1080/16506073.2013.846401.
Open trial (N=41) self-referred women with a fibromyalgia diagnosis, pre/post/ 6 mo f-up. The 10-week Internet-delivered ACT + contact with an online ACT therapist. Moderate to large within-group effect sizes on all main measures (d = 0.62-1.56; symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility.) Improvements maintained at follow-up. Positive cost-benefit by 2 mos. 

Hawkes, A. L., Chambers, S. K., Pakenham, K. I., Patrao, T. A., Baade, P. D., Lynch, B. M., Aitken, J. F., Meng, X. Q., & Courneya, K. S. (2013). Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: A randomized controlled trial. Journal of Clinical Oncology, 31, 2313-2321. Large RCT (N = 410) with colorectal cancer survivors assigned to usual care or to 11 ACT-based telephone health coaching sessions over 6 months focusing for physical activity, weight management, dietary habits, alcohol, and smoking. Significant differences at 1 year follow up for physical activity, body mass, and fat intake; vegetable intake better at 6 month. Alcohol and smoking not significantly different.

Kristjánsdóttir, Ó. B., Fors, E. A., Eide, E., Finset, A., Stensrud, T. L., vanDulmen, S., Wigers, S. H., & Eide, H. (2013). A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: Randomized controlled trial. Journal of Medical Internet Research, 15, 1-17. Doi: 10.2196/jmir.2249 140 women with chronic pain, after inpatient rehab receive a website and also randomized to also receive 1 face-to-face session and 4 weeks of ACT-based smartphone program. At 5-month follow-up, moderate effect sizes in favor of ACT for catastrophizing (Cohen's d=0.74, P=.003), acceptance of pain (Cohen's d=0.54, P=.02), and functioning and symptom levels (Cohen's d=0.75, P=.001).

Bricker, J., Wyszynski, C., Comstock, B., & Heffner, J. L. (2013). Pilot randomized controlled trial of web-based acceptance and commitment therapy for smoking cessation. Nicotine & Tobacco Research, 15(10), 1756-1764. RCT (N = 222) of a web-based ACT intervention for smoking cessation as compared to the U. S. National Cancer Institute’s Smokefree.gov website. Participants spent significantly longer on the ACT site and we more satisfied with it; quite rates at 3 month follow up were more than double on the ACT site than the NCI site (23% vs. 10%). Smoking cessation was mediated by increases in total acceptance of physical, cognitive, and emotional cues to smoke (80% of the effect).

Fledderus, M., Bohlmeijer, E. T., Fox, J. P., Schreurs, K. M. G., & Spinhoven, P. (2013). The role of psychological flexibility in a self-help Acceptance and Commitment Therapy intervention for psychological distress in a randomized controlled trial. Behaviour Research and Therapy, 51, 142-151. Adults with mild to moderate depression and anxiety (N = 376) randomized to ACT based self-help with e-mail support (n = 250), or to a waiting list control group (n = 126). Pre, 3 week, 6 week, post, and 3 mo f-up. Effect greater for those higher in psychological flexibility; effects also mediated by psychological flexibility, esp. improvement in the last three sessions of the intervention.
Lappalainen, P., Kaipainen, K., Lappalainen, R., Hoffren, H., Myllymaki, T., Kinnunen, M. L., Mattila, E., Happonen, A. P., Rusko, H., & Korhonen, I. (2013). Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: Randomized controlled pilot trial. Journal of Medical Internet Research, 15. Very small RCT (N = 24) of group ACT + behavioral methods (relaxation; etc) as well as Internet/Web portal, mobile phone applications, and personal monitoring devices; versus wait list. 6 mo f-up. Lower depression and psychological distress; better working ability in ACT group.

Buhrman, M., Skoglund, A., Husell, J., Bergström, K., Gordh, T., Hursti, T., Bendelin, N., Furmark, T. & Andersson, G. (2013). Guided internet-delivered Acceptance and Commitment Therapy for chronic pain patients: A randomized controlled trial. Behaviour Research and Therapy, 51, 307–315. RCT (N = 76) comparing a 7 week guided internet-delivered ACT intervention for persons with chronic pain versus a moderated online discussion forum. Intent-to-treat analyses showed significant increases in active engagement and pain willingness and decreases in pain-related distress, anxiety and depression. Gains maintained at a 6-mo follow-up.

Carlbring, P., Hagglund, M., Luthstromb, A., Dahlin, M., Kadowaki, A., Vernmark, K., & Andersson, G. (2013). Internet-based behavioral activation and acceptance-based treatment for depression: A randomized controlled trial. Journal of Affective Disorders, 148, 331–337.  RCT (N = 80) of 8 weeks of internet-based ACT and behavioral activation versus wait list; 3 month follow up. Large effect on depression.

Hesser, H., Gustafsson, T., Lundén, C., Henrikson, O., Fattahi, K., Johnsson, E., Westin, V. Z., Carlbring, P., Mäki-Torkko, E., Kaldo, V., & Andersson, G. (2012). A randomized controlled trial of internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus. Journal of Consulting and Clinical Psychology, 80(4), 649-61. Three arm RCT (n = 99) testing on line version of ACT and CBT vs. control (on line discussion group) for tinnitus distress. Better effects for CBT and ACT. No significant differences between ACT and CBT.