ACT-Related Research on Health Problems
ACT-Related Research on Health ProblemsThe pages below list published ACT-related research studies for specific health problems that are available on the website as of July 2008. Empirical studies listed include ACT outcome studies, case studies, correlational research and micro/component studies. The literature is moving quickly and it takes a while to update pages like this. For a more detailed list of outcome studies and other empirical research you can download the "ACT Handout" and/or check the research summaries posted on the website, which are updated more regularly.
Update in Aug 2016: a new meta-analysis is useful in many of these areas: Graham, C. D., Gouick, J., Krahé, C., & Gillanders, D. (2016). A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clinical Psychology Review, 46, 46–58. doi:10.1016/j.cpr.2016.04.009
Cancer Research
Cancer Research- Páez, M., Luciano, M. C., & Gutiérrez, O. (2007). Tratamiento psicológico para el afrontamiento del cáncer de mama. Estudio comparativo entre estrategias de aceptación y de control cognitivo. [Psychological treatment for breast cancer. Comparison between acceptance based and cognitive control based strategies] Psicooncología, 4, 75–95.
- Branstetter, A. D., Wilson, K. G., Hildebrandt, M., & Mutch, D. (2004). Improving psychological adjustment among cancer patients: ACT and CBT. Paper presented at the Association for Advancement of Behavior Therapy, New Orleans.
Large randomized trial showing that ACT is more helpful than traditional CBT in dealing with end stage cancer and works through a different process. Amazing data.
- Montesinos, F., Hernández, B., & Luciano, C. (2001). Application of Acceptance and Commitment Therapy (ACT) in cancer patients. Análisis y Modificación de Conducta, 27, 113, 503-524.
Chronic Pain Research
Chronic Pain ResearchOutcome Studies: Chronic Pain
- Greco, L. A., Blomquist, K. K., Acra, S., & Moulton, D. (2006). Acceptance and Commitment Therapy for Adolescents with Functional Abdominal Pain: Results of a Pilot Investigation. Manuscript submitted for publication.
- Wicksell, R. K., Melin, L., Lekander, M., & Olsson, G. L. (2009). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain – A randomized controlled trial. Pain, 141(3), 248-257.
- Vowles, K. E., Wetherell, J. L., & Sorrell, J. T. (2009). Targeting acceptance, mindfulness, and values-based action in chronic pain: Findings of two preliminary trials of an outpatient group-based intervention. Cognitive and Behavioral Practice, 16, 49-58.
- Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76, 397-407.
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Wicksell, R.K., Ahlqvist, J., Bring, A., Melin, L. & Olsson, G.L. (2008). Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial. Cognitive Behaviour Therapy
Included people (adults) with longstanding pain due to whiplash (WAD). A 10-session protocol was compared with a wait list control group, and found significant improvements following treatment in functioning and life satisfaction, as well as in psychological flexibility (as measured with PIPS).
- McCracken, L. M., MacKichan, F., & Eccleston, C. (2007). Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: Effectiveness and clinically significant change. European Journal of Pain, 11, 314-322.
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Wicksell R.K, Melin, L. & Olsson, G.L. (2007). Exposure and acceptance in the rehabilitation of children and adolescents with chronic pain.European Journal of Pain, 11, 267-274.
Open trial with 14 adolescents. Good outcomes that continue to improve through follow up.
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McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335-1346.
108 chronic pain patients with a long history of treatment are followed through an ACT-based 3-4 week residential treatment program. Measures improved from initial assessment to pre-treatment on average only 3% (average of 3.9 month wait), but improved on average 34% following treatment. 81% of these gains were retained through a 3 month follow up. Changes in acceptance predicted positive changes in depression, pain related anxiety, physical disability, psychosocial disability, and the ability to stand. Positive outcomes were also seen in a timed walk, decreased medical visits, daily rest due to pain, pain intensity, and decreased pain medication use.
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Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-802.
A small randomized controlled trial shows that a four hour ACT intervention reduced sick day usage by 91% over the next six months compared to treatment as usual in a group of chronic pain patients at risk for going on to permanent disability.
Mediation Analyses
- Wicksell, R. K., Olsson, G. L., Hayes, S. C. (2010). Psychological flexibility as a mediator of improvement in acceptance and commitment therapy for patients with chronic pain following whiplash. European Journal of Pain.
Case Studies: Chronic Pain
- Kleen, M., & Jaspers, J. P. C. (2007). Women should not be allowed to run. Acceptance and commitment therapy (ACT) with a pain disorder. Translated from: Vrouwen horen niet hard te lopen. Acceptance and commitment therapy (ACT) bij een pijnstoornis. Gedragstherapie, 40, 7-26.
- Wicksell, R. K., Dahl, J., Magnusson, B., & Olsson, G. L. (2005). Using Acceptance and Commitment Therapy in the rehabilitation of an adolescent female with chronic pain: A case example. Cognitive and Behavioral Practice, 12, 415-423. Shows dramatic improvement with a 14 year old chronic pain patient using a values focused ACT protocol.
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Luciano, C., Visdómine, J.C., Gutiérrez, O., & Montesinos, F. (2001). ACT (Acceptance and Commitment Therapy) and chronic pain. Análisis y Modificación de Conducta, 27, 113, 473-502.
Describes the use of ACT in the treatment of chronic pain and shows resulting data. Case study.
Micro/Component Studies: Chronic Pain
- Vowles, K., McNeil, D.W., Bates, M., Gallimore, P. & McCall, C. (2007). Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behavior Therapy, 38, 412-425.
- A number of other micro/component studies have examined the impact of brief ACT interventions on performance in pain inducing preparations and are listed here.
Correlational Studies: Chronic Pain
- McCracken, L. M., & Zhao-O'Brien, J. (2010). General psychological acceptance and chronic pain: There is more to accept than pain itself. European Journal of Pain, 14, 170-175.
- McCracken, L. M., & Vowles, K. E. (2008). A prospective analysis of acceptance and values in patients with chronic pain. Health Psychology, 27, 215-220.
- Vowles, K. E., McCracken, L. M., & Eccleston, C. (2008). Patient functioning and catastrophizing in chronic pain: The mediating effects of acceptance. Health Psychology, 27, S136-S143.
- Wicksell, R. K., Renofalt, J., Olsson, G. L., Bond, F. W., & Melin, L. (2008). Avoidance and cognitive fusion - Central components in pain related disability? Development and preliminary validation of the Psychological Inflexibility in Pain Scale (PIPS). European Journal of Pain, 12, 491-500.
- McCracken, L. M., Gauntlett-Gilbert, J., & Vowles, K. E. (2007). The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain, 131, 63-69.
- McCracken, L. M., & Vowles, K. E. (2007). Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument.Journal of Pain, 8, 339-349.
- McCracken, L. M., Vowles, K. E., & Gauntlett-Gilbert, J. (2007). A prospective investigation of acceptance and control-oriented coping with chronic pain. Journal of Behavioral Medicine, 30, 339-349.
- Vowles, K. E., McCracken, L. M., & Eccleston, C. (2007). Processes of behavior change in interdisciplinary treatment of chronic pain: Contributions of pain intensity, catastrophizing, and acceptance.European Journal of Pain, 11, 779-787.
- McCracken, L. M. (2006). Toward a fully functional, flexible, and defused approach to pain in young people. Cognitive and Behavioral Practice, 13, 182-184.
- McCracken, L. M., & Eccleston, C. (2006). A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers. European Journal of Pain, 10(1), 23-29.
- McCracken, L. M., & Yang, S. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123, 137-145.
- McCracken, L. M. (2005). Social context and acceptance of chronic pain: The role of solicitous and punishing responses. Pain, 113, 155-159.
- McCracken, L. M., & Eccleston, C. (2005). A prospective study of acceptance of pain and patient functioning with chronic pain. Pain, 118, 164-169.
- McCracken, L. M. , Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method.Pain, 107, 159-166.
- McCracken, L. M. & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain. Pain, 105, 197-204.
- Viane, I., Crombez, G., Eccleston, C., Poppe, C., Devulder, J., Van Houdenhove, B., & De Corte, W.(2003). Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain, 106(1/2), 65-73.
- McCracken, L. M., Spertus, I. L. , Janeck, A. S., Sinclair, D., & Wetzel, F. T. (1999). Behavioral dimensions of adjustment in persons with chronic pain: Pain-related anxiety and acceptance. Pain, 80, 283-289.
- McCracken, L. M. (1999). Behavioral constituents of chronic pain acceptance: Results from factor analysis of the Chronic Pain Acceptance Questionnaire. Journal of Back & Musculoskeletal Rehabilitation, 13, 93-100.
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McCracken, L. M. (1998). Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21-27.
This study is based on a pain related early version of the AAQ. Greater acceptance of pain was associated with reports of lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily uptime, and better work status. A relatively low correlation between acceptance and pain intensity showed that acceptance is not simply a function of having a low level of pain. Regression analyses showed that acceptance of pain predicted better adjustment on all other measures of patient function, independent of perceived pain intensity. This work is replicated, refined and extended in McCracken, L. M. & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain. Pain, 105, 197-204. and McCracken, L. M. , Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159-166.
Epilepsy Research
Epilepsy ResearchOutcome Studies: Epilepsy
- Lundgren, T., Dahl, J., Yardi, N., & Melin, J. (2008). Acceptance and Commitment Therapy and Yoga for drug refractory epilepsy: A randomized controlled trial. Epilepsy and Behavior, 13, 102-108.
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Lundgren, A. T., Dahl, J., Melin, L., & Kies, B. (2006). Evaluation of Acceptance and Commitment Therapy for drug refractory epilepsy: A randomized controlled trial in South Africa. Epilepsia, 47, 2173-2179.
RCT with 27 drug resistant epileptics comparing 9 hours of ACT – individual and group -- to supportive therapy. Reduction of seizures to near zero level; maintenance for a year. Quality of life improves continuously through the follow up. Mediational analyses fit the ACT model and are described in more detail in Lundgren, T., Dahl, J., & Hayes, S. C. (2008). Evaluation of mediators of change in the treatment of epilepsy with Acceptance and Commitment Therapy. Journal of Behavior Medicine, 31(3), 225-235.
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Lundgren, A. T. (2004). Development and evaluation of an integrative health model in the treatment of epilepsy: Two randomized controlled trials investigating the effects of a short term ACT intervention, yoga, and attention control therapy in India and South Africa. Unpublished thesis, University of Uppsala, Uppsala, Sweden.
Two small RCTs (N = 18; and N = 28) comparing a three session ACT protocol (two individual; one group) to two other conditions. As compared to yoga, significantly reduced seizures in the ACT condition; as compared to attention control, significantly reduced seizures and experiential avoidance, and significantly increased quality of life in the ACT condition at a one year follow up.
Other Health-Related Research
Other Health-Related ResearchOutcome Studies: Diabetes Management
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Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2), 336-343.
RCT showing that ACT + patient education is significantly better than patient education alone in producing good self-management and better blood glucose levels in lower SES patients with Type II diabetes. Effects at follow up are mediated by changes in self-management and greater psychological flexibility with regard to diabetes related thoughts and feelings.
Outcome Studies: High-Risk Sexual Behavior
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Metzler, C. W., Biglan, A., Noell, J., Ary, D., & Ochs, L. (2000). A randomized controlled trial of a behavioral intervention to reduce high-risk sexual behavior among adolescents in STD clinics. Behavior Therapy, 31, 27-54.
Components from ACT were included as component of a successful program to reduce high risk sexual behavior in adolescents.
Case Studies: Athletic Performance
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Gardner, F. L. & Moore, Z.E. (2004). A mindfulness-acceptance-commitment based approach to athletic performance enhancement: Theoretical considerations. Behavior Therapy, 35, 707-724.
Case study. An ACT protocol with an emphasis on mindfulness helps with sports outcomes.
Case Studies: Erectile Dysfunction
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Montesinos, F. (2003). ACT, sexual desire orientation and erectile dysfunction. A case study. Analisis y Modificación de Conducta, 29, 291-320.
A successful application of ACT to a 30-year-old male with difficulties in accepting his bisexual orientation and with an erectile dysfunction is presented.
Smoking Research
Smoking ResearchOutcome Studies: Smoking
- Bricker, J. B., Mann, S. L., Marek, P. M., Liu, J. M., Peterson, A. V. (2010). Telephone-delivered acceptance and commitment therapy for adult smoking cessation: A feasibility study. Nicotine & Tobacco Research, 12, 454-458.
- Hernandez-Lopez, M., Luciano, M. C, Bricker, J., B., Roales-Nieto, J. G., & Montesinos, F. (2009). Acceptance and commitment therapy for smoking cessation: A preliminary study of its effectiveness in comparison with cognitive behavioral therapy. Psychology of Addictive Behaviors, 23, 723-730.
- Brown, R. A., Palm, K. M., Strong, D. R., Lejuez, C. W., Kahler, C. W., Zvolensky, M. J., Hayes, S. C., Wilson, K. G., & Gifford, E. V. (2008). Distress tolerance treatment for early-lapse smokers: Rationale, program description, and preliminary findings. Behavior Modification, 32(3), 302-332.
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Rosenqvist, D. & Sand, J. (2006). Mindfulness based smoking cessation for groups - an explorative study. Thesis at the Lund University, Sweden.
6 acceptance and mindfulness group sessions during 35 days including individual homework assignments. 8 of 10 participants completed the program. At 1 mo follow up 50 percent (of 8 completers) were non-smokers, and the rest showed a decrease in smoking at a rate between 45 and 75 percent. Increase of the acceptance aspect of mindfulness was correlated with non-smoking.
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Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M.., Rasmussen-Hall, M. L., & Palm, K. M. (2004). Acceptance theory-based treatment for smoking cessation: An initial trial of Acceptance and Commitment Therapy. Behavior Therapy, 35, 689-705.
Medium sized randomized controlled trial comparing ACT to nicotine replacement therapy (NRT) as a method of smoking cessation. Quit rates were similar at post but at a one-year follow-up the two groups differed significantly. The ACT group had maintained their gains (35% quit rates) while the NRT quit rates had fallen (less than 10%). Mediational analyses shows that ACT works through acceptance and response flexibility.
Stress and Burnout Research
Stress and Burnout ResearchOutcome Studies: Stress and Burnout
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Blackledge, J. T., & Hayes, S. C. (2006). Using Acceptance and Commitment Training in the Support of Parents of Children Diagnosed with Autism. Child & Family Behavior Therapy, 28(1), 1-18.
Pre – post study shows that ACT workshop helps parents cope with the stress of raising autistic children.
- Luoma, J. B., Hayes, S. C., Twohig, M. P., Roget, N., Fisher, G., Padilla, M., Bissett, R., & Kohlenberg, B. (2007). Augmenting continuing education with psychologically focused group consultation: Effects on adoption of group drug counseling. Psychotherapy: Theory, Research, Practice, Training, 44(4), 463-469.
As small study examining whether a group consultation including elements of Acceptance and Commitment Therapy improved adoption compared to a standard 1-day continuing education workshop on Group Drug Counseling (GDC). The group consultation appeared to result in greater adoption as well as greater sense of personal accomplishment ( a burnout subscale).
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Blackledge, J. T., & Hayes, S. C. (2006). Using Acceptance and Commitment Training in the Support of Parents of Children Diagnosed with Autism. Child & Family Behavior Therapy, 28(1), 1-18.
Pre – post study shows that ACT workshop helps parents cope with the stress of raising autistic children.
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Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., Masuda, A., Pistorello, J., Rye, A. K., Berry, K. & Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835.
A medium sized randomized controlled trial that found that a one day ACT workshop produces greater decreases in stigmatization of clients by therapists and greater decreases in therapist burnout than an educational control and (or some comparisons) than multicultural training. Mediational analyses fit the model.
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Bond, F. W. & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.
Randomized controlled trial. Shows that ACT is more effective than a previously empirically supported behavioral approach to reducing worksite stress and anxiety, and that both are better than a wait list control.
Correlational Studies: Stress and Burnout
- Bond, F.W., Flaxman, P.E., & Bunce, D. (2008). The influence of psychological flexibility on work redesign: Mediated moderation of a work reorganization intervention. Journal of Applied Psychology, 93, 645-654.
- Bond, F. W., & Flaxman, P. E. (2006). The Ability of Psychological Flexibility and Job Control to Predict Learning, Job Performance, and Mental Health. Journal of Organizational Behavior Management, 26, 113-130.
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Donaldson, E. & Bond, F.W. (2004). Psychological acceptance and emotional intelligence in relation to workplace well-being. British Journal of Guidance and Counselling, 32, 187-203.
Study compared experiential avoidance (as measures by the AAQ) and emotional intelligence in terms of their ability to predict general mental health, physical well-being, and job satisfaction in workers (controlling for the effects of job control since this work organisation variable is consistently associated with occupational health and performance). Results from 290 United Kingdom workers showed that emotional intelligence did not significantly predict any of the well-being outcomes, after accounting for acceptance and job control. Acceptance predicted general mental health and physical well-being but not job satisfaction, Job control was associated with job satisfaction, only. Not controlling one’s thoughts and feelings (as advocated by acceptance) may have greater benefits for mental well-being than attempting consciously to regulate them (as emotional intelligence suggests).
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Bond, F. W. & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88, 1057-1067.
Shows that AAQ predicts positive work outcomes (mental health, satisfaction, performance) even one year later, especially in combination with job control. Re-factors the AAQ and shows that a two factor solution can work on a slightly different 16 item version.
Weight Maintenance Research
Weight Maintenance ResearchOutcome Studies: Weight Maintenance
- Lillis, J., Hayes, S. C., Bunting, K., & Masuda, A. (2009). Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Annals of Behavioral Medicine, 37, 58-69.
Micro/Component Studies: Weight Maintenance Outcome Studies: Weight Maintenance
- Lillis, J. (2008). Acceptance and Commitment Therapy for the treatment of obesity-related stigma and sustained weight loss. Unpublished doctoral dissertation. University of Nevada, Reno.
Micro/Component Studies: Weight Maintenance
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Forman, E.M., Hoffman, K.L., McGrath, K.B., Herbert, J.D., Brandsma, L.L. & Lowe, M.R. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study. Behaviour Research and Therapy, 45, 2372-2386.
98 participants with chocolate cravings were exposed to a CBT-based protocol and an ACT-based protocol or no instructions and required to carry chocolate with them of for two days. Those more impacted by food related cues ate less and had fewer cravings in the ACT condition.
Measurement Development: Weight Maintenance
- Lillis, J., & Hayes, S. C. (2008). Measuring avoidance and inflexibility in weight related problems. International Journal of Behavior Consultation and Therapy, 4(4), 348-354.