State of the ACT Evidence

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ACT is committed to a high standard of empirical evaluation. This includes not just controlled assessment and evaluations of outcomes but also the specification and evaluation moderations and of the putative processes of change. Furthermore, we also seek to understand the links between these processes of change and basic functional behavioral principles, including those drawn from RFT.

One web page is unable to collect together the growing evidence for all of the above areas at one time point or to keep it up to date going forward. More modestly, the three sections below aim to provide information on:

1. Organizations that describe ACT, or areas of ACT, as evidence based
2. Links to peer reviewed assessments of the ACT evidence base
3. Snapshots of the ACT RCT evidence base (a list of actual randomized controlled trials can be found at another page: https://contextualscience.org/ACT_Randomized_Controlled_Trials; a list of mediational studies can be found at

This page will be updated approximately once every six months. Date of late update: November 2017. If you are aware of missing data, please contact the ACBS staff: "acbsstaff@contextualscience.org" <acbsstaff@contextualscience.org>

1. Organizations that describe ACT, or areas of ACT, as evidence based:

A number of different organizations, external to ACBS, have stated that ACT is empirically supported in certain areas or as a whole according to their standards. These include:

i. American Psychological Association, Society of Clinical Psychology (Div. 12), Research Supported Psychological Treatments:

Chronic Pain - Strong Research Support
Depression - Modest Research Support
Mixed anxiety - Modest Research Support
Obsessive-Compulsive Disorder - Modest Research Support
Psychosis - Modest Research Support
For more information on what the "modest" and "strong" labels mean, click here

ii. SAMHSA's National Registry of Evidence-based Programs and Practices, ACT, last review July 2010.

2. Links to peer reviewed assessments of the ACT evidence base:

Below is a list of meta-analyses, systematic or narrative reviews of the ACT evidence base, either overall or in specific areas. They are presented in reverse chronological order, by year of publication.  

The cummulative number of meta-analyses of the ACT literature is growing rapidly and will likely fit 40 by the end of 2018 (a graphic of the growth is attached as a JPEG file at the bottom of this page)

 

2018 (to date)

Reeve, A., Tickle, A., & Moghaddam, N. (2018) Are acceptance and commitment therapy-based interventions effective for reducing burnout in direct-care staff? A systematic review and meta-analysis. Mental Health Review Journal, 23 (3), 131-155.  DOI: 10.1108/MHRJ-11-2017-0052 

Lee, EK., Song, MK. (2018). Effectiveness of ACT-based Group Counseling for Depression and Anxiety : A Meta-Analysis. The Korean Journal of Counseling and Psychotherapy, 30(3), 635-661. Full Text is available at: : http://www.dbpia.co.kr/Article/NODE07524914. This meta-analysis is in Korean so you may need to reach out to the corresponding Author: Mikyoung Song (songdouce@swu.ac.kr)

Schütze, R. Rees, C., Smith, A., Alater, H., Campbell, J. M., & O'Sullivan, P. (2018). How Can We Best Reduce Pain Catastrophizing in Adults With Chronic Noncancer Pain? A Systematic Review and Meta-Analysis,
The Journal of Pain, 19, 233-256. DOI: 10.1016/j.jpain.2017.09.010.

Linardon, J., Gleeson, J., Yap, K., Murphy, K. & Brennan, L. (2018) Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention, Cognitive Behaviour Therapy. DOI: 10.1080/16506073.2018.1517389

Wilson, A.C., Mackintosh, K., Power, K. & Chan, S. W. Y. (2018). Effectiveness of self-compassion related therapies: A systematic review and meta-analysis. Mindfulness  DOI: 10.1007/s12671-018-1037-6

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.

Kishita, N., Hammond, L., Dietrich, C., & Mioshi, E. (2018). Which interventions work for dementia family carers?: An updated systematic review of randomized controlled trials of carer interventions. International Psychogeriatrics, 1-18.                      doi: S1041610218000947

Serfaty, S., Gale, G., Beadman, M., Froeliger, B., & Sunjeev, S. K. (2018). Mindfulness, acceptance and defusion strategies in smokers: A systematic review of laboratory studies. Mindfulness, 9, 44-58.
DOI: 10.1007/s12671-017-0767-1
Full Text: Available Through DOI

Collins, R. N., & Kishita, N. (2018). The effectiveness of mindfulness- and acceptance-based interventions for informal caregivers of people with dementia: A meta-analysis. The Gerontologist, gny024.
DOI: 10.1093/geront/gny024
Full Text: Available Through DOI

Maynard, B. R., Wilson, A. N., Labuzienski, E., & Whiting, S. W. (2018). Mindfulness-based approaches in the treatment of disordered gambling: A systematic review and meta-analysis. Research on Social Work Practice, 28, 348-362.
DOI: 10.1177/1049731515606977
Full Text: Available Through DOI

Feliu-Soler, A., Cebolla, A., McCracken, L. M., D’Amico, F., Knapp, M., López-Montoyo, A., García-Campayo, J., Soler, J., Baños, R. M., Pérez-Aranda, A., Andrés-Rodriguez, L., Rubio-Valera, M., & Luciano, J. V. (2018). Economic impact of third-wave cognitive behavioral therapies: A systematic review and quality assessment of economic evaluations in randomized controlled trials. Behavior Therapy, 49, 124-147.
DOI: 10.1016/j.beth.2017.07.001
Full Text: Available Through DOI

2017

Twohig, M. P., & Levin, M. E. (2017). Acceptance and commitment therapy as a treatment for anxiety and depression: A review. Psychiatric Clinics of North America, 40, 751-770.
DOI: 10.1016/j.psc.2017.08.009
Full Text: Available Through DOI

Rogers, J.M., Ferrari, M., Mosely, K., Lang, C.P., & Brennan, L. (2017). Mindfulness-based interventions for adults who are overweight or obese: A meta-analysis of physical and psychological health outcomes. Obesity Reviews, 18, 51-67.
DOI: 10.1111/obr.12461
Full Text: Available Through DOI

Gilpin, H. R., Keyes, A., Stahl, D. R., Greig, R. & McCracken, L. M. (2017). Predictors of treatment outcome in contextual cognitive and behavioral therapies for chronic pain: A systematic review. The Journal of Pain, 18, 1153-1164.
DOI: 10.1016/j.jpain.2017.04.003
Full Text: Available Through DOI

Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and commitment therapy (ACT) for chronic pain: A systematic review and meta-analyses. Clinical Journal of Pain, 33, 552-568.
DOI: 10.1097/AJP.0000000000000425
Full Text: Available Through DOI

Noetel, M., Ciarrochi, J., Van Zanden, B., & Lonsdale, C. (2017). Mindfulness and acceptance approaches to sporting performance enhancement: A systematic review. International Review of Sport and Exercise Psychology,.
DOI: 10.1080/1750984X.2017.1387803
Full Text: Available Through DOI

Atkins, P. W. B., Ciarrochi, J., Gaudiano, B. A., Bricker, J. B., Donald, J., Rovner, G., Smout, M., Livheim, F., Lundgren, T., & Hayes, S. C. (2017). Departing from the essential features of a high quality systematic review of psychotherapy: A response to Öst (2014) and recommendations for improvement. Behaviour Research and Therapy, 97, 259-272.
DOI: 10.1016/j.brat.2017.05.016
Full Text: Available Through DOI

Simpson, P. A., Mars, T., & Esteves, J. E. (2017). A systematic review of randomised controlled trials using acceptance and commitment therapy as an intervention in the management of non-malignant, chronic pain in adults. International Journal of Osteopathic Medicine, 24, 18-31.
DOI: 10.1016/j.ijosm.2017.03.001
Full Text: Available Through DOI

Lønfeldt, N. N., Silverman, W. K., & Esbjørn, B. H. (2017). A systematic review and meta-analysis of the association between third-wave cognitive constructs and youth anxiety. International Journal of Cognitive Therapy, 10, 115-137.
DOI: 10.1521/ijct.2017.10.2.115
Full Text: Available Through DOI

2016

Tonarelli, S. B., Pasillas, R., Alvarado, L., Dwivedi, A., & Cancellare, A. (2016). Acceptance and commitment therapy compared to treatment as usual in psychosis: A systematic review and meta-analysis. Journal of Psychiatry, 19, 366.
DOI: 10.4172/2378-5756.1000366
Full Text: Available Through DOI

Hacker, T., Stone, P., & MacBeth, A. (2016). Acceptance and commitment therapy - Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. Journal of Affective Disorders, 190, 551-565.
DOI: 10.1016/j.jad.2015.10.053
Full Text: Available Through DOI

Brown, M., Glendenning, A., Hoon, A. E. & John, A. (2016). Effectiveness of web-delivered acceptance and commitment therapy in relation to mental health and well-being: A systematic review and meta-analysis. Journal of Medical Internet Research, 18(8), e221.
DOI: 10.2196/jmir.6200 [Current DOI Error]
Full Text: Journal Website

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
Full Text: Available Through DOI

Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T. & Schreurs, K. M. G. (2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: A meta-analytic review. Cognitive Behaviour Therapy, 45, 5-31.
DOI: 10.1080/16506073.2015.1098724
Full Text: Available Through DOI

2015

Ducasse, D., & Fond, G. (2015). La thérapie d’acceptation et d’engagement [Acceptance and commitment therapy. L'Encéphale, 41, 1-9.
DOI: 10.1016/j.encep.2013.04.017
Full Text: Available Through DOI

Lee, E. B., An, W., Levin, M. E., & Twohig, M. P. (2015). An initial meta-analysis of acceptance and commitment therapy for treating substance use disorders. Drug and Alcohol Dependence, 155, 1-7.
DOI: 10.1016/j.drugalcdep.2015.08.004
Full Text: Available Through DOI

Godfrey, K. M., Gallo, L. C., & Afari, N. (2015). Mindfulness-based interventions for binge eating: A systematic review and meta-analysis. Journal of Behavioral Medicine, 38, 348-362.
DOI: 10.1007/s10865-014-9610-5
Full Text: Available Through DOI

A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(30), 30-36.
DOI: 10.1159/000365764
Full Text: Available Through DOI

2014

Cavanagh, K., Strauss, C., Forder, L., & Jones, F. (2014). Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clinical Psychology Review, 34, 118-129.
DOI: 10.1016/j.cpr.2014.01.001
Full Text: Available Through DOI

Öst, L. G. (2014). The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis. Behaviour Research and Therapy, 61, 105-121.
DOI: 10.1016/j.brat.2014.07.018
Full Text: Available Through DOI
Note: See review above: Atkins et al., 2017

2013

Swain, J., Hancock, K., Hainsworth, C., & Bowman, J. (2013). Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clinical Psychology Review, 33, 965-978.
DOI: 10.1016/j.cpr.2013.07.002
Full Text: Available Through DOI

2012

Klainin-Yobas, P., Cho, M. A. A., & Creedy, D. (2012). Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: A meta-analysis. International Journal of Nursing Studies, 49, 109-121.
DOI: 10.1016/j.ijnurstu.2011.08.014
Full Text: Available Through DOI

Smout, M. F., Hayes, L., Atkins, P. W. B., Klausen, J., & Duguid, J. E. (2012). The empirically supported status of acceptance and commitment therapy: An update. Clinical Psychologist, 16, 97-109.
DOI: 10.1111/j.1742-9552.2012.00051.x
Full Text: ACBS Website

2011

Veehof, M. M., Oskam, M., Schreurs, K. M. G., & Bohlmeijer, E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152, 533-542.
DOI: 10.1016/j.pain.2010.11.002
Full Text: Available Through DOI

2010

Ruiz, F. J. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10, 125-162.
DOI: No DOI
Full Text: ACBS Website

2009

Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78, 73-80.
DOI: 10.1159/000190790
Full Text: ACBS Website

Gaudiano, B. A. (2009). Öst's (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching apples with oranges? Behaviour Research and Therapy, 47, 1066-1070.
DOI: 10.1016/j.brat.2009.07.020
Full Text: ACBS Website

2008

Öst, L. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46, 296-321.
DOI: 10.1016/j.brat.2007.12.005
Full Text: ACBS Website

2006

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
DOI: 10.1016/j.brat.2005.06.006
Full Text: ACBS Website

3. Mediational analyses

ACT is a process-oriented approach and the list of studies testing mediation or moderation is quite large. As of Spring 2016 we were aware of approximately 45 mediational studies. This list is rapidly growing. A partial list can be found here (a child page to this webpage).

4. Qualitative Research

After the first three RCTs in the early 1980's ACT research turned toward transcript analysis and qualitative research. Examples are the first ACT dissertations done at the Univeristy of Nevada by Sue McCurry and Durriyah Khorakiwala. This work in turn lead to the first item set for the AAQ, and to the commonly used ACT adherence measures, in addition to the protocol described in the first ACT book in 1999.

Qualitative work is hard to do but it has continued throughout the ACT research program. Examples can be found here (a child page to this webpage). If you find any more send them to ACBS staff to add to the list.

5. Snapshots of the ACT RCT evidence base:

As of December 2017, there are 202 randomized controlled trials (RCTs) of ACT published. Details of each of these studies, along with links to the original research articles, can be found here (a child page to this webpage) Below, we provide a snapshot of this ACT RCT evidence-base, summarizing clinical areas in order of the number of published RCTs. This list is current as of August 2016. It is, of course, acknowledged that evidence from RCTs is only one part of evidence-based practice, and for some questions and issues it is arguably not the most important.

 

Area: Number of studies: RCT page study number(s):
Pain 19 9, 14, 20, 24, 31, 37, 39, 52, 55, 65, 68, 73, 74, 75, 91, 106, 122, 126, 127
Depression 16 1, 2, 26, 41, 43, 47, 49, 66, 67, 69, 78, 89, 92, 114, 125, 133
Stress 13 3, 34, 35, 46, 61, 62, 63, 64, 79, 83, 85, 118, 119
Anxiety 14 5,19, 22, 45, 48, 59, 86, 94, 108, 110, 112, 130, 131, 136
Various 10 17, 32, 33, 40, 51, 97, 105, 107, 111, 117
Weight Loss 7 25, 27, 44, 70, 72, 87, 116
Substance Abuse 9 6, 29, 53, 58, 84, 103, 121, 123, 134
Smoking 5 8, 42, 71, 98, 99
Cancer 5 15, 57, 81, 90, 101
Eating Disorders 4 30, 56, 60, 76
Social Anxiety 4 77, 80, 82, 96
Psychosis 3 4, 13, 36
Epilepsy 2 11, 23
Borderline Personality Disorder 2 12, 54
Diabetes 2 18, 93
Tinnitus 2 38, 50
Parenting 3 95, 100, 124
Stigma 4 7, 16, 104, 128
Trichotillomania 1 10
OCD 1 28
Prevention 1 88
Exercise 3 113, 115, 129
Quality of Life 2 102, 132
Aggression 1 109
Procrastination 1 120
Pornography 1 135
Training 1 21
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