Could you describe the aim of the study?
A systematic review and meta-analysis were conducted which aimed to identify whether web-delivered Acceptance and Commitment Therapy (ACT pronounced as the word act) was effective in the management of common mental disorders and improving wellbeing.
What would you say are the key take-home messages from this study?
Findings supported the use of ACT, delivered via the web, for the management of depression and anxiety but interventions employing ACT were not found to be effective for improving quality of life. However, none of the Randomised controlled trials included for review focused on quality of life or wellbeing as their primary outcome.
Drop out and non-completion of psychological interventions is an area of critical concern across web-based delivery formats. This issue is relevant across all psychological approaches, for example, interventions based on Cognitive Behaviour Therapy (CBT) and positive psychology as well as ACT. Adherence to study protocol and completion rate were found to be high overall suggesting that this therapeutic approach (ACT) is highly acceptable for patients and the general public.
What is ACT?
ACT has enjoyed a steady rise in interest as an alternative therapeutic intervention to CBT. ACT is considered a third wave CBT, philosophically rooted in functional contextualism and relational frame theory. ACT differs from traditional CBT in a number of ways, most notably in that it does not consider thoughts and beliefs as correct or incorrect; and symptom reduction is not the goal of treatment but is a by-product of the process. ACT is based on the principles of self-acceptance and a commitment to one’s personal values; and encourages the adoption of behaviours that are in alignment with those personal values. ACT aims to encourage individuals toward (1) acceptance of difficult and unwelcome thoughts or emotions, and (2) promotion and simultaneous adoption of actions and behaviours, into daily practice, which are in line with these individual values. ACT interventions commonly incorporate mindfulness and experiential exercises that promote contact with the present moment.
How would these findings impact clinical practice?
The findings clearly show that ACT, delivered via the web is an effective psychological intervention which can help reduce individual suffering in relation to depression and anxiety. Web-delivered psychological interventions have previously been found to be cost-effective and offer suffers convenient and flexible access to sources of help which may not be so freely accessible or available via traditional face-to-face delivery methods. From a public health perspective, such interventions offer an alternative approach to CBT.
Who would benefit most from this sort of intervention?
Those suffering from depression and anxiety who are willing and able to interact with a web-delivered intervention.
Are there individuals for whom web-based interventions may not be helpful?
No individual characteristics have been identified to suggest that some people might not benefit from web-based psychological interventions in this context.
What future studies would you recommend to further establish these results?
Further research into the use of web-delivered ACT is required to continue to explore its effectiveness and to understand the most effective components for this delivery context. Specifically, those targeting anxiety and well-being would be of benefit as positive well-being continues to grow as an area of public interest. Studies should focus on recruiting larger populations to avoid concerns with a lack of statistical power and to ensure wider generalizability of findings. Studies should also seek to examine the long-term effect of ACT through the inclusion of follow-up periods in future RCTs.
A link to the primary paper. Brown M, Glendenning AC, Hoon AE, John A. Effectiveness of Web-Delivered Acceptance and Commitment Therapy in Relation to Mental Health and Well-Being: A Systematic Review and Meta-Analysis. J Med Internet Res 2016;18(8):e221 DOI: 10.2196/jmir.6200
Menna Brown (MSc) is a lecturer and PhD candidate at Swansea University, Medical School. She is an experienced researcher working with qualitative methodology and has an interest in health behaviour change and health psychology.