Zou Yanxiang, Wang Ruxuan, Xiong Xiaochen, Bian Cheng, Yan Shirui, Zhang Yanhong
School of Nursing, Nanjing Medical University, Nanjing, China.
The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
BMC Psychiatry. 2025 Jul 1;25(1):602. doi: 10.1186/s12888-025-07067-w.
Acceptance and Commitment therapy (ACT) has been widely used in patients with depression. However, its effectiveness in improving psychological flexibility and reducing automatic thoughts remains uncertain. This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of ACT on depression, anxiety, automatic thought, and psychological flexibility in patients with depression, as well as its acceptability.
RCTs were systematically searched in nine databases and gray literature, with the last update on March 25, 2025. Effect sizes were synthesized using a random-effects model, and subgroup analyses were conducted to explore potential heterogeneity. Publication bias was corrected using three methods: PET-PEESE, selection models, and robust Bayesian meta-analysis. The certainty of evidence was evaluated using the GRADE approach.
A total of 13 RCTs from 1362 patients were included in this meta-analysis. Pooled results showed that ACT significantly improved depression [SMD = - 0.66 (- 0.80, - 0.52), P <.001, I = 24% (0%, 75%), Certainty: Low], anxiety [SMD = - 0.43 (- 0.77, - 0.10), P <.05, I = 77% (34%, 97%), Certainty: Moderate], and psychological flexibility [SMD = 0.50 (0.35, 0.66), P <.001, I = 36% (0%, 83%), Certainty: Moderate] compared with controls at post-test. However, there was no significant positive effect on automatic thoughts [SMD = - 0.28 (- 0.69, 0.12), P =.17, I = 65% (0%, 97%), Certainty: Very low]. Notably, the positive effects of ACT on depression, anxiety and psychological flexibility were maintained at follow-up. Furthermore, the difference in acceptability between ACT and the control condition was not statistically significant (P ≥.05). Subgroup analyses indicated that face-to-face ACT was more effective than internet-based ACT.
According to the GRADE assessment, the certainty of the evidence ranges from very low to moderate. ACT appears to significantly improve depressive symptoms, anxiety, and psychological flexibility in individuals with depression. However, its effects on automatic thoughts and its acceptability still require further investigation.
META-ANALYSIS REGISTRATION ON PROSPERO: CRD42024533794.
接纳与承诺疗法（ACT）已广泛应用于抑郁症患者。然而，其在改善心理灵活性和减少自动思维方面的有效性仍不确定。这项随机对照试验（RCT）的荟萃分析旨在评估ACT对抑郁症患者的抑郁、焦虑、自动思维和心理灵活性的影响及其可接受性。
在九个数据库和灰色文献中系统检索RCT，最后更新时间为2025年3月25日。使用随机效应模型合成效应量，并进行亚组分析以探索潜在的异质性。使用三种方法校正发表偏倚：PET-PEESE、选择模型和稳健贝叶斯荟萃分析。使用GRADE方法评估证据的确定性。
本荟萃分析共纳入13项RCT，涉及1362名患者。汇总结果显示，与对照组相比，ACT在测试后显著改善了抑郁[标准化均数差（SMD）=-0.66（-0.80，-0.52），P<.001，I²=24%（0%，75%），确定性：低]、焦虑[SMD=-0.43（-0.77，-0.10），P<.05，I²=77%（34%，97%），确定性：中等]和心理灵活性[SMD=0.50（0.35，0.66），P<.001，I²=36%（0%，83%），确定性：中等]。然而，对自动思维没有显著的积极影响[SMD=-0.28（-0.69，0.12），P=.17，I²=65%（0%，97%），确定性：非常低]。值得注意的是，ACT对抑郁、焦虑和心理灵活性的积极影响在随访中得以维持。此外，ACT与对照条件之间的可接受性差异无统计学意义（P≥.05）。亚组分析表明，面对面的ACT比基于互联网的ACT更有效。
根据GRADE评估，证据的确定性范围从非常低到中等。ACT似乎能显著改善抑郁症患者的抑郁症状、焦虑和心理灵活性。然而，其对自动思维的影响及其可接受性仍需进一步研究。
荟萃分析在PROSPERO上的注册：CRD42024533794。
