Latella Desirèe, Marafioti Giulia, Formica Caterina, Calderone Andrea, La Fauci Elvira, Foti Angela, Calabrò Rocco Salvatore, Filippello Giuseppa
Giulia Marafioti, Psy, IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy.
Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy.
Healthcare (Basel). 2025 Jul 2;13(13):1587. doi: 10.3390/healthcare13131587.
Acceptance and commitment therapy (ACT) enhances psychological flexibility by fostering acceptance of thoughts and emotions, promoting mindfulness practices, and encouraging engagement in value-based actions. These processes have been associated with improvements in mental health and social functioning, with accumulating evidence supporting ACT's efficacy across various psychiatric disorders. This systematic review aimed to evaluate current evidence on ACT interventions for reducing psychiatric symptoms and enhancing social functioning and interpersonal relationships in adults with psychiatric conditions.
A comprehensive search was conducted across PubMed, Web of Science, the Cochrane Library, and Embase for studies published between 2014 and 2024. The review protocol was registered on the Open Science Framework (OSF; registration ID: 2ZAGT).
Seventeen studies met the inclusion criteria; however, the evidence base remained fragmented, with most psychiatric diagnoses represented by only one or two studies. The reviewed studies exhibited several methodological limitations, including small sample sizes, lack of randomization and blinding, high risk of bias, reliance on subjective outcome measures, and inadequately designed or absent control groups. Despite these limitations, ACT was associated with beneficial effects in conditions such as post-traumatic stress disorder (PTSD), insomnia, psychosis, and autism spectrum disorder, particularly in reducing experiential avoidance, enhancing mindfulness, and promoting long-term improvements in emotional regulation and life satisfaction.
Due to the limited number of studies per diagnosis, significant methodological weaknesses, and the lack of high-quality controlled trials, this review cannot provide strong evidence for the efficacy of ACT in improving social functioning among adults with psychiatric disorders. The heterogeneity and overall low quality of the available literature highlight the urgent need for further large-scale well-controlled studies.
接纳与承诺疗法（ACT）通过培养对思想和情绪的接纳、推广正念练习以及鼓励参与基于价值观的行动来增强心理灵活性。这些过程与心理健康和社会功能的改善相关，越来越多的证据支持ACT在各种精神障碍中的疗效。本系统评价旨在评估当前关于ACT干预措施对减轻有精神疾病的成年人的精神症状、增强社会功能和人际关系的证据。
在PubMed、科学网、考克兰图书馆和Embase上全面检索了2014年至2024年发表的研究。该评价方案已在开放科学框架（OSF；注册号：2ZAGT）上注册。
17项研究符合纳入标准；然而，证据基础仍然零散，大多数精神诊断仅有一两项研究代表。所审查的研究存在若干方法学局限性，包括样本量小、缺乏随机化和盲法、偏倚风险高、依赖主观结局测量以及对照组设计不当或缺失。尽管存在这些局限性，但ACT在创伤后应激障碍（PTSD）、失眠、精神病和自闭症谱系障碍等病症中具有有益效果，特别是在减少经验性回避、增强正念以及促进情绪调节和生活满意度的长期改善方面。
由于每个诊断的研究数量有限、方法学存在重大缺陷以及缺乏高质量的对照试验，本评价无法为ACT在改善有精神疾病的成年人的社会功能方面的疗效提供有力证据。现有文献的异质性和总体低质量凸显了进一步开展大规模严格对照研究的迫切需求。
