Knudsen Francesca M, Donahue Marissa L, Klimczak Korena S, Aller Ty B, Levin Michael E
Department of Psychology, Utah State University, 6430 Old Main Hill, Logan, UT, USA.
Institute for Disability Research, Policy and Practice, Utah State University, 6800 Old Main Hill, Logan, UT, USA.
J Behav Med. 2025 Jul 16. doi: 10.1007/s10865-025-00585-8.
Living with a chronic health condition (CHC) can negatively impact quality of life (QoL) through a complex interaction of mental health challenges, functional limitations, and disease management demands. Acceptance and Commitment Therapy (ACT) is a transdiagnostic approach that shows promise in addressing shared challenges across various CHCs by fostering psychological flexibility (PF). PF has been associated with improved QoL and functional outcomes and reduced psychological symptoms in individuals living with specific CHCs; yet its mediating role in these outcomes remains underexplored. This secondary analysis examined whether changes in PF mediated improvements in QoL, psychological symptoms, and functional impairment among individuals with various CHCs. Participants (n = 100) were randomized to a six-session self-guided, online ACT program or a waitlist control group. Outcomes were assessed at baseline, post-treatment, and four-week follow-up. Results revealed that increases in PF significantly mediated improvements in QoL, with indirect effects indicating that higher PF at post-treatment predicted better QoL at follow-up. The ACT group demonstrated significant reductions in functional impairment at follow-up compared to the waitlist group, though this effect was not mediated by changes in PF. Improvements in psychological symptoms were not statistically significant and were not mediated by PF. These findings suggest that ACT effectively enhances PF, which subsequently improves QoL in individuals with CHCs. This supports the transdiagnostic applicability of ACT for improving mental health and QoL across diverse chronic conditions. Future research should explore additional mechanisms underlying ACT's effects and investigate ways to optimize its impact on functional and psychological outcomes within CHCs.
患有慢性健康状况（CHC）会通过心理健康挑战、功能限制和疾病管理需求之间的复杂相互作用对生活质量（QoL）产生负面影响。接纳与承诺疗法（ACT）是一种跨诊断方法，通过培养心理灵活性（PF），在应对各种CHC的共同挑战方面显示出前景。PF与生活质量的改善、功能结果的改善以及患有特定CHC的个体心理症状的减轻有关；然而，其在这些结果中的中介作用仍未得到充分探索。这项二次分析研究了PF的变化是否介导了各种CHC患者在生活质量、心理症状和功能损害方面的改善。参与者（n = 100）被随机分配到一个为期六节的自我指导在线ACT项目或一个等待名单对照组。在基线、治疗后和四周随访时评估结果。结果显示，PF的增加显著介导了生活质量的改善，间接效应表明治疗后较高的PF预测随访时更好的生活质量。与等待名单组相比，ACT组在随访时功能损害显著降低，尽管这种效应不是由PF的变化介导的。心理症状的改善没有统计学意义，也不是由PF介导的。这些发现表明，ACT有效地增强了PF，随后改善了CHC患者的生活质量。这支持了ACT在改善不同慢性疾病的心理健康和生活质量方面的跨诊断适用性。未来的研究应该探索ACT效果的其他潜在机制，并研究优化其对CHC患者功能和心理结果影响的方法。
