Penubarthi Sravanthi, Reddy Mounika, Donthu Raj Kiran, Guhan Naga, Ravindra Adimulam Ganga, Bhongir Aparna Varma
Dept. of Psychiatry, Kamineni Institute of Medical Sciences, Narketpalle, Telangana, India.
Dept. of Pediatrics, All India Institute of Medical Sciences, Bibinagar, Telangana, India.
Indian J Psychol Med. 2025 Aug 13:02537176251363856. doi: 10.1177/02537176251363856.
Acceptance and commitment therapy (ACT) is a third-wave psychological therapy that has shown effectiveness in managing psychological distress across various conditions, including chronic illnesses. Traumatic brain injury (TBI) often leads to cognitive impairments, mood disturbances, and psychological distress. While pharmacological treatments have limitations, non-pharmacological approaches, such as ACT, offer a promising alternative. This study systematically examined the efficacy of ACT on depression and anxiety in adults with TBI.
A systematic search identified randomized controlled trials (RCTs) comparing ACT with treatment as usual or other psychological therapies in adults with TBI. Primary outcomes included depression and anxiety, while secondary outcomes assessed psychological flexibility, functional disability, rehabilitation participation, and quality of life (QOL). A random effects model meta-analysis was conducted using the language. Four eligible RCTs (pooled = 227) were included. ACT significantly reduced depression and anxiety with a moderate effect size [Cohen's = 0.54; 95% CI = 0.18-0.90; = .003; = 61.1%]. It also improved psychological flexibility [Cohen's = 0.36; 95% CI = 0.19-0.53; < .001; = 0%], mental health-related QOL [Cohen's = 0.24; 95% CI = 0.02-0.49; = .015; = 90.8%], and decreased functional disability [Cohen's = 0.47; 95% CI = 0.18-0.76; = .001; = 0%]. Regarding risk of bias, two studies had some concerns, and the rest were of low risk.
The evidence for the efficacy of ACT in TBI is positive but preliminary. More methodologically sound trials using standardized measures are required to confirm the findings.
接纳与承诺疗法（ACT）是一种第三波心理治疗方法，已显示出在管理包括慢性病在内的各种情况下的心理困扰方面的有效性。创伤性脑损伤（TBI）常导致认知障碍、情绪紊乱和心理困扰。虽然药物治疗有局限性，但非药物方法，如ACT，提供了一个有前景的替代方案。本研究系统地考察了ACT对TBI成年患者抑郁和焦虑的疗效。
一项系统检索确定了比较ACT与常规治疗或其他心理治疗方法对TBI成年患者疗效的随机对照试验（RCT）。主要结局包括抑郁和焦虑，次要结局评估心理灵活性、功能残疾、康复参与度和生活质量（QOL）。使用该语言进行随机效应模型荟萃分析。纳入了四项符合条件的RCT（汇总样本量 = 227）。ACT显著降低了抑郁和焦虑，效应量中等[科恩d值 = 0.54；95%置信区间 = 0.18 - 0.90；P = 0.003；异质性I² = 61%]。它还改善了心理灵活性[科恩d值 = 0.36；95%置信区间 = 0.19 - 0.53；P < 0.001；异质性I² = 0%]、与心理健康相关的生活质量[科恩d值 = 0.24；95%置信区间 = 0.02 - 0.49；P = 0.015；异质性I² = 90.8%]，并降低了功能残疾[科恩d值 = 0.47；95%置信区间 = 0.18 - 0.76；P = 0.001；异质性I² = 0%]。关于偏倚风险，两项研究存在一些问题其余研究风险较低。
ACT对TBI疗效的证据是积极的，但为初步证据。需要更多使用标准化测量方法的方法学严谨的试验来证实这些发现。
