The effects of acceptance and commitment therapy (ACT) intervention on inflammation and stress biomarkers: a randomized controlled trial
Open accessAbstract
BACKGROUND: Psychological processes can be manifested in physiological health. We investigated whether acceptance and commitment therapy (ACT), targeted on psychological flexibility (PF), influences inflammation and stress biomarkers among working-age adults with psychological distress and overweight/obesity. METHOD: Participants were randomized into three parallel groups: (1) ACT-based face-to-face (n = 65; six group sessions led by a psychologist), (2) ACT-based mobile (n = 73; one group session and mobile app), and (3) control (n = 66; only the measurements). Systemic inflammation and stress markers were analyzed at baseline, at 10 weeks after the baseline (post-intervention), and at 36 weeks after the baseline (follow-up). General PF and weight-related PF were measured with questionnaires (Acceptance and Action Questionnaire, Acceptance and Action Questionnaire for Weight-Related Difficulties). RESULTS: A group × time interaction (p = .012) was detected in the high-sensitivity C-reactive protein (hsCRP) level but not in other inflammation and stress biomarkers. hsCRP decreased significantly in the face-to-face group from week 0 to week 36, and at week 36, hsCRP was lower among the participants in the face-to-face group than in the mobile group (p = .035, post hoc test). Age and sex were stronger predictors of biomarker levels at follow-up than the post-intervention PF. CONCLUSION: The results suggest that ACT delivered in group sessions may exert beneficial effects on low-grade systemic inflammation. More research is needed on how to best apply psychological interventions for the health of both mind and body among people with overweight/obesity and psychological distress. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01738256, Registered 17 August, 2012.
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An eight-week intervention of Acceptance and Commitment Therapy showed no effect on CRP, plasma cortisol, IL-1 receptor antagonist, and adiponectin concentrations in adults with overweight and psychological distress compared to a no-treatment control.
“More recently, an eight-week intervention of Acceptance and Commitment Therapy showed no effect on CRP, plasma cortisol, IL-1 receptor antagonist, and adiponectin concentrations in adults with overweight and psychological distress compared to a no-treatment control (Järvelä-Reijonen et al., 2020).”
From Inflammatory markers changes following acceptance-based behavioral psychotherapy in generalized anxiety disorder patients: Evidence from a randomized controlled trial (2024) · cites this paper as Järvelä-Reijonen et al., 2020
The AAQ-2 was selected as it is the most used measure within ACT research and is often cited as measuring psychological flexibility or psychological inflexibility.
“It was selected as it is the most used measure within ACT research and is often cited as measuring psychological flexibility (e.g. J ¨ arvel ¨ a-Reijonen et al., 2020) or psychological inflexi bility (e.g. Bond et al., 2011).”
From A randomised controlled trial of brief web-based acceptance and commitment Therapy on the general mental health, depression, anxiety and stress of college Students (2022) · cites this paper as Järvelä-Reijonen et al., 2020
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Cited by
Sorted by citations
New generation psychological treatments in chronic pain
McCracken, L. M., Yu, L., & Vowles, K. E. (2022) · BMJ · doi:10.1136/bmj-2021-057212 · Cited by 123 · see citing works
Dunn, T. J., & Dimolareva, M. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102124 · Cited by 69 · see citing works
A systematic review of associations between emotion regulation characteristics and inflammation
Moriarity, D. P., Grehl, M. M., Walsh, R. F. L., Roos, L. G., Slavich, G. M., & Alloy, L. B. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105162 · Cited by 55 · see citing works
Larsson, A., Hartley, S., & McHugh, L. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.02.005 · Cited by 42 · see citing works
Metzendorf, M., Wieland, L. S., & Richter, B. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013591.pub2 · Cited by 48 · see citing works
Intuitive Eating Intervention and Diet Quality in Adults: A Systematic Literature Review
Hensley-Hackett, K., Bosker, J., Keefe, A. G., Reidlinger, D. P., Warner, M. M., D’Arcy, A., & Utter, J. (2022) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2022.08.008 · Cited by 37 · see citing works
Inflammatory biomarkers link perceived stress with metabolic dysregulation
Jurgens, S. M., Prieto, S., & Hayes, J. P. (2023) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2023.100696 · Cited by 31 · see citing works
Ballesio, A., Zagaria, A., Vacca, M., Pariante, C. M., & Lombardo, C. (2023) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2023.05.006 · Cited by 29 · see citing works
Sauer, C., Haussmann, A., & Weissflog, G. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100810 · Cited by 27 · see citing works
Grasmann, J., Almenräder, F., Voracek, M., & Tran, U. S. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24054445 · Cited by 24 · see citing works
Sîrbu, V., & David, D. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102515 · Cited by 24 · see citing works
Lee, S.-C., Tsai, P., Yu, K., & Chan, T. (2025) · Healthcare · doi:10.3390/healthcare13080952 · Cited by 25 · see citing works
Meulders, A., Vlaeyen, J. W. S., Evers, A. W. M., Köke, A. J. A., Smeets, R., Zundert, J. H. M. V., Verbunt, J., & Ryckeghem, D. M. L. V. (2021) · Pain · doi:10.1097/j.pain.0000000000002428 · Cited by 19 · see citing works
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The Interplay of Chronic Stress and Cancer: Pathophysiology and Implications for Integrated Care
Talukdar, J., Megha, M., Choudhary, H., Bhatnagar, S., Pandit, A., Mishra, A. K., Karmakar, S., & Sharan, P. (2025) · Cancer Reports · doi:10.1002/cnr2.70143 · Cited by 14 · see citing works
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Saldarini, F., & Cropley, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811304 · Cited by 5 · see citing works
dortaj, A., Aliakbar Dehkordi, M., Naser moghadasi, A., & Alipour, A. (2021) · Journal of Applied Psychology · doi:10.52547/apsy.2021.216250.0 · Cited by 4 · see citing works
Marchesi, G., Rapelli, G., Semonella, M., Bruzzese, A., Molinaro, M., Andersson, G., Castelnuovo, G., & Pietrabissa, G. (2026) · Current Obesity Reports · doi:10.1007/s13679-026-00735-2 · Cited by 1 · see citing works
Behavioral interventions of dietary changes to reduce depressive symptoms: a meta-analysis
Eissenstat, S. J., Gao, N., Kim, B., Brody, R. A., & Hauck, E. (2023) · Journal of Public Health · doi:10.1007/s10389-023-02157-z · Cited by 1 · see citing works
Gandarela, L. M. (2021) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.5.2021.tde-08122021-140003
Future Directions of Contextual Behavioral Science
Wicksell, R. K., Törneke, N., McCracken, L. M., Bricker, J. B., Murrell, A. R., Masuda, A., & Biglan, A. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197550076.013.32
Susila, W. D. C., Nurwahidah, N., & Metrikayanto, W. D. (2023) · Adi Husada Nursing Journal · doi:10.37036/ahnj.v9i1.385
Saldarini, F., Yamasaki, K., & Miyata, H. (2024) · Mindfulness · doi:10.1007/s12671-024-02376-9
Bisenio, W., & Hocson, S. M. G. (2026) · Psychology and Education A Multidisciplinary Journal · doi:10.70838/pemj.550806
Park, E. K. C., Park, W. H., & Jeon, E. (2026) · Medicina · doi:10.3390/medicina62101841
- Authors
- Järvelä-Reijonen, E., Puttonen, S., Karhunen, L., Sairanen, E., Laitinen, J., Kolehmainen, M., Pihlajamäki, J., Kujala, U. M., Korpela, R., Ermes, M., Lappalainen, R., & Kolehmainen, M.
- Affiliations
- Finnish Institute of Occupational Health (FI)
- University of Eastern Finland (FI)
- Karlstad University (SE)
- University of Jyväskylä (FI)
- University of Helsinki (FI)
- ORCID
- Venue
- International Journal of Behavioral Medicine
- Published
- 2020-05-11
- Volume
- 27
- Issue
- 5
- Pages
- 539-555
- ISSN
- 1070-5503 (ISSN-L)
- 1532-7558
- PMC
- PMC7497453
- OpenAlex
- W3025534555
- Cited by
- 27
- References
- 98
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 6 · 2021: 3 · 2020: 1
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Journal of Behavioral Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Jyväskylä University Digital Archive (University of Jyväskylä) (submittedVersion, cc-by)
- Digitala vetenskapliga arkivet (Diva) (Karlstad University) (submittedVersion, other-oa)
- Työväentutkimus Vuosikirja (submittedVersion)
- Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by)
- Funders
- Doctoral Programme in Nutrition of the Faculty of Health Sciences, University of Eastern Finland (N/A)
- Tekes (1104/10)
- Pohjois-Savon Rahasto (N/A)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
- Keywords
- acceptance and commitment therapy, psychological flexibility, psychological distress, overweight and obesity, systemic inflammation, C-reactive protein, stress biomarkers, mobile app intervention, mind-body health
- MeSH terms
- Adult, Humans, Inflammation, Obesity, Biomarkers, Overweight, Acceptance and Commitment Therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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