Technology-supported Acceptance and Commitment Therapy for chronic health conditions: A systematic review and meta-analysis
Open accessAbstract
Chronic health conditions (CHCs) are common and associated with functional limitations. Acceptance and commitment therapy (ACT) shows promise in improving functioning, quality of life, and distress across several CHCs. The purpose of this study was to conduct a systematic review of technology-supported ACT for CHCs and perform a meta-analysis on functioning and ACT process outcomes. Multiple databases were systematically searched for randomized controlled trials. A total of 20 unique studies with 2,430 randomized participants were included. CHCs addressed in these studies were chronic pain (k = 9), obesity/overweight (k = 4), cancer (k = 3), hearing loss (k = 1), HIV (k = 1), multiple sclerosis (k = 1), and tinnitus (k = 1). Internet and telephone were the most used technology platforms. All studies included therapist contact with considerable heterogeneity between studies. Random effects meta-analyses found medium effect sizes showing technology-supported ACT outperformed comparator groups on measures of function at post-treatment (Hedges' g = -0.49; p = 0.002) and follow-up (Hedges' g = -0.52; p = 0.02), as well as ACT process outcomes at post-treatment (Hedges' g = 0.48; p < 0.001) and follow-up (Hedges' g = 0.44; p < 0.001). Technology-supported ACT shows promise for improving function and ACT process outcomes across a range of CHCs. Recommendations are provided to optimize technology-supported ACT for CHCs. PROSPERO registration number: CRD42020200230.
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A systematic review by Inês and colleagues, including 5 randomized controlled trials with 746 participants, found that technology-based ACT demonstrated moderate effects in pain intervention and pain acceptance, and smaller effects in depression, mindfulness, and psychological flexibility compared to control groups.
“Inês and colleagues focused on technology-based ACT interventions for patients with chronic pain, incorporating 5 RCTs with a total of 746 participants [26]. They observed that, compared to control groups, technology-based ACT demonstrated moderate effects in pain intervention and pain acceptance, and smaller effects in depression, mindfulness, and psychological flexibility [26].”
From Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life (2024) · cites this paper as [26]
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Experimental — accuracy not yet measuredMultiple systematic reviews have confirmed that clinical personnel using ACT can effectively improve certain indicators of patients with chronic pain, such as anxiety, depression, and pain acceptance.
“Our literature review shows that multiple systematic reviews have confirmed that clinical personnel using ACT can effectively improve certain indicators of patients with chronic pain, such as anxiety, depression, and pain acceptance [23, 25, 26].”
From Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life (2024) · cites this paper as [26]
The Discussion reports that technology-supported ACT improved functioning and ACT-process outcomes across chronic health conditions, including chronic pain; the Results list pain acceptance among the processes measured. Nearly all interventions involved a therapist. The review does not establish improvements in anxiety and depression specifically for chronic-pain patients, and its findings concern technology-supported ACT rather than clinician-delivered ACT generally. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFace-to-face psychological treatment has been limited by high costs, long waiting times and therapist availability, and internet-delivered ACT has potential to increase accessibility.
“face-to-face psychological treatment has been limited by high costs, long-waiting times and therapist availability, and internet-delivered ACT has the potential to increase the accessibility of treatment.23”
From SoundMind Trial: a study protocol for a randomised controlled trial for online acceptance and commitment therapy and sound therapy for tinnitus (2024) · cites this paper as [23]
The Introduction says that in-person ACT can be difficult for people with chronic health conditions who lack the time, money, or ability to attend weekly appointments, and that technology-supported ACT, including internet delivery, could increase access. It does not identify long waiting times or therapist availability as barriers; its access claim is also specific to people with chronic health conditions. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHerbert's study focused solely on technology-supported ACT.
“Our meta-analysis, incorporating a variety of ACT interventions, stands in contrast to Herbert’s study, which focused solely on technology-supported ACT [26].”
From Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life (2024) · cites this paper as [26]
ACT interventions have been found to benefit individuals with a range of chronic health conditions.
“ACT interventions have been found to benefit individuals with a range of chronic health conditions.”
From Real-world evaluation of an acceptance and commitment therapy–based group programme for breast cancer survivors with fear of cancer recurrence (2023) · cites this paper as [14]
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Klimczak, K. S., San Miguel, G. G., Mukasa, M. N., Twohig, M. P., & Levin, M. E. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2178498 · Cited by 88 · see citing works
“Previous studies, including meta-analyses and systematic reviews, have demonstrated the efficacy of ACT-based online interventions for depression and anxiety (Brown et al., 2016; Herbert et al., 2022; Kelson et al., 2019; O’Connor et al., 2018; Sierra et al., 2018; Thompson et al., 2021).”
ResultKonstantinou, P., Ioannou, M., Melanthiou, D., Georgiou, K., Almas, I., Gloster, A. T., Kassianos, A. P., & Karekla, M. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.08.004 · Cited by 53 · see citing works
Tao, T. J., Lim, T. K., Yeung, E. T. F., Liu, H., Shris, P. B., Lawrence, K., Lee, T. M. C., & Hou, W. K. (2023) · npj Digital Medicine · doi:10.1038/s41746-023-00809-8 · Cited by 49 · see citing works
Ye, L., Li, Y., Deng, Q., Zhao, X., Zhong, L., & Yang, L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0301226 · Cited by 43 · 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
Catella, S., Gendreau, R. M., Kraus, A. C., Vega, N., Rosenbluth, M. J., Soefje, S., Malhotra, S., Luciano, J. V., McCracken, L. M., Williams, D. A., et al. (2024) · Journal of Behavioral Medicine · doi:10.1007/s10865-023-00429-3 · Cited by 23 · see citing works
Zhou, S., Ni, Z., Ogihara, A., & Wang, X. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19138221 · Cited by 23 · see citing works
Zhang, X., Ma, H., Lam, C. Y., Ho, G. W., & Mak, Y. W. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.05.007 · Cited by 17 · see citing works
Peterson, A. L., Moore, B. A., Evans, W. R., Young-McCaughan, S., Blankenship, A. E., Straud, C. L., McLean, C. S., Miller, T. L., Meyer, E. C., & for the STRONG STAR Consortium (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1299532 · Cited by 19 · see citing works
Lappalainen, P., Keinonen, K., Lappalainen, R., Selinheimo, S., Vuokko, A., Sainio, M., Liesto, S., Tolvanen, A., & Paunio, T. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111830 · Cited by 17 · see citing works
Multidisciplinary Management Strategies for Long COVID: A Narrative Review
Prusinski, C. C., Yan, D., Klasová, J., McVeigh, K. H., Shah, S. Z., Fermo, O. P., Kubrova, E., Farr, E. M., Williams, L., Gerardo-Manrique, G., et al. (2024) · Cureus · doi:10.7759/cureus.59478 · Cited by 15 · see citing works
Assessing Psychological Flexibility in Chronic Illness
Tyndall, I., Vagos, P., Cano, S., Pinto, H., & Trindade, I. A. (2023) · The Psychological Record · doi:10.1007/s40732-023-00572-y · Cited by 12 · see citing works
Powell, L. D., Vasiliou, V. S., & Thompson, A. R. (2023) · Body Image · doi:10.1016/j.bodyim.2023.101637 · Cited by 11 · see citing works
“Evidence demonstrates that overall psychological flexibility processes promote more advantageous outcomes in functioning and quality of life than focusing on reducing symptomatology that might not be easily changed (Herbert et al., 2022; McCracken, Yu, Vowles, 2022).”
BackgroundSinclair, F., Gillanders, D., Rooney, N., Bonathan, C., Hendry, K., McLoone, P., & Hewitt, C. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-08179-3 · Cited by 9 · see citing works
“The overall aim of ACT is to increase psychological flexibility [14].”
BackgroundSchriger, S. H., Nurse, C. N., & O’Hayer, C. V. (2025) · Journal of Huntington s Disease · doi:10.1177/18796397251315162 · Cited by 9 · see citing works
Lin, K., Cavadino, A., Ow, M., Douglas, M., & Serlachius, A. S. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1587765 · Cited by 7 · see citing works
Engström, A. H., Bohm‐Starke, N., Buhrman, M., Högberg, U., Skalkidou, A., & Lagenskiöld, S. (2023) · Scientific Reports · doi:10.1038/s41598-023-33406-6 · Cited by 6 · see citing works
Gentili, C., Zetterqvist, V., Rickardsson, J., Holmström, L., Ljótsson, B., & Wicksell, R. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2191826 · Cited by 5 · see citing works
Levin, M. E., Aller, T. B., Klimczak, K. S., Donahue, M. L., & Knudsen, F. M. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104729 · Cited by 5 · see citing works
Liem, W. W., Lattie, E. G., Taple, B. J., Stamatis, C. A., Gordon, J. D., Kornfield, R., & Berry, A. B. L. (2024) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3687000 · Cited by 5 · see citing works
Huang, X., Tang, D., Sun, S., & Li, H. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-080863 · Cited by 3 · see citing works
“23 Given the limited evidence on the efficacy of combining ACT with sound therapy for patients with tinnitus-related insomnia, the proposed study aims to examine the efficacy of an internet-delivered ACT combined with a sound therapy treatment programme among a sample of people with tinnitus and…”
Buhrman, M., Tillfors, M., Holländare, F., Lekström, E., Håkansson, A., & Boersma, K. (2023) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000001157 · Cited by 5 · see citing works
Donahue, M. L., & Levin, M. E. (2024) · International Journal of Mental Health · doi:10.1080/00207411.2024.2321432 · Cited by 4 · see citing works
Gallego, A., Serrat, M., Royuela-Colomer, E., Sanabria‐Mazo, J. P., Borràs, X., Esteve, M., Grasa, M., Rosa, A., Rozadilla‐Sacanell, A., Almirall, M., et al. (2024) · Digital Health · doi:10.1177/20552076241239177 · Cited by 8 · see citing works
Afari, N., Yarish, N. M., Wooldridge, J. S., Materna, K., Hernandez, J., Blanco, B. H., Camodeca, A. L., Peters, J., & Herbert, M. S. (2022) · Journal of Medical Internet Research · doi:10.2196/37797 · Cited by 4 · see citing works
Self-citationDietary Co-supplements attenuate the chronic unpredictable mild stress-induced depression in mice
Sirasangi, M. I., Roohi, T. F., Krishna, K. L., Kinattingal, N., Wani, S. U. D., & Mehdi, S. (2023) · Behavioural Brain Research · doi:10.1016/j.bbr.2023.114788 · Cited by 3 · see citing works
Knudsen, F. M., Donahue, M. L., Klimczak, K. S., Aller, T. B., & Levin, M. E. (2025) · Journal of Behavioral Medicine · doi:10.1007/s10865-025-00585-8 · Cited by 3 · see citing works
Esiason, D. C., Smith, P. J., Peppers, C. L., Wakschal, E. S., Andrews, L. A., Nurse, C. N., Kushner, H. M., Drescher, C. F., Bruschwein, H. M., Erler, W., et al. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106630 · Cited by 3 · see citing works
Scheerder, G., Landeghem, E. V., Smekens, T., Aerts, M., Courjaret, K., Hemelaer, E., Lamonte, C., Mertens, W., Platteau, T., Berghe, W. V., et al. (2025) · AIDS Care · doi:10.1080/09540121.2025.2577315 · Cited by 3 · see citing works
Funk, M., Reinke, M., Löwe, B., & Engelmann, P. (2025) · PLoS ONE · doi:10.1371/journal.pone.0317905 · Cited by 3 · see citing works
Kroemeke, A., Dudek, J. E., Kijowska, M., Owen, R., & Sobczyk‐Kruszelnicka, M. (2024) · Trials · doi:10.1186/s13063-024-08235-1 · Cited by 2 · see citing works
Martin, S., Kihlbom, U., Pasquini, G., Gerli, F., Niccolai, C., Bella, S. D., Portaccio, E., Betti, M., Amato, M. P., Achiron, A., et al. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.106143 · Cited by 2 · see citing works
García-Torres, F., García-Carmona, M., Moreno, E., Jurado-González, F., & Aguilera-Martín, Á. (2024) · SAGE Open · doi:10.1177/21582440241297591 · Cited by 1 · see citing works
“…via eHealth, previous studies suggest the efficacy of this technique in reducing pain, anxiety and depression, and in improving quality of life as well as psychological flexibility in participants with a variety of conditions, including cancer patients (Herbert et al., 2022; Thompson et al., 2021).”
Petäjä, M., Lappalainen, R. I., Kettunen, T., Lappalainen, P., Kaipainen, K., Muotka, J. S., & Kasila, K. (2024) · Health Psychology Open · doi:10.1177/20551029241302977 · Cited by 1 · see citing works
Roth, A. J., & Foldvary‐Schaefer, N. (2025) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11634 · Cited by 1 · see citing works
Nicoletti, A. E., Tonelli, M., Purin, B., & Rizzi, S. (2026) · Behavioral Sciences · doi:10.3390/bs16040585 · Cited by 1 · see citing works
Ryan, A., Ferreira, N. B., Moffat, H., Eugenicos, M. P., Howson, W., Casburn-Jones, A., Moroni, F., Stevens, P., Wolters, M. K., & Gillanders, D. T. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100887 · Cited by 1 · see citing works
Afari, N., Golaszewski, N. M., Wooldridge, J. S., Materna, K., Hernandez, J., Blanco, B. H., Camodeca, A. L., Peters, J., & Herbert, M. S. (2022) · doi:10.2196/preprints.37797
Self-citationAdaptation and psychometric network analysis of the Psy-Flex in Peruvian population
Huerta, S. L., Barbaran-Alvarado, R., Travezaño-Cabrera, A., & Vilca, L. W. (2025) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2025.100555
A co-designed video intervention for self-management of type 1 diabetes in young adults
Gibb, C., & Ogden, J. (2025) · Health Psychology Update · doi:10.53841/bpshpu.2025.34.2.3
Gkofa, V., Godfrey, E. L., & Scott, W. (2026) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2026.100994
Mukasa, M. N., Donahue, M. L., Levin, M. E., Rodríguez, M. M. D., Kasujja, R., Damulira, C., & Vance, J. (2026) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2026.101017
Selinheimo, S., Vuokko, A., Lappalainen, P., Keinonen, K., Tolvanen, A. J., Lappalainen, R. I., Sainio, M., & Paunio, T. (2026) · International Journal of Behavioral Medicine · doi:10.1007/s12529-026-10477-z
El-Gabalawy, R. M., Sabourin, B. C., Tkachuk, G. A., Logan, G. S., Penner, K. E., Shay, B. L., Bilevicius, E., Graff, L. A., Skrabek, R. Q., Senn, J., et al. (2026) · Canadian Journal of Pain · doi:10.1080/24740527.2026.2696248
- Authors
- Herbert, M. S., Dochat, C., Wooldridge, J. S., Materna, K., Blanco, B. H., Tynan, M., Lee, M. W., Gasperi, M., Camodeca, A., Harris, D., & Afari, N.
- Affiliations
- University of California San Diego (US)
- San Diego State University (US)
- VA San Diego Healthcare System (US)
- Corresponding author
- Herbert, Matthew S.
- ORCID
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2022-01
- Volume
- 148
- Pages
- 103995
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC8712459
- OpenAlex
- W3213115339
- Cited by
- 44
- References
- 86
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 13 · 2023: 12 · 2022: 3
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Behaviour Research and Therapy (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- NIH (R01DK106415)
- Department of Veterans Affairs (1IK2CX002107, 1IK2RX002807)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- acceptance and commitment therapy, chronic disease, online therapy, telephone-delivered therapy, functional outcome, chronic pain, obesity, cancer, hearing loss, HIV, multiple sclerosis, tinnitus, quality of life
- MeSH terms
- Humans, Quality of Life, Technology, Telephone, Randomized Controlled Trials as Topic, Chronic Pain, Acceptance and Commitment Therapy
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