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Cited by 130Mindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

Acceptance and commitment therapy - Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials.

Open access
Hacker, Thomas, Stone, Paul, MacBeth, Angus·2016·Journal of Affective Disorders
DOI 10.1016/j.jad.2015.10.053
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Abstract

Acceptance and Commitment Therapy (ACT) has accrued a substantial evidence base. Recent systematic and meta-analytic reviews suggest that ACT is effective compared to control conditions. However, these reviews appraise the efficacy of ACT across a broad range of presenting problems, rather than addressing specific common mental health difficulties. Focussing on depression and anxiety we performed a meta-analysis of trials of ACT. We incorporated sequential meta-analysis (SMA) techniques to critically appraise the sufficiency of the existing evidence base. Findings suggest that ACT demonstrates at least moderate group and pre-post effects for symptom reductions for both anxiety and depression. However using SMA findings are more qualified. There is currently insufficient evidence to confidently conclude that ACT for anxiety is efficacious when compared to active control conditions or as primary treatment for anxiety. Similarly, using SMA, there is currently insufficient evidence to suggest a moderate efficacy of ACT for depression compared to active control conditions. To stimulate further research we offer specific estimates of additional numbers of participants required to reach sufficiency to help inform future studies. We also discuss the appropriate strategies for future research into ACT for anxiety given the current evidence suggests no differential efficacy of ACT in the treatment of anxiety compared to active control conditions.

Integrity signals

Registry

Crossref · 10.1016/j.jad.2015.10.053

Cites

85 of 85 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

2 of 18 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Meta-analyses of randomized controlled trials of ACT have suggested moderate to large effects on primary outcomes after treatment and at follow-up.

    “Meta-analyses of randomized controlled trials of ACT have suggested a moderate to large effect size on primary outcomes measures after treatment and at follow-up (Hayes, Luoma, Bond, Masuda, Lillis, 2006;Ost, 2008;Powers, Zum Vorde Sive Vording, & Emmelkamp, 2009, Ruiz, 2010, 2012).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Hayes, Luoma, Bond, Masuda, Lillis, 2006 source

      The ‘Quantitative characterization of the relative strength of ACT outcomes’ section (p. 15) reports average between-condition effects of Cohen’s d = 0.66 both after treatment and at follow-up for clinically relevant outcomes. That supports the claimed magnitude and timing, but the summary covers applied ACT outcome studies generally, not exclusively randomized controlled trials. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Ost, 2008 source
    • cites Powers, Zum Vorde Sive Vording, & Emmelkamp, 2009 source
  • Interpretationreasoning

    The current analyses cannot comment on the efficacy of ACT for other complex mental health conditions such as psychosis or physical health conditions such as chronic pain.

    “Consequently, the current analyses cannot comment on the efficacy of ACT for other complex mental health conditions e.g.psychosis (White et al., 2013) or physical health conditions such as chronic pain (McCracken, Sato, & Taylor, 2013).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites White et al., 2013 source
    • cites McCracken, Sato, & Taylor, 2013 source
  • Findingown data

    Cumulative pooled effect sizes for depression ranged from d = .54 to d = .92.

    “In turn, the cumulative pooled effect sizes for depression in trials comparing ACT in pre-post and group comparisons ranged from d= .54 to d=.92.”
    Quote in the paperSubstantial claim
  • Findingown data

    All four cumulative meta-analyses for anxiety and depression were statistically significant.

    “All four cumulative meta-analyses for anxiety and depression were statistically significant.”
    Quote in the paperSubstantial claim
  • Findingown data

    Group comparisons for ACT for depression as the primary target showed large significant effects (d = .73, p < .001).

    “Group comparisons for ACT for depression as a primary treatment target suggested also large significant effects (d= .73,p<.001).”
    Quote in the paperSubstantial claim
  • May combine two claims. 28
  • Classified as probably not a substantial claim. 19
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Eighteen per cent of anxiety trials (k = 5) and 31% of depression trials (k = 12) specified the primary target outcome in advance.

    “Eighteen per cent of anxiety trials (k=5) and 31% of depression trials (k=12) predetermined the primary target outcome.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For ACT for depression, there is sufficient evidence of at least a medium effect when depression was a-priori specified as the target outcome, in both pre-post and group comparisons.

    “In relation to ACT for depression findings suggest that there is sufficient evidence of a least a medium effect in studies where depression was a-priori specified as a target outcome.This is the case for both pre-post and group comparisons (Fig. 4a & 4b),.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For ACT for depression in group comparisons with active controls, there is currently insufficient evidence for a medium effect even though the optimal information size was reached.

    “Conversely, our findings suggest that ACT for depression in group comparisons with active control conditions there is currently insufficient evidence to indicate a medium effect as sufficiency (HOIS) has been reached (HOIS) (Fig. 4c).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For anxiety, cumulative evidence showed a strong significant pre-post effect (d = 1.85, p < .001), but other cumulative meta-analyses for ACT for anxiety were not significant.

    “For anxiety, although cumulative evidence suggest a strong significant effect in pre-post comparisons (d=1.85,p<.001) other cumulative meta-analyses for ACT for anxiety were not significant.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most trials compared ACT with a waiting-list control: 17 anxiety trials and 22 depression trials.

    “For both anxiety and depression outcomes the majority of trials compared ACT against a waiting list control (WL; k=17 and k=22 studies for anxiety and depression respectively).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The search identified 28 eligible randomized controlled trials of ACT for anxiety and 39 for depression.

    “The systematic literature search identified k=28 and k=39 eligible randomized controlled trials studies of ACT for anxiety and depression respectively.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The heterogeneity-adjusted optimal information size was 220 for pre-post comparisons and 848 for group comparisons.

    “The calculated heterogeneity adjusted optimal information size was n=220 and n=848 for pre-post and group comparisons respectively.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Where ACT for depression was the primary outcome, cumulative evidence showed large significant effects in both group (d = .73, p < .01) and pre-post (d = 1.22, p < .001) comparisons.

    “Conversely, where ACT for depression was the primary outcome the cumulative evidence suggest large significant effects in both group-(dgroup, primary =.73, p<.01) and pre-post comparisons (dpre-post, primary=1.22,p<.001).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The most frequent bona fide control in depression trials was CBT (k = 9).

    “Similarly, the most frequent bona fide control treatment condition in depression treatment trials was CBT (k=9).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sequential meta-analyses suggested sufficiency of evidence for at least a moderate effect for these conditions, except ACT for anxiety in group comparisons.

    “Equally findings from SMAs suggested sufficiency of evidence of an at least moderate effect for these conditions with the exception of ACT for anxiety in group comparisons.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The total participant sample was 1628 in anxiety trials and 1987 in depression trials.

    “The total participant sample in this quantitative review was n=1628 and n=1987 participants in anxiety and depression trials.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Fewer than one third of anxiety trials (k = 10) used an active control, compared with 38% of depression trials (k = 15).

    “Less than a third of anxiety trials (k=10) employed an active control condition compared to 38% of depression trials (k=15).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The most frequently used anxiety outcome measure was the DASS-A (k = 9).

    “The most frequently used anxiety outcome measure was the Depression Anxiety and Stress Scale (DASS-A, k=9).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For ACT for depression in pre-post comparisons, the intermittent Z crossed the threshold at some point, but at the endpoint the sequential boundary was not crossed (Z alpha=.01 = 2.46, Zt>=1 = 2.17).

    “It is of note that for ACT for depression in pre-post comparisons, the intermittent Z-value crossed the threshold boundary at some point in the analysis (Fig. 2c).However, at the end point when the accumulated alpha has been reached (i.e.t≥1), the sequential boundary was not crossed (Z α=.01 =2.46, Zt≥=1=2.17).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The most frequently used depression outcome measure was the Beck Depression Inventory (k = 18).

    “In turn, the most frequently used depression outcome measure was the Beck Depression Inventory (BDI, k=18).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    In the primary cumulative meta-analysis, ACT showed a moderate group-comparison effect on depression (d=0.54, 95% CI 0.34-0.73).

    “| Depression/G | 3 | 848 19 | > | .54** | 0.3 | 80.6 Y | Y | 0 | | |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Although the endpoint sequential boundary was not crossed, the statistical criterion for ACT as an efficacious intervention was met.

    “Although at the end point of the analysis the sequential boundary has not been crossed, nonetheless statistical criterion for ACT as an efficacious intervention has been met.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic literature search followed PRISMA guidelines.

    “A systematic literature search was conducted to identify potential studies, following PRISMA guidelines (Moher, Schulz, & Altman, 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher, Schulz, & Altman, 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Symptom reduction is not the primary objective of ACT; ACT aims to improve psychological flexibility.

    “Lastly, it is important to note that symptom reduction is not the primary intervention objective of ACT interventions; instead ACT aims to improve psychological flexibility (Harris & Hayes, 2009;Hayes et al., 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Harris & Hayes, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Hayes et al., 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ruiz (2012) concluded that ACT outperformed CBT with a Hedges g of 0.4.

    “A recent meta-analysis of ACT by Ruiz (2012) concluded that ACT outperformed CBT (Hedges g = 0.4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ruiz, 2012

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    When multiple relevant outcomes were reported, the most conservative effect size per study was used.

    “When several relevant outcome measures were reported, the outcomes yielding the most conservative effect size estimate per study were included in the analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Inter-rater reliability for quality assessment was Kappa = 0.85, indicating excellent agreement.

    “Overall the inter reviewer concordance was Kappa = 0.85, suggesting an excellent agreement (Banerjee, Capozzoli, McSweeney, & Sinha, 1999).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Banerjee, Capozzoli, McSweeney, & Sinha, 1999 source

  • May combine two claims.

    Interpretationown data

    Findings are more qualified when considering ACT against active control conditions and when anxiety or depression were primary treatment targets.

    “However, findings are more qualified when considering the evidence for ACT compared to active control conditions i.e. existing evidence-based therapies, and when anxiety or depression were the primary treatment targets.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data were extracted by the first author and independently reviewed by the second author.

    “The data was extracted into an electronic data extraction sheet by the first author and independently reviewed by the second author.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    For ACT for anxiety in group comparisons, although the optimal information size was reached, the threshold boundary was not crossed, so ACT cannot be assumed to be moderately effective.

    “In this comparison, although statistical sufficiency (HOIS) was reached, the threshold boundary was not crossed thus based on these data it cannot be assumed that ACT is moderately effective in treatment of anxiety in group comparisons.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The sequential meta-analyses for anxiety were underpowered, so their findings may have been erroneous.

    “Firstly, these SMAs for anxiety were underpowered; thus findings may have been erroneous.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent reviewers screened studies and disagreements were resolved through discussion.

    “Two independent reviewers conducted screening (first and second authors).Studies were assessed by considering the eligibility by the second author and revised by the first author.Disagreement was resolved through discussion.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Separate meta-analyses were run for anxiety and depression to satisfy the assumption of independent effect sizes.

    “Independent meta-analyses were conducted for anxiety and depression in order to conform to the assumption of independent effect sizes that underline meta-analytic procedures (Borenstein, 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Borenstein, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • The authors state this as an assumption: The assumption of independent effect sizes underlies meta-analytic procedures.

  • May combine two claims.

    Interpretationown data

    Overall, ACT is effective for common mental health difficulties but not more so than traditional treatment approaches.

    “Overall, the findings suggest that ACT is effective in the treatment of common mental health difficulties; however not more so than traditional treatment approaches.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Inclusion and exclusion criteria and search terms were specified before the review.

    “Inclusion, exclusion criteria and search terms were specified a-priori.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    All reported anxiety and depression outcomes were included to reduce data selection bias.

    “To minimise the risk of data selection biases we included data pertaining to all reported anxiety and depression outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The findings are consistent with previous quantitative reviews and add support for their veracity.

    “However, our findings are in keeping with previous quantitative reviews and as such offer additional support for the veracity of our findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Study quality was assessed with the 34-item CONSORT 2010 checklist.

    “Quality assessments of the studies were evaluated using the 34-item Consort 2010 checklist (Moher et al., 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher et al., 2010

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductown data

    Results indicate no significant file-drawer effect, so publication errors are unlikely to have substantially biased the results.

    “Results of the analyses indicate no significant file drawer effect, thus publication errors are not likely to have significantly biased our results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The observed heterogeneity may reflect the scope of ACT application and may suggest external validity.

    “In addition, the observed heterogeneity may be considered an accurate reflection of the scope of the application of ACT and as such might be suggestive of the external validity of our findings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Publication bias was assessed with funnel plots and Fail-safe N.

    “As we did not include unpublished work in our meta-analyses we tested for publication bias in the following ways.Firstly, funnel plots were examined.demonstrating no systematic publication biases (tables available from first author on request).Secondly..Fail-safe N (Rosenthal, 1979) values ranged from k=2048 to k=6708 studies for the primary study aims, suggesting absence of publication bias.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Rosenthal, 1979 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Efforts were made to retrieve grey literature to reduce publication bias.

    “Efforts were made to retrieve grey literature in relation to ACT RCTs to minimise the impact of publication biases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    For ACT versus control conditions, statistical sufficiency is reached and no further randomized clinical trials are required.

    “Thus one can conclude that with respect to the efficacy of ACT versus control conditions statistical sufficiency is reached and no further randomized clinical trials are required.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Fail-safe N values for the primary aims ranged from k = 2048 to k = 6708, suggesting no publication bias.

    “Fail-safe N (Rosenthal, 1979) values ranged from k=2048 to k=6708 studies for the primary study aims, suggesting absence of publication bias.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rosenthal, 1979 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Knapp and Hartung adjustments were calculated to produce standard errors closer to nominal values.

    “Additionally, considering the small study samples Knapp and Hartung's adjustments (Knapp & Hartung, 2003) were calculated, yielding closer to nominal standard errors of the estimated parameters.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Knapp & Hartung, 2003

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Stringent alpha, power, and effect-size criteria (alpha = .01, 1-beta = .9) were chosen.

    “To render authorities conclusions regarding the evidence base for ACT we chose more stringent criteria for alpha, power and proposed effect sizes (α=.01, 1-β=.9) as recommended by Kuppens and Onghena (2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kuppens and Onghena, 2012 source
41 of 41

  • The paper relies on this without support.

    Existing systematic and meta-analytic reviews assess ACT across broad presenting problems rather than focusing on specific common mental health difficulties.

    “However, these reviews appraise the efficacy of ACT across a broad range of presenting problems, rather than addressing specific common mental health difficulties.”

  • The authors state this as an assumption.

    The assumption of independent effect sizes underlies meta-analytic procedures.

    “Independent meta-analyses were conducted for anxiety and depression in order to conform to the assumption of independent effect sizes that underline meta-analytic procedures (Borenstein, 2009).”

  • The paper relies on this without support.

    Using cumulative and sequential meta-analysis can increase confidence in the conclusions of quantitative reviews.

    “Use of Cumulative and Sequential Meta Analysis can increase confidence in the conclusions of quantitative reviews.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Power analysis indicated a total sample size of 154 to reach an effect of f=0.25 and 80% power, two-tailed alpha of 0.05, two groups and three measurement points.

    “To reach an effect of f =0.25 and 80% Power, a two-tailed alpha of 0.05, two groups and three points of measurement where entered and resulted in a total sample size of 154.”

    From A clinical effectiveness trial comparing ACT and CBT for inpatients with depressive and mixed mental disorders (2021) · cites this paper as Hacker et al., 2016

    The paper’s “Computing optimal information size (OIS)” section specifies α=.01, 90% power, and an effect size of d=.5—not the claimed inputs. Section 3.2.1 reports calculated sample sizes of 220 for pre-post comparisons and 848 for group comparisons, not 154. No page numbers are available in our copy. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • A substantial evidence base exists linking ACT with reductions in anxiety, depression, and stress, and evidence is emerging for mindfulness based-approaches and ACT in self-help formats.

    “Although ACT focuses on promoting values-based living, rather than attempting to directly control or reduce symptoms, a substantial evidence base exists linking ACT with reductions in anxiety, depression, and stress, 27 and evidence is emerging for mindfulness based-approaches and ACT 28 in self-help formats.”

    From Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: A cluster randomised trial (2020) · cites this paper as [27]

    The Discussion reports cumulative evidence linking ACT to reduced anxiety and depression symptoms, but the paper does not report a separate finding for stress. The self-help claim is attached to citation 28 in the citing sentence, so it is not attributed to this source. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • ACT improves anxiety disorders.

    “There is strong empirical evidence to show that ACT improves several conditions, with robust evidence for the treatment of pain, depression, anxiety disorders, and psychosis [31,32,33].”

    From A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (2022) · cites this paper as [31]

    The cumulative meta-analyses (section 3.2.2) report reduced anxiety scores after ACT and a small significant benefit over controls. But the Discussion (section 4) says the evidence is insufficient to confidently establish efficacy against active treatments or when anxiety is the primary treatment target. The cited paper therefore supports improvement in anxiety symptoms, but not the unqualified claim of robust evidence for treating anxiety disorders. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • ACT improves psychosis.

    “There is strong empirical evidence to show that ACT improves several conditions, with robust evidence for the treatment of pain, depression, anxiety disorders, and psychosis [31,32,33].”

    From A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (2022) · cites this paper as [31]

    The Introduction says controlled trials have suggested ACT may be effective for psychotic disorders. But the Discussion states that this paper’s analyses address anxiety and depression and cannot comment on ACT’s efficacy for psychosis. It therefore does not support the citing sentence’s claim of robust evidence for psychosis. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • That anxiety meta-analysis's effect was negligible and non-significant (g=0.04, p>.05).

    “however the effect was negligible and non-significant ( g = 0.04, p &gt; .05).”

    From The empirical status of acceptance and commitment therapy: A review of meta-analyses (2020) · cites this paper as Hacker, Stone, & Macbeth, 2016

    Section 3.2.2 (page not provided) reports a negligible, non-significant anxiety effect for ACT versus active controls, but gives it as d = −0.04, not g = 0.04. The claim also omits the active-control qualifier: the paper’s overall anxiety group comparison was significant (d = 0.45, p < .05). (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Clarke study's sex counts exceed its sample size

    Minor

    Table 1 lists 20 male and 41 female participants, totaling 61, although both the initial and analysed sample sizes are 45.

    Reported 45 · recomputed 61

  • Depression trial count changes from 39 to 439

    Minor

    The results report 39 eligible depression trials, but the discussion says 439.

  • Depression active-control information size is both reached and unmet

    Minor

    The results say this comparison has reached its heterogeneity-adjusted optimal information size, then state that 93 more participants are needed to reach it.

3 of 3

Cites

Flagged first, then by citations

5 of the 90 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Alonso, 2013, Acceptance and commitment therapy and selective optimization with compensation for older people with chronic pain: a pilot study, Behav. Psychol., 21, 59
  2. Gilbert, P., (Ed.), 2004. Compassion: Conceptualisations, Research and use in Psychotherapy, Routledge.
  3. McCracken, 2013, A trial of a brief group-based form of acceptance and commitment therapy (ACT) for chronic pain in general practice: pilot outcome and process results, J. Pain, 14, 1398, 10.1016/j.jpain.2013.06.011 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Hacker, T., Stone, P., & MacBeth, A.
Affiliations
  • NHS Fife (GB)
  • University of Edinburgh (GB)
ORCID
MacBeth, Angus
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2016-01
Volume
190
Pages
551-565
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2015.10.053
OpenAlex
W1853962844
Cited by
130
References
90
Citations by year
2026: 4 · 2025: 6 · 2024: 12 · 2023: 13 · 2022: 13 · 2021: 15 · 2020: 18 · 2019: 14 · 2018: 20 · 2017: 8 · 2016: 7
FWCI
1.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
acceptance and commitment therapy, depression, anxiety, treatment efficacy, active control, sufficiency of evidence, sample size determination, psychological intervention
MeSH terms
Anxiety, Depression, Humans, Randomized Controlled Trials as Topic, Sample Size, Acceptance and Commitment Therapy

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