Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury
Open accessAbstract
Behaviour therapies have a well-established, useful tradition in psychological treatments and have undergone several major revisions. Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches are considered a third wave of behavioural therapies. Emerging evidence for ACT has demonstrated that this paradigm has promising effectiveness in improving functionality and well-being in a variety of populations that have psychological disturbances and/or medical problems. In this review we first evaluate traditional cognitive behavioural therapy (CBT) interventions used to manage psychological problems in distressed individuals who have sustained an acquired brain injury (ABI). We provide an overview of the ACT paradigm and the existent evidence base for this intervention. A rationale is outlined for why ACT-based interventions may have potential utility in assisting distressed individuals who have sustained a mild to moderate ABI to move forward with their lives. We also review emerging evidence that lends preliminary support to the implementation of acceptance and mindfulness-based interventions in the rehabilitation of ABI patient groups. On the basis of existent literature, we recommend that it is an opportune time for forthcoming research to rigorously test the efficacy of ACT-based interventions in facilitating ABI patient groups to re-engage in living a valued and meaningful life, in spite of their neurocognitive and physical limitations. The promising utility of testing the efficacy of the ACT paradigm in the context of multimodal rehabilitation programmes for ABI populations is also addressed.
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The moderate effect sizes for the DASS-21 total score, PCL, M2CQ, and AAQ are similar to those reported in a meta-analysis of ACT for psychological outcomes in acquired brain injury.
“the moderate effect sizes found for the DASS-21 total score, PCL, M2CQ, and AAQ are similar to those reported in a meta-analysis looking at the effectiveness of ACT compared to other treatments/wait-list on psychological outcomes in those with acquired brain injury [39].”
From Development and evaluation of an 1-day Acceptance and Commitment Therapy workshop for Veterans with comorbid chronic pain, TBI, and psychological distress: Outcomes from a pilot study (2020) · cites this paper as [39]
The ‘Evidence base for ACT interventions’ section reports moderate effect sizes from a meta-analysis across clinical and medical conditions, not specifically acquired brain injury (ABI). The paper explicitly states that no study had yet tested ACT’s efficacy in ABI populations, contradicting the claim that it reports a meta-analysis of ACT outcomes in people with ABI. Page numbers are not available in the supplied copy. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredACT has been shown to better fit the needs of people with disabling long-term conditions.
“ACT has been shown to better fit the needs of people with disabling long-term conditions 46”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [46]
The ACT evidence-base section reports effectiveness in several chronic medical conditions, and the Core processes section explains why ACT may suit people facing lasting deficits. But the Future directions section says whether ACT is more accessible than traditional CBT for people with cognitive deficits remains an empirical question. The paper therefore supports potential suitability, not that ACT has been shown to better fit the needs of people with disabling long-term conditions; page numbers were unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredACT may be particularly suitable for people with life-limiting illnesses and disabling long-term conditions such as MND, muscle disorders, brain injury and chronic pain.
“Acceptance and Commitment Therapy (ACT) may be particularly suitable for people with life-limiting illnesses and disabling long-term conditions such as MND, muscle disorders, brain injury and chronic pain [5, 23–25].”
From Acceptance and Commitment Therapy for people living with motor neuron disease: an uncontrolled feasibility study (2023) · cites this paper as [24]
The Evidence base for ACT interventions section reports benefits for chronic pain and discusses ACT’s potential for people with acquired brain injury. The Future directions section narrows its recommendation to distressed people recovering from mild to moderate brain injury; the cited passages do not address MND or muscle disorders. No page numbers are provided in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBased on a literature review, several alterations of psychotherapy were identified: memory aids, simplified tasks, emphasis on behavioural techniques, repetition of content, structured sessions, incorporating breaks, use of concrete examples, involving relatives in therapy or homework tasks, one-on-one face-to-face sessions, adjusting the number of sessions and the duration of the sessions, and包括
“Based on a literature review, several alterations of psychotherapy were identified: memory aids (visual resources, workbook, session summaries, written notes), simplified tasks, emphasis on behavioural techniques, repetition of content, structured sessions, incorporating breaks, use of concrete examples, involving relatives in therapy or homework tasks, one-on-one face-to-face sessions, adjusting”
From Acceptance and commitment therapy for people with acquired brain injury: Rationale and description of the BrainACT treatment. (2023) · cites this paper as [9]
The CBT section (page unavailable) describes written materials, prompts, repetition, structured information, visual aids, simplified cognitive strategies, and shorter sessions for people with acquired brain injury. Future Directions (page unavailable) recommends one-to-one face-to-face ACT, session handouts, and a suggested number and duration of sessions. The retrieved passages do not support the listed recommendations to incorporate breaks or involve relatives in therapy or homework; they also do not specifically recommend a workbook. (LLM, conf=0.86)
Experimental — accuracy not yet measuredModifications specific to acceptance and commitment therapy can include: summaries of the core components covered in each session, focussing on experiential exercises which are audiotaped, using concrete and personally relevant metaphors and exercises, using shorter mindfulness exercises, providing tangible ideas, and focussing on promoting values-based goal-directed behaviour and behavioural激活
“Modifications specific to acceptance and commitment therapy can include: summaries of the core components covered in each session, focussing on experiential exercises which are audiotaped, using concrete and personally relevant metaphors and exercises, using shorter mindfulness exercises, providing tangible ideas (for instance the card sorting task as an aid for value exploration), and focussing”
From Acceptance and commitment therapy for people with acquired brain injury: Rationale and description of the BrainACT treatment. (2023) · cites this paper as [9]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Unmet psychological needs potentially hamper recovery and add to the health service resource burden produced by long-term conditions, highlighting the pressing need to evaluate a greater range of therapeutic approaches for stroke with a focus on cost-effective delivery formats such as group-based interventions.
“This potentially hampers recovery (Gillen et al., 2001) and adds to the health service resource burden produced by long-term conditions (Department of Health, 2012), thus highlighting the pressing need to evaluate a greater range of therapeutic approaches for stroke (Kangas & McDonald, 2011;Soo, Tate, & Lane-Brown, 2011) with a focus on cost-effective delivery formats, such as group-based”
From Brief group‐based acceptance and commitment therapy for stroke survivors. (2019) · cites this paper as Kangas & McDonald, 2011
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe acceptance and commitment therapy treatment protocol was adapted to the needs and possible cognitive deficits of patients with brain injury, based on suggestions made in previous literature and knowledge gained in clinical practice.
“Fourth, the ACT treatment protocol was adapted to the needs and possible cognitive deficits of patients with brain injury. These adaptations were based on suggestions made in previous literature and knowledge gained in clinical practice.”
From The BrainACT study: acceptance and commitment therapy for depressive and anxiety symptoms following acquired brain injury: study protocol for a randomized controlled trial. (2019) · cites this paper as [24]
In “Future Directions: Clinical and Research Implications” (page unavailable), the paper recommends modifying ACT-based treatment programmes for people with cognitive impairments after acquired brain injury, drawing on the literature. It offers guidance rather than reporting that a treatment protocol was actually adapted, and it does not identify knowledge gained in clinical practice as the basis for adaptations. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPsychosocial therapies inherently involve cognitive domains like learning, memory, and executive function.
“Because psychosocial therapies inherently involve cognitive domains like learning, memory, and executive function”
From Neuropsychological Functioning and Treatment Outcomes in Acceptance and Commitment Therapy for Chronic Pain. (2018) · cites this paper as [23]
The section on CBT for adults with acquired brain injury says that psycho-education and rehearsal enhance learning, and that cognitive restructuring can be demanding for people with working-memory or executive-function impairments. This supports the role of those domains in CBT, but the paper does not establish that psychosocial therapies generally and inherently involve all three. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIt has been argued that ACT is ideal for individuals with NP impairments because of its delivery style.
“Indeed, it has been argued that ACT is ideal for individuals with NP impairments because of this delivery style.23”
From Neuropsychological Functioning and Treatment Outcomes in Acceptance and Commitment Therapy for Chronic Pain. (2018) · cites this paper as [23]
The Core processes of ACT interventions section argues that ACT may be advantageous for people with cognitive impairments because it avoids the cognitive restructuring required by traditional CBT. But the Future directions section says whether ACT is more accessible for people with such deficits remains an empirical question, and the authors do not assume it suits people with severe impairment. Calling it “ideal” for individuals with NP impairments overstates their qualified argument. (LLM, conf=0.88)
Experimental — accuracy not yet measuredACT has been shown to better fit the needs of people with disabling long-term conditions and may be particularly helpful when distress is associated with realistic or valid thoughts.
“Supporting this, ACT has been shown to better fit the needs of people with disabling long-term conditions 46 and may be particularly helpful when distress is associated with realistic or valid thoughts.47”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [46]
ACT includes a strong focus on validating and acknowledging the difficulties associated with mTBI rather than a focus on reframing thoughts.
“This includes a strong focus on validating and acknowledging the difficulties associated with their mTBI rather than a focus on reframing their thoughts.84 85”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [85]
The potential usefulness of acceptance and commitment therapy for people with acquired brain injury has been mentioned before.
“The potential usefulness of acceptance and commitment therapy for this patient group has been mentioned before9,10”
From Acceptance and commitment therapy for people with acquired brain injury: Rationale and description of the BrainACT treatment. (2023) · cites this paper as [9]
Strong points of the BrainACT treatment are its adaptation to possible cognitive deficits based on previous recommendations, incorporation of opinions of an expert group, and feedback from participants and therapists in a pilot study.
“Strong points of the BrainACT treatment are (i) its adaption to the possible cognitive deficits of patients with acquired brain injury based on previous recommendations,9,10,26,27 (ii) the incorporation of the opinions of an expert group, and (iii) feedback from participants and therapists in a pilot study.”
From Acceptance and commitment therapy for people with acquired brain injury: Rationale and description of the BrainACT treatment. (2023) · cites this paper as [9]
Theoretically, the six core components of acceptance and commitment therapy can contribute to the adaptation process following acquired brain injury.
“Theoretically, the six core components of acceptance and commitment therapy can contribute to the adaptation process following acquired brain injury.9,10”
From Acceptance and commitment therapy for people with acquired brain injury: Rationale and description of the BrainACT treatment. (2023) · cites this paper as [9]
ACT might help people to live in a meaningful way with the lasting and impairing consequences of an ABI.
“ACT might help people to live in a meaningful way with the lasting and impairing consequences of an ABI (Kangas & McDonald, 2011; Robinson et al., 2019).”
From Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases. (2023) · cites this paper as Kangas & McDonald, 2011
Acceptance and Commitment Therapy (ACT) is a promising treatment for acquired brain injury-related anxiety and depressive symptoms.
“Acceptance and Commitment Therapy (ACT) is a promising treat ment for ABI-related anxiety and depressive symptoms [8,9].”
It has been argued that ACT may be particularly beneficial for those living in objectively difficult or immutable situations such as chronic or life-limiting conditions.
“It has been argued that it may be particularly beneficial for those living in objectively difficult or immutable situations such as chronic or life-limiting conditions (29,30).”
From Needs and preferences for psychological interventions of people with motor neuron disease (2019) · cites this paper as [30]
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“The principles of ACT have been applied to a diverse range of populations (Pull, 2008).”
BackgroundInfluentialNotes on the Development of my Concepts
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Cognitive Therapy: 100 Key Points and Techniques
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“Although there are commonalities between ACT and traditional CBT interventions (Arch & Craske, 2008; Heimberg & Ritter, 2008) because ACT does not include CR techniques it circumvents the logistical and feasibility problems inherent in applying such techniques in populations that are cognitively…”
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Flagged first, then by citations
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Brief group‐based acceptance and commitment therapy for stroke survivors.
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“…on previous research, strategies were implemented to accommodate for cognitive 8 D. WHITING ET AL. impairments (Gallagher, McLeod, & McMillan, 2019; Kangas & McDonald, 2011; Soo et al., 2011; Whiting et al., 2017) including repeating programme content, presenting information in multiple formats…”
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“ACT might help people to live in a meaningful way with the lasting and impairing consequences of an ABI (Kangas & McDonald, 2011; Robinson et al., 2019).”
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“120 Physical activity such as dance, Tai Chi, and walking appeared to be effective for depression and stress.”
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“Modifications specific to acceptance and commitment therapy can include: summaries of the core components covered in each session, focussing on experiential exercises which are audiotaped, using concrete and personally relevant metaphors and exercises, using shorter mindfulness exercises, providing tangible ideas (for…”
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Kanser Tanısı Olan Kişilerde Kabul ve Kararlılık Terapisi Uygulamaları: Sistematik Bir Derleme
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- Authors
- Kangas, M., & McDonald, S.
- Affiliations
- Macquarie University (AU)
- UNSW Sydney (AU)
- Corresponding author
- Kangas, Maria
- Venue
- Neuropsychological Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2011-04
- Volume
- 21
- Issue
- 2
- Pages
- 250-276
- ISSN
- 0960-2011 (ISSN-L)
- 1464-0694
- PMC
- PMC3877858
- OpenAlex
- W1998126526
- Semantic Scholar
- 038780339a7c79d4ca54ce59e3bde886cdc9cfdf
- Cited by
- 133
- References
- 91
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 10 · 2023: 11 · 2022: 13 · 2021: 8 · 2020: 8 · 2019: 12 · 2018: 11 · 2017: 14 · 2016: 7 · 2015: 5 · 2014: 7 · 2013: 3 · 2012: 5
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neuropsychological Rehabilitation (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- acceptance and commitment therapy, acquired brain injury, cognitive behavioral therapy, mindfulness-based interventions, psychological rehabilitation, valued living, multimodal rehabilitation
- MeSH terms
- Mental Disorders, Brain Injuries, Humans, Research Design, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic
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