Effectiveness of psychotherapy for Hwa-Byung: A systematic review of interventional studies
Open accessAbstract
Background: This systematic review aimed to review and synthesize the effects of different psychotherapies on Hwa-Byung (HB), a Korean culture-bound syndrome. Methods: Ten electronic databases were comprehensively searched for interventional studies on psychotherapy, including language-based communication, for patients with HB, published until July 2023. The Cochrane risk-of-bias assessment tool and risk-of-bias in non-randomized studies of interventions were used to assess the methodological quality of the included studies. Results: Nine studies including 7 controlled clinical trials were included. Interventions encompassed 6 types: acceptance and commitment therapy, Adlerian counseling, integrated counseling, emotional freedom technique, art therapy, and psychotherapeutic programs for HB treatment. Except for the 2 types of counseling, all interventions were implemented in a group format, with total sessions ranging from 4 to 15 (average 8.11). Most interventions significantly improved HB symptoms compared to the waitlist or before-and-after comparisons. In the before-after comparison, the most frequently reported outcome of effectiveness was the HB Scale total score (100%, 6/6), followed by state anger (50%, 3/6), and state anxiety (50%, 2/4). For other outcomes, statistically significant positive results were reported in less than half of the cases, or there were only a small number of reported cases. Conclusions: To our knowledge, this systematic review comprehensively investigated the effectiveness of psychotherapy for HB and found evidence for some psychotherapies not previously presented in the clinical practice guidelines for HB. However, methodological limitations, including the lack of an appropriate control group, make it difficult to obtain high-quality evidence on psychotherapy for HB.
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Previous research consistently shows the effectiveness of ACT in managing the core components of HB, including anger, depression, somatic symptoms, and emotional distress.
“Previous research consistently shows the effectiveness of ACT in managing the core components of HB, including anger, depression, somatic symptoms, and emotional distress [6, 23-27].”
From User Experience and Clinical Utility of a Smartphone-Based Application for Hwa-Byung Treatment: a protocol for a single-arm prospective pilot study. (2026) · cites this paper as [6]
The Results (§3.4; page not provided) report that two ACT studies improved overall Hwa-Byung symptoms and some anger measures versus wait-list controls. They do not establish ACT’s effectiveness for depression, somatic symptoms, or emotional distress specifically; the Discussion (§4.1; page not provided) attributes improvements in depression and somatic symptoms to other therapies. Some anger measures also showed no significant improvement, so 'consistently' overstates the findings. (LLM, conf=0.89)
Experimental — accuracy not yet measuredPsychotherapy facilitates the expression of suppressed emotions and promotes emotional recovery.
“psychotherapy facilitates the expression of suppressed emotions and promotes emotional recovery [6].”
From User Experience and Clinical Utility of a Smartphone-Based Application for Hwa-Byung Treatment: a protocol for a single-arm prospective pilot study. (2026) · cites this paper as [6]
The Discussion (section 4.2) says the Hwa-Byung psychotherapies reviewed encouraged expression of suppressed anger and other emotions. It says these components may have contributed to symptom improvement, but does not establish that psychotherapy generally promotes emotional recovery as a definite effect. (LLM, conf=0.82)
Experimental — accuracy not yet measuredACT emphasizes psychological flexibility and acceptance of internal experiences rather than symptom elimination.
“ACT emphasizes psychological flexibility and acceptance of internal experiences rather than symptom elimination, aligning with the emotional suppression and experiential avoidance typical of HB [6].”
From User Experience and Clinical Utility of a Smartphone-Based Application for Hwa-Byung Treatment: a protocol for a single-arm prospective pilot study. (2026) · cites this paper as [6]
The Results (§3.4, page unavailable) identify acceptance, defusion, values, and committed action as core ACT processes. The Discussion (§4.2, page unavailable) says ACT encouraged acceptance and value-driven action and addressed suppressed anger in Hwa-Byung. The copy does not explicitly characterize ACT’s goal as psychological flexibility rather than symptom elimination, or describe experiential avoidance as typical of Hwa-Byung. (LLM, conf=0.82)
Experimental — accuracy not yet measuredACT's emphasis on psychological flexibility and acceptance aligns with the emotional suppression and experiential avoidance typical of HB.
“ACT emphasizes psychological flexibility and acceptance of internal experiences rather than symptom elimination, aligning with the emotional suppression and experiential avoidance typical of HB [6].”
From User Experience and Clinical Utility of a Smartphone-Based Application for Hwa-Byung Treatment: a protocol for a single-arm prospective pilot study. (2026) · cites this paper as [6]
The Results (§3.4; page unavailable) identify acceptance as a core ACT process, and the Discussion (§4.2; page unavailable) describes suppressed anger as central to HB and ACT as encouraging acceptance and detachment from anger. The copy does not characterize experiential avoidance as typical of HB or explicitly frame ACT as emphasizing psychological flexibility rather than symptom elimination. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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Cited by
Sorted by citations
Kwon, C.-Y., Lee, B., Kim, M., & Yoon, D. (2026) · Journal of Pharmacopuncture · doi:10.3831/kpi.2026.29.1.118
“Previous research consistently shows the effectiveness of ACT in managing the core components of HB, including anger, depression, somatic symptoms, and emotional distress [6, 23-27].”
Self-citationKwon, C.-Y., Lee, B., Kim, M., Moon, J.-H., Seo, M., & Yoon, D. (2026) · Healthcare · doi:10.3390/healthcare14132027
“These findings are directionally consistent with ACT-based face-to-face outcomes [25]; however, within-group effect sizes are structurally inflated relative to between-group estimates in the absence of a control condition, as they incorporate spontaneous remission, regression to the mean, and…”
Self-citation
- Authors
- Kwon, C.-Y., & Lee, B.
- Affiliations
- Dong-Eui University (KR)
- Korea Institute of Oriental Medicine (KR)
- Corresponding author
- Kwon, Chan-Young
- Venue
- Medicine
- Published
- 2025-02-07
- Volume
- 104
- Issue
- 6
- Pages
- e41315
- ISSN
- 0025-7974 (ISSN-L)
- 1536-5964
- PMC
- PMC11813000
- OpenAlex
- W4407305361
- Cited by
- 0
- References
- 29
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Korea Health Industry Development Institute (RS-2023-KH139364)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- Hwa-byung, psychotherapy, acceptance and commitment therapy, Adlerian counseling, Emotional Freedom Technique, art therapy, group therapy, state anger, state anxiety, treatment effectiveness
- MeSH terms
- Humans, Psychotherapy, Treatment Outcome, Republic of Korea
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