The Effects of Internet-Based Acceptance and Commitment Therapy on Process Measures: Systematic Review and Meta-analysis
Open accessAbstract
Background: Acceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures. Methods: A comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable. Results: A total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear. Conclusions: Relatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT.
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A prior meta-analysis analyzing process variables of online ACT found generally higher effect sizes for psychological flexibility at post-test (SMD=0.38 vs g=0.29) and follow-up (SMD=0.41 vs g=0.37) when comparing waitlist conditions, and for post-treatment when comparing active controls (SMD=0.60 vs g=0.16).
“Regarding psychological flexibility, a prior meta-analysis analyzing process variables of online ACT found generally higher effect sizes for psychological flexibility at post-test ( SMD = 0.38, compared to g = 0.29) and follow-up ( SMD = 0.41, compared to g = 0.37) when comparing waitlist conditions, and for post-treatment when comparing active controls ( SMD = 0.60, compared to g = 0.”
From A systematic review and meta-analysis of self-guided online acceptance and commitment therapy as a transdiagnostic self-help intervention (2023) · cites this paper as Han & Kim, 2022
The Results sections on immediate posttest and follow-up report the cited psychological-flexibility estimates: SMD=0.38 and 0.41 against passive controls, and SMD=0.60 against active controls at posttest. The paper labels the first two comparisons as passive-control comparisons, not waitlist-only comparisons, so the claim is more specific than the source supports. The g values appear to be the citing authors’ comparators, rather than estimates attributed to this source. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThree of these processes-cognitive defusion, mindfulness, and values-have received the most attention.
“Three of these processes, namely, cognitive defusion, mindfulness, and values, have received the most attention [28].”
From Effects and Mechanisms of a Web- and Mobile-Based Acceptance and Commitment Therapy Intervention for Anxiety and Depression Symptoms in Nurses: Fully Decentralized Randomized Controlled Trial. (2023) · cites this paper as [28]
The Introduction (Background) says that measuring cognitive defusion, mindfulness, and valued living has been emphasized. But it does not establish that these three have received the most attention among the ACT processes; the Discussion says psychological flexibility was assessed in two to five times more studies than each of them. (LLM, conf=0.82)
Experimental — accuracy not yet measured
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- Authors
- Han, A., & Kim, T. H.
- Affiliations
- University of Alabama at Birmingham (US)
- Yonsei University (KR)
- Corresponding author
- Kim, Tae Hui
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2022-08-30
- Volume
- 24
- Issue
- 8
- Pages
- e39182
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC9472046
- OpenAlex
- W4288764663
- Cited by
- 20
- References
- 58
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 1
- FWCI
- 0.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Korea Health Industry Development Institute
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- process indicators, psychological flexibility, mindfulness, valued living, cognitive defusion, self-as-context, acceptance, committed action, change processes, digital mental health interventions
- MeSH terms
- Humans, Mental Health, Models, Psychological, Internet, Mindfulness, 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.
What counts as a claim ›How we measure confidence ›How we check this ›
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