Table 2.
Manuscripts reporting studies of single-session ACT interventions for medical populations (K =14)
| First author (year) | Population/Condition | Participant characteristics | Study design, setting, intervention duration, assessment schedule | Intervention and comparator conditions | Outcomes and measures | Key Findings | |
|---|---|---|---|---|---|---|---|
| 1 | Gregg (2007) | Adults with diabetes mellitus type 2 | N = 81; Mage = 50.9 years; female = 46.9%; white = 23.5%; employment = 10% working full-time, 9% working part-time, 25% unemployed looking for work, 6% unemployed not looking for work, 8% retired, 28% disabled/unable to work; education = 57% with some education greater than High School; income not reported; MBMI = 32.6 | Randomized controlled trial; 7-hour workshop; Setting: community health center; Baseline, 3-month FU | (1) ACT + Diabetes management education (n = 43) (2) Diabetes management education (n = 38) |
(a) HbA1c (b) Diabetic Control (HbA1c < 7.0%) (c) Diabetes self-management (3 self-report items based on exercise, diet, glucose monitoring) (d) Diabetes acceptance (Acceptance and Action Diabetes Questionnaire/AADQ) |
(a) Nonsignificant trend for greater improvement in HbA1c in Group (1) > Group (2) at FU; Cohen’s d = 0.35 (b) Significant increase in rate of diabetic control in Group (1) at FU, p < .01, but not Group (2); Cohen’s d = 0.61 (c) Group (1) increase > Group (2) increase at FU, both p < .05; Cohen’s d = 0.68 (d) Group (1) increase significant (p < .01) and > Group (2) increase at FU; Cohen’s d = 0.78 |
| 2 | Sheppard (2010) | Adults with multiple sclerosis (MS) | N = 15; Mage (SD) = 53.13 years (7.68); female = 80%; white = 66.7 %; employment = 46% unemployed or receiving disability payments; education = 60% with Bachelors degree or higher; income not reported | Uncontrolled feasibility trial; 5-hour workshop; Setting: local hotel conference venue; Baseline, 3-month FU | ACT + MS education | (a) Depression (Beck Depression Inventory-II/BDI-II) (b) Impact of Fatigue (Modified Fatigue Impact Scale/MFIS) (c) Pain Effects on mood/behavior (Pain Effects Scale/PES) (d) Physical Health (SF-36) (e) Mental Health (SF-36) (f) Quality of Life (Quality of Life Inventory/QOLI) (g) Thought Suppression (White Bear Suppression Inventory/WBSI) (h) Mindful Attention Awareness Scale (MAAS) |
(a) Baseline to FU mean difference = −8.31; Hedge’s g = −0.73 (b) Baseline to FU mean difference = −11.21; Hedge’s g = −0.50 (c) Baseline to FU mean difference = 4.98; Hedge’s g = −0.98 (d) Baseline to FU mean difference for physical health = −0.86; Hedge’s g = −0.10 (e) Baseline to FU mean difference for mental health = 4.23; Hedge’s g = 0.36 (f) Baseline to FU mean difference = 1.11; Hedge’s g = 0.45 (g) Baseline to FU mean difference = 5.35; Hedge’s g = −0.33 (h) Baseline to FU mean difference = 0.22; Hedge’s g = −0.22 |
| 3 | Dindo (2012) | Adults with migraine and depression (current depressive episode) | N = 45; Mage (SD) = 32.8 years (13.2); female = 94%; white = 92%; employment = 89% working or in school; education = 89% > 12 years; income not reported | Non-randomized controlled pilot trial; 5-hour workshop; Setting: university hospital and clinics; Baseline, 2-, 6-, 12-week FU | (1) ACT + migraine psychoeducation (n = 31) (2) Waitlist/TAU (n = 14) |
(a) Depression Sx (Hamilton Rating Scale for Depression/HRSD) (b) General functioning (World Health Organization Disability Assessment Schedule II/WHODAS) M (c) Migraine-related disability (Headache Disability Inventory/HDI) |
(a) Group (1) decrease > Group (2) decrease at 12-week FU; Cohen’s d = 1.18 (b) Group (1) increase > Group (2) increase at 12-week FU; Cohen’s d = 0.98 (c) Group (1) decrease > Group (2) decrease at 12-week FU; Cohen’s d = 1.03 |
| 4 | Dindo (2014)† | Adults with migraine and depression (current depressive episode) | N = 45; Mage (SD) = 31.4 years (12.3); female = 94%; white = 87%; employment = 90% working or in school; education = 92% > 12 years; income not reported | Non-randomized controlled pilot trial; 5-hour workshop; Setting: university hospital and clinics; Baseline, 2-, 6-, 12-week FU | (1) ACT + migraine psychoeducation (n = 38) (2) Waitlist/TAU (n = 22) | (a) Headache frequency/severity (b) Acute headache medication use (c) Leisure and work disability (d) Visit to healthcare professional Note: all outcomes measured using daily headache diary |
(a) Group (1) decreased in frequency (OR=0.57) and severity (OR=0.41) at 12-week FU, no change for Group (2) (OR=0.84, 1.0) (b) Group (1) decreased in acute medication use (OR=0.64) at 12-week FU, no change for Group (2) (OR=0.97) (c) Group (1) decreased in leisure disability (OR=0.56) and work disability (OR=1.0) at 12-week FU, no change for Group (2) (OR=0.78, 1.8) (d) At baseline, 20% of Group (1) and 22% of Group (2) attended medical visit in last month; at 12-week FU, 3% of Group (1) and 33% of Group (2) |
| 5 | Welch (2014) | Adults with diabetes mellitus type 2 with significant distress (either diabetes management regimen distress or emotional burden) | N = 31; Mage (SD)= 43 years (9.1); female = 70%; white = 45%; employment status not reported; Myears education (SD) = 13.9 (1.2); income not reported | Uncontrolled pilot trial; 8-hour workshop; Setting: psychology graduate school; Baseline, post-treatment, 2-week FU | ACT | (a) Self-care behavior (Summary of Diabetes Self-Care Activities scale revised version/SDSCA) (b) Diabetes-related distress (Diabetes Distress Scale 17/DDS17) total (c) Diabetes acceptance (AADQ) (d) Thought suppression (WBSI) (e) Depression (DASS-21) (f) Anxiety (DASS-21) (g) Stress (DASS-21) |
(a) Baseline to FU mean difference on subscales: (1) General diet = 0.82; Cohen’s d = 0.52 (2) Diabetes-specific diet = 0.62; Cohen’s d = 0.61 (3) Exercise = −2.12; Cohen’s d = 1.62 (4) Blood-glucose testing = 0.58; Cohen’s d = 0.29 (5) Foot care = −1.29; Cohen’s d = 0.76 (6) Smoking status = −0.9; Cohen’s d = 0.22 (b) Baseline to FU mean difference on total score = −1.51; Cohen’s d = 1.74 (c) Baseline to FU mean difference = 18.85; Cohen’s d = 1.95 (d) Baseline to FU mean difference = 19.15; Cohen’s d = 1.58 (e) Baseline to FU mean difference = −3.1; Cohen’s d = 0.57 (f) Baseline to FU mean difference = −4.4; Cohen’s d = 0.42 (g) Baseline to FU mean difference = −5.7; Cohen’s d = 0.72 |
| 6 | Dindo (2015) | Adults at risk for vascular disease* with clinically significant anxiety or depression Sx | N = 44; Mage = 45 years; female = 67%; white = 74%; employment not reported; education = 70% completed college; income not reported | Randomized controlled pilot trial; 6-hour workshop; Setting: university hospital and clinics; Baseline, 12- and 24-week FU | (1) ACT + psychoeducation (n = 30) (2) TAU (n = 14) |
(a) General wellbeing (World Health Organization Quality of Life-BREF/WHOQOL-BREF) M (b) Depression (HRSD) (c) Anxiety (Hamilton Rating Scale for Anxiety/HSRA) (d) Psychological Flexibility/decentering (Experiencing Questionnaire/EQ) |
(a) In Group (1), all four domains (physical, social, psychological, environment) improved at 24-week FU; in Group (2), only psychological domain was improved (b) Group (1) decrease > Group (2) decrease at 12- and 24-week FU; unspecified effect size = 1.4 at 24-week FU (c) Group (1) decrease > Group (2) decrease at 12- and 24-week FU; unspecified effect size = 1.5 at 24-week FU (d) Increase in Group (1) at unspecified FU; Group (2) results not reported |
| 7 | Hou (2017) | Adults with inflammatory bowel disease (IBD) and clinically significant anxiety or depression symptoms | N = 20; Mage = 51 years; female = 30%; % white not reported; employment not reported; education not reported; income not reported; n=9 with Crohn’s disease, n=10 with ulcerative colitis, n=1 IBD unclassified | Uncontrolled feasibility study; 5-hour workshop; Setting: Veterans Affairs medical center and university medical school; Baseline, 3-month FU | ACT + IBD education | (a) Health-related Quality of Life (the Short IBD Questionnaire/SIBDQ) (b) Depression (DASS-21) (c) Anxiety (DASS-21) (d) Stress (DASS-21) (e) IBD activity (Harvey Bradshaw Index for pts. with Crohn’s/HBI) (f) IBD activity (partial Mayo score for pts with Ulcerative Colitis/pMayo) |
(a) Baseline to FU mean difference = 0.5; Hedge’s g = 0.41 (b) Baseline to FU mean difference = −2.1; Hedge’s g = −0.39 (c) Baseline to FU mean difference = −2.6; Hedge’s g = −0.65 (d) Baseline to FU mean difference = −1.9; Hedge’s g = −0.39 (e) Baseline to FU mean difference = −0.5; Hedge’s g = −0.15 (f) Baseline to FU mean difference = −1.2; Hedge’s g = −0.47 |
| 8 | Dindo (2018) | Veterans receiving orthopedic surgery at risk for chronic pain or prolonged opioid use** | N = 88; Mage (SD) = 63 years (10); female = 7%; white = 82.5%; employment not reported; education = 68% with some education greater than High School; income not reported | Randomized controlled pilot trial; 5-hour workshop; Setting: Veterans Affairs medical center; Baseline and 3-month FU for CPAQ and CPVI; DLPM submitted weekly for 14 weeks post-treatment | (1) ACT workshop + 1 individualized “booster” session by phone 2–4 wks following workshop (n = 44) (2) TAU (n = 44) |
(a) Pain cessation (Daily Log of Pain and Pain Medication/ DLPM) (b) Opioid use/ cessation (DLPM) (c) Pain acceptance (Chronic Pain Acceptance Questionnaire total/CPAQ) (d) Values-based behavior (Chronic Pain Values Inventory/ CPVI) |
(a) Median days to pain cessation was 66 for Group (1) and 74 for Group (2); HR = 1.42 [95% CI: 0.68, 2.95] (b) 29% of Group (1) taking opioids at 7 weeks v. 52% of Group (2); HR = 1.44 [95% CI: 0.74, 2.78] (c) Mean difference between Group (1) and (2) at FU = 2.07 [95% CI: −7.46, 11.61]; HR = 1.42 [95% CI: −7.11, 9.57] (d) Mean difference between Group (1) and (2) on ‘mean success’ at FU = −0.50 [95% CI: −1.01, 0.01]; HR = 0.13 [95% CI: −0.33, 0.59]; mean difference between Group (1) and (2) on ‘discrepancy score’ at FU = 0.21 [95% CI: −0.23, 0.65]; HR = −0.42 [95% CI = −0.85, 0.01] |
| 9 | Ferreira (2018) | Adults with refractory Irritable Bowel Syndrome (IBS) | N = 79; Mage (SD) = 48 years (13); female = 93%; race/ethnicity not reported; employment not reported; education = 68% with post-secondary education; income not reported. | Uncontrolled pilot trial; 6-hour workshop followed by 2 months of bibliotherapy and 2 FU support calls; Setting: gastroenterology outpatient clinic; Enrollment, pre-treatment, post-treatment (2 months following pre-treatment), 6-month FU | ACT + IBS education workshop, bibliotherapy, 2 individualized support calls | (a) IBS Acceptance (IBS Acceptance and Action Questionnaire; IBSAAQ) (b) Symptom severity (IBS Symptom Severity Scale; IBSSSS) (c) Quality of life (IBS Impact on Quality of Life Scale; IBS36) (d) IBS avoidant behaviors (Behavioural Responses Questionnaire; IBS-BRQ) (e) Gastrointestinal specific anxiety (Visceral Sensitivity Index; VSI) |
(a) Pre- to post-treatment mean difference = 7.24; Cohen’s d = 0.32; Pre-treatment to FU mean difference = 9.82; Cohen’s d = 0.50 (b) Pre- to post-treatment mean difference = −41.48; Cohen’s d = 0.41; Pre-treatment to FU mean difference = −49.78; Cohen’s d = 0.47 (c) Pre- to post-treatment mean difference = −17.41; Cohen’s d = 0.41; Pre-treatment to FU mean difference = −23; Cohen’s d = 0.55 (d) Pre- to post-treatment mean difference = −8.57; Cohen’s d = 0.32; Pre-treatment to FU mean difference = −10.18; Cohen’s d = 0.39 (e) Pre- to post-treatment mean difference = −6.3; Cohen’s d = 0.76; Pre-treatment to FU mean difference = −8.73; Cohen’s d = 1.10 |
| 10 | Huddleston (2018) | Veterans with migraines and co-occurring depression (current depressive episode) | N = 32; Age = 36% under 45, 36% 45–55 years, 24% 56–65 years, 1% over 65 years; female = 36%; white = 24%; employment = 25% employed full- or part-time, 6% retired, 34% unemployed, 22% disabled, 13% student; education = 56% with some education greater than High School; income not reported | Uncontrolled pilot trial; 5-hour workshop; Setting: Veterans Affairs medical center; Baseline, 3-month FU | ACT + migraine education | (a) Depression Sx (HRSD) (b) Anxiety Sx (HRSA) (c) General functioning (WHO Disability Assessment Schedule II/WHODAS) (d) Headache-related disability (HDI) (e) Pain acceptance (CPAQ) (f) Values-based behavior (CPVI) (g) Psychological flexibility (Acceptance and Action Questionnaire/AAQ-II) |
(a) Baseline to FU mean difference = −7.95; Cohen’s d = −1.93 (b) Baseline to FU mean difference = −6.57; Cohen’s d = −1.84 (c) Baseline to FU mean difference = −5.38; Cohen’s d = −0.38 (d) Baseline to FU mean difference = −7.44; Cohen’s d = −0.39 (e) Baseline to FU mean difference = 8.48; Cohen’s d = 0.48 (f) Baseline to FU mean difference = 0.5; Cohen’s d = 0.48 (g) Baseline to FU mean difference = −5.53; Cohen’s d = −0.71 |
| 11 | Hadlandsmyth (2019) | Adult women undergoing surgery for breast cancer or ductal carcinoma in situ at risk for persistent postsurgical pain*** | N = 62; Mage (SD) = 53 years (12); female = 100%; white = 87%; employment not reported; education not reported; income = 17% <$40,000, 24% $40,000–79,999, 59% $80,000+ | Randomized controlled pilot trial; 2-hour individual session 2 weeks post-surgery; Setting: comprehensive cancer center; Baseline, 3-month FU | (1) ACT therapy + TAU (n = 24) (2) TAU (medical care) (n = 30) |
(a) Pain intensity (0–10 scale) (b) Pain catastrophizing (Pain Catastrophizing Scale/PCS) (c) Depression (Patient Health Questionnaire-8) (d) Anxiety (Generalized Anxiety Disorder-7) (e) Pain acceptance (CPAQ) |
(a) At FU, 8.3% in Group (1) reported moderate-to-severe pain v. 13.3% in Group (2); phi = 0.08 (b) At FU, 4.2% in Group (1) reported elevated pain catastrophizing v. 3.3% in Group (2); phi = 0.02 (c) At FU, 12.5% in Group (1) reported elevated depression v. 13.3% in Group (2); phi = 0.01 (d) At FU, 4.2% in Group (1) reported elevated anxiety v. 13.3% in Group (2); phi = 0.16 (e) Mean difference at FU = 1.66, favoring Group (1); Cohen’s d = 0.10 |
| 12 | Pedersen (2019) | Adults with multiple functional somatic syndromes (FSS) | N = 121 (for conditions of interest); Mage (SD) = 39 years (9); female = 83%; race/ ethnicity not reported; employment = 26% employed or student, 31% unemployed, 31% disability pension or flexible work; education = 31% greater than basic school (Denmark); income not reported; Functional Somatic Syndromes: 29% Irritable Bowel Syndrome, 79% Chronic Fatigue Syndrome, 74% Fibromyalgia, 74% tension headaches, 55% non-cardiac chest pain; average number of FSS = 3.9 | Randomized, controlled, 3-arm trial; Setting: university general hospital; Baseline, 6-, 14, and 20-month FU | (1) ACT (6-hour workshop) + Enhanced Care (1–1.5 hour psychoeducation consultation with a physician 1–2 weeks after randomization) (n = 61) (2) Enhanced Care only (n = 60) (3) Extended ACT (nine 3-hr group sessions) + Enhanced Care (n = 59) Note: this review reports results comparing Groups (1) and (2) only |
(a) Patient-rated overall health (5-pt clinical global improvement scale/CGI) (b) Physical Health (SF-36) (c) Mental Health (SF-36) Note: total of 18 secondary outcomes assessed, including: depression Sx, anxiety and somatic Sx (Hopkins Symptom Checklist/SCL-92; BDS checklist); illness worry (Whiteley-7); disability (WHODAS 2.0) M |
(a) No difference between Groups (1) and (2) at 14-month FU (b) No difference between Groups (1) and (2), p = .98 at 14-month FU (c) No difference between Groups (1) and (2), p = .59 at 14-month FU Note: no significant differences between Groups (1) and (2) in change over time on the 18 secondary outcomes |
| 13 | Dindo (2020a) | Veterans with chronic pain, mild Traumatic Brain Injury (mTBI), and current diagnosis of MDD, GAD, or PTSD | N = 39; Mage (SD) = 36.6 years (6.2); female = 0%; white = 42%; employment = 51% employed full- or part-time; Myears education (SD) = 14.2 (1.7); Past month diagnoses: 68% PTSD, 54% MDD, 16% GAD; most severe TBI = 26% Stage 1 mTBI, 55% Stage 2 mTBI, 19% Stage 3 mTBI | Randomized controlled pilot trial; 5-hour workshop; Setting: Veteran Affairs medical center; Baseline, 3-month FU | (1) ACT + psychoeducation (n = 20) (2) TAU (n = 12) |
(a) PTSD (Posttraumatic Stress Disorder Checklist; PCL-C) (b) Depression, Anxiety, and Stress (DASS-21 total) (c) Reintegration (Military to Civilian Questionnaire/M2C-Q) (d) Disability (WHODAS 2.0) M (e) Pain Severity (Brief Pain Inventory/BPI) (f) Pain Interference (BPI) (g) Psychological flexibility (AAQ-II) |
(a) Group (1) decrease > Group (2) decrease at FU; Cohen’s d = 0.33 (b) Group (1) decrease > Group (2) increase at FU; Cohen’s d = 0.68 (c) Group (1) improved, Group (2) worsened at FU; Cohen’s d = 0.47 (d) Group (1) decrease > Group (2) decrease at FU; Cohen’s d = 0.44 (e) No difference in Group (1) and Group (2) decrease at FU; Cohen’s d = 0.10 (f) Group (2) decrease > Group (1) decrease at FU; Cohen’s d = 0.78 (g) Group (1) increase > Group (2) increase at FU; Cohen’s d = 0.56 |
| 14 | Dindo (2020b) | Adults with migraines and co-occurring depression (current depressive episode) | N = 136; Mage (SD) = 35.8 years (13.9); female = 83%; white = 76%; employment = 81% employed or in school; education = 57% with more than 12 years of education; age of onset of migraines M (SD) = 19 (10.6); 31% taking antidepressants; number of migraine/headache days during month prior to baseline M (SD) = 7.4 (3.4); 87% taking abortive anti-migraine medication; 35% taking preventative anti-migraine medication | Randomized controlled trial; 5 to 6-hour workshop; Setting: hospital; Baseline, 3-, and 6-month FU | (1) ACT + migraine education (n = 56) (2) Support + migraine education (n = 47) |
(a) Depression Sx (Hamilton Rating Scale of Depression/HRSD) (b) Current depressive episode (depression module of SCID-IV) (c) Anxiety (Structured Interview Guide for the Hamilton Anxiety Rating Scale/SIGH-A) (d) Headache-related disability (HDI) (e) General Functioning (WHODAS 2.0) M (f) Social relationship functioning (World Health Organization Quality of Life/WHO-QOL) (g) Environment (WHO-QOL) (h) Psychological well-being (WHO-QOL) (i) Physical health (WHO-QOL) |
(a) Group (1) proportion of treatment responders > Group (2) at 3-month FU, p < .05, OR = 3.10 (b) Nonsignificant result for group (1) proportion of participants meeting criteria < Group (2) at 3-month FU, p = .33, OR = 0.54 (c) Nonsignificant result for group (1) proportion of treatment responders > Group (2) at 3-month FU, p = .11, OR = 2.45 (d) Group (1) proportion of treatment responders (i.e., ≥ 29 decline in total score) mean decrease > Group (2) at 3-month FU, p < .05, OR = 4.47 (e) Nonsignificant difference in mean improvement at 3-month FU, p = .23, Cohen’s d = 0.33 (f) Group (1) increase > Group (2) increase at 3-month FU, p = .01, Cohen’s d = 0.62 (g) Group (1) increase > Group (2) increase at 3-month FU, p = .05, Cohen’s d = 0.47 (h) Nonsignificant trend for Group (1) increase > Group (2) increase at 3-month FU, p = .06, Cohen’s d = 0.46 (i) Nonsignificant difference in mean increase at 3-month FU, p = .40, Cohen’s d = 0.27 |
Note. N reflects the number of participants randomized (for studies with > 1 condition) or assigned to treatment (for single-arm studies); FU = follow-up; Sx = symptoms; M = mean; SD = standard deviation; TAU = treatment as usual; OR = odds ratio; HR = hazard ratio; SCID-IV = Structured Clinical Interview for DSM-IV; PTSD = posttraumatic stress disorder; MDD = major depressive disorder; GAD = generalized anxiety disorder. Unable to calculate effect sizes for Pedersen (2019). Effect sizes reported for studies with comparison conditions are between-group effects; effect sizes reported those studies without comparison conditions are within-group effects.
†
Subsample from Dindo (2012) study, focused on headache outcomes
*
At-risk defined as having hypertension, diabetes mellitus or impaired fasting glucose, dyslipidemia, or obesity
**
At-risk defined as having high levels of preoperative pain and clinically significant anxiety or depression
***
At-risk defined as under the age of 50, having a preexisting chronic pain condition, elevated anxiety, elevated depression, or elevated pain catastrophizing, assessed pre-surgery
M
Included in meta-analysis