Acceptance and commitment therapy improved the psychological health of informal caregivers of people with chronic health conditions

Ye F, Lee JJ, Xue D, et al. Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2023;6:e2346216.

Review question

In informal caregivers who take care of family, friends, or neighbours who have chronic health conditions, what is the effect of acceptance and commitment therapy (ACT) on their psychological health?

Background

Informal caregiving of family members or friends who have chronic illness can be stressful. ACT is a type of cognitive behaviour therapy that encourages people to accept their negative feelings and thoughts and to commit to healthy activities to help them manage their experiences. This review looked at research on ACT to determine if it improves psychological wellbeing and to uncover the best ways to offer ACT to informal caregivers.

How the review was done

The researchers did a systematic review of studies available up to February 2023. They found 29 randomized controlled trials that included 2010 people. On average, the caregivers were 46 years of age, and most were women.

The key features of the studies were:

• participants were informal caregivers, including family, friends, or neighbours;
• the people they were caring for could be children (16 studies) or adults with any chronic health condition;
• ACT was mostly facilitated by trained professionals, such as psychiatrists, psychologists, counselors, nurses, or social workers;
• some ACT programs used a self-help approach;
• ACT was offered individually, in groups, or a combination of both;
• most ACT was offered face-to-face; and
• ACT programs ranged from 1 to 24 weeks and could include 1 to 24 sessions.

What the researchers found

Compared with active controls or usual care, ACT programs:

• reduced experiential avoidance (unwillingness to be exposed to painful feelings, thoughts, or emotions) by a large amount immediately after ACT and after 1 to 6 months;
• improved value-based living by a large amount immediately after ACT but not after 1 to 6 months;
• improved mindfulness (ability to be fully present and aware of where you are and what you are doing) by a large amount after 1 to 6 months;
• reduced cognitive fusion (becoming stuck in one’s thoughts) by a moderate amount immediately after ACT and after 1 to 6 months;
• reduced depressive symptoms by a large amount immediately after ACT and after 1 to 6 months;
• reduced anxiety symptoms by a large amount immediately after ACT and after 1 to 6 months; and reduced stress symptoms by a moderate amount immediately after ACT and a large amount after 1 to 6 months;

ACT was more likely to work when it was delivered face-to-face using a mixed individual- and group-based format over a greater number of sessions.

Conclusion

Acceptance and commitment therapy improved the psychological health of informal caregivers of people with chronic health conditions.

Acceptance and commitment therapy (ACT) vs. control for informal caregivers of people with chronic health conditions

*Experiential avoidance (unwillingness to be exposed to painful feelings, thoughts, or emotions), value-based living, mindfulness (ability to be fully present and aware of where you are and what you are doing), and cognitive fusion (becoming stuck in one’s thoughts) are measures of psychological flexibility.

†Amount of improvement with ACT is based on standardized mean differences (SMDs), where SMD ≤ 0.20 indicates a small effect, 0.20 to 0.80 a moderate effect, and ≥ 0.80 a large effect.