Rationale

Chronic health conditions (CHCs) are costly and difficult to manage. Patients often struggle with behavioral adherence to complex treatment regimens and experience psychiatric distress. Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral approach that aims to improve functioning and quality of life (QoL), which are important treatment outcomes for this population. Preliminary efficacy of multi-session ACT in patients with CHCs has been demonstrated, and single-session ACT interventions have since been developed to increase feasibility, acceptability, and accessibility. The purpose of this systematic review and meta-analysis was to describe the literature on single-session ACT intervention studies in CHC populations with regards to (1) study design and methodology, (2) patient characteristics and conditions targeted, and (3) efficacy for outcomes across various domains, using narrative and quantitative methods.

Methods

PsycINFO, PubMed, and Web of Science were systematically searched in August 2020. Studies of single-session ACT interventions in adult patients with CHCs that reported quantitative outcomes in any of the following domains were included: (a) functioning and related domains (e.g., disability, QoL, well-being); (b) mental health; (c) physical health; (d) ACT processes. Both controlled and uncontrolled studies were included. Study quality was assessed using the Psychotherapy Outcome Study Methodology Rating Scale (POMRF). Between-group random effects meta-analysis was conducted on general functioning outcomes.

Results

Fourteen manuscripts reporting outcomes from 13 studies (N = 793) met inclusion criteria. Ten studies were identified by their authors as pilot or feasibility trials. Eight studies used comparison or control groups. Twelve studies delivered the ACT content in workshop format. Studies recruited for a variety of conditions. Narrative review found that between- and within-group effect sizes showed generally positive results favoring single-session ACT overall (69%), especially for measures of functioning and related domains (88%), mental health (67%), and ACT processes (73%). Meta-analysis found that ACT did not significantly outperform comparison groups on measures of general functioning (Hedges’ g: −0.51, 95% confidence interval: [-1.19, 0.16]; I² = 86%; K = 5) despite a medium-sized pooled effect.

Discussion

Use of single-session ACT interventions in CHC populations is an emergent field. There is preliminary evidence for the acceptability, feasibility, and efficacy of these interventions, which provides support for further testing in fully-powered RCTs. Additional RCTs will enable larger meta-analyses and stronger conclusions about efficacy. Recommendations for future trials are provided.

中文翻译：

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针对慢性病患者的单次接受与承诺治疗 (ACT) 干预措施：系统评价和荟萃分析

基本原理

慢性健康状况 (CHC) 成本高昂且难以管理。患者常常难以坚持复杂的治疗方案，并经历精神困扰。接受与承诺疗法 (ACT) 是一种跨诊断行为方法，旨在改善功能和生活质量 (QoL)，这是该人群的重要治疗结果。多次 ACT 对 CHC 患者的初步疗效已得到证实，随后开发了单次 ACT 干预措施以提高可行性、可接受性和可及性。本系统回顾和荟萃分析的目的是描述 CHC 人群单次 ACT 干预研究的文献，涉及 (1) 研究设计和方法，(2) 患者特征和目标状况，以及 (3) 疗效使用叙述和定量方法来了解各个领域的成果。

方法

2020 年 8 月对 PsycINFO、PubMed 和 Web of Science 进行了系统检索。对成人 CHC 患者进行单次 ACT 干预的研究报告了以下任何领域的定量结果：(a) 功能和相关领域（例如，残疾、生活质量、幸福感）；(b) 心理健康；(c) 身体健康；(d) ACT 流程。包括对照和非对照研究。使用心理治疗结果研究方法评定量表（POMRF）评估研究质量。对一般功能结果进行组间随机效应荟萃分析。

结果

报告 13 项研究结果的 14 篇手稿 ( N  = 793) 符合纳入标准。十项研究被其作者确定为试点或可行性试验。八项研究使用了比较组或对照组。十二项研究以研讨会的形式提供了 ACT 内容。针对各种条件招募的研究。叙述性审查发现，组间和组内效应大小总体上显示出有利于单次 ACT 的积极结果 (69%)，特别是对于功能和相关领域 (88%)、心理健康 (67%) 和 ACT 过程的衡量（73%）。荟萃分析发现，ACT 在一般功能测量方面并未显着优于对照组（Hedges g：-0.51，95% 置信区间：[-1.19, 0.16]；I ²  = 86%；K  = 5），尽管具有中等水平规模的汇集效应。

讨论

在 CHC 人群中使用单次 ACT 干预措施是一个新兴领域。这些干预措施的可接受性、可行性和有效性已有初步证据，这为进一步开展全功效随机对照试验提供了支持。额外的随机对照试验将能够进行更大规模的荟萃分析并得出关于疗效的更有力的结论。提供了未来试验的建议。