Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions

Abstract

ImportanceAlthough there is substantial evidence to suggest the health benefits of acceptance and commitment therapy (ACT) among informal caregivers of people with chronic health conditions, the great variation in intervention designs among published studies limits its application.ObjectivesTo identify intervention characteristics of ACT that are associated with improved psychological health and to assess the acceptability of ACT among informal caregivers.Data SourcesSeven English- and 3 Chinese-language databases without limits on publication dates, the reference lists of previous reviews, and gray literature were searched up to February 2023.Study SelectionRandomized clinical trials comparing the effect of ACT vs control groups on improving psychological health among informal caregivers.Data Extraction and SynthesisTwo reviewers independently screened searched records and extracted data from eligible studies. Random-effects meta-analysis and mixed-effects metaregression were performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed.Main Outcomes and MeasuresPsychological health outcomes (eg, depressive symptoms) measured by valid measurements and the acceptability of ACT based on identified parameters.ResultsA total of 29 studies with 2010 participants, published between 2015 and 2023, were identified. ACT showed moderate to large effect sizes for improving psychological health at postintervention assessments (Hedges g range, −0.55 [95% CI, −0.98 to −0.12] to −1.14 [95% CI, −1.83 to −0.45]) and at 1-to-3–month and 4-to-6–month follow-ups (Hedges g range, −0.47 [95% CI, −0.69 to −0.25] to −1.29 [95% CI, −2.33 to −0.24]). Multivariable metaregression analysis regarding intervention characteristics found that ACT delivered in a mixed individual- and group-based format, face-to-face, or through more intervention sessions was associated with greater improvements for experiential avoidance (face-to-face: β = −1.170 [95% CI, −2.020 to −0.319]; number of sessions: β = −0.242 [95% CI, −0.353 to −0.130]), depressive symptoms (mixed delivery format: β = −2.583 [95% CI, −4.845 to −0.321]; face-to-face: β = −1.555 [95% CI, −3.002 to −0.108]), or anxiety symptoms (face-to-face: β = −1.241 [95% CI, −2.337 to −0.146]). In general, ACT had low attrition rates (11%), and participants’ adherence (51%-80%) and satisfactory ratings (72%-95%) lend support to its acceptability.Conclusions and RelevanceThis systematic review and meta-analysis found that ACT was consistently associated with improvements in psychological health, supporting its application to improve informal care for chronic disease management. This review provides specific details on the design parameters of ACT for achieving greater efficacy.

Outcomes Among Mexican American and Non-Hispanic White Informal Stroke Caregivers

“…29 Acceptance and commitment therapy, which focuses on increasing psychological flexibility to improve mental health outcomes, showed high feasibility and acceptability but mixed outcomes in a recent systematic review of trials in the caregiving stress context, but methodological limitations, including a lack of studies in US Hispanic people or stroke caregivers, suggest the need for additional research. 30 We noted demographic differences in MA and NHW stroke caregivers, namely that MA caregivers were on average 5 to 6 years younger, more often female, and not married compared with NHW caregivers. These findings are in line with the results from a national study of caregivers for adults aged ≥50 years, which found that Hispanic caregivers were younger, less likely to be married, and more likely to have young children or grandchildren in the household, as well as a more recent report from the National Study of Caregiving and Hispanic Established Populations for the Epidemiologic Studies of the Elderly, which also noted the younger age and preponderance of female caregivers.…”