Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review

Abstract

Background Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises on the Web, either as pure self-help or with therapist guidance. Objective This systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions. Methods The EMBASE, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by 2 authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardized measure of anxiety. Included studies were appraised on methodological quality and had their data extracted into a standardized coding sheet. Findings were then tabulated, and a narrative synthesis was performed because of the heterogeneity found between studies. Results A total of 20 studies met inclusion criteria. There were 11 randomized controlled trials (RCTs) and 9 uncontrolled pilot studies. Participants across all studies were adults. The anxiety conditions treated were as follows: generalized anxiety disorder (GAD), social anxiety disorder (SAD), illness anxiety disorder (IAD), and general anxiety symptoms, with or without comorbid physical and mental health problems. A total of 18 studies reported significant anxiety reduction after iACT treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 19.19%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction. Conclusions These findings indicate that iACT can be an efficacious and acceptable treatment for adults with GAD and general anxiety symptoms. More RCT studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (eg, internet-delivered cognitive behavioral therapy). This would potentially validate the promising results found for SAD and IAD as well as address the full spectrum of anxiety disorders.

Marital communication skills training to promote marital satisfaction and psychological health during pregnancy: a couple focused approach

“…The present study indicated that the efforts made to increase women's communication skills would be associated with their improved psychological health and increased marital satisfaction. Many studies have shown that communication skill training is effective in reducing marital conflicts [19,20] and improving the communication between couples [16], and improves the couples' psychological health [13,21]. During pregnancy, due to physical and emotional changes in women, abnormal relationships may be experienced by the couples [2]; however, this study confirmed that during pregnancy, like other periods of life, communication skills training for women can improve such communications and relationships.…”

“…The communication skills training package with the couple-based intervention was developed based on the documents [14][15][16] as well as the opinions of experts on psychology, psychiatry and reproductive health. For example, a psychologist believed that to improve the couple's relationship, the couples' mutual understanding of each other's feelings and conditions are necessary factor.…”

“…During training, the problems were described by couples, and the self-awareness strategy training was provided, to be used at an occurrence of interpersonal problems and describing the cycle of awareness and familiarity. Then the five parts of awareness cycle were practiced by the couples, including sensory information, expressing the thoughts, feelings, desires and expectations with respect to the needs and changes of pregnancy [16].…”

<p>Efficacy Of Acceptance And Commitment Therapy For Emotional Distress In The Elderly With Type 2 Diabetes: A Randomized Controlled Trial</p>

“…in this population is felt. 26,27 As several studies have supported the effectiveness of ACT in reducing the symptoms of depression, anxiety and stress, [28][29][30] the present study aimed to determine the efficacy of ACT compared to routine educations and care provided in community therapeutic center on emotional distress in the elderly with type 2 diabetes.…”

Psychotherapie der Angststörungen

“…Das primäre Ziel von ACT ist nicht, die Angstsymptome zu reduzieren, sondern die psychische Flexibilität zu erhöhen, also sich bewusst dem gegenwärtigen Moment zu stellen und werteorientiert zu handeln [20]. Ein wichtiger Prozess ist dabei die kognitive Defusion, die Fähigkeit, sich von den eigenen Gedanken zu lösen und diese distanziert zu betrachten.…”