Effect of Acceptance and Commitment Therapy on Psychological Symptoms and Disease Activity in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis - 17/05/26
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Highlights |
• | Acceptance and commitment therapy (ACT) led to a significant reduction in anxiety scores compared to the control group. |
• | There were no statistically significant effects on depression, stress, or disease activity overall. |
• | Subgroup analysis showed that ACT significantly improved depression and stress when compared with treatment-as-usual. |
• | Anxiety improvements were evident both immediately post-intervention and at 1-2 months, while stress reduction was significant at 1-2 months. |
Abstract |
Background: Inflammatory Bowel Disease (IBD) negatively impacts quality of life, increasing the risk of psychological disorders. Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that has shown promise for individuals living with chronic illnesses. This meta-analysis aims to explore the efficacy of ACT in managing psychological symptoms in patients with IBD, compared to usual care.
Methods: A systematic search was conducted across PubMed, Web of Science, SCOPUS, CENTRAL, and Google Scholar from inception to August 2025. Eligible studies comprised randomized controlled trials and quasi-experimental studies that compared ACT with usual or other interventions in IBD patients. Standardized Mean Differences (SMDs) with 95% confidence intervals (CIs) were calculated for assessed continuous outcomes. PROSPERO ID: CRD420251153446.
Results: Nine studies involving 459 patients were included. ACT significantly reduced anxiety scores compared to non-ACT (SMD = -0.34; 95% CI: [-0.56 to -0.12]; P < 0.01). Still, the improvements in depression (P = 0.08), stress (P = 0.08), Crohn's disease activity (P = 0.06), and ulcerative colitis activity (P =0.59) were not statistically significant compared to non-ACT. Subgroup analysis indicated significant improvements in anxiety (SMD = -0.34; 95% CI: -0.64 to -0.03; P = 0.03, I² = 0%), depression (SMD = -0.44; 95% CI: [-0.80 to -0.08]; P = 0.02) and stress (SMD = -0.55; 95% CI: [-0.92 to -0.19]; P < 0.01) scores when ACT was compared with treatment-as-usual. In contrast, no significant differences in depression, anxiety, or stress were found between ACT and other active psychoeducational interventions. Anxiety score was significantly improved post-intervention (SMD = -0.37; 95% CI: [-0.70 to -0.04]; P = 0.03) and at 1-2 months (SMD = -0.33; 95% CI: [-0.63 to -0.03]; P=0.03), while stress score was significantly improved at 1-2 months (SMD = -0.41; 95% CI: [-0.74 to -0.07]; P = 0.02).
Conclusion: ACT reduced anxiety, depression, and stress versus treatment-as-usual. Additionally, ACT reduced anxiety and stress scores at 1-2 months versus the control group. However, no improvement was observed in CD or UC activity. ACT was not superior to other active controls, such as CBT. Larger, longer follow-up periods and randomized trials are needed to confirm effects on psychological outcomes and disease activity.
Le texte complet de cet article est disponible en PDF.Keywords : psychotherapy
Abbreviations : IBD, ACT, CD, UC, CBT, HPA, QoL, MBIs, PRISMA, DASS-21, PSS, HBI, short CDAI, SCCAI, RCTs, SMD, CI
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