Efficacy of Acceptance and Commitment Therapy in Improving Depression and Anxiety in Adults with Traumatic Brain Injury: A Systematic Review and Meta-analysis

Abstract

Purpose of the Review: Acceptance and commitment therapy (ACT) is a third-wave psychological therapy that has shown effectiveness in managing psychological distress across various conditions, including chronic illnesses. Traumatic brain injury (TBI) often leads to cognitive impairments, mood disturbances, and psychological distress. While pharmacological treatments have limitations, non-pharmacological approaches, such as ACT, offer a promising alternative. This study systematically examined the efficacy of ACT on depression and anxiety in adults with TBI. Collection and Analysis of Data: A systematic search identified randomized controlled trials (RCTs) comparing ACT with treatment as usual or other psychological therapies in adults with TBI. Primary outcomes included depression and anxiety, while secondary outcomes assessed psychological flexibility, functional disability, rehabilitation participation, and quality of life (QOL). A random effects model meta-analysis was conducted using the R language. Four eligible RCTs (pooled N = 227) were included. ACT significantly reduced depression and anxiety with a moderate effect size [Cohen’s d = 0.54; 95% CI = 0.18–0.90; p = .003; I2 = 61.1%]. It also improved psychological flexibility [Cohen’s d = 0.36; 95% CI = 0.19–0.53; p < .001; I2 = 0%], mental health-related QOL [Cohen’s d = 0.24; 95% CI = 0.02–0.49; p = .015; I2 = 90.8%], and decreased functional disability [Cohen’s d = 0.47; 95% CI = 0.18–0.76; p = .001; I2 = 0%]. Regarding risk of bias, two studies had some concerns, and the rest were of low risk. Conclusions: The evidence for the efficacy of ACT in TBI is positive but preliminary. More methodologically sound trials using standardized measures are required to confirm the findings.