Grup Temelli Kabul ve Kararlılık Terapisinin (ACT) Depresif Belirtiler Üzerine Etkililiği: Sistematik Bir Derleme

Öz

Bu çalışmada depresif belirtilerin tedavisinde grup temelli Kabul ve Kararlılık Terapisinin etkililiğini ele alan randomize kontrollü çalışmaların sistematik olarak incelenmesi amaçlanmıştır. Ocak 2004 ile Haziran 2025 yılları arasında yayımlanmış, İngilizce ve Türkçe dillerindeki çalışmalar; Medline, PsycArticles, PubMed, Scopus, Web of Science ve TRDizin veri tabanlarında taranmıştır. Tarama sonucunda dahil etme kriterlerine uyan 17 çalışmaya bu sistematik derlemede yer verilmiştir. Bu çalışmalarda müdahale, en az 4 oturumdan en fazla 12 oturuma kadar değişiklik göstermiştir. Müdahalelerin çoğunlukla 8 oturum halinde uygulandığı görülmektedir. Bu derlemeye dahil edilen çalışmalarda standardize ölçüm araçları kullanılmıştır. Çalışmaların bulguları, grup temelli Kabul ve Kararlılık Terapisi’nin depresif belirtileri azaltmada etkili olduğunu ve izlem ölçümlerinde de bu etkinin devam ettiğini ortaya koymuştur. Sonuç olarak, grup temelli Kabul ve Kararlılık Terapisi’nin depresif belirtilerin tedavisinde etkili olduğu bulunmuştur. Dahil edilen çalışmaların çoğunda örneklem büyüklüğü sınırlıdır ve cinsiyet dağılımı heterojendir; ancak kanser hastaları, askerler, menopoz dönemindeki kadınlar gibi çeşitli örneklemleri kapsıyor oluşu genellenebilirliği artırmaktadır. Grup terapi müdahalelerinin maliyet-etkinlik açısından avantajlı oluşuyla ilişkili olarak etkili tedaviye erişimi artırmaları nedeniyle, bu sonuçlar klinik açıdan önem taşımaktadır.

Anahtar Kelimeler

• Kabul ve Kararlılık
• Grup
• Depresif Semptomlar
• Etkililik

Effectiveness of Acceptance and Commitment Therapy (ACT) in Group Format on Depressive Symptoms: Systematic Review

Abstract

This study aims to systematically review randomized controlled trials that evaluate the effectiveness of group Acceptance and Commitment Therapy (ACT) in treating depressive symptoms. Studies published between January 2004 and June 2025 in English and Turkish languages were searched in databases such as Medline, PsycArticles, PubMed, Scopus, Web of Science, and TR Index. Ultimately, 17 studies meeting the inclusion criteria were included in this systematic review. In the studies, the intervention ranged from a minimum of 4 sessions to a maximum of 12 sessions. Most commonly, the interventions were implemented over 8 sessions. The studies included in this review utilized standardized measurement scales. Findings suggest that group-based Acceptance and Commitment Therapy is effective in reducing depressive symptoms and that this effect persists at follow-up measurements. As a result, group-based Acceptance and Commitment Therapy was found to be effective in treating depressive symptoms. Although most of the included studies had limited sample sizes and heterogeneous gender distribution, the inclusion of diverse groups -such as cancer patients, military personnel, and menopausal women- increases the generalizability of the findings. The results are clinically important because group therapy interventions are cost-effective and increase access to effective treatment for individuals.

Keywords

• Acceptance and Commitment
• Group
• Depressive Symptoms
• Effectiveness

Kaynakça

1. APA (2022) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. text revision (DSM-5-TR). Washington DC, American Psychiatric Association.
2. Bardeen JR, Fergus TA (2016) The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. J Contextual Behav Sci, 5:1-6.
3. Berman NC, Wheaton MG, McGrath P, Abramowitz JS (2010) Predicting anxiety: The role of experiential avoidance and anxiety sensitivity. J Anxiety Disord, 24:109-113.
4. Bluett EJ, Homan KJ, Morrison KL, Levin ME, Twohig, MP (2014) Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review. J. Anxiety Disord, 28:612–624.
5. Bond FW, Hayes SC, Barnes-Holmes D (2006) Psychological flexibility, ACT and organizational behavior. J Organ Behav Manage, 26:25–54.
6. Chawla, N, Ostafin B (2007) Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. J Clin Psychol, 63:871-890.
7. Coto-Lesmes R, Fernández-Rodríguez C, González-Fernández S (2020) Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. J Affect Disord, 263:107-120.
8. Dindo L, Van Liew JR, Arch JJ (2017) Acceptance and commitment therapy: a transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics, 14:546-553.

9. Dinis A, Carvalho S, Gouveia JP, Estanqueiro C (2015) Shame memories and depression symptoms: The role of cognitive fusion and experiential avoidance. Rev Int Psicol Ter Psicol, 15:63-86.
10. Ebrahimi A, Esfahan EN, Akuchekian S, Izadi R, Shaneh E, Mahaki B (2022) A randomized clinical trial: Comparison of group acceptance and commitment therapy with drug on quality of life and depression in patients with obsessive–compulsive disorder. Int J Res Med Sci, 27:1-7.
11. Fernández-Rodríguez C, González-Fernández S, Coto-Lesmes, R, Pedrosa I (2021) Behavioral activation and acceptance and commitment therapy in the treatment of anxiety and depression in cancer survivors: a randomized clinical trial. Behav Modif, 45:822-859.
12. Ferreira MG, Mariano LI, de Rezende JV, Caramelli P, Kishita N (2022) Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord, 309:297-308.
13. Golestanifar S, Dasht Bozorgi Z (2020) The Effectiveness of acceptance and commitment based therapy on depression, psychological health and life expectancy of the elderly with nonclinical depression. Aging Psychology, 6:191-203.
14. González-Fernández S, Fernández-Rodríguez C, Paz-Caballero MD, Pérez-Álvarez M (2018) Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy. Psicothema, 30:14-20.
15. Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M (2020) The empirical status of acceptance and commitment therapy: A review of meta-analyses. J Contextual Behav Sci, 18:181-192.
16. Grégoire S, Lachance L, Bouffard T, Dionne F (2018) The use of acceptance and commitment therapy to promote mental health and school engagement in university students: A multisite randomized controlled trial. Behav Ther, 49:360-372.
17. Harris R (2023) ACT’i Kolay Öğrenmek (ikinci edisyon) (Çeviri Ed. FB Esen, KF Yavuz). İstanbul, Litera Yayıncılık.
18. Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J (2013) Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther, 44:180-198.
19. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther, 44:1-25.
20. Hayes SC, Strosahl KD, Bunting K, Twohig M, Wilson KG (2004) What is acceptance and commitment therapy? In A Practical Guide To Acceptance and Commitment Therapy (Eds SC Hayes, KD Strosahl):3–29). Boston, Springer.
21. Hayes SC, Strosahl KD, Wilson KG (1999) Acceptance and Commitment Therapy: An Experiential Approach To Behavior Change. New York, Guilford.
22. Hayes SC, Strosahl KD, Wilson KG (2012) Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. New York, Guilford Press.
23. Kalodner CR, Hanus, AE (2010) Groups across settings. In The Oxford Handbook of Group Counseling (Eds RK Conyne):399-415. New York, Oxford University Press.
24. Karakış S, Karaaziz M (2024) Türkiye’de deprem kaygısı, anksiyete, stres ve depresyon ilişkisinin psikolojik esneklik açısından incelenmesi. ISPEC International Journal of Social Sciences & Humanities, 8:131-144.
25. Kashdan TB, Rottenberg J (2010) Psychological flexibility as a fundamental aspect of health. Clin Psychol Rev, 30:865-878.
26. Ksiksou J, Maskour L, Alaoui S (2024) Effect of acceptance and commitment therapy on depression, anxiety, stress, and psychological flexibility in women with breast cancer. Kontakt, 26:104-111.
27. Lappalainen P, Granlund A, Siltanen S, Ahonen S, Vitikainen M, Tolvanen A et al. (2014) ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: An 18-month follow-up. Behav Res Ther, 61:43-54.
28. Lappalainen P, Langrial S, Oinas-Kukkonen H, Tolvanen A, Lappalainen R (2015) Web-based acceptance and commitment therapy for depressive symptoms with minimal support: a randomized controlled trial. Behav Modif, 39:805-834.
29. Levin ME, An W, Davis CH, Twohig MP (2020) Evaluating acceptance and commitment therapy and mindfulness-based stress reduction self-help books for college student mental health. Mindfulness, 11:1275-1285.
30. Levin ME, Hayes SC, Pistorello J, Seeley JR (2016) Web-based self-help for preventing mental health problems in universities: Comparing acceptance and commitment training to mental health education. J Clin Psychol, 72:207-225.
31. Liu YE, Lv J, Sun FZ, Liang JJ, Zhang YY, Chen J et al. (2023) Effectiveness of group acceptance and commitment therapy in treating depression for acute stroke patients. Brain Behav, 13(12).
32. Luoma JB, Nobles RH, Drake CE, Hayes SC, O’Hair A, Fletcher L et al. (2013) Self-stigma in substance abuse: Development of a new measure. J Psychopathol Behav Assess, 35:223-234.
33. Marshall EJ, Brockman RN (2016) The relationships between psychological flexibility, self-compassion, and emotional well-being. J Cogn Psychother, 30:60-72.
34. Moghanloo VA, Moghanloo RA, Moazezi M (2015) Effectiveness of acceptance and commitment therapy for depression, psychological well-being and feeling of guilt in 7-15 years old diabetic children. Iran J Pediatr, 25(4).
35. Mohabbat-Bahar S, Maleki-Rizi F, Akbari ME, Moradi-Joo M (2015) Effectiveness of group training based on acceptance and commitment therapy on anxiety and depression of women with breast cancer. Iran J Cancer Prev, 8:71-76.
36. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Inter Med, 151:264-269.
37. Monfaredi Z, Malakouti J, Farvareshi M, Mirghafourvand M (2022) Effect of acceptance and commitment therapy on mood, sleep quality and quality of life in menopausal women: a randomized controlled trial. BMC Psychiatry, 22(1).
38. Moroz M, Dunkley DM (2019) Self-critical perfectionism, experiential avoidance, and depressive and anxious symptoms over two years: A three-wave longitudinal study. Behav Res Ther, 112:18-27.
39. Muto T, Hayes SC, Jeffcoat T (2011) The effectiveness of acceptance and commitment therapy bibliotherapy for enhancing the psychological health of Japanese college students living abroad. Behav Ther, 42:323-335.
40. Østergaard T, Lundgren T, Rosendahl I, Zettle RD, Jonassen R, Harmer CJ et al. (2019) Acceptance and commitment therapy preceded by attention bias modification on residual symptoms in depression: a 12-month follow-up. Fron Psychol, 10:1995.
41. Otared N, Moharrampour NG, Vojoudi B, Najafabadi AJ (2021) A group-based online acceptance and commitment therapy treatment for depression, anxiety symptoms and quality of life in healthcare workers during COVID-19 pandemic: A randomized controlled trial. Rev Int Psicol Ter Psicol, 21:399-411.
42. Puolakanaho A, Muotka JS, Lappalainen R, Lappalainen P, Hirvonen R, Kiuru N (2023) Adolescents' stress and depressive symptoms and their associations with psychological flexibility before educational transition. J Adolesc, 95:990-1004.
43. Rath JF, Bertisch H, Elliott TR (2017) Groups in behavioral health settings. In: Handbook of Group Counseling and Psychotherapy (Eds JL DeLucia-Waack, CR Kalodner, M Riva):340–350.
44. Räsänen P, Lappalainen P, Muotka J, Tolvanen A, Lappalainen R (2016) An online guided ACT intervention for enhancing the psychological wellbeing of university students: A randomized controlled clinical trial. Beh Res Ther, 78:30-42.
45. Ruiz FJ (2010) A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. Rev Int Psicol Ter Psicol, 10:125-162.
46. Shahkaram H, Yaztappeh JS, Sadeghi A, Kianimoghadam AS, Soltanabadi S, Bakhtiari M et al. (2024) Comparing the effectiveness of transdiagnostic treatment with acceptance and commitment therapy on emotional disorders, rumination, and life satisfaction in patients with irritable bowel syndrome: a randomized clinical trial. BMC Gastroenterol, 24:66.
47. Shareh H, Robati Z (2022) Effect of acceptance and commitment group therapy on cognitive flexibility, suicidal ideation, depression, and hopelessness in conscripts. Iranian Journal of Psychiatry and Clinical Psychology, 27:412-427.
48. Shojaeifar S, Torkestani NA, Ahmadlou, M (2022) The effect of acceptance and commitment therapy on postpartum depression. Gazi Medical Journal, 33:204-209.
49. Solé E, Tomé-Pires C, de la Vega R, Racine M, Castarlenas E, Jensen MP et al. (2016) Cognitive fusion and pain experience in young people. Clin J Pain, 32:602-608.
50. Trindade IA, Mendes, AL, Ferreira, NB (2020) The moderating effect of psychological flexibility on the link between learned helplessness and depression symptomatology: A preliminary study. J Contextual Behav Sci, 15:68-72.
51. Tull MT, Gratz KL, Salters K, Roemer L (2004) The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. J Nerv Ment Dis, 192:754-761.
52. van Aubel E, Bakker JM, Batink T, Michielse S, Goossens L, Lange I et al. (2020) Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults: A randomized controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL). Behav Res Ther, 128:103592.
53. Viskovich S, Pakenham KI (2020) Randomized controlled trial of a web‐based acceptance and commitment therapy (ACT) program to promote mental health in university students. J Clin Psychol, 76:929-951.
54. Wang J, Fang S, Yang, C, Tang X, Zhu L, Nie Y (2023) The relationship between psychological flexibility and depression, anxiety and stress: a latent profile analysis. Psychol Res Behav Manag, 16:997-1007.
55. WHO (2017) Depression and Other Common Mental Disorders: Global Health Estimates Geneva, World Health Organization.
56. Yüncü Ö, Aktan EA (2024) The impact of acceptance and commitment therapy on trauma and psychological flexibility among university students affected by the earthquake. Experimental and Applied Medical Science, 4:559–572.
57. Zemestani M, Mozaffari S (2020) Acceptance and commitment therapy for the treatment of depression in persons with physical disability: a randomized controlled trial. Clin Rehabil, 34:938-947.
58. Zettle RD, Rains JC, Hayes SC (2011) Processes of change in acceptance and commitment therapy and cognitive therapy for depression: A mediation reanalysis of Zettle and Rains. Behav Modif, 35:265-283.