The use of Acceptance and Commitment Therapy (ACT) in informal caregivers of people with dementia and other long-term or chronic conditions: A systematic review and conceptual integration

Golnaz L Atefi; Marjolein E de Vugt; Rosalia J M van Knippenberg; Michael E Levin; Frans R J Verhey; Sara Laureen Bartels

doi:10.1016/j.cpr.2023.102341

The use of Acceptance and Commitment Therapy (ACT) in informal caregivers of people with dementia and other long-term or chronic conditions: A systematic review and conceptual integration

Clin Psychol Rev. 2023 Nov:105:102341. doi: 10.1016/j.cpr.2023.102341. Epub 2023 Sep 25.

Authors

Golnaz L Atefi¹, Marjolein E de Vugt², Rosalia J M van Knippenberg², Michael E Levin³, Frans R J Verhey², Sara Laureen Bartels⁴

Affiliations

¹ Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands. Electronic address: g.atefi@maastrichtuniversity.nl.
² Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands.
³ Department of Psychology, Utah State University, Logan, UT 84322, USA.
⁴ Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands; Department of Clinical Neuroscience, Karolinska Institute, Sweden.

PMID: 37776577
DOI: 10.1016/j.cpr.2023.102341

Abstract

Informal caregivers are the primary source of support for adults with chronic conditions and disabilities. Empirical research highlights chronic stress and other risks of adverse outcomes of caregiving. Acceptance and Commitment Therapy (ACT) is an emerging evidenced-based practice that shows promise in improving an array of outcomes, theoretically by increasing psychological flexibility as the primary process of change. Research has begun to evaluate ACT among informal caregivers of adult populations, and a systematic review is now needed to summarise this evidence base. Electronic searches from five databases, including PubMed, PsycInfo, Embase, CINAHL, and Cochrane Library, yielded an initial 7896 hits, which after screening for inclusion criteria, resulted in 21 clinical trials. Studies were coded to synthesise the feasibility, effectiveness, and quality of evidence. Findings show that ACT was reported to be largely feasible and acceptable. However, the efficacy of ACT was mixed, with a more consistent pattern for informal caregivers of people with dementia. Several methodological quality issues limited the findings. However, theoretical synthesis and preliminary evidence support the promising effect of ACT in subgroups of informal caregivers. Research on the process of change, as well as larger-scale, methodologically rigorous trials, are needed to consolidate these findings.

Keywords: Acceptance and commitment therapy; Caregiver stress; Dementia; Informal caregivers; Long-term condition; Systematic review.

Publication types

Review