Acceptance and Commitment Therapy May Be Associated With Reduced Post-Stroke Depressive Symptoms

Acceptance and Commitment Therapy may be associated with statistically significant reductions in both depressive and anxiety symptoms among stroke patients immediately following treatment, according to a systematic review and meta-analysis published in Frontiers in Neurology. In synthesizing post-intervention outcomes across randomized controlled trials, the research team found that the therapy may be associated with reductions in depressive and anxiety symptoms. Specifically, pooled estimates for depressive symptoms showed a standardized mean difference of −1.32, with a 95 percent confidence interval ranging from −1.80 to −0.84. Concurrently, post-intervention anxiety symptoms showed a similar reduction, yielding a pooled standardized mean difference of −1.36, with a 95 percent confidence interval spanning from −1.90 to −0.82.

The investigation was situated within the clinical context of stroke rehabilitation, recognizing stroke as a leading cause of disability worldwide that is frequently accompanied by significant psychological and functional impairments. While previous reviews had suggested potential beneficial effects of the therapy in stroke populations, whether those improvements persist in the short term after the intervention ends, along with the overall certainty of the underlying evidence, had remained unclear in the medical literature.

Reductions in depressive symptoms remained statistically significant during follow-up assessments, registering a standardized mean difference of −0.76 with a 95 percent confidence interval between −1.07 and −0.45. Conversely, the improvement previously observed in anxiety symptoms was not maintained to a statistically significant degree at follow-up, where the analysis revealed a standardized mean difference of −0.51 with a 95 percent confidence interval crossing zero from −1.42 to 0.40.

The systematic review also examined broader psychological and health-related parameters, observing that Acceptance and Commitment Therapy may be associated with improvements in psychological flexibility, overall quality of life, and sleep quality. However, the study authors emphasized that these secondary psychological findings must be interpreted cautiously by clinicians and researchers. These positive signals were supported by only a limited number of trials within the evidence base, and each of these secondary domains exhibited considerable statistical heterogeneity, with I-squared values spanning from 74.68 percent to 92.26 percent across the pooled analyses.

The researchers reported that no statistically significant effects were observed for activities of daily living, neurological function, or hope. Consequently, the review concluded that evidence for functional recovery remains insufficient.

Methodologically, the work was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was prospectively registered in PROSPERO under identifier CRD420261325108. The final evidence synthesis incorporated 22 randomized controlled trials comprising a total of 1,975 participants, with pooled effect sizes calculated utilizing random-effects models across distinct post-intervention and follow-up measurement intervals.

Statistical evaluations of the trial data revealed considerable heterogeneity among included studies at post-intervention, with I-squared values reaching 93.68 percent for depressive symptoms and 93.60 percent for anxiety symptoms. Because heterogeneity was considerable, the investigators noted that the pooled estimates represent average effects across studies. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity, indicating that intervention duration may not be a significant moderator of treatment effects.

Methodological quality across the primary studies was formally evaluated using the Cochrane Risk of Bias 2 tool, and the certainty of evidence for each outcome was rated through the Grading of Recommendations Assessment, Development and Evaluation framework. The authors concluded that Acceptance and Commitment Therapy may serve as a useful adjunctive intervention for improving psychological outcomes in people with stroke, while reiterating that evidence for functional recovery remains insufficient.

Subject of Research: Effects of acceptance and commitment therapy on psychological and health outcomes in stroke rehabilitation

Article Title: Effects of acceptance and commitment therapy on psychological and health-related outcomes in stroke patients: a systematic review and meta-analysis of randomized controlled trials

Article References: Li, X., Huang, W., Gao, Y., Wu, Y., & Wang, P. (2026). Effects of acceptance and commitment therapy on psychological and health-related outcomes in stroke patients: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Neurology, 17, Article 1953111. https://doi.org/10.3389/fneur.2026.1953111

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DOI: 10.3389/fneur.2026.1953111

Keywords: acceptance and commitment therapy, stroke rehabilitation, depressive symptoms, anxiety symptoms, psychological flexibility, quality of life, sleep quality, activities of daily living, neurological function, systematic review, meta-analysis, randomized controlled trials, random-effects models, risk of bias 2, grade framework, prospero crd420261325108, heterogeneity, intervention duration