Meta-Analysis Evaluates Acceptance and Commitment Therapy for Treating Anxiety Disorders

A systematic review and meta-analysis of eight randomized controlled trials found that acceptance and commitment therapy is associated with reduced anxiety symptoms, improved quality of life, and enhanced psychological flexibility compared with waitlist controls in patients with anxiety disorders, while demonstrating no clear difference in outcomes when compared with cognitive behavioral therapy.

The study authors initiated the synthesis to evaluate the intervention effect of acceptance and commitment therapy specifically for anxiety disorders, noting that while the therapy has been increasingly applied in clinical treatment, evidence addressing its efficacy in this specific diagnostic population had not been comprehensively synthesized.

To assemble the evidence base, investigators conducted systematic searches across six literature databases, including Web of Science, Embase, PubMed, the Cochrane Library, APA PsycNET, and OVID MEDLINE, covering records from database inception through November 2025. Following screening, eight randomized controlled trials comprising a total of 1,173 patients met the inclusion criteria for quantitative analysis.

Methodological quality across the included randomized controlled trials was evaluated using the Cochrane Risk of Bias 2 tool, while the overall certainty of evidence for each outcome was rated using the Grading of Recommendations Assessment, Development and Evaluation approach, with statistical meta-analysis performed using RevMan 5.3 software.

In comparisons against waitlist controls, acceptance and commitment therapy was associated with a statistically significant reduction in anxiety symptoms, yielding a standardized mean difference of -0.67 with a 95 percent confidence interval of -0.91 to -0.43 (p < 0.00001). Patients receiving the intervention also experienced statistically significant improvements in quality of life (standardized mean difference = 0.51, 95 percent confidence interval [0.20, 0.83], p = 0.001) and psychological flexibility (standardized mean difference = 0.63, 95 percent confidence interval [0.47, 0.79], p < 0.00001).

Subgroup analyses exploring potential sources of variation showed no statistically significant differences in outcomes based on intervention format (p = 0.11) or intervention duration (p = 0.99).

When compared directly against cognitive behavioral therapy, acceptance and commitment therapy showed no statistically significant differences across any measured outcome, including anxiety symptoms (standardized mean difference = 0.19, 95 percent confidence interval [-0.14, 0.52], p = 0.26), quality of life (standardized mean difference = -0.19, 95 percent confidence interval [-0.39, 0.00], p = 0.06), and psychological flexibility (standardized mean difference = 0.07, 95 percent confidence interval [-0.30, 0.43], p = 0.73).

The certainty of the evidence base was assessed as ranging from low to moderate under the GRADE framework, leading the authors to conclude that while current data suggest acceptance and commitment therapy may improve clinical outcomes relative to waitlist conditions, findings should be interpreted cautiously and do not indicate a clear distinction in treatment effects between acceptance and commitment therapy and cognitive behavioral therapy.

Subject of Research: Efficacy of acceptance and commitment therapy for anxiety disorders

Article Title: Effect of acceptance and commitment therapy for anxiety disorders: a systematic review and meta-analysis

Article References: Zhang, Y., Zhao, B., Wang, Q., Ma, T., Xu, M., Chen, J., & Cheng, X. (2026). Effect of acceptance and commitment therapy for anxiety disorders: a systematic review and meta-analysis. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08804-5

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08804-5

Keywords: acceptance and commitment therapy, anxiety disorders, systematic review, meta-analysis, cognitive behavioral therapy, psychological flexibility, quality of life, clinical psychology, Effect, acceptance, commitment, therapy