JMIR Publications

ABSTRACT

Background:

Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, mindfulness-based psychological treatment for anxiety. However, there are treatment barriers (e.g. financial, geographical, and attitudinal) which prevent people from accessing it. To overcome these barriers, internet-delivered Acceptance and Commitment Therapy (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises online, either as pure self-help or with therapist guidance.

Objective:

The present systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardised measure of anxiety. Data on participant characteristics, intervention delivery, anxiety outcomes, user attrition rates, and treatment satisfaction were extracted to help identify efficacious and acceptable interventions, elucidate research gaps, and guide the design, development and administration of new iACT programs.

Methods:

The Embase, Medline, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by two authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Included studies were appraised on methodological quality and had their data extracted into a standardised coding sheet. Findings were then tabulated and a narrative synthesis was performed due to the heterogeneity found between studies.

Results:

Twenty studies met inclusion criteria. There were 11 randomised controlled trials and 9 uncontrolled pilot studies. Participants across all studies were adults. Treated anxiety conditions included: generalised anxiety disorder, social anxiety disorder, illness anxiety disorder, and general anxiety symptoms with or without comorbid physical and/or mental health problems. Eighteen studies reported significant anxiety reduction after iACT treatment with effect sizes ranging from small to large. This was observed in studies that delivered iACT with (n = 13) or without (n = 5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 24.21%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction.

Conclusions:

These findings indicate that iACT can be an efficacious and acceptable treatment for adults with generalised anxiety disorder and general anxiety symptoms. More randomised controlled trial studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (e.g. internet-delivered cognitive behavioural therapy). This would potentially validate the promising results found for social anxiety disorder and illness anxiety disorder as well as address the full spectrum of anxiety disorders.