Effect of acceptance and commitment therapy on psychological symptoms and disease activity in patients with inflammatory bowel disease: A systematic review and meta-analysis.

BACKGROUND

Inflammatory Bowel Disease (IBD) negatively impacts quality of life, increasing the risk of psychological disorders. Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that has shown promise for individuals living with chronic illnesses. This meta-analysis aims to explore the efficacy of ACT in managing psychological symptoms in patients with IBD, compared to usual care.

METHODS

A systematic search was conducted across PubMed, Web of Science, SCOPUS, CENTRAL, and Google Scholar from inception to August 2025. Eligible studies comprised randomized controlled trials and quasi-experimental studies that compared ACT with usual or other interventions in IBD patients. Standardized Mean Differences (SMDs) with 95% confidence intervals (CIs) were calculated for assessed continuous outcomes.

PROSPERO ID: CRD420251153446.

RESULTS

Nine studies involving 459 patients were included. ACT significantly reduced anxiety scores compared to non-ACT (SMD = -0.34; 95% CI: [-0.56 to -0.12]; P < 0.01). Still, the improvements in depression (P = 0.08), stress (P = 0.08), Crohn's disease activity (P = 0.06), and ulcerative colitis activity (P = 0.59) were not statistically significant compared to non-ACT. Subgroup analysis indicated significant improvements in anxiety (SMD = -0.34; 95% CI: -0.64 to -0.03; P = 0.03, I² = 0%), depression (SMD = -0.44; 95% CI: [-0.80 to -0.08]; P = 0.02) and stress (SMD = -0.55; 95% CI: [-0.92 to -0.19]; P < 0.01) scores when ACT was compared with treatment-as-usual. In contrast, no significant differences in depression, anxiety, or stress were found between ACT and other active psychoeducational interventions. Anxiety score was significantly improved post-intervention (SMD = -0.37; 95% CI: [-0.70 to -0.04]; P = 0.03) and at 1-2 months (SMD = -0.33; 95% CI: [-0.63 to -0.03]; P = 0.03), while stress score was significantly improved at 1-2 months (SMD = -0.41; 95% CI: [-0.74 to -0.07]; P = 0.02).

CONCLUSION

ACT reduced anxiety, depression, and stress versus treatment-as-usual. Additionally, ACT reduced anxiety and stress scores at 1-2 months versus the control group. However, no improvement was observed in CD or UC activity. ACT was not superior to other active controls, such as CBT. Larger, longer follow-up periods and randomized trials are needed to confirm effects on psychological outcomes and disease activity.