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Acceptance and commitment therapy
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==Evidence == === Small effect sizes === The effect sizes for ACT have generally been small to moderate.<ref name="Veehof2016" /> Meta-analyses have shown that ACT is no more effective in the treatment of chronic pain and other health problems than traditional cognitive behavioral therapy.<ref name="Veehof2016" /><ref name="Simister" /> The quality of ACT trials is considered to be low because of the frequent use of inactive treatment comparisons.<ref name="Hann2014" /> Proponents of ACT have been criticized for focusing on promotion and slogans instead of gathering reliable scientific evidence.<ref name="Coyne2017-08">{{Cite web | url = https://jcoynester.wordpress.com/2017/08/20/is-acceptance-and-commitment-therapy-act-in-a-post-evidence-phase/ | title = Is acceptance and commitment therapy (ACT) in a post-evidence phase? | last = Coyne | first = James C. | author-link = James Coyne | date = 2017-08-20 | website = Quick Thoughts|language=en | access-date = 2019-03-17}}</ref>=== Studies on acceptance and psychological flexibility === Several studies investigated the role of acceptance in ME/CFS patients. Van Damme et al.<ref name="Damme2006">{{Cite journal | last = Van Damme | first = Stefaan | last2 = Crombez | first2 = Geert | last3 = Van Houdenhove | first3 = Boudewijn | last4 = Mariman | first4 = An | last5 = Michielsen | first5 = Walter | date = Nov 2006 | title = Well-being in patients with chronic fatigue syndrome: the role of acceptance | url =https://www.ncbi.nlm.nih.gov/pubmed/17084136 | journal = Journal of Psychosomatic Research | volume = 61 | issue = 5 | pages = 595–599|doi=10.1016/j.jpsychores.2006.04.015|issn=0022-3999|pmid=17084136}}</ref> found that acceptance was related to more emotional stability and less psychological distress, even after controlling for the effects of demographic variables, and fatigue severity. Acceptance however was not related to functional impairment, somatic autonomy, mobility control, psychic autonomy, social behavior or mobility range. In a large study of 259 ME/CFS patients, Brooks et al.<ref name="Brooks2011">{{Cite journal | last = Brooks | first = Samantha K. | last2 = Rimes | first2 = Katharine A. | last3 = Chalder | first3 = Trudie | date = Dec 2011 | title = The role of acceptance in chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/22118384 | journal = Journal of Psychosomatic Research | volume = 71 | issue = 6 | pages = 411–415|doi=10.1016/j.jpsychores.2011.08.001|issn=1879-1360|pmid=22118384}}</ref> reported that lack of acceptance was associated with impaired physical functioning and work and social adjustment. Following CBT, acceptance increased, although there was no control group to account for placebo effects. Acceptance at baseline was not a predictor of outcomes of [[fatigue]], physical functioning or social adjustment, post-treatment. Poppe et al.<ref name="Poppe2013">{{Cite journal | last = Poppe | first = Carine | last2 = Petrovic | first2 = Mirko | last3 = Vogelaers | first3 = Dirk | last4 = Crombez | first4 = Geert | date = May 2013 | title = Cognitive behavior therapy in patients with chronic fatigue syndrome: the role of illness acceptance and neuroticism | url = https://www.ncbi.nlm.nih.gov/pubmed/23597322 | journal = Journal of Psychosomatic Research | volume = 74 | issue = 5 | pages = 367–372|doi=10.1016/j.jpsychores.2013.02.011|issn=1879-1360|pmid=23597322}}</ref> found that pre-treatment levels of acceptance were negatively correlated with changes in mental quality of life, suggesting that ME/CFS patients with low levels of acceptance benefit more from CBT. There was no correlation with physical quality of life however, and acceptance could only explain less than 10% of the variance in mental quality of life. Densham et al.<ref name="Densham2016">{{Cite journal | last = Densham | first = Sarah | last2 = Williams | first2 = Deborah | last3 = Johnson | first3 = Anne | last4 = Turner-Cobb | first4 = Julie M. | date = Sep 2016 | title = Enhanced psychological flexibility and improved quality of life in chronic fatigue syndrome/myalgic encephalomyelitis |url =https://www.ncbi.nlm.nih.gov/pubmed/27521652 | journal = Journal of Psychosomatic Research | volume = 88 | pages = 42–47|doi=10.1016/j.jpsychores.2016.07.009|issn=1879-1360|pmid=27521652}}</ref> tested psychological flexibility (PF) in patients with ME/CFS, a concept that is central to ACT. Following treatment with graded exercise or CBT, one aspect of PF improved (activity engagement), along with quality of life and fatigue severity. ===ME/CFS === A Swedish feasibility study of ACT in 40 patients with ME/CFS indicated that the treatment was accepted by participants, with a drop-out rate of 20% and no reported harmful effects during or after treatment.<ref name="Jonsjo2019" /> The primary outcome measured was psychological flexibility, which is a concept within ACT. The authors plan to do a larger randomized controlled trial with objective outcomes measures to test the efficacy of ACT in patients with ME/CFS.<ref name="Olsson2019">{{Cite web | url = https://www.s4me.info/threads/the-prevalence-and-impact-of-psychoneuroimmunological-factors-in-me-cfs-effects-and-mechanisms-of-act-2019-olsson-et-al.8461/ | title = The prevalence and impact of psychoneuroimmunological factors in ME/CFS: Effects and mechanisms of ACT (2019) Olsson et al. | website = Science for ME|language=en-US | access-date = 2019-03-17}}</ref> A larger randomized trial by Pedersen et al. compared ACT (2018) to enhanced care in patients with multiple functional somatic syndromes included many patients with [[chronic fatigue syndrome]].<ref name="Pedersen">{{Cite journal | last = Pedersen | first = Heidi Frølund | last2 = Agger | first2 = Johanne L. | last3 = Frosthom | first3 = Lisbeth | last4 = Jensen | first4 = Jens S. | last5 = Ørnbøl | first5 = Eva | last6 = Fink | first6 = Per | last7 = Schröder | first7 = Andreas | date = 2018-06-26 | title = Acceptance and Commitment group Therapy for patients with multiple functional somatic syndromes: a three-armed trial comparing ACT in a brief and extended version with enhanced care | url =https://www.ncbi.nlm.nih.gov/pubmed/29941062 | journal = Psychological Medicine | pages = 1–10|doi=10.1017/S0033291718001666|issn=1469-8978|pmid=29941062}}</ref> Approximately 75% of the 180 patients in the trial met diagnostic criteria for chronic fatigue syndrome. Although the primary outcome, patient-rated overall health improvement, was significantly greater in the ACT-group, most of the 18 secondary outcomes showed no change over time compared to the control group. According to the authors, the results suggest "limited or no clinical effect of ACT as compared with enhanced care."<ref name="Pedersen" />
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