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The expanding evidence for the efficacy of ACT:

The expanding evidence for the efficacy of ACT: . results from a meta analysis on clinical applications. Earlier meta analysis. Hayes et al 2006 Ost, 2008 Powers et al, 2009 Veehof at al, 2011 Ruiz, 2012 . For Cohen's d an effect size of 0.2 to 0.3 might be a "small" effect,

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The expanding evidence for the efficacy of ACT:

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  1. The expanding evidence for the efficacy of ACT: resultsfrom a metaanalysisonclinicalapplications

  2. Earlier meta analysis • Hayes et al 2006 • Ost, 2008 • Powers et al, 2009 • Veehof at al, 2011 • Ruiz, 2012

  3. For Cohen's d an effect size of 0.2 to 0.3 might be a "small" effect, • around 0.5 a "medium" effect • and 0.8 to infinity, a "large" effect

  4. Hayes et al 2006 • Until spring 2005 • the meta-analysis examines the average relationship between the AAQ or its specific variants and measures of psychopathology and quality of life. • And, a simple version of outcome analysis • 17 studies, N=704

  5. Criteria for inclusion • RCT • articles and any other available data set (dissertation, paper) • Levitt, 2004 is not a treatment study • Acceptance based

  6. Results • weighting average effect sizes by the number of cases that produced the effect • ACT compared to general control conditions (9 studies): post: d =.66 (N=704) FU: d =.66 (N=519) • Comparisonsbetween ACT and structuredinterventions (12 studies): post: d =.48 (N=456) FU: d =.63 (N=404) • comparisons between ACT and C(B)T (4 studies): d =.73 at post and d = .83 at FU

  7. Overlap with other MA • 12 studies included in Ost • 12 studies included in Powers • 1 study included in Veehof • 5 studies included in Ruiz • 8 studies included in A-Tjak

  8. Öst, 2008 • from 1985 to mid 2007 • ACT and other third wave therapies • Complicated system of matching studies of ACT to studies of CBT • Rating methodological quality of studies: • CBT studies M = 27.8 (SD = 4.2) • ACT studies M = 18.1-18.32 (SD = 5.0).  

  9. Criteria for inclusion • RCT (13 studies, N = 677) • published or in press • Published in English • Acceptance based

  10. Results • an overall mean ES of 0.68 for ACT (13 studies; N = 677) • ACT compared to waitlist (2 studies) ES = 0.96 • ACT compared to TAU (5 studies) ES = 0.79 • ACT compared to an active treatment (two studies comparing ACT to (CT) and one to Systematic Desensitization) ES = 0.53

  11. Overlap with other MA • 12 studies included in Hayes (one dissertation now as article) • 13 studies included in Powers • 1 study included in Veehof • 4 studies included in Ruiz • 9 studies included in A-Tjak

  12. Powers et al, 2009 • Until March 2008 • RCT • 18 studies (N = 917) • Separate analysis for depression (2 studies), physical health (5 studies) and other mental health conditions (7 studies)

  13. Criteria for inclusion • RCT • Acceptance based treatments • mental and physical health disorders • Published in English

  14. Results • ACT versus all control conditions ES = 0.42 on primary outcome measures • ACT versus established treatments ES = 0.18 • ACT versus waitlist condition and psychological placebos ES = 0.68 on secondary measures • ACT versus TAU ES = 0.42 on secondary measures

  15. Overlap with other MA • 12 studies included in Hayes (one dissertation now as article) • 12 studies included in Öst • 1 study included in Veehof • 6 studies included in Ruiz • 12 studies included in A-Tjak (one study published in 2012 FU information)

  16. Veehof et al, 2011 • ACT and mindfulness • Rating methodological quality with an 8-point scale, based on criteria by the Cochrane Collaboration and the validated Jadad scale • Until Januari 2009 • 22 studies, of which 9 RCT, 2 of which are concerning ACT (also in other MA) • Chronic pain only

  17. Ruiz, 2012 • Until the end of July 2012 • 16 studies (N= 954) comparing ACT to CBT • Not all CBT recognized as such by author(s) • outcome or mediation/moderation

  18. Criteria for inclusion • Published and unpublished studies • outcome or mediation/moderation study • comparing full treatments of face-to-face ACT versus traditional CBT • Published in English or Spanish

  19. Results • ACT better than CBT on primary outcomes (Hedges’s g= 0.40). • Post: g+= 0.37 FU: g+= 0.42 • no statistically significant differences in depression (g+= 0.27) and anxiety outcomes (g+= 0.14) between ACT and CBT • supports the hypothesized mediators suggested in the ACT model

  20. Overlap with other MA • 5 studies included in Hayes • 4 studies included in Öst • 6 studies included in Powers • 7 studies included in A-Tjak

  21. A-Tjak et al submitted • Michelle Davis, Southern Methodist University • Nexh Morina, University of Amsterdam • Mark Powers, Southern Methodist University • Jasper Smits, Southern Methodist University • Paul Emmelkamp , University of Amsterdam

  22. Until March 2013 • 39 RCT, N = 1.818 • Methodological quality measured • a mean score of 23.88 for ACT studies (SD = 4.96) on the methodology rating scale

  23. Criteria for inclusion • RCT, acceptance based treatments • Published or retreivable information • Only clinically relevant populations: psychiatric or medical diagnosis or high score on relevant psychological questionnaire, treatment seeking/needing • at least 10 participants in the active condition(s) at post treatment

  24. Results on primary outcomes • ACT outperformed control conditions (39 studies, N = 1.818) Hedges’s g = 0.70 • waitlist and psychological placebos (14 studies, N = 583) Hedges’s g = 0.74 • TAU (14 studies, N =509) Hedges’ g = 1.13 • established treatments (i.e., CBT, CT, or HBE) (7 studies, N = 401) Hedges’s g = 0.07, non significant

  25. Results on secondary outcomes • ACT was superior to control conditions (34 studies, N = 1.556 participants) Hedges’s g = 0.44 • life satisfaction/quality measures (14 studies, N = 731) Hedges’s g = 0.60 • process measures (16 studies, N = 733) Hedges’s g = 0. 86

  26. Results per group of conditions • ACT was superior control conditions for anxiety/depression (8 studies, N = 378 ) Hedges’s g = 1.35 • For addiction (8 studies, N = 501) Hedges’s g = 0.35 • For somatic complaints (15 studies, N = 682) Hedges’s g = 0.62 • For other mental disorders (8 studies, N = 258) Hedges’s g = 0.86

  27. Methodological Rating Scale Ost (2008)

  28. Overlap with other MA • 8 studies included in Hayes • 8 studies included in Öst • 11 studies included in Powers • 7 studies included in Ruiz • 22 studies included in no other MA

  29. Comparison of aspects of MA

  30. Comparison on primary and process measures

  31. Comparison on secundary measures and quality of life

  32. Comparison per group of conditions

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