Acceptance and Commitment Therapy (ACT) in End-of-Life Care: A Meta-Analysis of Efficacy and Process of Change

• Juanjo Macías ^[1] ; Lucía Lara-Merín ^[2] ; Carlos López-Pinar ^[2]
  1. [1] Universidad de Burgos

     Universidad de Burgos

     Burgos, España

     
  2. [2] European University of Valencia
• Localización: Psicothema, ISSN-e 1886-144X, ISSN 0214-9915, Vol. 38, Nº. 3, 2026, págs. 123-137
• Idioma: inglés
• DOI: 10.70478/psicothema.2026.38.12
• Títulos paralelos:
  • Terapia de Aceptación y Compromiso (ACT) en Cuidados al Final de la Vida: Un Metaanálisis de Eficacia y Procesos de Cambio
• Enlaces
  • Texto completo
• Resumen
  • español

    Introducción: La Terapia de Aceptación y Compromiso (ACT) es una psicoterapia basada en procesos que proporciona atención compasiva y centrada en la persona en cuidados paliativos. Este estudio evalúa la eficacia de ACT en calidad de vida (CdV) y malestar emocional, y examina variables de proceso (p.ej., flexibilidad psicológica). Método: Se buscó en PubMed, Scopus y PsycInfo estudios que midieran CdV, síntomas de ansiedad/depresión, y variables de proceso en intervenciones ACT. Se realizaron metaanálisis de efectos aleatorios y metarregresiones. Se evaluó el riesgo de sesgo. Resultados: Se incluyeron 13 estudios (1,109 participantes; Medad = 61,5; 55,7% mujeres; 6 ECA). ACT mostró efectos moderados significativos en CdV, ansiedad y depresión frente a grupos de control activos (SMD = 0,44 to 0,62), mantenidos en el seguimiento de 1-9 meses (SMD = 0,35 to 0,56). Las intervenciones presenciales mostraron resultados superiores a las remotas. Conclusiones: Estos hallazgos apoyan la relevancia clínica de ACT para abordar malestar psicológico y mejorar CdV en cuidados al final de la vida. Las limitaciones incluyen sesgo de autoinforme, alta heterogeneidad, solapamiento entre medidas, sesgo de publicación para CdV y tamaños muestrales limitados. Se requieren ensayos de alta calidad en poblaciones no oncológicas, cuidadores y profesionales sanitarios.

  • English

    Background: Acceptance and Commitment Therapy (ACT) is an evidence-based, process-oriented psychotherapy that provides palliative care through compassionate, person-centered care for terminal illness. This study evaluates the effects of ACT on quality of life (QoL) and emotional distress and examines the role of process variables (e.g., psychological flexibility). Method: Systematic review with meta-analysis following searches in PubMed, SCOPUS and PsycInfo for studies measuring QoL, anxiety/depression symptoms, and process variables in ACT interventions.

    Random-effects meta-analyses and meta-regressions were performed. Risk of bias was assessed. Results: 13 studies were included (1,109 participants; Mage = 61.5; 55.7% women; 6 RCTs). ACT showed significant, moderate effects for QoL, anxiety and depression symptoms versus active controls (SMD = 0.44 to 0.62), sustained at 1-9 months followup (SMD = 0.35 to 0.56). Psychological flexibility emerged as the strongest predictor of QoL improvement. Face-toface interventions demonstrated better results than remote delivery. Conclusions: These findings support the clinical relevance of ACT as an effective approach for addressing psychological distress and improving QoL in end-of-life care. Key limitations include self-report bias, high heterogeneity, potential overlap between measures, publication bias for QoL, and limited sample sizes in some analyses. High-quality trials are warranted, particularly in non-oncological populations, caregivers, and healthcare professionals.

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