Acceptance and commitment therapy for couples: A systematic review and meta-analysis

Abstract

Couple interventions have a long tradition, yet their effectiveness is generally less well-known than that of individual therapies, particularly within contextual therapies. Although Acceptance and Commitment Therapy (ACT) has already gathered significant evidence of effectiveness in various psychological health problems and disorders, its application in the context of couple therapy has not been thoroughly analyzed. A systematic review and meta-analysis were conducted, involving a total of 17 randomized controlled trials (RCTs), examining effectiveness in various areas of couple functioning. The analyses revealed that ACT was more effective than passive control groups for alexithymia, anxiety, communication skills, fertility quality of life, marital intimacy, marital satisfaction, psychological well-being, physical health, and relational social functioning. It did not, however, have any significant effect on marital burnout, marital conflict, or conflict resolution. ACT was also effective in post-traumatic stress disorder, but in a joint intervention with Mindfulness-Based Cognitive Therapy (MBCT). When compared with active controls, ACT was sometimes similar and sometimes inferior in results. For instance, ACT, Integrative Behavioral Couple Therapy (IBCT), and CBCT all increased marital intimacy, but with no significant difference between them (g = −0.26, 95% CI: −0.98, 0.46; I² = 0%). ACT, IBCT and Emotionally Focused Couples Therapy (EFCT) also all helped social functioning, and EFCT and ACT both fostered forgiveness. However, CBCT was clearly superior to ACT in improving marital satisfaction (g = −1.23, 95% CI: −1.86, −0.59; I² = 0%) and ACT was also beaten out by Schema Therapy for fostering forgiveness. Imago therapy seems to help anxiety more than ACT while ACT helped more with physical health. The RCTs included in the review exhibit a significant series of biases and limitations, which were analyzed in detail. Taking these limitations into account, although ACT can be a promising therapy for some couple difficulties, it still needs to gather more evidence of effectiveness with new, better-controlled studies, carried out in a wider variety of countries and cultures, with well-defined protocols and comparisons with active controls like EFCT, IBCT, and CBCT, all of which have more empirical support.