@article{a2201af671374c1c8b8172e069d84704,
title = "Acceptance and commitment therapy for insomnia and sleep quality: A systematic review and meta-analysis",
keywords = "Acceptance and commitment therapy, GRADE, Insomnia, Non-pharmacological, Psychological, Sleep",
author = "Jiayin Ruan and Shucheng Chen and Jiagui Liang and Mak, {Yim Wah} and {Yee Ho}, {Fiona Yan} and Chung, {Ka Fai} and {Kwun Tong}, {Anthony Kwok} and Zhang, {Xue Lin} and Yeung, {Wing Fai}",
note = "Funding Information: Acceptance and Commitment Therapy (ACT), one of the “third wave” behavior therapies, might be such a potential option. ACT, an evidence-based transdiagnostic approach, is suitable for treating both mental disorders and medical conditions (Dindo et al., 2017). This therapy relies on the philosophical principles of functional contextualism and adopts concepts from relational frame theory, a behavioral-analytic account of language, and human cognition (Hayes, 2016). The key goal of ACT is to promote psychological flexibility (i.e., the ability to be in contact with the present moment more fully by accepting unpleasant thoughts and feelings and commit to behaviors that are congruent with deeply held values), which is established through six core processes: acceptance, cognitive defusion, self as context, being present, values, and committed action (Kashdan & Rottenberg, 2010). Unlike CBT, symptom reduction (e.g., alleviating insomnia) is not the primary goal of ACT but occurs as a byproduct (Harris, 2006). Several potential explanations support the application of ACT in the treatment of sleep disorders.Fourteen ACT interventions were described in total, performed by different instructors (Baik, 2015; Chen et al., 2022; Davoudi et al., 2020; EI Rafihi-Ferreira et al., 2021; EI Rafihi-Ferreira et al., 2022; Huang et al., 2021; Lang et al., 2017; Monfaredi et al., 2022; Pelkonen & Puha, 2013; Rickardsson et al., 2021; Simister et al., 2018; Westin et al., 2011; Wiklund et al., 2018; Zakiei et al., 2021). Two studies did not report instructor information (Gao & He, 2015; Zhang, 2018). In two self-help ACT interventions, one involved therapists who provided guidance and support (Hesser et al., 2012) while the other was not aided by therapists (Lappalainen et al., 2019).Thus, future trials should adopt strategies to reduce attrition, such as the use of text message reminders and recordings to provide evidence for fidelity reporting. Data analysts should conduct intention-to-treat analysis and sensitivity analysis to achieve a more accurate estimate of the effectiveness of ACT in primary studies. Moreover, although double-blinded ACT designs for sleep studies are difficult to perform, researchers are encouraged to utilize objective measures, such as actigraphy and polysomnography, combined with subjective sleep outcome measurements to decrease the influence of ACT on outcome measures, as participants would be aware of the intervention being administered. Furthermore, trials should report the study results according to consolidated standards of reporting trials (Grant et al., 2018). In addition, the study protocols should be provided to readers, including the revised versions. Additionally, a pre-specified statistical analysis that adopts a standard framework such as Pre-SPEC should be used to reduce reporting bias (Kahan et al., 2020).The present systematic review and meta-analysis conditionally suggested that ACT might be an efficacious method for treating insomnia and improving sleep quality at posttreatment and/or short-term follow-up when compared with waitlist control and education/discussion control, but its long-term effectiveness is uncertain. In interpreting and generalizing the findings of this review, caution should be exercised because of the limited number of available studies and concerns regarding the quality of the studies included in this review. Further high-quality RCTs with a larger sample size, rigorous design, and standard sleep outcome measures of ACT for sleep improvement should be conducted to generate more robust evidence to support its use.",
year = "2022",
month = oct,
doi = "10.1016/j.jcbs.2022.09.002",
language = "English",
volume = "26",
pages = "139--155",
journal = "Journal of Contextual Behavioral Science",
issn = "2212-1447",
publisher = "Elsevier Inc.",
}
