Group-based acceptance and commitment therapy interventions for improving general distress and work-related distress in healthcare professionals : a systematic review and meta-analysis

Prudenzi, Arianna and Graham, Christopher D. and Clancy, Faye and Hill, Deborah and O'Driscoll, Ruairi and Day, Fiona and O'Connor, Daryl B. (2021) Group-based acceptance and commitment therapy interventions for improving general distress and work-related distress in healthcare professionals : a systematic review and meta-analysis. Journal of Affective Disorders, 295. pp. 192-202. ISSN 0165-0327 (https://doi.org/10.1016/j.jad.2021.07.084)

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Abstract

Background: A large proportion of the healthcare workforce reports significant distress and burnout, which can lead to poor patient care. Several psychological interventions, such as Acceptance and Commitment Therapy (ACT), have been applied to improve general distress and work-related distress in healthcare professionals (HCPs). However, the overall efficacy of ACT in this context is unknown. This review and meta-analysis aimed to: 1) test the pooled efficacy of ACT trials for improving general distress and reducing work-related distress in HCPs; 2) evaluate the overall study quality and risk of bias; and 3) investigate potential moderators of intervention effectiveness. Method: Four databases (Ovid MEDLINE, EMBASE, PsycINFO, CINHAL) were searched, with 22 pre-post design and randomised controlled trial (RCTs) studies meeting the inclusion criteria. 10 RCTs studies were included in the meta-analysis. Results: Two random effects meta-analyses on general distress and work-related distress found that ACT outperformed pooled control conditions with a small effect size for general distress at post-intervention (g = 0.394, CIs [.040; .748]) and for work-related distress (g = 0.301, CIs [.122; .480]) at follow-up. However, ACT was more effective than controls. The number of treatment sessions was a moderator of intervention efficacy for general distress. ACT process measures (psychological flexibility) did not show significantly greater improvements in those who received the intervention. Limitations: The methodological quality of studies was poor and needs to be improved. Conclusions: Overall, ACT interventions are effective in improving general distress and work-related distress in HCPs. These findings have implications for policymakers, healthcare organisations and clinicians.

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