Relieve Anxiety Disorders with Online Acceptance and Commitment Therapy

Relieve Anxiety Disorders with Online Acceptance and Commitment Therapy


By John M. de Castro, Ph.D.


“The essential components of ACT include letting go of the struggle to control unwanted thoughts and feelings, being mindfully aware of the present moment, and committing to a course of action that is consistent with what you value most in life. . . Acceptance of your anxious thoughts and feelings allows you to focus more clearly on the present and to take the steps that move you closer to the life you truly want to live.” – AnxietyHappens


Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders.


A therapeutic technique that contains mindfulness training is Acceptance and Commitment Therapy (ACT). It is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT) and has also been shown to relieve anxietyACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.


The original form of Acceptance and Commitment Therapy (ACT), however, required a certified trained therapist. This resulted in costs that many clients couldn’t afford. In addition, the participants had to be available to attend multiple sessions at particular scheduled times that were not always compatible with busy schedules and at locations that were not always convenient. As an alternative, mindfulness-based treatments delivered over the internet have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But the question arises as to the effectiveness of ACT for anxiety disorder when delivered over the internet.



In today’s Research News article “Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review.” (See summary below or view the full text of the study at: ), Kelson and colleagues review and summarize the published research literature on the effectiveness of Acceptance and Commitment Therapy (ACT) delivered online for the treatment of Anxiety Disorders. They discovered 20 published studies.


They found that on average 81% of participants completed the online ACT program. They also found that the ACT program produced small to moderate significant reduction in anxiety. These include generalized anxiety disorder, social anxiety disorder, and illness anxiety disorder. Hence, the published research suggests that Acceptance and Commitment Therapy (ACT) delivered online is effective for the treatment of Anxiety Disorders. This adds to the list of mindfulness-based therapies that can be successfully delivered online. This is important as online presentation is inexpensive, convenient, and available to a very large population of anxiety disorder sufferers.


So, relieve anxiety disorders with online acceptance and commitment therapy


Research has shown that ACT can produce symptom improvement in people with GAD, and it may also be a particularly good fit for older adults.” – Deborah Glasofer


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


Kelson, J., Rollin, A., Ridout, B., & Campbell, A. (2019). Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. Journal of medical Internet research, 21(1), e12530. doi:10.2196/12530




Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises on the Web, either as pure self-help or with therapist guidance.


This systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions.


The EMBASE, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by 2 authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardized measure of anxiety. Included studies were appraised on methodological quality and had their data extracted into a standardized coding sheet. Findings were then tabulated, and a narrative synthesis was performed because of the heterogeneity found between studies.


A total of 20 studies met inclusion criteria. There were 11 randomized controlled trials (RCTs) and 9 uncontrolled pilot studies. Participants across all studies were adults. The anxiety conditions treated were as follows: generalized anxiety disorder (GAD), social anxiety disorder (SAD), illness anxiety disorder (IAD), and general anxiety symptoms, with or without comorbid physical and mental health problems. A total of 18 studies reported significant anxiety reduction after iACT treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 19.19%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction.


These findings indicate that iACT can be an efficacious and acceptable treatment for adults with GAD and general anxiety symptoms. More RCT studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (eg, internet-delivered cognitive behavioral therapy). This would potentially validate the promising results found for SAD and IAD as well as address the full spectrum of anxiety disorders.


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