The effect of acceptance and commitment therapy on negative emotions and quality of life in stroke patients: a systematic review and meta-analysis

Objectives Stroke survivors often experience depression, anxiety and declining quality of life. This systematic review and meta-analysis aimed to evaluate the efficacy of acceptance and commitment therapy (ACT)-based interventions (including ACT alone or ACT combined with conventional rehabilitation) compared with conventional rehabilitation in improving negative emotions and quality of life in stroke patients. Methods Two reviewers independently searched PubMed, Web of Science, Embase, the Cochrane Library, CNKI, Wanfang, VIP and SinoMed from database inception to August 31, 2025. Study selection, data extraction, and risk of bias assessment were independently performed by two reviewers. The methodological quality of included randomized controlled trials (RCTs) was evaluated using the Cochrane risk of bias tool. Meta-analyses were conducted using RevMan 5.4. A random-effects model was applied if heterogeneity (I 2 > 50%) was detected, otherwise a fixed-effects model was used. Results Nineteen RCTs involving 1704 patients were included. Meta-analysis showed that ACT significantly alleviated depression (SMD = −1.37, 95% CI −1.86 to −0.87, p < 0.00001) and anxiety (SMD = −1.25, 95% CI: −1.76 to −0.74, p < 0.00001) compared with control interventions. ACT also significantly enhanced quality of life (SMD = 1.36, 95% CI: 0.69 to 2.02, p < 0.0001). Positive effects were also observed on secondary outcomes including psychological flexibility, self-efficacy, sleep quality, and activities of daily living. Conclusion ACT is effective in alleviating depression and anxiety, as well as improving quality of life among stroke patients, demonstrating benefits across multiple psychological and functional domains. Future research should focus on large-scale, high-quality RCTs with standardized protocols to confirm long-term efficacy. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier: CRD420251113679.