Effect of acceptance and commitment therapy for anxiety disorders: a systematic review and meta-analysis

Acceptance and commitment therapy (ACT) has been increasingly applied in the treatment of anxiety disorders. However, evidence regarding its effectiveness specifically in patients with anxiety disorders has not been comprehensively synthesized. To systematically evaluate the intervention effect of acceptance and commitment therapy (ACT) for anxiety disorders. Databases, including Web of Science, Embase, PubMed, the Cochrane Library, APA PsycNET and OVID MEDLINE, were systematically searched from their inception to November 2025. The risk of bias of included RCTs was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and the certainty of evidence was evaluated using the GRADE approach. Meta-analysis was conducted via RevMan 5.3 software. A total of 8 randomized controlled trials involving 1173 patients were ultimately included. Compared with the WL, ACT was associated with reduced anxiety symptoms ( SMD = −0.67, 95% CI [−0.91, −0.43], p < 0.00001), improved quality of life ( SMD = 0.51, 95% CI [0.20, 0.83], p = 0.001) and improved psychological flexibility ( SMD = 0.63, 95% CI [0.47, 0.79], p < 0.00001) in patients with anxiety disorders. Subgroup analyses found no significant differences according to intervention format ( p = 0.11) or intervention duration ( p = 0.99). Compared with CBT, ACT showed no significant differences in anxiety symptoms ( SMD = 0.19, 95% CI [−0.14, 0.52], p = 0.26), quality of life ( SMD = −0.19, 95% CI [−0.39, 0.00], p = 0.06), or psychological flexibility ( SMD = 0.07, 95% CI [−0.30, 0.43], p = 0.73). The certainty of evidence ranged from low to moderate according to the GRADE assessment. Current evidence suggests that ACT may improve clinical outcomes in individuals with anxiety disorders compared with WL. The current evidence does not indicate a clear difference in treatment effects between ACT and CBT for anxiety disorders. These findings should be interpreted cautiously because the certainty of evidence ranged from low to moderate. Not applicable