Acceptance and Commitment Therapy for Psychosocial Outcomes in Children and Young People with Long-Term Conditions: A Systematic Review of Intervention Studies

Background: Children and young people (CYP) with long-term physical health conditions (LTCs) are at greater risk of psychosocial difficulties. Systematic reviews on adults with LTCs have supported acceptance and commitment therapy (ACT) in improving several psychosocial outcomes. Aims: This systematic review aimed to investigate the effectiveness of ACT for CYP-reported psychosocial outcomes among CYP with LTCs. It also examined the factors associated with better outcomes and the acceptability of the included interventions. Methods: Eligible studies used a quantitative experimental design to evaluate ACT for CYP-reported psychosocial outcomes in CYP (≤18 years old) with LTCs. Only studies published in English in peer-reviewed journals, from any year, were included. CINAHL (EBSCO), Cochrane Library, Embase (Ovid), MEDLINE (Ovid) and PsycInfo (Ovid) were systematically searched. Google Scholar and Web of Science were also searched and forward and backward citation searching were completed for included papers. Research quality was appraised using Cochrane risk of bias tools. Results were narratively synthesised. Results: Sixteen studies (nine randomised controlled trials [RCTs], seven non-RCTs) from 19 reports met inclusion criteria, with 777 participants and five LTCs (chronic pain, diabetes, cancer, obesity, visual impairment). Findings provided preliminary support for the effectiveness of ACT on most CYP-reported psychosocial outcomes studied. Seven studies considered factors associated with intervention effects, with mixed findings. Acceptability was supported in the three studies that assessed it quantitatively. However, almost all studies had overall high/serious risk of bias ratings. Conclusions: There is preliminary evidence supporting ACT for improving psychosocial outcomes in CYP with LTCs, with limited but supportive findings for its acceptability. However, findings are constrained by high/serious risk of bias and small sample sizes. Larger, high-quality trials with active controls and longer follow-ups are needed to inform future care pathways. Registration: This systematic review was pre-registered (PROSPERO registration number: CRD42023425918).