The current systematic and meta-analytic review sought to integrate a growing number of studies examining dimensions of psychological flexibility as treatment mechanisms for Acceptance and Commitment Therapy (ACT). Analyses of 77 records (67 unique studies; N = 9123 participants) from comprehensive searches of multiple databases suggested that ACT interventions led to reduced inflexibility (i.e., lowered global inflexibility, lack of present moment awareness, cognitive fusion, experiential avoidance, self-as-content, & inaction) and increased flexibility (i.e., committed action/contact with values, global flexibility/acceptance, & defusion). Those changes remained significant when ACT was compared with waitlist or active treatments and were significantly linked to corresponding drops in psychological distress, supporting their roles as ACT treatment mechanisms. Moderation analyses revealed that the use of student samples, exclusion of clinically symptomatic individuals, and comparisons of ACT with other active treatments weakened these effects whereas offering ACT as an individual therapy and excluding individuals in extreme crisis (i.e., with suicidal ideation) strengthened them. The meta-analytic findings and systematic review suggested specific recommendations for future clinical work and research on ACT mechanisms: (1) Evaluate both psychological flexibility and inflexibility as distinct treatment mechanisms, (2) Evaluate specific dimensions of psychological flexibility/inflexibility as mechanisms with multidimensional scales (CompACT, MPFI), (3) Broaden treatment outcomes to include forms of wellbeing (peace of mind, vitality, connectedness), (4) Assess mechanisms and outcomes repeatedly throughout treatment to model the process of therapeutic change, (5) Investigate non-specific factors (therapeutic alliance, treatment adherence) as mechanisms, and (6) Explore treatment mechanisms in effectiveness studies.

中文翻译：

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检查心理灵活性和不灵活性领域作为接受和承诺疗法中的治疗机制：全面的系统和荟萃分析综述


当前的系统和荟萃分析综述试图整合越来越多的研究，以检验心理灵活性的维度作为接受和承诺疗法（ACT）的治疗机制。对多个数据库的综合检索中的 77 项记录（67 项独特的研究；N = 9123 名参与者）进行的分析表明，ACT 干预措施可以减少不灵活性（即降低整体不灵活性、缺乏当下意识、认知融合、经验性回避、自我作为） -内容和不作为）和增加的灵活性（即，承诺的行动/与价值观的接触，全球灵活性/接受和解散）。当 ACT 与候补治疗或积极治疗进行比较时，这些变化仍然很显着，并且与相应的心理困扰下降显着相关，支持了 ACT 治疗机制的作用。适度分析显示，使用学生样本、排除有临床症状的个体以及将 ACT 与其他积极治疗进行比较削弱了这些效果，而将 ACT 作为个体治疗并排除处于极端危机（即有自杀意念）的个体则增强了这些效果。 荟萃分析结果和系统评价为 ACT 机制的未来临床工作和研究提出了具体建议：（1）将心理灵活性和不灵活性作为不同的治疗机制进行评估，（2）将心理灵活性/不灵活性的具体维度作为多维机制进行评估量表（CompACT、MPFI），(3) 扩大治疗结果，包括幸福感的形式（内心平静、活力、连通性），(4) 在整个治疗过程中反复评估机制和结果，以模拟治疗变化的过程，(5) 调查非特异性因素（治疗联盟、治疗依从性）作为机制，（6）在有效性研究中探索治疗机制。