Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND): a multicentre, parallel, randomised controlled trial in the UK

BackgroundGiven the degenerative nature of the condition, people living with motor neuron disease (MND) experience high levels of psychological distress. The purpose of this research was to investigate the cost‐effectiveness of acceptance and commitment therapy (ACT), adapted for the specific needs of this population, for improving quality of life.MethodsA trial‐based cost–utility analysis over a 9‐month period was conducted comparing ACT plus usual care (n = 97) versus usual care alone (n = 94) from the perspective of the National Health Service. In the primary analysis, quality‐adjusted life years (QALYs) were computed using health utilities generated from the EQ‐5D‐5L questionnaire. Sensitivity analyses and subgroup analyses were also carried out.ResultsDifference in costs was statistically significant between the two arms, driven mainly by the intervention costs. Effects measured by EQ‐5D‐5L were not statistically significantly different between the two arms. The incremental cost‐effectiveness was above the £20,000 to £30,000 per QALY gained threshold used in the UK. However, the difference in effects was statistically significant when measured by the McGill Quality of Life‐Revised (MQOL‐R) questionnaire. The intervention was cost‐effective in a subgroup experiencing medium deterioration in motor neuron symptoms.ConclusionsDespite the intervention being cost‐ineffective in the primary analysis, the significant difference in the effects measured by MQOL‐R, the low costs of the intervention, the results in the subgroup analysis, and the fact that ACT was shown to improve the quality of life for people living with MND, suggest that ACT could be incorporated into MND clinical services.

BackgroundMotor neuron disease (MND) is a rapidly progressive, fatal neurodegenerative disease that predominantly affects motor neurons from the motor cortex to the spinal cord and causes progressive wasting and weakening of bulbar, limb, abdominal and thoracic muscles. Prognosis is poor and median survival is 2–3 years following symptom onset. Psychological distress is relatively common in people living with MND. However, formal psychotherapy is not routinely part of standard care within MND Care Centres/clinics in the UK, and clear evidence-based guidance on improving the psychological health of people living with MND is lacking. Previous research suggests that Acceptance and Commitment Therapy (ACT) may be particularly suitable for people living with MND and may help improve their psychological health.AimsTo assess the clinical and cost-effectiveness of ACT modified for MND plus usual multidisciplinary care (UC) in comparison to UC alone for improving psychological health in people living with MND.MethodsThe COMMEND trial is a multi-centre, assessor-blind, parallel, two-arm RCT with a 10-month internal pilot phase. 188 individuals aged ≥ 18 years with a diagnosis of definite, laboratory-supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis, and additionally the progressive muscular atrophy and primary lateral sclerosis variants, will be recruited from approximately 14 UK-based MND Care Centres/clinics and via self-referral. Participants will be randomly allocated to receive up to eight 1:1 sessions of ACT plus UC or UC alone by an online randomisation system. Participants will complete outcome measures at baseline and at 6- and 9-months post-randomisation. The primary outcome will be quality of life at six months. Secondary outcomes will include depression, anxiety, psychological flexibility, health-related quality of life, adverse events, ALS functioning, survival at nine months, satisfaction with therapy, resource use and quality-adjusted life years. Primary analyses will be by intention to treat and data will be analysed using multi-level modelling.DiscussionThis trial will provide definitive evidence on the clinical and cost-effectiveness of ACT plus UC in comparison to UC alone for improving psychological health in people living with MND.Trial registrationISRCTN Registry, ISRCTN12655391. Registered 17 July 2017, https://www.isrctn.com/ISRCTN12655391.Protocol version: 3.1 (10/06/2020).

Motor neuron disease is a progressive, fatal neurodegenerative disease for which there is no cure. Formal psychological therapies are not routinely part of United Kingdom standard motor neuron disease care due to a lack of evidence-based guidance resulting from a paucity of clinical trials. We aimed to evaluate the clinical and cost-effectiveness of Acceptance and Commitment Therapy plus usual care compared to usual care alone for improving psychological health in people living with motor neuron disease. We conducted qualitative interviews with 15 people living with motor neuron disease, 10 caregivers and 12 healthcare professionals. Findings were used to develop an Acceptance and Commitment Therapy intervention specifically for people living with motor neuron disease. Next, we examined its acceptability and feasibility in an uncontrolled feasibility study with 29 people living with motor neuron disease. Findings from qualitative interviews with 14 people living with motor neuron disease and 11 therapists were used to revise the intervention. Finally, we conducted a multicentre, parallel, two-arm randomised controlled trial in 16 United Kingdom motor neuron disease care centres/clinics. Eligible participants were aged ≥ 18 years with motor neuron disease. Participants were randomly assigned (1 : 1) to receive up to eight sessions of Acceptance and Commitment Therapy plus usual care or usual care alone and followed up at 6 and 9 months post randomisation by blinded outcome assessors. The primary outcome was total score on the McGill Quality of Life Questionnaire-Revised at 6 months. Secondary outcomes included health status using the EuroQol-5 Dimensions, five-level version. Primary analyses were by intention to treat. Acceptance and Commitment Therapy was acceptable to people living with motor neuron disease, and it was feasible to recruit participants, hence trial progression criteria were met. From September 2019 to August 2022, 191 participants were recruited: 97 were allocated to Acceptance and Commitment Therapy plus usual care and 94 to usual care alone. Mean age was 61.9 years (standard deviation 11.4), 58% were male and 95% were White/White British. Acceptance and Commitment Therapy plus usual care was superior to usual care alone on the McGill Quality of Life Questionnaire-Revised at 6 months [adjusted mean difference 0.66 (95% confidence interval 0.22 to 1.10); Cohen's d = 0.46 (95% confidence interval 0.16 to 0.77); p = 0.003] and 9 months [adjusted mean difference 0.76 (95% confidence interval 0.30 to 1.22); Cohen's d = 0.53 (95% confidence interval 0.21 to 0.85); p = 0.001]. Mean differences in total costs and quality-adjusted life-years at 9 months between Acceptance and Commitment Therapy plus usual care versus usual care alone were not statistically significant [costs: £1019 (95% confidence interval -£34 to £2074); quality-adjusted life-years: 0.019 (95% confidence interval -0.07 to 0.05)]. The incremental cost-effectiveness ratio was £88,507/quality-adjusted life-year: this decreased to £13,817/quality-adjusted life-year in those with medium disease-related deterioration in subgroup analyses. Acceptance and Commitment Therapy plus usual care is clinically effective at maintaining or improving psychological health, as measured by the McGill Quality of Life Questionnaire-Revised, in people living with motor neuron disease compared to usual care alone. It was not cost-effective overall when calculated using a standard health status measure (EuroQol-5 Dimensions, five-level version). However, it was cost-effective in a subgroup of people experiencing a medium rate of disease-related deterioration. Participants from ethnic minorities were under-represented, despite recruiting from sites with diverse communities. Between-group differences in outcomes may have been partly attributable to expectancy or non-specific therapeutic effects due to the lack of an active control. Cost-effectiveness analyses may have been underpowered to detect significant between-group differences. Studies should examine the effectiveness of Acceptance and Commitment Therapy in diverse populations, compared to an active control, using a more appropriate measure to assess cost-effectiveness, and in those with different rates of disease-related deterioration. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/81/01.

Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease.

There is growing evidence supporting the use of third-wave psychological therapies, such as mindfulness-based interventions (MBIs) and acceptance and commitment therapy (ACT), for people with long-term or chronic physical health conditions. We conducted a systematic review and meta-analysis to critically evaluate the effectiveness of third-wave interventions for improving hearing-related distress and psychological well-being in people with audiological problems. We searched online bibliographic databases and assessed study quality. We conducted random-effects meta-analyses if at least two randomized controlled trials (RCTs) examined hearing-related distress, depression, anxiety, or quality of life in people with audiological problems. Findings of pre-post studies were summarized narratively. We identified 15 studies: six RCTs and nine pre-post studies. The methodological quality of studies was mostly poor to moderate, and sample sizes were typically small (overall n = 750). Most studies focused on tinnitus (n = 12), MBIs (n = 8), and ACT (n = 6). Statistically significant improvements in hearing-related distress were found with ACT and MBIs versus controls and other treatments at post-intervention in people with tinnitus, while improvements in depression and anxiety were only found for ACT versus controls at post-intervention. However, gains were either not maintained or not examined at follow-up, and there was no evidence for improvements in quality of life. At present, there is insufficient evidence to recommend the use of third-wave interventions for improving hearing-related distress or psychological well-being in people with audiological problems. There is some evidence that ACT and MBIs may be useful in addressing hearing-related distress in people with tinnitus, but only in the short term. However, findings should be interpreted with caution given the small number of studies with generally small sample sizes and mostly poor-to-moderate methodological quality. More high-quality, adequately powered, double-blind RCTs, particularly in audiological problems other than tinnitus, are needed to draw firm conclusions and meaningful clinical recommendations. https://doi.org/10.23641/asha.19735975.

سالمندی فرایند زیستی است که تمام موجودات زنده از جمله انسان‌ها آن را تجربه می‌کنند، از این رو توجه خاص و پیشگیری از اختلالاتی نظیر باورهای غیرمنطقی و نگرش منفی به مرگ در سالمندی بسیار مهم است. بنابراین مطالعه حاضر با هدف تعیین اثربخشی درمان مبتنی بر تعهد و پذیرش بر باورهای غیرمنطقی و نگرش به مرگ سالمندان انجام شد. روش پژوهش نیمه آزمایشی با طرح پیش‌آزمون-پس‌آزمون با گروه کنترل بود.جامعه آماری پژوهش کلیه سالمندان شهر خرم آباد در سال 1399 بودند. حجم نمونه پژوهش شامل 30 نفر سالمند (60 تا 70 سال) بود که با روش نمونه‌گیری در دسترس و با توجه به ملاک‌های ورود و خروج مطالعه انتخاب شدند. گروه آزمایش مداخله آموزشی را در قالب هشت جلسه 90 دقیقه‌ای هفتگی دریافت نمودند. پرسش‌نامه‌های مورد استفاده در این پژوهش شامل پرسش‌نامه باورهای غیرمنطقی اهواز و نیمرخ نگرش به مرگ وونگ بود. داده‌ها با تحلیل کوواریانس تک متغیره، با استفاده از نرم‌افزارSPSS نسخه 22 مورد تجزیه و تحلیل قرار گرفتند. یافته‌ها نشان داد که بین گروه‌های آزمایش و کنترل در پس­آزمون از نظر باورهای غیرمنطقی و نگرش به مرگ تفاوت معنی‌داری وجود داشت (001/0>P). به عبارت دیگر درمان مبتنی بر تعهد و پذیرش باعث کاهش باورهای غیرمنطقی و نگرش منفی به مرگ شد. منطبق با یافته‌های پژوهش حاضر می‌توان درمان مبتنی بر تعهد و پذیرش را به عنوان یک روش کارا جهت کاهش باورهای غیرمنطقی و نگرش منفی به مرگ سالمندان پیشنهاد داد.

Purpose: While metastatic breast cancer (BC) has no cure, treatment advances are helping women live longer. However, these women often experience debilitating treatment symptoms and emotional distress. Acceptance and commitment therapy (ACT) is an evidence-based intervention that improves mood and quality of life while allowing for the feelings of grief and loss that are expected when facing a life-limiting prognosis. There is a paucity of randomized controlled trials of ACT among women with metastatic BC. This study examined acceptability, feasibility, and preliminary efficacy of a tailored ACT intervention in a randomized pilot trial. Procedures: Women with stage IV BC (N=30) were randomized 1:1:1 to ACT, usual care, or Cognitive and Behavioral Stress Management (CBSM). ACT and CBSM included 8 weekly group sessions (90 minutes each) delivered via videoconference. Participants completed FACT-B and PROMIS measures at baseline, mid-intervention, post-intervention and 1-month follow-up. Cohen’s D effect sizes were calculated. Results: On average, women were 59.7 years old and 5.6 years from metastatic BC diagnosis. Enrollment rate was 88.5% (31/35), randomization rate was 96.8% (30/31), and retention rate was 90% (9/10 for ACT, 9/10 for usual care, 9/10 for CBSM). 100% of women in both ACT and CBSM attended at least half of the 8 sessions and 88.8% attended at least 6 sessions. 94.4% of women in ACT and 88.2% in CBSM would recommend the intervention to another woman living with metastatic BC. The effect sizes at post intervention were greater than .8 for ACT vs. usual care, while only anxiety and meaning were greater than .8 in CBSM vs. usual care (Table 1). Conclusion: Findings demonstrate high feasibility and acceptability for ACT and CBSM in metastatic BC. A full-scale randomized control trial is needed to determine the stability of effects and whether ACT has robust effects on outcomes of interest and optimizes HRQoL among women with metastatic BC. Citation Format: Ashley Hatch, Joanna B. Torzewski, Jessica L. Thomas, Heidy N. Medina, Fiona S. Horner, William J. Gradishar, David Victorson, Frank J. Penedo, Michael H. Antoni, Patricia I. Moreno. Feasibility, acceptability, and preliminary efficacy of acceptance and commitment therapy in women living with metastatic breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7356.

Background: Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it. Method: Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis. Results: Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy. Conclusions: Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND. Key learning aims (1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition. (2) To understand the facilitators of and barriers to ACT for plwMND. (3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.

The purpose of this article is to present the characteristics of the Acceptance and Commitment Therapy (ACT) for the treatment of chronic pain. The historical context of the development of cognitive and behavioural therapy (CBT) for chronic pain will be described and the theoretical aspects of ACT will be introduced. The components of an acceptance and mindfulness based treatment will also be presented by exploring various processes of the psychological flexibility model. Finally, the article will summarize the scientific evidence supporting ACT based on experimental, correlational and clinical studies in the field of chronic pain. The theoretical aspects underlying ACT, as well as its clinical components in the specific domain of chronic pain were described based on major books in this area, such as McCracken (2005) and Dahl et al. (2005). A descriptive literature review was undertaken to explore the data on the efficacy of ACT for the treatment of chronic pain. Psycinfo and Medline, as well as the Association for Contextual Science website were analyzed for relevant articles. The key search terms were: "Acceptance and Commitment Therapy" or "ACT" or "acceptance" or "mindfulness" or "defusion" and "chronic pain" or "pain." The reference lists of the articles retrieved were also analyzed. The articles that were not in English or French were excluded as well as those that were not specific to ACT and chronic pain. Results show that ACT is a relevant and empirically supported approach that may be used as a complement to CBT strategies in the treatment of chronic pain. There is growing evidence stemming from experimental and correlational studies that support the majority of the ACT processes. Clinical studies undertaken in the field of chronic pain from different backgrounds support the efficacy of ACT for the management of this condition. ACT is a promising and evidence-based approach for the treatment of chronic pain. More research is needed to further validate its theoretical model and further refine our understanding of how ACT could be effective for the management of chronic pain and enhance quality of life for people who suffer from this health condition. For now, ACT is considered to be as effective as traditional cognitive and behavioral therapy for chronic pain.

This paper presents a vision of mental health using the model of psychological flexibility of Acceptance and Commitment Therapy (ACT). ACT is a representative approach of the third wave of cognitive-behavioural therapy (CBT). This article first describes the theoretical and practical aspects of ACT and, in a second part, reviews some of the empirical data supporting its clinical use. Due to the high rate of comorbidity in mental health settings, transdiagnostic approaches in CBT, such as ACT, have recently become popular and particularly appealing to various clinical settings. The theoretical aspects underlying ACT, as well as its clinical components in the treatment of psychopathology were described based on major books in this area, such as Hayes, Strosahl and Wilson (2012). A descriptive literature review was undertaken to explore the data on the efficacy of ACT for the treatment of mental health problems. Psycinfo and Medline, as well as the Association for Contextual Science website were analyzed for relevant articles. The key search terms were: "Acceptance and Commitment therapy" or "ACT" or "acceptance" or "mindfulness" or "defusion." The reference lists of the articles retrieved were also analyzed. The articles that were not in English or French were excluded. Data suggest that ACT is particularly effective for stress, anxiety disorders, depression, substance abuse and various chronic medical conditions. The six processes of the model of psychological flexibility have been validated based on the results of correlational and meditational studies. More than seventy randomized clinical trials and a meta-analysis including 18 randomized control trials conclude that ACT is more effective than waiting list, placebo and treatment as usual control conditions. ACT is a promising and evidence-based approach in mental health for the treatment of anxiety and depression as well as for complex and chronic conditions. More research is needed to further validate its theoretical model and further refine our understanding of how ACT could be effective for the management of mental health illness and how it could enhance quality of life for people who suffer from these conditions.

IntroductionIn adults, muscle disease (MD) is often a chronic long-term condition with no definitive cure. It causes wasting and weakness of the muscles resulting in a progressive decline in mobility,...

Objective To identify current evidence on oral health-related quality of life in people with Motor Neurone Disease (MND), as well as identify barriers to oral health and care, and establish priorities for future research. Methods A scoping review was conducted. Electronic databases and grey literature sources were searched from 2000 to 2024. Articles discussing oral health in adults with MND were included. Findings were supplemented by stakeholder consultation with people with MND, caregivers, clinicians, and researchers. Results Fourteen articles met inclusion criteria, comprising eight cross-sectional studies, one prospective quality improvement project, one single center observational and four review articles. Five key themes emerged: dental status and oral hygiene activities, orofacial function, secretion management, service delivery and Oral health-related quality of life (OHRQoL). Studies indicated that MND negatively impacts oral health through impaired ability to perform oral hygiene and altered orofacial functioning. Only one study examined oral health-related quality of life. Stakeholder consultation highlighted additional concerns including challenges with service access, the impact of MND on oral health, and difficulties maintaining oral hygiene due to physical limitations. Conclusions Oral health remains an under-researched area in MND care despite its potential impact on quality of life and overall wellbeing. Future research priorities should include investigating relationships between oral health and MND outcomes, improving service delivery models, and increasing dental professional awareness. Active involvement of people with MND in research design and implementation is essential for developing effective interventions.

Acceptance and commitment therapy (ACT) is the most widely used and researched recent variant of cognitive behavioral therapy and has been shown to increase quality of life in people with chronic illnesses, including multiple sclerosis (MS). However, few MS health practitioners are trained in ACT. This study evaluated a 2-day ACT training workshop for Italian psychologists working with people with MS. Data were collected via online questionnaires from 34 psychologists before the workshop, after the workshop, and at 6-month follow-up. Two sets of variables were measured at each assessment: primary outcomes (well-being, negative affect, positive affect, and job satisfaction) and ACT processes (values, mindfulness, psychological flexibility, and cognitive defusion). A separate online workshop evaluation questionnaire and an ACT knowledge examination were administered after the workshop. Most participants (94%) acknowledged the potential beneficial effects of the workshop on their work. Almost all participants reported their intention to apply ACT clinically. More than 90% of participants indicated that the workshop was efficacious. All participants scored higher than 75% on the examination. Mindfulness increased from after the workshop to follow-up; however, there were no statistically significant changes in other variables. Correlations suggested beneficial associations between the ACT processes and the primary outcomes. Results suggest that ACT training is personally and professionally helpful for psychologists in the MS field.

BackgroundChronic muscle diseases (MD) are progressive and cause wasting and weakness in muscles and are associated with reduced quality of life (QoL). The ACTMuS trial examined whether Acceptance and Commitment Therapy (ACT) as an adjunct to usual care improved QoL for such patients as compared to usual care alone.MethodsThis two-arm, randomised, multicentre, parallel design recruited 155 patients with MD (Hospital and Depression Scale ⩾ 8 for depression or ⩾ 8 for anxiety and Montreal Cognitive Assessment ⩾ 21/30). Participants were randomised, using random block sizes, to one of two groups: standard medical care (SMC) (n = 78) or to ACT in addition to SMC (n = 77), and were followed up to 9 weeks. The primary outcome was QoL, assessed by the Individualised Neuromuscular Quality of Life Questionnaire (INQoL), the average of five subscales, at 9-weeks. Trial registration was NCT02810028.Results138 people (89.0%) were followed up at 9-weeks. At all three time points, the adjusted group difference favoured the intervention group and was significant with moderate to large effect sizes. Secondary outcomes (mood, functional impairment, aspects of psychological flexibility) also showed significant differences between groups at week 9.ConclusionsACT in addition to usual care was effective in improving QoL and other psychological and social outcomes in patients with MD. A 6 month follow up will determine the extent to which gains are maintained.

BackgroundPermanent colostomies after colorectal cancer surgery can seriously affect patients' quality of life (QoL) and psychosocial adjustment. Research on the benefits of Acceptance and Commitment Therapy (ACT) for this group is still limited.ObjectiveTo examine whether adding ACT to standard stoma care improves self-efficacy, resilience, QoL, and stoma-related complication rates compared with standard care alone.MethodsThis single-center retrospective cohort study (2022–2024) included 120 patients with permanent colostomies. After 1:1 propensity score matching (60 patients per group, caliper = 0.2 SD), one group received an 8-session ACT program over 6 weeks alongside usual care, while the control group received usual care only. Outcomes were measured at 3 months (T1) and 6 months (T2) post-surgery. Primary outcomes were self-efficacy (C-SSES), resilience (CD-RISC), and stoma-related QoL (Stoma-QOL). Secondary outcomes included stoma complications. Linear mixed-effects models and conditional logistic regression were applied for analysis.ResultsSignificant improvements over time were observed in the ACT group compared with controls (all p < 0.001). At T2, the ACT group showed higher self-efficacy [mean difference (MD) = 14.7, 95% CI: 10.9–18.5; d = 0.92], resilience (MD = 11.1, 95% CI: 7.8–14.4; d = 0.89), and QoL (MD = 12.3, 95% CI: 8.7–15.9; d = 0.86). ACT also reduced overall complication rates (33.3% vs. 51.7%; OR = 0.48, 95% CI: 0.24–0.96), particularly dermatitis (16.7% vs. 31.7%; OR = 0.43, 95% CI: 0.19–0.99). At T2, self-efficacy, resilience, and QoL were strongly correlated (all r ≥ 0.65, p < 0.001).ConclusionAdding ACT to routine stoma care improves self-efficacy, resilience, and quality of life, while also lowering complication rates in patients with permanent colostomies. These findings suggest ACT is a valuable supportive therapy in stoma care.