The Effects of Acceptance and Commitment Therapy (ACT) Intervention on Inflammation and Stress Biomarkers: a Randomized Controlled Trial

Abstract

Background: Psychological processes can be manifested in physiological health. We investigated whether acceptance and commitment therapy (ACT), targeted on psychological flexibility (PF), influences inflammation and stress biomarkers among working-age adults with psychological distress and overweight/obesity.

Method: Participants were randomized into three parallel groups: (1) ACT-based face-to-face (n = 65; six group sessions led by a psychologist), (2) ACT-based mobile (n = 73; one group session and mobile app), and (3) control (n = 66; only the measurements). Systemic inflammation and stress markers were analyzed at baseline, at 10 weeks after the baseline (post-intervention), and at 36 weeks after the baseline (follow-up). General PF and weight-related PF were measured with questionnaires (Acceptance and Action Questionnaire, Acceptance and Action Questionnaire for Weight-Related Difficulties).

Results: A group × time interaction (p = .012) was detected in the high-sensitivity C-reactive protein (hsCRP) level but not in other inflammation and stress biomarkers. hsCRP decreased significantly in the face-to-face group from week 0 to week 36, and at week 36, hsCRP was lower among the participants in the face-to-face group than in the mobile group (p = .035, post hoc test). Age and sex were stronger predictors of biomarker levels at follow-up than the post-intervention PF.

Conclusion: The results suggest that ACT delivered in group sessions may exert beneficial effects on low-grade systemic inflammation. More research is needed on how to best apply psychological interventions for the health of both mind and body among people with overweight/obesity and psychological distress.

Trial registration: ClinicalTrials.gov Identifier: NCT01738256, Registered 17 August, 2012.

Keywords: ACT; Low-grade inflammation; Mindfulness; Obesity; Psychological flexibility; Stress.

Fig. 1

The effects of ACT intervention on logarithmized hsCRP adjusted for study center and starting time of the study. The values are log-transformed estimated (adjusted for study center and starting time of the study) marginal means ± standard error (SE). The measurements were conducted before the intervention (baseline, study week 0), after the 8-week intervention period (study week 10), and 36 weeks after the baseline measurements (study week 36). The group × time interaction for the entire study period was significant (p = .012). The face-to-face and mobile groups had a significant difference at week 36 (p = .035, post hoc test, indicated with an asterisk). The decrease of hsCRP from week 0 to week 36 and from week 10 to week 36 was significant in the face-to-face group (p = .045 and p = .014, respectively)