Jenna A. Macri and Ronald D. Rogge (2024), Clinical Psychology Review 110:102432 — DOI-10.1016/j.cpr.2024.102432
Key takeaways
Seeded from the abstract alone, not a reading. What follows is what the work says about itself.
- Scale. “Analyses of 77 records (67 unique studies; Ntotal = 9123 participants)” from searches of several databases.
- Both sides of the model move. ACT “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)”. The changes held against waitlist and active treatments and “were significantly linked to corresponding drops in psychological distress”.
- Moderators. Student samples, excluding clinically symptomatic people, and comparison with other active treatments weakened the effects. Individual ACT and excluding people in extreme crisis strengthened them.
- Recommendations. Measure flexibility and inflexibility as distinct mechanisms, with multidimensional scales (CompACT, MPFI). Broaden outcomes to well-being, assess repeatedly during treatment, study non-specific factors such as the alliance, and test mechanisms in effectiveness studies.
Standing in the record
Filed on 2026-10-03 at the owner’s request, as the current quantitative test of the ACT process model. No anthology topic holds it, and it carries no instruction for machine-learning practice.
Deferred because it was not read (see the status note).
What it tests, from the abstract. The six inflexibility domains it lists are the six inflexibility processes of the ACT model stated in the 2006 review (LIT-555), one of which is the experiential avoidance introduced in 1996 (LIT-551). Its recommendation to measure flexibility and inflexibility separately, with multidimensional scales, answers the measurement complaint of Kashdan and Rottenberg (LIT-553) in part. They objected to global self-report, and this review still pools self-report scales, only more finely divided.
No extends relation is declared until it is read. The abstract shows what
it tests, but not which works it builds on. A reading should add extends
to the 2006 review if, as expected, its model is the one tested.
What a reading should check:
- Whether the mediation is temporal. The abstract says changes “were significantly linked” to drops in distress. The 2006 review’s own caveat was that mediators were often measured after outcomes had already moved.
- Whether flexibility and inflexibility separate as factors, which is the open question the 2006 review left on the AAQ’s single factor.
- How the effect against active treatments compares with the effect against waitlist. The abstract says the active comparison weakened the effects.
Hayes and Hofmann’s process-based therapy (2019), filed in parallel by another agent, is the programme this kind of mechanism meta-analysis serves.
Priority for a reading: high. It is the evidence a THEORY on psychological inflexibility would rest on.