Influence of Acceptance and Commitment Therapy Core Processes on Anxiety and Stress in Persons With Spinal Cord Injury: A Cross-sectional Study

Published:December 04, 2022DOI:



      To explore the relationship between the core Acceptance and Commitment Therapy (ACT) processes (mindfulness, self as context, acceptance, defusion, values, and committed action) and anxiety and stress in a sample of individuals with spinal cord injury (SCI).


      Variance accounted for by ACT on anxiety and stress as outcome variables was examined using multiple linear regression.


      Study measures were completed via online survey.


      159 participants with a SCI completed self-report study measures relevant to the ACT core processes as well as measures of depression, anxiety, and perceived stress.

      Main Outcome Measures

      Outcome measures included the Spinal Cord Injury—Quality of Life Anxiety subdomain and the Perceived Stress Scale.


      Higher reported engagement with acceptance (β=0.238, P=.004), pursuit of values (β=0.187, P<.008), and defusion (β=0.351, P<.001) related to less anxious distress. Perceived stress was predicted by depression (β = 0.230, P=.038) and the ACT core processes as a whole (P<.001).


      : The results of our study indicate that considerable variance in anxiety and stress in individuals with SCI is accounted for by the core processes of ACT. Lower levels of anxiety and stress were predicted by the ACT components as a whole. Anxiety was uniquely predicted by pursuit of values, acceptance, and defusion, indicating these 3 components of ACT may be particularly beneficial in the treatment of anxiety in SCI. These results may provide targeted treatment opportunities via tailored ACT-based interventions.


      List of abbreviations:

      AAQ-II (Acceptance and Action Questionnaire), ACT (Acceptance and Commitment Therapy), CBT (cognitive behavioral therapy), MAAS (Mindful Attention Awareness Scale), PSS (Perceived Stress Scale), QOL (quality of life), SCI (spinal cord injury), VQ (Valuing Questionnaire), VQ-Obs (VQ Obstruction), VQ-Prog (VQ Progress)
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