Acceptance and Commitment Therapy in Adults with Social Anxiety: a Systematic Review
Article Sidebar
Main Article Content
Abstract
Social anxiety (SA) is a problem that can significantly impair people's academic, work, and relational performance. For this reason, this systematic review focused on determining the effectiveness of Acceptance and Commitment Therapy (ACT) in adults with SA by integrating the latest evidence. The PRISMA method was used to compile and analyze 12 clinical trials and empirical studies published in the PubMed, Scopus, and EBSCOhost databases between 2017 and 2025. The results indicated that 91.66% of the studies showed a statistically significant reduction (p < 0.05) in SA symptoms in the experimental groups, consistently outperforming the control groups. The interventions developed over 12 individual sessions proved to be effective in both traditional formats and self-help books and virtual reality modalities. Thus, it is suggested that ACT may be an effective and versatile alternative for the treatment of SA in adults, promoting psychological flexibility through its hexaflex model.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish in this journal agree to the following terms: Authors retain the copyright and guarantee the journal the right to be the first publication of the work, as well as, licensed under a Creative Commons Attribution License that allows others share the work with an acknowledgment of the authorship of the work and the initial publication in this journal. Authors may separately establish additional agreements for the non-exclusive distribution of the version of the work published in the journal (for example, placing it in an institutional repository or publishing it in a book), with acknowledgment of its initial publication in this journal. Authors are allowed and encouraged to disseminate their work electronically (for example, in institutional repositories or on their own website) before and during the submission process, as it may lead to productive exchanges as well as further citation earliest and oldest of published works.
How to Cite
References
American Psychiatric Association. (2014). Manual diagnóstico y estadístico de los trastornos mentales (5ta. Edición). Editorial médica panamericana.
Barnes-Holmes, Y., Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2002). Relational Frame Theory: A Post-Skinnerian Account of Human Language and Cognition. En H. W. Reese & R. Kail (Eds.), Advances in Child Development and Behavior (Vol. 28, pp. 101-138). JAI. https://doi.org/10.1016/S0065-2407(02)80063-5
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. En Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). The Guilford Press. https://psycnet.apa.org/record/1995-98887-004
Desnoyers, A. J., Kocovski, N. L., Fleming, J. E., & Antony, M. M. (2017). Self-focused attention and safety behaviors across group therapies for social anxiety disorder. Anxiety, Stress & Coping, 30(4), 441-455. (123413171). https://doi.org/10.1080/10615806.2016.1239083
Errazuriz, A., Avello-Vega, D., Passi-Solar, A., Torres, R., Bacigalupo, F., Crossley, N. A., Undurraga, E. A., & Jones, P. B. (2025). Prevalence of anxiety disorders in Latin America: A systematic review and meta-analysis. The Lancet Regional Health - Americas, 45, 101057. https://doi.org/10.1016/j.lana.2025.101057
García-Pérez, L., & Valdivia-Salas, S. (2018). Intervención en el Trastorno de Ansiedad Social a través de la Terapia de Aceptación y Compromiso: Una Revisión Sistemática. Behavioral Psychology/Psicología Conductual, 26(2), 379-392. https://www.imrpress.com/journal/BP/26/2/pii/20182602379
Gorinelli, S., Gallego, A., Lappalainen, P., & Lappalainen, R. (2023). Virtual reality acceptance and commitment therapy intervention for social and public speaking anxiety: A randomized controlled trial. Journal of Contextual Behavioral Science, 28, 289-299. https://doi.org/10.1016/j.jcbs.2023.05.004
Haller, H., Breilmann, P., Schröter, M., Dobos, G., & Cramer, H. (2021). A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders. Scientific Reports, 11(1), 20385. https://doi.org/10.1038/s41598-021-99882-w
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180-198. https://doi.org/10.1016/j.beth.2009.08.002
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (pp. xvi, 304). Guilford Press.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change, 2nd ed (pp. xiv, 402). The Guilford Press.
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies. Annual Review of Clinical Psychology, 7(Volume 7, 2011), 141-168. https://doi.org/10.1146/annurev-clinpsy-032210-104449
Herbert, J. D., Forman, E. M., Kaye, J. L., Gershkovich, M., Goetter, E., Yuen, E. K., Glassman, L., Goldstein, S., Hitchcock, P., Tronieri, J. S., Berkowitz, S., & Marando-Blanck, S. (2018). Randomized controlled trial of acceptance and commitment therapy versus traditional cognitive behavior therapy for social anxiety disorder: Symptomatic and behavioral outcomes. Journal of Contextual Behavioral Science, 9, 88-96. https://doi.org/10.1016/j.jcbs.2018.07.008
Khoramnia, S., Bavafa, A., Jaberghaderi, N., Parvizifard, A., Foroughi, A., Ahmadi, M., & Amiri, S. (2020). The effectiveness of acceptance and commitment therapy for social anxiety disorder: A randomized clinical trial. Trends in Psychiatry and Psychotherapy, 42(1), 30-38. https://doi.org/10.1590/2237-6089-2019-0003
Kocovski, N. L., Fleming, J. E., Blackie, R. A., MacKenzie, M. B., & Rose, A. L. (2019). Self-Help for Social Anxiety: Randomized Controlled Trial Comparing a Mindfulness and Acceptance-Based Approach With a Control Group. Behavior Therapy, 50(4), 696-709. https://doi.org/10.1016/j.beth.2018.10.007
Krafft, J., Twohig, M. P., & Levin, M. E. (2020). A Randomized Trial of Acceptance and Commitment Therapy and Traditional Cognitive-Behavioral Therapy Self-Help Books for Social Anxiety. Cognitive Therapy & Research, 44(5), 954-966. (145260330). https://doi.org/10.1007/s10608-020-10114-3
Mattikoppa, N. V., Harshitha, G. S., Yahiya, G. K. M., & Paluru, M. S. (2025). Efficacy of Acceptance and Commitment Therapy in Social Anxiety Disorder: A Systematic Review and Meta-analysis. Journal of Psychiatry Spectrum, 4(1), 111. https://doi.org/10.4103/jopsys.jopsys_23_24
Mesri, B., Niles, A. N., Pittig, A., LeBeau, R. T., Haik, E., & Craske, M. G. (2017). Public speaking avoidance as a treatment moderator for social anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 55, 66-72. https://doi.org/10.1016/j.jbtep.2016.11.010
Organización Mundial de la Salud. (2023). Anxiety disorders. https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
Organización Panamericana de la Salud. (2020). Perfil de salud mental del Ecuador. Organización Panamericana de la Salud. https://www.paho.org/sites/default/files/2020-09/MentalHealth-profile-2020%20Ecuador%20esp.pdf?utm
Salehi, S., Vaziri, S., & Nasri, M. (2025). Comparing the Effectiveness of Acceptance and Commitment Therapy and Paradoxical Timetable Therapy on Worry in Individuals with Social Anxiety Disorder. Sadra Medical Sciences Journal, 13(1), 138-154. https://doi.org/10.30476/smsj.2025.101698.1495
Salehpoor, A., Yousefi, Z., & Golparvar, M. (2023). Comparing the Effectiveness of Mindfulness-Based Stress Reduction with Acceptance and Commitment Therapy on Social Anxiety and Its Dimensions in Stuttering Adults. Avicenna Journal of Clinical Medicine, 30(2), 90-98. https://doi.org/10.32592/ajcm.30.2.90
Sewart, A. R., Niles, A. N., Burklund, L. J., Saxbe, D. E., Lieberman, M. D., & Craske, M. G. (2019). Examining Positive and Negative Affect as Outcomes and Moderators of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy for Social Anxiety Disorder. Behavior Therapy, 50(6), 1112-1124. https://doi.org/10.1016/j.beth.2019.07.001
Soltani, E., Bahrainian, S. A., Farhoudian, A., Arani, A. M., & Gachkar, L. (2023). Effectiveness of Acceptance Commitment Therapy in Social Anxiety Disorder: Application of a Longitudinal Method to Evaluate the Mediating Role of Acceptance, Cognitive Fusion, and Values. Basic & Clinical Neuroscience, 14(4), 479-490. (171863546). https://doi.org/10.32598/bcn.2021.2785.1
Stein, D. (2015). Social anxiety disorder and the psychobiology of self-consciousness. Frontiers in Human Neuroscience, 9. https://doi.org/10.3389/fnhum.2015.00489
Stein, D., Lim, C. C. W., Roest, A. M., de Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bromet, E. J., Bruffaerts, R., de Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Harris, M. G., He, Y., Hinkov, H., Horiguchi, I., Hu, C., … WHO World Mental Health Survey Collaborators. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine, 15(1), 143. https://doi.org/10.1186/s12916-017-0889-2
Toghiani, Z., Ghasemi, F., & Samouei, R. (2019). The effectiveness of acceptance and commitment group therapy on social anxiety in female dormitory residents in Isfahan university of medical sciences. Journal of Education and Health Promotion, 8(1). https://doi.org/10.4103/jehp.jehp_111_18