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

Elina Järvelä-Reijonen (Corresponding Author), Sampsa Puttonen, Leila Karhunen, Essi Sairanen, Jaana Laitinen, Mikko Kolehmainen, Jussi Pihlajamäki, Urho M. Kujala, Riitta Korpela, Miikka Ermes, Raimo Lappalainen, Marjukka Kolehmainen

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    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).

    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: Identifier: NCT01738256, Registered 17 August, 2012.
    Original languageEnglish
    Pages (from-to)539-555
    JournalInternational Journal of Behavioral Medicine
    Issue number5
    Publication statusPublished - 1 Oct 2020
    MoE publication typeA1 Journal article-refereed


    Open access funding provided by University of Eastern Finland (UEF) including Kuopio University Hospital. The Elixir study was funded by the SalWe Research Program for Mind and Body (Tekes, the Finnish Funding Agency for Technology and Innovation grant 1104/10). The preparation of this paper was also funded by the PhD student position (EJ-R) in the Doctoral Programme in Nutrition of the Faculty of Health Sciences, University of Eastern Finland, and by personal grant (EJ-R) of Finnish Cultural Foundation, North Savo Regional fund.


    • ACT
    • Low-grade inflammation
    • Mindfulness
    • Obesity
    • Psychological flexibility
    • Stress


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