The Effectiveness of Online Acceptance and Commitment Therapy (ACT) on Psychological Distress, Quality of Life, and Treatment Adherence in Patients with Chronic Pain and Psychosomatic Disorders

Chronic pain and psychosomatic disorders are complex health conditions that involve persistent physical symptoms, psychological distress, functional limitations, and reduced quality of life. Patients with these conditions may also experience treatment fatigue, avoidance behaviors, low motivation, and difficulties maintaining adherence to therapeutic recommendations. Online psychological interventions have emerged as accessible and flexible alternatives to conventional face-to-face treatment. Among these interventions, Acceptance and Commitment Therapy (ACT) focuses on enhancing psychological flexibility and helping patients engage in meaningful activities despite ongoing pain or emotional discomfort. This narrative review aimed to examine the effectiveness of online ACT in reducing psychological distress, improving quality of life, and enhancing treatment adherence among patients with chronic pain and psychosomatic disorders. It also explored the theoretical mechanisms and delivery characteristics that may influence the effectiveness of digital ACT interventions. Relevant evidence was synthesized from systematic reviews, meta-analyses, randomized controlled trials, clinical trial protocols, and quantitative studies addressing ACT, internet-based psychological treatment, chronic pain, psychosomatic symptoms, quality of life, psychological distress, and treatment adherence. The reviewed literature was organized according to three primary outcome domains: psychological consequences of chronic illness, quality of life and daily functioning, and engagement with treatment. Particular attention was given to psychological flexibility, experiential avoidance, cognitive fusion, values-based action, and the role of therapist guidance in online interventions. The reviewed evidence suggests that online ACT can reduce psychological distress, anxiety, depressive symptoms, catastrophizing, helplessness, and pain-related emotional suffering. Improvements in psychological flexibility may allow patients to respond more adaptively to painful sensations and reduce the extent to which symptoms control daily life. Online ACT is also associated with improvements in quality of life, social participation, physical functioning, self-efficacy, and engagement in personally meaningful activities, even when pain intensity does not substantially decrease. Treatment adherence appears to be stronger in guided or blended interventions that combine digital modules with therapist feedback, monitoring, reminders, and individualized support. However, outcomes may vary according to baseline psychological well-being, symptom severity, digital literacy, intervention design, and the degree of personalization.

کلیدواژه ها:

Online Acceptance and Commitment Therapy ، Chronic Pain ، Psychosomatic Disorders ، Psychological Distress ، Treatment Adherence