# The effectiveness of online acceptance and commitment therapy-based interventions on depression, burnout, anxiety and stress in occupational contexts: A systematic narrative review

## TL;DR

This review explores how online Acceptance and Commitment Therapy interventions affect employee mental health, finding modest but promising results for reducing stress, anxiety, and burnout.

## Contribution

The study is the first systematic narrative review to evaluate online ACT interventions specifically in occupational contexts.

## Key findings

- Online ACT interventions show modest but significant improvements in depression, anxiety, stress, and burnout.
- Psychological flexibility is consistently identified as the key mechanism of change in these interventions.
- Partially guided programs show higher adherence compared to fully self-guided formats.

## Abstract

Declining employee mental health has led to an interest in Acceptance and Commitment Therapy (ACT)-based interventions that aim to develop psychological flexibility. While existing literature primarily focuses on face-to-face interventions, evidence on online ACT interventions in occupational settings remains limited. This systematic narrative review synthesized findings on the outcomes of online ACT-based interventions for employees. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Synthesis Without Meta-analysis (SWiM) guidelines, six databases were searched, yielding 11 randomized controlled trials targeting burnout, depression, anxiety, and stress. Most studies reported modest but significant improvements in these outcomes, often sustained at follow-up. Psychological flexibility consistently emerged as the principal mechanism of change. Intervention formats and engagement varied widely; partially guided programs demonstrated higher adherence than fully self-guided formats, though time constraints and workload frequently hindered participation. Online ACT-based interventions appear tentatively promising for improving employee well-being, but methodological heterogeneity, limited cultural diversity, and short follow-up periods constrain firm conclusions. Future studies should employ standardized protocols, process-based measures, and longer follow-ups to clarify the mechanisms and sustainability of change.

•Online ACT interventions show tentative promise in reducing depression, anxiety, stress, and burnout.•Psychological flexibility is identified as central to change in interventions.•Intervention effects can strengthen during follow-up periods.•Organizational support is crucial for intervention engagement.•Variability in methodologies limits the strength of conclusions.

Online ACT interventions show tentative promise in reducing depression, anxiety, stress, and burnout.

Psychological flexibility is identified as central to change in interventions.

Intervention effects can strengthen during follow-up periods.

Organizational support is crucial for intervention engagement.

Variability in methodologies limits the strength of conclusions.