A Systematic Review of Acceptance and Commitment Therapy in Sub-Saharan Africa: Understanding the Cultural Adaptations

Acceptance and Commitment Therapy (ACT) is a type of therapy that helps people handle difficult thoughts and feelings by staying present, accepting what they cannot control, and focusing on what truly matters to them. Despite its growing global popularity, the implementation and effectiveness of ACT in sub-Saharan Africa remains underexplored. We evaluated the current evidence on the application, effectiveness, and cultural adaptation of ACT in sub-Saharan Africa, identifying gaps and providing recommendations for future research. 18 unique studies that met the inclusion criteria were found. Studies on improving athletic performance were the most common, with ACT also being evaluated for academic achievement, self-esteem, and social phobia, among others. We found ACT interventions were generally effective in reducing symptoms and improving psychological flexibility. Cultural adaptations were made to include language adaptations including simplifying English to a lower grade level, delivery methods adaptations such as the use of non-technology-based methods, change of metaphors, and context specific adaptations. In conclusion, we found that ACT was applied with equal frequency in youth and adult populations with most sessions occurring in group settings. The most commonly used ACT process was acceptance. Cultural adaptations enhanced the feasibility and acceptability of ACT. Western normed assessment measures were utilized in all studies. These findings offer valuable insights for mental health practitioners and policy makers supporting the implementation and cultural adaptation of ACT as an evidence-based intervention.