Washington State Institute for Public Policy
Acceptance and Commitment Therapy for adult anxiety
Adult Mental Health: Anxiety
Benefit-cost estimates updated May 2017.  Literature review updated September 2016.
Acceptance and Commitment Therapy for anxiety aims to increase client acceptance of negative thoughts and feelings and to reduce the negative behavioral impact of anxiety. Acceptance and Commitment Therapy relies on six core processes of change: 1) acceptance; 2) learning to view thoughts as hypotheses rather than facts, 3) being present, 4) viewing the self as context for experience, 5) identifying core values, and 6) acting based on those values. These core principles are applied through various exercises and through homework.

Treatments in this review provided 7 to 18 hours per client of either group or individual therapy in an outpatient setting. Comparison groups were either on a waitlist for treatment or received treatment as usual. This review excludes studies of acceptance and commitment therapy for other disorders.

BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $6,643 Benefits minus costs $20,562
Participants $13,809 Benefit to cost ratio $48.55
Others $541 Chance the program will produce
Indirect $3 benefits greater than the costs 85 %
Total benefits $20,995
Net program cost ($432)
Benefits minus cost $20,562
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Labor market earnings associated with anxiety disorder $6,206 $13,666 $0 $0 $19,873
Health care associated with anxiety disorder $437 $142 $541 $218 $1,338
Adjustment for deadweight cost of program $0 $0 $0 ($216) ($216)
Totals $6,643 $13,809 $541 $3 $20,995
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,319 2015 Present value of net program costs (in 2016 dollars) ($432)
Comparison costs $814 2008 Cost range (+ or -) 10 %
These therapies took place over 8-16 weekly sessions; total length of treatment averaged 12 weeks. The per-participant cost of treatment by modality (individual or group) was weighted by the treatment Ns reported in the studies. Cost per session is $40.04/session for group and $122.25/session for individual (2015 dollars). This rate is based on actuarial tables reported in Mercer (2014) Behavioral Health Data Book for the State of Washington For Rates Effective January 1, 2015. The comparison group costs are from the average Medicaid expenditures for anxiety treatment in Washington in 2009.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Anxiety disorder 4 74 -0.395 0.175 31 -0.205 0.214 33 -0.710 0.004
Citations Used in the Meta-Analysis

England, E.L., Herbert, J.D., Forman, E.M., Rabin, S.J., Juarascio, A., & Goldstein, S.P. (2012). Acceptance-based exposure therapy for public speaking anxiety. Journal of Contextual Behavioral Science, 1, 66-72.

Roemer, L., Orsillo, S.M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76 (6), 1083-9.

Craske, M.G., Niles, A.N., Burklund, L.J., Wolitzky-Taylor, K.B., Vilardaga, J.C., Arch, J.J., Saxbe, D.E., ... Lieberman, M.D. (2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. Journal of Consulting and Clinical Psychology, 82 (6), 1034-48.

Zargar, F., Asgharnejad, F.A.A., Atef-Vahid, M.K., Afshar, H., Maroofi, M., & Omranifard, V. (2012). Effect of acceptance-based behavior therapy on severity of symptoms, worry and quality of life in women with generalized anxiety disorder. Iranian Journal of Psychiatry and Behavioral Sciences, 6(2), 23-32.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov