Caring for the psychological health of caregivers: Acceptance and commitment therapy

The Bottom Line

  • In Canada, almost a quarter of people aged 15 and over are caregivers for an adult living with a long-term condition or disability. The majority are informal, unpaid caregivers.       
  • Informal caregivers are at an increased risk of experiencing burden, overwhelm, and symptoms of depression and anxiety.  
  • Acceptance and commitment therapy can enhance psychological health in informal caregivers by reducing symptoms of depression, anxiety, and stress, and improving mindfulness, amongst other benefits. 

Whether for a family member, friend, or neighbour, caring for loved ones and members of our community is a fulfilling and important act carried out by many Canadians and people around the world. In Canada alone, nearly one-quarter of those aged 15 and over provide care for adults living with chronic conditions or disabilities. What’s more, over 90% are informal caregivers, meaning they provide unpaid care (1).

While providing care is a “labour of love,” like many things in life, it comes with its own set of challenges and hardships. Timewise, informal caregivers for care-dependent adults in Canada spend anywhere between four to twenty hours a week on caregiving-related activities, with the average being eight hours a week (1). Caregiving responsibilities can interfere with a caregiver’s career and finances, reduce the ability to appropriately balance work and life and identify when they need help, and increase the risk of psychological burden, feelings of overwhelm, and symptoms of depression and anxiety (1-10). As you can imagine, these issues can lead to a decrease in the quality of care a person receives and a reduced quality of life for both the caregiver and the person they provide care for (2; 11-13).  

Luckily, caregivers don’t have to do it alone. There are a variety of supports and services they can access to help them along their care journey. Acceptance and commitment therapy (aka ACT) is one of these strategies. While traditional forms of cognitive behavioural therapy place more focus on trying to identify and alter negative thoughts, ACT opts to encourage acceptance of negative thoughts and feelings and then the use of healthy activities to manage one’s experiences. To further investigate ACT, a recent systematic review looked at its effect on the psychological health of informal caregivers taking care of family, friends, or neighbours living with chronic health conditions (2).  

So, is ACT effective or all an “act”? 

What the research tells us

The review found multiple positive results when it compared ACT, which was generally delivered by trained psychiatrists, psychologists, counselors, nurses, or social workers, to usual care or active controls (aka control group engaging in some other type of activity).

For example, ACT was able to impact several outcomes immediately after therapy and after one to six months. These included reductions in (2):

  • symptoms of depression and anxiety by large amounts; 

  • symptoms of stress by moderate amounts right after therapy and large amounts after one to six months; 

  • caregivers’ unwillingness to be exposed to painful feelings by a large amount, which is important because this unwillingness can result in caregivers avoiding hard things like their role as caregivers, as well as other aspects of life (2;14); and  

  • getting stuck in one’s thoughts by a moderate amount. 

But the good news doesn’t stop there! ACT was also shown to improve both value-based living and mindfulness by large amounts after one to six months. Here, value-based living refers to people expressing and representing what they’ve identified to be purposeful and meaningful action, while mindfulness refers to full awareness of where one is and what they are doing.

You might be thinking, “great, ACT is effective but what features of ACT should I be looking for?”. Well, the review was able to help answer this too. It appears that ACT may be more effective when it’s delivered through a mix of both individual and group formats, and when it’s face-to-face versus other methods like telephone, email or online. Receiving ACT over a larger number of sessions may also be more beneficial (2).

Caring for your own psychological health and well-being is an important part of being a caregiver. ACT is one tool that caregivers can add to their support toolkit. Caregivers can access ACT on their own by reaching out to a professional who specializes in this type of therapy or speaking with their healthcare team about how to access it in their community.

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Author Details


  1. Statistics Canada. More than half of women provide care to children and care-dependent adults in Canada, 2022. [Internet] 2022. [cited March 2024]. Available from: 
  2. Ye F, Lee JJ, Xue D, et al. Acceptance and commitment therapy among informal caregivers of people with chronic health conditions: A systematic review and meta-analysis. JAMA Netw Open. 2023; 6(12):e2346216. doi: 10.1001/jamanetworkopen.2023.46216.
  3. Janson P, Willeke K, Zaibert L, et al. Mortality, morbidity and health-related outcomes in informal caregivers compared to non-caregivers: A systematic review. Int J Environ Res Public Health. 2022; 19(10):5864. doi: 10.3390/ijerph19105864. 
  4. Wister A, Li L, Mitchell B, et al. Levels of depression and anxiety among informal caregivers during the COVID-19 pandemic: A study based on the Canadian Longitudinal Study on Aging. J Gerontol B Psychol Sci Soc Sci. 2022; 77(9):1740-1757. doi: 10.1093/geronb/gbac035.   
  5. Stratmann M, Forsell Y, Möller J, et al. Informal care and the impact on depression and anxiety among Swedish adults: A population-based cohort study. BMC Public Health. 2021; 21(1):1263. doi: 10.1186/s12889-021-11246-1. 
  6. Zarit SH, Zarit JM. Family caregiving. In: Bensadon BA, ed. Psychology and Geriatrics. Academic Press; 2015:21-43.  
  7. Sallim AB, Sayampanathan AA, Cuttilan A, et al. Prevalence of mental health disorders among caregivers of patients with Alzheimer disease. J Am Med Dir Assoc. 2015; 16(12):1034-1041. doi: 10.1016/j.jamda.2015.09.007.   
  8. Loh AZ, Tan JS, Zhang MW, et al. The global prevalence of anxiety and depressive symptoms among caregivers of stroke survivors. J Am Med Dir Assoc. 2017; 18(2):111-116. doi: 10.1016/j.jamda.2016.08.014.   
  9. Cohn LN, Pechlivanoglou P, Lee Y, et al. Health outcomes of parents of children with chronic illness: A systematic review and meta-analysis. J Pediatr. 2020; 218:166-177.e2. doi: 10.1016/j.jpeds.2019.10.068.   
  10. Angioli R, Capriglione S, Aloisi A, et al. Economic impact among family caregivers of patients with advanced ovarian cancer. Int J Gynecol Cancer. 2015; 25(8):1541-1546. doi: 10.1097/IGC.0000000000000512.   
  11. Litzelman K, Kent EE, Mollica M, et al. How does caregiver well-being relate to perceived quality of care in patients with cancer? Exploring associations and pathways. J Clin Oncol. 2016; 34(29):3554-3561. doi: 10.1200/JCO.2016.67.3434.   
  12. Goren A, Gilloteau I, Lees M, et al. Quantifying the burden of informal caregiving for patients with cancer in Europe. Support Care Cancer. 2014; 22(6):1637-1646. doi: 10.1007/s00520-014-2122-6.   
  13. Ademosu T, Ebuenyi I, Hoekstra RA, et al. Burden, Impact, and needs of caregivers of children living with mental health or neurodevelopmental conditions in low-income and middle-income countries: A scoping review. Lancet Psychiatry. 2021; 8(10):919-928. doi: 10.1016/S2215-0366(21)00207-8.   
  14. Hayes SC, Wilson KG. Acceptance and commitment therapy: Altering the verbal support for experiential avoidance. Behav Anal. 1994; 17(2):289-303. doi: 10.1007/BF03392677.  

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

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