Effectiveness of acceptance and commitment therapy among adolescent athletes: a systematic review

This systematic review summarises research on the effectiveness of ACT among adolescent athletes. Eligibility criteria for inclusion were: (i) athletes aged 10 to 19 years participated in a study; (ii) a study utilised ACT; (iii) a study was an article in a peer-reviewed journal. Searches were conducted in October 2024 and June 2025 using the Web of Science, Scopus, and EBSCOhost. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, the Risk of Bias in Non-randomised Studies – of Interventions tool, and the Risk of Bias in N-of-1 Trials scale. Data were synthesised by vote counting based on the direction of effect, descriptive summaries of the effect sizes, and robust Bayesian meta-analysis with publication bias adjustment. In total, 29 studies (n > 570) were included in the syntheses. Evidence for the early adolescent athletes (k = 4) was very limited across all outcomes, and meta-analyses were not feasible. For middle-to-late adolescent athletes (k = 26), descriptive summaries of effect magnitudes suggested small to moderate effects, while primary meta-analyses showed small effects favouring ACT for mindfulness (g = 0.28 [0.00–0.75]; n = 279), avoidance and fusion (g = 0.25 [–0.12, 0.94]; n = 100), and sports anxiety (g = 0.21 [0.06–0.74]; n = 271). The certainty of the evidence was very low across all outcome domains. The findings align with previous syntheses in non-athletic adolescent populations and the general population of athletes, highlighting the potential benefits of ACT but underscoring the need for additional research.