{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:04:24Z","timestamp":1780401864441,"version":"3.54.1"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>Depression is a prevalent issue among patients with chronic kidney disease, particularly those undergoing hemodialysis. Its presence is associated with reduced quality of life, poor treatment adherence, and an increased risk of hospitalization and clinical deterioration. There is a pressing need for further research into effective psychological interventions aimed at improving the mental health of this population. This open-label pilot clinical trial involved five hemodialysis patients residing in Madrid who had been receiving treatment for over 3 months and exhibited clinically significant depressive symptoms. The intervention consisted of eight weekly, individual, 60-min face-to-face sessions based on a structured Acceptance and Commitment Therapy (ACT) protocol, delivered during dialysis. Outcomes were assessed using standardized questionnaires measuring quality of life, psychological symptoms, psychological inflexibility, and coping strategies at four time points: pre-treatment, post-treatment, and at 3- and 8-month follow-ups. A within-subject analysis was conducted, and the Reliable Change Index was applied to evaluate clinical significance. All participants completed the intervention, which was well accepted and deemed feasible, with high levels of satisfaction reported. Sustained reductions in depressive symptoms were observed in all participants, and improvements in quality of life were noted in three. No significant changes were found in psychological inflexibility or coping strategies. This pioneering pilot study in a Western context provides preliminary evidence supporting the feasibility and potential effectiveness of ACT for treating depression in hemodialysis patients. It highlights the viability of delivering psychological interventions within dialysis units and suggests ACT as a promising therapeutic approach for this population.<\/jats:p>","DOI":"10.3389\/fpsyg.2025.1656929","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T13:28:28Z","timestamp":1757078908000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Acceptance and commitment therapy for depression in chronic kidney patients: a pilot study"],"prefix":"10.3389","volume":"16","author":[{"given":"Sonia","family":"Di\u00e9guez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Garc\u00eda-Llana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Lobato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Teresa","family":"Mar\u00edn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Dolores","family":"Arenas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"Dapena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Montesinos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"216","DOI":"10.37551\/52254-28842022022","article-title":"Aspectos psicosociales del paciente en di\u00e1lisis. Una revisi\u00f3n bibliogr\u00e1fica","volume":"25","author":"Ar\u00e1nega-Gavil\u00e1n","year":"2022","journal-title":"Enferm. Nefrol."},{"key":"ref2","first-page":"470","article-title":"Evaluation of health-related quality of life (HRQL) based on information from Coop\/Wonca sheets in hemodialysis patients","volume":"24","author":"Arenas","year":"2004","journal-title":"Nefrologia"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"158","DOI":"10.26389\/AJSRP.B071118","article-title":"The effectiveness of a brief program based on the acceptance and commitment therapy to increase psychological well-being in a sample of patients with renal failure","volume":"3","author":"Arnout","year":"2019","journal-title":"Majallat Ul\u016bm Tarbaw\u012byah wa al-Nafs\u012byah."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"412","DOI":"10.22038\/jfmh.2016.7859","article-title":"The effectiveness of acceptance and commitment therapy based on depression, mental health, and physical health in hemodialysis patients","volume":"18","author":"Azemi Zeynal","year":"2016","journal-title":"J. Fundam. Ment. 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Danub."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.nefroe.2019.06.006","article-title":"Psychological inflexibility and clinical impact: adaptation of the acceptance and action questionnaire-II in a sample of patients on haemodialysis treatment","volume":"40","author":"Dom\u00ednguez","year":"2020","journal-title":"Nefrolog\u00eda"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.genhosppsych.2006.03.008","article-title":"Characteristics of depression in hemodialysis patients: symptoms, quality of life and mortality risk","volume":"28","author":"Drayer","year":"2006","journal-title":"Gen. Hosp. 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Pain Res."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"637","DOI":"10.3265\/Nefrologia.pre2014.Jun.11959","article-title":"El papel de la depresi\u00f3n, la ansiedad, el estr\u00e9s y la adhesi\u00f3n al tratamiento en la calidad de vida relacionada con la salud en pacientes en di\u00e1lisis: revisi\u00f3n sistem\u00e1tica de la literatura","volume":"34","author":"Garc\u00eda-Llana","year":"2014","journal-title":"Nefrologia"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.jcbs.2020.09.009","article-title":"The empirical status of acceptance and commitment therapy: a review of meta-analyses","volume":"18","author":"Gloster","year":"2020","journal-title":"J. Contextual Behav. Sci."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/j.nefro.2018.04.004","article-title":"Prevalencia de enfermedad renal cr\u00f3nica en Espa\u00f1a: impacto de la acumulaci\u00f3n de factores de riesgo cardiovascular","volume":"38","author":"Gorostidi","year":"2018","journal-title":"Nefrologia"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/j.beth.2016.11.006","article-title":"Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies\u2013republished article","volume":"47","author":"Hayes","year":"2016","journal-title":"Behav. Ther."},{"key":"ref16","volume-title":"A liberated mind: The essential guide to ACT","author":"Hayes","year":"2019"},{"key":"ref17","doi-asserted-by":"crossref","DOI":"10.1037\/17335-000","volume-title":"Acceptance and commitment therapy: the processes and practice of mindful change","author":"Hayes","year":"2012"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1097\/TP.0000000000001715","article-title":"Potential impact of risk and loss aversion on the process of accepting kidneys for transplantation","volume":"101","author":"Heilman","year":"2017","journal-title":"Transplantation"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/S0163-8343(03)00043-4","article-title":"A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population","volume":"25","author":"Herrero","year":"2003","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e28","DOI":"10.2196\/mental.9198","article-title":"Development and feasibility testing of internet-delivered acceptance and commitment therapy for severe health anxiety: pilot study","volume":"5","author":"Hoffmann","year":"2018","journal-title":"JMIR mental health."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1037\/10109-042","article-title":"Clinical significance: a statistical approach to defining meaningful change in psychotherapy research","volume":"59","author":"Jacobson","year":"1991","journal-title":"J Consult Clin Psychol"},{"key":"ref22","volume-title":"Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness","author":"Kabat-Zinn","year":"1990"},{"key":"ref23","first-page":"25","article-title":"The effectiveness of acceptance and commitment therapy in quality of life and blood pressure index of hemodialysis patients","volume":"23","author":"Kalbasi","year":"2021","journal-title":"EBNESINA"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.9734\/jpri\/2019\/v30i130260","article-title":"The effectiveness of acceptance and commitment therapy on the illness perception in Dialysis patients","volume":"30","author":"Karimi","year":"2019","journal-title":"J Pharm Res Int."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1016\/j.cpr.2010.03.001","article-title":"Psychological flexibility as a fundamental aspect of health","volume":"30","author":"Kashdan","year":"2010","journal-title":"Clin. Psychol. Rev."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"171","DOI":"10.32598\/hsmej.8.3.6","article-title":"Effectiveness of ACT with and without mindfulness plus exercises on spiritual health in hemodialysis","volume":"8","author":"Kazemi Daluee","year":"2021","journal-title":"Health Spiritual. Med. Ethics."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"4179","DOI":"10.1111\/jocn.14608","article-title":"Development and effect of a rational-emotive-behaviour-therapy-based self-management programme for early renal dialysis patients","volume":"27","author":"Kim","year":"2018","journal-title":"J. Clin. Nurs."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/j.jcbs.2023.08.004","article-title":"The impact of acceptance and commitment therapy (ACT) on quality of life and symptom improvement among chronic health conditions: a systematic review and meta-analysis","volume":"29","author":"Konstantinou","year":"2023","journal-title":"J. Context. Behav. 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Case Stud."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.jpsychores.2012.04.015","article-title":"Screening for anxiety and depression in dialysis patients: comparison of the hospital anxiety and depression scale and the Beck depression inventory","volume":"73","author":"Preljevic","year":"2012","journal-title":"J. Psychosom. Res."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"131","DOI":"10.32598\/shenakht.10.2.131","article-title":"Comparing the effectiveness of acceptance and commitment therapy and dialectical behavioral therapy on coherent self-knowledge, emotional regulation, and life quality of hemodialysis patients","volume":"10","author":"Rouhi","year":"2023","journal-title":"Shenakht J. Psychol. 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Health Promot."},{"key":"ref43","first-page":"e153038","article-title":"Effectiveness of acceptance and commitment therapy on subjective well-being among hemodialysis patients: a randomized clinical trial study","volume":"21","author":"Sarizadeh","year":"2019","journal-title":"Koomesh"},{"key":"ref44","first-page":"48","article-title":"A study on quality of life in haemodialysis patients","volume":"8","author":"Shery","year":"2019","journal-title":"Int. J. Sci. Res."},{"key":"ref45","year":"2022"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"82","DOI":"10.22034\/JHPM.12.3.82","article-title":"Comparison of the effect of acceptance and commitment therapy and metacognitive therapy on the resilience of women undergoing hemodialysis","volume":"12","author":"Tajbakhsh","year":"2023","journal-title":"J. Health Promot. Manag."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"85","DOI":"10.6018\/analesps.478671","article-title":"CSI-SF: propiedades psicom\u00e9tricas de la versi\u00f3n espa\u00f1ola del inventario breve de estrategias de afrontamiento","volume":"38","author":"Tous-Pallar\u00e9s","year":"2022","journal-title":"An. Psicol."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/S1405-8871(16)30074-8","article-title":"Factores asociados a la depresi\u00f3n en pacientes bajo tratamiento con hemodi\u00e1lisis","volume":"23","author":"V\u00e1zquez-Mart\u00ednez","year":"2016","journal-title":"Atenc. Fam."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1080\/00981380903212107","article-title":"Improving psychosocial health in hemodialysis patients after a disaster","volume":"49","author":"Weiner","year":"2010","journal-title":"Soc. 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