The relationships between valued living and depression and anxiety: A systematic review, meta-analysis, and meta-regression

Introduction: Valued living is one of the core processes of Acceptance and Commitment Therapy (ACT). The main aim of this study is to systematically review the relationship between valued living and depression, and valued living and anxiety, and to examine how these relationships vary across different demographic characteristics and populations/clinical groups (PROSPERO ID: CRD42021236882).Method: Literature searches were carried out using MEDLINE, EMBASE, PsycINFO, ProQuest Dissertations and Thesis Global, Social Science databases. All studies using a validated measurement of valued living (as conceptualized in ACT) and a measurement of depression and/or anxiety were considered for inclusion. The methodological quality of included studies was assessed using a risk of bias assessment tool specifically devel-oped for this systematic review.Results: A total of 72 studies with 78 (sub)samples were included in this review, of which 17 studies were rated as high risk of bias, while 61 were rated as low risk for bias. The primary high-risk quality issue related to small sample sizes. Most included studies were student or chronic pain samples. Meta-analyses overall showed negative correlations between both valued living and depression (r =-0.42, 95%CI [-0.45;-0.39], p < .001, k = 72, o = 14,797), and valued living and anxiety (r =-0.26, 95%CI [-0.29;-0.22], p < .001, k = 60, o = 11,628). Meta -regression analyses uncovered significant moderations suggesting that the negative correlation between valued living and depression was stronger in studies using the Valuing Questionnaire compared to those using the Valued Living Questionnaire. The inverse association between valued living and anxiety tended to be stronger in older samples and in chronic pain samples compared to the general population.Discussion: The evidence overall demonstrated significant negative relationships between valued living and both depression and anxiety, with a greater effect size for the association between valued living and depression. This highlights the importance for clinicians in considering valued living as a potential mechanism of change for depression and anxiety.