Previous randomised controlled trials assessing psychological support such as mindfulness-based stress reduction and cognitive behavioural therapy have been limited to rather small patient numbers and short observation periods as well as few adequate control groups.4,5 Recommendations for psychological interventions are therefore without reliable evidence and have not been included into current guidelines for the treatment of motor neuron disease.6,7 Rebecca L Gould and colleagues8 now have conducted the largest clinical study on the effect of any type of psychological intervention in amyotrophic lateral sclerosis (ALS) to date, reported in The Lancet. The main result was significantly increased quality of life at 6 months and 9 months post-randomisation in the ACT plus usual care group compared with usual care alone, regardless of pre-existing depression; p=0.0032). Limitations of the study are mainly associated with the specific nature of trials on psychological interventions. Because the control group did not receive any type of treatment in addition to usual care, conclusions regarding specific effects of ACT, as opposed to general effects of the regular provision of attention and support via the sessions, are restricted.