Research on acceptance and commitment therapy (ACT) and its application to various clinical issues have proliferated across the world. Despite very active clusters of ACT research occurring worldwide, the science that is disseminated through the literature does not fully reflect this scope and diversity, with Iran serving as a prime example of this issue. To increase awareness of ACT research findings in Iran, we conducted a systematic review of 110 randomized trials and extracted data on key study features. RCTs were identified, suggesting the efficacy of ACT in Iran for a wide range of clinical areas, including anxiety disorders, obsessive-compulsive related disorders, posttraumatic stress disorder, mood disorders, substance use disorders, eating disorders, and psychological outcomes among patients diagnosed with medical conditions including cancer, diabetes, gastric dysfunctions, pain, infertility, HIV/AIDS, and multiple sclerosis as well as improving multiple health-related biomarkers in medical samples. The majority of studies had a relatively high risk of potential bias due to methodological limitations. Several important cultural factors were identified related to how ACT has been delivered and evaluated in Iran. These included targets of treatment and ways that clinical research itself is conducted that differentiate this important body of work from ACT research conducted in Western cultural contexts.