scholarly journals S109. FEASIBILITY AND ACCEPTABILITY OF ACCEPTANCE AND COMMITMENT THERAPY IN DAILY LIFE (ACT-DL): PATIENTS’ PERSPECTIVES

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S75-S76
Author(s):  
Evelyne van Aubel ◽  
Thomas Vaessen ◽  
Ulrich Reininghaus ◽  
Inez Myin-Germeys
Keyword(s):  
Acceptance And Commitment Therapy ◽  
Daily Life ◽  
Perceived Usefulness ◽  
Early Psychosis ◽  
Daily Lives ◽  
Face To Face ◽  
On Demand ◽  
Acceptance And Commitment ◽  
The Face ◽  
User Data

Abstract Background Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral intervention that holds promise for treatment of individuals in the early stages of psychosis. To increase its treatment effects, we have developed an ACT smartphone app that can be used as an add-on to traditional ACT – ACT in Daily-Life (ACT-DL). Augmenting face-to-face ACT with a mobile health ecological momentary intervention (EMI) may empower clients to take treatment into their own hands and bridge the treatment-practice gap. We tested the feasibility and acceptability of ACT-DL as part of a randomized controlled trial in individuals in the early stages of psychosis. Methods Participants at ultra-high risk (UHR) for, or with a first episode of psychosis (FEP) were randomized to ACT-DL (n=71) or to treatment-as-usual (n=77). In ACT-DL, participants followed seven face-to-face individual ACT-sessions. After each session, they took home a smartphone with the ACT-DL app installed on it that reminded individuals of ACT principles with visual cues of metaphors and provided exercises, 8 times a day for three subsequent days. On-demand exercises were always available. We gathered user data on adherence to app notifications, on-demand use of the app, and rated metaphor usefulness after each session. At post-measurement, a debriefing questionnaire assessed user evaluation on the use, usefulness, and burden of (parts of) the ACT-DL intervention. Results ACT-DL participants attended on average 5 out of 7 ACT sessions, with 42 completing all sessions. App user data (n=58) showed that on a weekly basis, participants interacted on average 16 times with the ACT-DL app, responding to 25% of the notifications, and initiating 5 on-demand exercises. Perceived usefulness of ACT-metaphors varied substantially between participants and weeks. Neither clinical status (UHR vs FEP), nor other baseline (or therapy) related variables were related to dropout, while minority status (b=-4.88; p<.01) and extraversion (b=-.44; p<.05) predicted lower app compliance. A debriefing questionnaire (n=41) showed that the majority of the participants (defined as endorsing a score of 5 or higher on a 7-point Likert scale) indicated that ACT-DL in general (69%), as well as the face-to-face ACT sessions (74%) were useful, and that the app had helped them to implement ACT exercises in their daily lives (71%). There was less consensus on whether the ACT-DL app was useful (40%) and whether it helped to increase mindful awareness (52%). Both the number of beeps (61%) and the length of beep questionnaires (57%) were perceived as burdensome. Whereas 90% of participants practiced the ACT exercises using the ACT-DL app and 85% using the workbook at least once, only 49% did the exercises on their own. Discussion This study showed that, despite large between-subject variability, early psychosis patients are largely positive about ACT-DL, acknowledging the usefulness of the app to implement ACT in their daily lives, the homework exercises, and the face-to-face sessions. This argues for the use of a blended care approach in early psychosis. However, the relatively low number of completion rates and app compliance, the perceived burden from notifications, and the variability in perceived usefulness of (parts of) the app, corroborates the need for future improvements in intervention design. I will provide suggestions for app optimisation.

Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: findings on treatment adherence and acceptability from the multi-center INTERACT randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Evelyne van Aubel ◽  
Thomas Vaessen ◽  
Henrietta Steinhart ◽  
Annelie Klippel ◽  
Tim Batink ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Acceptance And Commitment Therapy ◽  
Daily Life ◽  
Controlled Trial ◽  
Early Psychosis ◽  
Face To Face ◽  
Randomized Controlled ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Ecological Momentary

BACKGROUND Acceptance and Commitment Therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with a mobile health (mHealth) ecological momentary intervention (EMI) may increase its treatment effects and empower clients to take treatment into their own hands. OBJECTIVE This study aimed to investigate treatment adherence to and acceptability of Acceptance and Commitment Therapy in Daily Life (ACT-DL), a novel Ecological Momentary Intervention for people with Ultra-High-Risk (UHR) state and a First-Episode Psychosis (FEP). METHODS In the multi-center INTERACT randomized controlled trial, UHR and FEP individuals aged 15-65 were randomized to treatment as usual only (TAU) (control) or to ACT-DL+TAU (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone application, delivering ACT skills and techniques in daily life. We collected data on treatment adherence to and acceptability of ACT-DL. Predictors included baseline demographic, clinical and functional outcomes. RESULTS ACT-DL+TAU participants (n=71) completed a mean of 6 (SD=3) sessions, with 59% (n=42) of participants completing all sessions. App adherence data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant to 6 out of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness), and that 91% reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Ethnic minority background predicted lower notification response compliance (b=-4.37; p=.012), yet higher app usefulness (b=1.25; p=.049). Negative (b=-0.26; p=.010) and affective (b=0.14; p=.04) symptom severity predicted lower and higher ACT training usefulness respectively. Being female (b=-1.03; p=.049) predicted lower usefulness of the ACT metaphor images on the app. CONCLUSIONS Our results corroborate good treatment adherence to and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. CLINICALTRIAL The trial was prospectively registered within the Dutch Trial Register (ID: NTR4252). INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-019-3912-4

scholarly journals The Effects of Acceptance and Commitment Therapy (ACT) Intervention on Inflammation and Stress Biomarkers: a Randomized Controlled Trial

2020 ◽  
Vol 27 (5) ◽  
pp. 539-555 ◽  
Author(s):  
Elina Järvelä-Reijonen ◽  
Sampsa Puttonen ◽  
Leila Karhunen ◽  
Essi Sairanen ◽  
Jaana Laitinen ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Acceptance And Commitment Therapy ◽  
Systemic Inflammation ◽  
Post Intervention ◽  
Face To Face ◽  
Stress Biomarkers ◽  
Acceptance And Commitment ◽  
Acceptance And Action Questionnaire ◽  
The Face

Abstract Background Psychological processes can be manifested in physiological health. We investigated whether acceptance and commitment therapy (ACT), targeted on psychological flexibility (PF), influences inflammation and stress biomarkers among working-age adults with psychological distress and overweight/obesity. Method Participants were randomized into three parallel groups: (1) ACT-based face-to-face (n = 65; six group sessions led by a psychologist), (2) ACT-based mobile (n = 73; one group session and mobile app), and (3) control (n = 66; only the measurements). Systemic inflammation and stress markers were analyzed at baseline, at 10 weeks after the baseline (post-intervention), and at 36 weeks after the baseline (follow-up). General PF and weight-related PF were measured with questionnaires (Acceptance and Action Questionnaire, Acceptance and Action Questionnaire for Weight-Related Difficulties). Results A group × time interaction (p = .012) was detected in the high-sensitivity C-reactive protein (hsCRP) level but not in other inflammation and stress biomarkers. hsCRP decreased significantly in the face-to-face group from week 0 to week 36, and at week 36, hsCRP was lower among the participants in the face-to-face group than in the mobile group (p = .035, post hoc test). Age and sex were stronger predictors of biomarker levels at follow-up than the post-intervention PF. Conclusion The results suggest that ACT delivered in group sessions may exert beneficial effects on low-grade systemic inflammation. More research is needed on how to best apply psychological interventions for the health of both mind and body among people with overweight/obesity and psychological distress. Trial Registration ClinicalTrials.gov Identifier: NCT01738256, Registered 17 August, 2012

scholarly journals Evaluation of a Workplace Health and Wellbeing Training Course Delivered Online and Face-To-Face

2018 ◽  
Vol 15 (11) ◽  
pp. 2422 ◽  
Author(s):  
Zenobia Talati ◽  
Emily Davey ◽  
Carly Grapes ◽  
Trevor Shilton ◽  
Simone Pettigrew
Keyword(s):  
Repeated Measures ◽  
Relative Effectiveness ◽  
Perceived Competence ◽  
Perceived Usefulness ◽  
Workplace Health ◽  
Face To Face ◽  
Training Course ◽  
Health And Wellbeing ◽  
The Face ◽  
Potential Benefits

Organisations may benefit from training champions to promote healthy workplace environments and initiatives. This study compared the perceived usefulness and relative effectiveness of an employee training course offered via online and face-to-face formats. Individuals who took part in the training course were assessed on their perceived competence and confidence to implement changes pre- and post-training. Repeated measures Analysis of Variance (ANOVA) and a t-test were conducted to test for significant differences between pre- and post-training scores and/or mode of training, respectively. Although the face-to-face training course was rated as slightly more useful, there were no significant differences between the two modes of training for the other dependent variables, and both modes led to significantly greater perceived competence and confidence post-training. These findings demonstrate the potential benefits of training employees to implement changes in their workplaces.

scholarly journals Efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: Results from the multi-center INTERACT randomized controlled trial

2021 ◽  
Author(s):  
Inez Myin-Germeys ◽  
Evelyne van Aubel ◽  
Thomas Vaessen ◽  
Henrietta Steinhart ◽  
Annelie Klippel ◽  
...  
Keyword(s):  
Acceptance And Commitment Therapy ◽  
Symptom Severity ◽  
Negative Symptoms ◽  
Primary Outcome ◽  
Daily Life ◽  
Post Intervention ◽  
Global Functioning ◽  
Treatment As Usual ◽  
Acceptance And Commitment

Importance Treatment in the early stages of psychosis is crucial to prevent poor clinical and social outcomes. Currently, no preventive interventions are available that reduce psychotic distress, or affective and negative symptoms as well as functioning, calling for more and dedicated treatments for these. Objective To investigate the efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in addition to treatment as usual for psychotic distress, in comparison to treatment as usual only. Design This single-blinded randomized clinical INTERACT trial investigated participants post-intervention and at 6 and 12-month follow-up. Participants were recruited between June 1, 2015 and December 31, 2018. Assessors were blinded to treatment allocation. Setting INTERACT is a multi-center trial recruiting participants from secondary mental health services in 5 regions in Belgium and The Netherlands. Participants The sample was a referral sample of individuals aged 15-65 years with a clinically established UHR or FEP status. Interventions Individuals were randomly assigned (1:1) to ACT-DL, consisting of 8 ACT sessions augmented with an EMI app in addition to treatment as usual, or to treatment as usual only. Main outcomes and measures The primary outcome was a reduction in psychotic distress as assessed with CAARMS at post-intervention, 6- and 12-month follow-up. Secondary outcomes included symptom severity (measured with BPRS and BNNS), functioning (measured with SOFAS and SFS) and momentary psychotic distress (measured with the Experience Sampling Method, a structured diary technique). All analyses were described in the trial protocol and in a postregistration on the open-science framework, prior to accessing the data. Results Of the 196 individuals assessed for eligibility, 148 were randomized to ACT-DL+TAU (n=71) or TAU (n=77) (72 female (49%), average age 25 (SD = 6), 71 FEP (48%)). 115 (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of a greater reduction in CAARMS distress in ACT-DL+TAU compared to TAU (χ2(3)=2.38; p=.50). However, general psychopathology (χ2(3)=14.44; p=.002); affective (χ2(3)=8.55; p=.04) and negative symptom severity (χ2(3)=19.96; p<.001) as measured with the BPRS was reduced, as well as negative symptoms as assessed with BNNS (χ2(3)=15.96; p=.001) in. Furthermore, global functioning improved (χ2(3)=8.72; p=.033) in ACT-DL+TAU compared to TAU, whereas social functioning failed to reach significance (χ2(3)=7.41; p=.060). Finally, a clear and significant reduction was found in momentary psychotic distress (χ2(3)=21.56; p<0.001), whereas no effects were found for momentary psychotic experiences (χ2(3)=1.02; p=.599), momentary positive (χ2(3)=4.17; p=.124) or negative (χ2(3)=2.78; p=.249) affect. No serious adverse events directly related to the therapy occurred. Conclusions and relevance INTERACT did not support a significant effect on psychotic distress as assessed with the CAARMS. However, significant improvements were found for momentary psychotic distress, global functioning and negative symptomatology. These results are promising given that these latter problems are among the hardest to treat.

scholarly journals Changes in daily-life social processes and psychopathology symptoms in Flemish youth from before to during the COVID-19 pandemic

2021 ◽  
Author(s):  
Robin Achterhof ◽  
Inez Myin-Germeys ◽  
Eva Bamps ◽  
Noëmi Hagemann ◽  
Karlijn Susanna Francisca Maria Hermans ◽  
...  
Keyword(s):  
Social Interactions ◽  
Social Deprivation ◽  
Daily Life ◽  
Adolescent Psychopathology ◽  
Brief Symptom Inventory ◽  
Family Interactions ◽  
Daily Lives ◽  
Face To Face ◽  
Psychopathology Symptoms ◽  
The Impact

Early findings on the impact of the COVID-19 pandemic on adolescents, suggest that – despite being at the lowest physical health risk – both their mental health and day-to-day social lives are strongly affected. In this longitudinal study, we assessed changes in adolescent psychopathology symptoms, the quality and quantity of daily-life social interactions, and the relationship between social interactions and psychopathology symptoms before and during the pandemic.A sample of n=173 Flemish adolescents (mean age=16.0 at latest measurement; 89% girls) from the SIGMA cohort was tested between January 2018 - June 2019; and between April 27th - May 10th 2020. Subclinical psychopathology was assessed using the Brief Symptom Inventory-53; daily social interactions were assessed in six-day experience sampling periods with ten daily questionnaires.Multilevel linear and logistic regression analyses indicated lower general psychopathology and anxiety symptoms, beyond age effects; fewer face-to-face social interactions, more online social interactions; and higher-quality face-to-face interactions during the pandemic than before. Negative associations between psychopathology and the quality of face-to-face peer and family interactions were stronger during the pandemic than pre-pandemic.The observed decrease and stability in psychopathology symptoms is surprising and potentially reflects resilience. Although digital communication may buffer much of the quarantine-induced distress, the current results imply that high-quality face-to-face interactions with family and peers may have been more powerful in keeping adolescents resilient. As restrictions are lifted and adolescents’ daily lives and social worlds change, it is crucial to learn more about the longer-term effects of the experienced social deprivation.

scholarly journals Efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: study protocol for a multi-centre randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ulrich Reininghaus ◽  
Annelie Klippel ◽  
Henrietta Steinhart ◽  
Thomas Vaessen ◽  
Martine van Nierop ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Acceptance And Commitment Therapy ◽  
Daily Life ◽  
Controlled Trial ◽  
Psychotic Experiences ◽  
Intervention Period ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Randomised Controlled

Abstract Background Psychotic experiences, social functioning and general psychopathology are important targets for early intervention in individuals with Ultra-High-Risk state (UHR) and a first-episode psychosis (FEP). Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets, but evidence on sustainable change and its underlying mechanisms in individuals’ daily lives remains limited. The aim of the INTERACT study is to investigate the efficacy of a novel ecological momentary intervention, Acceptance and Commitment Therapy in Daily Life (ACT-DL) in a multi-centre randomised controlled trial of individuals with UHR or FEP. Methods/design In a multi-centre randomised controlled trial, individuals aged 16–65 years with UHR or FEP will be randomly allocated to ACT-DL in addition to treatment as usual (TAU) as the experimental condition or a control condition of TAU only, which will include – for the entire study period – access to routine mental health care and, where applicable, CBT for psychosis (CBTp). Outcomes will be assessed at baseline (i.e. before randomisation), post-intervention (i.e. after the 8-week intervention period), and 6-month and 12-month follow-ups (i.e. 6 and 12 months after completing the intervention period) by blinded assessors. The primary outcome will be distress associated with psychotic experiences, while secondary outcomes will include (momentary) psychotic experiences, social functioning and psychopathology. Process measures to assess putative mechanisms of change will include psychological flexibility, stress sensitivity and reward experiences. In addition, acceptability, treatment adherence and treatment fidelity of ACT-DL will be assessed. Discussion The current study is the first to test the efficacy of ACT-DL in individuals with UHR and FEP. If this trial demonstrates the efficacy of ACT-DL, it has the potential to significantly advance the treatment of people with UHR and FEP and, more generally, provides initial support for implementing mHealth interventions in mental health services. Trial registration Netherlands Trial Register, ID: NTR4252. Registered on 26 September 2013.

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