scholarly journals Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study

2018 ◽  
Vol 5 (2) ◽  
pp. e28 ◽  
Author(s):  
Ditte Hoffmann ◽  
Charlotte Ulrikka Rask ◽  
Erik Hedman-Lagerlöf ◽  
Brjánn Ljótsson ◽  
Lisbeth Frostholm
Keyword(s):  
Acceptance And Commitment Therapy ◽  
Health Anxiety ◽  
Small Sample ◽  
Post Treatment ◽  
Self Report ◽  
Care Utilization ◽  
Specialized Treatment ◽  
Commitment Therapy ◽  
Acceptance And Commitment

Background Severe health anxiety (hypochondriasis), or illness anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, is characterized by preoccupation with fear of suffering from a serious illness in spite of medical reassurance. It is a debilitating, prevalent disorder associated with increased health care utilization. Still, there is a lack of easily accessible specialized treatment for severe health anxiety. Objective The aims of this paper were to (1) describe the development and setup of a new internet-delivered acceptance and commitment therapy (iACT) program for patients with severe health anxiety using self-referral and a video-based assessment; and (2) examine the feasibility and potential clinical efficacy of iACT for severe health anxiety. Methods Self-referred patients (N=15) with severe health anxiety were diagnostically assessed by a video-based interview. They received 7 sessions of clinician-supported iACT comprising self-help texts, video clips, audio files, and worksheets over 12 weeks. Self-report questionnaires were obtained at baseline, post-treatment, and at 3-month follow-up. The primary outcome was Whiteley-7 Index (WI-7) measuring health anxiety severity. Depressive symptoms, health-related quality of life (HRQoL), life satisfaction, and psychological flexibility were also assessed. A within-group design was employed. Means, standard deviations, and effect sizes using the standardized response mean (SRM) were estimated. Post-treatment interviews were conducted to evaluate the patient experience of the usability and acceptability of the treatment setup and program. Results The self-referral and video-based assessments were well received. Most patients (12/15, 80%) completed the treatment, and only 1 (1/15, 7%) dropped out. Post-treatment (14/15, 93%) and 3-month follow-up (12/15, 80%) data were available for almost all patients. Paired t tests showed significant improvements on all outcome measures both at post-treatment and 3-month follow-up, except on one physical component subscale of HRQoL. Health anxiety symptoms decreased with 33.9 points at 3-month follow-up (95% CI 13.6-54.3, t11= 3.66, P=.004) with a large within-group effect size of 1.06 as measured by the SRM. Conclusions Treatment adherence and potential efficacy suggest that iACT may be a feasible treatment for health anxiety. The uncontrolled design and small sample size of the study limited the robustness of the findings. Therefore, the findings should be replicated in a randomized controlled trial. Potentially, iACT may increase availability and accessibility of specialized treatment for health anxiety. Trial Registration Danish Data Protection Agency, Central Denmark Region: 1-16-02-427-14; https://www.rm.dk/sundhed/faginfo/forskning/datatilsynet/ (Archived by Webcite at http://www.webcitation.org/6yDA7WovM)

scholarly journals Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study (Preprint)

2017 ◽  
Author(s):  
Ditte Hoffmann ◽  
Charlotte Ulrikka Rask ◽  
Erik Hedman-Lagerlöf ◽  
Brjánn Ljótsson ◽  
Lisbeth Frostholm
Keyword(s):  
Acceptance And Commitment Therapy ◽  
Health Anxiety ◽  
Small Sample ◽  
Post Treatment ◽  
Self Report ◽  
Care Utilization ◽  
Specialized Treatment ◽  
Commitment Therapy ◽  
Acceptance And Commitment

BACKGROUND Severe health anxiety (hypochondriasis), or illness anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, is characterized by preoccupation with fear of suffering from a serious illness in spite of medical reassurance. It is a debilitating, prevalent disorder associated with increased health care utilization. Still, there is a lack of easily accessible specialized treatment for severe health anxiety. OBJECTIVE The aims of this paper were to (1) describe the development and setup of a new internet-delivered acceptance and commitment therapy (iACT) program for patients with severe health anxiety using self-referral and a video-based assessment; and (2) examine the feasibility and potential clinical efficacy of iACT for severe health anxiety. METHODS Self-referred patients (N=15) with severe health anxiety were diagnostically assessed by a video-based interview. They received 7 sessions of clinician-supported iACT comprising self-help texts, video clips, audio files, and worksheets over 12 weeks. Self-report questionnaires were obtained at baseline, post-treatment, and at 3-month follow-up. The primary outcome was Whiteley-7 Index (WI-7) measuring health anxiety severity. Depressive symptoms, health-related quality of life (HRQoL), life satisfaction, and psychological flexibility were also assessed. A within-group design was employed. Means, standard deviations, and effect sizes using the standardized response mean (SRM) were estimated. Post-treatment interviews were conducted to evaluate the patient experience of the usability and acceptability of the treatment setup and program. RESULTS The self-referral and video-based assessments were well received. Most patients (12/15, 80%) completed the treatment, and only 1 (1/15, 7%) dropped out. Post-treatment (14/15, 93%) and 3-month follow-up (12/15, 80%) data were available for almost all patients. Paired t tests showed significant improvements on all outcome measures both at post-treatment and 3-month follow-up, except on one physical component subscale of HRQoL. Health anxiety symptoms decreased with 33.9 points at 3-month follow-up (95% CI 13.6-54.3, t11= 3.66, P=.004) with a large within-group effect size of 1.06 as measured by the SRM. CONCLUSIONS Treatment adherence and potential efficacy suggest that iACT may be a feasible treatment for health anxiety. The uncontrolled design and small sample size of the study limited the robustness of the findings. Therefore, the findings should be replicated in a randomized controlled trial. Potentially, iACT may increase availability and accessibility of specialized treatment for health anxiety. CLINICALTRIAL Danish Data Protection Agency, Central Denmark Region: 1-16-02-427-14; https://www.rm.dk/sundhed/faginfo/forskning/datatilsynet/ (Archived by Webcite at http://www.webcitation.org/6yDA7WovM)

Behavioral Activation and Acceptance and Commitment Therapy in the Treatment of Anxiety and Depression in Cancer Survivors: A Randomized Clinical Trial

2020 ◽  
pp. 014544552091644
Author(s):  
Concepción Fernández-Rodríguez ◽  
Sonia González-Fernández ◽  
Rocío Coto-Lesmes ◽  
Ignacio Pedrosa
Keyword(s):  
Cancer Survivors ◽  
Acceptance And Commitment Therapy ◽  
Experiential Avoidance ◽  
Behavioral Activation ◽  
Emotional Problems ◽  
Post Treatment ◽  
Behavioural Activation ◽  
Commitment Therapy ◽  
Acceptance And Commitment

Behavioural Activation (BA) and Acceptance and Commitment Therapy (ACT) aim to reduce the inflexible avoidance of painful thoughts, feelings and memories and to encourage involvement in relevant activities, objectives which are clearly relevant to the situation of cancer survivors with emotional problems. With a view to evaluating and comparing the efficacy of both therapies, applied on a group basis, a randomized controlled trial was developed. Cancer survivors (age 18–65 years) with anxiety and/or depression were assigned at random to two experimental groups (BA; ACT) and a waiting list control group (WL). Of the 66 cancer survivors randomized to trial (intention-to-treat sample), 46 participants ( M = 51.49; SD = 6.88) completed the intervention (BA, n = 17; ACT, n = 12; WL, n = 17) (per-protocol sample). The emotional state, experiential avoidance and behavioural activation of the participants was evaluated in the pre- and post-treatment and in a 3-month follow-up using standardized instruments. Both treatment groups showed statistically significant changes, indicating an improvement in all the result variables in the post-treatment and follow-up as compared to the pre-treatment. BA showed better results than ACT regarding impact on anxiety and activation. This greater efficacy may have been due to factors such as the emphasis placed in BA on behavioural activation and the central role played in it by functional analysis. The key role played by experiential avoidance and behavioral activation in the maintenance and treatment of emotional problems in cancer survivors is discussed. Raw data are available online ( http://dx.doi.org/10.17632/m7w688khs8.1 )

scholarly journals Development and feasibility of a digital Acceptance and Commitment Therapy-based Intervention for Generalised Anxiety Disorder: Pilot study (Preprint)

2020 ◽  
Author(s):  
Nicola R Hemmings ◽  
Jamie M Kawadler ◽  
Rachel Whatmough ◽  
Sonia Ponzo ◽  
Alessio Rossi ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Acceptance And Commitment Therapy ◽  
Feasibility Study ◽  
Psychological Flexibility ◽  
Post Treatment ◽  
Self Report ◽  
Generalised Anxiety Disorder ◽  
Commitment Therapy ◽  
Digital Intervention ◽  
Acceptance And Commitment

BACKGROUND Generalised anxiety disorder (GAD) is characterised by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. OBJECTIVE This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing wellbeing app platform, BioBase. A pilot feasibility study evaluating acceptability, usability and efficacy study is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. METHODS Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for two weeks. Self-report questionnaires were obtained at baseline and post-treatment. The primary outcome was psychological flexibility (AAQ-II) as this is the aim of ACT. Mental wellbeing (WEMWBS) and symptoms of anxiety (GAD-7) and depression (PHQ-9) were also assessed. Post-treatment usability was assessed via self-report measures (SUS) in addition to interviews that further explored feasibility of the digital intervention in this sample. RESULTS The app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline. Participants had higher psychological flexibility and wellbeing scores at exit, although these were not significantly different from baseline. CONCLUSIONS This ACT prototype within BioBase is an acceptable and feasible digital intervention, with evidence of preliminary efficacy in reducing symptoms of anxiety and depression. This study suggests this intervention warrants a larger feasibility study in adults with GAD.

scholarly journals Evaluating the Open and Engaged Components of Acceptance and Commitment Therapy in an Online Self-Guided Website: Results from a Pilot Trial

2019 ◽  
pp. 014544551987866 ◽  
Author(s):  
Julie M. Petersen ◽  
Jennifer Krafft ◽  
Michael P. Twohig ◽  
Michael E. Levin
Keyword(s):  
Acceptance And Commitment Therapy ◽  
Psychosocial Functioning ◽  
Pilot Trial ◽  
Post Treatment ◽  
Optimal Outcomes ◽  
Online Platforms ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
High Satisfaction

Online acceptance and commitment therapy (ACT) is promising for treating a range of psychological problems. Component research can further clarify which components are needed for optimal outcomes in what contexts. Online platforms provide a highly controlled format for such research. In this pilot trial, 55 adults were randomized to: ACT-Open (i.e., acceptance, defusion components), ACT-Engaged (i.e., values, committed action), or ACT-Combined (i.e., acceptance, defusion, values, committed action). Each condition was 12 sessions over 6 weeks, with assessments at baseline, post-treatment, and 4-week follow-up. ACT-Open, ACT-Engaged, and ACT-Combined all significantly improved from pre- to post-treatment on mental health, psychosocial functioning, and components of psychological flexibility. Compared to ACT-Combined, ACT-Open improved less on psychosocial functioning at post-treatment, and ACT-Engaged worsened on functioning at follow-up. The platform was acceptable with high satisfaction ratings. Results support the feasibility of conducting online ACT component research, which will be tested in a fully powered non-inferiority trial.

Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme

2021 ◽  
pp. bmjspcare-2020-002786
Author(s):  
Nicholas J Hulbert-Williams ◽  
Lee Hulbert-Williams ◽  
Pandora Patterson ◽  
Sahil Suleman ◽  
Lesley Howells
Keyword(s):  
Clinical Practice ◽  
Acceptance And Commitment Therapy ◽  
Cancer Care ◽  
Psychological Flexibility ◽  
Training Programme ◽  
Free Text ◽  
Evaluation Data ◽  
Commitment Therapy ◽  
Acceptance And Commitment

BackgroundPsychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT).AimsWe developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach.MethodWe report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions.ResultsAt 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees’ stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility.DiscussionAcceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.

scholarly journals MECHANISM OF ACTION: AGE DIFFERENCES IN RESPONSE TO ACCEPTANCE AND COMMITMENT THERAPY FOR CHRONIC PAIN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S809-S809
Author(s):  
Julie L Wetherell ◽  
Matthew Herbert ◽  
Niloofar Afari
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Behavioral Therapy ◽  
Pain Interference ◽  
Younger Adults ◽  
Pain Acceptance ◽  
Commitment Therapy ◽  
Acceptance And Commitment

Abstract A recent randomized comparison of Acceptance and Commitment Therapy (ACT) vs. Cognitive-Behavioral Therapy for chronic pain found a clear age interaction effect, such that older adults benefitted more from ACT. In a subsequent study comparing ACT delivered in person to ACT delivered via telehealth to a sample of veterans (N=128, mean age 51.9, SD 13.3, range 25-89), we found no significant age by modality interactions, suggesting that older veterans responded as well as younger people did to telehealth delivery. Consistent with our previous findings, we found a trend for older adults to experience greater reduction in pain interference (p = .051) and significantly greater reduction in pain severity (p = .001) than younger adults following ACT. In younger veterans, change in pain acceptance from baseline to posttreatment was related to change in pain interference from baseline to 6-month follow-up (r = -.38), but change in pain interference from baseline to posttreatment was not related to change in pain acceptance from baseline to follow-up (r = .14), suggesting that, consistent with the ACT model, increased pain acceptance at posttreatment was related to reduced pain interference at follow-up. By contrast, in older veterans, both correlations were significant and of comparable magnitude (rs = -.43 and -.46, respectively), providing no support for the idea that change in pain acceptance drove change in pain interference. Overall, our findings suggest that ACT may work better in older adults with chronic pain than in younger adults, but via a different mechanism.

A Preliminary Investigation of Acceptance and Commitment Therapy for Adolescent Obsessive-Compulsive Disorder

2013 ◽  
Vol 27 (2) ◽  
pp. 175-190 ◽  
Author(s):  
Andrew B. Armstrong ◽  
Kate L. Morrison ◽  
Michael P. Twohig
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Acceptance And Commitment Therapy ◽  
Preliminary Investigation ◽  
Obsessive Compulsive ◽  
Self Monitoring ◽  
Compulsive Disorder ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Treatment Procedures

There is growing support for the use of acceptance and commitment therapy (ACT) as a treatment for adults with obsessive-compulsive disorder (OCD), but no research has been published on the use of ACT for adolescent OCD. This preliminary study investigated ACT for youth with OCD using a multiple baseline across participants design. Three adolescents, ages 12 or 13 years, were treated with 8–10 sessions of ACT (without in-session exposure exercises). The primary dependent variable was daily self-monitoring of compulsions. Results showed a 40% mean reduction in self-reported compulsions from pretreatment to posttreatment, with results maintained at 3-month follow-up, for a reduction of 43.8%. Pretreatment to posttreament reductions in Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) ratings of OCD severity were 50.0%, 12.5%, and 22.0%; pretreatment to follow-up reductions were 54.0%, 12.5%, and 61.0%. Treatment procedures were rated by participants and parents as highly acceptable. Implications and future directions are discussed.

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