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Sanabria-Mazo JP, D'Amico F, Cardeñosa E, Ferrer M, Edo S, Borràs X, McCracken LM, Feliu-Soler A, Sanz A, Luciano JV. Economic Evaluation of Videoconference Group Acceptance and Commitment Therapy and Behavioral Activation Therapy for Depression Versus Usual Care Among Adults With Chronic Low Back Pain Plus Comorbid Depressive Symptoms. THE JOURNAL OF PAIN 2024; 25:104472. [PMID: 38242333 DOI: 10.1016/j.jpain.2024.01.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
Chronic pain and depression are frequently comorbid conditions associated with significant health care and social costs. This study examined the cost-utility and cost-effectiveness of videoconference-based group forms of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD), as a complement to treatment-as-usual (TAU), for patients with chronic low back pain (CLBP) plus depressive symptoms, compared to TAU alone. A trial-based economic evaluation (n = 234) was conducted from a governmental and health care perspective with a time horizon of 12 months. Primary outcomes were the Brief Pain Inventory-Interference Scale (BPI-IS) and Quality Adjusted Life Year. Compared to TAU, ACT achieved a significant reduction in total costs (d = .47), and BATD achieved significant reductions in indirect (d = .61) and total costs (d = .63). Significant improvements in BPI-IS (d = .73 and d = .66, respectively) and Quality Adjusted Life Year scores (d = .46 and d = .28, respectively) were found in ACT and BATD compared to TAU. No significant differences in costs and outcomes were found between ACT and BATD. In the intention-to-treat analyses, from the governmental and health care perspective, no significant differences in cost reduction and incremental effects were identified in the comparison between ACT, BATD, and TAU. However, in the complete case analysis, significant incremental effects of ACT (∆BPI-IS = -1.57 and -1.39, respectively) and BATD (∆BPI-IS = -1.08 and -1.04, respectively) compared with TAU were observed. In the per-protocol analysis, only the significant incremental effects of ACT (∆BPI-IS = -1.68 and -1.43, respectively) compared to TAU were detected. In conclusion, ACT and BATD might be efficient options in the management of CLBP plus comorbid depression symptoms as compared to usual care. However, no clear difference was found in the comparison between the 2 active therapies regarding cost-effectiveness or cost-utility. PERSPECTIVE: The economic evaluation of psychological therapies for the management of complex conditions can be used in decision-making and resource allocation. This study provides evidence that ACT and BATD are more effective and involve a greater reduction in costs than usual care in the management of CLBP plus comorbid depressive symptoms. TRIAL NUMBER: NCT04140838.
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Affiliation(s)
- Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Francesco D'Amico
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Eugenia Cardeñosa
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Basic Health Area (ABS) Maria Bernades, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, Viladecans, Spain
| | - Montse Ferrer
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Xavier Borràs
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Garland MM, Wilson R, Thompson WK, Stein MB, Paulus MP, Feinstein JS, Khalsa SS. A randomized controlled safety and feasibility trial of floatation-REST in anxious and depressed individuals. PLoS One 2024; 19:e0286899. [PMID: 38843272 PMCID: PMC11156321 DOI: 10.1371/journal.pone.0286899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/04/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Reduced Environmental Stimulation Therapy via floatation (floatation-REST) is a behavioral intervention designed to attenuate exteroceptive sensory input to the nervous system. Prior studies in anxious and depressed individuals demonstrated that single sessions of floatation-REST are safe, well-tolerated, and associated with an acute anxiolytic and antidepressant effect that persists for over 48 hours. However, the feasibility of using floatation-REST as a repeated intervention in anxious and depressed populations has not been well-investigated. METHODS In this single-blind safety and feasibility trial, 75 individuals with anxiety and depression were randomized to complete six sessions of floatation-REST in different formats: pool-REST (weekly 1-hour float sessions), pool-REST preferred (float sessions with flexibility of duration and frequency), or an active comparator (chair-REST; weekly 1-hour sessions in a Zero Gravity chair). Feasibility (primary outcome) was assessed via an 80% rate of adherence to the assigned intervention; tolerability via study dropout and duration/frequency of REST utilization; and safety via incidence of adverse events and ratings about the effects of REST. RESULTS Of 1,715 individuals initially screened, 75 participants were ultimately randomized. Six-session adherence was 85% for pool-REST (mean, M = 5.1 sessions; standard deviation, SD = 1.8), 89% for pool-REST preferred (M = 5.3 sessions; SD = 1.6), and 74% for chair-REST (M = 4.4 sessions; SD = 2.5). Dropout rates at the end of the intervention did not differ significantly between the treatment conditions. Mean session durations were 53.0 minutes (SD = 12.3) for pool-REST, 75.4 minutes (SD = 29.4) for pool-REST preferred, and 58.4 minutes (SD = 4.3) for chair-REST. There were no serious adverse events associated with any intervention. Positive experiences were endorsed more commonly than negative ones and were also rated at higher levels of intensity. CONCLUSIONS Six sessions of floatation-REST appear feasible, well-tolerated, and safe in anxious and depressed individuals. Floatation-REST induces positively-valenced experiences with few negative effects. Larger randomized controlled trials evaluating markers of clinical efficacy are warranted. CLINICAL TRIAL REGISTRATION IDENTIFIER NCT03899090.
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Affiliation(s)
- McKenna M. Garland
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
- Kendall College of Arts and Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Raminta Wilson
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Wesley K. Thompson
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Martin P. Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Justin S. Feinstein
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
- Float Research Collective, Kihei, Hawaii, United States of America
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
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Atefi GL, Koh WQ, Kohl G, Seydavi M, Swift JK, Akbari M, de Vugt ME. Adherence to Online Interventions for Family Caregivers of People With Dementia: A Meta-Analysis and Systematic Review. Am J Geriatr Psychiatry 2024:S1064-7481(24)00319-1. [PMID: 38735829 DOI: 10.1016/j.jagp.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Online interventions hold promise in supporting the well-being of family caregivers and enhancing the quality of care they provide for individuals with long-term or chronic conditions. However, dropout rates from support programs among specific groups of caregivers, such as caregivers of people with dementia, pose a challenge. Focused reviews are needed to provide more accurate insights and estimates in this specific research area. METHODS A meta-analysis of dropout rates from available online interventions for family caregivers of people with dementia was conducted to assess treatment acceptability. A systematic search yielded 18 studies involving 1,215 caregivers. RESULTS The overall pooled dropout rate was 18.4%, with notable heterogeneity indicating varied intervention adherence. Interventions incorporating human contact, interactive features, and personalization strategies for specific types and stages of dementia predicted significantly lower dropout rates. Methodological assessment revealed variability in study quality. CONCLUSION Findings support the effectiveness of social support, personalization strategies, and co-design in enhancing intervention adherence among dementia family caregivers. Further research is needed to explore factors influencing dropout rates and conduct robust trials to refine the implementation of future interventions.
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Affiliation(s)
- Golnaz L Atefi
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (GLA, MEV), Maastricht University, Maastricht, The Netherlands.
| | - Wei Qi Koh
- School of Health and Rehabilitation Sciences (WQK), The University of Queensland, Brisbane, Australia
| | - Gianna Kohl
- Research Department of Clinical (GK), Educational and Health Psychology, University College London, London, UK
| | - Mohammad Seydavi
- Department of Clinical Psychology (MS, MA), Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Joshua K Swift
- Department of Psychology (JKS), Idaho State University, 921 S. 8th St, Pocatello, ID
| | - Mehdi Akbari
- Department of Clinical Psychology (MS, MA), Faculty of Psychology and Education, Kharazmi University, Tehran, Iran.
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (GLA, MEV), Maastricht University, Maastricht, The Netherlands
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Zhang X, Ho GWK, Mak YW. Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial. PLoS One 2024; 19:e0298178. [PMID: 38635558 PMCID: PMC11025806 DOI: 10.1371/journal.pone.0298178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/03/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Chronic heart failure (CHF) poses a significant burden on both patients and their family caregivers (FCs), as it is associated with psychological distress and impaired quality of life (QOL). Acceptance and Commitment Therapy (ACT) supports QOL by focusing on value living and facilitates acceptance of psychological difficulties by cultivating psychological flexibility. A protocol is presented that evaluates the effectiveness of a dyad ACT-based intervention delivered via smartphone on QOL and other related health outcomes compared with CHF education only. METHODS This is a single-center, two-armed, single-blinded (rater), randomized controlled trial (RCT). One hundred and sixty dyads of CHF patients and their primary FCs will be recruited from the Cardiology Department of a hospital in China. The dyads will be stratified block randomized to either the intervention group experiencing the ACT-based intervention or the control group receiving CHF education only. Both groups will meet two hours per week for four consecutive weeks in videoconferencing sessions over smartphone. The primary outcomes are the QOL of patients and their FCs. Secondary outcomes include psychological flexibility, psychological symptoms, self-care behavior, and other related outcomes. All outcomes will be measured by blinded outcome assessors at baseline, immediately post-intervention, and at the three-month follow-up. Multilevel modeling will be conducted to assess the effects of the intervention. DISCUSSION This study is the first to adopt an ACT-based intervention for CHF patient-caregiver dyads delivered in groups via smartphone. If effective and feasible, the intervention strategy and deliverable approach could be incorporated into clinical policies and guidelines to support families with CHF without geographic and time constraints. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04917159. Registered on 08 June 2021.
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Affiliation(s)
- Xuelin Zhang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Grace W. K. Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Atefi GL, van Knippenberg RJM, Bartels SL, Losada-Baltar A, Márquez-González M, Verhey FRJ, de Vugt ME. A Web-Based Intervention Based on Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Mixed Methods Feasibility Study. JMIR Aging 2024; 7:e53489. [PMID: 38574360 PMCID: PMC11027053 DOI: 10.2196/53489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/24/2023] [Accepted: 01/12/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Acceptance and commitment therapy (ACT), as an empirically based third-wave cognitive behavioral therapy, has shown promise in enhancing well-being and functioning across diverse populations. However, in the context of caregiving, the effect size of available ACT interventions remains at best moderate, sometimes accompanied by high dropout rates, highlighting the need for more effective and feasible intervention designs. OBJECTIVE The objective of our study was to evaluate the feasibility and acceptability of a fully online ACT program designed for family caregivers of people with dementia. This study aimed to boost psychological flexibility and support caregivers, enabling them to realize and prioritize their own life values alongside their caregiving responsibilities. METHODS A mixed methods feasibility study using an uncontrolled pretest-posttest design was conducted. This intervention included a 9-week web-based self-help program based on ACT incorporating collaborative goal setting and weekly web-based motivational coaching for family caregivers of people with dementia. This study involved 30 informal caregivers recruited through memory clinics and social media platforms in the Netherlands and received approval from the Medical Ethics Committee of the Maastricht University Medical Center+ (NL77389.068.21/metc21-029). RESULTS A total of 24 caregivers completed the postintervention assessment, indicating a high adherence rate (24/29, 83%). Caregivers reported positive feedback regarding collaborative goal setting, but some found challenges in implementing new skills due to their own habitual responses or the unpredictable context of dementia caregiving. Personalizing the intervention based on individual value preferences was highlighted as beneficial. CONCLUSIONS Compared to other web-based self-help ACT interventions for family caregivers, this intervention showed a high adherence and sufficient level of feasibility, which underscores the use of personalization in delivering web-based interventions. Moreover, the potential of this ACT-based intervention for family caregivers of people with dementia was demonstrated, suggesting that further research and a larger-scale controlled trial are warranted to validate its effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2022-070499.
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Affiliation(s)
- Golnaz L Atefi
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Rosalia J M van Knippenberg
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Sara Laureen Bartels
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Andrés Losada-Baltar
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - María Márquez-González
- Biological and Health Psychology Department, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
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Uysal B, Gormez V, Karatepe HT, Sönmez D, Taştekne F, Tepedelen MS, Jordan TR. Reducing Test Anxiety During the COVID-19 Pandemic: A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy. Psychol Rep 2024; 127:159-177. [PMID: 37140196 PMCID: PMC10160818 DOI: 10.1177/00332941231174394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Educational assessments can affect students' mental health, particularly during a pandemic. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are widely efficacious for reducing test anxiety, as well as general anxiety and rumination. However, the effectiveness of these two therapies for students during COVID-19 is unclear. We measured the effectiveness of ACT and CBT for managing test anxiety, general anxiety, and rumination during COVID-19 for 77 students taking Türkiye's national university entrance exam, assigned to either the ACT or CBT psychoeducation programs. Both programs reduced test anxiety, general anxiety, and rumination, and showed similar levels of effectiveness. This suggests that ACT and CBT are both important for improving students' mental health during COVID-19 and either may be beneficial.
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Affiliation(s)
- Burcu Uysal
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Vahdet Gormez
- Department of Child and Adolescent, Medical Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hasan Turan Karatepe
- Department of Psychiatry, Medical Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Dilruba Sönmez
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Feyzanur Taştekne
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Mehmed Seyda Tepedelen
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Timothy R Jordan
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
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Wijk I, Amsberg S, Johansson UB, Livheim F, Toft E, Anderbro T. Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: a randomised controlled trial. BMJ Open 2023; 13:e072061. [PMID: 38101850 PMCID: PMC10729111 DOI: 10.1136/bmjopen-2023-072061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To evaluate the impact of an Acceptance and Commitment Therapy (ACT) programme, tailored for people living with type 1 diabetes, on glycated haemoglobin (HbA1c), self-management and psychosocial factors among individuals with HbA1c>60 mmol/mol compared with treatment as usual (TAU). SETTING An endocrinologic clinic in Sweden. PARTICIPANTS In this randomised controlled trial, 81 individuals with type 1 diabetes, aged 18-70 years with HbA1c>60 mmol/mol, were randomly assigned to either an ACT group intervention or TAU. Exclusion criteria were: unable to speak Swedish, untreated or severe psychiatric disease, cortisone treatment, untreated thyroid disease and newly started insulin pump therapy. At the 2-year follow-up, HbA1c was measured in 26 individuals. INTERVENTION The ACT programme comprised seven 2-hour sessions held over 14 weeks and focused on acceptance of stressful thoughts and emotions, and to promote value-based committed action. OUTCOMES The primary outcome was HbA1c, and the secondary outcomes were measures of depression, anxiety, general stress, fear of hypoglycaemia, diabetes distress, self-care activities, psychological flexibility (general and related to diabetes) and quality of life. The primary endpoint was HbA1c 2 years after the intervention programme. Linear mixed models were used to test for an interaction effect between measurement time and group. RESULTS Likelihood ratio test of nested models demonstrated no statistically significant interaction effect (χ2=0.49, p=0.485) between measurement time and group regarding HbA1c. However, a statistically significant interaction effect (likelihood ratio test χ2=12.63, p<0.001) was observed with improved scores on The Acceptance and Action Questionnaire in the intervention group after 1 and 2 years. CONCLUSIONS No statistically significant difference was found between the groups regarding the primary outcome measure, HbA1c. However, the ACT programme showed a persistent beneficial impact on psychological flexibility in the intervention group. The dropout rate was higher than expected, which may indicate a challenge in this type of study. TRIAL REGISTRATION NUMBER NCT02914496.
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Affiliation(s)
- Ingrid Wijk
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Susanne Amsberg
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Livheim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toft
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Therese Anderbro
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Zhao C, Zhao Z, Levin ME, Lai L, Shi C, Hu J, Chen W, Ren Z. Efficacy and acceptability of mobile application-delivered acceptance and commitment therapy for posttraumatic stress disorder in China: A randomized controlled trial. Behav Res Ther 2023; 171:104440. [PMID: 37992482 DOI: 10.1016/j.brat.2023.104440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/22/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
Due to the COVID-19 pandemic and its extensive effects, the incidence of posttraumatic stress disorder (PTSD) symptoms is rapidly increasing in China. This research aimed to assess the efficacy and acceptability of a mobile application delivering Acceptance and Commitment Therapy (ACT) in reducing PTSD symptoms. 221 Chinese individuals with elevated PTSD symptoms were randomly assigned to app-delivered ACT (ACT condition), app-delivered mindfulness (MI condition), or a waitlist (WL condition). Assessments were performed pre- and post-intervention. The results showed that participants in both the ACT and MI groups had significantly greater improvements across mental health outcomes compared to the WL group. No significant differences were observed between the ACT and MI groups except for psychological flexibility, which improved more in ACT than MI (d = -0.37). Compared to WL, the ACT group showed a greater improvement in PTSD symptoms (d = -0.79), anxiety (d = -0.62), depression (d = -0.51), posttraumatic growth (d = 0.46), and psychological flexibility (d = 0.76). The drop-out rates in the ACT and MI were 25.76% and 39.71%, respectively. Participants in the ACT condition reported medium program satisfaction. The study suggests app-delivered ACT is efficacious in reducing PTSD symptoms and improving overall mental health among Chinese adults.
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Affiliation(s)
- Chunxiao Zhao
- School of Humanities, Hubei University of Chinese Medicine, 16 Huangjiahu West Road, Hongshan District, Wuhan, Hubei, China
| | - Ziyi Zhao
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, 382 Xiongchu Avenue, Luonan Street, Hongshan District, Wuhan, Hubei, China
| | - Michael E Levin
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA
| | - Lizu Lai
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, 382 Xiongchu Avenue, Luonan Street, Hongshan District, Wuhan, Hubei, China
| | - Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, 382 Xiongchu Avenue, Luonan Street, Hongshan District, Wuhan, Hubei, China
| | - Jiawei Hu
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, 382 Xiongchu Avenue, Luonan Street, Hongshan District, Wuhan, Hubei, China
| | - Wenke Chen
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, 382 Xiongchu Avenue, Luonan Street, Hongshan District, Wuhan, Hubei, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, 382 Xiongchu Avenue, Luonan Street, Hongshan District, Wuhan, Hubei, China.
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Lu Y, Li Y, Huang Y, Zhang X, Wang J, Wu L, Cao F. Effects and Mechanisms of a Web- and Mobile-Based Acceptance and Commitment Therapy Intervention for Anxiety and Depression Symptoms in Nurses: Fully Decentralized Randomized Controlled Trial. J Med Internet Res 2023; 25:e51549. [PMID: 38010787 PMCID: PMC10714267 DOI: 10.2196/51549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/04/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) is a promising intervention for improving mental health. However, there is limited evidence on its effectiveness for nurses, particularly in web- and mobile-based intervention forms, in mitigating anxiety and depression symptoms. OBJECTIVE In this study, we aimed to examine the effect and underlying psychological mechanisms of a web- and mobile-based ACT intervention on nurses' anxiety and depression symptoms. METHODS In this fully decentralized randomized controlled trial, nurses were recruited nationwide across China through advertisements and posters. They were randomly assigned to either the 5-week fully automated intervention or the waiting group. Primary outcomes (anxiety and depression symptoms); secondary outcomes (sleep quality, burnout, and work performance); and mediators (psychological flexibility, cognitive defusion, mindfulness, and values) were assessed using the Wenjuanxing platform. Data collectors were blinded to the group assignments throughout the study period. RESULTS A total of 145 nurses with anxiety or depression symptoms were randomly assigned to either the intervention group (n=72, 49.7%) or the control group (n=73, 50.3%); 97.2% (n=141) were female. During the study, 36 (24.8%) nurses were lost to follow-up, and 53 (73.6%) completed the entire intervention. Nurses in the intervention group showed significant improvement in anxiety (d=0.67, 95% CI 0.33-1.00) and depression symptoms (d=0.58, 95% CI 0.25-0.91), and the effects were sustained for 3 months after the intervention (anxiety: d=0.55, 95% CI 0.22-0.89; depression: d=0.66, 95% CI 0.33-1.00). Changes in psychological flexibility, cognitive defusion, and values mediated the effect of the intervention on anxiety and depression symptoms, while mindfulness did not have a mediating effect. CONCLUSIONS The web- and mobile-based ACT intervention used in this study significantly improved nurses' anxiety and depression symptoms by improving psychological flexibility, cognitive defusion, and values. The results provide new ideas for hospital administrators to prevent and intervene in nurses' psychological issues. TRIAL REGISTRATION Chinese Clinical Trial Register ChiCTR2200059218; https://tinyurl.com/4mb4t5y9.
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Affiliation(s)
- Yan'e Lu
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Yang Li
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
| | - Yongqi Huang
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xuan Zhang
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Juan Wang
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Liuliu Wu
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Fenglin Cao
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, Jinan, China
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10
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Carpallo-González M, Muñoz-Navarro R, González-Blanch C, Cano-Vindel A. Symptoms of emotional disorders and sociodemographic factors as moderators of dropout in psychological treatment: A meta-review. Int J Clin Health Psychol 2023; 23:100379. [PMID: 36922928 PMCID: PMC10009192 DOI: 10.1016/j.ijchp.2023.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/08/2023] [Indexed: 03/07/2023] Open
Abstract
Objective Dropout from psychological treatment is an important problem that substantially limits treatment effectiveness. A better understanding of this phenomenon, could help to minimize it. Therefore, we performed a systematic review of meta-analyses (MA) on dropout from psychological treatments to (1) determine the estimated overall dropout rate (DR) and (2) to examine potential predictors of dropout, including clinical symptoms (anxiety and depression) and sociodemographic factors. Method A literature search of the PubMed PsycINFO, Embase, Scopus and Google Scholar databases was conducted. We identified 196 MAs on dropout from psychological treatment carried out primarily in adult patients or mixed samples (adults and children) between 1990 and 2022. Of these, 12 met all inclusion criteria. Two forest plots were created to visualize the DR and the relationship between DR and the disorder. Results The DR ranged from 15.9% to 46.8% and was significantly moderated by symptoms of emotional disorders. The highest DR were observed in younger, unmarried patients, and those with lower educational and income levels. Conclusions DR in patients undergoing psychological treatment is highly heterogeneous, but higher in individuals presenting symptoms of anxiety and/or depression, especially the latter. Given that high DR undermine the effectiveness of psychological interventions, it is clear that greater efforts are needed to reduce dropout, particularly among individuals with symptoms of emotional disorders.
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Affiliation(s)
| | | | - César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
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11
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Sanabria-Mazo JP, Colomer-Carbonell A, Borràs X, Castaño-Asins JR, McCracken LM, Montero-Marin J, Pérez-Aranda A, Edo S, Sanz A, Feliu-Soler A, Luciano JV. Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study). THE JOURNAL OF PAIN 2023; 24:1522-1540. [PMID: 37105508 DOI: 10.1016/j.jpain.2023.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
This study examined the efficacy of adding a remote, synchronous, group, videoconference-based form of acceptance and commitment therapy (ACT) or behavioral activation therapy for depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at posttreatment (d = .64) and at follow-up (d = .73). BATD was only superior to TAU at follow-up (d = .66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at posttreatment (d = .45 and d = .59, respectively) and at follow-up (d = .59, in both) compared to TAU. Stress was significantly reduced at posttreatment by ACT in comparison to TAU (d = .69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant number needed to treat (NNT) values for reduction in pain interference were obtained at posttreatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at posttreatment in psychological flexibility. These findings suggest that new forms of cognitive-behavioral therapy are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions. TRIAL NUMBER: NCT04140838. PERSPECTIVE: Group videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.
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Affiliation(s)
- Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Ariadna Colomer-Carbonell
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Xavier Borràs
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | | | - Jesus Montero-Marin
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Adrián Pérez-Aranda
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain; Institute of Health Research of Aragon (IIS Aragon), Miguel Servet University Hospital, Zaragoza, Spain
| | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
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12
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Castaño-Asins JR, Sanabria-Mazo JP, Luciano JV, Barceló-Soler A, Martín-López LM, Del Arco-Churruca A, Lafuente-Baraza J, Bulbena A, Pérez-Solà V, Montes-Pérez A. Effectiveness of Acceptance and Commitment Therapy (ACT) for the Management of Postsurgical Pain: Study Protocol of a Randomized Controlled Trial (SPINE-ACT Study). J Clin Med 2023; 12:4066. [PMID: 37373758 DOI: 10.3390/jcm12124066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Research on the use of Acceptance and Commitment Therapy (ACT) for patients with degenerative lumbar pathology awaiting surgery are limited. However, there is evidence to suggest that this psychological therapy may be effective in improving pain interference, anxiety, depression, and quality of life. This is the protocol for a randomized controlled trial (RCT) to evaluate the effectiveness of ACT compared to treatment as usual (TAU) for people with degenerative lumbar pathology who are candidates for surgery in the short term. A total of 102 patients with degenerative lumbar spine pathology will be randomly assigned to TAU (control group) or ACT + TAU (intervention group). Participants will be assessed after treatment and at 3-, 6-, and 12-month follow-ups. The primary outcome will be the mean change from baseline on the Brief Pain Inventory (pain interference). Secondary outcomes will include changes in pain intensity, anxiety, depression, pain catastrophizing, fear of movement, quality of life, disability due to low back pain (LBP), pain acceptance, and psychological inflexibility. Linear mixed models will be used to analyze the data. Additionally, effect sizes and number needed to treat (NNT) will be calculated. We posit that ACT may be used to help patients cope with the stress and uncertainty associated with their condition and the surgery itself.
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Affiliation(s)
| | - Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 St. Boi de Llobregat, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, 08193 Cerdanyola del Vallès, Spain
- Centre of Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 St. Boi de Llobregat, Spain
- Centre of Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Clinical & Health Psychology, Autonomous University of Barcelona, 08193 Cerdanyola del Vallès, Spain
| | | | | | | | | | - Antonio Bulbena
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Cerdanyola del Vallès, Spain
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13
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Garland MM, Wilson R, Thompson WK, Stein MB, Paulus MP, Feinstein JS, Khalsa SS. A randomized controlled safety and feasibility trial of floatation-REST in anxious and depressed individuals. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.27.23290633. [PMID: 37333146 PMCID: PMC10275007 DOI: 10.1101/2023.05.27.23290633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Reduced Environmental Stimulation Therapy via floatation (floatation-REST) is a behavioral intervention designed to attenuate exteroceptive sensory input to the nervous system. Pilot studies in anxious and depressed individuals demonstrated that single sessions of floatation-REST are safe, well-tolerated, and associated with acute anxiolysis. However, there is not sufficient evidence of the feasibility of floatation-REST as a repeated intervention. Methods We randomized 75 individuals with anxiety and depression to six sessions of floatation-REST in different formats (pool-REST or pool-REST preferred) or an active comparator (chair-REST). Feasibility was assessed via adherence rate to the assigned intervention, tolerability via duration of REST utilization and overall study dropout rate, and safety via incidence of serious or non-serious adverse events. Results Six-session adherence was 85% for pool-REST, 89% for pool-REST preferred, and 74% for chair-REST. Dropout rates did not differ significantly between the treatment conditions. Mean session durations were consistently above 50 minutes, and when allowed to choose the duration and frequency, participants opted to float for an average of 75 minutes. There were no serious adverse events associated with any intervention. Positive experiences were endorsed more commonly than negative ones and were also rated at higher levels of intensity. Conclusions Taken together, six sessions of floatation-REST appear feasible, well-tolerated, and safe in anxious and depressed individuals. Floatation-REST induces positively-valenced experiences with few negative effects. Larger randomized controlled trials evaluating markers of clinical efficacy are warranted.Clinical Trial Registration Identifier: NCT03899090.
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Affiliation(s)
- McKenna M. Garland
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
- Kendall College of Arts and Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Raminta Wilson
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
| | - Wesley K. Thompson
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Martin P. Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Justin S. Feinstein
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
- Float Research Collective, Kihei, Hawaii
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
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14
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Foroughe M, Browne DT, Thambipillai P, Cordeiro K, Muller RT. Brief emotion-focused family therapy: A 12-month follow-up study. JOURNAL OF MARITAL AND FAMILY THERAPY 2023; 49:394-410. [PMID: 36682069 DOI: 10.1111/jmft.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
This study provides a 12-month follow-up evaluation of caregivers after participating in a 2-day Emotion-focused family therapy (EFFT) intensive, a brief intervention for caregivers of youth struggling with mental health difficulties. Caregivers (N = 498) of children (N = 337) completed measures of caregiver self-efficacy and child mental health difficulties 1 week before the intervention, immediately after the intervention, and at 4, 8, and 12-month follow-ups. Piecewise latent trajectory models revealed that parental self-efficacy showed a large immediate increase following the intervention, β = 1.61 (1.32, 2.14), and although this effect was attenuated by 4 months, β = -0.77 (-1.31, -0.52), it did not change further by 12 months. Reductions in child mental health difficulties were observed by 4 months, β = -0.54 (-0.77, -0.37), and remained stable through the 12-month follow-up. Caregivers reporting more increases in self-efficacy also reported greater reductions in their children's symptoms at 4 and 12 months.
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Affiliation(s)
- Mirisse Foroughe
- Emotion Transformation Lab, Family Psychology Centre, Toronto, Ontario, Canada
| | - Dillon T Browne
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Robert T Muller
- Department of Psychology, York University, Toronto, Ontario, Canada
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15
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Fang S, Ding D. The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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16
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Zhou J, Yun J, Ye X, Liu W, Xiao W, Song P, Wang H. Interventions to improve antiretroviral adherence in HIV-infected pregnant women: A systematic review and meta-analysis. Front Public Health 2022; 10:1056915. [PMID: 36568785 PMCID: PMC9773995 DOI: 10.3389/fpubh.2022.1056915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Background Medication adherence in HIV-infected pregnant women remains suboptimal. This systematic review and meta-analysis aimed to evaluate the effectiveness of interventions on improving antiretroviral adherence targeting among HIV-infected pregnant women. Methods Five databases were screened to identify quasi-experimental studies and randomized controlled trials. The risk ratios (RR) and confidential intervals (CI) were extracted to estimate the improvement in antiretroviral adherence after interventions compared with control conditions. This study was registered with PROSPERO, number CRD42021256317. Results Nine studies were included in the review, totaling 2,900 participants. Three interventions had significance: enhanced standard of care (eSOC, RR 1.14, 95%CI 1.07-1.22, Z = 3.79, P < 0.01), eSOC with supporter (RR 1.12, 95%CI 1.04-1.20, Z = 2.97, P < 0.01) and device reminder (RR 1.33, 95%CI 1.04-1.72, Z = 2.23, P = 0.03). Discussion The study supported the eSOC and the device reminder as effective intervention strategies for improving HIV medication adherence. Based on the current findings, the study called for more efforts to improve antiretroviral care for pregnant women through involving multicenter, large-sample, and high-quality research and combining the device reminder with other intervention methods. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256317, identifier CRD42021256317.
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Affiliation(s)
- Jie Zhou
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingyi Yun
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinxin Ye
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Liu
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenhan Xiao
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peige Song
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China,Peige Song
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,*Correspondence: Hongmei Wang
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17
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Efficacy and mechanisms of mobile application-delivered Acceptance and Commitment Therapy for posttraumatic stress disorder in China: Study protocol for a randomized controlled trial. Internet Interv 2022; 30:100585. [PMID: 36426200 PMCID: PMC9678960 DOI: 10.1016/j.invent.2022.100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As a result of the COVID-19 pandemic and its far-reaching impact, the prevalence of posttraumatic stress disorder (PTSD) symptoms is increasing significantly in China. Yet access to reliable and effective psychological treatment is still limited during the pandemic. The widespread adoption of mobile technologies may provide a new way to address this gap. In this research we will develop an Acceptance and Commitment Therapy (ACT) based intervention delivered by mobile application and will test its usability, efficacy, and mechanism of its effects in relieving PTSD symptoms. METHODS A total of 147 Chinese participants with a diagnosis of PTSD according to the Clinician Administered PTSD Scale (CAPS-5) will be randomly assigned to an intervention group (app-delivered ACT), an active comparison group (app-delivered mindfulness), or a waitlist group. Participants in the intervention group or comparison group will use their respective apps for one month. Online self-report questionnaires will be used to assess the primary outcome of PTSD symptoms and the secondary outcomes symptoms of depression, symptoms of anxiety, and posttraumatic growth. The potential mediating variable to be tested is psychological flexibility and its components. These assessments will be conducted at baseline, at five times during treatment, at the end of treatment, and at 1- and 3-month follow-ups. DISCUSSION As far as we know, this study is the first randomized controlled trial to investigate the usability, efficacy, and mechanism of an app-delivered ACT intervention for PTSD. Furthermore, the research will assess the effect of treatment in reducing dropout rates, explore effective therapeutic components, and investigate mechanisms of symptom change, which will be valuable in improving the efficacy and usability of PTSD interventions.Trial registration: ChiCTR2200058408.
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18
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Ferreira MG, Mariano LI, Rezende JVD, Caramelli P, Kishita N. Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord 2022; 309:297-308. [PMID: 35489560 DOI: 10.1016/j.jad.2022.04.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A comprehensive meta-analysis quantitatively examining the effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms is required to advance our understanding of its efficacy and moderating factors. METHODS Four electronic databases were searched in August 2018. An update search was conducted in November 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). RESULTS The overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI = 0.30-0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31-0.64). Subgroup analyses demonstrated that group ACT was significantly superior to non-active controls (e.g., waiting list) in reducing anxiety and depressive symptoms. Group ACT was only significantly superior to active controls (e.g., CBT) in reducing depressive symptoms. Subgroup analyses also demonstrated that the effect size can vary depending on the number of sessions provided and the primary condition of participants recruited. LIMITATIONS The number of studies included in each category of subgroup analyses was small and the risk of bias varied across studies. There was high heterogeneity among the included studies, and this might have affected the results. CONCLUSION The current evidence suggests that group ACT may be effective in treating anxiety and depressive symptoms, perhaps more so for depressive symptoms when compared to other well-established treatments. The intensity of treatment and the targeted population may need to be considered when delivering group ACT.
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Affiliation(s)
- Michele Gomes Ferreira
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil
| | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Junio Vieira de Rezende
- Programa de Pós-Graduação em Psicologia, Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, Caixa Postal N° 253, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil; Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil.
| | - Naoko Kishita
- School of Health Science, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
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Cordeiro K, Wyers C, Oliver M, Foroughe M, Muller RT. Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop. Clin Psychol Psychother 2022; 29:1728-1741. [PMID: 35373406 DOI: 10.1002/cpp.2739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
This single-arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2-day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self-efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12-month post-workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self-efficacy (B = -0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans-diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment.
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Affiliation(s)
- Kristina Cordeiro
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Cassandra Wyers
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Meghan Oliver
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Robert T Muller
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
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20
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Holmberg Bergman T, Renhorn E, Berg B, Lappalainen P, Ghaderi A, Hirvikoski T. Acceptance and Commitment Therapy Group Intervention for Parents of Children with Disabilities (Navigator ACT): An Open Feasibility Trial. J Autism Dev Disord 2022; 53:1834-1849. [PMID: 35239083 PMCID: PMC10123046 DOI: 10.1007/s10803-022-05490-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Parents of children with autism spectrum disorder and other disabilities report high levels of distress, but systematically evaluated interventions are few. This study aimed to evaluate the feasibility of a novel, manualized Acceptance and Commitment Therapy group intervention (Navigator ACT) in a sample of 94 parents of children with disabilities. Feasibility was measured by treatment completion, credibility, and satisfaction, and preliminary outcomes by using self-rating scales administered at the baseline, post-intervention, and follow-up. The results imply the intervention is feasible in the context of Swedish outpatient habilitation services. A preliminary analysis of the outcome measures suggests that parents experienced significant improvements in well-being. The results indicate that the treatment is feasible and should be evaluated in a randomized controlled trial.
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Affiliation(s)
- T Holmberg Bergman
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden. .,Habilitation and Health, Region Stockholm, Stockholm, Sweden. .,Center for Psychiatry Research, Stockholm, Sweden.
| | - E Renhorn
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden.,Habilitation and Health, Region Stockholm, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm, Sweden
| | - B Berg
- Habilitation and Health, Region Stockholm, Stockholm, Sweden
| | - P Lappalainen
- Department of Psychology, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland
| | - A Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 17165, Stockholm, Sweden
| | - T Hirvikoski
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden.,Habilitation and Health, Region Stockholm, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm, Sweden
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21
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A Feasibility and Pilot Randomised Dismantling Trial of the Efficacy of Self-As-Context During Acceptance and Commitment Therapy. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe comparative clinical utility of the components of the psychological flexibility model of acceptance and commitment therapy (ACT) have not been equally evaluated. This study therefore conducted a feasibility and pilot two-arm dismantling trial by quarantining the self-as-context component. Sixteen participants were randomised to either 8 sessions of protocol-based ACT (Full-ACT) or 8 sessions of protocol-based ACT minus self-as-context (ACT-SAC). Process measures (flexibility and decentring) were taken at start of treatment, end of treatment, and at 6-week follow-up. Clinical outcome measures (functioning, anxiety, and depression) were collected on a session-by-session basis. Randomisation was well tolerated, all measures were completed, both interventions were competently delivered, and one adverse effect occurred in the full-ACT arm. Ten participants attended all 8 sessions creating a dropout rate of 37.50%. Clinical change appeared linear in both treatments and that treatment gains were maintained. Findings suggest that a full trial is possible and sample size calculations and methodological improvements are provided for this.
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22
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Chatbot-Delivered Cognitive Defusion versus Cognitive Restructuring for Negative Self-Referential Thoughts: A Pilot Study. PSYCHOLOGICAL RECORD 2021. [DOI: 10.1007/s40732-021-00478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractConversational agents or chatbots are a novel, highly accessible, and low-resource method of psychological intervention delivery. The present research aims to compare two brief chatbot interventions that delivered cognitive restructuring and defusion interventions, respectively. It was hypothesized that a defusion chatbot would lead to reduced cognitive fusion and decreased thought believability relative to cognitive restructuring and a nonactive control. Participants (N = 223; M age of 28.01 [SD = 10.29]; 47 identified as male, 174 as female, and 2 as nonbinary) were randomized into one of three conditions (defusion, restructuring, control), engaged for 5 days completing thought and mood measures pre- and postintervention. Sixty-two participants (M age of 25.98; SD = 8.647 years) completed measures again at time 2 (49 identified as female, 12 as male, and 1 as nonbinary). No statistically significant differences were observed among groups on believability of thoughts (F[2, 25] = .79, p = .47, ηp2 = .06), negativity of thoughts (F[2,25] = 1.49, p = .25, η 2 = .11), discomfort associated with thoughts (F[2, 25] = .48, p = .62, ηp2 = .04), and willingness (F[2, 25] = 3.00, p = .07, ηp2 = .19) to have negative self-referential thoughts. Moreover, substantial attrition of 72% was observed. Acceptability and usability of the chatbots employed are discussed as contributing toward the limited effectiveness of interventions and elevated attrition. Various recommendations are presented to support researchers and clinicians in developing engaging and effective chatbots.
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Carvalho SA, Skvarc D, Barbosa R, Tavares T, Santos D, Trindade IA. A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion-focused therapy for chronic illness. Clin Psychol Psychother 2021; 29:524-541. [PMID: 34269493 DOI: 10.1002/cpp.2643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/28/2021] [Accepted: 07/06/2021] [Indexed: 12/27/2022]
Abstract
Literature suggests that acceptance and commitment therapy (ACT) is effective in improving well-being and in reducing psychopathological symptoms commonly experienced by people with chronic illness (CI). Compassion-focused therapy (CFT) reduces psychological distress, especially in individuals with high levels of shame and self-criticism, but few studies have explored CFT in CI. Additionally, studies almost exclusively compared ACT and CFT with inactive controls (wait-list; treatment as usual). Also, there is an interest in developing cost-effective mental health solutions, such as low-intensity online psychological interventions. This randomized controlled trial (RCT) aimed to assess the acceptability and compare the efficacy of four-session online ACT (n = 25) and CFT (n = 24) interventions in a sample of people with CI. Results showed both interventions were acceptable, with attrition rates at post-intervention comparable to those found in similar studies (around 50%). Intention-to-treat analyses showed that participants presented significantly less illness-related shame, less uncompassionate self-responding and more valued living after the intervention, although no difference was found between conditions. Results were sustained at 3- and 6-month follow-up. Results did not find statistical differences between conditions through reliable change index (RCI). Correlation between demographics and RCI showed that, at post-intervention, younger participants presented more behavioural awareness, men presented more valued action, and participants with CI for shorter periods presented less uncompassionate self-responding and less anxiety. Results suggest that low-intensity (four sessions) online ACT and CFT are cost-effective approaches to promote mental health of individuals with CI. Results and limitations are thoroughly discussed.
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Affiliation(s)
- Sérgio A Carvalho
- Universidade Lusófona de Humanidades e Tecnologias, Escola de Psicologia e Ciências da Vida, HEI-Lab, Lisboa, Portugal.,Universidade de Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
| | - David Skvarc
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Rosa Barbosa
- Unidade de Psico-Oncologia, Núcleo Regional do Centro da Liga Portuguesa Contra o Cancro (Portuguese League Against Cancer), Coimbra, Portugal
| | - Tito Tavares
- Universidade de Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
| | - Diana Santos
- Universidade de Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
| | - Inês A Trindade
- Universidade de Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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24
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Meier ST. Client attendance measures in counselling psychology trainees. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Scott T. Meier
- Department of Counseling, School, & Educational Psychology University at Buffalo Buffalo NY USA
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25
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Hemmings NR, Kawadler JM, Whatmough R, Ponzo S, Rossi A, Morelli D, Bird G, Plans D. Development and Feasibility of a Digital Acceptance and Commitment Therapy-Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study. JMIR Form Res 2021; 5:e21737. [PMID: 33560232 PMCID: PMC7902195 DOI: 10.2196/21737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/04/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background Generalized anxiety disorder (GAD) is characterized 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 well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability 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 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [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 (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for AAQ-II and WEMWBS, respectively). Conclusions This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD.
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Affiliation(s)
- Nicola R Hemmings
- Department of Organizational Psychology, Birkbeck University of London, London, United Kingdom.,BioBeats Group Ltd, London, United Kingdom
| | | | - Rachel Whatmough
- Work With Wellbeing, London, United Kingdom.,Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, United Kingdom
| | | | - Alessio Rossi
- Department of Computer Science, University of Pisa, Pisa, Italy
| | - Davide Morelli
- BioBeats Group Ltd, London, United Kingdom.,Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Geoffrey Bird
- BioBeats Group Ltd, London, United Kingdom.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David Plans
- BioBeats Group Ltd, London, United Kingdom.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Initiative in the Digital Economy, Department of Science, Innovation, Technology, and Entrepreneurship, University of Exeter, Exeter, United Kingdom
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26
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Apolinário-Hagen J, Drüge M, Hennemann S, Breil B. Acceptance and Commitment Therapy for Major Depressive Disorder: Insights into a New Generation of Face-to-Face Treatment and Digital Self-Help Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1305:311-332. [PMID: 33834407 DOI: 10.1007/978-981-33-6044-0_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15 years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre of Health and Society (chs), Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- Centre of Health and Society (chs), University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Marie Drüge
- Institute of Psychology, Department of Clinical Psychology/Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Severin Hennemann
- Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Bernhard Breil
- Faculty of Healthcare, Niederrhein University of Applied Sciences, Krefeld, Germany
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27
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Cooke J, Ivey G, Godfrey C, Grady J, Dean S, Beaufoy J, Tonge B. Patient‐reported reasons for discontinuing psychotherapy in a low‐cost psychoanalytic community clinic. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jessica Cooke
- Discipline of Psychology College of Health and Biomedicine Victoria University Melbourne Vic. Australia
| | - Gavin Ivey
- Discipline of Psychology College of Health and Biomedicine Victoria University Melbourne Vic. Australia
| | - Celia Godfrey
- Discipline of Psychology College of Health and Biomedicine Victoria University Melbourne Vic. Australia
- Centre for Developmental Psychology and Psychiatry Monash University Melbourne Vic. Australia
| | - Jacqueline Grady
- Centre for Developmental Psychology and Psychiatry Monash University Melbourne Vic. Australia
| | - Suzanne Dean
- Discipline of Psychology College of Health and Biomedicine Victoria University Melbourne Vic. Australia
- Centre for Developmental Psychology and Psychiatry Monash University Melbourne Vic. Australia
| | - Jeanette Beaufoy
- Centre for Developmental Psychology and Psychiatry Monash University Melbourne Vic. Australia
| | - Bruce Tonge
- Centre for Developmental Psychology and Psychiatry Monash University Melbourne Vic. Australia
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28
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Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: a pilot study. BMC Psychiatry 2020; 20:457. [PMID: 32957944 PMCID: PMC7507241 DOI: 10.1186/s12888-020-02862-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Recurrent and impairing functional somatic syndromes (FSS) are common in adolescents. Despite a high need for care, empirically supported treatments are lacking for youth. The aim of this uncontrolled pilot study was to assess feasibility and treatment potential of a new intervention with group-based Acceptance and Commitment Therapy (ACT) in a generic treatment approach for adolescents with multiple FSS. METHODS Twenty-one patients received 'ACT for Health in Adolescents' (AHEAD) (30 h), specifically developed for adolescents (aged 15-19 years) with moderate to severe FSS. Close relatives attended an information meeting to facilitate support of the patients throughout treatment. Treatment satisfaction was evaluated by means of self-report and relatives' impressions. Self-reported physical health at 3 months follow-up (FU) after end of treatment was the primary outcome whereas secondary outcomes included symptom burden, limitation due to symptoms, illness worry, emotional distress and physical and emotional symptoms. Treatment targets were assessed by measures on illness behaviour, illness perception and psychological inflexibility. RESULTS Nineteen patients (90.5%) completed the treatment with a high overall attendance rate of 93%. All would recommend the treatment to a friend with similar problems. Close relatives rated it valuable to participate in an information meeting. Patients' physical health improved significantly from assessment to FU with a clinically relevant mean change of 8.9 points (95% CI [5.4; 12.4]; SRM 0.91 [0.26;1.57]). Improvement was also seen on all secondary outcome measures, from assessment to FU. Maladaptive illness behaviours and perceptions as well as psychological inflexibility showed a significant decline from assessment to FU. CONCLUSION AHEAD was feasible and potentially efficacious and warrants testing in a larger clinical trial. TRIAL REGISTRATION Clinical Trials gov NCT04464447 , registration date July 9th, 2020. Retrospectively registered.
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29
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Borgogna NC, McDermott RC, Berry A, Lathan EC, Gonzales J. A multicultural examination of experiential avoidance: AAQ – II measurement comparisons across Asian American, Black, Latinx, Middle Eastern, and White college students. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Wharton E, Edwards KS, Juhasz K, Walser RD. Acceptance-based interventions in the treatment of PTSD: Group and individual pilot data using Acceptance and Commitment Therapy. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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The Phenomenon of Treatment Dropout, Reasons and Moderators in Acceptance and Commitment Therapy and Other Active Treatments: A Meta-Analytic Review. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i3.33058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Treatment dropout is one of the most crucial issues that a therapist has to face on a daily basis. The negative effects of premature termination impact the client who is usually found to demonstrate poorer treatment outcomes. This meta-analysis reviewed and systematically examined dropout effects of Acceptance and Commitment Therapy (ACT) as compared to other active treatments. The goals of this study were to compare treatment dropout rates and dropout reasons, examine the influence of demographic variables and identify possible therapy moderators associated with dropout.
The current meta-analysis reviewed 76 studies of ACT reporting dropout rates for various psychological and health-related conditions.
Across reviewed studies (N = 76), the overall weighted mean dropout rate was 17.95% (ACT = 17.35% vs. comparison conditions = 18.62%). Type of disorder, recruitment setting and therapists’ experience level were significant moderators of dropout. The most frequently reported reasons for dropout from ACT were lost contact, personal and transportation difficulties, whereas for comparative treatments they were lost contact, therapy factors and time demands.
Given that most moderators of influence are not amenable to direct changes by clinicians, mediation variables should also be explored. Overall, results suggest that ACT appears to present some benefits in dropout rates for specific disorders, settings and therapists.
There was no difference in dropout rate between ACT and control conditions (17.35% vs.18.62%). Significant moderators were client disorder, therapists’ experience level and recruitment and setting.
Comparison condition frequently reported therapy related dropout factors, suggesting that ACT may be a more acceptable option.
There was no difference in dropout rate between ACT and control conditions (17.35% vs.18.62%). Significant moderators were client disorder, therapists’ experience level and recruitment and setting.
Comparison condition frequently reported therapy related dropout factors, suggesting that ACT may be a more acceptable option.
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32
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Dixon LJ, Linardon J. A systematic review and meta-analysis of dropout rates from dialectical behaviour therapy in randomized controlled trials. Cogn Behav Ther 2019; 49:181-196. [PMID: 31204902 DOI: 10.1080/16506073.2019.1620324] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dropout is an important factor that may compromise the validity of findings from randomized controlled trials (RCTs) of dialectical behaviour therapy (DBT). We conducted a targeted meta-analytic review of dropout from RCTs of DBT, with the aims of (1) calculating average rates of dropout from DBT; (2) investigating factors that moderate dropout; (3) examining whether dropout rates from DBT differ to control interventions; (4) synthesising reasons for dropout. Forty RCTs of DBT met full inclusion criteria. The weighted mean dropout rate was 28.0% (95% CI = 23.6, 32.9). Dropout rates were not related to target disorder, dropout definition, delivery format, therapist experience, and therapist adherence. Unexpectedly, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team. DBT dropout rates did not significantly differ to dropout rates from control interventions. Few trials reported reasons for dropout, and there was little consistency in the reported reasons. Findings suggest that over one in four patients drop out from DBT in RCTs. This review highlights the urgency for future trials to explicitly report detail pertaining to patient dropout, as this may assist in the development of strategies designed to prevent future dropouts in RCTs of DBT.
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33
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Feliu-Soler A, Montesinos F, Gutiérrez-Martínez O, Scott W, McCracken LM, Luciano JV. Current status of acceptance and commitment therapy for chronic pain: a narrative review. J Pain Res 2018; 11:2145-2159. [PMID: 30323649 PMCID: PMC6174685 DOI: 10.2147/jpr.s144631] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It is well known that chronic pain is prevalent, complex to manage, and associated with high costs, in health care and society in general. Thanks to advances in new forms of cognitive behavioral therapy (known as third-wave CBT), currently clinicians and researchers have an empirically validated psychological treatment with increasing research support for the treatment of chronic pain. This treatment is called acceptance and commitment therapy (ACT). The main aim of this paper is to provide a narrative review that summarizes and integrates the current state of knowledge of ACT in the management of chronic pain as well as discuss current challenges and opportunities for progress. Based on the psychological flexibility model, ACT extends previous forms of CBT and integrates many CBT-related variables into six core therapeutic processes. ACT is a process-based therapy that fosters openness, awareness, and engagement through a wide range of methods, including exposure-based and experiential methods, metaphors, and values clarification. To our knowledge, there are three published systematic reviews and meta-analyses that support the effectiveness of ACT for chronic pain and many studies focused on specific processes derived from the psychological flexibility model. There is also promising support for the cost-effectiveness of ACT; however, the current evidence is still insufficient to establish firm conclusions about cost-effectiveness and the most efficient means of delivery. Additional well-designed economic evaluations are needed. Other research aims include delineating the neurobiological underpinnings of ACT, refining available outcome and process measures or develop new ones for ACT trials, and meeting the challenge of wide dissemination and implementation in real-world clinical practice.
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Affiliation(s)
- Albert Feliu-Soler
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain,
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain,
| | - Francisco Montesinos
- Department of Psychology, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
- Instituto ACT, Madrid, Spain
| | | | - Whitney Scott
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lance M McCracken
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- INPUT Pain Management, Guys and St Thomas NHSFT, London, UK
| | - Juan V Luciano
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain,
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain,
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34
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Linardon J, Fitzsimmons-Craft EE, Brennan L, Barillaro M, Wilfley DE. Dropout from interpersonal psychotherapy for mental health disorders: A systematic review and meta-analysis. Psychother Res 2018; 29:870-881. [PMID: 30005586 DOI: 10.1080/10503307.2018.1497215] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: Dropout is one factor that might limit the effectiveness of interpersonal psychotherapy (IPT). Improved understanding of IPT dropout is an important research priority. This meta-analysis examined dropout rates from IPT in randomized controlled trials. Method: Seventy-two trials met inclusion criteria. Results: The weighted mean dropout rate from IPT was 20.6% (95% CI = 17.4-24.2). Dropout rates were similar for depressive (20.9%; 95% CI = 17.2-25.2), anxiety (16.1%; 95% CI = 11.1-22.9), and eating disorders (18.7%; 95% CI = 11.6-28.8). Dropout was highest when more stringent definitions of dropout were applied (e.g., failure to complete the entire IPT protocol versus failure to complete at least 50% of sessions) and was lowest when adolescent patients were sampled. There was some evidence that IPT was associated with significantly lower rates of dropout than both CBT and non-specific supportive therapies. These effects were generally replicated when analysing trials that provided a clear definition of treatment (rather than study) dropout. Conclusions: Overall, findings provide preliminary evidence to suggest that IPT may be an accepted and tolerated treatment option for patients with common mental health disorders. This review also highlights the need for future trials to rigorously report detail pertaining to patient dropout.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | | | - Leah Brennan
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Mary Barillaro
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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