Longitudinal Impact of the ACT-Based Positive Psychology Intervention to Improve Happiness, Mental Health, and Well-Being

This study aims to examine the effectiveness of ACT-based positive psychology intervention on young people's mental health and well-being. Existing literature offers limited insights into the impacts of ACT-based PPIs, particularly concerning young people. The study explores the potential of this intervention to enhance positive psychological outcomes such as subjective well-being, self-compassion, and optimism, while reducing negative psychological outcomes like pessimism, anxiety, depressive symptoms, and somatic symptoms, and improving resilience. Conducted at a state university, the study involved 42 participants between the ages of 19 and 23 who were assigned to experimental (n = 20) and control (n = 22) group. The experimental group participated in an 8-week ACT-based PPI program. Employing a longitudinal experimental design, the study included a pre-test, post-test, and a follow-up test approximately two years later. Results indicated that the experimental group experienced significant improvements in positive psychological outcomes and reductions in negative outcomes, with the effects sustained during the follow-up period. Notably, long-term enhancements in resilience and self-compassion were observed. Overall, this study provides important evidence of the effectiveness of ACT-based PPI in promoting young people's long-term outcomes, with implications for developing intervention programs to support their mental health and well-being.

Acceptance and Commitment Therapy and Psychological Well-Being: A Narrative Review

Acceptance and commitment therapy (ACT) is an innovative psychological intervention emphasizing psychological flexibility and values-driven actions to enhance overall well-being. Unlike traditional cognitive-behavioral therapies (CBT), which often focus on altering maladaptive thoughts and behaviors, ACT encourages the acceptance of negative thoughts and emotions while fostering a commitment to personal values. This review explores ACT's effectiveness in promoting psychological well-being (PWB) by encompassing emotional, psychological, and social dimensions. Key aspects of PWB include emotional regulation, life satisfaction, and the reduction of experiential avoidance. The theoretical foundations of ACT are based on relational frame theory (RFT), which addresses cognitive fusion and experiential avoidance as central contributors to psychological distress. Extensive research, including meta-analyses and randomized controlled trials (RCTs), supports ACT's efficacy in treating various psychological issues and improving PWB. Despite strong empirical support, several gaps remain, including the need for more longitudinal studies, the exploration of cultural adaptability, and research on specific populations. Recommendations for future research include examining the long-term effects of ACT, its application across diverse cultural contexts, and its efficacy among underrepresented groups. This review underscores ACT's potential as a versatile therapeutic approach, providing valuable insights for mental health professionals and researchers.

Provider and patient barriers and facilitators to integration of digital mental health applications in routine clinical care

BACKGROUND

The limited accessibility of mental healthcare providers highlights the need for innovative approaches to provide effective and efficient care. Digital mental health applications (DMHAs) can improve patient access to evidence-based treatments and reduce burden on the healthcare system. Here, we examined the provider and patient barriers and facilitators to integration of DMHAs in a healthcare system.

METHODS

Patients (n = 57) and providers (n = 100) were recruited from a large healthcare system over five months. Participants completed a survey assessing attitudes towards DMHAs, and perceived facilitators and barriers to adoption and utilization of DMHAs in mental healthcare.

RESULTS

DMHA credibility was a key facilitator for provider adoption, while usability and accessibility were identified as key facilitators for patient utilization. Provider barriers included patient cost/provider reimbursement, limited knowledge, perceived limits to credibility, patient outcome enhancement, and personalization of DMHAs for patient needs. Patients identified privacy concerns as the top barrier for using DMHAs.

LIMITATIONS

The self-report survey nature of this study, modest sample size, and majority of sample identifying as White and upper middle class make results subject to biases and limitations. Given the potential of DMHAs to address disparities in access to mental healthcare, more research is needed including populations who are at greatest risk.

CONCLUSIONS

Findings provide new insights to inform the development of intervention strategies to improve the integration of DMHAs within healthcare systems. Additional research examining key stakeholders at different levels of care is critical to address barriers, optimize facilitators, and develop roadmaps for best-practice use in healthcare systems.

An online peer support program to improve mental health among university students: A randomized controlled trial

Despite recent calls for more peer support initiatives aimed at promoting mental health in postsecondary institutions, those initiatives remain scarce. In this study, a multisite randomized controlled trial was designed to assess the effect of an online peer support intervention based on acceptance and commitment therapy using mental health and school indicators. Undergraduate students were recruited in three Canadian universities and randomly assigned to an intervention (n = 54) or a wait-list control group (n = 53). Compared to control participants, those who took part in the program self-reported reduced psychological inflexibility, stress, anxiety and depression, and increased psychological flexibility and well-being. The intervention had no effect on academic satisfaction and engagement. These results were found both in completer and intent-to-treat samples. The findings provide evidence that peer support may be a beneficial adjunct to mental health interventions offered to college and university students.

Acceptance and commitment therapy group protocol for caregivers of anxious youth: an open trial pilot study

Introduction

Anxiety disorders are common, distressing, and impairing for children and families. Cognitive-behavioral interventions targeting the role of family interactions in child anxiety treatment may be limited by lack of attention to antecedents to parental control; specifically, internal parent factors such as experiential avoidance and cognitive fusion. This pilot study evaluates the preliminary efficacy of a group-delivered caregiver treatment program, ACT for Parents of Anxious Children (ACT-PAC) that targets parental experiential avoidance, cognitive fusion, and child internalizing symptoms.

Methods

Twenty-three youth ages 7-17 years with a primary anxiety disorder diagnosis and their primary caregiver participated in six one-hour, weekly group treatment sessions. Parents and children reported on child symptomatology and parents reported on parent symptomatology and quality of life at two assessment points: within one week before ACT-PAC treatment and within one week after treatment. Parents self-reported on parental internal processes specifically targeted by ACT (e.g., cognitive fusion) weekly during the 6-week treatment.

Results

Results support the feasibility and acceptability of ACT-PAC and indicate reductions in parents' cognitive fusion and child internalizing symptoms.

Optimizing Rehabilitation for Nerve Gap Repair: Evidence-Based Recommendations

Peripheral nerve surgeries are a complex undertaking that require a multifaceted team approach. For optimal outcomes, early involvement of therapy, planning with the surgical team, and communication with the patient are crucial. This facilitates compliance and is an integral component of the recovery process after these large procedures.

A 6-Week Mindfulness-Acceptance-Commitment Intervention to Improve Professional Ballet Dancers' Psychological States Around Performance

Background: Mindfulness and acceptance-based approaches have been trialled in professional sport. The present pilot study was a randomized controlled trial with professional ballet dancers investigating the effectiveness of the Mindfulness-Acceptance-Commitment (MAC) approach, developed for athletes, compared to an education program which included topics relevant to ballet and performance. Methods: Participants included 16 professional ballet dancers (2 men and 14 women) who were randomly assigned into either the MAC or education group for 1 session per week, for 6 weeks. Participants were assessed pre-and post-intervention using the Mindfulness Inventory for Sport (MIS) and the Acceptance Action Questionnaire (AAQ-II). Within 2 weeks of the final mindfulness session, all participants completed a semi-structured interview. Results: No differences were found when comparing the questionnaire responses between pre- and post- intervention, nor between the MAC group and the control group at post intervention for all subscales. Although dancers reported in the interviews that the sessions were valuable, they advised their ability to dedicate time to mindfulness ongoing would be challenging. Conclusions: Mindfulness interventions, as explored in this study, show promise to promote the well-being of professional ballet dancers. For consistent and ongoing mindfulness practice, future designs should seek to embed mindfulness practice into dancer and company schedules.

"BrainHeart": Pilot Study on a Novel Application for Elderly Well-Being Based on Mindfulness Acceptance and Commitment Therapy

The rising prevalence of mental illness is straining global mental health systems, particularly affecting older adults who often face deteriorating physical health and decreased autonomy and quality of life. Early detection and targeted rehabilitation are crucial in mitigating these challenges. Mindfulness acceptance and commitment therapy (ACT) holds promise for enhancing motivation and well-being among the elderly, although delivering such psychological interventions is hindered by limited access to services, prompting exploration of remote delivery options like mobile applications. In this paper, we introduce the BrainHeart App (v.1.1.8), a mobile application tailored to improve physical and mental well-being in seniors. The app features a 10-day ACT program and other sections promoting healthy lifestyle. In a pilot study involving twenty participants, individuals engaged in daily mental exercises for 10 days using the app. Clinical evaluations, including assessments of psychological flexibility, overall cognitive profile, mindfulness disposition, cognitive fusion, and heart rate collected with Polar H10, were conducted at baseline (T0) and one month post-intervention (T1). Analysis revealed significant improvements in almost all neuropsychological scores, with high usability reported (system usability scale average score: 82.3 ± 9.31). Additionally, a negative correlation was found between usability and experiential avoidance (r = -0.51; p = 0.026), and a notable difference in heart rate was observed between baseline and post-intervention (F-value = 3.06; p-value = 0.09). These findings suggest that mindfulness-ACT exercises delivered via the BrainHeart App can enhance the well-being of elderly individuals, highlighting the potential of remote interventions in addressing mental health needs in this population.

Predictors and Moderators of Panic Disorder: Cognitive Behavioral Therapy vs. Acceptance and Commitment Therapy

BACKGROUND

Understanding variables that influence therapy outcomes can improve the results of interventions and reduce socio-health costs. The current study examined possible predictors and moderators of outcome (age, gender, duration of panic disorder, motivation to change, conscientiousness, and experiential avoidance) in Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT).

METHOD

Eighty participants with a diagnosis of panic disorder, 56 women and 24 men, with an average age of 38 years, received 12 group sessions of CBT or ACT. They were assessed with several measures at pre-treatment, post-treatment, and 3-month follow-up.

RESULTS

CBT outperformed ACT among older subjects, men, and those with a shorter duration of panic disorder. ACT outperformed CBT among younger subjects, women, and those with a long duration of panic disorder. In general, the greatest improvements in both CBT and ACT were in older subjects, women, those with a long duration of panic disorder, those in the contemplation stage, and those with high experiential avoidance.

CONCLUSIONS

Although future studies are necessary, there appear to be predictors and moderators of the effectiveness of CBT and ACT. Taking these variables into account can help improve treatment for people with panic disorder.

Study protocol on the efficacy of exergames-acceptance and commitment therapy program for the treatment of major depressive disorder: comparison with acceptance and commitment therapy alone and treatment-as-usual in a multicentre randomised controlled trial

BACKGROUND

The prevalence of major depressive disorder (MDD) is on the rise globally, and the use of antidepressant medications for its treatment does not usually result in full remission. However, the combination of physical exercise and psychotherapy for the treatment of MDD increase the rate of full remission among patients. This three-armed, parallel-group, double-blinded randomised controlled trial (RCT) aims to assess and compare the effects between the combination of exergame and acceptance and commitment therapy (e-ACT) programme, ACT only and treatment-as-usual (TAU) control groups on the severity of depression and anxiety symptoms, the degree of experiential avoidance and quality of life (QoL) and the serum levels of depression biomarkers (such as brain-derived neurotrophic factor, C-reactive protein and vascular endothelial growth factor) among patients with MDD across three time points.

METHODS AND ANALYSIS

This RCT will recruit 126 patients with MDD who will be randomised using stratified permuted block randomisation into three groups, which are the combined e-ACT programme, ACT-only and TAU control groups in a 1:1:1 allocation ratio. The participants in the e-ACT and ACT-only intervention groups will undergo once a week intervention sessions for 8 weeks. Assessments will be carried out through three time points, such as the pre-intervention assessment (t0), assessment immediately after completion of the intervention at 8 weeks (t1) and assessment at 24 weeks after completion of the intervention (t2). During each assessment, the primary outcome to be assessed includes the severity of depression symptoms, while the secondary outcomes to be assessed are the severity of anxiety symptoms, experiential avoidance, QoL and depression biomarkers.

ETHICS AND DISSEMINATION

Approval of this study was obtained from the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/PP/23050420). The findings of the study will be published in academic peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05812001 (ClinicalTrials.gov). Registered on 12 April 2023.

Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review

The current systematic and meta-analytic review sought to integrate a growing number of studies examining dimensions of psychological flexibility as treatment mechanisms for Acceptance and Commitment Therapy (ACT). Analyses of 77 records (67 unique studies; Ntotal = 9123 participants) from comprehensive searches of multiple databases suggested that ACT interventions led to reduced inflexibility (i.e., lowered global inflexibility, lack of present moment awareness, cognitive fusion, experiential avoidance, self-as-content, & inaction) and increased flexibility (i.e., committed action/contact with values, global flexibility/acceptance, & defusion). Those changes remained significant when ACT was compared with waitlist or active treatments and were significantly linked to corresponding drops in psychological distress, supporting their roles as ACT treatment mechanisms. Moderation analyses revealed that the use of student samples, exclusion of clinically symptomatic individuals, and comparisons of ACT with other active treatments weakened these effects whereas offering ACT as an individual therapy and excluding individuals in extreme crisis (i.e., with suicidal ideation) strengthened them. The meta-analytic findings and systematic review suggested specific recommendations for future clinical work and research on ACT mechanisms: (1) Evaluate both psychological flexibility and inflexibility as distinct treatment mechanisms, (2) Evaluate specific dimensions of psychological flexibility/inflexibility as mechanisms with multidimensional scales (CompACT, MPFI), (3) Broaden treatment outcomes to include forms of wellbeing (peace of mind, vitality, connectedness), (4) Assess mechanisms and outcomes repeatedly throughout treatment to model the process of therapeutic change, (5) Investigate non-specific factors (therapeutic alliance, treatment adherence) as mechanisms, and (6) Explore treatment mechanisms in effectiveness studies.

Psychological flexibility as a mechanism of change in psilocybin-assisted therapy for major depression: results from an exploratory placebo-controlled trial

Several phase II studies have demonstrated that psilocybin-assisted therapy shows therapeutic potential across a spectrum of neuropsychiatric conditions, including major depressive disorder (MDD). However, the mechanisms underlying its often persisting beneficial effects remain unclear. Observational research suggests that improvements in psychological flexibility may mediate therapeutic effects. However, no psychedelic trials to date have substantiated this finding in a clinical sample. In an exploratory placebo-controlled, within-subject, fixed-order study, individuals with moderate to severe MDD were administered placebo (n = 19) followed by psilocybin (0.3 mg/kg) (n = 15) 4 weeks later. Dosing sessions were embedded within a manualized psychotherapy that incorporated principles of Acceptance and Commitment Therapy. Depression severity, psychological flexibility, mindfulness, and values-congruent living were measured over a 16-weeks study period. Psychological flexibility, several facets of mindfulness, and values-congruent living significantly improved following psilocybin and were maintained through week 16. Additionally, improvements in psychological flexibility and experiential acceptance were strongly associated with reductions in depression severity following psilocybin. These findings support the theoretical premise of integrating psilocybin treatment with psychotherapeutic platforms that target psychological flexibility and add to emerging evidence that increasing psychological flexibility may be an important putative mechanism of change in psilocybin-assisted therapy for MDD and potentially, other mental health conditions.

Acceptance and Commitment Therapy for Major Depressive Disorder: Navigating Depression Treatment in Traditional and Digital Settings with Insights from Current Research

Given the shortcomings of a mechanistic assumption of traditional cognitive behavioral therapy (CBT), a newer generation of CBT-grounded interventions focusing on process-orientated emotional and motivational aspects has emerged. These so-called third-wave CBTs emphasize function and context of inner experience over form and content, and have become evidence-based practice in the past four decades. Among these approaches, acceptance and commitment therapy (ACT) has both a large body of research for various (mental) health conditions, including major depressive disorder (MDD) in particular. ACT is a transdiagnostic approach that intends to increase psychological flexibility (PF) of clients as a universal mechanism of behavior change and a value-driven orientation in life. By focusing on present-moment awareness, acceptance, defusion, establishing a stable sense of self, clarifying personal valued life directions, and committing to behaviors consistent to these values, ACT targets the core processes of PF. Meta-analyses have indicated the efficacy and effectiveness of ACT in reducing depressive symptoms and increasing well-being, with mainly moderate effect sizes in clinical trials. ACT for MDD has been shown to be effective across different delivery modes (e.g., individual, group, digital). ACT can also be applied using self-help formats (e.g., mobile apps) and combined with features from compatible approaches like behavioral activation. There is also evidence for a high acceptability of ACT and adherence rates comparable to classic CBT. Moreover, process research has shown that ACT works specifically through the mediator of PF and by addressing its suggested core therapeutic processes. Given the essential role of offering a personalized therapeutic strategy in treatment outcomes and adherence, it is central to provide more effective options that match clients' needs and preferences. This chapter illustrates different applications of ACT for adults with MDD and the current evidence base to promote informed decisions on using ACT as additional or stand-alone therapeutic approach.

Research protocol of the efficacy of probiotics for the treatment of alcohol use disorder among adult males: A comparison with placebo and acceptance and commitment therapy in a randomized controlled trial

BACKGROUND AND AIM

Primarily, this study compares the efficacy of probiotic and acceptance and commitment therapy (ACT) in alleviating the severity of alcohol craving and alcohol use disorder (AUD) among patients who had undergo two weeks of in-patient detoxification. Secondarily, this study compares the efficacy of probiotic and ACT in mitigating the severity of comorbid depression and anxiety symptoms; decreasing serum level of pro-inflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α); changing the event-related potential in electroencephalogram (EEG) and restoring microbiota flora in the gut of AUD patients.

METHODS AND ANALYSIS

Initially, during Phase I of the study, the serum level of IL-1β, IL-6 and TNF-α; ERP changes in the EEG and fecal microbiota content will be compared between 120 AUD patients and 120 healthy controls. Subsequently in Phase II of the study, 120 AUD patients will be randomized by stratified permuted block randomization into the probiotic, ACT and placebo groups in a 1:1:1 ratio. Participants in the probiotic and placebo groups will be administered one sachet per day of Lactobacillus spp. probiotic and placebo, respectively for 12 weeks. While those in the ACT group will receive one session per week of ACT for 8 weeks. Outcome measures will be administered at four timepoints, such as t0 = baseline assessment prior to intervention, t1 = 8 weeks after intervention began, t2 = 12 weeks after intervention and t3 = 24 weeks after intervention. Primary outcomes are the degrees of alcohol craving, alcohol withdrawal during abstinence and AUD. Secondary outcomes to be assessed are the severity of co-morbid depression and anxiety symptoms; the serum levels of IL-1β, IL-6 and TNF-α; changes in ERP and fecal microbiota content.

TRIAL REGISTRATION NUMBER

NCT05830708 (ClinicalTrials.gov). Registered on April 25, 2023.

Acceptance and Commitment Therapy Processes and Mediation: Challenges and How to Address Them

Acceptance and commitment therapy (ACT) emphasizes a focus on theory-driven processes and mediating variables, a laudable approach. The implementation of this approach would be advanced by addressing five challenges, including (a) distinguishing ACT processes in measurement contexts, (b) developing and rigorously validating measures of ACT processes, (c) the wide use of psychometrically weaker ACT process measures and the more limited use of stronger measures in earlier work, (d) the inconsistency of past evidence that ACT processes are sensitive or specific to ACT or mediate ACT outcomes specifically, and (e) improving statistical power and transparency. Drawing on the existing literature, we characterize and provide evidence for each of these challenges. We then offer detailed recommendations for how to address each challenge in ongoing and future work. Given ACT's core focus on theorized processes, improving the measurement and evaluation of these processes would significantly advance the field's understanding of ACT.

Toward a synthesis of cognitive behaviour therapy via component analysis of self-regulation

The cognitive behavioural therapies (CBTs) are the choice psychotherapies for many clinicians treating a wide range of adult psychological disorders including various anxieties, mood, substance use, eating, schizophrenia and personality-related. Empirical research in the CBTs is ever increasing, and the accumulating evidence supporting efficacious treatments is substantial and well documented. However, with prolific research comes a seemingly accelerating and worrying trend of purportedly different therapies, and numerous hybrids and combinations of therapies and techniques. For many clinicians this is increasingly confusing and not helpful in clinical practice. This article is a critique of current trends and directions in clinical research, which show signs of limited effectiveness, fragmentation, and obfuscation. An alternative strategy is proposed-examining transdiagnostic therapeutic effects, which appear related to treating pervasive dysregulated emotions, with component analyses of four principal self-regulation components (viz., self-monitoring; functional analysis; identifying values, goals and treatment-plans; and feedback). Such a strategy is likely to lead to a more coherently synthesized and effective CBT.

The Effects of Dose, Practice Habits, and Objects of Focus on Digital Meditation Effectiveness and Adherence: Longitudinal Study of 280,000 Digital Meditation Sessions Across 103 Countries

BACKGROUND

The efficacy of digital meditation is well established. However, the extent to which the benefits remain after 12 weeks in real-world settings remains unknown. Additionally, findings related to dosage and practice habits have been mixed, and the studies were conducted on small and homogeneous samples and used a limited range of analytical procedures and meditation techniques. Findings related to the predictors of adherence are also lacking and may help inform future meditators and meditation programs on how to best structure healthy sustainable practices.

OBJECTIVE

This study aimed to measure outcome change across a large and globally diverse population of meditators and meditations in their naturalistic practice environments, assess the dose-response relationships between practice habits and outcome change, and identify predictors of adherence.

METHODS

We used ecological momentary assessment to assess participants' well-being over a 14-month period. We engineered outcomes related to the variability of change over time (equanimity) and recovery following a drop in mood (resilience) and established the convergent and divergent validity of these outcomes using a validated scale. Using linear mixed-effects and generalized additive mixed-effects models, we modeled outcome changes and patterns of dose-response across outcomes. We then used logistic regression to study the practice habits of participants in their first 30 sessions to derive odds ratios of long-term adherence.

RESULTS

Significant improvements were observed in all outcomes (P<.001). Generalized additive mixed models revealed rapid improvements over the first 50-100 sessions, with further improvements observed until the end of the study period. Outcome change corresponded to 1 extra day of improved mood for every 5 days meditated and half-a-day-faster mood recovery compared with baseline. Overall, consistency of practice was associated with the largest outcome change (4-7 d/wk). No significant differences were observed across session lengths in linear models (mood: P=.19; equanimity: P=.10; resilience: P=.29); however, generalized additive models revealed significant differences over time (P<.001). Longer sessions (21-30 min) were associated with the largest magnitude of change in mood from the 20th session onward and fewer sessions to recovery (increased resilience); midlength sessions (11-20 min) were associated with the largest decreases in recovery; and mood stability was similar across session lengths (equanimity). Completing a greater variety of practice types was associated with significantly greater improvements across all outcomes. Adhering to a long-term practice was best predicted by practice consistency (4-7 d/wk), a morning routine, and maintaining an equal balance between interoceptive and exteroceptive meditations.

CONCLUSIONS

Long-term real-world digital meditation practice is effective and associated with improvements in mood, equanimity, and resilience. Practice consistency and variety rather than length best predict improvement. Long-term sustainable practices are best predicted by consistency, a morning routine, and a practice balanced across objects of focus that are internal and external to the body.

The efficacy of virtual reality exposure therapy for the treatment of alcohol use disorder among adult males: a randomized controlled trial comparing with acceptance and commitment therapy and treatment as usual

Background

This multicenter, three-armed, parallel, single-blind randomized controlled trial (RCT) primarily aims to compare the efficacy of virtual reality exposure therapy (VRET) with that of acceptance and commitment therapy (ACT) and treatment as usual (TAU) to depreciate the degree of alcohol craving among alcohol use disorder patients who have undergone in-patient detoxification across four timelines (t0 = baseline prior to intervention, t1 = 4 weeks after baseline, t2 = 12 weeks after baseline, and t3 = 24 weeks after baseline). The secondary aims of this RCT are to compare the efficacy of VRET with that of ACT and TAU to alleviate the severity of alcohol use disorder, dissipate comorbid depressive and anxiety symptoms, and normalize event-related potential (ERP) in electroencephalogram (EEG) monitoring across the four timelines.

Methods

Initially, after 2 weeks of in-patient detoxification, 120 patients with alcohol use disorder will be randomized into three groups (VRET, ACT, and TAU control groups) via stratified permuted block randomization in a 1:1:1 ratio. Baseline assessment (t0) commences, whereby all the participants will be administered with sociodemographic, clinical, and alcohol use characteristics questionnaire, such as Alcohol Use Disorder Identification Test (AUDIT), Penn Alcohol Craving Scale (PACS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), while event-related potential (ERP) detection in electroencephalogram (EEG) will also be carried out. Then, 4 weeks of VRET, ACT, and non-therapeutic supportive activities will be conducted in the three respective groups. For the subsequent three assessment timelines (t1, t2, and t3), the alcohol use characteristic questionnaire, such as AUDIT, PACS, HAM-D, HAM-A, and ERP monitoring, will be re-administered to all participants.

Discussion

As data on the effects of non-pharmacological interventions, such as VRET and ACT, on the treatment of alcohol craving and preventing relapse in alcohol use disorder are lacking, this RCT fills the research gap by providing these important data to treating clinicians. If proven efficacious, the efficacy of VRET and ACT for the treatment of other substance use disorders should also be investigated in future.

Clinical trial registration

NCT05841823 (ClinicalTrials.gov).

Efficacy of stand-alone digital mental health applications for anxiety and depression: A meta-analysis of randomized controlled trials

BACKGROUND

Anxiety and depressive disorders affect 20% of the population, cause functional impairment, and represent a leading cause of disability. Although evidence-based treatments exist, the shortage of trained clinicians and high demand for mental health services have resulted in limited access to evidence-based care. Digital mental health applications (DMHA) present innovative, scalable, and sustainable solutions to address disparities in mental health care.

METHODS

The present study used meta-analytic techniques to evaluate the therapeutic effect of DMHAs in randomized controlled trials (RCTs) for individuals experiencing anxiety and/or depressive symptoms. Search terms were selected based on concepts related to digital mental health applications, mental health/wellness, intervention type, trial design, and anxiety and/or depression symptoms/diagnosis outcomes to capture all potentially eligible results. Potential demographic, DMHA, and trial design characteristics were examined as moderators of therapeutic effects.

RESULTS

Random effects meta-analyses found that stand-alone DMHAs produced a modest reduction in anxiety (g = 0.31) and depressive (g = 0.35) symptom severity. Several moderators influenced the therapeutic effects of DMHAs for anxiety and/or depressive symptoms including treatment duration, participant inclusion criteria, and outcome measures.

LIMITATIONS

Minimal information was available on DMHA usability and participant engagement with DMHAs within RCTs.

CONCLUSIONS

While DMHAs have the potential to be scalable and sustainable solutions to improve access and availability of evidence-based mental healthcare, moderator analyses highlight the considerations for implementation of DMHAs in practice. Further research is needed to understand factors that influence therapeutic effects of DMHAs and investigate strategies to optimize its implementation and overcome the extant research-to-practice gap.

Effect of a group-based acceptance and commitment therapy (ACT) intervention on self-esteem and psychological flexibility in patients with schizophrenia in remission

The present study explored whether acceptance and commitment therapy (ACT), a cognitive behavioral therapy approach, could improve the symptoms of schizophrenia spectrum disorders among patients with schizophrenia in remission. A pre- and post-treatment design with two evaluation time points was employed. Sixty outpatients with schizophrenia in remission were randomly divided into two groups: the ACT plus treatment as usual (ACT+TAU) and treatment as usual (TAU) groups. The ACT+TAU group participated in 10 group-based ACT interventions and TAU in the hospital, and the TAU group only received TAU interventions. General psycho-pathological symptoms, self-esteem, and psychological flexibility were assessed before intervention (baseline; pre-test) and after intervention (five weeks; post-test). Results indicated that, compared to the TAU group, the ACT+TAU group exhibited a more significant improvement in general psychopathological symptoms, self-esteem, cognitive fusion, and acceptance and action at post-test. ACT intervention could effectively decrease the general psycho-pathological symptoms and increase self-esteem level and psychological flexibility in people with schizophrenia in remission.

Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis

OBJECTIVE

Type D personality, a joint tendency toward negative affectivity and social inhibition, has been linked to adverse events in patients with heart disease, although with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies ( N = 11,151) to investigate the prediction of adverse outcomes by type D personality in patients with acquired cardiovascular disease.

METHOD

For each outcome (all-cause mortality, cardiac mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event, any adverse event), we estimated type D's prognostic influence and the moderation by age, sex, and disease type.

RESULTS

In patients with cardiovascular disease, evidence for a type D effect in terms of the Bayes factor (BF) was strong for major adverse cardiac event (BF = 42.5; odds ratio [OR] = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99), and myocardial infarction (BF = 16.9; OR = 1.12), suggesting that type D had no effect on these outcomes. This evidence was similar in the subset of patients with coronary artery disease (CAD), but inconclusive for patients with heart failure (HF). Positive effects were found for negative affectivity on cardiac and all-cause mortality, with the latter being more pronounced in male than female patients.

CONCLUSION

Across 19 prospective cohort studies, type D predicts adverse events in patients with CAD, whereas evidence in patients with HF was inconclusive. In both patients with CAD and HF, we found evidence for a null effect of type D on cardiac and all-cause mortality.

A longitudinal investigation of the role of perceived autonomy support from coaches in reducing athletes' experiential avoidance: The mediating role of subjective vitality

Experiential avoidance, a personality trait that refers to individuals' tendency to avoid negative experiences, can have a negative impact on athletes' goal achievement. For this reason, it is crucial to identify the factors that can mitigate such a tendency. Drawing on self-determination theory and referring specifically to the function of subjective vitality, we first hypothesize that perceived autonomy support from coaches is positively associated with athletes' subjective vitality, which in turn is negatively associated with athletes' experiential avoidance. Data were collected from one hundred eighty-five high school athletes in Taiwan using a three-wave, time-lagged survey design spanning a period of seven months. These athletes were drawn from ten senior high schools and were in their second year of high school. The results of regression analysis showed that perceived autonomy support from coaches at Time 1 was associated with higher vitality among athletes at Time 2, which was, in turn, associated with lower levels of experiential avoidance at Time 3, conditional on the athletes' experiential avoidance at Time 2. While perceived autonomy support from coaches at Time 1 was also associated with lower experiential avoidance at Time 2, experiential avoidance at Time 2 was not associated with vitality at Time 3 after controlling for vitality at Time 2. The results of mediation analysis further supported the claim that vitality is a critical mediator of the relationship between perceived autonomy support from coaches and athletes' experiential avoidance. Implications concerning the identification of this mediator are discussed.

The Effectiveness of Mindful Hypnotherapy on Depression, Self-Compassion, and Psychological Inflexibility in Females with Major Depressive Disorder: A Single-Blind, Randomized Clinical Trial

The effectiveness of the novel intervention mindful hypnotherapy on depression, self-compassion, and psychological inflexibility in females with major depressive disorder was examined in a randomized, clinical trial. Thirty-four participants were randomly allocated into mindful hypnotherapy and waitlist control groups. The intervention group was treated in 8 face-to-face, 60-minute weekly therapy sessions along with mindful hypnosis audio tapes to be used daily. The results of analysis of covariance indicated that there were significant differences between the mindful hypnotherapy and waitlist control groups after intervention and at 2-month follow-up (p < .001). The between-subject test of repeated measures ANOVAs also indicated a clinically significant difference between groups across time (baseline, postintervention, and 2-month follow-up) in depression, F = 53.86, p < .001, effect size = .65, and in self-compassion, F = 33.18, p < .001, effect size = .53, as well as psychological inflexibility, F = 26.84, p < .001, effect size = .48. In conclusion, this study indicates that mindful hypnotherapy is an effective intervention for treating depression as well as reducing psychological inflexibility and improving self-compassion for patients with major depressive disorder.

Efficacy and mechanisms of mobile application-delivered Acceptance and Commitment Therapy for posttraumatic stress disorder in China: Study protocol for a randomized controlled trial

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.

Effects of Hydrogen Peroxide on In Vitro Cultures of Tea (Camellia sinensis L.) Grown in the Dark and in the Light: Morphology, Content of Malondialdehyde, and Accumulation of Various Polyphenols

Tea plants (Camellia sinensis L.) are phenol-accumulating crops that are widely used for public health. The healing effect of tea leaf products is due to the biosynthesis of such phenolic compounds (PCs) as flavans, which have P-vitamin capillary-strengthening activity. Due to their limited habitat and the value of their specialized metabolites of a phenolic nature, a promising approach is to establish in vitro cultures from them that retain the ability to form PCs, which is characteristic of ex vivo tea plants. The aim of this study was to investigate the effect of exogenic H₂O₂ (0.01 mM; 0.1 mM; 1 mM) on the growth, morphology, degree of stress response, and accumulation of various phenolic compounds in tea plant callus cultures of different ages (24 or 36 days) grown under different cultivation conditions (darkness or light). According to the results obtained, the H₂O₂ effect on tea callus cultures of different ages did not cause changes in their morphophysiological characteristics, both after 2 h of exposure (rapid response of callus culture, RRCC) and after 48 h (delayed response of callus culture, DRCC). The determination of the malondialdehyde (MDA) content, which serves as an indicator of changes in the level of lipid peroxidation (LPO) and the presence of stress responses in plant cells, indicated either its maintenance at the control level, a decrease, or an increase. All these effects depended on the growth conditions of the tea callus cultures (darkness or light), their age, the duration of exposure (rapid or delayed response), and the H₂O₂ concentration. Similar trends were noted for the total content of PCs as well as the amount of flavans, proanthocyanidins (soluble and insoluble forms), and lignin. The plant cell responses reflected changes in its adaptation programs, when specialized metabolites act as a target for the action of H₂O₂, thereby contributing to an increase in their resistance.

Predictors of mental health in aid workers: meaning, resilience, and psychological flexibility as personal resources for increased well-being and reduced distress

Aid workers operate in stressful environments and tend to experience high psychological distress, yet not enough is known about their well-being and how to improve their mental health. This research project surveyed 243 aid workers in 77 countries undertaking humanitarian and development work who reported lower well-being and higher psychological distress than the general population. Well-being and distress emerged as two related but distinct mental health outcomes, encouraging further research on well-being in the sector. Better mental health outcomes were predicted by the presence of meaning, psychological flexibility, and resilience. Presence of meaning was the strongest predictor, whereas resilience was the weakest. Meaning was a stronger predictor of good mental health among national workers, whereas psychological flexibility was a stronger predictor among female, older, and international workers. These results can support evidence-based approaches to staff care and mental health interventions for aid workers, expanding the current focus on resilience to include meaning and psychological flexibility.

The impact of psychological flexibility on family dynamics amidst the COVID-19 pandemic: A longitudinal perspective

Background

Health risks associated with contracting COVID-19, stay-at-home orders, and pandemic-related economic and social hardships created unique challenges for individuals throughout the pandemic, and in particular for families whose daily routines were disrupted at the start of the pandemic. This study applied a contextual behavioral science lens to Family Systems Theory to examine the impact of COVID-19 stressors on family and individual functioning.

Methods

A sample of 742 coparents (86% married/engaged; 84% Caucasian; 71% female; M = 40.7 years old, SD = 8.1; M _income = $82,435, SD _income = $27,604) of school-aged children (5-18 years old) completed a baseline survey from late March to late April 2020. Of the initial sample, 556 coparents completed weekly diaries for 8 weeks.

Results

Mediation models were tested within a multilevel path modeling framework to evaluate both the stable, between-family differences (i.e., at level 2) and the within-family changes from week to week (i.e., at level 1). Across both levels of the model, parent psychological inflexibility was robustly linked to poorer functioning across all levels of the family system, showing direct links to a majority of the processes assessed. The results further supported a top-down spillover cascade in which parent inflexibility was proximally linked to greater COVID-19 related stress and parent depressive symptoms, which were proximally linked to poorer romantic functioning (greater negative conflict, lower satisfaction), which were proximally linked to poorer family functioning (greater coparent discord and family chaos), which were proximally linked to poorer parenting (greater angry/reactive parenting), which was proximally linked to greater child distress. Multi-group models suggested that the results were largely stable across (1) parent race (white vs non-white), (2) family size (1 child vs 2 or more), (3) child age (less than 10 years old vs 10 or older), (4) parent age (under 40 vs. 40 or older), (5) perceived COVID-19 risk, (6) parent gender (mothers vs fathers), (7) household income groups (less than $100k vs $100k or more), and (8) perceived economic stress/uncertainty (low vs high). However, a handful of moderated effects emerged from those multi-group models suggesting that fathers might be slightly more prone to negative spillover effects across the family systems and that wealthier families might have experienced the stress of new demands (e.g., homeschooling, remote working) as more disruptive.

Conclusions

Results highlight the crucial role parental psychological flexibility and inflexibility play in families managing the stress of COVID-19, as well as key mechanisms for how those stressors may either reverberate or become dampened throughout the family system.

Acceptance and commitment therapy versus mindfulness-based stress reduction for newly diagnosed head and neck cancer patients: A randomized controlled trial assessing efficacy for positive psychology, depression, anxiety, and quality of life

Background and aim

Head and neck cancer patients are vulnerable to various psychological complications due to the effects of both cancer itself and cancer treatment on patients’ appearance and physical well-being. Nevertheless, few data have been obtained on effective psychosocial interventions that could protect this group of cancer patients’ psychological well-being. Therefore, this three-armed, parallel-group, double-blind, randomized control trial (RCT) aims to evaluate and compare the effects of acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR) on positive psychology (such as posttraumatic growth [PTG], hope, and optimism), quality of life (QoL), and psychological complications (depression, anxiety, and experiential avoidance) among newly diagnosed head and neck cancer patients.

Methods and analysis

This RCT will target newly diagnosed head and neck cancer patients who have been treated only with surgery or who have not yet received any treatment. In total, 120 patients who meet all of the study’s inclusion criteria and none of its exclusion criteria will be randomly assigned into three groups—an ACT group, an MBSR group, and a treatment-as-usual control group—at a 1:1:1 allocation ratio. Participants in the two intervention groups (the ACT and MBSR groups) will undergo an eight-week group intervention program. During this program, each intervention will comprise eight modules based on ACT and MBSR, respectively. Outcome assessments will be performed across a three-point timeline, including before the intervention (t₀), immediately after the psychosocial intervention at eight weeks (t₁), and six months after the intervention (t₂). The primary outcome that will be assessed during this RCT is PTG. Meanwhile, the secondary outcomes that will be evaluated in this study are such as QoL, hope, optimism, depression, anxiety, and experiential avoidance.

Trial registration number

NCT04800419 (ClinicalTrials.gov). Registered on March 16, 2021.

Systematic Review of Acceptance and Commitment Training Components in the Behavioral Intervention of Individuals with Autism and Developmental Disorders

Acceptance and commitment therapy (ACT) is a contemporary approach to dealing with unhelpful private events and improving psychological flexibility (Hayes et al., 2006) that is often used in psychotherapy (Szabo, 2019). Nonpsychotherapeutic uses of ACT have been referred to as acceptance and commitment training (ACTraining; Moran, 2011, 2015; Szabo, 2019), which refers to the use of one or more of six processes-present moment attention or mindfulness, values clarification, committed action, self-as-context, defusion, and acceptance (Hayes et al., 2006)-implemented outside of psychotherapeutic settings. There has been a recent increase in interest in ACTraining within the behavior-analytic community, which has led behavior analysts to question whether ACTraining is useful to the field of applied behavior analysis (ABA) and whether it is within the scope of practice of behavior analysts. Tarbox et al. (2020) proposed that the use of ACTraining is within the scope of practice of behavior analysts and aligns with the seven dimensions of ABA as outlined by Baer et al. (1968). The purpose of the current study was to provide a systematic review of single-case research designs that measure the behavioral effects of ACTraining components conducted with individuals with autism spectrum disorder or developmental disorders, their parents, and their staff, and to inform clinicians and researchers about what variables have been evaluated and what gaps still exist.

Psychological aspects of living with an artificial eye

PURPOSE

Artificial eye clinics address physical and aesthetic aspects of orbital prostheses, but psychological effects may not be formally addressed. In general, without effective coping mechanisms, stress can lead to anxiety and depression. This study aims to determine, in the context of having an artificial eye, whether coping strategies, as well as perception of illness and other demographic and clinical variables are associated with anxiety or depression.

METHODS

Consecutive patients attending two artificial eye clinics were invited to participate in this audit. Participants completed questionnaires: HADS, Brief IPQ and Brief COPE. Variables with a correlation coefficient of ≥0.2 with anxiety or depression were included in regression modeling. The extent to which the participants' emotional and cognitive representations of their artificial eye related to feelings of anxiety and depression was determined.

RESULTS

In the cohort of 208, clinically significant anxiety was present in 29.5% and clinically significant depression was present in 8.4%. Perceptions of the impact of the artificial eye and self-blame as a coping strategy were correlated with anxiety. Depression levels were higher when participants believed that their artificial eye had a greater impact on their life, when they lived alone, and when they used substances as a coping strategy.

CONCLUSION

Significant levels of anxiety exist in those living with artificial eyes, with various coping strategies used. Addressing this and offering alternative coping strategies may improve patient well being and overall satisfaction.

Full-scale Randomized Trial Comparing Acceptance and Commitment Therapy Telephone-Delivered Coaching With Standard Telephone-Delivered Coaching Among Medicare/Uninsured Quitline Callers

INTRODUCTION

The aim of this study was to compare Acceptance and Commitment Therapy (ACT) telephone-delivered coaching with standard quitline (QL) telephone-delivered coaching.

METHODS

Medicare/uninsured adults (analyzable sample N = 1170) who smoked at least 10 cigarettes per day were recruited from Optum, a major US provider of QL services, in a two-arm stratified double-blind randomized trial with main outcome of self-reported missing = smoking 30-day point prevalence abstinence (PPA) at the 12-month follow-up. Participants were mean (SD) age 47.4 (12.7), 61% female, and 72% white race. Five sessions of telephone-delivered ACT or QL interventions were offered. Both arms included combined nicotine patch (4 weeks) and gum or lozenge (2 weeks).

RESULTS

The 12-month follow-up data retention rate was 67.8%. ACT participants reported their treatment was more useful for quitting smoking (92.0% for ACT vs. 82.3% for QL; odds ratio [OR] = 2.48; 95% confidence interval [CI]: 1.53 to 4.00). Both arms had similar 12-month cessation outcomes (missing = smoking 30-day PPA: 24.6% for ACT vs. 28.8% for QL; OR =.81; 95% CI: 0.62 to 1.05) and the ACT arm trended toward greater reductions in number cigarettes smoked per day (-5.6 for ACT vs. -1.7 QL, among smokers; p = .075).

CONCLUSIONS

ACT telephone-delivered coaching was more satisfying, engaging, and was as effective as standard QL telephone-delivered coaching. ACT may help those who fail to quit after standard coaching or who choose not to use nicotine replacement therapy.

IMPLICATIONS

In a sample of Medicare and uninsured QL callers, a large randomized trial with long-term follow-up showed that ACT) telephone-delivered coaching was more satisfying, engaging, and was as effective as standard QL telephone-delivered coaching-which has followed the same behavior change approach since the 1990s. This newer model of coaching might be a welcome addition to QL services.

Psychometric properties of the Valuing Questionnaire in a Spaniard sample and factorial equivalence with a Colombian sample

BACKGROUND

The Valuing Questionnaire (VQ) is considered as one of the most psychometrically robust instruments to measure valued living according to the acceptance and commitment therapy model. It consists of 10 items that are responded to on a 7-point Likert-type scale and has two factors: Progression and Obstruction. The Spanish version of the VQ showed good psychometric properties in Colombian samples. However, there is no evidence of the psychometric properties of the VQ in Spaniard samples. This study aims to analyze the validity of the VQ in a large Spaniard sample and analyze the measurement invariance with a similar Colombian sample.

METHOD

The VQ was administered to a Spaniard sample of 846 adult participants from general online population. Cronbach's alpha and McDonald's omega were computed to analyze the internal consistency of the VQ. The fit of the VQ's two-factor model was tested through a confirmatory factor analysis with a robust maximum likelihood (MLR) estimation method. Afterward, we analyzed the measurement invariance across countries and gender. Convergent construct validity was analyzed with a package of questionnaires that evaluated experiential avoidance (Acceptance and Action Questionnaire-II, AAQ-II), emotional symptoms (Depression Anxiety and Stress Scale-21, DASS-21), life satisfaction (Satisfaction with Life Scale, SWLS), and cognitive fusion (Cognitive Fusion Questionnaire, CFQ).

RESULTS

The internal consistency across samples was adequate (alphas and omegas were .85 for VQ-Progress and .84 for VQ-Obstruction). The two-factor model obtained a good fit to the data (RMSEA = 0.073, 90% CI [0.063, 0.083], CFI = 0.98, NNFI = 0.97, and SRMR = 0.053). The VQ showed strict invariance across countries and gender and showed theoretically coherent correlations with emotional symptoms, life satisfaction, experiential avoidance, and cognitive fusion. In conclusion, the Spanish version of the VQ demonstrated good psychometric properties in a large Spaniard sample.

Self-stigma and cognitive fusion in parents of children with autism spectrum disorder. The moderating role of self-compassion

Background

Research shows that people with autism spectrum disorder and their families often experience social stigma. The internalization of social stigma can lead to the occurrence of self-stigma, understood as an internalized cognitive-affective self-directed and rigid process that results in individuals agreeing with stigmatizing opinions and applying them to themselves. Experiencing self-stigma can lead to a cognitive fusion with negative thoughts–especially those about oneself. Previous studies show that self-compassion reduces feelings of suffering, shame and self-stigma in a group of parents of children with autism spectrum disorder. The aim of this study was to test the relationship between self-stigma and cognitive fusion among parents of children with ASD. The moderating role of self-compassion as a protective factor was also verified.

Methods

The following questionnaires were used: Perceived Public Stigma Scale, Perceived Courtesy Stigma Scale, Self-Compassion Scale–Short Form, Cognitive Fusion Questionnaire, and Depression, Anxiety and Stress Scale. The study included 233 Polish parents of children with autism spectrum disorder (including 218 women).

Results

The results showed a positive correlation between fusion and both affiliate (r = 0.31, p < 0.001) and public stigma (r = 0.33, p < 0.001). Fusion and self-compassion were significant predictors of affiliate stigma. Self-compassion moderated the relationship between fusion and depression (β = −0.11, p < 0.05) and the relationship between fusion and stress (β = −0.11, p < 0.05). Cognitive fusion with negative beliefs about oneself can contribute to self-stigma. Defusion-oriented actions are an opportunity to distance oneself from emerging thoughts and eliminate their negative consequences. Self-compassion manifests itself in a compassionate and accepting attitude towards oneself and improves the individual’s well-being. Actions taken to strengthen the indicated factors could contribute to a better quality of life of parents of children with ASD.

Two-Year Follow-Up of a Randomized Clinical Trial of Inpatient Multimodal Occupational Rehabilitation Vs Outpatient Acceptance and Commitment Therapy for Sick Listed Workers with Musculoskeletal or Common Mental Disorders

Purpose There is a lack of results on long-term effects of return to work interventions. We previously reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective in reducing sickness absence and facilitating return to work (RTW) at 12 months follow-up compared to an outpatient program that consisted mainly of Acceptance and Commitment Therapy (O-ACT). We now report the 2-year outcome data. Methods A randomized clinical trial with parallel groups. Participants were 18-60 years old, sick listed with musculoskeletal, common mental or general/unspecified disorders. I-MORE lasted 3.5 weeks and consisted of ACT, physical training and work-related problem solving. O-ACT consisted mainly of 6 weekly sessions (2.5 h. each) of ACT in groups. Outcomes were cumulated number of days on medical benefits and time until sustainable RTW (1 month without medical benefits) during 2-years of follow-up, measured by registry data. Results For the 166 randomized participants, the median number of days on medical benefits was 159 (IQR 59-342) for I-MORE vs 249 days (IQR 103-379; Mann-Whitney U test, p = 0.07), for O-ACT. At 2 years, 40% in I-MORE received long-term benefits (work assessment allowance) vs 51% in O-ACT. The crude hazard ratio (HR) for sustainable RTW was 1.59 (95% CI 1.04-2.42, p = 0.03) and the adjusted HR 1.77 (95% CI 1.14-2.75, p = 0.01), in favor of I-MORE. Conclusions The 2-year outcomes show that I-MORE had long-term positive effects on increasing work participation for individuals sick listed with musculoskeletal and mental disorders. Further follow-up and economic evaluations should be performed.

Identifying the Coping Strategies of Nonoffending Pedophilic and Hebephilic Individuals From Their Online Forum Posts

Individuals who identify as pedophilic or hebephilic, and who do not offend, are increasingly visible in online discourse and as a focus of research. Developing knowledge about this population will offer insights into their psychological needs and, potentially, into the mechanisms and strategies individuals use to live offense-free lives. This study examined coping strategies among members of an online forum supporting pedohebephilic individuals who do not wish to offend. Forum users' posts were analyzed using thematic analysis. Eleven themes emerged, which were classifiable into three superordinate themes around (a) the acceptance of pedophilia, (b) strategies to stay safe, and (c) dealing with sexual arousal. These themes offer insight into the varying strategies used by these individuals to cope with stress and/or to remain offense-free. Understanding whether these strategies are adaptive or maladaptive may help develop better support services for those who have not offended and may inform prevention efforts.

Complementary and alternative medicine therapies and COVID-19: a systematic review

OBJECTIVES

Despite the high prevalence of coronavirus and various treatment approaches, including complementary and alternative medicine (CAM), there is still no definitive treatment for coronavirus. The present study aimed to evaluate the effect of CAM interventions on COVID-19 patients.

CONTENT

Four databases (Web of Science, PubMed, Scopus, and EMBASE) were searched from the inception of databases until July 16, 2020. Keywords included complementary and alternative medicine therapies and Coronavirus.

SUMMARY AND OUTLOOK

Of the 1,137 studies searched, 14 studies performed on 972 COVID-19 patients entered the systematic review final stage. The results showed that different CAM interventions (acupuncture, Traditional Chinese medicine [TCM], relaxation, Qigong) significantly improved various psychological symptoms (depression, anxiety, stress, sleep quality, negative emotions, quality of life) and physical symptoms (inflammatory factors, physical activity, chest pain, and respiratory function) in COVID-19 patients. The results showed that various CAM interventions have a positive effect on improving the various dimensions of coronavirus disease but since there are few studies in this regard, further studies using different CAM approaches are recommended.

Processes of change within acceptance and commitment therapy for university students: Preliminary evidence from a randomized controlled trial

This randomized controlled trial examined whether KORSA workshops indirectly influence anxiety, depression and stress symptoms among university students through their effect on two second-order psychological flexibility processes: 1) mindfulness and acceptance, and 2) commitment and behavior change. Participants: During the fall 2014 and the winter 2015 semesters, 124 students participated in the study. Methods: They were randomized to either a 4-week intervention group (n = 61) or a wait-list control group (n = 63). They completed measures of anxiety, depression, stress and psychological flexibility before and immediately after the intervention. Results: Bootstrapping-based mediation analyses showed that the intervention indirectly influenced symptoms reduction through its effect on acceptance and mindfulness processes, but not through commitment and behavior change processes. Conclusions: These initial findings suggest that contact with the present moment, acceptance, cognitive defusion and self as context are important processes of change through which KORSA workshops affect the students mental health.

Acceptance and commitment therapy for individuals having attention deficit hyperactivity disorder (ADHD): A scoping review

OBJECTIVES

Acceptance and commitment therapy (ACT) has accumulated increasing evidence-base for a broad range of mental health issues. Considering that ACT encourages broad and flexible patterns of behaviour and neutralizes the pervasive psychological processes proposed to be caused by most individuals' distress, such a modality may be effective for ADHD. This review aimed to give a synthesis of the studies, so far, focusing on the usefulness of ACT approaches among individuals having ADHD.

DESIGN/METHODS

This scoping review searched studies exploring the effectiveness of ACT approaches for individuals with ADHD across eight electronic databases (Medline, Embase, PsycInfo, ScienceDirect, PubMed, Emcare, Scopus, and Google Scholar). This review was based on a total of two quasi-experimental and four experimental studies.

RESULTS

A thematic analysis was suggested based on the PRISMA guidelines. Overall, the review presented preliminary evidence demonstrating the use of ACT among individuals with ADHD. It was found that the ACT was used to treat a variety of behavioural and psychosocial outcomes, which included reducing ADHD symptoms (e.g., impulsivity, inattention, inflexibility, etc.) and other sequelae related to the ADHD diagnosis such as poor quality of life, academic procrastination, depression and anxiety symptoms, and psychological maladjustment.

CONCLUSIONS

This review revealed that ACT was a flexible approach that could be adapted to deliver both targeted treatment of ADHD symptomatology and more general psychosocial issues. It could also be delivered in group or individual formats. Nevertheless, although the findings of the present scoping review indicate promising results, more research is needed.

Transforming Health and Resiliency Through Integration of Values-based Experiences: Implementation of an Electronic Evidence-based Whole Health Clinical Program

BACKGROUND

Complementary and integrative health (CIH) is the foundation of the Department of Veterans Affairs (VA) Whole Health System program (WH), including Transforming Health and Resiliency through Integration of Values-based Experiences (THRIVE). The global COVID-19 pandemic prompted an urgent need to provide services such as THRIVE while following guidelines for social distancing.

OBJECTIVE

The objective of this paper was to describe the systematic implementation of THRIVE using an electronic delivery model.

METHODS

The study involved an observational clinical program implementation project using the RE-AIM framework to contextualize the implementation strategies and results, and then the implementation of an electronically delivered CIH group medical appointment program (eTHRIVE).

RESULTS

Clinical staff transitioned to 100% electronic delivery of the THRIVE curriculum using the new eTHRIVE delivery model. The current electronic delivery model, eTHRIVE, has effectively enrolled 10-12 veterans per cohort, with 8 cohorts, totaling 87 veterans to date. eTHRIVE attrition has been 6% (5/87) since initiation.

CONCLUSIONS

The current climate of the VA WH programmatic initiative combined with the public health needs during a global pandemic prompted the move of THRIVE program into an electronic format to broaden scalability and reach.

Acceptability and Effectiveness of Artificial Intelligence Therapy for Anxiety and Depression (Youper): Longitudinal Observational Study

Background

Youper is a widely used, commercially available mobile app that uses artificial intelligence therapy for the treatment of anxiety and depression.

Objective

Our study examined the acceptability and effectiveness of Youper. Further, we tested the cumulative regulation hypothesis, which posits that cumulative emotion regulation successes with repeated intervention engagement will predict longer-term anxiety and depression symptom reduction.

Methods

We examined data from paying Youper users (N=4517) who allowed their data to be used for research. To characterize the acceptability of Youper, we asked users to rate the app on a 5-star scale and measured retention statistics for users’ first 4 weeks of subscription. To examine effectiveness, we examined longitudinal measures of anxiety and depression symptoms. To test the cumulative regulation hypothesis, we used the proportion of successful emotion regulation attempts to predict symptom reduction.

Results

Youper users rated the app highly (mean 4.36 stars, SD 0.84), and 42.66% (1927/4517) of users were retained by week 4. Symptoms decreased in the first 2 weeks of app use (anxiety: d=0.57; depression: d=0.46). Anxiety improvements were maintained in the subsequent 2 weeks, but depression symptoms increased slightly with a very small effect size (d=0.05). A higher proportion of successful emotion regulation attempts significantly predicted greater anxiety and depression symptom reduction.

Conclusions

Youper is a low-cost, completely self-guided treatment that is accessible to users who may not otherwise access mental health care. Our findings demonstrate the acceptability and effectiveness of Youper as a treatment for anxiety and depression symptoms and support continued study of Youper in a randomized clinical trial.

Following up internet-delivered cognitive behaviour therapy (CBT): A longitudinal qualitative investigation of clients' usage of CBT skills

BACKGROUND

While the acquisition and application of Cognitive Behaviour Therapy (CBT) skills is a core component and likely mechanism of effect maintenance in all CBT-based treatments, the extent of post-therapeutic CBT skills usage among internet-delivered CBT (iCBT) clients remains under-researched.

METHOD

Nested within a pragmatic randomized controlled trial, 241 participants received an 8-week supported iCBT intervention for anxiety and/or depression and answered open-ended questions about their use and experience of CBT skills at 3-, 6-, 9-, and 12-month follow-up. Recurrent, cross-sectional qualitative analysis following the descriptive and interpretive approach was used to create a taxonomy, through which all qualitative data was coded.

RESULTS

In total, 479 qualitative responses across 181 participants were analysed. Participants reported using a wide range of CBT skills and associated helpful and hindering experiences and impacts. The reasons for discontinued CBT skills usage were diverse, ranging from rare adverse effects to healthy adaptation.

CONCLUSION

The study shows how clients receiving iCBT in routine care learn CBT skills during treatment and utilize them in productive ways post-treatment. Findings coincide with similar research in face-to-face CBT and may inform future research to drive innovation and iCBT intervention development.

Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial

Background

Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated.

Objective

This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention.

Methods

Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction.

Results

Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=−.63, P=.26; T1-T3: B=−.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ²₁=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes.

Conclusions

The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life.

Trial Registration

Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131