"I Really Felt the Feeling": A Systematic Review and Qualitative Thematic Synthesis of Healthcare Workers' Experiences of Acceptance and Commitment Therapy Training

Purpose: Existing research suggests that Acceptance and Commitment Therapy (ACT) training is beneficial for healthcare workers' professional practice and personal well-being. This review aimed to further understanding of healthcare workers' experiences of ACT training by synthesizing existing qualitative studies.Methods: A systematic literature review identified papers published up until April 2022 using the Embase, Ovid MEDLINE, and PsycINFO databases as well as relevant studies within the gray literature. Nine studies were included in the review, which were analyzed using Thematic Synthesis (Thomas & Harden, 2008).Results: Three analytical themes were identified through the thematic synthesis: I am both the patient and the professional; a powerful and empowering experience; and it is not always comfortable.Conclusion: This review has highlighted the importance of experiential learning. The training was a powerful experience for staff, but as such, it was not always comfortable. Recommendations for the future delivery of ACT training are made.

Acceptance-Commitment Therapy for Women with Episodic Migraine: A Pilot Randomized Trial

Objective: The aim of this study was to conduct a pilot, randomized controlled trial (RCT) of acceptance-commitment therapy (ACT) among women with episodic migraine, aged 18-65 years, and living in the United States. Background: Biobehavioral treatments have recently been proposed as possible preventive therapies for migraine management. ACT is a third wave biobehavioral therapy focused on acceptance and development of psychological flexibility and is evidence based for use in other chronic pain conditions. However, its use for reducing migraine frequency and disability has been understudied to date. Methods: The authors performed a pilot RCT evaluating ACT versus enhanced usual care (EUC) among adult women with episodic migraine. ACT consisted of eight virtual weekly sessions (for 8 weeks). Primary aims evaluated feasibility, retention, and protocol adherence. Secondary clinical outcomes included changes in migraine days and Migraine Disability Assessment (MIDAS). Results: We were able to successfully recruit 54 women in 15 months, which surpassed our recruitment goal. However, the completion rates of migraine logs and questionnaires at both outcome assessments were lower than anticipated. Among the 17 individuals randomized to EUC, 12 (71%) completed migraine logs and 12 (71%) completed questionnaires at the end of the intervention. In the postintervention follow-up, 11 (65%) individuals completed logs and 11 (65%) completed questionnaires. We observed slightly larger decreases in migraine days for those assigned to ACT from baseline to the end of the intervention, but these differences did not persist during postintervention follow-up. Both groups reported similar decreases in MIDAS over time. Conclusions: Recruitment for a large-scale trial of ACT is feasible. Challenges with remote data collection as well as participant burden during the COVID-19 pandemic resulted in lower than anticipated completion rates. Future studies should focus on decreasing participant burden and streamlining study procedures. Clinical Trials Registration: NCT05003362.

Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress

BACKGROUND

The bidirectional relationship between inflammatory bowel disease (IBD) flare-ups and depression/anxiety symptoms has prompted investigations into psychotherapy to improve health-related quality of life (HRQoL) by targeting depression and anxiety. Acceptance commitment therapy (ACT) is effective in improving symptoms of depression and anxiety in people with chronic diseases, yet minimal research has examined ACT's effectiveness for IBD. This study examines the feasibility, acceptability, and preliminary efficacy of the ACTforIBD program, an online program codesigned with consumers to deliver ACT to those with IBD.

METHODS

Adults with IBD and symptoms of mild-moderate distress were randomized to ACTforIBD or an active control (psychoeducation) condition. Participants completed 8 weekly, 1-hour sessions, 4 of which were therapist facilitated. Feasibility was based on recruitment and retention and acceptability was derived from postprogram satisfaction measures. Preliminary efficacy was determined by group differences in rate of change in study outcomes from baseline to postprogram.

RESULTS

Of 62 participants (89% women, 11% men; mean age  33 years), 55 completed the program (ACTforIBD: n = 26 [83.9%]; active control: n = 29 [93.5%]). Adherence and acceptability were high in the ACTforIBD group, with 80% of participants completing all self-directed modules and 78% of participants expressing satisfaction with the program. Significant and marginally significant group × time interactions were found for anxiety symptoms (b = -1.89; 95% confidence interval, -3.38 to -0.42) and psychological HRQoL (b = -0.04; 95% confidence interval, -0.07 to 0.01), showing decreased anxiety and increased psychological HRQoL in the intervention group.

CONCLUSIONS

ACTforIBD is feasible, acceptable, and improved anxiety symptoms, and psychological HRQoL. This highlights the need for a full-scale randomized controlled trial to further examine the program's efficacy.

Videoconference-delivered group acceptance commitment therapy for perinatal mood and anxiety disorders: facilitators views and recommendations

OBJECTIVES

To examine, in depth, the perspectives of facilitators of a videoconference-delivered group Acceptance Commitment Therapy (ACT) intervention for perinatal women with moderate-severe mood and/or anxiety disorders.

DESIGN

Qualitative study.

METHODS

Thematic analysis was used to analyse semi-structured interviews with seven facilitators and post-session reflections with six facilitators.

RESULTS

Four themes were generated. First, there are barriers to accessing psychological therapies during the perinatal period and improvements are required. Second, COVID-19 has accelerated the provision of remote therapies, including videoconference-delivered group therapy, enabling a continuity of service, and facilitating diversification of treatment access and choice. Third, there are benefits of videoconference-delivered group ACT in the perinatal period, with reservations. Attending a group via videoconference is perceived to be less exposing, and offers normalisation, social support, empowerment, and flexibility. Facilitators also shared reservations including whether service users would prioritise videoconference-delivered group therapy, concerns about limited non-verbal cues and the therapeutic alliance, reporting a lack of an evidence base, and technology challenges when working online. Finally, facilitators offered recommendations for videoconference-delivered group therapy best practice in the perinatal period, including the provision of equipment and data, contracts for attendance and suggestions to maximise engagement and group cohesion.

CONCLUSIONS

This study raises important considerations regarding the use of videoconference-delivered group ACT in the perinatal context. There are opportunities afforded by videoconference-delivered group therapies, which is important and timely given the increased drive towards improving access to perinatal services and psychological therapies, and the need for 'COVID-proof' therapies. Recommendations for best practice are offered.

Third wave cognitive behavioural therapies for people with multiple sclerosis: a scoping review

PURPOSE

Multiple sclerosis (MS) is a chronic condition linked to a wide range of psychological difficulties. While traditional cognitive behavioural therapy has been studied extensively with people with MS, much less is known about more recent "third wave" approaches.

METHODS

A scoping review was carried out by performing a systematic search across MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library up to January 2022.

RESULTS

From an initial return of 8306 citations, 35 studies were included, 20 of which were randomised controlled trials (RCTs). These showed that four third wave approaches have been investigated with people with MS to date: acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). MBSR and MBCT may be helpful to address a range of psychological difficulties up to three months post-intervention. However, MS-specific adaptations may be required, and more evidence is needed on longer-term effectiveness. Limited evidence is also available for DBT and ACT, but additional research is warranted before any recommendation can be made.

CONCLUSIONS

As third wave approaches keep being refined, further more rigorous investigations are needed to implement them to the benefit of people with MS. Implications for RehabilitationMultiple sclerosis is linked to a wide range of psychological difficulties in adults.Little is currently known on third wave psychotherapies for people with MS.Mindfulness-based stress reduction and mindfulness-based cognitive therapy may be helpful to address a wide range of difficulties in MS.Specific adaptations may be needed to deliver suitable therapies to people with MS.Additional research is warranted to build on preliminary findings for DBT and ACT.

Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment

Background

During a global pandemic, it is critical to rapidly deploy a psychological intervention to support the mental health and resilience of highly affected individuals and communities.

Objective

This is the rationale behind the development and implementation of the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training, an online, blended, skills building intervention to increase the resilience and well-being of participants while promoting their individual and collective empowerment and capacity building.

Methods

Based on acceptance and commitment therapy (ACT) and social justice–based group empowerment psychoeducation (GEP), we developed the Acceptance and Commitment to Empowerment (ACE) model to enhance psychological resilience and collective empowerment. The PACER program consists of 6 online, interactive, self-guided modules complemented by 6 weekly, 90-minute, videoconference, facilitator-led, group sessions.

Results

As of August 2021, a total of 325 participants had enrolled in the PACER program. Participants include frontline health care providers and Chinese-Canadian community members.

Conclusions

The PACER program is an innovative intervention program with the potential for increasing resilience and empowerment while reducing mental distress during the pandemic.

International Registered Report Identifier (IRRID)

DERR1-10.2196/33495

Relationship among self-injury, experiential avoidance, cognitive fusion, anxiety, and depression in Chinese adolescent patients with nonsuicidal self-injury

OBJECTIVE

To explore relationship among self-injury behavior, experiential avoidance, cognitive fusion, anxiety, and depression in Chinese adolescent patients with nonsuicidal self-injury (NSSI).

METHODS

Cognitive fusion questionnaire (CFQ), Acceptance and Action Questionnaire-2nd edition (AAQ-II), adolescent nonsuicidal self-injury behavior questionnaire (ANSAQ), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) were used as research tools to investigate 120 subjects with NSSI and 130 healthy controls.

RESULTS

The scores of CFQ and AAQ-II in the NSSI group were significantly higher than those in the healthy control group (p < .001). The results of regression analysis showed that the experiential avoidance score of patients with NSSI could predict the score of self-injury questionnaire (β = 0.585, p < .001); when predicting anxiety, only CFQ (β = 0.361, p < .001) entered the equation, with an explanatory variation of 12.3%; when predicting depression, CFQ (β = 0.287, p < .01) entered the equation, with an explanatory variation of 7.4%.

CONCLUSION

A high level of cognitive fusion and experiential avoidance may be important factors for the maintenance of self-injury behavior in patients with NSSI.

Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol

Background

Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status.

Objective

The Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants’ satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined.

Methods

A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale – Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program.

Results

WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021.

Conclusions

WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations.

International Registered Report Identifier (IRRID)

DERR1-10.2196/31211

Relationship Between Cognitive Fusion, Experiential Avoidance, and Obsessive-Compulsive Symptoms in Patients With Obsessive-Compulsive Disorder

Objective: This study aimed to explore the relationship among cognitive fusion, experiential avoidance, and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder (OCD). Methods: A total of 118 outpatient and inpatient patients with OCD and 109 healthy participants, gender- and age-matched, were selected using cognitive fusion questionnaire (CFQ), acceptance and action questionnaire-2nd edition (AAQ-II), Yale-Brown scale for obsessive-compulsive symptoms, Hamilton anxiety scale, and Hamilton depression scale for questionnaire testing and data analysis. Results: The levels of cognitive fusion and experiential avoidance in the OCD group were significantly higher than those in the healthy control group (P < 0.05). Regression analysis results showed that, in predicting the total score of obsessive-compulsive symptoms, AAQ-II (β = 0.233, P < 0.05) and CFQ (β = 0.262, P < 0.01) entered the equation, which explained 17.1% variance. In predicting anxiety, only AAQ-II (β = 0.222, P < 0.05) entered the equation, which explained 13% variance. In the prediction of depression, AAQ-II (β = 0.412, P < 0.001) entered the equation, which explained 17.7% variance. Conclusion: Cognitive fusion and experiential avoidance may be important factors for the maintenance of OCD, and experiential avoidance can positively predict the anxiety and depression of OCD patients.

A Two-Day Acceptance and Commitment Therapy (ACT) Workshop Increases Presence and Work Functioning in Healthcare Workers

BACKGROUND

In this controlled naturalistic study performed in healthcare workers we examined the effect of a two-day acceptance commitment therapy (ACT) workshop on work presence and productivity, i.e. the influence the workshop had on treatment efficacy in a routine hospital care setting.

AIM

To examine the influence of ACT on productivity and presence in healthcare workers.

METHOD

Study participants were all healthcare workers (nurses, medical doctors, physiotherapists, social workers, and art therapists) of four inpatient wards for depression. Half of the healthcare workers attended the workshop. Measures were evaluated 3 months after the intervention in the study participants and the patients treated by them in the same time period.

RESULTS

A significantly higher treatment efficacy [as measured with HoNOS (Health of the nation outcome scales) change in the patients treated by the participants] has been observed in the healthcare workers who attended the ACT workshop when compared to the control group who did not attend the workshop. Moreover, the work presence of the participants of the ACT workshop was increased when compared with the time period before the intervention and with the presence of the control group. A cost analysis showed that ACT workshops lead to a significant return of investment for the employer as the costs for the workshop were ten times compensated by the increase of work presence in participants of the workshop.

CONCLUSION

These findings provide support that ACT interventions motivate healthcare workers to work and increase their patients' treatment quality. To our knowledge this is the first study showing an ACT workshop in healthcare workers can influence HoNOS outcome in the treated patients.

Acceptance and commitment therapy for psychosis and trauma: Improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention

OBJECTIVES

Acceptance and Commitment Therapy (ACT) has shown effectiveness for individuals with psychosis and individuals with a history of childhood trauma, but has not been investigated with people with psychosis who also have a history of childhood trauma. This study aims at determining the efficacy of a mindfulness-based ACT with this clientele in diminishing psychiatric symptoms, trauma-related symptoms, as well as in improving treatment adherence.

DESIGN AND METHODS

Fifty participants meeting our inclusion criteria were recruited and randomized to take part in either 10 sessions of ACT group, or Treatment as Usual (TAU).

RESULTS

Using RCT it was found that symptom severity, for both overall symptoms (BPRS) and anxiety (GAD), decreased over the course of the treatment, and participants' ability to regulate their emotional reactions (i.e., accept them) increased. The study also found that treatment engagement increased with regards to help-seeking for those in the ACT group, compared with the TAU controls.

CONCLUSIONS

Acceptance and Commitment Therapy offered in a group appears a promising treatment for those with psychosis and history of trauma.

PRACTITIONER POINTS

To understand the benefits of ACT with those who suffer from psychosis and a history of trauma. To further the understanding of the effectiveness of ACT.

Understanding the usage of content in a mental health intervention for depression: an analysis of log data

Background

Web-based interventions for the early treatment of depressive symptoms can be considered effective in reducing mental complaints. However, there is a limited understanding of which elements in an intervention contribute to effectiveness. For efficiency and effectiveness of interventions, insight is needed into the use of content and persuasive features.

Objective

The aims of this study were (1) to illustrate how log data can be used to understand the uptake of the content of a Web-based intervention that is based on the acceptance and commitment therapy (ACT) and (2) to discover how log data can be of value for improving the incorporation of content in Web-based interventions.

Methods

Data from 206 participants (out of the 239) who started the first nine lessons of the Web-based intervention, Living to the Full, were used for a secondary analysis of a subset of the log data of the parent study about adherence to the intervention. The log files used in this study were per lesson: login, start mindfulness, download mindfulness, view success story, view feedback message, start multimedia, turn on text-message coach, turn off text-message coach, and view text message. Differences in usage between lessons were explored with repeated measures ANOVAs (analysis of variance). Differences between groups were explored with one-way ANOVAs. To explore the possible predictive value of the login per lesson quartiles on the outcome measures, four linear regressions were used with login quartiles as predictor and with the outcome measures (Center for Epidemiologic Studies—Depression [CES-D] and the Hospital Anxiety and Depression Scale—Anxiety [HADS-A] on post-intervention and follow-up) as dependent variables.

Results

A significant decrease in logins and in the use of content and persuasive features over time was observed. The usage of features varied significantly during the treatment process. The usage of persuasive features increased during the third part of the ACT (commitment to value-based living), which might indicate that at that stage motivational support was relevant. Higher logins over time (9 weeks) corresponded with a higher usage of features (in most cases significant); when predicting depressive symptoms at post-intervention, the linear regression yielded a significant model with login quartile as a significant predictor (explained variance is 2.7%).

Conclusions

A better integration of content and persuasive features in the design of the intervention and a better intra-usability of features within the system are needed to identify which combination of features works best for whom. Pattern recognition can be used to tailor the intervention based on usage patterns from the earlier lessons and to support the uptake of content essential for therapy. An adaptable interface for a modular composition of therapy features supposes a dynamic approach for Web-based treatment; not a predefined path for all, but a flexible way to go through all features that have to be used.