Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 3, 2023
Date Accepted: Oct 24, 2023
Effects and mechanisms of an acceptance and commitment therapy web-based and mobile intervention on anxiety and depression symptoms in nurses: a fully decentralized randomized controlled trial
ABSTRACT
Background:
Acceptance and Commitment Therapy (ACT) is a promising intervention for mental health, but there is limited evidence on its effectiveness for nurses, particularly in digital form to mitigate anxiety and depression symptoms.
Objective:
To examine the effect and underlying psychological mechanism of digital ACT on nurses’ anxiety and depression symptoms.
Methods:
In this fully decentralized, randomized controlled trial, nurses were recruited nationwide through advertisements and posters, and were randomly assigned to either the 5-week digital ACT group or the waiting group. Primary outcomes (anxiety and depression symptoms) were assessed at baseline (pre-intervention, T1), weekly (T2: week two, T3: week three, T4: week four), post- intervention (week five, T5), and follow-up (3 months post-intervention, T6). Secondary outcomes (sleep quality, burnout, and work performance) were assessed at T1, T5, T6, and mediators (psychological flexibility, cognitive defusion, mindfulness, and value) were assessed at T1 and T5. All assessments were conducted on the “Wenjuanxing” platform, and data collectors were blind to the group assignments throughout the study period.
Results:
145 nurses with anxiety or depression symptoms were randomly assigned to digital ACT group (n=72) or control group (n=73). During the study, 36 (24.8%) were lost to follow-up, and 53 (73.61%) completed the entire intervention. Compared to the waiting group, nurses in the digital ACT group showed significant improvement in anxiety and depression symptoms, and the effect was sustained for three months after the intervention. Changes in psychological flexibility, cognitive defusion, and value mediated the effect of the intervention on anxiety and depression symptoms, while mindfulness did not have a mediating effect.
Conclusions:
The digital ACT significantly improved nurses’ anxiety and depression symptoms by improving psychological flexibility, cognitive defusion, and value. Clinical Trial: Chinese Clinical Trial Register ChiCTR2200059218; https://www.chictr.org.cn/showproj.aspx?proj=65376
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