Accepted for/Published in: JMIR Formative Research
Date Submitted: Feb 10, 2024
Date Accepted: Sep 25, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: findings on treatment engagement and acceptability from the multi-center INTERACT randomized controlled trial
ABSTRACT
Background:
Acceptance and Commitment Therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with a mobile health (mHealth) ecological momentary intervention (EMI) may increase its treatment effects and empower clients to take treatment into their own hands.
Objective:
This study aimed to investigate treatment engagement with and acceptability of Acceptance and Commitment Therapy in Daily Life (ACT-DL), a novel Ecological Momentary Intervention for people with Ultra-High-Risk (UHR) state and a First-Episode Psychosis (FEP).
Methods:
In the multi-center INTERACT randomized controlled trial, UHR and FEP individuals aged 15-65 were randomized to treatment as usual only (TAU) (control) or to ACT-DL+TAU (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone application, delivering ACT skills and techniques in daily life. We collected data on treatment engagement with and acceptability of ACT-DL. Predictors included baseline demographic, clinical and functional outcomes.
Results:
ACT-DL+TAU participants (n=71) completed a mean of 6 (SD=3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant to 6 out of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness), and that 91% reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Ethnic minority background predicted lower notification response compliance (B=-4.37; P=.012), yet higher app usefulness (B=1.25; P=.049). Negative (B=-0.26; P=.010) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness respectively. Being female (B=-1.03; P=.049) predicted lower usefulness of the ACT metaphor images on the app.
Conclusions:
Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. Clinical Trial: The trial was prospectively registered within the Dutch Trial Register (ID: NTR4252).
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