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van Aubel E, Vaessen T, Uyttebroek L, Steinhart H, Beijer-Klippel A, Batink T, van Winkel R, de Haan L, van der Gaag M, van Amelsvoort T, Marcelis M, Schirmbeck F, Reininghaus U, Myin-Germeys I
Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial
Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life (ACT-DL) in Early Psychosis: Secondary Findings from a Multi-Center Randomized Controlled Trial
Evelyne van Aubel;
Thomas Vaessen;
Lotte Uyttebroek;
Henrietta Steinhart;
Annelie Beijer-Klippel;
Tim Batink;
Ruud van Winkel;
Lieuwe de Haan;
Mark van der Gaag;
Thérèse van Amelsvoort;
Machteld Marcelis;
Frederike Schirmbeck;
Ulrich Reininghaus;
Inez Myin-Germeys
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: OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803
Citation
Please cite as:
van Aubel E, Vaessen T, Uyttebroek L, Steinhart H, Beijer-Klippel A, Batink T, van Winkel R, de Haan L, van der Gaag M, van Amelsvoort T, Marcelis M, Schirmbeck F, Reininghaus U, Myin-Germeys I
Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial