JMIR Publications

ABSTRACT

Background:

Acceptance and Commitment Therapy (ACT) relies heavily on between-session practice of therapeutic exercises to promote skill acquisition and improve psychological flexibility. However, adherence to between-session practice remains a challenge. Mobile applications offer a promising solution to bridge this gap. However, few ACT apps focus exclusively on supporting clients in their between-session practice, and fewer involve stakeholders in their design. ACTaide, a therapy companion mobile application co-designed with stakeholders, aims to address these barriers by guiding clients through ACT exercises and metaphors using annotated image sequences, supporting their between-session practice.

Objective:

The study aimed to co-design ACTaide with therapists and clients, incorporating their feedback to ensure the app aligns with clinical goals and the needs of end-users. The research focused on exploring stakeholder preferences and feedback related to app functionality, design, and features to form iterative design refinements.

Methods:

Using a qualitative, user-centered design framework, we conducted four consecutive focus groups: two with licensed ACT therapists (n = 10) and two with psychotherapy clients (n = 14). Each focus group included semi-structured discussions and co-design activities. Data were collected through audio recordings and design artefacts (e.g., sketches), which were analyzed using thematic content analysis.

Results:

Nine themes were identified, reflecting areas of convergence and divergence between therapists and clients. Therapists and clients expressed enthusiasm for ACTaide as a tool to support between-session practice. Both groups emphasized the importance of a user-friendly, intuitive, and aesthetically appealing interface, with a preference for high-quality visuals over text-heavy features. Personalization and customization were viewed as essential for enhancing app engagement. Therapists prioritized accessibility and clinical appropriateness, voicing concerns with features that may be inconsistent with ACT principles, such as symptom rating scales, and clarified their role in app delivery. Clients on the other hand emphasized wanting greater interactivity and elements of gamification to improve engagement. Slight discrepancies were noted between therapists’ preferences for minimal designs and clients’ preferences for more vibrant and engaging aesthetics. Overall, both groups recognized the app’s potential to address barriers to homework adherence and to extend the benefits of therapy into clients’ daily lives.

Conclusions:

The study illustrates the value of using a user-centered, co-design approach in the development of ACTaide, an adjunctive mental health app for between session practice of ACT exercises and metaphors tailored to therapist and client preferences. Through the integration of stakeholder feedback, the findings provide actionable insights for designing psychotherapy tools that balance clinical goals with user preferences. Future research will focus on testing high-fidelity prototypes to evaluate acceptability, usability, and engagement.