JMIR Publications

ABSTRACT

Background:

Chronic medical illnesses frequently coexist with mental health challenges, negatively impacting quality of life and well-being. Compassion-based interventions have shown promise in improving psychological outcomes for individuals with chronic conditions, yet accessibility barriers limit their implementation. Internet-delivered interventions may address these limitations while maintaining therapeutic effectiveness.

Objective:

This randomized controlled trial aimed to evaluate the efficacy of Internet Attachment-Based Compassion Therapy (iABCT) in improving quality of life and well-being (primary outcomes) and secondary psychological variables in individuals with chronic medical conditions, compared to a waiting list (WL) control, and to examine treatment acceptability and implementation barriers.

Methods:

A two-arm parallel-group randomized controlled trial was conducted with 146 Spanish-speaking adults diagnosed with chronic medical conditions, randomly assigned to iABCT (n=72) or WL (n=74). Assessments were conducted at baseline, 3-month, and 6-month follow-up. Primary outcomes included quality of life (EQ-5D) and well-being (PHI). Secondary outcomes included self-compassion (SOCS-S), self-care behaviors (B-MSCS), self-criticism (SCRS), psychological symptoms (DASS-21), attachment styles (RQ), and social support (MOS-SSS). Data were analyzed using linear mixed-effects models with intent-to-treat approach. Treatment acceptability was assessed through satisfaction and usability measures, and qualitative interviews explored barriers and facilitators.

Results:

Of 146 randomized participants, 93 completed pre-assessment (iABCT=48, WL=45). At 3-month follow-up, 53 completed assessments (iABCT=27, WL=26), and at 6-month follow-up, 30 remained (iABCT=18, WL=12). Significant condition × time interactions were found for quality of life (F(1,68.01)=6.33, P =.014), well-being (F(1,60.72) =4.69, P =.034), self-compassion (F(1,59.95)=4.90, P =.031), self-criticism (F(1,61.16)=6.76, p=.012), secure attachment (F(1,66.43)=7.15, P =.009), and preoccupied attachment (F(1,65.53) =10.19, P=.002). At 3 months, between-group comparisons favored iABCT for quality of life (d=.62), secure attachment (d=.47), and preoccupied attachment (d=.59). Within the iABCT group, moderate improvements were observed in quality of life (d=.60), general health (d=.61), self-compassion (d=.64), and self-criticism (d=.67), with small-to-moderate effects for well-being (d=.26), secure attachment (d=.25), preoccupied attachment (d=.46), and fearful attachment (d=.44). Quality of life improvements were maintained at 6-month follow-up (d=.54). Participants reported high satisfaction (M=26.06, SD=5.74) and usability (M=82.79, SD=18.64). Qualitative analysis (n=34 interviews) identified key barriers including need for therapist contact (92.3% of dropouts), insufficient monitoring (61.5%), and excessive program demands (61.5%).

Conclusions:

The iABCT demonstrated efficacy in improving quality of life, self-compassion, and attachment security in Spanish-speaking adults with chronic medical conditions at 3-month follow-up, with quality of life improvements maintained at 6 months. Despite high treatment satisfaction and acceptability, significant engagement barriers highlight the need for enhanced human support, personalized content, and user-centered design in digital health interventions. These findings support iABCT as a promising, scalable intervention for chronic illness management, though larger studies with active controls and strategies to address attrition are warranted. Clinical Trial: ClinicalTrials.gov NCT04809610