No abstract

No abstract

Background Acceptance and Commitment Therapy (ACT) has been successfully established in hundreds of efficacy trials. It is less understood, however, how ACT works in real-world settings. Furthermore, little is known about how contextual variables such as treatment setting (inpatient vs. outpatient), social network and environment of the patient impact outcome. Methods This paper describes the methods of the Choose Change study that compares transdiagnostic inpatients ( n = 85) and outpatients (n = 85) with varying degrees of treatment experience and treatment success (i.e., no previous treatment vs. previous remission vs. treatment-resistant). Patients received ACT during an intensive treatment phase lasting approximately twelve treatment sessions, and were accompanied up to twelve months following intensive treatment. Main outcomes include symptoms, functioning, and well-being. Multiple levels of data are investigated, including treatment context, weekly assessments, a behavioral approach test, multiple follow-up phases, and ambulatory assessment using Event Sampling Methodology, to examine patients’ daily context. Discussion We aim to investigate antecedents, consequences, and inherent processes that contribute to the maintenance or fluctuations of psychological disorders and the efficacy of ACT treatment. Furthermore, this study intends to increase understanding of how accurately participants can report on their own experiences, in order to expand our knowledge of how to probe for such information in the future. The results of Choose Change will provide basic clinical theory and clinical care with important and meaningful insights into the effectiveness of ACT, trans diagnostically, in in- and outpatients, and in a naturalistic setting. Trial registration This study was retrospectively registered in the ISRCTN Registry (registration number ISRCTN11209732 ) on May 20th 2016.

Objective: Social interactions are crucial to human beings. As technology advances, new possibilities of interaction emerge, bringing both opportunities and risks, especially when interpersonal behaviors are impaired (e.g. depression) or associated with strong fear (e.g. social phobia). The authors investigated whether technological social interactions (i.e., phone and internet/chat) are used equally as often as face-to-face social interactions in participants with mental disorders and in controls and whether differences are associated with unpleasant emotions, that is, whether the association between negative affect (NA) or positive affect (PA) differed by type of social interaction.Methods: The self-chosen social interactions of participants diagnosed with major depressive disorder (MDD) or social phobia (SP) were compared with participants without these diagnoses (control group, CG). Using event sampling methodology (ESM), participants' everyday social behavior was sampled six times per day for one week in their natural environment. Findings/Results:The CG engaged more often in face-to-face social interactions, while participants diagnosed with MDD or SP engaged more often in phone social interactions. Across all groups, there was a positive relationship between NA and the frequency of technological social interactions, and a positive relationship between PA and the frequency of face-to-face social interactions. Conclusions:The propensity to experience higher levels of PA during face-to-face social interactions and NA during technological social interactions is important to consider when selecting and planning social interactions. Clinicians may consider exploring the social interaction patterns of their patients in the light of these findings. Likewise, developers of technological interventions and clinicians using them should consider the potential that technological social interactions may increase NA.

Meaningful relationships are centrally important for human functioning. It remains unclear, however, which aspects of meaningful relationships impact wellbeing the most and whether these differ between psychiatric patients and members of the community. Information about relationship attributes and functions were collected in community members (N = 297) and psychiatric patients (N = 177). Relationship attributes and functions were examined for differences between groups (community vs. patients), their impact on wellbeing and symptoms, and the size of network (one vs. many relationships). Community members reported fewer relationships, higher frequency of contact and less desire for change when compared to the psychiatric patients. Nevertheless, both groups reported relatively high levels of fulfilled functions. Quality of the relationship and investment into the relationship was associated with both wellbeing and symptoms for both the community and the patient group. Almost all functions were associated with wellbeing and symptoms for the community group. However, for the patient group, only few functions (sexual partner, go-to person for compassion, go-to person when happy) were associated with wellbeing and no functions were associated with symptoms. Contrary to our hypotheses, the results show that psychiatric patients do not have a deficit in fulfilling relationships. Most people report a well-functioning network of meaningful, high-quality relationships. Patients benefit from meaningful, function-fulfilling relationships just as much as community members. Results are discussed with respect to how targeting relationships can be used clinically.