ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: An 18-month follow-up

Lappalainen, Päivi; Granlund, Anna; Siltanen, Susan A.; Ahonen, Suvi; Vitikainen, Minna; Tolvanen, Asko; Lappalainen, Raimo

doi:10.1016/j.brat.2014.07.006

Cited by 114 publications

(112 citation statements)

References 65 publications

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“…The findings from a recent open pilot trial of multimodal DBT for school refusal show promise for such treatments (Chu, Rizvi, Zendegui, & Bonavitacola, 2015). In addition, future research should extend the work of Lappalainen et al (2014) by investigating whether third-wave eHealth treatments are noninferior to existing empirically supported therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Therapist guidance was provided in eight of these studies (Buhrman et al, 2013;Hesser et al, 2012;Kristjánsdóttir et al, 2013;Lappalainen et al, 2014;Lappalainen, Langrial, Oinas-Kukkonen, Tolvanen, & Lappalainen, 2015;Pots et al, 2015;Trompetter, Bohlmeijer, Veehof, & Schreurs, 2015;Weineland, Arvidsson, Kakoulidis, & Dahl, 2012), the duration FIGURE 1 Flow diagram of study selection. Note.…”

Section: Interventionsmentioning

confidence: 99%

“…Participants rated the treatments as satisfactory (Trompetter et al, 2015;Lappalainen et al, 2014Lappalainen et al, , 2015, enjoyable (Glick & Orsillo, 2015), useful (Kristjánsdóttir et al, 2013), and helpful (Cukrowicz & Joiner, 2007), as measured by the Client Satisfaction Questionnaire (Attkisson & Zwick, 1982), visual analogue scales, and brief questionnaires, respectively. Four studies administered the Credibility/Expectancy Questionnaire (Borkovec & Nau, 1972;Devilly & Borkovec, 2000) and ratings indicated that participants perceived the third-wave eHealth treatments as credible (Kelly & Carter, 2015;Ljótsson et al, 2010;Ly et al, 2014).…”

Section: Secondary Outcomesmentioning

confidence: 99%

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The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2018

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eHealth is an innovative method of delivering therapeutic content with the potential to improve access to third-wave behaviural and cognitive therapies. This systematic review and meta-analysis aimed to determine the efficacy and acceptability of third-wave eHealth treatments in improving mental health outcomes. A comprehensive search of electronic bibliographic databases including PubMed, PsycINFO, Web of Science, and CENTRAL was conducted to identify randomized controlled trials of third-wave treatments in which eHealth was the main component. Twenty-one studies were included in the review. Meta-analyses revealed that thirdwave eHealth significantly outperformed inactive control conditions in improving anxiety, depression, and quality-oflife outcomes and active control conditions in alleviating anxiety and depression with small to medium effect sizes. No statistically significant differences were found relative to comparison interventions. Findings from a narrative synthesis of participant evaluation outcomes and meta-analysis of participant attrition rates provided preliminary support for the acceptability of third-wave eHealth.Third-wave eHealth treatments are efficacious in improving mental health outcomes including anxiety, depression, and quality of life, but not more so than comparison interventions. Preliminary evidence from indices of participant evaluation and attrition rates supports the acceptability of these treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

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The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2018

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“…The app was originally designed as a toolkit of exercises to (1) teach psychological flexibility through the ACT processes and skills and (2) support learning ACT as a daily habit. Similar methods and exercises had previously been studied in treatment of depression symptoms with web-based interventions [27,28,37,38]. The app was available for the Android platform at the time of the study (September 2013).…”

Section: Mobile Appmentioning

confidence: 99%

“…ACT utilizes acceptance and mindfulness methods to increase psychological flexibility, which allows a person to commit valued actions despite psychological distress [21,22]. ACT appears to be equally effective in treating depression as established psychological treatments [23,24], and recent studies suggest that ACT-based online programs can be feasible in reducing or preventing symptoms of depression [25][26][27][28]. Mobile delivery of ACT has been studied in small-scale non-clinical samples, and initial findings suggest that it can promote well-being and satisfaction with life [19,29].…”

Section: Introductionmentioning

confidence: 99%

Applicability of acceptance and commitment therapy-based mobile app in depression nursing

Kaipainen¹,

Välkkynen²,

Kilkku

2016

Behav. Med. Pract. Policy Res.

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Due to the high burden of depression, new models and methods of mental healthcare need to be developed. Prior research has shown the potential benefits of using technology tools such as mobile apps as self-help or combined with psychological treatment. Therefore, professionals should acquaint themselves with evidence-based apps to be able to use them with clients and guide the clients in their use. The purpose of this study was to explore how an acceptance and commitment therapy-based mobile app was perceived as a self-management tool among nurses, and how it could be applied in the prevention and treatment of depression and other mental health issues. Sixteen Finnish nurses undergoing depression nurse specialist education used the app for 5 weeks and participated in semistructured focus group interviews. Interviews were analyzed by qualitative content analysis. In general, the nurses found the app suitable as a self-management tool and identified three models of using it in clinical practice. Having used the app personally, the nurses were eager to take it into use with various client groups, especially in occupational health but also in the treatment of mental health problems. However, they also raised concerns about the effort needed in familiarizing oneself with the content and pointed out specific client groups for whom the benefits of the app should be carefully weighed against the potential risks. Despite the small sample size, the findings suggest that involving technology tools as part of the nurses' education could ease their adoption in clinical practice. The degree of professional support in the app use should be aligned to the severity of the mental health problems.

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Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression

Terhorst,

Kaiser,

Brakemeier

et al. 2024

JAMA Netw Open

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ImportanceWhile the effects of internet- and mobile-based interventions (IMIs) for depression have been extensively studied, no systematic evidence is available regarding the heterogeneity of treatment effects (HTEs), indicating to what extent patient-by-treatment interactions exist and personalized treatment models might be necessary.ObjectiveTo investigate the HTEs in IMIs for depression as well as their efficacy and effectiveness.Data SourcesA systematic search in Embase, MEDLINE, Central, and PsycINFO for randomized clinical trials and supplementary reference searches was conducted on October 13, 2019, and updated March 25, 2022. The search string included various terms related to digital psychotherapy, depression, and randomized clinical trials.Study SelectionTitles, abstracts, and full texts were reviewed by 2 independent researchers. Studies of all populations with at least 1 intervention group receiving an IMI for depression and at least 1 control group were eligible, if they assessed depression severity as a primary outcome and followed a randomized clinical trial (RCT) design.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. HTE was investigated using logarithmic variance ratios (lnVR) and effect sizes using Hedges g. Three-level bayesian meta-regressions were conducted.Main Outcomes and MeasuresHeterogeneity of treatment effects was the primary outcome of this study; magnitudes of treatment effect sizes were the secondary outcome. Depression severity was measured by different self-report and clinician-rated scales in the included RCTs.ResultsThe systematic review of 102 trials included 19 758 participants (mean [SD] age, 39.9 [10.58] years) with moderate depression severity (mean [SD] in Patient Health Questionnaire–9 score, 12.81 [2.93]). No evidence for HTE in IMIs was found (lnVR = −0.02; 95% credible interval [CrI], −0.07 to 0.03). However, HTE was higher in more severe depression levels (β̂ = 0.04; 95% CrI, 0.01 to 0.07). The effect size of IMI was medium (g = −0.56; 95% CrI, −0.46 to −0.66). An interaction effect between guidance and baseline severity was found (β̂ = −0.24, 95% CrI, −0.03 to −0.46).Conclusions and RelevanceIn this systematic review and meta-analysis of RCTs, no evidence for increased patient-by-treatment interaction in IMIs among patients with subthreshold to mild depression was found. Guidance did not increase effect sizes in this subgroup. However, the association of baseline severity with HTE and its interaction with guidance indicates a more sensitive, guided, digital precision approach would benefit individuals with more severe symptoms. Future research in this population is needed to explore personalization strategies and fully exploit the potential of IMI.

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ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: An 18-month follow-up

Cited by 114 publications

References 65 publications

The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Applicability of acceptance and commitment therapy-based mobile app in depression nursing

Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression

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