“Choose change”: design and methods of an acceptance and commitment therapy effectiveness trial for transdiagnostic treatment-resistant patients

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.

Patterns of Psychological Responses among the Public during the Early Phase of COVID-19: A Cross-Regional Analysis

“…The participants completed a battery of measures using the language of their choice: the Mental Health Continuum Short Form for Adults (MHC-SF) assessing one’s mental health focusing on emotional, social and psychological well-being (14 items, 6-point Likert scale) [ 25 , 26 ]; the Brief Illness Perception Questionnaire (IPQ) items assessing the perceived consequences (“How much does COVID-19 affects your life?”), timeline (“How long do you think COVID-19 will continue?”), concern (“How much does COVID-19 worry you?”) and emotional responses toward COVID-19 (“How much does the pandemic COVID-19 affect you emotionally (e.g., makes you sad, angry, scared, worried”)? (4 items, 10-point Likert scale) [ 27 ]; the measures assessing the perceived susceptibility (3 items, 6-point Likert scale) and severity of COVID-19 (3 items, 6-point Likert scale) in line with the principles of the Health Belief Model [ 28 ]; the Brief Coping Orientation to Problems Experienced (Brief COPE) inventory composing of 28 items assessing a total of 14 coping strategies, which could be consolidated into four coping dimensions: seeking social support (venting, use of emotional support, use of instrumental support, religious belief); problem-solving (active coping, planning); avoidance (behavioral disengagement, self-distraction, substance use, denial, self-blaming) and positive thinking (humor, positive reframing, acceptance) [ 29 , 30 , 31 ]; the PsyFlex assessing all the six processes of psychological flexibility, including contacting the present moment, defusion, acceptance, self-as-context, values and committed action, of an individual (6 items, 5-point Likert scale) [ 32 , 33 ]; the Prosocialness Scale evaluating the level of prosocial behaviors, including sharing, helping, taking care of, and feeling empathic with others, which were carried out by the participant during the COVID-19 pandemic (6 items, 5-point Likert scale) [ 34 ]. …”

“…the PsyFlex assessing all the six processes of psychological flexibility, including contacting the present moment, defusion, acceptance, self-as-context, values and committed action, of an individual (6 items, 5-point Likert scale) [ 32 , 33 ];…”

“…The details of scoring instructions and psychometric properties of the aforementioned measures have been reported in our previous publications [ 18 , 23 , 24 ]. In summary, these measures showed satisfactory internal consistencies across participating regions (Cronbach’s alphas = 0.76–0.85) and adequate construct validity to their corresponding validation measures ( r s = 0.68–0.82) [ 25 , 29 , 33 , 34 ]. In addition, the participants responded to questions about their sociodemographic characteristics, including their age, gender, country of residence, marital status, educational attainment, employment status, working as health care professionals (yes/no), and living status (living alone/others).…”

Can psychological flexibility and prosociality mitigate illness perceptions toward COVID-19 on mental health? A cross-sectional study among Hong Kong adults

“…The PsyFlex questionnaire was used to assess all the six processes of psychological flexibility, including contacting the present moment, defusion, acceptance, self-ascontext, values and committed action, of an individual (6 items, 5-point Likert scale) [44,45]. Example item is "Even if I am somewhere else with my thoughts, in important moments I can focus on what's going on at that time".…”

Neural Mechanisms of Acceptance and Commitment Therapy for Chronic Pain: A Network-Based fMRI Approach

“…Villaneuva et al (2019) investigated three key aspects of ACT, including its effectiveness, long-term follow-up, social context, and social processes. The authors contend that researchers should include longer follow up periods in clinical studies (Gloster et al, 2013).…”