@Article{info:doi/10.2196/57109,
author="van Aubel, Evelyne
and Vaessen, Thomas
and Uyttebroek, Lotte
and Steinhart, Henrietta
and Beijer-Klippel, Annelie
and Batink, Tim
and van Winkel, Ruud
and de Haan, Lieuwe
and van der Gaag, Mark
and van Amelsvoort, Th{\'e}r{\`e}se
and Marcelis, Machteld
and Schirmbeck, Frederike
and Reininghaus, Ulrich
and Myin-Germeys, Inez",
title="Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="21",
volume="8",
pages="e57109",
keywords="acceptance and commitment therapy; ACT; first episode of psychosis; FEP; ultrahigh risk for psychosis; UHR; ecological momentary intervention; EMI; mobile health; mHealth; blended care; mobile phone",
abstract="Background: Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands. Objective: This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis. Methods: In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes. Results: Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59{\%} (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25{\%}) notifications. Distribution plots of debriefing scores (n=46) show that 85{\%}-96{\%} of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91{\%} (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=--4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=--0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=--1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app. Conclusions: Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. Trial Registration: OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803 ",
issn="2561-326X",
doi="10.2196/57109",
url="https://formative.jmir.org/2024/1/e57109",
url="https://doi.org/10.2196/57109",
url="http://www.ncbi.nlm.nih.gov/pubmed/39570655"
}