TY  - JOUR
AU  - van Aubel, Evelyne
AU  - Vaessen, Thomas
AU  - Uyttebroek, Lotte
AU  - Steinhart, Henrietta
AU  - Beijer-Klippel, Annelie
AU  - Batink, Tim
AU  - van Winkel, Ruud
AU  - de Haan, Lieuwe
AU  - van der Gaag, Mark
AU  - van Amelsvoort, Thérèse
AU  - Marcelis, Machteld
AU  - Schirmbeck, Frederike
AU  - Reininghaus, Ulrich
AU  - Myin-Germeys, Inez
PY  - 2024
DA  - 2024/11/21
TI  - Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial
JO  - JMIR Form Res
SP  - e57109
VL  - 8
KW  - acceptance and commitment therapy
KW  - ACT
KW  - first episode of psychosis
KW  - FEP
KW  - ultrahigh risk for psychosis
KW  - UHR
KW  - ecological momentary intervention
KW  - EMI
KW  - mobile health
KW  - mHealth
KW  - blended care
KW  - mobile phone
AB  - 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 
SN  - 2561-326X
UR  - https://formative.jmir.org/2024/1/e57109
UR  - https://doi.org/10.2196/57109
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39570655
DO  - 10.2196/57109
ID  - info:doi/10.2196/57109
ER  -