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2376 to 2400 of 2,546The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention.
Background/Objective: Prolonged stress can overwhelm coping resources, leading people to seek mental health care. Acceptance and commitment therapy (ACT) is an intervention that enhances well-being and reduces distress, assumedly by means of increasing psychological flexibility (PF). We examined the association between a total increase in PF during an intervention and decreases in stress and increases in well-being during and after the intervention. Method: The intervention was a randomized controlled trial of an ACT-based self-help intervention. Participants were 91 individuals reporting elevated levels of work-related stress. Measurements were completed at preintervention, postintervention, and 3-month follow-up. Results: Structural equation models revealed that the total increase in PF during the intervention was negatively associated with a decrease in stress (b = -0.63, SE = 0.14, p…
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The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management.
In an era of considerable advances in anaesthesiology and pain medicine, chronic pain after major surgery continues to be problematic. This article briefly reviews the known psychological risk and protective factors associated with the development of chronic postsurgical pain (CPSP). We begin with a definition of CPSP and then explain what we mean by a risk/protective factor. Next, we summarize known psychological risk and protective factors for CPSP. Psychological interventions that target risk factors and may impact postsurgical pain are reviewed, including the acceptance and commitment therapy (ACT)-based approach to CPSP prevention and management we use in the Transitional Pain Service (TPS) at the Toronto General Hospital. Finally, we conclude with recommendations for research in risk factor identification and psychological interventions to prevent CPSP. Several pre-surgical psychol…
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Sundermann B, Bode J, Lueken U, Westphal D, Gerlach AL, Straube B, Wittchen HU, Ströhle A, Wittmann A, Konrad C, Kircher T, Arolt V, Pfleiderer B (2017)MEDLINE-indexed journal, not yet read by usFrontiers in psychiatry23 citations Support Vector Machine Analysis of Functional Magnetic Resonance Imaging of Interoception Does Not Reliably Predict Individual Outcomes of Cognitive Behavioral Therapy in Panic Disorder with Agoraphobia.
Background: The approach to apply multivariate pattern analyses based on neuro imaging data for outcome prediction holds out the prospect to improve therapeutic decisions in mental disorders. Patients suffering from panic disorder with agoraphobia (PD/AG) often exhibit an increased perception of bodily sensations. The purpose of this investigation was to assess whether multivariate classification applied to a functional magnetic resonance imaging (fMRI) interoception paradigm can predict individual responses to cognitive behavioral therapy (CBT) in PD/AG.
Methods: This analysis is based on pretreatment fMRI data during an interoceptive challenge from a multicenter trial of the German PANIC-NET. Patients with DSM-IV PD/AG were dichotomized as responders (n = 30) or non-responders (n = 29) based on the primary outcome (Hamilton Anxiety Scale Reduction ≥50%) after 6 weeks of CBT (2 h/week).…
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The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials.
The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi-sector investment along with wide-scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta-analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24-0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, …
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Web-Based Acceptance and Commitment Therapy for Mental Health Problems in College Students: A Randomized Controlled Trial.
There are significant challenges in addressing the mental health needs of college students. The current study tested an acceptance and commitment therapy (ACT), web-based self-help program to treat a broad range of psychological problems students struggle with. A sample of 79 college students was randomized to web-based ACT or a waitlist condition, with assessments at baseline and posttreatment. Results indicated adequate acceptability and program engagement for the ACT website. Relative to waitlist, participants receiving ACT improved on overall distress, general anxiety, social anxiety, depression, academic concerns, and positive mental health. There were no between-group effects on eating concerns, alcohol use, or hostility, or on some key ACT process of change measures. ACT participants improved more on mindful acceptance and obstruction to valued living, both of which mediated treat…
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Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: Preliminary outcomes from the Toronto General Hospital Transitional Pain Service.
Background: Chronic postsurgical pain (CPSP) and associated long-term opioid use are major public health concerns. Aims: The Toronto General Hospital Transitional Pain Service (TPS) is a multidisciplinary, hospital-integrated program developed to prevent and manage CPSP and support opioid tapering. This clinical practice-based study reports on preliminary outcomes of the TPS psychology program, which provides acceptance and commitment therapy (ACT) to patients at risk for CPSP and persistent opioid use. Methods: Ninety-one patients received ACT, whereas 252 patients did not (no ACT group). Patient outcomes were compared for the two groups at first and last TPS visits. Pain, pain interference, sensitivity to pain traumatization, pain catastrophizing, anxiety, depression, and opioid use were analyzed using two-way (Group [ACT, no ACT] × Time [first, last visit]) analyses of variance (ANOVA…
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Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective.
The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following …
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Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild.
Background: Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support.
Objective: The objective of this study is 2-fold, first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinically meaningful depression level, second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms.
Methods: A total of 126 adults (age 20-57) were …
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A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain.
Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and post-treatment and during a nine-month follow-up. Significant improvements were observed from pre- to post-treatment a…
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Process and Effects Evaluation of a Digital Mental Health Intervention Targeted at Improving Occupational Well-Being: Lessons From an Intervention Study With Failed Adoption.
Background: Digital interventions have the potential to serve as cost-effective ways to manage occupational stress and well-being. However, little is known about the adoption of individual-level digital interventions at organizations.
Objectives: The aim of this paper is to study the effects of an unguided digital mental health intervention in occupational well-being and the factors that influence the adoption of the intervention.
Methods: The intervention was based on acceptance and commitment therapy (ACT) and its aim was to teach skills for stress management and mental well-being. It was delivered via a mobile and a Web-based app that were offered to employees of two information and communication technology (ICT) companies. The primary outcome measures were perceived stress and work engagement, measured by a 1-item stress questionnaire (Stress) and the Utrecht Work Engagement Scale (U…
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Changes in Sleep Problems and Psychological Flexibility following Interdisciplinary Acceptance and Commitment Therapy for Chronic Pain: An Observational Cohort Study.
Aims: Cognitive and behavioral treatments (CBT) for sleep problems and chronic pain have shown good results, although these results could improve. More recent developments based on the psychological flexibility model, the model underlying Acceptance and Commitment Therapy (ACT) may offer a useful addition to traditional CBT. The aim of this study was to examine whether an ACT-based treatment for chronic pain is associated with improved sleep. Secondly, we examined the associations between changes on measures of psychological flexibility and sleep-related outcomes.
Methods: The study used an observational cohort methodology. Participants were 252 patients (73.8% female) attending a 4-week, interdisciplinary, pain management program in London, United Kingdom. Participants completed standard self-report measures of pain and functioning, sleep outcomes, and processes of psychological flexibi…
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Mattila E, Lappalainen R, Välkkynen P, Sairanen E, Lappalainen P, Karhunen L, Peuhkuri K, Korpela R, Kolehmainen M, Ermes M (2016)MEDLINE-indexed journal, not yet read by usJMIR mHealth and uHealth46 citations Usage and Dose Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis of the Intervention Arm of a Randomized Controlled Trial.
Background: Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT).
Objective: To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility.
Methods: An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interv…
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Using Acceptance and Commitment Therapy to Increase Self-Compassion: A Randomized Controlled Trial.
Self-compassion has been shown to be related to several types of psychopathology, including traumatic stress, and has been shown to improve in response to various kinds of interventions. Current conceptualizations of self-compassion fit well with the psychological flexibility model, which underlies acceptance and commitment therapy (ACT). However, there has been no research on ACT interventions specifically aimed at self-compassion. This randomized trial therefore compared a 6-hour ACT-based workshop targeting self-compassion to a wait-list control. From pretreatment to 2-month follow-up, ACT was significantly superior to the control condition in self-compassion, general psychological distress, and anxiety. Process analyses revealed psychological flexibility to be a significant mediator of changes in self-compassion, general psychological distress, depression, anxiety, and stress. Explor…
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Acceptance and commitment therapy for chronic pain: evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation.
Unlabelled: There is an emerging body of evidence regarding interdisciplinary acceptance and commitment therapy in the rehabilitative treatment of chronic pain. This study evaluated the reliability and clinical significance of change following an open trial that was briefer than that examined in previous work. In addition, the possible mediating effect of psychological flexibility, which is theorized to underlie the acceptance and commitment therapy model, was examined. Participants included 117 completers of an interdisciplinary program of rehabilitation for chronic pain. Assessment took place at treatment onset and conclusion, and at a 3-month follow-up when 78 patients (66.7%) provided data. At the 3-month follow-up, 46.2% of patients achieved clinically significant change, and 58.9% achieved reliable change, in at least 1 key measure of functioning (depression, pain anxiety, and disa…
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Pachankis JE (2014)MEDLINE-indexed journal, not yet read by usClinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association106 citations Uncovering Clinical Principles and Techniques to Address Minority Stress, Mental Health, and Related Health Risks Among Gay and Bisexual Men.
Gay and bisexual men disproportionately experience depression, anxiety, and related health risks at least partially because of their exposure to sexual minority stress. This paper describes the adaptation of an evidence-based intervention capable of targeting the psychosocial pathways through which minority stress operates. Interviews with key stakeholders, including gay and bisexual men with depression and anxiety and expert providers, suggested intervention principles and techniques for improving minority stress coping. These principles and techniques are consistent with general cognitive behavioral therapy approaches, the empirical tenets of minority stress theory, and professional guidelines for LGB-affirmative mental health practice. If found to be efficacious, the psychosocial intervention described here would be one of the first to improve the mental health of gay and bisexual men…
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Mobile mental wellness training for stress management: feasibility and design implications based on a one-month field study.
Background: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens.
Objective: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management.
Methods: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes…
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Treating depression in Muslim communities: Meta-analysis of three trials of culturally adapted behavioural activation for Muslims (BA-M).
Faith-sensitive depression therapies address a core aspect of cultural values but are not specifically promoted within global mental health policy. This study evaluated a culturally adapted Behavioural Activation intervention for Muslim patients (BA-M) compared with standard treatments across diverse settings. A patient-level meta-analysis combined data from two randomised controlled trials and one feasibility trial, comparing BA-M with cognitive behavioural therapy (CBT) and, in the UK, social interventions. The primary outcome was post-treatment depression severity (PHQ-9) and retention was analysed using Poisson regression alongside qualitative evaluation. A total of 266 participants were recruited (Turkey: 22; Pakistan: 103; UK: 141), with no baseline differences in depression severity between groups. BA-M produced significantly greater reductions in PHQ-9 scores, with an adjusted me…
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Online single-session interventions for Kenyan adolescents: study protocol for a comparative effectiveness randomised controlled trial.
Background: Mental health problems are the leading cause of disability among adolescents worldwide, yet access to treatment is limited. Brief digital interventions have been shown to improve youth mental health, but little is known about which digital interventions are most effective.
Aims: To evaluate the effectiveness of two digital single-session interventions (Shamiri-Digital and Digital-CBT (cognitive-behavioural therapy)) among Kenyan adolescents.
Methods: We will perform a school-based comparative effectiveness randomised controlled trial. Approximately 926 Kenyan adolescents will be randomly assigned to one of three conditions: Shamiri-Digital (focused on gratitude, growth mindsets and values), Digital-CBT (focused on behavioural activation, cognitive restructuring and problem solving) or a study-skills control condition (focused on note-taking and essay writing skills). The prim…
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Aldakhil AF (2026)MEDLINE-indexed journal, not yet read by usResearch in developmental disabilities Sensory-integrated habit reversal intervention for hair pulling and classroom engagement in children with autism: A multiple-baseline pilot study.
Background: Hair pulling is a body-focused repetitive behavior frequently observed in individuals with autism and is increasingly conceptualized as a developmentally mediated self-regulatory behavior that may interfere with adaptive participation across everyday contexts. Although habit reversal training (HRT) has demonstrated efficacy for reducing repetitive behaviors, evidence supporting its implementation in naturalistic settings, particularly when integrated with sensory-regulation supports remains limited.
Methods: This study examined the effects of a sensory-integrated habit reversal (SI-HR) intervention on hair pulling and functional engagement in autistic children within a naturalistic educational context. A multiple-baseline across participants single-case experimental design was employed with eight autistic students (four boys, four girls) aged 8-14 years. Following staggered b…
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O02 Kids in control: development and assessment of a 3 part virtual behavioural intervention programme to reduce scratching in children with atopic eczema.
Eczema, an itchy skin condition, affects up to 20% of children. Habitual scratching/chronic itch-scratch cycle promotes inflammation, infection, affects sleep and causes psycho-social distress. Habit reversal has been used to reduce scratching and improve eczema but randomised controlled trial (RCT) evidence is limited, particularly in children, and no RCTs have utilised virtual interventions. The Kids in Control (KIC) MDT team was awarded a UKDCTN themed research grant to develop and assess the acceptability, usability, and feasability of a virtual behavioural intervention for children aged 8-12 with itchy eczema. Existing educational and intervention materials were refined to a virtual 3 part programme designed to increase eczema understanding, scratching awareness and change scratching behaviour. Using the person based approach to intervention development a bespoke KIC website was bui…
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Webb Hooper M, Pérez-Stable EJ (2023)MEDLINE-indexed journal, not yet read by usHealth psychology : official journal of the Division of Health Psychology, American Psychological Association7 citations Health equity is not possible without addressing disparities.
Health equity is the aspirational assurance of optimal health for all. Synonymous with fair and just opportunities for physical and mental health, equity work reflects intentional efforts to remove access barriers and allocate high-quality, need-based resources. Health equity is not possible without meaningful reductions in disparities-and evaluating progress goes further to describe, assess, and continuously evaluate fairness and social justice within structures, community contexts, and healthcare. The National Institute on Minority Health and Health Disparities (NIMHD) has a longstanding and deep commitment to advancing health equity. This article describes efforts in two specific areas: workforce diversity, equity, and inclusion (DEI) and scientific initiatives. We also summarize five actionable strategies for health equity promotion in health psychology-relevant research and practice…
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Can School-Wide Positive Behavioral Interventions and Supports (SWPBIS) improve adolescents' perceptions of school climate?
As school climate plays a key role in adolescents' academic and socio-emotional outcomes, interventions that can enhance this climate are of major interest. In considering research on practices linked to a positive school climate, School-Wide Positive Behavioral Interventions and Supports (SWPBIS) is a promising approach. To date, most SWPBIS studies have been conducted in English-speaking countries and have been based primarily on adults' perceptions or reports (e.g., suspension rates, office discipline referrals). There is a dearth of research on the effectiveness of SWPBIS among adolescents in different cultural contexts. Moreover, little is known about its propensity to influence adolescents' perceptions of school climate dimensions. The present study examined the effects of SWPBIS on different dimensions of school climate as perceived by French adolescents enrolled in Grades 6-9. An…
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Johnson BJ, Hunter KE, Golley RK, Chadwick P, Barba A, Aberoumand M, Libesman S, Askie L, Taylor RW, Robledo KP, Mihrshahi S, O'Connor DA, Hayes AJ, Wolfenden L, Wood CT, Baur LA, Rissel C, Staub LP, Taki S, Smith W, Sue-See M, Marschner IC, Espinoza D, Thomson JL, Larsen JK, Verbestel V, Odar Stough C, Salvy SJ, O'Reilly SL, Karssen LT, Rasmussen FE, Messito MJ, Gross RS, Bryant M, Paul IM, Wen LM, Hesketh KD, González Acero C, Campbell K, Øverby NC, Linares AM, Wasser HM, Joshipura KJ, Palacios C, Maffeis C, Thompson AL, Ghaderi A, Lakshman R, Banna JC, Oken E, Campos Rivera M, Pérez-Expósito AB, Taylor BJ, Savage JS, Røed M, Goran M, de la Haye K, Anzman-Frasca S, Seidler AL, Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration (2022)MEDLINE-indexed journal, not yet read by usBMJ open20 citations Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol.
Introduction: Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity.
Methods and analysis: Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will…
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Lightfoot CJ, Wilkinson TJ, Hadjiconstantinou M, Graham-Brown M, Barratt J, Brough C, Burton JO, Hainsworth J, Johnson V, Martinez M, Nixon AC, Pursey V, Schreder S, Vadaszy N, Wilde L, Willingham F, Young HML, Yates T, Davies MJ, Smith AC (2022)MEDLINE-indexed journal, not yet read by usJournal of medical Internet research32 citations The Codevelopment of "My Kidneys & Me": A Digital Self-management Program for People With Chronic Kidney Disease.
Background: Health care self-management is important for people living with nondialysis chronic kidney disease (CKD). However, the few available resources are of variable quality.
Objective: This work describes the systematic codevelopment of "My Kidneys & Me" (MK&M), a theory-driven and evidence-based digital self-management resource for people with nondialysis CKD, guided by an established process used for the successful development of the diabetes education program MyDESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed, DESMOND).
Methods: A multidisciplinary steering group comprising kidney health care professionals and researchers and specialists in the development of complex interventions and digital health provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behavior change. A patient and public involvem…
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Experiences of and attitudes to lifestyle modification for the management of multiple sclerosis: A qualitative analysis of free-text survey data.
Background: Growing evidence suggests a role of lifestyle modification in improved health outcomes for people with multiple sclerosis (pwMS); however, perspectives of pwMS who engage in lifestyle modification are lacking.
Objective: We explored perspectives of pwMS regarding the modification of lifestyle-related risk factors in multiple sclerosis (MS) for disease management to understand attitudes to and experiences of lifestyle modification as part of self-management from a patient perspective.
Design: Participants were ≥18 years and English speaking who responded to a free-text open-ended question in the Health Outcomes and Lifestyle In a Sample of pwMS (HOLISM), an international online survey. Responses were analysed utilizing inductive thematic analysis.
Results: Under the exploration of lifestyle modification, themes describing the experiences and attitudes of participants included …
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