Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults:A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL)

In this study, the feasibility and efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), ACT augmented with a daily life application, was investigated in 55 emerging adults (age 16 to 25) with subthreshold depressive and/or psychotic complaints. Participants were randomized to ACT-DL (n = 27) or to active control (n = 28), with assessments completed at pre- and post-measurement and 6- and 12-months follow-up. It took up to five (ACT-DL) and 11 (control) months to start group-based interventions. Participants attended on average 4.32 out of 5 ACT-DL sessions. On the app, they filled in on average 69 (48%) of signal-contingent beep-questionnaires, agreed to 15 (41%) of offered beep-exercises, initiated 19 on-demand exercises, and rated ACT-DL metaphors moderately useful. Relative to active control, interviewer-rated depression scores decreased significantly in ACT-DL participants (p =.027). Decreases in self-reported depression, psychotic-related distress, anxiety, and general psychopathology did not differ between conditions. ACT-DL participants reported increased mean NA (p =.011), relative to active controls. Mean PA did not change in either group, nor did psychological flexibility. ACT-DL is a feasible intervention, although adaptations in future research may improve delivery of and compliance with the intervention. There were mixed findings for its efficacy in reducing subthreshold psychopathology in emerging adults. Dutch Trial Register no.: NTR3808

Third wave behaviour therapy: process measures and contextual interventions

Acceptance and commitment therapy (ACT) is a form of behavioural therapy that focuses on developing psychological flexibility (resilience). The first part of this dissertation describes the measurement tools currently available and focuses on the development of a new valid and reliable questionnaire – the Flexibility Index Test (FIT-60)* – to identify psychological flexibility. The second part describes the application of ACT in the daily life of clients using an mHealth intervention. The initial results in the field of feasibility and acceptability are positive; follow-up research on its effectiveness is currently on-going. * Available for free at www.hoeflexibelbenjij.n

Early maladaptive schemas and their relation to personality disorders: a correlational examination in a clinical population

Personality Disorder (PD) pathology has been linked to Early Maladaptive Schemas (EMSs; Young, 1999). Because of a large heterogeneity in study populations, sample size, statistical analyses and conceptualizations in the literature, the exact relationships between PDs and EMSs are still unclear. The current study examined the relationship between borderline, dependent, avoidant and obsessive-compulsive PDs, represented dimensionally as number of traits, and 15 different EMSs as measured by the YSQ. A total of N = 130 inpatients took part in the study (Mage = 43.6, gender = 51.5% female). Stepwise regressions indicated that borderline, dependent, avoidant and obsessive-compulsive PD traits were partly characterized by specific EMSs and EMSs grouped as domains (i.e. other-directedness domain for dependent PD and overvigilance for obsessive-compulsive PD), and that relations with a variety of domains and EMSs were overlapping for the PD dimensions (i.e. disconnection and rejection for both borderline and avoidant PD). This suggests that PDs are reflected by a hybrid model of EMSs, with some EMSs and domains that relate to a broader vulnerability factor for PDs, and other domains that differentially relate to the independent PDs. Findings are informative for clinicians, as various EMSs per PD may be targeted in therapy

Early maladaptive schemas and their relation to personality disorders:a correlational examination in a clinical population

Personality Disorder (PD) pathology has been linked to Early Maladaptive Schemas (EMSs; Young, 1999). Because of a large heterogeneity in study populations, sample size, statistical analyses and conceptualizations in the literature, the exact relationships between PDs and EMSs are still unclear. The current study examined the relationship between borderline, dependent, avoidant and obsessive-compulsive PDs, represented dimensionally as number of traits, and 15 different EMSs as measured by the YSQ. A total of N = 130 inpatients took part in the study (Mage = 43.6, gender = 51.5% female). Stepwise regressions indicated that borderline, dependent, avoidant and obsessive-compulsive PD traits were partly characterized by specific EMSs and EMSs grouped as domains (i.e. other-directedness domain for dependent PD and overvigilance for obsessive-compulsive PD), and that relations with a variety of domains and EMSs were overlapping for the PD dimensions (i.e. disconnection and rejection for both borderline and avoidant PD). This suggests that PDs are reflected by a hybrid model of EMSs, with some EMSs and domains that relate to a broader vulnerability factor for PDs, and other domains that differentially relate to the independent PDs. Findings are informative for clinicians, as various EMSs per PD may be targeted in therapy

Loneliness and Mental Health during the COVID-19 pandemic in the Dutch general population: the moderating role of Psychological Flexibility

Previous studies conducted during the COVID-19 pandemic found an increased risk of loneliness due to measurements taken by governments to limit social interaction. The current study addresses the relationship between loneliness and both positive and negative mental health in times of the COVID-19 pandemic and the role of psychological flexibility. Data was collected in the Dutch general population (18+) with two online questionnaires (T1-T2), with an interval of four weeks. A sample of 340 participants varying in age from 18 to 83 years (Mage(SD): 52.83 (13) and 61.8% female, filled in both questionnaires. Loneliness and (the six core processes of) psychological flexibility were measured at T1 and negative mental health (depression, anxiety and stress) and positive mental health (psychological, emotional and social well-being) at T2. Regression analyses indicated a positive prospective relation between loneliness and negative mental health and a negative prospective relation between loneliness and well-being. Psychological flexibility had a moderating effect on the relation between loneliness and negative mental health but not on the relation between loneliness and well-being. Looking at the six core processes of psychological flexibility, only acceptance was a significant moderator of the relation between negative mental health and loneliness. We conclude that while it has yet to be determined whether the moderating relationships found in this study hold beyond COVID-19 conditions, the findings do provide support for the benefits of psychological flexibility to intervene in situations where external circumstances or psychological challenges are beyond one's control

Acceptance and Commitment Therapy and white matter plasticity in individuals with subclinical depression and psychotic experiences:A Randomised Controlled Trial

Background: Research indicates that Acceptance and Commitment Therapy in Daily Life (ACT-DL) is effective in reducing symptoms of depression, anxiety and psychosis. During adolescence, vulnerability to psychopathology peaks, creating a window for early interventions, while white matter development is ongoing. This study aims to examine microstructural white matter after ACT-DL intervention in youngsters with mild psychopathology. Methods: Forty-five individuals with mild psychopathology were randomly allocated to ACT-DL (n=20) or topic discussion control (TD, n=25). Symptomatology was assessed with the Community Assessment of Psychic Experiences (CAPE), Montgomery–Åsberg Depression Rating Scale (MADRS) and the Experience Sampling Method (ESM). Diffusion Weighted Imaging (DWI) and network-connectivity parameters were obtained and compared before and after the intervention/control condition. Interactions between microstructural white matter change and condition were examined in models of CAPE positive symptoms and ESM subclinical psychotic experiences (PE) and negative affect (NA) levels. Results: ACT-DL, compared to TD, was associated with changes on subclinical depressive and psychotic symptom levels. There was no significant change in DWI or network connectivity in either condition and no significant difference between both conditions. In the model of NA, several regional interactions between condition and network measures were significant, but stratification per condition provided no significant associations. There were no significant interactions between DWI or network connectivity parameters and condition in the models of the CAPE positive symptoms, MADRS and PE. Conclusions: The findings suggest that behavioral (symptom) changes are more sensitive to a five-week psychological training than microstructural white matter changes which did not show significant changes over time.</p

Mediation analysis pathway, for the effect of MBCT on residual symptoms of depression.

<p>N.B. All variables are change scores over time. The numbers show the four different levels of analyses.</p

CONSORT participant flow diagram.

<p>MBCT = Mindfulness-based Cognitive Behavioral Therapy; CONTROL = waitlist control condition.</p

Acceptance and Commitment Therapy in Daily Life Training: A Feasibility Study of an mHealth Intervention

BACKGROUND: With the development of mHealth, it is possible to treat patients in their natural environment. Mobile technology helps to bridge the gap between the therapist's office and the "real world." The ACT in Daily Life training (ACT-DL) was designed as an add-on intervention to help patients practice with acceptance and commitment therapy in their daily lives. The ACT-DL consists of two main components: daily monitoring using experience sampling and ACT training in daily life. OBJECTIVES: To assess the acceptability and feasibility of the ACT-DL in a general outpatient population. A secondary objective was to conduct a preliminary examination of the effectiveness of the ACT-DL. METHODS: An observational comparative study was conducted. The experimental group consisted of 49 patients who volunteered for ACT-DL, and the control group consisted of 112 patients who did not volunteer. As part of an inpatient treatment program, both groups received a 6-week ACT training. Participants went home to continue their treatment on an outpatient basis, during which time the experimental group received the 4-week add-on ACT-DL. Acceptability and feasibility of the ACT-DL was assessed weekly by telephone survey. Effectiveness of the ACT-DL was evaluated with several self-report questionnaires ( Flexibility Index Test (FIT-60): psychological flexibility, Brief Symptom Inventory: symptoms, Utrechtse Coping List: coping, and Quality of life visual analog scale (QoL-VAS): quality of life). RESULTS: More than three-quarters of the participants (76%) completed the full 4-week training. User evaluations showed that ACT-DL stimulated the use of ACT in daily life: participants practiced over an hour a week (mean 78.8 minutes, standard deviation 54.4), doing 10.4 exercises (standard deviation 6.0) on average. Both ACT exercises and metaphors were experienced as useful components of the training (rated 5 out of 7). Repeated measures ANCOVA did not show significant effects of the ACT-DL on psychological flexibility (P=.88), symptoms (P=.39), avoidant coping (P=.28), or quality of life (P=.15). CONCLUSIONS: This is the first study that uses experience sampling to foster awareness in daily life in combination with acceptance and commitment therapy to foster skill building. Adherence to the ACT-DL was high for an intensive mHealth intervention. ACT-DL appears to be an acceptable and feasible mHealth intervention, suitable for a broad range of mental health problems. However, short-term effectiveness could not be demonstrated. Additional clinical trials are needed to examine both short-term and long-term effects.status: publishe

Acceptance and Commitment Therapy in Daily Life Training: A Feasibility Study of an mHealth Intervention

Background: With the development of mHealth, it is possible to treat patients in their natural environment. Mobile technology helps to bridge the gap between the therapist's office and the "real world." The ACT in Daily Life training (ACT-DL) was designed as an add-on intervention to help patients practice with acceptance and commitment therapy in their daily lives. The ACT-DL consists of two main components: daily monitoring using experience sampling and ACT training in daily life. Objectives: To assess the acceptability and feasibility of the ACT-DL in a general outpatient population. A secondary objective was to conduct a preliminary examination of the effectiveness of the ACT-DL. Methods: An observational comparative study was conducted. The experimental group consisted of 49 patients who volunteered for ACT-DL, and the control group consisted of 112 patients who did not volunteer. As part of an inpatient treatment program, both groups received a 6-week ACT training. Participants went home to continue their treatment on an outpatient basis, during which time the experimental group received the 4-week add-on ACT-DL. Acceptability and feasibility of the ACT-DL was assessed weekly by telephone survey. Effectiveness of the ACT-DL was evaluated with several self-report questionnaires (Flexibility Index Test (FIT-60): psychological flexibility, Brief Symptom Inventory: symptoms, Utrechtse Coping List: coping, and Quality of life visual analog scale (QoL-VAS): quality of life). Results: More than three-quarters of the participants (76%) completed the full 4-week training. User evaluations showed that ACT-DL stimulated the use of ACT in daily life: participants practiced over an hour a week (mean 78.8 minutes, standard deviation 54.4), doing 10.4 exercises (standard deviation 6.0) on average. Both ACT exercises and metaphors were experienced as useful components of the training (rated 5 out of 7). Repeated measures ANCOVA did not show significant effects of the ACT-DL on psychological flexibility (P=.88), symptoms (P=.39), avoidant coping (P=.28), or quality of life (P=.15). Conclusions: This is the first study that uses experience sampling to foster awareness in daily life in combination with acceptance and commitment therapy to foster skill building. Adherence to the ACT-DL was high for an intensive mHealth intervention. ACT-DL appears to be an acceptable and feasible mHealth intervention, suitable for a broad range of mental health problems. However, short-term effectiveness could not be demonstrated. Additional clinical trials are needed to examine both short-term and long-term effects