ACT in daily life in early psychosis: an ecological momentary intervention approach

Abstract

The current article describes the Acceptance and Commitment Therapy (ACT) in Daily Life (ACT-DL) training, a new mobile health treatment protocol for ACT applied in a randomized controlled trial in early psychosis individuals. Between weekly ACT therapy sessions, patients fill out brief questionnaires on an app about their mood, symptoms, activity, and current context, thus promoting awareness-a crucial component of ACT. The app also provides them with visual cues and exercises specifically related to the ACT sessions, to help them implement the techniques previously learned in therapy into their daily lives. Here we assess the feasibility of this protocol in 16 early psychosis individuals, as part of an ongoing randomized controlled trial. Specifically, we investigate the experienced usefulness of the ACT therapy and app, and burden of the protocol. Results indicate that participants find both the therapy sessions and the app useful, and that ACT-DL guides them in putting ACT into everyday practice, although the protocol may be moderately burdensome. These findings indicate that ACT-DL may help early psychosis patients applying ACT skills to diverse contexts of everyday life. Since ACT is not symptom-specific, ACT-DL may also be suited for different target populations. Limitations and future directions are discussed.

Smartphone Apps to Support Coordinated Specialty Care for Prodromal and Early Course Schizophrenia Disorders: Systematic Review

“…The acceptance and commitment therapy in daily life (ACT-DL) study [29] utilized a subset of participants to determine the feasibility of an ongoing randomized controlled trial, which plans to enroll 150 participants into the program. The ACT-DL app offers ACT toward improving negative symptoms.…”

“…The 16 participants to date found both the ACT therapy sessions and the home exercises useful. They also reported that the app helped them implement ACT into their daily life and helped bring awareness to their emotions [29].…”

Efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: study protocol for a multi-centre randomized controlled trial

“…The manualised ACT-DL intervention consists of eight ACT training sessions (including one session for psychoeducation) administered face-to-face by a trained clinician (i.e. psychologists having received a 5-day training in ACT-DL and receiving fortnightly supervision sessions for the purposes of the trial), each for around 45–60 min, and an ACT-based EMI, which participants will receive following randomisation to the experimental condition [46], over an 8-week intervention period. The latter will be administered through a smartphone-based app (i.e.…”

“…Delivering ACT and evaluating its effects on putative mechanisms in daily life based on principles of EMIs is, therefore, both timely and eminently important. Acceptance and Commitment Therapy in Daily Life (ACT-DL) has recently been developed for enhancing the therapeutic effects of ACT under real-world conditions [28–30, 46]. ACT may be particularly amenable to be implemented as an EMI, as it emphasises the context in which a behavior occurs as well as the function of this behavior in a given context [46].…”

“…Acceptance and Commitment Therapy in Daily Life (ACT-DL) has recently been developed for enhancing the therapeutic effects of ACT under real-world conditions [28–30, 46]. ACT may be particularly amenable to be implemented as an EMI, as it emphasises the context in which a behavior occurs as well as the function of this behavior in a given context [46]. In a recently completed pilot study to evaluate the acceptability and clinical feasibility of ACT-DL in a heterogeneous clinical sample of patients with mental disorder, very good completion rates, use of exercises, and positive user experience were found [47], but there is no robust, trial-based evidence on its effects in the early stages of psychosis.…”