Online Acceptance and Commitment Therapy for People with Painful Diabetic Neuropathy in the United Kingdom: A Single-Arm Feasibility Trial

Abstract

Objective This study aimed to assess the feasibility of online Acceptance and Commitment Therapy for painful diabetic neuropathy in the United Kingdom and to determine if a larger randomized controlled trial testing treatment efficacy is justified. Methods Participants with painful diabetic neuropathy were recruited online and from hospital services. This was a single-arm study in which all participants received online Acceptance and Commitment Therapy. Participants completed questionnaires at baseline and three months post-treatment. Primary feasibility outcomes were recruitment, retention, and treatment completion rates. Secondary outcomes were pre- to post-treatment effects on pain outcomes and psychological flexibility. Results Of 225 potentially eligible participants, 30 took part in this study. Regarding primary feasibility outcomes, the treatment completion and follow-up questionnaire completion rates were 40% and 100%, respectively. Generally, at baseline those who completed the treatment, compared with those who did not, had better daily functioning and higher psychological flexibility. With respect to secondary outcomes, results from the completers group showed clinically meaningful effects at post-treatment for 100% of participants for pain intensity and pain distress, 66.7% for depressive symptoms, 58.3% for functional impairment, 41.7% for cognitive fusion, 66.7% for committed action, 58.3% for self-as-context, and 41.7% for pain acceptance. Conclusions This preliminary trial suggests feasibility of recruitment and follow-up questionnaire completion rates, supporting planning for a larger randomized controlled trial. However, treatment completion rates did not achieve the prespecified feasibility target. Changes to the treatment content and delivery may enhance the feasibility of online Acceptance and Commitment Therapy for people with painful diabetic neuropathy on a larger scale.

A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion‐focused therapy for chronic illness

“…Although our study presented higher drop‐out rates from pre‐ to post‐intervention (around 50% for both conditions) than those reported in face‐to‐face ACT (Ong et al, 2018) and CFT (e.g., Hudson et al, 2019) interventions, it was in line with those reported in online interventions (e.g., Halamová et al, 2020; Kioskli et al, 2020), suggesting that both conditions are acceptable for CI. Also, the acceptability of both conditions was evaluated through open ended questions.…”

“…Also, ACT's focus on promoting valued based action and acceptance of internal experiences, instead of aiming at cognitive restructuring, makes it an especially fitting approach to CI, where negative illness beliefs and anticipatory distressing thoughts may be indeed realistic (Graham et al, 2016). Online‐delivered ACT has been found effective in promoting mental health and well‐being (see Thompson et al, 2021) and shown promising results in CI (e.g., Kioskli et al, 2020; Lin et al, 2018; Trindade, Guiomar, et al, 2021; Trompetter et al, 2015). However, results suggest no significant difference between online ACT and comparison interventions (see O'Connor et al, 2018), which calls for more thorough investigations on the optimal intervention approaches that best tackle different difficulties and psychological processes (Hacker et al, 2016).…”

The Psychological Functioning in the COVID-19 Pandemic and Its Association With Psychological Flexibility and Broader Functioning in People With Chronic Pain

“…It is possible and theoretically consistent that people who are more willing to experience unwanted thoughts and feelings, and more committed to actions guided by their goals, will experience less COVID-19-related fear and avoidance, or less impact on their functioning from these. Under the circumstances of reduced access to treatments, interventions that are designed to foster PF, and can be flexibly delivered online, such as internet-based ACT 27 , 32 , 57 could potentially help address the psychological impact of COVID-19, and its potential implications for functioning and wellbeing in people with chronic pain. ACT is designed to be flexibly applied.…”

Usability and Acceptability of a Videoconference Program for the Treatment of Depression in Adults With Peripheral Neuropathy

“…A previous feasibility study of virtual ACT for painful, diabetic PN used 10 online sessions, compared with six sessions in this study 38 . The 30 individuals in that study had a lower completion rate than participants in this pilot (40% vs 83.3%).…”