technology

Conversational agents or chatbots are a novel, highly accessible, and low-resource method of psychological intervention delivery. The present research aims to compare two brief chatbot interventions that delivered cognitive restructuring and defusion interventions, respectively. It was hypothesized that a defusion chatbot would lead to reduced cognitive fusion and decreased thought believability relative to cognitive restructuring and a nonactive control. Participants (N = 223; M age of 28.01 [SD = 10.29]; 47 identified as male, 174 as female, and 2 as nonbinary) were randomized into one of three conditions (defusion, restructuring, control), engaged for 5 days completing thought and mood measures pre- and postintervention. Sixty-two participants (M age of 25.98; SD = 8.647 years) completed measures again at time 2 (49 identified as female, 12 as male, and 1 as nonbinary). No statistically significant differences were observed among groups on believability of thoughts (F[2, 25] = .79, p = .47, ηp2 = .06), negativity of thoughts (F[2,25] = 1.49, p = .25, η 2 = .11), discomfort associated with thoughts (F[2, 25] = .48, p = .62, ηp2 = .04), and willingness (F[2, 25] = 3.00, p = .07, ηp2 = .19) to have negative self-referential thoughts. Moreover, substantial attrition of 72% was observed. Acceptability and usability of the chatbots employed are discussed as contributing toward the limited effectiveness of interventions and elevated attrition. Various recommendations are presented to support researchers and clinicians in developing engaging and effective chatbots.

Introduction
Working mothers with small child face work and life difficulties and show low psychological well-being (PWB).

Objectives
This randomized controlled trial aimed to examine the effectiveness of a newly developed, fully automated internet-based Acceptance and Commitment Therapy (iACT) program, ‘Happiness Mom,’ on improving Ryff's PWB of working mothers with a preschool child.

Methods
The eligible participants were working mothers with at least one preschool child and were randomly assigned to either an iACT intervention group (n = 424) or a wait-list control group (n = 417). The intervention contained eight modules for 10 weeks. Primary outcomes were measured in six dimensions of Ryff's PWB (Ryff, 1989a; 1989b), using self-administered questionnaires at baseline, three months, and six months after the baseline. A mixed model for repeated measures conditional growth model analysis was conducted using a group*time interaction as an intervention effect.

Results
A total of 841 eligible working mothers participated in this study. For the main pooled analysis, positive relationship with others was significantly improved in the intervention group (pooled effect 0.41 [95% CI 0.08–0.74], t = 2.44, p = 0.015), while the effect size was small (Cohen's d = 0.18). There was no significant effect on autonomy, environmental mastery, personal growth, purpose in life, and self-acceptance.

Conclusions
The study demonstrated that the fully automated iACT program was effective in improving PWB in working mothers. However, the effect was small and shown in the limited domain of PWB. Further program improvement is required to achieve a greater effect size and impact on a wider range of PWB.

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Objective
To report the theoretical basis and design of a novel digital Acceptance and Commitment Therapy (ACT) intervention for people with chronic pain, the Pain Tracker Self Manager (PTSM), which had promising efficacy in a recent pilot trial.

Methods
Content development by a multidisciplinary panel of experts in psychiatry, clinical psychology, nursing and social work, with feedback from a group of patients with chronic pain and their providers. Materials included paper-based sketching of a story character, visual metaphors, and a series of stories designed to deliver the theory-based components of our behavioral intervention.

Results
This development and design process resulted in 4 digitally delivered clinical modules that combine visual and verbal cues. In addition, it generated a series of novel ACT metaphors specifically tailored to patients with chronic pain: Pain: Injury vs. Threat, Life Navigation System, The Fog of Pain, and Get Rhythm. Consistent with ACT theory and the contextual behavioral science framework, PTSM utilized: perspective-taking, values clarification, acceptance strategies, and nursing and psychological care recommendations.

Discussion
Reports of the design and theoretical basis of digital health interventions are highly needed to increase the rigor of their development process and more progressively advance our body of knowledge. This pilot study developed and tested a series of ACT metaphors that can be readily used by ACT clinicians working with this population.

Conclusion
PTSM is a novel digital ACT intervention for patients with chronic pain with features directly linked to ACT processes and theory.

To find the full text version of this article and others (as well as download a full text .pdf.), ACBS members can visit the ScienceDirect homepage here.