technology

A randomised multiple-baseline design assessed the preliminary efficacy of a low-intensity, minimally-guided, online, self-help Acceptance and Commitment Therapy (ACT) intervention for people affected by cancer on quality of life (QoL), psychological symptoms, psychological flexibility, and level of interference from pain and fatigue. Acceptability and feasibility was also assessed. Adult participants (n = 7) had either completed cancer treatment within the last 18 months or were currently receiving treatment. Participants were randomly assigned to a baseline length of 1–3 weeks prior to completing the six-week ACT intervention, followed by a one-month follow-up. At pre- and post-intervention, and one-month follow-up, cancer-specific QoL, psychological symptoms (anxiety and depression), and psychological flexibility were assessed using standardised questionnaires. Single-item daily ratings of mood, anxiety, psychological flexibility, and bother ratings of pain and fatigue were also assessed. Questionnaire data were analysed using reliable and clinically significant change. Daily measures were analysed using visual and Tau-U analysis. Participants reported less negative impact of cancer on QoL (n = 3: CancerDQoL), fewer depressive symptoms (n = 5: HADS depression), less anxiety (n = 3; HADS anxiety) and greater psychological flexibility (n = 3: MPFI) at follow-up. Daily measures showed improvements in self-reported mood (n = 3), anxiety (n = 3) and psychological flexibility (n = 5) across different phase comparisons. Most participants (n = 5) were significantly less bothered by fatigue at follow-up, and two were significantly less bothered by pain. Feedback from participants supported the acceptability of the intervention. The results provide preliminary support for the efficacy of the ACT intervention in reducing the negative impact of cancer on QoL, and improving self-reported psychological outcomes and psychological flexibility. Longitudinal studies utilising a larger sample are warranted.

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Acceptance and commitment therapy (ACT) is based on the psychological flexibility model, underpinned by six core processes: contact with the present moment, acceptance, cognitive defusion, self as context, values, and committed action. The current study examined the roles of these processes in the first randomized controlled trial to examine the efficacy of a mental health promotion intervention for college students based on Trauma-Focused ACT (TFACT; Ajayi et al., 2024; Harris, 2021). The hybrid intervention combined web-based modules with peer coaching in a research laboratory setting. This current study aimed to extend those findings by empirically evaluating the theoretical components of the ACT model of psychological flexibility. Participants were 78 college students ranging between 18 and 32 years of age. It was found that the level of changes in awareness, self as context, values, and committed action were significantly different between the intervention and control groups, while psychological inflexibility, acceptance, and cognitive fusion were not. Simple regressions suggested that changes in psychological inflexibility significantly predicted changes in life satisfaction at post-intervention and 3-month follow-up. Whereas, changes in psychological inflexibility predicted changes in psychological distress only at follow-up. Furthermore, penalized regressions suggested awareness and cognitive fusion significantly predicted changes in psychological distress, but did not predict changes in psychological inflexibility or life satisfaction. The current study adds to the knowledge base regarding the process of change in ACT interventions to inform the design and implementation of more targeted and effective mental health interventions.

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As social costs rise due to the increasing prevalence of depression, there is a growing emphasis on cost-effective and evidence-based psychotherapeutic methods. Acceptance and Commitment Therapy (ACT) for depression is an effective approach that reduces depressive symptoms and helps prevent recurrence by enhancing psychological flexibility. This study developed a mobile app-based ACT and tested its effectiveness for college students with depression. Eighty college students with depression were randomly assigned to either a treatment group (n = 41) or a control group (n = 39). The treatment group received mobile app-based ACT for 4 weeks, the control group waited without treatment. The scores from pre, post, and follow-up assessments were compared between the two groups. Significant interaction effects of time and group were found for depression and anxiety symptoms, as well as for treatment process variables such as acceptance, inflexibility, defusion, values, commitment, and mindfulness. Acceptance and cognitive defusion emerged as significant mediators in the impact of mobile app-based ACT on depression. The mobile app-based ACT effectively reduced depression and improved treatment process variables, demonstrating its cost-effectiveness. The study also discusses the implications, limitations, and directions for future research.

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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.

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