Commitment Therapy Research Articles

Exploring The Efficacy Of Acceptance And Commitment Therapy (ACT) Group Sessions In Reducing Maternal Stress Among Mothers With Autism

This study investigates the impact of Acceptance and Commitment Therapy (ACT) group sessions on maternal stress among six mothers of children diagnosed with autism, in India. The sessions were facilitated by a team consisting of a clinical psychologist and a Board Certified Behavior Analyst who implemented evidence based techniques combining Relational Frame Theory and culturally modified ACT. Maternal stress is a critical concern, particularly in the context of individuals with autism, where ASD specific challenges may amplify the daily pressures both social and parenting that is experienced by mothers. The study utilized a pre-post intervention design, assessing maternal stress levels before and after participants attended ACT based group sessions. The results revealed a significant reduction in maternal stress scores following participation in the ACT group sessions, measured using tools such as the Autism Parenting Stress Index (APSI) and The Family Adjustment to Childhood Developmental Disability (FICD). The findings suggest that the structured and supportive environment provided by ACT counselling sessions contributed to a meaningful decrease in stress levels among the mothers who participated in the study. The cultural context of India adds depth to the understanding of how therapeutic interventions can be adapted to diverse populations, emphasizing the need for use of evidence based methods such as ACT in parent training and counselling. Additionally, the use of this method furthers the parent’s acceptance of Autism as a lifelong condition and transforms their parenting approach. This research not only contributes to the growing body of literature on interventions for individuals with autism and their families but also underscores the adaptability of evidence-based practices in diverse cultural settings. Further exploration and replication of these findings with larger sample sizes are recommended to strengthen the evidence supporting the use of ACT group sessions as a valuable tool in mitigating maternal stress among mothers with autism in the Indian context.

Values Work With Adolescents: A Qualitative Component Analysis Using an Integrative Model of Values and Behavior

Adolescence is a time of vulnerability to psychological distress and emotional disorders, necessitating effective and developmentally appropriate treatment. Acceptance and commitment therapy (ACT) is an evidence-based intervention with values work at the heart of the method. Values work involves clinical interventions that shore up a client’s ability to act in alignment with their personal values, a practice evidenced to improve psychological well-being. However, there is a dearth of research into the process of values work within ACT and values work research with adolescents is even more sparse. The current study aims to clarify values work with adolescents. We used a qualitative online survey of 28 ACT clinicians. Responses were analyzed using defined content analysis with a research-based integrative model of values and behavior (IMVB). Analysis indicated the IMVB’s mechanisms were prevalent across and within surveys, suggesting applicability to clinical values work interventions. The IMVB functioned to clarify components and adaptations of values work with adolescents. Several themes were generated outside of the IMVB, suggesting adolescents have further developmental needs during values work. Results indicate distinct alterations may be warranted for effective values work with adolescents. The IMVB may have further utility for exploring research and clinical inquiry into ACT values work.

Acceptance and Commitment Therapy for an Emerging Adult Female With Misophonia: A Case Study.

Misophonia is characterized by decreased tolerance to idiosyncratic and repetitive human-generated sounds (ie, triggers), coupled with affective-based reactions that result in impairment and distress. Often having its onset in youth, misophonia can become especially prominent during key developmental periods, including emerging adulthood. While efforts to develop interventions for misophonia remain ongoing, a consensus has not yet been reached concerning recommended first-line treatments. Acceptance and commitment therapy (ACT), which has demonstrated efficacy in treating various psychiatric disorders via targeting psychological flexibility processes, represents one potentially feasible approach for addressing misophonia. This case study describes the application of an individually delivered, 12-session ACT intervention for a black female in her early 20s with misophonia. Descriptive data collected at 4 time points (pretreatment, mid-treatment, posttreatment, and at 2-month follow-up) suggested the potential promise of ACT as a treatment for misophonia, improving psychological flexibility processes and reducing secondary depression and anxiety symptoms. Findings are discussed in the context of the possible mechanisms of ACT most likely responsible for misophonia-related clinical improvement. More rigorous studies (eg, clinical trials) are needed to confirm promising findings from existing case studies.

Erratum: The effectiveness of acceptance and commitment therapy on identity crisis and distress tolerance in mothers of children with cancer

Erratum: The effectiveness of acceptance and commitment therapy on identity crisis and distress tolerance in mothers of children with cancer

Evidence-Based Review of Randomized Controlled Trials of Interventions for Mental Health Management Post-Moderate to Severe Traumatic Brain Injury.

To present an evidence-based review of randomized controlled trials (RCTs) evaluating interventions for mental health post-moderate to severe traumatic brain injury (post-MSTBI), as part of an extensive database that has been conceptualized as a living systematic review. Systematic searches were conducted for RCTs published in the English language in MEDLINE, PubMed, Scopus, CINAHL, EMBASE, and PsycINFO, up to and including December 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale, and the level of evidence was assigned using a modified Sackett scale. Eighty-seven RCTs examining mental health interventions and outcome measures post-MSTBI were included. These studies collectively enrolled 6471 participants. A total of 41 RCTs (47.1%) were conducted in the United States and 56 studies (64.4%) were published after 2010. A total of 62 RCTs (71.3%) examined nonpharmacological interventions and 25 RCTs (28.7%) examined pharmacological interventions. Effective pharmacological treatments included desipramine and cerebrolysin; methylphenidate and rivastigmine showed conflicting evidence. Cognitive behavioral therapy (CBT) was found to be effective for hopelessness, stress, and anxiety, compared to usual care; however, it may be as effective as supportive psychotherapy for depression. CBT combined with motivational interviewing may be as effective as CBT combined with nondirective counseling for depression, stress, and anxiety. Acceptance and commitment therapy was effective for anxiety, stress, and depression. Tai Chi, dance, and walking appeared to be effective for depression and stress, while other nonpharmacological treatments such as peer mentoring showed limited effectiveness. This evidence-based review provides a comprehensive overview of the research landscape of RCTs addressing mental health post-MSTBI. The findings from these RCTs may be valuable for health care professionals, researchers, and policymakers involved in the field of mental health and neurorehabilitation.

Development and Initial Pilot Evaluation of a Psychoeducational Intervention for Individuals at High Risk for Pancreatic Cancer.

To develop and determine the acceptability of a group-based digital health psychoeducational intervention aimed at reducing cancer worry based on acceptance and commitment therapy for individuals at high risk for pancreatic cancer. 13 individuals at high risk for pancreatic cancer with a genetic variant or family history. Three groups met virtually for one hour each week for four weeks. These sessions provided psychoeducational materials. Digital resources provided mindfulness and educational content. Reported measurements included qualitative responses and participant-reported acceptability. All participants found the sessions to be useful and would recommend them to others. Recommendations from the first two groups included requests to access the content provided during the remote sessions, contributing to the creation of digital content for the third group. Individuals at high risk for pancreatic cancer can benefit from psychoeducation to reduce cancer worry, which can be accomplished through digital psychoeducational interventions.

A Systematic Review of Non-Pharmacological Treatment Options for Skin Picking Disorder (SPD).

While Skin Picking Disorder (SPD) is a well-described neuropsychiatric disorder that causes severe stress and impairment, there is no clear protocol for treating patients and a relatively small body of literature evaluating treatment approaches. This review aims to summarize and compare recent publications and provide an up-to-date guide of current non-pharmacological treatments for SPD. A literature review was conducted on all non-pharmacological SPD treatment studies published between 2017-2023 using PubMed, CINAHL Plus with Full text (EBSCO), and Scopus. Search terms included skin picking, excoriation, psychiatry, treatment, and psychodermatology. Studies including SPD within other body-focused repetitive behaviors (BFRBs), studies using pharmacological agents, and studies not available in English were excluded. A minimum of 2 authors screened each abstract while blinded to minimize bias to assess for inclusion. 11 studies (2068 participants) were included, with a variety of study designs including feasibility, randomized control trial, longitudinal cohort, multiple baseline experimental, naturalistic trial, and controlled single case design with multiple baseline studies. The treatments include cognitive behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), ACT-Enhanced Group Behavioral Therapy (AE-GBT), ACT-Informed Exposure Therapy, group therapy, psychotherapy, Repetitive Transcranial Magnetic Stimulation (rTMS), online self-help modules, and Expressive Writing (EW). Studies implementing CBT, Habit Reversal Therapy (HRT), AE-GBT, online self-help modules, and EW demonstrated the best results in treating SPD. Several studies achieved significant outcomes for SPD participants, confirming the usefulness of non-pharmacological treatment in SPD. Based on our results, CBT, AE-GBT, online self-help modules, and EW appear to be the most effective in treating SPD. Additionally, most of these treatment modalities can be tailored to meet patient-specific needs. Some limitations of the studies include small sample sizes, lack of control groups/randomization, limited long-term follow-up data, and lack of gender variability.

Effect of acceptance and commitment therapy on fear of falling and physical activity in Parkinson’s disease: a randomised controlled trial

IntroductionThis study aimed to evaluate the efficacy of acceptance and commitment therapy (ACT) in reducing the fear of falling (FOF) and promoting physical activity in individuals diagnosed with Parkinson’s disease...

An acceptance and commitment therapy and mindfulness group intervention for the psychological and physical well-being of adults with body mass indexes in the overweight or obese range: The Mind&Life randomized controlled trial

This trial aimed to assess the effect of an acceptance and commitment therapy (ACT) and mindfulness-based intervention on the various psychological and physical issues associated with obesity. A parallel group randomized controlled trial was conducted with 142 adults with body mass indexes in the overweight or obesity range seeking treatment. Participants were assigned either to the ACT and mindfulness-based group intervention (Mind&Life intervention) plus treatment as usual (TAU) or the TAU-only condition. Individuals receiving the Mind&Life intervention with TAU showed more adherence to the Mediterranean diet, and greater decrease in external eating, weight, and visceral fat both at posttreatment and at 6-month follow-up. Moreover, they displayed a greater reduction in total protein and animal protein intake and GPT enzymes level. By 6-month follow-up, the Mind&Life group experienced a lower impact of weight on quality of life than TAU participants. However, Mind&Life intervention completers showed greater restrained eating levels at follow-up. Overall, this study suggests that an ACT and mindfulness-based group intervention could produce improvements in the impact of weight on quality of life, some eating behaviors, dietary habits, and weight and body composition parameters of people facing weight-related challenges.

Limited effects of phone coaching in an RCT of online self-guided acceptance and commitment therapy for chronic pain

IntroductionOver 80% of patients with Chiari Malformation (CM) struggle with moderate to severe disability due to neck pain and headaches. Self-guided online Acceptance and Commitment Therapy (ACT) is efficacious in addressing chronic pain. However, it is unclear whether adjunctive weekly phone coaching (a cost- and labor-intensive component of the intervention) contributes to, or provides additional benefit to, ACT's success. MethodThis study randomized 112 participants with CM to ACT + Coaching, ACT-Only, or WC (WC) groups. Participants completed a baseline survey, weekly assessments, a self-guided online ACT intervention, and a one-month follow-up survey. Primary outcomes were psychological flexibility (PF) and chronic pain acceptance; secondary outcomes included pain intensity, pain interference, depression, and anxiety. ResultsThere were no differences between the ACT + Coaching and ACT-Only groups on chronic pain acceptance, pain interference, or anxiety; however, there was a small but statistically significant effect favoring ACT + Coaching for depression and PF. Compared to the WC group, both the ACT + Coaching and ACT-Only groups significantly improved in chronic pain acceptance, and anxiety. Adherence was high (91% completed all sessions) and equivalent between conditions. Participants reported coaching was helpful and important, but there were no group differences in intervention satisfaction. DiscussionThere were no differences between treatment groups on most outcomes, intervention satisfaction, engagement, or adherence. Online ACT without adjunctive phone coaching may be a cost- and time-efficient option to address chronic pain acceptance and anxiety, but additional research is needed to establish and improve efficacy for other outcomes. Clinical Trials RegistrationNCT05581472

Acceptance and commitment therapy versus progressive relaxation training for misophonia: Randomized controlled trial protocol, interventions, and audiological assessments

BackgroundMisophonia is a disorder characterized by an intense emotional reaction to specific sounds, often leading to significant distress and impairment in daily functioning. Acceptance and commitment therapy (ACT) is a promising psychotherapy for treating misophonia, but has only been previously tested in case studies. This paper presents a protocol for the first randomized controlled trial (RCT) assessing the efficacy and feasibility of ACT supplemented by audiological interventions for misophonia versus progressive relaxation training (PRT). MethodsThe outlined protocol is a RCT with 60 adults with misophonia. After undergoing a comprehensive psychological and audiological evaluation, participants were randomly assigned to ACT (n = 30) or PRT (n = 30). All participants completed clinician-administered and self-report assessments at baseline, post-intervention, 3-month follow-up, and 6-month follow-up. The primary outcome was misophonia severity and impairment measured via clinical interview. Secondary outcomes included disgust, anger, sensory sensitivities, well-being, distress, and psychological flexibility. DiscussionThis paper outlines the rationale of using ACT supplemented by audiological methods for misophonia with the novel therapeutic target of enhancing psychological flexibility. The results of this randomized controlled trial will help determine if ACT is an efficacious and acceptable treatment for misophonia. This trial will also help clarify active psychological mechanisms of misophonia, and assess whether this combination of psychological and audiological services can effectively help individuals with misophonia.

Behavioral, cognitive and emotional determinants of getting vaccinated for COVID-19 and the mediating role of institutional trust among young adults in Cyprus

BackgroundVaccination uptake is a complex behavior, influenced by numerous factors. Behavioral science theories are commonly used to explain the psychosocial determinants of an individual’s health behavior. This study examined the behavioural, cognitive, and emotional determinants of COVID-19 vaccination intention based on well-established theoretical models: Acceptance and Commitment Therapy (ACT), Capability, Opportunity, Motivation, and Behaviour (COM-B) and the Health Belief Model (HBM). Additionally, it examined the mediating role of institutional trust in the relationship between determinants of these models and vaccination intentions.MethodsA cross-sectional study was conducted from January to May 2022, where university students in Cyprus completed an online survey.ResultsA total of 484 university students completed the online survey, with 23.8% reporting being vaccinated with fewer than three vaccination doses and/or no intention to vaccinate further. Hierarchical logistic regression analysis showed that higher scores in institutional trust, perceived severity, motivation, physical and psychological capability were significantly associated with higher odds of intending to vaccinate. Higher psychological flexibility and not being infected with COVID-19 were also associated with higher odds of vaccination intention, but not in the final model when all determinants were included. Additionally, significant indirect effects of psychological and physical capability, motivation and perceived severity on vaccination intention were found to be mediated by institutional trust.ConclusionsWhen tackling COVID-19 vaccination hesitancy, behavioural, cognitive, and emotional aspects should be considered. Stakeholders and policymakers are advised to implement targeted vaccination programs in young people while at the same time building trust and improving their capabilities and motivation towards getting vaccinated.

Randomised controlled trial of a psychotherapeutic intervention to improve quality of life and other outcomes in people who repeatedly self-harm: FReSH START study protocol

BackgroundSelf-harm is a major public health challenge, and repeated self-harm is common in those attending hospital following an episode. Evidence suggests psychological interventions could help people who self-harm, but few definitive studies have assessed their clinical and cost-effectiveness. Repeated self-harm is associated with poor quality of life, depression, suicide and increased health service costs which justify the development of psychotherapeutic interventions tailored for people with repeated self-harm.MethodsFReSH START is a multicentre individually 1:1 randomised controlled trial evaluating the clinical and cost-effectiveness of standard care plus psychological therapy or standard care alone for adults (≥ 18 years) presenting at an emergency department (ED) with repeated self-harm. Recruiting 630 participants, it includes an internal pilot, economic evaluation and process evaluation. The intervention will be delivered by mental health staff working in acute settings, with experience of assessing and managing risk in people presenting to emergency services with self-harm. Staff will be trained and supervised to deliver one of three specially adapted therapies: psychodynamic interpersonal therapy, cognitive behavioural therapy or acceptance and commitment therapy. Participants allocated to the intervention will receive one of the adapted therapies according to therapist allocation for up to 6 months via 12 weekly, one to one, 45–50-min sessions. The primary outcome is quality of life measured by the Clinical Outcomes in Routine Evaluation Outcome Measure at 12 months post-randomisation. Secondary outcomes include suicidal intent, depression and cost-effectiveness. Data are collected using hospital attendance records and online/postal/telephone questionnaires at 6 and 12 months post-randomisation, with resource use additionally collected at 3 and 9 months.DiscussionThis protocol outlines a randomised controlled trial to investigate whether modified therapies are cost-effective and improve quality of life for people who repeatedly self-harm. Few interventions are proven to be deliverable in the NHS for this population. This study is strengthened by the involvement of qualified mental health workers experienced in managing risk as therapists.Trial registrationRegistered on August 03, 2021.IRAS number: 297939.ISRCTN: https://doi.org/10.1186/ISRCTN73357210.REC reference: 21/EE/0145.Sponsor: University of Leeds.

A Randomized Trial Evaluating Acceptance and Commitment Therapy and Smart Phone Care Management Application to Augment Buprenorphine Therapy for Opioid Use and Chronic Pain.

There is high comorbidity of opioid use disorder (OUD) and chronic pain (CP), which is often addressed by prescribing buprenorphine (BUP). While BUP is effective in preventing overdose, it does not address the psychological aspects of OUD and CP comorbidity and treatment retention rates are as low as 50%. The Virtual Opioid use disorder Integrated Chronic Pain Treatment (VOICE) study (NCT05039554) is a novel effectiveness-implementation trial to test a 12-week virtual group Acceptance and Commitment Therapy (ACT) protocol and a care management smartphone application (app; Valera Health) on pain and opioid use in patients with OUD and CP receiving BUP. Using a 2 × 2 factorial design, participants (expected N = 280) are randomized into: ACT, Valera app, ACT + Valera, or Treatment as Usual arm. This study is taking place in the Bronx, NY, a racially/ethnically diverse community that faces numerous socioeconomic stressors and is one of the nation's epicenters of the opioid epidemic. We created a culturally responsive ACT group protocol, and Valera psychoeducational material. Outcome measures include NIH HEAL Common Data Elements and ACT and Valera-specific measures. We are conducting a novel 2 × 2 trial investigating augmenting BUP treatment with ACT and Valera, with the goal that improved mental health and access to care will result in decreased and opioid use and pain interference.

PSTD Treatment of Joint Forces Operation Combatants: A Case Study.

The participation of military personnel in operations like the Anti-Terrorist Operation (ATO)/Joint Forces Operations (JFO) can lead to significant psychological trauma, potentially resulting in posttraumatic stress disorder (PTSD). Understanding the effectiveness of psychotherapy in treating PTSD among ATO/JFO participants is crucial given its profound impact on personal relationships, life scenarios, and overall well-being. This study evaluates how acceptance and commitment therapy can alleviate PTSD symptoms and enhance well-being in Ukrainian military personnel with combat-related PTSD. The main research method was a psychological experiment, and the case study method was used as an auxiliary research method. The study revealed the following: combatants in the ATO/JFO who have been diagnosed with PTSD should be classified as persons with disabilities due to certain limitations in their life activities, namely, the inability to control their behavior, and difficulties in work and communication. This study proves that cognitive-behavioral psychotherapy has a clear advantage in overcoming PTSD in the military, as it allows transforming psychological trauma into posttraumatic growth. Attachment and acceptance therapy, a form of behavioral therapy, has emerged as one of the most effective treatments for PTSD. It focuses on diagnosing and addressing the psychological consequences of war by analyzing the connections among cognition, affect, and behavior. Given the protracted nature of PTSD, the practical significance of the study is to develop effective psychotherapeutic interventions for the expected recovery of ATO/JFO participants affected by combat operations.

Acceptance and Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress: A Randomized Controlled Trial.

The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapeutic interventions such as acceptance and commitment therapy (ACT) on biopsychosocial outcomes. We aimed to examine the efficacy of an ACT program (intervention) in comparison with a cognitive behavioral therapy-informed psychoeducation program (active control) for individuals with IBD and coexistent psychological distress. Both programs were delivered online through a hybrid format (i.e., therapist-led and participant-led sessions). A total of 120 adults with IBD were randomized to either the intervention (N = 61) or active control groups (N = 59). Efficacy was determined using linear mixed models for group differences, in rate of changes in study outcomes, between baseline, postintervention, and 3-month follow-up. The primary outcome health-related quality of life significantly improved in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to postintervention ( t [190] = 2.15, P = 0.033) in favor of the intervention group with a medium effect size (β = 0.41, mean difference = 0.07, 95% confidence interval 0.01-0.12, P = 0.014). Similarly, the secondary outcome Crohn's disease activity significantly reduced in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to 3-month follow-up ( t [90] = -2.40, P = 0.018) in favor of the intervention group with a large effect size (β = -0.77, mean difference = -9.43, 95% confidence interval -13.72 to -5.13, P < 0.001) ( P = 0.014). Furthermore, when observing the rate of change in outcomes over time for the groups separately, anxiety symptoms and pain significantly improved in the intervention group only, and conversely, ulcerative colitis activity and stress symptoms significantly improved in the active control group only. All other outcomes (N = 14) significantly improved over time in both groups including IBD activity, gastrointestinal unhelpful thinking patterns, visceral anxiety, fatigue interference, fatigue severity, fatigue frequency, psychological inflexibility, self-efficacy, resilience, current health status, depression symptoms, IBD control, and pain catastrophizing; however, these changes were not significantly different between the groups. Both programs were of benefit to people with IBD and distress. However, ACT offers a significant added benefit for health-related quality of life and self-reported Crohn's disease activity and may be a useful adjuvant therapy in integrated IBD care.

Development of the Southampton Experiential Avoidance and Acceptance Scale (SEAAS)

Acceptance is an important construct in various psychological models seeking to describe psychological distress and emotion regulation. Existing measures either focus on broader constructs like psychological flexibility or lack proper validation. There are no established tools which measure acceptance as a general process, as defined within Acceptance and Commitment Therapy (ACT). The absence of valid and reliable measures impedes research on acceptance processes in clinical change. To address this, we developed the Southampton Experiential Avoidance and Acceptance Scale (SEAAS). Across four studies an item pool was generated, evaluated, and refined into an 18-item scale with a theoretically coherent two-factor structure. The SEASS demonstrates strong psychometric properties, including excellent internal consistency, convergent, concurrent, and discriminant validity, and test-retest reliability. This scale is a promising new tool for assessing acceptance and experiential avoidance.

Evaluating mobile mental health apps using the mobile application rating scale (MARS) in the U.S.

ABSTRACT Objective The objectives of this study were to comprehensively review and evaluate the quality of mobile mental health apps using the MARS and to identify high-quality apps. Method A quantitative content analysis was undertaken. A systematic search of the U.S. Apple App Store and Google resulted in the selection of 25 mobile mental health applications. Coders evaluated these applications using a set of criteria derived from the literature. The intraclass correlation coefficient was employed to assess two-way mixed interrater reliability. Descriptive statistics, including frequency and mean (SD) scores, were calculated for each criterion. Results MARS has two parts: classification category and app quality criteria. For the classification category, we found the majority of apps (1) focused on relieving negative emotions, (2) relied on principles of Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT), and (3) offered reminders to perform an activity and required login information. Regarding app quality, the 25 apps scored highest in functionality, followed by aesthetics, engagement, and information among the four categories. Wysa was the highest-scoring mental health app, followed by Woebot and Youper. Discussion The study offers descriptive and technical information about the mobile mental health applications, including their focus, theoretical background, and technical aspects. The findings demonstrates that the majority of these applications are of high quality. Consequently, the results facilitate an objective and comprehensive understanding of commercial mental health mobile apps.

Exploring the Impact of a Sleep App on Sleep Quality in a General Population Sample: Pilot Randomized Controlled Trial.

A third of adults in Western countries have impaired sleep quality. A possible solution involves distributing sleep aids through smartphone apps, but most empirical studies are limited to small pilot trials in distinct populations (eg, soldiers) or individuals with clinical sleep disorders; therefore, general population data are required. Furthermore, recent research shows that sleep app users desire a personalized approach, offering an individually tailored choice of techniques. One such aid is Peak Sleep, a smartphone app based on scientifically validated principles for improving sleep quality, such as mindfulness meditation and cognitive behavioral therapy. We aimed to test the impact of the smartphone app Peak Sleep on sleep quality and collect user experience data to allow for future app development. This was a 2-arm pilot randomized controlled trial. Participants were general population adults in the United Kingdom (aged ≥18 years) who were interested in improving their sleep quality and were not undergoing clinical treatment for sleep disorder or using sleep medication ≥1 per week. Participants were individually randomized to receive the intervention (3 months of app use) versus a no-treatment control. The intervention involved free access to Peak Sleep, an app that offered a choice of behavioral techniques to support better sleep (mindfulness, cognitive behavioral therapy, and acceptance commitment therapy). The primary outcome was sleep quality assessed using the Insomnia Severity Index at baseline and 1-, 2-, and 3-month follow-ups. Assessments were remote using web-based questionnaires. Objective sleep data collection using the Oura Ring (Ōura Health Oy) was planned; however, because the COVID-19 pandemic lockdowns began just after recruitment started, this plan could not be realized. Participant engagement with the app was assessed using the Digital Behavior Change Intervention Engagement Scale and qualitative telephone interviews with a subsample. A total of 101 participants were enrolled in the trial, and 21 (21%) were qualitatively interviewed. Sleep quality improved in both groups over time, with Insomnia Severity Index scores of the intervention group improving by a mean of 2.5 and the control group by a mean of 1.6 (between-group mean difference 0.9, 95% CI -2.0 to 3.8), with was no significant effect of group (P=.91). App users' engagement was mixed, with qualitative interviews supporting the view of a polarized sample who either strongly liked or disliked the app. In this trial, self-reported sleep improved over time in both intervention and control arms, with no impact by group, suggesting no effect of the sleep app. Qualitative data suggested polarized views on liking or not liking the app, features that people engaged with, and areas for improvement. Future work could involve developing the app features and then testing the app using objective measures of sleep in a larger sample. ClinicalTrials.gov NCT04487483; https://www.clinicaltrials.gov/study/NCT04487483.

Validation of the comprehensive assessment of acceptance and commitment therapy processes for youth: The CompACT‐Y

AbstractBackgroundAcceptance and Commitment Therapy (ACT) is a transdiagnostic approach which aims to increase psychological flexibility. Higher psychological flexibility has been associated with reduced psychological distress, mental health symptoms and improvements in well‐being and functioning. Reviews of ACT for children and young people (CYP) indicate it shows potential as an effective treatment for a range of difficulties, however a comprehensive measure of psychological flexibility processes does not exist for CYP. Following revision of the adult Comprehensive assessment of Acceptance and Commitment Therapy Processes (CompACT), through cognitive interviewing with adolescents and consultation with ACT experts, the present study aimed to assess the factor structure and validity of the revised youth measure (the CompACT‐Y).MethodThe CompACT‐Y measure was administered alongside measures of ACT processes, mental health and well‐being to 334 young people across six UK schools, to assess for convergent and concurrent validity.ResultsExploratory factor analysis indicated a 19‐item three‐factor structure was the most stable, with all items loading above 0.50. The CompACT‐Y correlated with measures of psychological flexibility (r = ‐0.64 – 0.66), mental health (r = −0.58 – −0.66), well‐being (r = 0.57–0.65) and behaviour (r = −0.63) as expected, indicating acceptable convergent and concurrent validity.ConclusionsThe CompACT‐Y appears to be a valid and reliable measure of psychological flexibility in young people. Further research is needed to replicate the findings and confirm factor structure, validity and reliability, particularly in younger adolescents and those from diverse backgrounds. The CompACT‐Y offers a promising tool to improve the methodological rigour of ACT studies in young people, and has implications for the use of ACT in clinical practice.