Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: findings on treatment adherence and acceptability from the multi-center INTERACT randomized controlled trial (Preprint)

BACKGROUND Acceptance and Commitment Therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with a mobile health (mHealth) ecological momentary intervention (EMI) may increase its treatment effects and empower clients to take treatment into their own hands. OBJECTIVE This study aimed to investigate treatment adherence to and acceptability of Acceptance and Commitment Therapy in Daily Life (ACT-DL), a novel Ecological Momentary Intervention for people with Ultra-High-Risk (UHR) state and a First-Episode Psychosis (FEP). METHODS In the multi-center INTERACT randomized controlled trial, UHR and FEP individuals aged 15-65 were randomized to treatment as usual only (TAU) (control) or to ACT-DL+TAU (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone application, delivering ACT skills and techniques in daily life. We collected data on treatment adherence to and acceptability of ACT-DL. Predictors included baseline demographic, clinical and functional outcomes. RESULTS ACT-DL+TAU participants (n=71) completed a mean of 6 (SD=3) sessions, with 59% (n=42) of participants completing all sessions. App adherence data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant to 6 out of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness), and that 91% reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Ethnic minority background predicted lower notification response compliance (b=-4.37; p=.012), yet higher app usefulness (b=1.25; p=.049). Negative (b=-0.26; p=.010) and affective (b=0.14; p=.04) symptom severity predicted lower and higher ACT training usefulness respectively. Being female (b=-1.03; p=.049) predicted lower usefulness of the ACT metaphor images on the app. CONCLUSIONS Our results corroborate good treatment adherence to and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. CLINICALTRIAL The trial was prospectively registered within the Dutch Trial Register (ID: NTR4252). INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-019-3912-4