Logo: to the web site of Uppsala University

Appearance concerns after burns start soon after injury. However, early psychological interventions to support individuals with their changed appearance are absent. This study investigated the acceptability of an early acceptance and commitment therapy (ACT) intervention delivered by a psychological therapist either in person or virtually to help individuals adjust to changes to their appearance after burns. As a secondary objective, the potential effectiveness of ProACTive was also investigated. Using mixed-methods, 13 adults (eight women, five men) participated. Acceptability was measured by uptake rates, module completion rates and interview data. Over two-thirds of participants completed all modules. Three main themes were identified from interviews: An acceptable intervention; Valuing the therapeutic relationship; and Early support is key. Data suggested that ProACTive may be acceptable, although some inconsistencies within the data were observed. Ratings of helpfulness were positive and qualitative feedback suggested that ProACTive seemed helpful by providing space to explore and reflect on appearance changes, developing psychological flexibility and self-compassion, and preparing individuals for being around other people. Positive and negative affect significantly decreased (moderate effect sizes) but no significant changes on appearance concerns, psychological flexibility or self-compassion (small effect sizes) were revealed. ProACTive may be an acceptable early psychological intervention to support the adjustment of appearance changes after burns. Acceptability may be higher in individuals with appearance concerns and those admitted to hospital. The intervention holds promise soon after burns but further research on acceptability and effectiveness is needed.

This study analyzed the efficacy of acceptance and commitment therapy (ACT) in six individuals with chronic low back pain plus depressive symptoms using an idiographic approach within a randomized controlled trial. Daily ecological momentary assessments (EMA) and full assessments at baseline, posttreatment, and follow-up were collected. Outcomes included pain interference, pain intensity, and depressed mood, and the process variable was psychological inflexibility. Analyses involved visual inspection, non-overlap of all pairs, Tau, Tau-U, and idiographic network analysis. Moderate improvements were observed in pain interference (5/6), depressed mood (5/6), and psychological inflexibility (3/6), with limited change in pain intensity (1/6). Most participants (4/6) reported an overall relevant improvement. Idiographic networks showed considerable variability across participants, with psychological inflexibility and depressed mood playing a central role. Findings suggest ACT may help reduce pain interference and depressed mood, highlighting the need for personalized approaches and the continued use of single-case methods combined with EMA.

BackgroundIn digital health innovations, sustainable implementation should be considered from the initiation of the development to ensure that the solution fits into the existing healthcare system. This study aims at identifying barriers and facilitators for the prospective implementation of a digital behavioral intervention for chronic pain in the Swedish healthcare system, as perceived by key stakeholders.MethodsEight semi-structured individual interviews were conducted with stakeholders (n = 2 IT developers, n = 4 healthcare managers, n = 2 healthcare professionals). Qualitative data were analyzed using a framework analysis following the Consolidated Framework for Implementation Research (CFIR).ResultsA total of 86 facilitators and 38 barriers to prospective implementation were identified across stakeholder interviews. Facilitators included perceived relevance of the digital intervention and organizational readiness. Identified barriers primarily related to insufficient training and supervision, unclear decision-making processes (e.g., specific actions, responsibilities of stakeholders), and the lack of systematic needs assessment to guide implementation planning.ConclusionOverall, findings indicate a high level of openness toward digital interventions within the implementation context. While implementation context largely demonstrates readiness, successful integration will depend on proactively addressing identified barriers. Awareness of these factors enhances the likelihood of successful and sustainable implementation.

Introduction:

Idiographic network analysis, where associations between multiple nodes are estimated, can potentially guide choice of interventions in psychological treatment. In this single case experiment using ecological momentary assessment data to estimate continuous time network models, we aimed to test the so-called centrality hypothesis. We did so by comparing effects of interventions guided by the most central node to those guided by the least central node. We used the composite level psychological inflexibility processes lack of openness, lack of awareness, and lack of engagement, alongside an interference outcome, as network nodes. Effects on pain interference, motivation, and pain intensity were examined.

Method:

We employed a multiple baseline design across six participants. Therapists and participants were blinded to participants' treatment conditions. Baseline length and order of treatment phases were randomized.

Results:

Four participants had an overall treatment effect on pain interference, but it was generally not possible to discern that one particular phase was more beneficial than another. For three participants, the picture was somewhat clearer, indicating one of the treatment phases as more beneficial, although the results for these participants were not consistently in line with hypotheses. Retrospectively examining other potential guidance methods for these three participants, we saw a potential in discrete time contemporaneous network models.

Discussion:

Current results are not in line with previous assumptions or research on idiographic network models for treatment personalization, although the previous research in this area is scarce. Future research should investigate alternative network models or estimation choices to determine the potential utility of data driven idiographic networks.

Background: The COVID-19 pandemic left many people with persistent health problems following a COVID-19 infection. Research on the condition better known as Post-Covid Condition (PCC) is still inconclusive, and few evidence-based treatments are currently available, although several studies report promising results. There are however people in need of treatment and support.

Methods: To better understand what such help might entail, we conducted an online-based survey (n = 629, 82.6% women) to examine the impact of PCC in Sweden and explore relationships among various variables using correlation analysis. Swedish-speaking adults with at least one persisting health problem after COVID-19 were included in the study. The survey included demographic and psychosocial variables, historic COVID-19 data, other clinical measures of psychological distress, satisfaction with life, and daily functioning impairment.

Results: Results indicate a substantial and heterogeneous impact of PCC in this sample. Participants reported an average of 10.70 (SD = 5.62) symptoms with the most frequently reported being fatigue (90.9%, n = 507) and cognitive deficits (73.3%, n = 409). The highest average symptom burden scores were reported for post-exertional malaise (PEM; M = 8.37, SD = 1.70) and fatigue (M = 8.22, SD = 1.77). Medication, self-help advice, and physiotherapy were the most frequently reported treatment modalities. Most participants reported their problems being unchanged or improved after treatment, but there were reports of worsening as well. Regarding psychological distress, participants reported mild anxiety, moderate depression, and subclinical but notable levels of sleeping problems. On average, daily functioning was substantially impaired by PCC and participants reported being "somewhat dissatisfied with life". The correlational analyses revealed several significant correlations (|r| = 0.11-0.93, p < .01), with strongest relationships between the clinical variables.

Conclusions: While this study aimed to measure impacts of PCC in many different areas of life, it holds some limitations, and there are many questions remaining. We present several recommendations for methodology and future research topics. Identifying modifiable variables that can be used in developing a treatment is naturally a next step. Based on empiric evidence from similar conditions, psychological flexibility (PF) may be a promising one.

Introduction: Idiographic network analysis, assessing associations between a system of variables of interest, also called nodes, is a proposed method for personalizing psychological treatment. The aim of this study was to test the centrality hypothesis that a treatment condition delivering interventions guided by the most central network node will yield better outcomes compared to a treatment condition delivering interventions guided by the least central node. We tested this using perceived causal networks (PECAN) and focusing on psychological inflexibility processes. Effects were examined in terms of pain interference, motivation, and pain intensity.

Method: We used a single case design with multiple baselines across six participants. Therapists were blind to treatment conditions. While participants were not blind to the responses that they provided for creating the PECAN, they were blind to the resulting network and the treatment conditions. Randomization was applied to baseline length and to whether the most central node or the least central node intervention came first.

Results: All participants had at least one outcome changing in beneficial directions in line with hypotheses. However, two participants also had one outcome each that changed in contradiction to the hypotheses.

Discussion: Adapting psychological treatment by matching interventions to the most central node in a perceived causal network looks promising. However, it is unlikely that this method will always be the best matching method. We need to keep exploring additional personalization methods and under which circumstances they are efficient.

Background: People with Parkinson's disease can experience psychological distress and have difficulties accessing face-to-face psychological support due to symptom burden and limited availability of psychological services. Digital options for psychological support can bridge this gap. We have developed an app based on acceptance and commitment therapy (ACT) to support people with Parkinson's to improve psychological wellbeing.

Aim: To assess the acceptability of the app and the feasibility of conducting a randomised controlled trial (RCT) to evaluate the effectiveness of using the app to improve wellbeing for people with Parkinson's.

Methods: We will conduct a parallel-group randomised controlled feasibility trial comparing a digital app based on ACT (intervention group) to usual care (waitlist control group). We will recruit 60 people with Parkinson's, 40 to the intervention group and 20 to the control group. Primary feasibility outcomes include recruitment and retention rate, intervention engagement and satisfaction. Secondary outcomes include measures of clinical effectiveness (anxiety and depression), quality of life and cost-effectiveness. Interviews will be conducted to assess acceptability of the app. Primary feasibility outcome data will be analysed descriptively and compared against pre-defined feasibility criteria. Secondary outcomes will be analysed based on an intention-to-treat principle, and a cost-consequence analysis will be used to estimate cost-effectiveness. Interviews will be analysed using a deductive thematic analysis based on the Theoretical Framework of Acceptability.

Discussion: This trial will provide data on the feasibility of conducting a full-scale RCT of the effectiveness and cost-effectiveness of the app to improve psychological wellbeing for people with Parkinson's disease.

Background: Motor neuron disease is a progressive, fatal neurodegenerative disease for which there is no cure. Formal psychological therapies are not routinely part of United Kingdom standard motor neuron disease care due to a lack of evidence-based guidance resulting from a paucity of clinical trials. We aimed to evaluate the clinical and cost-effectiveness of Acceptance and Commitment Therapy plus usual care compared to usual care alone improving psychological health in people living with motor neuron disease.

Methods: We conducted qualitative interviews with 15 people living with motor neuron disease, 10 caregivers and 12 healthcare professionals. Findings were used to develop an Acceptance and Commitment Therapy intervention specifically for people living with motor neuron disease. Next, we examined its acceptability and feasibility in uncontrolled feasibility study with 29 people living with motor neuron disease. Findings from qualitative interviews with 14 people living with motor neuron disease and 11 therapists were used to revise the intervention. Finally, we conducted a multicentre, parallel, two-arm randomised controlled trial in 16 United Kingdom motor neuron disease care centres/clinics. Eligible participants were aged ≥ 18 years with motor neuron disease. Participants were randomly assigned (1 : 1) to receive up to eight sessions of Acceptance and Commitment Therapy plus usual care or usual care alone and followed up at 6 and 9 months post randomisation by blinded outcome assessors. The primary outcome was total score on the McGill Quality of Life Questionnaire-Revised at 6 months. Secondary outcomes included health status using the EuroQol-5 Dimensions, five-level version. Primary analyses were by intention to treat.

Results: Acceptance and Commitment Therapy was acceptable to people living with motor neuron disease, and was feasible to recruit participants, hence trial progression criteria were met. From September 2019 to August 2022, 191 participants were recruited: 97 were allocated to Acceptance and Commitment Therapy plus usual care and 94 to usual care alone. Mean age was 61.9 years (standard deviation 11.4), 58% were male and 95% were White/ White British. Acceptance and Commitment Therapy plus usual care was superior to usual care alone on the McGill Quality of Life Questionnaire-Revised at 6 months [adjusted mean difference 0.66 (95% confidence interval 0.22 to 1.10); Cohen's d = 0.46 (95% confidence interval 0.16 to 0.77); p = 0.003] and 9 months [adjusted mean difference 0.76 (95% confidence interval 0.30 to 1.22); Cohen's d = 0.53 (95% confidence interval 0.21 to 0.85); p = 0.001]. Mean differences in total costs and quality-adjusted life-years at 9 months between Acceptance and Commitment Therapy plus usual care versus usual care alone were not statistically significant [costs: £1019 (95% confidence interval -£34 to £2074); quality-adjusted life-years: 0.019 (95% confidence interval-0.07 to 0.05)]. The incremental cost-effectiveness ratio was £88,507/quality-adjusted life-year: this decreased to £13,817/quality-adjusted life-year in those with medium disease-related deterioration in subgroup analyses.

Conclusion: Acceptance and Commitment Therapy plus usual care is clinically effective at maintaining or improving psychological health, as measured by the McGill Quality of Life Questionnaire-Revised, in people living with motor neuron disease compared to usual care alone. It was not cost-effective overall when calculated using a standard health status measure (EuroQol-5 Dimensions, five-level version). However, it was cost-effective in a subgroup of people experiencing a medium rate of disease-related deterioration.