Effective ACT-based interventions with chronic illness patients:
Achievable with online self-management programs?
Matthew Maley, M.A., Abbie Beacham, Ph.D., John Forrette, M.A.
Xavier University, Cincinnati, OH
INTRODUCTION
Figure 1.
Percent of sample endorsing specific CI diagnoses
RESULTS
Those who expressed interest in sessions reported greater numbers of
diagnosed CIs [Yes (mean = 2.47) versus No (mean = 1.95); p<.001].
Chronic medical illness (CI) is the leading cause of death in the world,
accounting for 63% of mortalities in 2008, and nearly 80% of deaths in
lower SES groups [11]. CIs also cause significant strain economically,
accounting for varying proportions of GDP from country to country [11].
Health behaviors are often considered independent risk factors for
many of the most common and costly CIs. Specific behavior change
targets include: tobacco use, unhealthy diet, insufficient physical
activity, and unhealthy alcohol use [11]. Behavior change interventions
contribute to management of these conditions. One particular area
psychologists may be able to intervene to improve health outcomes is
in improving psychological flexibility in these populations. ACT-based
interventions can be used to improve psychological flexibility, which
has been linked to improved health outcomes [6]. These interventions
have demonstrated efficacy with several CI populations and can
impact medical conditions as well as behaviorally linked risk factors
[10] including diabetes [7], epilepsy, weight loss, and chronic pain [9].
Despite the efficacy, effectiveness, and promise of ACT interventions,
one of the most challenging barriers to successful intervention is
generating interest in, and adherence to, behavioral CI management
programs. The current study was an investigation of level of interest
for CI management programs and potential modalities for program
delivery. Additionally, differences in ACT related measures between
interest groups were examined.
Those who expressed interest in programming (“Yes”) endorsed:
• Lower levels of mindfulness [Yes (mean = 4.09) versus No (mean = 4.36);
p=.028]
• Lower CI Acceptance-activity engagement [Yes (mean = 35.05] versus
No (mean = 39.02); p=.013) and CI Acceptance-willingness Yes [(mean =
24.81) versus No (mean = 28.51); p=.021]
• Higher experiential avoidance [Yes (mean = 20.65) versus No (mean =
17,95]; p =.003]
Contrary to original hypotheses, when those who preferred programming on
the internet were compared to all others, there were no differences in
experiential avoidance, CI acceptance or mindfulness scores.
Figure 2.
“If chronic illness management sessions were available, would you
be interested in participating in them?”
METHOD
Study participants (N=577) were recruited from online CI support groups and
completed self-report measures as part of a larger survey study. The sample
(mean age=53.02, SD=12.37) was primarily Caucasian (86.1%), female
(80.2%), married (54.9%), and well educated (mean years=15.36, SD=2.74).
Mean number of chronic illnesses was 2.36 (SD=1.39). CI diagnoses
endorsed by study participants are presented in Figure 1.
Measures:
Program interest items Participants were asked to complete the following
items regarding CI behavioral management programming:
- “If chronic illness management sessions were available, would you
be interested in participating in them?”
- “If you attended these sessions, where would you most like to attend
them?”
Mindful Attention and Awareness Scale (MAAS) [3]
The MAAS consists of 15 items designed to measure of a single-factor
construct of mindfulness [3]. Each of the items is rated on a 6-point scale
from 1 (“almost always”) to 6 (“almost never”).
Chronic Illness Acceptance Questionnaire (CIAQ) [1]
The CIAQ was adapted from the Chronic Pain Acceptance Questionnaire
(CPAQ; McCracken et al., 2004). Twenty items are rated on a 0 (“Never
true”) to 6 (“Always true”) scale to produce a two-factor structure: Activity
Engagement and Pain Willingness. All CPAQ items were retained in the
development of the CIAQ, and analyses revealed item loadings on the same
two-factor structure as the CPAQ
Acceptance and Action Questionnaire-II (AAQ-II) [2]
The AAQ-II is a shortened, seven-item measure of psychological inflexibility
and experiential avoidance designed to measure the same constructs as the
Acceptance and Action Questionnaire (AAQ; Hayes et al., 2004). Items are
rated from 1 (“never true”) to 7 (“always true”) scale for statements like
“Emotions cause problems in my life.”
“Yes” = 77.7%
DISCUSSION
The study results support the desirability of behavioral programming in
persons with one or more CIs. In this sample, online CI self-management
programs were the most appealing mode of delivery. There were no
characteristic differences in ACT-related variables between those who
preferred internet versus all others was contrary to our hypotheses that
those who preferred internet programs would be higher in experiential
avoidance than those who preferred to attend face-to-face programs in a
physical space.
Online interventions have been successful in changing several health and
safety behaviors [5]. These mediums may be an effective mode of
intervention for those who struggle to manage their CI and related
symptoms, who may not otherwise seek treatment. Online intervention
modalities may be considered either a first step in treatment engagement or
an adjunct to face-to-face intervention. By increasing the likelihood of
individuals receiving treatment through online modalities, outcomes may be
improved.
The willingness to engage in treatment via online intervention may be
considered an avenue of through which psychological flexibility is enhanced.
Several studies have investigated, or are investigating the effectiveness of
online or smartphone delivered ACT-based interventions [4, 8].
Figure 3.
“If you attended these sessions, where would you most Like to
attend them?”
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