title: Acceptance and Commitment Therapy in Daily Life Training: A Feasibility Study of an mHealth Intervention.
abstract: BACKGROUND
  With the development of mHealth, it is possible to treat patients in their natural environment. Mobile technology helps to bridge the gap between the therapist's office and the "real world." The ACT in Daily Life training (ACT-DL) was designed as an add-on intervention to help patients practice with acceptance and commitment therapy in their daily lives. The ACT-DL consists of two main components: daily monitoring using experience sampling and ACT training in daily life.
  
  
  OBJECTIVE
  To assess the acceptability and feasibility of the ACT-DL in a general outpatient population. A secondary objective was to conduct a preliminary examination of the effectiveness of the ACT-DL.
  
  
  METHODS
  An observational comparative study was conducted. The experimental group consisted of 49 patients who volunteered for ACT-DL, and the control group consisted of 112 patients who did not volunteer. As part of an inpatient treatment program, both groups received a 6-week ACT training. Participants went home to continue their treatment on an outpatient basis, during which time the experimental group received the 4-week add-on ACT-DL. Acceptability and feasibility of the ACT-DL was assessed weekly by telephone survey. Effectiveness of the ACT-DL was evaluated with several self-report questionnaires ( Flexibility Index Test (FIT-60): psychological flexibility, Brief Symptom Inventory: symptoms, Utrechtse Coping List: coping, and Quality of life visual analog scale (QoL-VAS): quality of life).
  
  
  RESULTS
  More than three-quarters of the participants (76%) completed the full 4-week training. User evaluations showed that ACT-DL stimulated the use of ACT in daily life: participants practiced over an hour a week (mean 78.8 minutes, standard deviation 54.4), doing 10.4 exercises (standard deviation 6.0) on average. Both ACT exercises and metaphors were experienced as useful components of the training (rated 5 out of 7). Repeated measures ANCOVA did not show significant effects of the ACT-DL on psychological flexibility (P=.88), symptoms (P=.39), avoidant coping (P=.28), or quality of life (P=.15).
  
  
  CONCLUSIONS
  This is the first study that uses experience sampling to foster awareness in daily life in combination with acceptance and commitment therapy to foster skill building. Adherence to the ACT-DL was high for an intensive mHealth intervention. ACT-DL appears to be an acceptable and feasible mHealth intervention, suitable for a broad range of mental health problems. However, short-term effectiveness could not be demonstrated. Additional clinical trials are needed to examine both short-term and long-term effects.
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht University, Maastricht, Netherlands. tim.batink@maastrichtuniversity.nl.
authors.forename: Tim
authors.identifier: http://orcid.org/0000-0003-1965-6248
authors.initials: T
authors.lastname: Batink
authors.forename: Jindra
authors.identifier: http://orcid.org/0000-0002-5270-0581
authors.initials: J
authors.lastname: Bakker
authors.forename: Thomas
authors.identifier: http://orcid.org/0000-0002-9300-3117
authors.initials: T
authors.lastname: Vaessen
authors.forename: Zuzana
authors.identifier: http://orcid.org/0000-0002-8795-5373
authors.initials: Z
authors.lastname: Kasanova
authors.forename: Dina
authors.identifier: http://orcid.org/0000-0002-2323-5780
authors.initials: D
authors.lastname: Collip
authors.forename: Jim
authors.identifier: http://orcid.org/0000-0002-7245-1586
authors.initials: J
authors.lastname: van Os
authors.forename: Marieke
authors.identifier: http://orcid.org/0000-0001-5024-9064
authors.initials: M
authors.lastname: Wichers
authors.forename: Inez
authors.identifier: http://orcid.org/0000-0002-3731-4930
authors.initials: I
authors.lastname: Germeys
authors.forename: Frenk
authors.identifier: http://orcid.org/0000-0002-6167-8582
authors.initials: F
authors.lastname: Peeters
keywords: acceptance and commitment therapy; behavior change; daily life intervention; experience sampling; mHealth