Effects and Mechanisms of a Web- and Mobile-Based Acceptance and Commitment Therapy Intervention for Anxiety and Depression Symptoms in Nurses: Fully Decentralized Randomized Controlled Trial

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Abstract

Background

Acceptance and commitment therapy (ACT) is a promising intervention for improving mental health. However, there is limited evidence on its effectiveness for nurses, particularly in web- and mobile-based intervention forms, in mitigating anxiety and depression symptoms.

Objective

In this study, we aimed to examine the effect and underlying psychological mechanisms of a web- and mobile-based ACT intervention on nurses’ anxiety and depression symptoms.

Methods

In this fully decentralized randomized controlled trial, nurses were recruited nationwide across China through advertisements and posters. They were randomly assigned to either the 5-week fully automated intervention or the waiting group. Primary outcomes (anxiety and depression symptoms); secondary outcomes (sleep quality, burnout, and work performance); and mediators (psychological flexibility, cognitive defusion, mindfulness, and values) were assessed using the Wenjuanxing platform. Data collectors were blinded to the group assignments throughout the study period.

Results

A total of 145 nurses with anxiety or depression symptoms were randomly assigned to either the intervention group (n=72, 49.7%) or the control group (n=73, 50.3%); 97.2% (n=141) were female. During the study, 36 (24.8%) nurses were lost to follow-up, and 53 (73.6%) completed the entire intervention. Nurses in the intervention group showed significant improvement in anxiety ( d=0.67, 95% CI 0.33-1.00) and depression symptoms ( d=0.58, 95% CI 0.25-0.91), and the effects were sustained for 3 months after the intervention (anxiety: d=0.55, 95% CI 0.22-0.89; depression: d=0.66, 95% CI 0.33-1.00). Changes in psychological flexibility, cognitive defusion, and values mediated the effect of the intervention on anxiety and depression symptoms, while mindfulness did not have a mediating effect.

Conclusions

The web- and mobile-based ACT intervention used in this study significantly improved nurses’ anxiety and depression symptoms by improving psychological flexibility, cognitive defusion, and values. The results provide new ideas for hospital administrators to prevent and intervene in nurses’ psychological issues.

Trial Registration

Chinese Clinical Trial Register ChiCTR2200059218; https://tinyurl.com/4mb4t5y9

Related collections

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Acceptance and commitment therapy: model, processes and outcomes.

Steven C. Hayes, Jason B Luoma, Frank W Bond … (2006)

The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional Cognitive-Behavior Therapy (CBT). There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data are promising.

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Author and article information

Contributors

Fenglin Cao:

ORCID: https://orcid.org/0000-0002-6292-6840

Department of Nursing PsychologySchool of Nursing and RehabilitationShandong University44 Wenhua West RoadLixia DistrictJinan, 250012China86 13065093172caofenglin2008@126.com

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J Med Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: 2023

Publication date (Electronic): 27 November 2023

Volume: 25

Electronic Location Identifier: e51549

Affiliations

[1 ] Department of Nursing Psychology School of Nursing and Rehabilitation Shandong University Jinan China

[2 ] School of Nursing The University of Texas at Austin Austin, TX United States

Author notes

Corresponding Author: Fenglin Cao caofenglin2008@ 123456126.com

Author information

Yan'e Lu https://orcid.org/0000-0002-4662-7154

Yang Li https://orcid.org/0000-0001-8901-3454

Yongqi Huang https://orcid.org/0000-0003-0303-6095

Xuan Zhang https://orcid.org/0000-0003-4286-0407

Juan Wang https://orcid.org/0000-0002-4656-6865

Liuliu Wu https://orcid.org/0000-0002-1162-5079

Fenglin Cao https://orcid.org/0000-0002-6292-6840

Article

Publisher ID: v25i1e51549

DOI: 10.2196/51549

PMC ID: 10714267

PubMed ID: 38010787

SO-VID: 8e79ccf5-2522-40db-adce-c160d0194500

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 3 August 2023

Date revision requested : 19 September 2023

Date revision received : 4 October 2023

Date accepted : 24 October 2023

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