Development and feasibility of a digital acceptance and commitment therapy-based intervention for generalized anxiety disorder: pilot acceptability study

Nicola R. Hemmings*, Jamie M. Kawadler, Rachel Whatmough, Sonia Ponzo, Alessio Rossi, Davide Morelli, Geoffrey Bird, David Plans

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
33 Downloads (Pure)

Abstract

Background: Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD.

Objective: This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study.

Methods: Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. Results: The app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment.

Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for AAQ-II and WEMWBS, respectively).

Conclusions: This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD.

Original languageEnglish
Article numbere21737
Number of pages15
JournalJMIR Formative Research
Volume5
Issue number2
DOIs
Publication statusPublished - 9 Feb 2021

Bibliographical note

Funding Information:
The authors thank the study participants for their collaboration and honest feedback in this research project. This research has been supported by EU project H2020 SoBigData++ RI, grant #871042.

Publisher Copyright:
© Nicola R Hemmings, Jamie M Kawadler, Rachel Whatmough, Sonia Ponzo, Alessio Rossi, Davide Morelli, Geoffrey Bird, David Plans.

Keywords

  • Acceptance and commitment therapy
  • Anxiety
  • Depression
  • Digital
  • Mental health
  • MHealth
  • Mobile phone
  • Person-based approach
  • Remote
  • Smartphone

ASJC Scopus subject areas

  • Health Informatics
  • Medicine (miscellaneous)

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