VTT Technical Research Centre of Finland Ltd, Tampere, Finland.
JMIR Mhealth Uhealth. 2016 Jul 28;4(3):e90. doi: 10.2196/mhealth.5241.
Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT).
To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility.
An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied.
The median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=-0.10, P=.01), usage days (B=-0.17, P=.008), and usage weeks (B=-0.73, P=.02), the number of exercises performed (B=-0.02, P=.03), and the total duration of use (B=-0.30, P=.04). Also, higher usage of Acceptance related exercises (B=-0.18, P=.04) was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study.
The results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement.
ClinicalTrials.gov NCT01738256; https://clinicaltrials.gov/ct2/show/NCT01738256 (Archived by WebCite at http://www.webcitation.org/6iTePjPLL).
手机应用程序为提供心理干预提供了一个有前景的媒介。我们开发并研究了一款基于接纳与承诺疗法（ACT）的手机应用程序，这是一项随机对照试验（RCT）。
研究基于移动设备的接受与承诺疗法干预的使用情况指标，并分析使用情况与心理灵活性改善之间的剂量反应关系。
开展了一项 RCT 来研究不同生活方式干预对有心理压力的超重人群的有效性。本研究对接受 8 周移动 ACT 干预的组进行了二次分析。在分析的 74 名参与者中，大多数为女性（n=64，86%）。他们的中位年龄为 49.6（四分位距，IQR 45.4-55.3）岁，使用接纳与行动问卷 II 测量的心理灵活性平均水平为 20.4（95%置信区间 18.3-22.5）。计算了几个描述使用强度、使用内容和使用方式的使用情况指标。进行线性回归分析，以研究使用与心理灵活性改善之间的剂量反应关系，并确定与改善关联最强的使用情况指标。进一步进行二项逻辑回归分析，以评估使用情况指标在心理灵活性改善者和未改善者之间的作用。此外，还研究了使用情况与基线参与者特征之间的关系。
中位数使用会话数为 21（IQR 11.8-35），使用天数为 15（IQR 9.0-24），使用周数为 7.0（IQR 4.0-8.0）。参与者使用移动应用程序的中位数时长为 4.7（IQR 3.2-7.2）小时，中位数完成 63（IQR 46-98）次练习。使用情况与心理灵活性改善之间存在剂量反应关系。与心理灵活性关联最强的指标（结果经过性别、年龄和基线心理变量调整）为自我作为相关练习的较低使用率（B=0.22，P=.001）和更高的使用强度，由使用会话数（B=-0.10，P=.01）、使用天数（B=-0.17，P=.008）和使用周数（B=-0.73，P=.02）、完成的练习数（B=-0.02，P=.03）和总使用时长（B=-0.30，P=.04）描述。此外，更高的接纳相关练习使用率（B=-0.18，P=.04）与改善相关。积极使用与女性性别、年龄较大以及在研究前没有智能手机有关。
研究结果表明，积极使用移动接受与承诺疗法干预与改善心理灵活性有关。与改善相关最强的使用情况指标包括描述使用强度的指标以及与内容使用相关的两个指标。
ClinicalTrials.gov NCT01738256；https://clinicaltrials.gov/ct2/show/NCT01738256（由 WebCite 存档；http://www.webcitation.org/6iTePjPLL）。
