Hemmings Nicola R, Kawadler Jamie M, Whatmough Rachel, Ponzo Sonia, Rossi Alessio, Morelli Davide, Bird Geoffrey, Plans David
Department of Organizational Psychology, Birkbeck University of London, London, United Kingdom.
BioBeats Group Ltd, London, United Kingdom.
JMIR Form Res. 2021 Feb 9;5(2):e21737. doi: 10.2196/21737.
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.
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.
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.
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).
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.
广泛性焦虑障碍（GAD）的特征是过度担忧且难以控制，并且与包括抑郁症在内的情绪障碍共病率很高。患者诊断等待时间长，且常常面临治疗可及性障碍。需要一种GAD患者可获取且能接受的数字解决方案。
本文旨在描述一种针对GAD的接纳与承诺疗法（ACT）数字干预原型的开发，该原型存在于现有的健康应用程序平台BioBase中。对自我推荐参与研究的成年GAD患者样本进行了一项评估可接受性和可用性的试点可行性研究。
第一阶段采用以人为本的方法（制定指导原则、干预设计目标和关键干预特征）。在第二阶段，参与者使用基于应用程序的疗法并佩戴配对的可穿戴设备，为期2周。在基线和治疗后获取自我报告问卷。主要结果是心理灵活性（接纳与行动问卷-II [AAQ-II]），因为这是ACT的目标。还评估了心理健康（沃里克-爱丁堡心理健康量表 [WEMWBS]）以及焦虑症状（7项广泛性焦虑障碍评估 [GAD-7]）和抑郁症状（9项患者健康问卷 [PHQ-9]）。除了通过访谈进一步探讨该数字干预在该样本中的可行性外，还通过自我报告测量（系统可用性量表 [SUS]）评估治疗后的可用性。
基于应用程序的疗法受到好评。13名参与者中，10名（77%）完成了治疗。结果显示可用性评分很高（83.5）。参与者发现该数字干预与他们的情况相关、有用且有助于管理焦虑。参与者在结束时焦虑（d=0.69）和抑郁（d=0.84）得分较低，且这些差异与基线相比有显著差异（GAD-7和PHQ-9分别为P=.03和.008）。参与者在结束时心理灵活性和幸福感得分较高，尽管与基线相比无显著差异（AAQ-II和WEMWBS分别为P=.11和.55）。
BioBase中的这个ACT原型是一种可接受且可行的数字干预，可减轻焦虑和抑郁症状。本研究表明，这种干预值得在成年GAD患者中开展更大规模的可行性研究。
