ACTing towards better living during COVID-19: The effects of Acceptance and Commitment therapy for individuals affected by COVID-19

Probably not a substantial claim: may not pass S3 (load-bearing).

Psychological flexibility interventions are suitable for wide digital distribution to reach a broad audience.

“Gloster, Lamnisos, et al. (2020) note the suitability of psychological flexibility interventions to be widely distributed via digital means to reach a broad audience.”

• cites Gloster, Lamnisos, et al., 2020 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

Webinar ACT fidelity was assessed by two research team members using criteria based on ACT-FM, with scores 0-15.

“Webinars were videorecorded and the two research team members assessed the ACT fidelity of their delivery according to criteria based on the ACT-FM (O'Neill et al., 2019).”

• cites O'Neill et al., 2019 sourceSupported

May combine two claims.

Lower psychological flexibility is associated with poorer coping and increased psychopathology.

“while lower psychological flexibility is well-documented to be associated with poorer coping and increased psychopathology (Kashdan et al., 2006; Levin et al., 2014; Woodruff et al., 2014).”

• cites Kashdan et al., 2006 sourceNot checked — no full text of the source
• cites Levin et al., 2014 sourceSupported
• cites Woodruff et al., 2014 sourceNot checked — no full text of the source

May combine two claims.

Mean pre-intervention scores indicated participants were in the 'low' wellbeing range (below 19.3) and experiencing COVID-related distress (above 6 out of 10).

“Mean pre-intervention scores suggested at the beginning of the study participants were within the ‘low’ wellbeing range (below 19.3; Ng Fat et al., 2017) and were experiencing COVID-related distress (above 6 out of 10).”

• cites Ng Fat et al., 2017 sourceSupported

• AssumptionRests on an assumption: The single-item Likert question used to measure COVID-related distress is a valid measure of that construct.

Probably not a substantial claim: may not pass S3 (load-bearing).

Attrition rates are similar to those seen in a similar study.

“Attrition rates are similar to those seen a similar study (Price et al., 2012).”

• cites Price et al., 2012 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Price et al. found that previous experience of considering or using online mental health resources buffered against attrition, which may have been an unmeasured factor in this study.

“Price et al. investigated reasons for early dropout and found that previous experience of considering/using online mental health resources buffered against attrition – this may have been an (unmeasured) factor contributing to variable engagement in the current study.”

• cites Price et al. (2012) sourcePartly supported

  The Discussion (page not provided) says that previously considering mental health treatment and using the Internet for health-related information were associated with reduced nonuse attrition. It also links online health or mental-health information use to reduced access or completion attrition. The paper does not say participants had previously considered using *online* mental-health resources; that combines two distinct predictors. The possibility that this was an unmeasured factor in the citing authors’ study is their own inference. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The observed pattern of early dropout is like that in Price et al. (2012).

“The observed pattern of early dropout (including non-usage [i.e., pre-intervention] attrition) is like that observed by Price et al. (2012) in their (contextually comparable) study of a web-based intervention for post-disaster mental health.”

• cites Price et al. (2012) sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This finding is similar to existing literature that ACT consistently reduces depression, anxiety, and other mental health conditions.

“This finding is similar to existing literature – ACT has been consistently found to reduce rates of depression, anxiety, and other mental health conditions (Bai et al., 2020; Stenhoff et al., 2020; Swain et al., 2013).”

• cites Bai et al., 2020 sourceNot checked — no full text of the source
• cites Stenhoff et al., 2020 sourceNot checked — no full text of the source
• cites Swain et al., 2013 sourcePartly supported

  The Conclusion (p. 12) says the review provides preliminary support for ACT in treating anxiety, while emphasizing methodological limitations and the need for replication. The General anxiety symptoms section (p. 9) reports improvement in a trial including patients with anxiety and/or depression, but says outcomes were not broken down by condition. This source does not establish that ACT consistently reduces depression and other mental health conditions, or their rates. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Psychological flexibility is malleable and trainable to support coping with distressing events, and interventions targeting it may help mitigate mental health effects of the COVID-19 pandemic.

“Psychological flexibility has been found to be malleable and trainable to support individuals to cope with distressing events, and interventions which target psychological flexibility may be particularly helpful in mitigating the mental health effects of the COVID-19 pandemic (Gloster et al., 2017, 2020a; Kroska et al., 2020).”

• cites Gloster et al., 2017, 2020aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Kroska et al., 2020 sourceSupported

May combine two claims.

FIML has been shown to produce estimates that are the best estimates of true effects under missingness, outperforming other approaches.

“this approach has been shown to produce estimates that are the best estimates of true effects (observed in complete data sets) under conditions of missingness (e.g., Witkiewitz et al., 2014), outperforming other approaches to handling missing data.”

• cites Witkiewitz et al., 2014 sourcePartly supported

  The Abstract (Conclusions) says FIML and multiple imputation (MI) yielded the best estimates of treatment effects for a continuous heavy-drinking outcome when participants dropped out of an alcohol trial. The Discussion says they performed equally well, so the source does not support FIML outperforming MI or establish the claim for missing data generally. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

48 participants completed at least one baseline data point ('starters'); 22 in group one; 13 in groups two and three.

“48 participants completed at least one baseline data point (‘starters’); 22 participants in group one; and 13 participants in both groups two and three.”

May combine two claims.

Thirteen participants reported increased acceptance of difficult experiences, which positively affected their lives.

“Thirteen participants stated that their acceptance of difficult experiences had increased, which positively impact their lives”

May combine two claims.

Two participants reported not worrying about COVID daily as a result of the intervention; two reported distress but feeling calmer and more able to cope; four reported still being fearful of COVID-19.

“Two participants described “not worrying about COVID on a daily basis” (ppt20) as a result of the intervention; two participants expressed experiencing distress but feeling “calmer and more able to cope” (ppt14); and four participants reported being “still fearful of COVID-19” (ppt7).”

Probably not a substantial claim: may not pass S3 (load-bearing).

One participant with worsening mental health described acceptance as particularly reassuring within the intervention.

“One participant who reported worsening mental health post-intervention (due to changing life-circumstances) described acceptance as “particularly reassuring” within the intervention (ppt16).”

May combine two claims.

No significant changes occurred between post-intervention and two-month follow-up for outcomes that had significant pre-post changes, indicating maintenance.

“No significant changes were seen between post-intervention and two-month follow-up for outcome variables which demonstrated significant changes between pre- and post-interventions – indicating post-therapy change was maintained.”

• Also stated in: § Conclusion · plain

  “no significant changes were observed between post-intervention and two-month follow-up for outcome variables which demonstrated significant changes between pre- and post-intervention”

May combine two claims.

Some participants reported negative changes post-intervention, typically attributed to external COVID-19 factors such as lockdown restriction changes.

“Some participants reported negative changes post-intervention; participants typically attributed these to external COVID-19 factors (e.g., lockdown restriction changes).”

May combine two claims.

For all outcome variables except BA and COVID-related distress, significant pre- to post-intervention changes occurred, indicating improvement over therapy.

“For all outcome variables except BA and COVID-related distress, significant changes were found between pre- and post-intervention scores – indicating these had improved over the course of therapy.”

May combine two claims.

Effect sizes for outcomes with significant phase effects were small-to-medium, except overall psychological flexibility, which was medium-to-large.

“Small-to-medium effect sizes were found for all outcome variables which exhibited this significant effect, except for overall psychological flexibility which demonstrated a medium-to-large effect size (Cohen, 1988).”

• cites Cohen, 1988Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Of the three reporting worsening, one found the intervention unhelpful, one did not comment, and one found it helpful but felt difficulties exceeded therapy level due to changing life circumstances.

“Of these three, one found the intervention unhelpful (but did not further specify); one did not comment on the intervention; and one described the intervention as helpful but felt their “difficulties have escalated beyond this level of therapy” (due to changing life-circumstances; ppt16).”

May combine two claims.

BA showed significant differences between pre-intervention and two-month follow-up, and between post-intervention and two-month follow-up.

“Regarding BA, significant differences were found between pre-intervention and two-month follow-up scores, as well as between post-intervention and two-month follow-up.”

May combine two claims.

Participants noted valued action rather than values clarity was helpful, but both were described as useful.

“Participants particularly noted valued action (rather than values clarity) was helpful, however both were described as useful”

May combine two claims.

Overall psychological flexibility improved with medium-to-large effect sizes, but differences were found between the three sub-processes.

“Overall psychological flexibility improved, demonstrating medium-to-large effect sizes, yet analysis found differences between the three sub-processes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One participant provided only one comment, describing the intervention as interesting self-reflection.

“One participant only provided one comment regarding the intervention within the post-intervention survey, which was that the intervention provided “interesting self-reflection” (ppt4).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One participant attributed increased anxiety to the COVID-19 pandemic; the other did not give a reason.

“One participant (ppt12) specified that this was due to the COVID-19 pandemic, whereas the second (ppt18) did not express a reason.”

May combine two claims.

Participants reported feeling more positive and better about things, and some referenced feelings of wellbeing.

“Participants reported feeling “more positive” (ppt10) and “better about things” (ppt6), however some participants also referenced “feelings of wellbeing” (ppt20) specifically.”

May combine two claims.

Participants attributed improved wellbeing to using psychological flexibility processes, adding credibility to the idea.

“participants attributed improved wellbeing to using psychological flexibility processes (in their qualitative responses) – adding credibility to this idea.”

May combine two claims.

Of those who mentioned COVID-related distress, participants described either no longer experiencing it or experiencing but coping better.

“Of those that did, participants described either no longer experiencing COVID-related distress, or experiencing but coping better with COVID-related distress.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Twelve participants referenced anxiety.

“Twelve participants referenced ‘anxiety’.”

May combine two claims.

VA and OE showed significant improvements over timepoints, whereas BA showed no improvement until follow-up.

“Conversely, both VA and OE demonstrated significant improvements throughout the intervention when exploring the effect of timepoint, whereas BA showed no improvement until follow-up.”

May combine two claims.

Participants attributed outcomes to intervention techniques and increased psychological flexibility processes.

“Participants attributed outcomes to intervention techniques and increased psychological flexibility processes.”

May combine two claims.

Most participants reported general mental health improvement; two reported no change; three reported worsening.

“most participants reported a general improvement; two participants reported no changes; and three participants reported worsening mental health.”

May combine two claims.

Following the intervention, significant improvements were found for wellbeing, overall psychological flexibility (and VA), and general psychological distress (including depression, stress, anxiety).

“Following the intervention, significant improvements were found for wellbeing, overall psychological flexibility (and one sub-process, VA) and general psychological distress (including depression, stress, and anxiety).”

Probably not a substantial claim: may not pass S3 (load-bearing).

No participant gave a response inconsistent with the insight theme.

“No participant gave a response that was inconsistent with (i.e., reputational to) this theme.”

May combine two claims.

Improved wellbeing was mentioned by 13 participants, making it the second most mentioned effect after changes in psychological flexibility processes.

“Improved wellbeing as an effect of the intervention was mentioned by 13 participants, making this the second most mentioned effect of the intervention after changes in psychological flexibility processes.”

May combine two claims.

Participants reported feeling more confident in decisions, working on themselves more, and giving themselves time to reflect daily.

“Participants reported feeling “more confident in making decisions” (ppt2), “working on myself more” (ppt10) and that they now “give [themselves] time to reflect each day” (ppt7).”

May combine two claims.

VA and BA showed significant phase effects with small-to-medium effect sizes, whereas OE did not.

“VA and BA both demonstrated a significant phase effect (following the addition of the intervention) with small-to-medium effect sizes, whereas no such effects were found for OE.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most themes had at least one contradictory opinion to the majority view.

“Most themes had at least one contradictory opinion to the majority view.”

May combine two claims.

Eight participants discussed finding defusion helpful and used it to aid other processes.

“Eight participants discussed finding defusion helpful, using defusion to aid other processes”

Probably not a substantial claim: may not pass S3 (load-bearing).

Content analysis identified five main themes regarding the intervention's effects.

“content analysis found five main themes regarding the effects of the intervention.”

May combine two claims.

Several participants remained anxious post-intervention but felt they coped better.

“Several participants described remaining anxious post-intervention, but felt they coped better”

May combine two claims.

Qualitatively, participants mentioned all three processes equally, but described OE and VA techniques in detail while only vaguely referencing BA.

“Qualitatively, participants mentioned all three processes equally, yet described OE and VA techniques in detail whilst only vaguely referencing BA factors.”

May combine two claims.

Qualitative results supported quantitative findings: most participants reported improved mental health (particularly anxiety) and improved wellbeing.

“Qualitative results supported quantitative findings: most participants reported improved mental health (particularly anxiety) and improved wellbeing.”

May combine two claims.

COVID-related distress scores were high at pre- and post-intervention (mean above 6/10) and did not change significantly, suggesting participants were distressed by COVID-19 throughout the study.

“COVID-related distress scores were high at both pre- and post-intervention (with a mean score of above 6 out of 10) and did not change significantly, suggesting participants were distressed by COVID-19 throughout the study.”

May combine two claims.

Eight participants discussed finding mindfulness helpful and reported increased present-moment awareness, but gave no further detail on wider effects.

“Eight participants discussed finding mindfulness helpful and reported increased present-moment awareness post-intervention, however no participant gave further detail on any wider effects.”

May combine two claims.

Two participants said the intervention's effects extended beyond COVID and also reduced COVID-related distress.

“Two participants expressed that the effects of the intervention had “hit wider than COVID” (ppt17), as well as reducing COVID-related distress.”

May combine two claims.

All domains of psychological distress (overall distress, depression, anxiety, stress) significantly reduced following the intervention and were maintained at follow-up.

“all domains of psychological distress (including overall distress, depression, anxiety and stress), significantly reduced following the introduction of the intervention which was maintained at follow-up.”

May combine two claims.

COVID-related distress did not reduce following the intervention, possibly due to measurement limitations.

“COVID-related distress did not reduce following the intervention; however, this may be due to limitations in the ways in which this was measured.”

May combine two claims.

Most participants commented about the modules; comments were typically positive, but some activities and sections were noted as unhelpful or inaccessible.

“most participants commented about the modules in the post-intervention survey. Comments were typically positive; however, some activities and sections were noted to be unhelpful or inaccessible.”

May combine two claims.

The study found the intervention improved wellbeing and psychological distress but had limited effect on COVID-related distress.

“The study found that the intervention improved wellbeing and psychological distress yet had a limited effect on COVID-related distress.”

May combine two claims.

Several participants described anxiety of similar or greater intensity than before but felt more able to cope.

“several participants described experiences of anxiety (of similar or greater intensity as before intervention) yet felt more able to cope with these experiences.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Baseline differences between intervention completers and non-completers were explored using independent t-tests and Fisher exact tests.

“We also explored baseline differences between intervention completers versus non-completers using independent t-tests (for continuous variables) and Fisher exact tests (for categorical variables).”

Classified as probably not a substantial claim.

ACT seeks to increase psychological flexibility and wellbeing by targeting six core processes.

“ACT seeks to increase psychological flexibility, and thus wellbeing, by targeting the six psychological flexibility core processes.”

• cites Harris, 2019Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Hayes et al., 2012 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Residual normality and linearity were examined, and an AR1 covariance structure was used to handle anticipated autocorrelation.

“For each outcome model, we checked for normality of residuals (via histograms) and linearity (via scatterplots); we expected that the assumption of independence structure would be violated given likely autocorrelation over time (serial dependence in observations) and thus modelled a first-order autoregressive covariance structure (AR1) to account for this.”

Classified as probably not a substantial claim.

Baseline data for each weekly outcome were checked for significant trends to see whether a stable baseline had been reached.

“For each of the (six) weekly outcome and process variables (wellbeing, COVID-related distress, psychological flexibility, OE, BA, VA), baseline data were first explored for significant trends (i.e., any within-phase effect of time) to determine if a stable baseline was achieved.”

May combine two claims.

A meta-analysis of thirteen studies established that ACT guided self-help may help ease depression and anxiety distress, with increased clinician support improving outcomes.

“A meta-analysis reviewing thirteen studies established that ACT guided self-help may help to ease the distress of depression and anxiety, with increased clinician support improving outcomes (French et al., 2017).”

• cites French et al., 2017 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A recent large-scale UK survey found that more than half of respondents satisfied criteria for common mental health conditions.

“In a recent large-scale UK survey, over half of respondents met criteria for common mental health conditions (Pieh et al., 2020).”

• cites Pieh et al., 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

ACT aims to help individuals live alongside psychological pain, regardless of distress manifestation, to improve overall wellbeing.

“ACT aims to help individuals live alongside psychological pain, regardless of the manifestation of the distress, to improve overall wellbeing.”

• cites Harris, 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Hayes et al., 2012 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

ACT holds that psychological pain is a normal and unavoidable reaction to hard circumstances.

“ACT posits that psychological pain is a healthy and inevitable response to difficult situations (Harris, 2006; Hayes et al., 2012).”

• cites Harris, 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Hayes et al., 2012 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

According to ACT, mental health problems are believed to stem from trying too hard to avoid or control pain, which produces rigid behaviour and interferes with valued activities.

“Mental ill-health is thought to arise from excessive attempts to avoid or control this pain, resulting in rigid and inflexible behaviour which disrupts personally meaningful activities.”

• cites Harris, 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Hayes et al., 2012 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A concurrent triangulation design was applied to mixing methods, with quantitative and qualitative data analysed separately then interpretively synthesised and triangulated.

“We applied a concurrent triangulation design (convergence model) in our approach to mixing methods (Creswell & Piano Clark, 2017). Quantitative and qualitative data were analysed separately (reported in the results section) and then interpretively synthesised and triangulated (in the discussion section).”

• cites Creswell & Piano Clark, 2017Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

COVID-related distress is not confined to people who work directly with the virus or are infected, and it may be widespread in the population.

“This suggests distress related to COVID-19 affects more than just those directly working with or suffering from the virus and may be pervasive throughout the population.”

May combine two claims.

ACT consistency of module materials was assessed by two trained research team members not involved in adaptation, who agreed all ACT sub-processes were well-represented and materials were model-consistent.

“The ACT consistency of module materials was assessed by two members of the research team trained in ACT who were not involved in the adaptation process prior to the start of the study: Assessors agreed that all ACT sub-processes were well-represented and that materials were model-consistent (with reference to Hayes & Smith, 2005).”

• cites Hayes & Smith, 2005Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Longitudinal data analyses such as MLM can explain variation over time within and between participants and are robust against missing data points.

“Longitudinal data analyses (such as multilevel modelling; MLM) are able to explain variation over time, both within and between participants, and are robust against missing data points (Tasca & Gallop, 2009).”

• cites Tasca & Gallop, 2009 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Because the analyses were exploratory and secondary, no correction for multiple comparisons was applied; however, the authors flag effects that would fail a Bonferroni threshold.

“Given the exploratory and secondary nature of these analyses, no adjustments were made for multiple comparisons. However, to illustrate the impact of applying multiplicity adjustments, we note where significant effects would not survive Bonferroni correction.”

May combine two claims.

Table 4 shows similar demographic variables, wellbeing and COVID-related distress pre-intervention scores between starters and completers.

“Table 4 provides demographic information for ‘starters’ compared to ‘completers’, and shows similar demographic variables, as well as wellbeing and COVID-related distress pre-intervention scores, between the two.”

Probably not a substantial claim: may not pass S3 (load-bearing).

18 participants completed both one- and two-month follow-up measures.

“Eighteen participants completed both one- and two-month follow-up measures.”

May combine two claims.

All improvements were sustained at follow-up, suggesting lasting change.

“All improvements were sustained at follow-up, suggesting lasting change.”

May combine two claims.

20 participants completed the six-week intervention ('completers'), with majority attrition in baseline (n=15) and early intervention (n=12 pre-midpoint; n=2 post-midpoint).

“20 participants completed the six-week intervention (‘completers’), with the majority of attrition occurring within the baseline phase (n = 15) and early in the intervention phase (n = 12 pre-midpoint; n = 2 post-midpoint).”

May combine two claims.

Results suggest improvements in wellbeing may come from overall improvement in psychological flexibility and may occur without improvements in specific sub-processes.

“These results could suggest that improvements in wellbeing come from an overall improvement in psychological flexibility, and therefore may still occur in the absence of improvements in specific sub-processes.”

May combine two claims.

Change in VA was consistently evidenced across analyses and had the greatest phase-change effect size, indicating increased valued living may be particularly potent.

“change in VA was consistently evidenced across analyses (and demonstrated the greatest effect size in phase-change analyses), indicating that (of ACT processes that might be contributory to outcome changes) increased engagement in valued living may be particularly potent.”

May combine two claims.

Normality and linearity assumptions were adequate, and autocorrelation was accounted for in the multilevel models.

“Parametric assumptions of normality were assessed and found to be adequate, data were found to be linear, and auto-correlation was taken into account during MLM modelling to accommodate the assumption of independent data points.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The absence of change in COVID-related distress scores might reflect problems with methods or measurement.

“No change in COVID-related distress scores may be due to methodological and measurement issues.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All 20 intervention completers completed the post-intervention survey, but three provided minimal information, so their views may not be fully represented.

“All 20 intervention-completers engaged in the post-intervention survey, however three participants provided minimal information (fewer than four comments each). These participants' views may, therefore, not be fully represented in analysis.”

Probably not a substantial claim: may not pass S4 (based).

Recent literature suggests psychological flexibility may moderate COVID-related distress.

“Recent literature suggests that psychological flexibility, the underlying process of ACT, may moderate COVID-related distress – making ACT a promising psychotherapy candidate.”

May combine two claims.

Although fewer participants mentioned self-worth, it was mentioned repeatedly and was clearly important for those individuals.

“Although fewer participants mentioned this area, it was mentioned repeatedly and was clearly of importance for these individuals.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

22 participants completed post-intervention measures, including two who withdrew during intervention and offered to complete exit measures.

“22 participants completed post-intervention measures, including two participants who withdrew during the intervention phase and offered to complete exit measures.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Detailed information about module use was not gathered.

“Detailed information regarding module use was not gathered as this was outside the aims of this study”

May combine two claims.

Completers and non-completers did not show substantive baseline differences, but unmeasured differences may account for dropout.

“In terms of measured variables, completers and non-completers did not show substantive differences at baseline, but there may be unmeasured differences accounting for dropout.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

At the time of writing, this is the first study to implement an ACT intervention to explore its effects.

“At the time of writing, this is the first study to implement an ACT intervention to explore the effects of this.”

May combine two claims.

At the time of writing, this is the first study to proceed to intervention and demonstrate that ACT improves wellbeing within the COVID-19 pandemic context.

“At the time of writing, this is the first study to proceed to intervention and demonstrate that ACT, an intervention targeting psychological flexibility, improves wellbeing within the context of the COVID-19 pandemic.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Findings regarding COVID-related distress should be seen as an indication of participants' experiences rather than firm conclusions and warrant further investigation.

“this study's findings regarding COVID-related distress may be seen as an indication of participants' experiences, rather than firm conclusions, and warrant further scientific investigation.”

May combine two claims.

The intervention demonstrated promising effects using scalable and remotely deliverable materials suited to the current context.

“The intervention has demonstrated promising effects utilising a scalable and remotely deliverable materials (suited to the current context)”

May combine two claims.

The study presents a scalable, flexible, remotely accessible intervention suited to delivery in the current climate.

“This study also presents a scalable intervention (i.e., one that could be readily adapted to greater demand, as a low-resource digital provision) which is flexible and remotely accessible: making it well suited to delivery within the current climate.”

May combine two claims.

The non-concurrent baseline, time-series design, and multiple testing improved internal validity.

“The non-concurrent baseline, time-series design and multiple testing improved internal validity”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The anonymous format of the post-intervention survey may have reduced demand characteristics, supporting the findings.

“the anonymous format of the post-intervention survey may have reduced demand characteristics – further supporting the findings of the study and highlighting an important study strength.”

May combine two claims.

Both quantitative and qualitative findings suggest ACT improves wellbeing, psychological flexibility, and psychological distress.

“Both quantitative and qualitative findings suggest ACT improves wellbeing, as well as psychological flexibility and psychological distress.”

May combine two claims.

Findings regarding increased wellbeing and lower psychological distress were established using measures with strong psychometric qualities and may be more representative of the intervention's effects.

“The findings regarding increased wellbeing and lower psychological distress, however, were established using measures with strong psychometric qualities, and therefore these findings may be more representative of the effects of the intervention.”

May combine two claims.

The single weekly question may not have fully or accurately captured COVID-related distress, so findings related to it may not be valid or reliable.

“It may be that this question did not fully or accurately capture COVID-related distress, meaning findings related to COVID-related distress may not be valid or reliable.”