Optimizing an Acceptance and Commitment Therapy Microintervention Via a Mobile App With Two Cohorts: Protocol for Micro-Randomized Trials
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Abstract
Background: Given gaps in the treatment of mental health, brief adaptive interventions have become a public health imperative. Transdiagnostic interventions may be particularly appropriate given high rates of medical comorbidity and the broader reach of transdiagnostic therapies. One such approach utilized herein is acceptance and commitment therapy (ACT), which is focused on increasing engagement with values, awareness, and openness to internal experiences. ACT theory posits that experiential avoidance is at the center of human suffering, regardless of diagnosis, and, as such, seeks to reduce unworkable experiential avoidance. Objective: Our objective is to provide the rationale and protocol for examining the safety, feasibility, and effectiveness of optimizing an ACT-based intervention via a mobile app among two disparate samples, which differ in sociodemographic characteristics and symptom profiles. Methods: Twice each day, participants are prompted via a mobile app to complete assessments of mood and activity and are then randomly assigned to an ACT-based intervention or not. These interventions are questions regarding engagement with values, awareness, and openness to internal experiences. Participant responses are recorded. Analyses will examine completion of assessments, change in symptoms from baseline assessment, and proximal change in mood and activity. A primary outcome of interest is proximal change in activity (eg, form and function of behavior and energy consumed by avoidance and values-based behavior) following interventions as a function of time, symptoms, and behavior, where we hypothesize that participants will focus more energy on values-based behaviors. Analyses will be conducted using a weighted and centered least squares approach. Two samples will run concurrently to assess the capacity of optimizing mobile ACT in populations that differ widely in their clinical presentation and sociodemographic characteristics: individuals with bipolar disorder (n=30) and distressed first-generation college students (n=50). Results: Recruitment began on September 10, 2019, for the bipolar sample and on October 5, 2019, for the college sample. Participation in the study began on October 18, 2019. Conclusions: This study examines an ACT-based intervention among two disparate samples. Should ACT demonstrate feasibility and preliminary effectiveness in each sample, a large randomized controlled trial applying ACT across diagnoses and demographics would be indicated. The public health implications of such an approach may be far-reaching. Trial Registration: ClinicalTrials.gov NCT04098497; https://clinicaltrials.gov/ct2/show/NCT04098497; ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/ct2/show/NCT04081662 International Registered Report Identifier (IRRID): DERR1-10.2196/17086
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A microrandomized trial has been successfully applied to evaluate dynamic and user-tailored eHealth interventions focused on weight management, smoking cessation, and mental health.
“an MRT has been successfully applied to evaluate dynamic and user-tailored eHealth interventions focused on weight management [52], smoking cessation [53], and MH [54].”
From Optimization of a Transdiagnostic Mobile Emotion Regulation Intervention for University Students: Protocol for a Microrandomized Trial (2023) · cites this paper as [54]
For this citation, the relevant part of the sentence is mental health, not weight management or smoking cessation. The Introduction describes micro-randomized trials for mobile interventions, and the Results report that participation had begun in the two mental-health cohorts. But this is a protocol: it reports enrollment, not a completed or successful evaluation of the intervention. (LLM, conf=0.88)
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“…in-person therapy based on transdiagnostic approaches to emotional disorders [59], we assume a smaller effect size for our study, which is in line with the results of internet interventions for MH in university students [27] and with a similar MRT study protocol examining an ACT intervention [54].”
MethodResultA Mixed-Methods Analysis of Mobile ACT Responses From Two Cohorts
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- Authors
- Kroska, E. B., Hoel, S., Victory, A., Murphy, S. A., McInnis, M. G., Stowe, Z. N., & Cochran, A.
- Affiliations
- University of Iowa (US)
- University of Wisconsin–Madison (US)
- University of Michigan (US)
- Harvard University (US)
- Corresponding author
- Cochran, Amy
- ORCID
- Venue
- JMIR Research Protocols
- Publisher
- JMIR Publications Inc.
- Published
- 2020-09-23
- Volume
- 9
- Issue
- 9
- Pages
- e17086
- ISSN
- 1929-0748 (ISSN-L)
- PMC
- PMC7542401
- OpenAlex
- W3047046976
- Cited by
- 12
- References
- 53
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 2
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Research Protocols (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (UL1TR002373)
- National Institute on Alcohol Abuse and Alcoholism (R01AA023187)
- National Institute of Mental Health (K01MH112876)
- National Institute on Drug Abuse (P50DA039838)
- National Cancer Institute (U01CA229437)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- acceptance and commitment therapy, mobile app intervention, micro-randomized trial, adaptive interventions, transdiagnostic treatment, experiential avoidance, bipolar disorder, first-generation college students, intervention optimization, feasibility and safety, comorbidities
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