Periodic Reporting for period 1 - IMPACT (Implementation of ACT in Daily Life)
Reporting period: 2019-09-01 to 2022-02-28
Summary of the context and overall objectives of the project
The “Acceptance and Commitment Therapy in Daily Life intervention” is a blended care intervention combining face-to-face sessions of Acceptance and Commitment Therapy with an ACT-DL app, on which patients and clients can practice ACT exercises in their daily lives. Within the current IMPACT project (project nr. 842501]), our aim was to extend the ACT-DL app as developed in previous projects (Batink et al., 2016; Myin-Germeys et al., 2022; van Aubel et al., 2020) within a research context on the PsyMate™ (www.psymate.eu) platform into a clinical app that could be implemented in a naturalistic clinical setting. In order to do so, we worked on four key objectives.
First, we have taken several steps to transform the PsyMate™ ACT-DL app into an app that can be used by patients and therapists in a clinical naturalistic setting. Based on data analysis of the feasibility and usability data of the PsyMate™ ACT-DL app as tested within our previous INTERACT trial (ERC consolidator grant, project 309767), we translated some of the key findings into recommendations for app optimization. We then partnered with m-Path as our app developer. M-Path (https://m-Path.io/landing/(opens in new window)) is a blended care tool developed by the research group of Quantitative Psychology and Individual Differences at KU Leuven. It consists of (a) an app on which patients can receive experience sampling method (ESM) questionnaires and (b) a web-based dashboard which clinicians can access via their computer. On the dashboard, clinicians can program specific ESM questionnaires and the notification schedule of these questionnaires for their patients as well as view their ESM data in various forms of data visualizations. New features were programmed within m-Path to ensure the development of an optimized ACT-DL app and dashboard, which in its current version includes, most importantly (1) the possibility to install the app on a personal smartphone with either an Android or iPhone operating system, (2) a modular approach to offer the various ACT skills to patients, (3) a built-in algorithm that triggers the most relevant ACT exercise within a specific moment, and (4) the possibility for ACT therapists, in a shared decision process with patients, to program the content of the ESM questionnaires as well as the notification schedule of these questionnaires, and to visualize ESM data gathered within these questionnaires on a dashboard on their computer.
Second, given our choice to work with m-Path as an independent platform, we choose an implementation strategy where patients remained the owner of their data. Data were thus not integrated in existing electronic patient data systems. This implementation strategy ensured that it was feasible to recruit ACT therapists across various settings (including psychiatric hospitals, mental health centers, and private practices) in Flanders, increasing the potential for further scale-up at the end of the IMPACT project. In addition, as part of our implementation strategy, we developed various training materials for therapists to facilitate the implementation of the intervention within their own workflow, including, amongst others, a short introductory video on IMPACT, and a therapy manual providing guidance on the session content, set-up and personalization of the ACT-DL app on the dashboard, visualization and integration of ESM data visualizations within the session.
Third, after an internal pilot in our lab in which colleagues tested the ACT-DL app to resolve any potential issues (content and technology) with the app, we conducted a pilot implementation trial which received favorable ethical opinion from the METC UZ Leuven. Our pilot implementation study aimed to investigate (1) the ACT-DL implementation feasibility within Flemish routine mental health care, (2) the clinical feasibility and usability of ACT-DL, (3) the preliminary effectiveness of ACT-DL on client empowerment, symptom distress, negative symptoms, wellbeing, quality of life, recovery, and social functioning, and (4) finally, the generalizability of results across various mental health settings. Our aim was to recruit a minimum of n=12 therapists, each with a minimum of n=4 clients, resulting in a minimum of a n=48 clients in total. Although we have ended recruitment by the end of February 2022, some of the post-measurements are still ongoing, which precludes, following open science framework (www.osf.io) and clinical trial analysis good practices, accessing our data at this stage. The final post-measurement is planned in June 2022. The analyses and write up of the results of the pilot implementation trial is planned for the summer of 2022.
Our fourth and final objective was to develop a business plan outlining how we would integrate ACT-DL in the existing clinical pathways to care in psychiatry. An interesting distributional route of the ACT-DL intervention would be to sell the intervention as a package to ACT therapists, which they would pay once. This package would include an online therapy manual including (1) the therapy protocol per session, (2) tutorials on how to set up the intervention, how to personalize its various elements, and how to work with the visualized data within ACT sessions, and (3) the therapy handouts. Second, it would include a 3-hour workshop in which we (1) tailor our ACT-DL template to the specific needs of the setting or population in which the ACT therapist works and (2) explain how the therapist can further personalize their template to the needs of their individual clients. We are currently taking the next steps to elaborate our business plan by talking to potential investors to create opportunities to increase the market potential of ACT-DL in Flemish psychiatry and by applying for new funding opportunities that will allow us (a) to strengthen the evidence-base of the ACT-DL intervention and to improve our understanding of basic therapeutic mechanisms at play within the intervention and (b) to increase the technology readiness level of ACT-DL within specific project that aim to bring interventions closer to the market.
References
Batink, T., Bakker, J., Vaessen, T., Kasanova, Z., Collip, D., van Os, J., Wichers, M., Germeys, I., & Peeters, F. (2016). Acceptance and commitment therapy in daily life training: A feasibility study of an mhealth intervention. JMIR MHealth and UHealth, 4(3), e103. https://doi.org/10.2196/mhealth.5437(opens in new window)
Myin-Germeys, I., van Aubel, E., Vaessen, T., Steinhart, H., Klippel, A., Lafit, G., Viechtbauer, W., Batink, T., van Winkel, R., van der Gaag, M., van Amelsvoort, T., Marcelis, M., Schirmbeck, F., de Haan, L., & Reininghaus, U. (2022). Efficacy of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Results from the Multi-Center INTERACT Randomized Controlled Trial. Psychotherapy and Psychosomatics, 1–13. https://doi.org/10.1159/000522274(opens in new window)
van Aubel, E., Bakker, J. M., Batink, T., Michielse, S., Goossens, L., Lange, I., Schruers, K., Lieverse, R., Marcelis, M., van Amelsvoort, T., van Os, J., Wichers, M., Vaessen, T., Reininghaus, U., & Myin-Germeys, I. (2020). Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults: A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL). Behaviour Research and Therapy, 128, 103592. https://doi.org/10.1016/j.brat.2020.103592(opens in new window)
First, we have taken several steps to transform the PsyMate™ ACT-DL app into an app that can be used by patients and therapists in a clinical naturalistic setting. Based on data analysis of the feasibility and usability data of the PsyMate™ ACT-DL app as tested within our previous INTERACT trial (ERC consolidator grant, project 309767), we translated some of the key findings into recommendations for app optimization. We then partnered with m-Path as our app developer. M-Path (https://m-Path.io/landing/(opens in new window)) is a blended care tool developed by the research group of Quantitative Psychology and Individual Differences at KU Leuven. It consists of (a) an app on which patients can receive experience sampling method (ESM) questionnaires and (b) a web-based dashboard which clinicians can access via their computer. On the dashboard, clinicians can program specific ESM questionnaires and the notification schedule of these questionnaires for their patients as well as view their ESM data in various forms of data visualizations. New features were programmed within m-Path to ensure the development of an optimized ACT-DL app and dashboard, which in its current version includes, most importantly (1) the possibility to install the app on a personal smartphone with either an Android or iPhone operating system, (2) a modular approach to offer the various ACT skills to patients, (3) a built-in algorithm that triggers the most relevant ACT exercise within a specific moment, and (4) the possibility for ACT therapists, in a shared decision process with patients, to program the content of the ESM questionnaires as well as the notification schedule of these questionnaires, and to visualize ESM data gathered within these questionnaires on a dashboard on their computer.
Second, given our choice to work with m-Path as an independent platform, we choose an implementation strategy where patients remained the owner of their data. Data were thus not integrated in existing electronic patient data systems. This implementation strategy ensured that it was feasible to recruit ACT therapists across various settings (including psychiatric hospitals, mental health centers, and private practices) in Flanders, increasing the potential for further scale-up at the end of the IMPACT project. In addition, as part of our implementation strategy, we developed various training materials for therapists to facilitate the implementation of the intervention within their own workflow, including, amongst others, a short introductory video on IMPACT, and a therapy manual providing guidance on the session content, set-up and personalization of the ACT-DL app on the dashboard, visualization and integration of ESM data visualizations within the session.
Third, after an internal pilot in our lab in which colleagues tested the ACT-DL app to resolve any potential issues (content and technology) with the app, we conducted a pilot implementation trial which received favorable ethical opinion from the METC UZ Leuven. Our pilot implementation study aimed to investigate (1) the ACT-DL implementation feasibility within Flemish routine mental health care, (2) the clinical feasibility and usability of ACT-DL, (3) the preliminary effectiveness of ACT-DL on client empowerment, symptom distress, negative symptoms, wellbeing, quality of life, recovery, and social functioning, and (4) finally, the generalizability of results across various mental health settings. Our aim was to recruit a minimum of n=12 therapists, each with a minimum of n=4 clients, resulting in a minimum of a n=48 clients in total. Although we have ended recruitment by the end of February 2022, some of the post-measurements are still ongoing, which precludes, following open science framework (www.osf.io) and clinical trial analysis good practices, accessing our data at this stage. The final post-measurement is planned in June 2022. The analyses and write up of the results of the pilot implementation trial is planned for the summer of 2022.
Our fourth and final objective was to develop a business plan outlining how we would integrate ACT-DL in the existing clinical pathways to care in psychiatry. An interesting distributional route of the ACT-DL intervention would be to sell the intervention as a package to ACT therapists, which they would pay once. This package would include an online therapy manual including (1) the therapy protocol per session, (2) tutorials on how to set up the intervention, how to personalize its various elements, and how to work with the visualized data within ACT sessions, and (3) the therapy handouts. Second, it would include a 3-hour workshop in which we (1) tailor our ACT-DL template to the specific needs of the setting or population in which the ACT therapist works and (2) explain how the therapist can further personalize their template to the needs of their individual clients. We are currently taking the next steps to elaborate our business plan by talking to potential investors to create opportunities to increase the market potential of ACT-DL in Flemish psychiatry and by applying for new funding opportunities that will allow us (a) to strengthen the evidence-base of the ACT-DL intervention and to improve our understanding of basic therapeutic mechanisms at play within the intervention and (b) to increase the technology readiness level of ACT-DL within specific project that aim to bring interventions closer to the market.
References
Batink, T., Bakker, J., Vaessen, T., Kasanova, Z., Collip, D., van Os, J., Wichers, M., Germeys, I., & Peeters, F. (2016). Acceptance and commitment therapy in daily life training: A feasibility study of an mhealth intervention. JMIR MHealth and UHealth, 4(3), e103. https://doi.org/10.2196/mhealth.5437(opens in new window)
Myin-Germeys, I., van Aubel, E., Vaessen, T., Steinhart, H., Klippel, A., Lafit, G., Viechtbauer, W., Batink, T., van Winkel, R., van der Gaag, M., van Amelsvoort, T., Marcelis, M., Schirmbeck, F., de Haan, L., & Reininghaus, U. (2022). Efficacy of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Results from the Multi-Center INTERACT Randomized Controlled Trial. Psychotherapy and Psychosomatics, 1–13. https://doi.org/10.1159/000522274(opens in new window)
van Aubel, E., Bakker, J. M., Batink, T., Michielse, S., Goossens, L., Lange, I., Schruers, K., Lieverse, R., Marcelis, M., van Amelsvoort, T., van Os, J., Wichers, M., Vaessen, T., Reininghaus, U., & Myin-Germeys, I. (2020). Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults: A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL). Behaviour Research and Therapy, 128, 103592. https://doi.org/10.1016/j.brat.2020.103592(opens in new window)