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BackgroundAcceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands. ObjectiveThis study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis. MethodsIn the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes. ResultsParticipants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=–4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=–0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=–1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app. ConclusionsOur results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. Trial RegistrationOMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803

Abstract Background Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes. Methods We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. Results The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). Conclusions This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated. Trial registration number ClinicalTrials.gov, NCT04325100 . Registered 27 March 27, 2020 -retrospectively registered. Reporting Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement were followed.

Abstract Background Psychotic experiences, social functioning and general psychopathology are important targets for early intervention in individuals with Ultra-High-Risk state (UHR) and a first-episode psychosis (FEP). Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets, but evidence on sustainable change and its underlying mechanisms in individuals’ daily lives remains limited. The aim of the INTERACT study is to investigate the efficacy of a novel ecological momentary intervention, Acceptance and Commitment Therapy in Daily Life (ACT-DL) in a multi-centre randomised controlled trial of individuals with UHR or FEP. Methods/design In a multi-centre randomised controlled trial, individuals aged 16–65 years with UHR or FEP will be randomly allocated to ACT-DL in addition to treatment as usual (TAU) as the experimental condition or a control condition of TAU only, which will include – for the entire study period – access to routine mental health care and, where applicable, CBT for psychosis (CBTp). Outcomes will be assessed at baseline (i.e. before randomisation), post-intervention (i.e. after the 8-week intervention period), and 6-month and 12-month follow-ups (i.e. 6 and 12 months after completing the intervention period) by blinded assessors. The primary outcome will be distress associated with psychotic experiences, while secondary outcomes will include (momentary) psychotic experiences, social functioning and psychopathology. Process measures to assess putative mechanisms of change will include psychological flexibility, stress sensitivity and reward experiences. In addition, acceptability, treatment adherence and treatment fidelity of ACT-DL will be assessed. Discussion The current study is the first to test the efficacy of ACT-DL in individuals with UHR and FEP. If this trial demonstrates the efficacy of ACT-DL, it has the potential to significantly advance the treatment of people with UHR and FEP and, more generally, provides initial support for implementing mHealth interventions in mental health services. Trial registration Netherlands Trial Register, ID: NTR4252. Registered on 26 September 2013.