Virtual Acceptance and Commitment Therapy (vACT) For Youth with Chronic Illnesses: A Case Report

Main Article Content

Mahrer N. E. Sommer V. S. Berman D. I. Ngo N Gold J. I.

Abstract

Youth with chronic medical conditions need accessible and effective mental health interventions to address high levels of disruption in their psychological, social, and emotional development. Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy based on behavioral interventions that combines the principles of Relational Frame Theory and Mindfulness. ACT has been shown to be effective in populations of youth with various chronic conditions. As telehealth use has increased, ACT has been administered virtually on an individual level to adults and adolescents with chronic conditions, including chronic pain and Type II diabetes. However, few studies have incorporated a group-based element to the virtual delivery of ACT, which may be more accessible, cost-effective and may have additional therapeutic value in the form of peer connection and cohesion. To investigate the potential benefits of a virtual group model, we developed a web-based virtual ACT (vACT) group intervention for youth with chronic illness aged 14-21. The 6-week virtual group consisted of 1.5-hour sessions that each focused on a unique ACT concept: acceptance, values, mindfulness, cognitive defusion, experiential avoidance, and willingness/commitment. Additionally, the sessions included exercises to engage group members and teach skills. Baseline, post-, and follow-up data were collected on stress, mental health, functional outcomes, and satisfaction from one participant, “Kasey”, a 14-year-old Latina adolescent with comorbid Type I diabetes, depression, and anxiety. This case report details the procedures for the vACT group, discusses the barriers, and provides examples and recommendations for future administration of the group model. The report also describes Kasey’s experience during the group and presents quantitative/qualitative data supporting her improvement. Kasey’s perceived stress declined across sessions, while her anxiety sensitivity and depressive symptoms improved from the moderate range to the mild range, with sustained improvements at follow-up. Additionally, Kasey reported improvements in her peer relations with sustained improvements at follow-up, which was initially a significant concern. This case report provides promising preliminary data for the virtual administration of a group-based ACT intervention. We hope that clinicians can use this approach to provide evidence-based services that can reach a wider range of youth with chronic illnesses who may not otherwise have access to care and/or are estranged from their peers.

Article Details

How to Cite
E., Mahrer N. et al. Virtual Acceptance and Commitment Therapy (vACT) For Youth with Chronic Illnesses: A Case Report. Medical Research Archives, [S.l.], v. 11, n. 6, june 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3897>. Date accessed: 15 may 2024. doi: https://doi.org/10.18103/mra.v11i6.3897.
Section
Case Reports

References

1. Compas BE, Jaser SS, Dunn MJ, Rodriguez EM. Coping with chronic illness in childhood and adolescence. Annu Rev Clin Psychol. 2012;8:455-480. doi:10.1146/annurev-clinpsy-032511-143108
2. Centers for Disease Control and Prevention. About Chronic Diseases. National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). https://www.cdc.gov/chronicdisease/about/index.htm. Published 2019. Accessed March 31, 2023.
3. Bethell CD, Kogan MD, Strickland BB, Schor EL, Robertson J, Newacheck PW. A national and state profile of leading health problems and health care quality for US children: Key insurance disparities and across-state variations. Acad Pediatr. 2011;11(3 SUPPL.):S22-S33. doi:10.1016/j.acap.2010.08.011
4. Pinquart M, Shen Y. Behavior problems in children and adolescents with chronic physical illness: A meta-analysis. J Pediatr Psychol. 2011;36(9):1003-1016. doi:10.1093/jpepsy/jsr042
5. Bai G, Houben-Van Herten M, Landgraf JM, Korfage IJ, Raat H. Childhood chronic conditions and health-related quality of life: Findings from a large population-based study. PLoS One. 2017;12(6):e0178539. doi:10.1371/journal.pone.0178539
6. Rodriguez EM, Dunn MJ, Zuckerman T, Vannatta K, Gerhardt CA, Compas BE. Cancer-related sources of stress for children with cancer and their parents. J Pediatr Psychol. 2012;37(2):185-197. doi:10.1093/jpepsy/jsr054
7. Hysing M, Elgen I, Gillberg C, Lie SA, Lundervold AJ. Chronic physical illness and mental health in children. Results from a large-scale population study. J Child Psychol Psychiatry Allied Discip. 2007;48(8):785-792. doi:10.1111/j.1469-7610.2007.01755.x
8. Pinquart M, Shen Y. Depressive symptoms in children and adolescents with chronic physical illness: An updated meta-analysis. J Pediatr Psychol. 2011;36(4):375-384. doi:10.1093/jpepsy/jsq104
9. Sansom-Daly UM, Peate M, Wakefield CE, Bryant RA, Cohn RJ. A systematic review of psychological interventions for adolescents and young adults living with chronic illness. Heal Psychol. 2012;31(3):380-393. doi:10.1037/a0025977
10. Fletcher L, Hayes SC. Relational frame theory, acceptance and commitment therapy, and a functional analytic definition of mindfulness. J Ration - Emotive Cogn - Behav Ther. 2005;23(4):315-336. doi:10.1007/s10942-005-0017-7
11. Hayes SC, Barnes-Holmes D, Roche B, eds. Relational Frame Theory:A Post-Skinnerian Account of Human Language and Cognition. Vol 28. Berlin: Springer Science & Business Media; 2001.
12. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and Commitment Therapy: Model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25. doi:10.1016/j.brat.2005.06.006
13. Wicksell RK, Melin L, Lekander M, Olsson GL. Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain - A randomized controlled trial. Pain. 2009;141(3):248-257. doi:10.1016/j.pain.2008.11.006
14. Wicksell RK, Olsson GL, Hayes SC. Mediators of change in Acceptance and Commitment Therapy for pediatric chronic pain. Pain. 2011;152(12):2792-2801. doi:10.1016/j.pain.2011.09.003
15. Moazzezi M, Moghanloo VA, Moghanloo RA, Pishvaei M. Impact of acceptance and commitment therapy on perceived stress and special health self-efficacy in seven to fifteen-year-old children with diabetes mellitus. Iran J Psychiatry Behav Sci. 2015;9(2):31-36. doi:10.17795/ijpbs956
16. Moghanloo VA, Moghanloo RA, Moazezi M. Effectiveness of acceptance and commitment therapy for depression, psychological well-being and feeling of guilt in 7-15 years old diabetic children. Iran J Pediatr. 2015;25(4):2436. doi:10.5812/ijp.2436
17. Woidneck MR, Morrison KL, Twohig MP. Acceptance and Commitment Therapy for the Treatment of Posttraumatic Stress Among Adolescents. Behav Modif. 2014;38(4):451-476. doi:10.1177/0145445513510527
18. Cantor JH, McBain RK, Kofner A, Hanson R, Stein BD, Yu H. Telehealth adoption by mental health and substance use disorder treatment facilities in the COVID-19 pandemic. Psych Services. 2022;73(4):411-417. doi: 10.1176/appi.ps.202100191
19. Lappalainen P, Langrial S, Oinas-Kukkonen H, Tolvanen A, Lappalainen R. Web-Based Acceptance and Commitment Therapy for Depressive Symptoms With Minimal Support: A Randomized Controlled Trial. Behav Modif. 2015;39(6):805-834. doi:10.1177/0145445515598142
20. Buhrman M, Skoglund A, Husell J, et al. Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial. Behav Res Ther. 2013;51(6):307-315. doi:10.1016/j.brat.2013.02.010
21. Trompetter HR, Bohlmeijer ET, Veehof MM, Schreurs KMG. Internet-based guided self-help intervention for chronic pain based on Acceptance and Commitment Therapy: A randomized controlled trial. J Behav Med. 2015;38(1):66-80. doi:10.1007/s10865-014-9579-0
22. Witlox M, Kraaij V, Garnefski N, et al. An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: Study protocol for a cluster randomized controlled trial. Trials. 2018;19(1):502. doi:10.1186/s13063-018-2731-3
23. Hoffmann D, Rask CU, Hedman-Lagerlöf E, Jensen JS, Frostholm L. Efficacy of internet-delivered acceptance and commitment therapy for severe health anxiety: Results from a randomized, controlled trial. Psychol Med. 2021;51(15):2685-2695. doi:10.1017/S0033291720001312
24. Kioskli K, Scott W, Winkley K, Godfrey E, McCracken LM. Online acceptance and commitment therapy for people with painful diabetic neuropathy in the United Kingdom: A single-arm feasibility trial. Pain Med (United States). 2020;21(11):2777-2788. doi:10.1093/PM/PNAA110
25. Ngan HY, Chong YY, Chien WT. Effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta-analysis. Diabet Med. 2021;38(4):e14525. doi:10.1111/dme.14525
26. Bell L V., Cornish P, Flusk D, Garland SN, Rash JA. The INternet ThERapy for deprESsion Trial (INTEREST): Protocol for a patient-preference, randomised controlled feasibility trial comparing iACT, iCBT and attention control among individuals with comorbid chronic pain and depression. BMJ Open. 2020;10(2):e033350. doi:10.1136/bmjopen-2019-033350
27. Rickardsson J, Zetterqvist V, Gentili C, et al. Internet-delivered acceptance and commitment therapy (iACT) for chronic pain—feasibility and preliminary effects in clinical and self-referred patients. mHealth. 2020;6(0):27. doi:10.21037/mhealth.2020.02.02
28. Scott W, Chilcot J, Guildford B, Daly-Eichenhardt A, McCracken LM. Feasibility randomized-controlled trial of online Acceptance and Commitment Therapy for patients with complex chronic pain in the United Kingdom. Eur J Pain (United Kingdom). 2018;22(8):1473-1484. doi:10.1002/ejp.1236
29. Cheng C, Brown RC, Cohen LL, Venugopalan J, Stokes TH, Wang MD. IACT - An interactive mHealth monitoring system to enhance psychotherapy for adolescents with sickle cell disease. In: Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS. ; 2013:2279-2282. doi:10.1109/EMBC.2013.6609992
30. Zetterqvist V, Gentili C, Rickardsson J, Sörensen I, Wicksell RK. Internet-delivered acceptance and commitment therapy for adolescents with chronic pain and their parents: A nonrandomized pilot trial. J Pediatr Psychol. 2020;45(9):990-1004. doi:10.1093/jpepsy/jsaa060
31. Dahl J, Lundgren T. Living beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain. Oakland: New Harbinger Publications; 2006.
32. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-396. doi:10.2307/2136404
33. Baik SH, Fox RS, Mills SD, et al. Reliability and validity of the Perceived Stress Scale-10 in Hispanic Americans with English or Spanish language preference. J Health Psychol. 2019;24(5):628-639. doi:10.1177/1359105316684938
34. DeWalt DA, Gross HE, Gipson DS, et al. PROMIS® pediatric self-report scales distinguish subgroups of children within and across six common pediatric chronic health conditions. Qual Life Res. 2015;24(9):2195-2208. doi:10.1007/s11136-015-0953-3
35. Varni JW, Magnus B, Stucky BD, et al. Psychometric properties of the PROMIS® pediatric scales: Precision, stability, and comparison of different scoring and administration options. Qual Life Res. 2014;23(4):1233-1243. doi:10.1007/s11136-013-0544-0
36. Silverman WK, Fleisig W, Rabian B, Peterson RA. Childhood Anxiety Sensitivity Index. J Clin Child Psychol. 1991;20(2):162-168. doi:10.1207/s15374424jccp2002_7
37. Silverman WK, Ginsburg GS, Goedhart AW. Factor structure of the childhood anxiety sensitivity index. Behav Res Ther. 1999;37(9):903-917. doi:10.1016/S0005-7967(98)00189-2
38. Greco LA, Lambert W, Baer RA. Psychological Inflexibility in Childhood and Adolescence: Development and Evaluation of the Avoidance and Fusion Questionnaire for Youth. Psychol Assess. 2008;20(2):93-102. doi:10.1037/1040-3590.20.2.93
39. Greco LA, Baer RA, Smith GT. Assessing Mindfulness in Children and Adolescents: Development and Validation of the Child and Adolescent Mindfulness Measure (CAMM). Psychol Assess. 2011;23(3):606-614. doi:10.1037/a0022819
40. Gámez W, Chmielewski M, Kotov R, Ruggero C, Suzuki N, Watson D. The brief experiential avoidance questionnaire: Development and initial validation. Psychol Assess. 2014;26(1):35-45. doi:10.1037/a0034473
41. Oei TPS, Green AL. The Satisfaction With Therapy and Therapist Scale-Revised (STTS-R) for Group Psychotherapy: Psychometric Properties and Confirmatory Factor Analysis. Prof Psychol Res Pract. 2008;39(4):435-442. doi:10.1037/0735-7028.39.4.435
42. Johnson JE, Pulsipher D, Ferrin SL, Burlingame GM, Davies DR, Gleave R. Measuring group processes: A comparison of the GCQ and CCI. Gr Dyn. 2006;10(2):136-145. doi:10.1037/1089-2699.10.2.136
43. McCracken LM, Keogh E. Acceptance, Mindfulness, and Values-Based Action May Counteract Fear and Avoidance of Emotions in Chronic Pain: An Analysis of Anxiety Sensitivity. J Pain. 2009;10(4):408-415. doi:10.1016/j.jpain.2008.09.015
44. Alldredge C, Burlingame G, Rosendahl J. Group psychotherapy for chronic pain: A meta-analysis. Psychotherapy. Published online March 30, 2023. doi:https://doi.org/10.1037/pst0000485
45. Coyne LW, McHugh L, Martinez ER. Acceptance and Commitment Therapy (ACT): Advances and Applications with Children, Adolescents, and Families. Child Adolesc Psychiatr Clin N Am. 2011;20(2):379-399. doi:10.1016/j.chc.2011.01.010