Internet-based ACT Intervention With Chronic Diseases Comorbid With Depression:Feasibility,Effectiveness And Mechanism

Worldwide,the number of people suffering from chronic diseases continues to grow,with more people dying each year from chronic diseases than from other diseases.Chronic diseases have the characteristics of long course and protracted disease,and complex etiology.China has always attached great importance to the management and treatment of chronic diseases,and reducing the premature mortality rate of major chronic diseases has also become an important goal of management and treatment.Chronic illness and depression often occur at the same time.Depression is a state of low mood that is mainly manifested as aversion to activity,excitement or retardation of thinking,difficulty concentrating,easy fatigue,and accompanied by guilt,feelings of worthlessness,and even suicidal tendencies.Chronic diseases significantly reduce patients’ health-related quality of life,with psychological distress being the most important,especially when they experience additional psychological distress in the face of treatment and changes in daily behavior,which greatly affects patients’ physical and mental health.Therefore,we need more effective interventions that focus on patients with chronic conditions with comorbid depression.The relationship between chronic illness and depression is complex.For years,researchers have been exploring the relationship between the two and how to intervene effectively.Acceptance and Commitment Therapy(ACT),as the third wave of cognitive behavioral therapy,is considered one of the most effective approaches.With the socio-economic development and the outbreak of major public health emergencies,remote networked treatment has great opportunities and prospects.Compared with face-to-face interventions,networked interventions have the advantages of not being limited by time and space,flexible use,and low threshold accessibility.At present,the network intervention for the treatment of depression is relatively mature,but there are few network interventions for patients with chronic diseases who pay attention to comorbid depression.Therefore,starting from the needs of patients with chronic diseases with comorbid depression,this study focuses on the development of a networked ACT intervention program to intervene in the depressive symptoms of patients with chronic diseases,tests the feasibility,acceptability and effect of intervention,and further explores the mechanism of intervention effect.This study included the following two sub-studies:The primary objective of study I was to develop a networked ACT program for the intervention of patients with chronic conditions with comorbid depression.Through semi-structured interviews with patients and healthcare workers,needs are investigated,and then intervention scripts are written,and the script and content presentation are initially evaluated and modified by experts to finalize a networked ACT intervention applet for intervention depression in patients with chronic diseases.Initial assessment by experts suggests that the intervention applet can significantly reduce depressive symptoms with good acceptability.The main objective of Study II was to investigate the effect and psychological mechanism of networked ACT intervention applets in the intervention of depressive symptoms in patients with chronic diseases.The randomized controlled trial was used to select patients diagnosed with chronic diseases and a temporary diagnosis of depression as study participants,set up intervention group and waiting control group,and took Beck Depression Inventory-II(BDI-II)as the main outcome variable to investigate the intervention effect of participants who completed the entire research process.Multidimensional Psychological Flexibility Inventory(MPFI),ConnorDavidson resilience scale(CD-RISC-10),and Cognitive Fusion Questionnaire(CFQ)were used as secondary outcome variables for ACT interventions.Explore the psychological mechanisms that work.The specific results were as follows:(1)Compared with the waiting group,the posttest level of the intervention group significantly reduced depressive symptoms(d = 1.99),the degree of cognitive fusion(d = 0.28),and significantly improved psychological flexibility(d = 1.00)and psychological resilience(d = 1.43).In the one-month follow-up test,the intervention group achieved significant intervention effects in the above four variables as well as at the post-test level.(2)The structural equation model was used to explore the core process of acceptance commitment therapy,that is,the mediating role of psychological flexibility and psychological resilience in the intervention of depressive symptoms.Results: Psychological resilience plays a mediating role in networked ACT interventions and depressive symptoms.From the initial development of networked intervention to the testing of effects and the exploration of mechanisms,this study establishes a relatively complete intervention technology path,which provides some reference for future research on networked intervention in patients with chronic diseases with comorbid depression.Intervention is affected by a variety of factors,is a complex process,network intervention as a new way of intervention,there are more possibilities to explore,our research also has room for improvement.