ACT2COPE: A brief online ACT-based intervention to improve psychological wellbeing for people living with chronic health conditions during the COVID-19 pandemic in New Zealand

Abstract

Background: In New Zealand, approximately 67% of adults and 33% of children live with a chronic health condition (CHC). The COVID-19 pandemic is likely to heighten psychological distress for this population. Online interventions have the potential for greater reach and accessibility to psychologically support people living with CHCs. To date, there are no known studies that have tested a brief online Acceptance and Commitment Therapy (ACT) intervention during a pandemic for people with CHCs. Aim: This study aimed to examine whether a one-week online psychological intervention (ACT2COPE) could reduce depression, anxiety and stress symptoms and improve wellbeing and psychological flexibility in adults living with CHCs during the COVID-19 pandemic in New Zealand. We also wanted to explore the relationships between these psychological outcomes and whether psychological flexibility was mediating the relationship between the intervention and reduced depressive symptoms. Method: This pilot randomised waitlist controlled trial investigated the effects of ACT2COPE on psychological outcomes (depression, anxiety, stress, wellbeing, and psychological flexibility) among 40 adults living with CHCs during the COVID-19 pandemic in New Zealand. Independent samples t-tests, Pearson’s correlations, repeated measures ANOVAs, and linear regression analyses were used to examine relationships and the effects of ACT2COPE. Additionally, qualitative data was gathered (using focus groups and questionnaires) to explore participants' experiences of the intervention. Results: Depressive symptoms significantly decreased over time compared to the waitlist group while anxiety, stress, wellbeing, and psychological flexibility did not demonstrate changes over time relative to the waitlist group. Exploratory analyses demonstrated that participants with higher adherence to the intervention showed improvements in depression, anxiety, and stress over time in comparison to the control group. Lastly, psychological flexibility was not found to be a significant mediator between ACT2COPE and depression scores. Qualitative findings suggested that participants found ACT2COPE acceptable and engaging. Conclusion: The novel ACT2COPE intervention presents a promising, scalable intervention that may reduce depressive symptoms in adults living with CHCs during the COVID-19 pandemic. Future research is needed to confirm these findings in a larger RCT to establish whether ACT2COPE is equally effective post pandemic and in a more diverse population.