Refining acceptance and commitment therapy in daily life (ACT-DL) for clinical care: Optimization and mixed-methods...

Blended care can enhance Acceptance and Commitment Therapy (ACT) by combining face-to-face sessions with digital tools. The ACT in Daily Life (ACT-DL) intervention integrates therapy sessions with a smartphone-based Ecological Momentary Intervention to promote psychological flexibility and to transfer ACT into daily life.

This study describes an iterative optimization and evaluation of ACT-DL, in terms of feasibility (i.e., practical implementation), usability (i.e., ease of using ACT-DL), and integration into clinical practice by clinicians.

ACT-DL was optimized using qualitative interviews with clients and resulted in adding a third component: a clinician dashboard to review app data. In a second step, we evaluated ACT-DL 2.0 in an uncontrolled pre-post implementation pilot study with 7 clinicians and 30 clients. Feasibility was assessed using indicators including adoption, attrition, engagement, attendance and adaptability. Usability data were gathered via weekly and post-intervention questionnaires. Integration in care was explored through thematic template analysis of clinician interviews.

ACT-DL was feasible, with clients attending on average 6.75 (SD = 7.83) sessions and engaging with 37.3% (SD = 27.16) of the programmed Ecological Momentary Assessment (EMA) questionnaires. Clients and clinicians found several elements usable (e.g. exercises, EMA items), though advanced features such as visualizing data remained challenging. Dashboard complexity, lack of time, limited mastery and client characteristics were barriers to integrating ACT-DL into practice.

ACT-DL is feasible, however mixed usability results highlight the need for further optimization and implementation strategies to support clinicians in fully integrating ACT-DL across clinical care contexts.