Self-help ACT and Spinal Cord Injury
Research type
Research Study
Full title
The effectiveness and acceptability of a guided self-help ACT intervention for individuals with a spinal cord injury (SCI).
IRAS ID
306658
Contact name
Danielle De Boos
Contact email
Sponsor organisation
University of Nottingham
ISRCTN Number
ISRCTN00000000
Clinicaltrials.gov Identifier
Clinicaltrials.gov Identifier
10.17605/OSF.IO/JB7TM, Open Science Framework
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Research Summary:
Spinal Cord Injury (SCI) is a life-changing neurological condition resulting from damage to the spinal cord or nerves at the end of the spinal canal. Varying levels of depression have been found within the SCI population ranging from 11 to 60% and without effective treatment, low mood can impact greatly on functional outcomes (Craig, Tran, & Middleton, 2009). Typically, co-morbid depression results in longer stays in hospital, increased pain, higher rate of pressure ulcers and poor quality of life (Fann et al., 2011).This study aims to evaluate the effectiveness and acceptability of a guided self-help ACT intervention for improving psychological wellbeing in individuals with a diagnosis of a SCI. This study will utilise a quantitative Single Case Experimental Design (SCED) method to investigate the effectiveness of a guided self-help ACT intervention for individuals with a SCI.
This will be followed up with a qualitative change interview to explore participants attributions to change and experience of the intervention. The guided self-help ACT intervention will be delivered to participants either by email or post, and completed within the home, with weekly check-ins also completed via video-call. The change interview will be conducted via video call. It is hoped this study will provide useful information regarding the effectiveness of ACT for individuals with a SCI.Summary of results:
The psychological impact of SCI is well known and there is a growing body of evidence supporting the effectiveness of Acceptance and Commitment Therapy (ACT) for people with a spinal cord injury (SCI). However, the acceptability of the ACT approach for those with a SCI and its underlying processes has rarely been considered. Self-help support could be a potentially useful intervention for providing support to this population as it has shown some efficacy in other populations. This study utilised a qualitative design to explore acceptability of an ACT self-help manual via 14 semi-structured interviews with those with a SCI, family members and professionals working with SCI. The data gathered was analysed using Reflexive Thematic Analysis (Braun & Clark., 2019). Two main themes were identified: (1) ACT Concepts, with three sub-themes identified (i) Is acceptance important or achievable, (ii) Cognitive Defusion, too airy fairy, (iii) Values important to rehabilitation; (2) Self-help, with three sub-themes identified, (i) Self-help after adjustment, (ii) Self-help too labour intensive, (iii) Language is the key to engagement.
This study aimed to explore whether the “ACTing towards better living” manual was acceptable to those with SCI. Adaptations to increase acceptability of this manual were suggested by participants because certain aspects of the “ACTing towards better living” manual were challenging to accept and the manual requires key adaptation.
Timing was identified as key to development of acceptance, in particular time since the event causing their SCI. The relationship between time since injury and level of acceptance was suggested by participants and indicated those who have had a recent injury might be less likely to accept their new reality and some of the ideas suggested in the “ACTing towards better living” manual. Research suggests ‘accepting your new reality’ may not be enough if not linked to ‘value-change’, particularly when considering the impact of acceptance on positive outcomes over time (Aaby et al., 2022). The section of the manual based around values was particularly acceptable to those with a SCI and the results of this study found this may be related to the reduced impact of physical ability on values as opposed to goals.This study’s findings indicated battling with thoughts was a common experience post-SCI and fusion to negative thoughts can increase distress. Participants found manual sections relating to cognitive defusion conjured negative reactions.
Participants discussed the burdensome nature of the “ACTing towards better living” manual in its current state. The amount of text became a barrier as many participants stated they struggled to read the full manual. Finally, language within the manual requires adaptation due to complexity and ambiguity.
Many studies investigating ACT focus on efficacy (Huang et al., 2021; Khanjanie et al., 2021; Dorenkamp et al., 2023). This study focuses on acceptability using semi-structured interviews to understand what we can learn to tailor a guided self-help intervention for SCI. The findings provide a clearer idea about aspects of ACT that are acceptable to those with a SCI and those likely to result in disengagement. The findings suggested key areas of relevance to this population; focusing on values, acceptance and committed action. It is recommended the manual be adapted to mirror the ACT Triflex Model (Harris, 2009) more closely to simplify and reduce the burden of text.
This study provides information on the acceptability of ACT processes for those with SCI and has supported the development of SCI specific self-help manual. This research could be improved by amending the methodological design.
REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
22/YH/0079
Date of REC Opinion
11 May 2022
REC opinion
Further Information Favourable Opinion