Trial Report Online acceptance and commitment therapy (iACT) for adults with persistent physical symptoms – 3-month follow-up study of a... 2024 Lappalainen et al

Andy

Andy

Retired committee member
Full title: Online acceptance and commitment therapy (iACT) for adults with persistent physical symptoms – 3-month follow-up study of a randomized controlled trial

Highlights

  • This RCT (n = 103) examined whether online ACT + TAU was superior to TAU for PPS.

  • Adults with PPS related to indoor environment, chronic fatigue or both were examined.

  • The iACT+TAU group improved more in somatic, depressive and anxiety symptoms.

  • Between-group effects were moderate to large (d = 0.71–1.09) at follow-up.

  • iACT combined with TAU could be effective for treating these PPS conditions.
Abstract

Objective
Persistent physical symptoms (PPS) represent a major health problem affecting daily functioning. This RCT aimed to examine whether a guided Internet-based treatment based on acceptance and commitment therapy (ACT) provided additional benefits compared to Treatment as Usual (TAU) in reducing somatic complaints and psychological distress in adults with PPS.

Methods
A total of 103 adults with PPS related to indoor environments, chronic fatigue or both conditions were assigned to receive either either a 14-week intervention (video-based case conceptualization + Internet-based ACT) combined with TAU (iACT + TAU; n = 50) or TAU alone (n = 53). Somatic symptoms, depression, anxiety, insomnia, and psychological flexibility were assessed from pre-intervention to a 3-month follow-up. Additionally, the association between changes in psychological flexibility from pre- to post-intervention and changes in symptoms from pre to 3-month follow-up was explored. Analyses were conducted using a multigroup method with full information maximum likelihood estimator.

Results
The results revealed a significant interaction effect, indicating reductions in somatic symptoms and symptoms of depression and anxiety with moderate to large between-group effects (d = 0.71–1.09). No significant interaction effect was observed in insomnia and measures of psychological flexibility.

Conclusion
Internet-based ACT, when combined with Treatment as Usual, demonstrated efficacy for individuals with PPS associated with indoor environments and chronic fatigue. These findings are pertinent for primary healthcare providers, suggesting that the current treatment model could serve as a low-threshold first-line treatment option.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399924002423
 
The results of the current intervention showed that the intervention had a statistically significant impact on somatic symptoms over a 3-month follow-up period
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Statistical significance is the new clinical significance, because if you can't hit between the goal posts, just move the goalposts.

34% attrition rate. When you look at the questionnaire data, it's pretty much just noise with blips of difference here and there that are entirely expected when you try, for 12 weeks, to influence participants' responses on those questionnaires.
Despite these limitations, our results suggest that therapist-guided Internet-based ACT combined with usual care could be effective on somatic and mental health symptoms among individuals with PPS associated with indoor environments and chronic fatigue
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If you shovel crap long enough, you can report that you could be shoveling a lot of crap.
 
alktipping said:
IT really would be cheaper for doctors to tell patients we do not know of any way to really help you but will try to reduce their symptom burden through proven treatments ie pain meds
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A few years back Australia medicos got their knickers in a twist about codeine based over the counter meds (with low levels of codeine 12-15mg, combined with 500mg paracetamol/acetaminophen), and got them made prescription only, and virtually impossible to get.

It was a major overreaction to the opioid disaster in the USA, just because they failed to do adequate opioid management, and let that monster run loose.

The response here has had a very modest impact on opioid deaths, and probably more benefit in reducing addiction levels. I am certainly not suggesting there was no problem at all, and it didn't need some management.

But it has left a lot more people who were using those drugs responsibly and for considerable benefit without that option and dealing with the long-term consequences. They are the only thing that has substantially improved my quality of sleep (via pain reduction), which has taken a substantial cumulative downturn since they stopped being available. Plain paracetamol and ibuprofen just don't do the job.

The pharmacists guild in Australia, of whom I am usually no fan, actually had a sensible plan that they were starting to trial, which was simply a national register of OTC codeine sales, so that the medical authorities could easily see if anybody was buying too much. But it was not given time to work and was just over ruled by medicos.
 
That’s a shame @Sean cocodamol is still available over the counter in the UK
When I had COVID in 2022 I had to get my sister in law to buy cocodamol for me as the paracetamol didn’t make any dent and I can’t have ibuprofen due to my BP medication.
 
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