iACT (Acceptance Commitment Therapy)

The iACT Project: Can digital Acceptance Commitment Therapy Prevent deterioration in the health-related quality of life among trauma patients? 

Data from Oslo University Hospital (OUH) revealed clinically relevant levels of posttraumatic stress (PTSS), anxiety and depression in 45%, 30% and 18% of patients shortly after injury. Importantly, 12-months later these numbers had barely changed. Moreover, depending on the sample, one-third to all trauma patients experience some level of chronic pain in the first year after surgery. Despite studies indicating both, pain, and psychological distress, to be driving factors for disability among trauma patients, they remain unaddressed by current standard care. Moreover, available psychological treatments (cognitive behavioral-, education-, exposure-based and collaborative treatments) are neither able to overcome these barriers, nor successfully address the complexity of symptoms observed following trauma. 

Acceptance Commitment Therapy (ACT) is amongst the most promising non-pharmacologic treatments to reduce risk factors associated with the development of persistent pain and has been shown to be effective at reducing symptoms of anxiety, depression and PTSS. Among surgical patients face-to-face ACT, compared to treatment as usual (TAU), was shown to result in earlier pain and opioid cessation. Interestingly, results equal or similar to that of face-to-face interventions, can be achieved through tailored eHealth content and recent data show that trauma patients rate online treatments as ‘very acceptable’.  

Based on this background, the iACT trial is a randomized controlled trial aimed at developing and implementing an autonomously functioning trauma-specific Acceptance Commitment Therapy-based intervention (iACT) to educate and train surgically treated trauma patients in the psychological management of pain and distress after hospital discharge. 

The trial will be performed at the Department of Orthopedics, OUH (inclusion) and at patients’ home (intervention). iACT will be delivered as a mobile app containing information in text- and video-from, as well as an accompanying workbook. Videos will involve biopsychosocial explanations of pain and psychological distress, alongside with an introduction to mindfulness, value-based living, and stress reduction through cognitive behavioral techniques. Moreover, there will be videos with information about what to expect and how to behave after hospital discharge presented by orthopedic surgeons at OUH. Participants will be granted with access for one year.

Comparing iACT to TAU the aim is to improve patients’ postsurgical HrQoL and to prevent pain, opioid-use, and psychological distress from deteriorating.